Extensor Tendon Repair — Zones IV–VI ICAM (Relative Motion Extension)

UW Health · UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Weight-Bearing

NWB surgical UE

Key Restrictions

ICAM orthosis worn at all times; wrist orthosis at night until week 4; no full composite PROM; no lifting/pushing/pulling >2 lbs; monitor for extensor lag; ICAM used when at least one but not all extensors (EDC/EIP/EDM) repaired; EAM begins 3-5 days post-op

Timeline & Phases

Phase I (day 3-5 to week 5): RME orthosis (involved MPJ 15-20° more extension than adjacent MPJs, PIPs/DIPs free) + custom wrist extension orthosis 20-25° (night until week 4); gentle composite finger flexion/extension within RME; week 3: if full AROM in orthosis, moderate-heavy tasks with ICAM; week 4: if no MP lag, PROM wrist with digits on slack (synergistic wrist extension/finger flexion); Phase II (weeks 5-8): week 5 — remove RME for AROM 5x/day, wear for activity; week 6 — gentle PROM fingers if no lag; week 7 — D/C RME if full composite motion; week 8 — gentle strengthening; Phase III (10-12 weeks): return to all activities, progressive heavy work and leisure

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; one PDF shared with Zones IV-VI Non-ICAM protocol; ICAM = Immediate Controlled Active Motion; RME = Relative Motion Extension orthosis; ICAM for at least one but not all extensors repaired; RME finger placement: IF or SF injured → IF and SF in extension; MF injured → MF in extension; RF injured → RF and MF in extension; criterion-based progression — extensor lag = stop; EAM starts 3-5 days post-op

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation