Flexor Tendon Repair — Zones IV–V Early Active

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

Weight-Bearing

NWB surgical UE

Key Restrictions

WHFO (wrist 20-30° extension, MCPs 30° flex, IPs ext) full time; no passive wrist ext/composite finger ext; 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 Phase VI; 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° ext, MCPs 30° flex, IPs ext), passive digit flex + active ext, tenodesis, progressive active fisting from 1/3 fist progressing each week, FDS glides unaffected fingers; Phase II (3 weeks): active 3/4 or full composite fist, tendon glides, full finger ext out of orthosis, IP blocking, wrist AROM, NMES optional; Phase III (4 weeks): light functional activities, nerve-specific wrist extension, NMES; Phase IV (5 weeks): passive finger/wrist ext, wean orthosis, light functional activities; Phase V (6 weeks): wrist isometrics, wean orthosis; Phase VI (7 weeks): progressive hand/wrist strengthening; Phase VII (8 weeks): D/C orthosis; Phase VIII (10-12 weeks): no restrictions

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; one PDF shared with Zones IV-V Conservative protocol; key difference from conservative: WHFO in wrist 20-30° EXTENSION and MCPs 30° flexion (less protective, allows more active motion earlier); progressive active fisting by week from 1/3 fist to full; NMES may begin 2-3 weeks to enhance flexor excursion; nerve-specific orthosis adjustments same as conservative approach; high scar adhesion risk — exercises every 2 hours; sensory re-education important; Strickland percentage tracking; published April 15, 2022

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Published

2022-04-15