Flexor Tendon Repair — Flexor Tendon Staged Repair (Two-Stage — Zones I–II)

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

Weight-Bearing

NWB surgical UE

Key Restrictions

Stage 1: no functional use; pulley tapes/rings for repaired A2/A4 pulleys worn continuously 6-8 weeks; Stage 2: no functional use weeks 0-4; light functional use only weeks 5-6; avoid forceful weighted resistance at 12 weeks; high adhesion risk — may require tenolysis 3-6 months post Stage 2

Timeline & Phases

Stage 1 (silicone rod): day 0-3 — extension gutter orthosis, PROM involved digit, AROM adjacent digits; weeks 3-4 — decrease orthosis, AROM extension, FDS glide if intact; weeks 5-6 — buddy taping, progressive strengthening; week 5 — static/dynamic orthosis for PROM PRN; goal before Stage 2: full PROM, supple soft tissue, maximum hand strength. Stage 2 (free tendon graft, 3-6 months after Stage 1): day 0-3 — DBS (wrist 20° flex, MCPs 70° flex, IPs full ext), Modified Duran PROM or early active if good repair; week 3 — AROM within orthosis, scar management; week 4 — AROM digits/wrist outside orthosis; weeks 5-6 — gentle AROM blocking, wean orthosis, light functional use; 8 weeks — progressive strengthening; 12 weeks — most activities except forceful weighted resistance

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; indicated for failed primary or delayed primary FDP repair in zones I-II; Stage 1: silicone rod through pulley system, distal end attached to FDP stump, proximal end free; A2 and A4 pulleys must be intact or repaired; Stage 2: free tendon graft (palmaris longus, plantaris, EDL to toes, FDL, or FDS) sutured at musculotendinous junction proximally and button distally (button remains 6 weeks); intrasynovial grafts preferred over extrasynovial; Strickland percentage used to track Stage 2 progress; severe adhesions likely — flexor tenolysis may be needed 3-6 months post Stage 2; published April 15, 2022

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Published

2022-04-15