Home Page

Date issued: August 2023

Review date: August 2025

Ref: B-489/Physiotherapy/AH/Flexor tendon repair Zone 1 and 2

PDF:  Flexor tendon repair zone 1 and 2 final August 2023.pdf [pdf] 418KB

Flexor tendons anatomy and function:

Flexor tendons are strong cord like structures that connect the muscles of the forearm to the bones in the fingers and thumb. There are two to each finger and one to the thumb. They allow us to bend our fingers and make a fist along with some other muscles within the hand.

Post operative aftercare:

Within the first 48 to 72 hours following your operation, you will have an appointment with one of our clinical specialist hand therapists in the Plastics trauma follow up clinic. This is situated on Level 4 in Derriford Hospital.

Within this appointment the team will:

• Discuss the history of the injury/surgery

• Remove the cast to review the wound, clean and apply a new dressing as required

• Discuss timescales of healing/Do’s/Don’ts

• Demonstrate exercises for you to complete at home

• Make a thermoplastic (TP) splint to wear to protect your tendon repair

Wound care:

Routinely the wound is closed with sutures (stitches) these need to be in place for 14 days. The therapist will decide the appropriate dressings for the wound at your initial appointment. It is important to keep the wound clean and dry until your sutures can be removed. This helps to reduce the chance of infection.

Swelling management:

Following your operation you will have been given a sling to wear. It is important to wear the sling during the day until your first appointment. If the sling becomes uncomfortable to wear you can just place your hand against your chest so it is higher than your heart. At rest or at night it can be elevated on pillows. Swelling management is crucial in the first 2 to 3 weeks following your operation. Reducing the swelling allows for better movement within your operated hand and improves post operative outcomes.

Splinting:

Your therapist will make a splint for you to wear out of thermoplastic material. You will need to wear the splint 24 hours a day for the first 6 weeks. You will be able to remove the splint only for hygiene purposes. The tendon repair is very delicate in the first 6 weeks following the operation. The splint is designed to protect your tendon repair but also allow for guided movement and exercise. If your splint becomes uncomfortable or irritates the skin please contact your therapist so it can be re-moulded or altered.                                                                                                                  

Hand Hygiene:

• To wash your arm/hand, place your forearm on the draining board/table, remove the splint keeping the wrist in the position as when in the splint.

• Using unperfumed soap or unperfumed wipes, wash the arm down (still with it supported on the draining board) from the elbow towards the fingers. Keeping your arm in the position as when in the splint.

• Do not wash across any unhealed wounds unless advised by your therapist. Use wipes to clean between the fingers.

• Ensure the arm is dry before reapplying the splint.

• Do not extend the wrist.

• Shower wearing the splint (covered by a plastic bag/limbo)

Weeks 1-2

Exercises:

The following exercises should be completed hourly (where possible) for the first six weeks:

1. Using your good hand bend your injured finger(s) down as far as possible. Repeat this exercise until the finger(s) bend easily. You may push the finger tips to touch the palm without harming the repair. Repeat this exercise for the other fingers.

2. Allow the wrist to flex forwards and your fingers will naturally straighten against the splint, then drop the wrist backwards into extension and your fingers will naturally bend. Repeat this motion 20 times. You must never force the fingers to make a full fist. It may take a few weeks to be able to bend the fingers fully.

3. With the wrist held backwards place x2 fingers of the uninjured hand in the middle of the palm and gently touch the fingers. Repeat 10 times.

4. With the wrist held backwards place x2 fingers of the  uninjured hand in the middle of the palm and gently touch the fingers. Repeat 10 times.

Weeks 2-6

Exercises: Continue with the previous exercises but you can work on gradually achieving a full fist (You may start the following exercises as advised by your therapist).

Within the splint

Begin with your hand on a table with palm side face up. Raise your finger up and down at the middle joint line (PIP joint) as shown as you block movement of the rest of your hand using your opposite hand and fingers.  

 Within the splint

Begin with your hand on a table with palm side face up. Raise your finger up and down at the last joint line (DIP joint) as shown as you block movement of the rest of your hand using your opposite hand and fingers.

6 weeks +

Discard the initial exercises. Your therapist may advise weaning off the splint around 5-6 weeks following your operation. You can begin some light everyday activities but lifting no heavier than a cup of tea. You should continue to wear your splint at night for a further 2 weeks.

Tendon gliding exercises

Flat Tabletop Movement

Bend the knuckle joints (base of your fingers) forward without bending any other joints of your fingers.

Straighten your fingers.

Hook Fist Movement

Hold your fingers straight.

Bend your fingers down only at the top joints and middle joints.

Straighten your fingers.

Straight Fist Movement

Bend the knuckle joints (base of your fingers) forward without bending any other joints of your fingers.

Then bend your fingers at the middle joints but keeping the tip of your fingers straight. Straighten your fingers.

Full Fist Movement

Make a fist with your hand without clenching it tight.

8 weeks +

Advised by your therapist you may begin

Strengthening exercises

Therapeutic putty

Place putty in the palm of your hand, curl your fingertips into make a fist around the putty. Reshape it and repeat.     

 Repetitions………….Sets…….……..

 Repetitions………….Sets……………..

Hold a spring grip strengthener. Squeeze, release and repeat.

Repetitions…………… Sets…………...

Find a soft ball/stress ball and put your wrist in the neutral position as shown in the image but facing away from you. Grip the ball in a natural position as shown in the first image and squeeze the ball for the prescribed amount. Next, place your hand in the mouse grip as shown in the middle image and squeeze the ball for the prescribed amount. Finally, place your hand in the teeth grip as shown in the third picture and squeeze the ball for the prescribed amount.