It is essential that the quality of the tendons and the Range of Motion achieved in surgery is charted. The following protocol is recommended for tendons which are felt to be in good condition throughout at the end of the tenolysis. Otherwise, the frayed tendon protocol may be more appropriate.
0 - 1 day:
The postoperative dressing is removed.
A light dressing and edema control is applied as needed. Elevation is emphasized.
Active and Passive Range of Motion exercises along with differential gliding exercises are initiated two to four times a day. The positions for differential glide are as follows:
Intrinsic minus position, Flat fist, Full fist, Full extension, Full extension with wrist extension, Full flexion with wrist flexion.
A Gutter splint in full extension is fitted to be worn between exercises and at night. A full excursion Resting Pan splint may be fitted if multiple digits are involved.
3 - 5 days:
Differential gliding exercises are increased to 15 min/hr. Dynamic extension splinting may be initiated as needed to increase pull through.
When good quality tendons are present, a foam piece or hand helper with minimal resistance may be issued to assist in flexor pull-through as needed.
Functional Electrical Stimulation or Standard Electrical Stimulation may be initiated within 48 hours postoperatively as needed to facilitate tendon excursion.
6 weeks:
Begin gentle strengthening (foam, putty, hand helper).
12 weeks:
Return to unrestricted activities.
Note:
Many factors may require altering this program, including poor vascularity, infection, poor quality tendons, severe edema, tendon graft, joint stiffness, and pulley reconstruction.