FLEXOR TENDON REPAIR FINGERS Indiana ACTIVE Motion Program Initial 4 Weeks Postop

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1 Initial 4 Weeks Postop Indianapolis Kokomo Avon Fishers Terre Haute HAND Restoring full motion following flexor tendon repairs can be a challenge. The tendons glide through a small area in the fingers. In order to achieve functional motion, it is important to perform each exercise. Outlined below is your initial therapy program. Wear your dorsal blocking splint for the PASSIVE exercises you are performing with your opposite hand. Once you have completed the passive exercises, transition to the hinged wrist splint. (Note: when transitioning to the hinged splint, be sure to keep your wrist bent forward.) While wearing your hinged wrist splint, you will perform the following ACTIVE exercises. Perform the exercises each 2 hours during the day, 15 repetitions. Once the active exercises are completed, transition back to your dorsal blocking splint to wear between exercise sessions and at night. Start with your wrist bent forward. With your opposite hand, bend your fingers into the palm, making sure the tips of your fingers are curled under. With your opposite hand, bring your wrist back while keeping the fingers bent into your palm. With the wrist back and fingers bent, gently make a fist on your own muscle power. Slowly remove your hand and keep your fingers bent on your own muscle power (5 seconds). Drop your wrist forward and let your fingers drop back to the splint. Repeat the exercise sequence. Once you have completed the exercises, transition back to your dorsal blocking splint, being sure your wrist is bent forward during the transition.

2 Initial 4 Weeks Postop Additional Instruction Patient Education It is essential you wear your dorsal blocking splint (protective splint) as outlined. Failure to wear your splint could result in your tendon repair rupturing. Do not grip objects with your fingers or thumb. This could result in rupture of your tendon repair. It is recommended that you do not drive while wearing splints or while on pain medication. Minimizing the swelling in your hand is important. Please keep your hand elevated to heart level and avoid getting hot and sweaty (e.g. exercising, being outdoors on hot days). Keep your wound dry. Do not apply ointments or other medications on the stitches or the wound. If you need to change the finger dressing, keep your wrist and fingers bent forward. Once the stitches are removed and the wound is completely closed, you may begin scar massage with lotion 3 times a day, 1-2 minutes within your protective splint. With a swollen finger, it can be easy to trap your fingers together. You can help minimize this problem during exercises by gently pushing the uninvolved digits away from the swollen finger. Your physician, physician assistant, nurse, and our therapists are all committed to helping you recover from this injury. Carefully follow your home program to achieve a functional outcome.

3 3 Weeks Postop Indianapolis Kokomo Avon Fishers Terre Haute HAND Outlined below is your new three week program. Continue the PASSIVE Motion Program in the protective splint. Continue the ACTIVE Motion Program in the hinged splint. Perform the following exercises prior to transitioning back to your protective splint. Rest the back of your forearm, wrist, and hand on the tabletop. With your opposite hand, bend your fingers into your palm. Straighten your back knuckles while keeping the tips bent., attempt to keep your fingers bent. Slowly remove your opposite hand, attempt to keep the fingers bent. Additional Instruction Patient Education It is essential you wear your dorsal blocking splint (protective splint) as outlined. Failure to wear your splint could result in your tendon repair rupturing. Do not grip objects with your fingers or thumb. This could result in rupture of your tendon repair. Perform scar massage with lotion 2-3 times a day, 1-2 minutes within your protective splint. With a swollen finger, it can be easy to trap your fingers together. You can help minimize this problem during exercises by gently pushing the uninvolved digits away from the swollen finger.

4 4 Weeks Postop Indianapolis Kokomo Avon Fishers Terre Haute HAND Congratulations you have reached the 4-week point in your therapy program. You are halfway through your formal therapy program! Outlined below is your new four week program. Your hinged wrist splint is discontinued at this time. Perform the following exercises (without a splint) each 2 hours during the day, 10 repetitions. Continue to wear your dorsal blocking splint (protective splint) between exercise sessions and at night. With your opposite hand, passively bend your fingers and bring your wrist back. Make a fist on your own muscle power. Remove your hand. On your own muscle power maintain the fist (5 seconds). Relax your fist and drop your wrist forward. gently straighten your fingers.

