Flexor Tendon Repair — Zones I–III Early Active Motion (EAM)

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

Weight-Bearing

NWB surgical UE

Key Restrictions

Elevate and immobilize 3-5 days before starting motion; orthosis 24/7 (including bathing) through 5.5-6 weeks; no composite finger/wrist extension; no functional use; Dr. Salyapongse: no strap blocking IP flexion; Zone 1: add dorsal DIP block at 45° flex; slower progression for diabetics/smokers; EAM begins 3-5 days post-op

Timeline & Phases

Phase I (0 to 3-5 days): WHFO (wrist 30° ext, MCPs 30° flex, IPs full ext); elevate and immobilize 3-5 days first; passive flexion/extension warm-up; active flexion 1/3-1/2 hook fist with scratch technique to contralateral IF; initiate DIP motion; MCP block in full flex + full active IP extension; synergistic wrist motion; Phase II (2-4 weeks): scratch progression — week 2 MF, week 3 RF, week 4 SF; 3 weeks allow orthosis off to shower; Phase III (4-6 weeks): 4 weeks change to Manchester short splint (limits wrist ext to 45°); blocking exercises: MPJ slight flex → full ext → PIPJ slight flex → full ext; 5.5-6 weeks D/C splint; Phase IV (6-12 weeks): passive composite finger/wrist extension; isolated IP flexion activities; light theraputty strengthening at 8 weeks; spring/thermoplastic extension splint at night if needed

Notes

UW Health / UnityPoint Health - Meriter (Plastics and Orthopedic Surgeons); OT-based; primary 4- or 6-strand FDS/FDP repair; EAM default protocol — Modified Duran ordered only when surgeon specifies; scratch technique progression (IF → MF → RF → SF) used as progression gate; Strickland percentage tracks PIP/DIP AROM; Manchester short splint at 4 weeks limits wrist extension to 45°; manual laborers RTW 3-6 months; sedentary workers 6-8 weeks

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation