Extensor Tendon Repair — Zones V-VI Relative Motion / Early Motion

University of Virginia Orthopaedic Surgery

Weight-Bearing

NWB surgical arm

Key Restrictions

NOT for EDC, EIP, or EDM tendon injuries (use delayed protocol); MCP of involved digit in 20-30° greater extension than adjacent digits at all times; avoid concurrent digit and wrist flexion; no resistance strengthening until 6 weeks; relative motion orthosis full time including sleep

Timeline & Phases

Phase 1 (0-2 wks): volar splint, elevation; Phase 2 (2-4 wks): relative motion orthosis (RMO) full time, composite fisting with RMO in place, place-and-hold MCP/PIP/DIP extension, dexterity; Phase 3 (4-6 wks): continue RMO full time, full hook fisting with MCP extension emphasis; Phase 4 (6+ wks): wean RMO with extension lag monitoring, RMO at night 2-4 more weeks

Notes

4 phases; NOT for EDC/EIP/EDM injuries; two orthosis options per surgeon: RMO only or RMO + wrist orthosis (WHO); may discontinue WHO in Phase 3 while maintaining RMO; MCP extension emphasis during hook fisting for scar adhesions

Published

09/2024