Phase 1: Immobilization and Early Protected Motion (Typically 0-4/6 weeks post-injury/surgery)

• Custom Splinting/Orthoses: The cornerstone of initial management. The hand and fingers are positioned in a specific splint (often dynamic or static progressive) to protect the healing tendon while allowing controlled, limited movement. The position depends on the specific tendon and zone of injury (e.g., extensor tendons are often splinted in extension).
• Dynamic splinting: Uses rubber bands or springs to assist specific movements (e.g., passive flexion and active extension) while protecting the repair. This allows early controlled motion to prevent adhesions.
• Static splinting: Holds the joint(s) completely still in a specific position.
• Edema Control: Elevating the hand, gentle massage, and compression (e.g., Coban wrap) to reduce swelling, which can impede healing and cause stiffness.
• Wound Care: If surgery was performed, ensuring the incision site heals properly and preventing infection.
• Gentle Passive Range of Motion (PROM) for Unaffected Joints: To prevent stiffness in joints that are not directly involved in the injury or are not included in the splint.
• Tendon Gliding Exercises (controlled): Very gentle, specific exercises (e.g., hook fist, straight fist) performed within the confines of the splint to promote tendon gliding and prevent adhesions, without putting excessive stress on the repair.

Phase 2: Gradual Increase in Motion and Light Strengthening (Typically 4/6 – 8/10 weeks)

• Progressive ROM Exercises: As the tendon gains strength, the splint may be gradually adjusted or weaned, and active range of motion (AROM) exercises are introduced. The focus is on regaining full flexion (bending) and extension (straightening) of the affected digits and wrist.
• Scar Management: Deep tissue massage, silicone sheets, or other techniques to minimize scar tissue formation and ensure smooth tendon gliding. Adhesions are a major concern in tendon healing as they can restrict movement.
• Initiation of Gentle Strengthening:
  • Isometrics: Gentle muscle contractions without joint movement.
  • Light Resistance Exercises: Using therapist’s resistance, putty, soft balls, or light resistance bands for finger and wrist muscles.
• Functional Activities: Incorporating light, controlled functional tasks into therapy to begin integrating the hand into daily activities.

Phase 3: Strengthening, Endurance, and Functional Return (Typically 8/10 – 12+ weeks)

• Progressive Strengthening: Increasing the intensity and resistance of exercises, including grip strengthening (e.g., hand grippers, therapeutic putty) and pinch strength exercises.
• Endurance Training: Repetitive functional tasks and exercises to build up stamina.