Physical Therapy Haven

Phase I: Weeks 0-3

• Splint: Dorsal blocking splint w/ wrist in neutral, MCP's at 50° flexion, IP's in full extension
• Precautions: No active flexion of involved digits, passive wrist extension, or passive finger extension unless cleared, no functional use of involved hand
• Exercises: Passive DIP extension w/ MCP and PIP in flexion, passive DIP/PIP flexion and active extension, passive wrist flexion and active wrist extension, block MCP in full flexion and active extension of IP's, isolated FDS glide of uninvolved digits, edema control and scar massage

Phase II: Week 3

• Splint: Serial static PIP extension splint at night if needed
• Precautions: Same as above, place/hold exercises under slight tension and avoiding co-contraction
• Exercises: Place/hold for hook, full, and straight fist with wrist extended, place/hold for isolated FDS glide of involved digits

?Phase III: Week 4

• Splint: Switch to hand-based dorsal block splint
• Exercises: Begin active, non-resisted digital flexion/extension in hook, full, and straight fist positions with wrist extended

?Phase IV: Week 5

• Splint: Discharge splint
• Exercises: Add gentle blocking exercises for PIP/DIP flexion is appropriate

Phase V: Weeks 6-8

• Splint: Can initiate dynamic PIP extension splint if appropriate
• Exercises: Gradually add resistive exercises 

Zones 2-5 Flexor Tendond Repair Protocol. Brigham and Women's Hospital Web site. http://www.brighamandwomens.org/Patients_Visitors/pcs/rehabilitationservices/Physical%20Therapy%20Standards%20of%20Care%20and%20Protocols/Hand%20-%20Flexor%20Tendon%20Repair%20PT%20Protocol%20Zone%202-5.pdf