Flexor tendon rehab

Flexor tendon rehab, general principle

Protect the repair, then restore motion, then build strength, then return to function. Anything resistive or forceful is held until the tendon is healed enough, usually around 8 to 12 weeks.

Phase 1: Protection or inflammatory phase (about 0 to 3 weeks)

The goals are to protect the repair, control edema and pain, and begin gentle tendon gliding. The client wears a dorsal blocking splint (wrist about 20 to 30 degrees flexion, MCPs about 50 to 70 degrees flexion, IPs neutral)

Phase 1: Protection or inflammatory phase (about 0 to 3 weeks) interventions

edema control, wound care, and passive or early active flexion depending on the protocol. No resistance, no gripping, and no active extension against the splint.

Phase 2: Proliferative or controlled motion phase (about 3 to 6 weeks)

The goals are to increase active tendon glide and range of motion while keeping the repair protected. The splint is often adjusted or weaned to a wrist-hinged or shorter version.

Phase 2: Proliferative or controlled motion phase (about 3 to 6 weeks) interventions

active flexion and extension, tendon gliding exercises, scar management, and continued edema control. Still no resistance, and still no heavy functional use.

Phase 3: Remodeling or early strengthening phase (about 6 to 8 weeks)

The goals are to improve active range and begin light functional use. The splint is discontinued, usually around 6 weeks.

Phase 3: Remodeling or early strengthening phase (about 6 to 8 weeks) interventions

are blocking exercises, light functional activities, and scar and adhesion management. Light resistance may begin toward the end of this phase if cleared by the surgeon.

Phase 4: Strengthening phase (about 8 to 12 weeks)

The goals are to rebuild grip and pinch strength and return to functional tasks.

Phase 4: Strengthening phase (about 8 to 12 weeks) interventions

progressive resistive exercise (putty, hand grippers), functional activities, and work simulation. Resistance is introduced gradually and monitored for signs of pain or tendon rupture.

Early active mobilization

Active flexion begins within a few days after surgery, using a strong multi-strand repair. It’s used to promote tendon gliding and reduce adhesions. Considerations include the strength of the suture repair, the client’s healing factors, edema and stiffness, and clinic resources like therapist availability and splint-making. No resistance is allowed in this phase.

Flexor tendon zones (I to V)

Zone II (“no man’s land”) sits between the A1 pulley and the FDS insertion, where both FDS and FDP run tightly together in the sheath. It is the highest-risk zone for adhesions and the hardest to rehabilitate. Zone I involves only the FDP at its insertion.

Place-and-active-hold exercise

The therapist passively places the finger in flexion and the client actively holds it with a light contraction. It promotes tendon glide and reduces adhesions with low force. It’s the hallmark of early active mobilization.

Scar management timing after tendon repair

Start after wound closure and suture removal (about 2 to 3 weeks), not at the first visit. The early visit focuses on protection, protected motion, and education.

Dorsal blocking orthosis position

Wrist about 20 to 30 degrees flexion, MCPs about 50 to 70 degrees flexion, IPs in neutral. It limits tension on the repaired flexor tendons.