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Date issued: November 2023

Review date: November 2025 

Ref: B-501/AH/Physiotherapy/Zone 1 and 2 Flexor Tendon Repair Rehabilitation

PDF:  Zone 1 and 2 Flexor Tendon Repair final November 2023.pdf [pdf] 358KB

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. They allow us to bend our fingers and make a fist along with some other muscles within the hand.

Wound care:

Routinely the wound is closed with sutures (stitches) these need to be in place for 14 days. It is important to keep the wound clean and dry until your sutures are removed. This helps to reduce the risk of infection.

Swelling management:

Reducing the swelling allows for better movement and improves post operative outcomes. Following your operation you will be 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 place your hand against your chest so it is higher than your heart. At rest or at night it can be elevated on pillows

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 a relaxed position and remember not to straighten your fingers.

• Using unperfumed soap or unperfumed wipes, wash the arm down (still with it supported on the draining board) from the elbow towards the fingers.

• 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: Your therapist may advise on the following 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 during this movement. 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.

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. Bend your finger at the joint line (PIP joint) as shown.

Weeks 6+

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 should not lift items heavier than a cup of tea. You should continue to wear your splint at night for a further 2 weeks.

Tendon gliding exercises:

Please complete………………

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.

Full Fist Movement

Make a fist with your hand without clenching it tight.

8 weeks +

Strengthening exercises: Therapeutic putty

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

Repetitions…….

Sets……..

Grip strengthening

Repetitions………….Sets……………..

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