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Flexor Tendon Repair Zone 1 Protocol

Flexor Tendon Repair Zone 1 Protocol-Brigham and Women's Hospital

Phase I: Weeks 0-3

  • Splint: Forearm-based dorsal block splint with wrist at 30° flexion, MP's 30° flexion, and IP's fully extended. A separate finger splint of repaired digits is applied with DIP in 45° flexion
  • Precautions: No active DIP flexion, wrist flexion, or passive finger extension
  • Exercises: Passive DIP flexion to 75°, actively extend PIP with MP in full flexion, place/hold repaired finger in PIP flexion for FDS gliding, passive wrist flexion, active wrist extension, passive wrist flexion with passive hook fist

Phase II: Weeks 3

  • Splint: Wrist to neutral in dorsal blocking splint, remove DIP flexion splint
  • Precautions: No resistive exercises, no functional use of hand
  • Exercises: Place/hold and gliding in all fist positions

Phase III: Week 4

  • Splint: Convert from dorsal forearm to dorsal hand splint
  • Precautions: Minimal tension during ROM, avoid resistance exercises
  • Exercises: Active tendon gliding in all fist positions, FDP gliding exercises

Phase IV: Weeks 5

  • Splint: Discard splint
  • Precautions: Avoid resistive exercises
  • Exercises: Progress exercises by increasing reps

Phase V: Week 6-7

  • Precautions: Avoid resistive exercises prior to week 7
  • Exercises: Gentle passive DIP extension, begin resistive exercises

Phase VI: Week 8

  • Exercises: Progress resistive exercises

Resources

Zone 1, FDP Flexor Tendon 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%201.pdf