Flexor Tendon Repair — Zones I–III Modified Duran (Passive)

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

Weight-Bearing

NWB surgical UE

Key Restrictions

Orthosis 24/7 through 6-8 weeks; no composite finger/wrist extension; no functional use; passive protocol — ordered only when surgeon specifically requests; Dr. Salyapongse: no strap blocking IP flexion; Zone 1: add dorsal DIP block at 45° flex; slower progression for diabetics/smokers

Timeline & Phases

Phase I (0 to 3-5 days): WHFO (wrist neutral/slight ext, MCPs 70° flex, IPs full ext); passive flexion + active/passive extension; passive composite fist; passive hook fist; orthosis 24/7; Phase II (4-6 weeks): modify orthosis (wrist 30° ext, MCPs 30° flex, IPs ext); active tendon glides — hook fist, composite fist, straight fist; MCP block in full ext + full active IP ext; synergistic wrist motion; Phase III (6-8 weeks): D/C splint; blocking progression: MPJ slight flex → full ext → PIPJ slight flex → full ext; Phase IV (8-12 weeks): passive composite finger/wrist extension; isolated IP flexion activities; light theraputty strengthening; spring/thermoplastic extension splint PRN

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; passive protocol used only when surgeon specifically orders Modified Duran; key orthosis difference from EAM: MCPs positioned 70° flexion (vs. 30°) and wrist in neutral/slight extension; active motion begins later (4 weeks vs. 3-5 days); Strickland percentage tracks progress from week 4; Zone 1: add DIP dorsal blocking at 45° flex; Dr. Salyapongse: no strap blocking IP flexion; manual laborers RTW 3-6 months; sedentary workers 6-8 weeks

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation