Extensor Tendon Repair — Zones III-IV

Orthopaedic Associates of Maine

Weight-Bearing

FWB; volar orthosis continuously except during exercises

Key Restrictions

Volar orthosis (PIP and DIP at 0°) continuously except exercises; two template orthoses for SAM protocol (Template 1: PIP 30°/DIP 20-25° flex; Template 2: PIP 0°); exercises hourly, 20 reps per template, wrist in 30° flex, hold extension 5 sec; progress PIP flex at 2 wks (30°→40°) and 4 wks (40°→50°) if no lag; discontinue orthosis at 6 wks; light activities at 8 wks; monitor for extension lag throughout

Timeline & Phases

3-5 days (volar orthosis, hourly SAM exercises), 2 wks (adjust to 40° PIP flex if no lag), 4 wks (adjust to 50° PIP flex if no lag), 6 wks (discontinue orthosis, strengthening), 8 wks (light activities, progress strengthening)

Notes

Early Active Short Arc Motion (SAM) Protocol per Evans and Thompson; if lateral bands repaired, limit DIP flexion to 30-35 degrees; monitor for extension lag throughout all stages