Extensor Tendon Repair — Zone III Central Slip Conservative

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation · Dr. Salyapongse

Weight-Bearing

NWB surgical UE

Key Restrictions

No lifting/pushing/pulling >2 lbs involved UE; no WB involved UE; no forceful gripping; orthosis 24/7 except hygiene

Timeline & Phases

Phase I (2–5 days to 2 wks): volar gutter PIP in full extension, DIP free (if lateral bands involved: DIP also in full extension); ADLs within restrictions; edema/wound/scar management; blocked DIP AROM 10 reps/hour | Phase II (2–4 wks): volar gutter full extension; may cast once edema subsides; AROM all joints except splinted PIP; monitor full PIP extension q2 wks as edema decreases | Phase III (4–5 wks): wean daytime orthosis for sedentary/light ADLs; begin gentle AROM MP/PIP/DIP; night extension splint; if >10° lag, resume full-time static splinting in full PIP extension | Phase IV (6–8 wks): night extension splint 6–8 wks then D/C if no lag; PROM may begin at 8 wks only if persistent stiffness/weakness and no lag; strengthening at 10 wks

Notes

Conservative (immobilization) protocol; surgeon: Dr. Salyapongse; indication: acute central slip and lateral band injuries; if lateral bands involved, DIP also immobilized in full extension Phase I–II; extension lag = hold progression; extension lag >10° = resume full-time splinting; tissue maturation may take up to 1 year in resistant cases; shared URL with SAM (Short Arc Motion) protocol; developed collaboratively by UW Health and UnityPoint Health - Meriter Rehabilitation

Surgeon / Author

Dr. Salyapongse