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Extensor tendon injury MCP level hammock protocol therapyThis protocol is indicated for patients with extensor tendon lacerations over the ring or middle finger metacarpal phalangeal joints that are otherwise not candidates for the other two protocols. This includes patients who have not been able to have a formal repair of the tendon due to infection. The idea of this protocol is that the tendinous junctures will take tension off the extensor tendon repair if the adjacent digits are maintained in a flexed position relative to the injured digit.0 - 4 weeks: The patient is placed in a two component splint. The first component is a forearm based wrist extension splint holding the wrist in 45 degrees of extension. The second component is a velcro band which forms a loop around the two fingers adjacent to the injured digit and which is entirely palmar to the injured digit, passed around the adjacent digits at the proximal phalanx level. This allows the patient to flex and extend all joints, but maintains the metacarpal phalangeal joint of the injured digit in 30 to 50 degrees of extension relative to the adjacent fingers. Scar massage is initiated as soon as sutures are removed. 4 - 6 weeks: The wrist component is discontinued. 6 - 12 weeks: Splinting is discontinued. Active range of motion exercises are initiated at all joints four to six times daily. 8 weeks: Passive range of motion exercises are initiated to all joints as needed. Gentle progressive strengthening exercises are initiated. The patient is expected to return to full work duties at 12 weeks.
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