Flexor Tendon Repair — Zones IV–V Conservative

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

Weight-Bearing

NWB surgical UE

Key Restrictions

WHFO (wrist 20-30° flexion, MCPs 60° flex, IPs ext) full time; no passive wrist ext/composite finger ext; no functional use through Phase IV; nerve repair: wrist 30° flex, increase 10°/week to neutral; ulnar nerve: block MCP ring/SF from hyperextension; median nerve: night web spacer; no lifting >1-2 lbs through 7 weeks; no restrictions at 10-12 weeks; high scar adhesion risk — exercises every 2 hours

Timeline & Phases

Phase I (3-5 days to 3 weeks): WHFO (wrist 20-30° flex, MCPs 60° flex, IPs ext), passive digit flex + active ext, passive MCP flex + IP ext, tenodesis exercise, FDS glides unaffected fingers; Phase II (3 weeks): active tendon glides, full finger ext with glides, IP blocking, wrist AROM with fingers relaxed; Phase III (4 weeks): continue tendon glides + IP blocking, wrist AROM; Phase IV (5 weeks): passive finger/wrist ext as needed; Phase V (6 weeks): passive finger/wrist ext, wrist isometrics, wean orthosis; Phase VI (7 weeks): wrist isometrics; Phase VII (8 weeks): D/C orthosis (night wrist orthosis optional); Phase VIII (10-12 weeks): no restrictions, progressive heavy work/leisure

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; one PDF shared with Zones IV-V Early Active protocol; Zone IV = within carpal tunnel (pure injuries rare due to retinaculum protection); Zone V = musculotendinous junction to proximal carpal tunnel; nerve injuries common — spaghetti wrist (3+ structures including median nerve); key difference from Early Active: WHFO in wrist 20-30° FLEXION and MCPs 60° (more protective); high scar adhesion risk — exercises every 1-2 hours; sensory re-education important; NMES for thenar/intrinsic stimulation; nerve regeneration ~1 inch/month; Strickland percentage tracking; published April 15, 2022

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Published

2022-04-15