Flexor Tendon Repair — Zones I-IV Early True Active Flexion (St. John)

University of Virginia Orthopaedic Surgery

Weight-Bearing

NWB surgical UE

Key Restrictions

"You can move the hand, but you cannot use it"; NOT for patients starting therapy ≥day 10; requires ≥4-strand repair; no composite wrist+finger extension; no resistance until 8-10 weeks; WHFO dorsal block full time including sleep

Timeline & Phases

Phase 1 (0-3-5 days): dorsal block splint; Phase 2 (3-9 days): PROM + true active half-fisting initiating from DIP joints; Phase 3 (10 days to 4 wks): synergistic tenodesis motion, may transition to Manchester Short Splint (MCP 30-40° flexion/wrist dorsal component limiting extension to 45°); Phase 4 (4-6 wks): AROM wrist, extrinsic flexibility; Phase 5 (6-12 wks): discontinue orthosis, resistance from week 8

Notes

5 phases; St. John protocol; true active flexion initiating from DIP (not MCP); active MCP limited to 30-40°; may progress to 3/4 fist in Phase 3; Manchester Short Splint transition possible at 2-4 weeks; PROM Modified Duran warmup always; if lag persists, may wean at week 5 per physician

Published

09/2024