• Forearm based POP – wrist neutral/MCP’s @ 90°/IPJ’s full extension
  • Advise not to use hand
  • Elevation 2/52 (longer if needed)
  • Patient not to be discharged until seen by hand physiotherapist or if Bank Holiday then referred to Hand Physio next working day with daytime telephone number
  • OPA next Hand Clinic
  • 48 hours POP and wound check
  • Splint.  Wrist neutral / MCP’s 70-90° flexion / IP’s extended.  No velcro  across fingers 

EXERCISES – every hour in splint
Weeks 1-3

  • Passive flexion of each digit into palm x10 of each
  • Passive composite flexion of all digits together (to make fist).  Isomentric hold for 5 seconds.  Active extension to splint level
  • Stitches out 10 days
  • 5 times active composite flexion/extension to level of splint
  • Scar massage – 10 minutes every hour using hand cream
  • Shoulder and elbow exercises.  Scapulothoracic exercises

Look out for:

  • Infection – if concerned, send to GP/SHO for AB’s ASAP
  • Rupture – always test tendon each session to ensure still intact.  Weakest time around 10 days
    If PIPJ is developing FFD then stretch with wrist and MPJ’s in full flexion

Weeks 3 – 6

  • Continue all exercises
  • Differential tendon gliding work – see separate sheet for exercises

Weeks 6 – 8

  • Splint is straightened
  • Wean off splint but continue to wear at night for another 2 weeks and ‘at risk’ times
  • Begin to stretch wrist backwards
  • Commence light strengthening


  • Pushing hard against objects e.g., pushing doors open, getting out of the bath, pushing out of a chair
  • No lifting anything heavier than a bag of sugar
  • Do not drive yet

Weeks 8 – 12

  • Can start light duties for short periods e.g., writing, light housework, using a keyboard
  • Can drive at 10 weeks.  It is up to the patient to make sure he/she is safe to do so
  • Upper limb strengthening


  • Contact sports
  • Lifting anything heavier than 6 lbs
  • Static flexed postures for long periods e.g., writing, driving

Weeks 12 +
If FFD still a problem then use dynamic extension splint
Return to heavy work and contact sports.  Be careful if patient does extreme sports such as climbing – may need longer rehab/strengthening


The Hand to Elbow Clinic
29a James Street West
Bath BA1 2BT

Tel 01225 316895
Fax 01225 484949
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