Flexor tendon repair or graft early active motion therapy - Belfast Protocol

Suture:  4.0 monofilament Kessler with peripheral epitenon suture

2 days:

Splint:  Standard Dorsal Blocking Plaster splint with wrist in full flexion minus 30° (usually 30-40°), Metacarpophalangeal joints at 90° flexion and interphalangeal joints at 0°.  More recent modifications of this regime have a less extreme flexion posture.

Early Active Exercises:  2 days post-op, commence 2 hourly exercise sessions with 2 active flexion movements into air (proximal interphalangeal joints to 30° and distal interphalangeal joints to 5-10°), then 2 passive flexion movements into the palm, and 2 active extension movements back into the splint.

6 weeks:

The splint is discontinued. The patient is started on active flexion exercises and differential gliding exercises are initiated.

8 weeks:

Strengthening and passive extension exercises are instituted as needed. At 12 weeks the patient may return to work and unrestricted activities.

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