5 4 Weeks Postop (continued) bend at your middle knuckles, letting the tips stay straight. Gently straighten your fingers. Additional Instruction With the tips bent, gently straighten your back knuckles on your own muscle power. Gently straighten your fingers. Patient Education It is essential you wear your dorsal blocking splint (protective splint) as outlined. Failure to wear your splint could result in your tendon repair rupturing. Do not grip objects tightly with your fingers or thumb. This could result in rupture of your tendon repair. Perform scar massage with lotion 3 times a day, 1-2 minutes within your protective splint.

6 5 Weeks Postop Indianapolis Kokomo Avon Fishers Terre Haute HAND Congratulations you have reached the 5-week point in your therapy program. You are more than halfway through your formal therapy program! Outlined below is your new five week program. Perform the following exercises each 2 hours during the day, 10 repetitions. Continue to wear your dorsal blocking splint (protective splint) between exercise sessions and at night. With your opposite hand, passively bend your fingers and bring your wrist back. Make a fist on your own muscle power. Remove your hand. On your own muscle power maintain the fist (5 seconds). Relax your fist and drop your wrist forward. gently straighten your fingers.

7 5 Weeks Postop (continued) and with your wrist back, Straighten your back knuckles on your own muscle power, while keeping the tips bent. Fully straighten your fingers. Additional Instruction With your back knuckle supported and bent forward, gently bend and straighten your middle knuckle. Patient Education It is essential you wear your dorsal blocking splint (protective splint) as outlined. Failure to wear your splint could result in your tendon repair rupturing. Do not grip objects tightly with your fingers or thumb. This could result in rupture of your tendon repair. Perform scar massage with lotion 3 times a day, 1-2 minutes within your protective splint.

8 6-8 Weeks Postop Indianapolis Kokomo Avon Fishers Terre Haute HAND Congratulations you have reached the 6-week point in your therapy program! You are more than halfway through your rehab program. Your protective splint is discontinued at this time. Outlined below is your new therapy program. Perform the following exercises each 2 hours during the day, 10 repetitions. fully straighten your fingers. and with your wrist back, Straighten your back knuckles on your own muscle power, while keeping the tips bent. Fully straighten your fingers.

9 FLEXOR TENDON REPAIR FINGER(S) 6-8 Weeks Postop (continued) With your back knuckle supported and bent forward, bend and straighten your middle knuckle. Should you be fitted with a handbased splint, wear the splint as much as possible during the day. 3 days later Support and straighten the back knuckle with your opposite hand; bend and straighten the middle knuckle. 3 days later With the back knuckle and middle knuckle slightly bent, gently bend and straighten the tip of your finger. (Note: No blocking small finger DIPJ.) 7 weeks postop Support the back and middle knuckle straight; bend and straighten the tip weeks postop Form the putty into a cylinder. Squeeze and rotate the putty in your hand. (3-5 minutes)

10 FLEXOR TENDON REPAIR FINGER(S) 6-8 Weeks Postop Additional Instruction Patient Education At 6 weeks postop, you may lift objects under 3 pounds with your hand. (Note: A gallon jug of milk is +8 pounds!) Avoid making a tight, sustained fist with your hand. If you injured your index finger (pointer finger), avoid a tight sustained pinch or a tight pinch to pull apart objects (e.g. opening a bag of chips, frozen vegetables, self-sealing bags). Avoid a tight, sustained pinch against resistance for 3 months from surgery (very important). Do not pinch and pull apart objects with your thumb and fingers. Perform scar massage with lotion 3 times a day, for 1-2 minutes. At 8 weeks postop, you may lift objects up to 5 pounds with your hand. Your tendon continues to strengthen, yet it will not tolerate normal use until 3 months following surgery. With respect to sports, it will be important to wait 4 months for sports that require a tight grip against resistance (e.g. golf, tennis)

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