 Week 0 to 6: ROM to the uninvolved joints +

splinting for 6 wks

 Week 6 to 8: Begin active ROM exercises:
active finger flexion up to 250 . Continue
with the extension splint.
 Week 8 to 10: Continue day and night
splinting. Begin flexion 25-300
 Week 10 to 12: If there is no extension lag,
discontinue day splint, but continue night
splinting.
 If extension lag persists, splinting and
exercise are performed every 2 hrly to
minimize lag.
 Week 12: Begin unrestricted use of hand in
daily activities. Continue to monitor for
extension lag, if lag returns, reinstitute
appropriate level of splinting for additional
weeks.
 If in addition to the mallet finger deformity,
the patient also has a swan neck deformity,
the PIP jt. is splinted at 300 flexion with DIP
jt. in neutral position.
 3-14 days post op., AROM exercises of PIP jt.
include full flexion and limited extension of
PIP joint are started.
 Week 6 to 10: The splint is gradually adjusted
to allow increased active extension of the
PIP jt., or the patient is permitted to
decrease the splint use.
 Dynamic extension splinting may be initiated
at 8 wks for PIP extension limitation greater
than 300.
 Strengthening for PIP flexion may begin at 6-
8 wks.
A static hand based splint with PIP at neutral
is recommended for night use.
 The hand based dynamic PIP extension splint
is fabricated with the MP at 200 flexion
 Traction is adjusted to allow PIP extension to
neutral or slight hyperextension.
 The DIP joint is left free
 PIP flexion during exercise is limited to 300
during 1st wk, 400 during the 2nd wk, and 500
during the 3rd wk.
 The patients are instructed to perform
flexion within a pain-free range 10-20 times
hrly within the limits of the splint.
 Begin gentle blocking exercises without
resistance
 Patients are also instructed in reverse
blocking exercises hrly to ensure full PIP
extension.
 The protective splinting is discontinued at 6
wks
 Gentle flexion strapping can be initiated at
6wks. The patient’s ability to maintain PIP
extension is monitored closely.
 Immobilization for 3 wks for simple injuries,
children, and non compliant patients.
 24 hrs to 3 days post operatively:
 Splinting: 2 part dynamic splinting:
a) Dorsal component: dynamic MP extension
splint, with MPs supported at neutral, wrist
at 300 extension
b) Volar component interlocked: supports the
wrist in 300 extension, MPs permitting
active flexion of 300 for index and middle
fingers and 400 for ring and small fingers
 Therapy:
a) Wound care
b) Edema control
c) Splint adjustment
d) Controlled IP PROM through complete range
while wrist and MPs are supported in full
extension
e) PIP and DIP jt. protected ROM 0 to 21 days
post op.
f) Patient also performs following exercises
each waking hour:
1) While maintaining IP extension, patient
actively flexes MP joints till the limits of
the splint.
 Then the patient releases the fingers,
allowing the extension loops to passively
extend the MPs to 00.
 This is done to promote gliding under the
retinaculum
 Tenodesis:
a) For Zones V and VI: simultaneous wrist
extension with 300 flexion of index and
middle finger MP jts.
AND
a) 400 flexion of ring and small finger MPs
followed by simultaneous wrist flexion to
200 with all IPs in neutral.
 For Zone VII: 00 finger extension with 100
wrist extension.
 If the wrist tendons are also involved: 00
finger extension with 200 wrist extension.
 3 wks post op:
a) Splinting: Volar block splint is removed
during daytime. The dorsal dynamic
splinting is continued. At night, the volar
splint is worn, with wrist in 300 extension,
and 00 MP extension.
b) Therapy: begin protected gradual active
motion of MP and IP joints within the splint
 MP AROM and AAROM with tenodesis
 IP AROM, AAROM and PROM through complete
range while wrist and MPs are supported in
full extension.
 4-5 wks post op:
 Initiate composite finger flexion with wrist in
extension.
 Splinting between exercise sessions and at
night until 6-8 wks post op
 6-12 wks post op:
 Zone V and VI: Splinting is done only as
needed. Patient’s ability to extend is closely
monitored.
 Therapy: Composite wrist and finger flexion
is initiated when there is no extension lag
 Mild progressive strengthening: wrist flexion-
extension and forearm pronation-supination

 ZoneVII: Splinting places the wrist in 300

extension, with MPs and IPs free. Continue
protective splinting up to 8 wks
 Slowly add increments of wrist flexion, radial
and ulnar deviation.
 8 – 12 wks post op.: slowly add progressive
strengthening.
 Repairs in this zone involve more muscles
than tendons.
 Distal injuries are managed similar to zone V
to VII rehab protocol
 Proximal repairs may also require temporary
splinting of elbow at 900 flexion