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Pagkumpuni ng Extensor Tendon

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Isang plano ng paggaling pagkatapos ng pag-aayos ng extensor tendon sa likod ng daliri o kamay (zonas IV hanggang VII), gamit ang isang relative-motion (yoke) splint na nagbibigay-daan sa paggamit ng kamay agad-agad habang pinoprotektahan ang pag-aayos, pagkatapos ay unti-unting pag-alis ng splint at pagpapalakas ng lakas sa maingat na yugto.

Illustrasyon ng mga extensor tendons na kumakalat sa likod ng kamay at mga daliri.
Ang mga extensor tendons na nagpapatuwid ng iyong mga daliri ay tumatawid sa likod ng kamay; pagkatapos ng pagkukumpuni, pinoprotektahan sila habang gumagaling ang pagkakabit. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protokol na ito ay gabay sa iyong paggaling pagkatapos ng operasyong pagkumpuni ng extensor tendon (isa sa mga tendon sa likod ng daliri o kamay na nagpapatuwid ng daliri) kay Dr. Kieran Hirpara sa Mater Private Hospital Rockhampton. Binabagay nito ang mga pagkumpuni sa likod ng daliri, kamay, at pulso (mga zona na tinatawag ng mga doktor na IV hanggang VII). Hindi nito kinabibilangan ang mallet finger (pagkumpuni sa dulo ng daliri) o ang central-slip / boutonnière repair sa gitnang knuckle; ang mga ito ay sumusunod sa ibang plano. Nagsisimula ito sa iyong home exercise program, sinundan ng istrukturadong klinikal na protokol na isinulat para sa iyong hand therapist. Dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa therapy upang manatiling koordinado ang iyong rehabilitasyon. Maaaring baguhin ng iyong therapist ang plano depende sa pag-unlad ng iyong paggaling.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Madalas na makakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Ang pag-aayos ng extensor tendon ay pagtahi ng hiwa o nahahati na tendon sa likod ng daliri o kamay. Ang dating paraan upang protektahan ang pag-aayos na ito ay pag-splint ng kamay sa loob ng ilang linggo, ngunit madalas itong nag-iiwan ng mga matigas na daliri at mabagal na pagbawi. Sa halip, ang iyong pagbawi ay gumagamit ng isang matalinong, modernong pamamaraan na tinatawag na relative-motion rehabilitation (Merritt method).

Ang susi ay isang maliit na splint na tinatawag na yoke, na isinusuot sa likod ng kamay. Ito ay nagpapanatili ng malaking knuckle ng naayos na daliri tungo sa 15 hanggang 20 degrees na mas tuwid kumpara sa mga knuckle ng mga daliri sa magkabilang gilid. Ang maliit na pagkakaiba na ito ay tahimik na nag-aalis ng bigat sa gumagaling na tendon, kaya maaari kang magsimulang gumamit ng kamay agad, dahan-dahan at sa loob ng kaginhawaan, sa halip na maghintay ng ilang linggo habang ito ay nakasplint. Ang maagang paggalaw sa paraang protektadong ito ay pinapanatili ang pagdudulas ng tendon upang hindi ito dumikit, habang ang offset ay pumipigil sa sobrang pagkapinsala nito.

Para sa karamihan ng mga pag-aayos (karaniwang mga zone sa likod ng daliri at kamay), ang yoke sa sarili nito ang kailangan mo lamang. Para sa ilang mga pag-aayos (mga mas malapit sa pulso, mahinang mga pag-aayos, o kung saan karapat-dapat ang karagdagang proteksyon), isang wrist splint ay idinadagdag para sa unang ilang linggo. Ang iyong hand therapist ang magtuturo kung mayroon ka ring wrist splint.

Ang plano ay unti-unting binubuksan sa maingat na mga yugto: ang yoke ay isinusuot nang buong oras sa loob ng humigit-kumulang anim na linggo at binabawasan mula sa ika-limang linggo; ang pinagsamang galaw ng pulso at daliri ay idinadagdag sa gitnang mga linggo; ang pagpapalakas ay nagsisimula mula sa humigit-kumulang walong linggo; at ang buong aktibidad ay babalik sa loob ng sampung hanggang labindalawang linggo, kapag ang pag-aayos ay matibay na.

Mga Paalala at Limitasyon

  • Isuot ang iyong yoke splint nang buong oras sa loob ng humigit-kumulang unang anim na linggo, kasama na ang paggawa ng mga ehersisyo at pang-araw-araw na gawain, at tanggalin o bawasan lamang ang paggamit nito ayon sa utos ng iyong hand therapist. Ipaalam ng iyong hand therapist kung mayroon ka ring wrist splint.
  • Magkaroon ng magaan na paggamit ng kamay sa splint sa pang-araw-araw na gawain mula sa simula, hangga't komportable. HUWAG mag-angat, mag-hila nang pilit, o gumawa ng mga gawaing may resistensya sa loob ng unang ilang linggo.
  • HUWAG magsimula ng pagpapalakas ng hawak (grip) o pinch hangga't hindi pa inaabot, karaniwan ay sa paligid ng walong linggo.
  • HUWAG gumawa ng mahigpit na buong sisisi o pilitin ang daliri nang maaga; gumalaw lamang sa mga banayad at kontroladong saklaw na ipinapakita sa iyo.
  • Panatilihing gumagalaw ang mas maliliit na joints ng daliri upang hindi ito maging matigas; ang banayad na pasibong pagwawasto (straightening) ay tumutulong dito.

Para sa pamamahala ng sugat, pamamaga, at peklat, tingnan ang gabay ng klinika tungkol sa wound care.

Ang iyong mga ehersisyo

Ito ang mga ehersisyo mula sa iyong handout. Simulan lamang ito ayon sa gabay ni Dr. Hirpara at ng iyong hand therapist, at manatili sa loob ng anumang range at limitasyon na ibinigay sa iyo. Ang mga unang ehersisyo ay ginagawa kasama ang yoke splint: banayad na pagbaluktot ng knuckle at pagkulot ng mga daliri na nagglide ng repaired tendon sa isang ligtas at kontroladong dami nang hindi ito hinahamon. Ang coupled wrist-and-finger movement at ang grip/pinch strengthening ay kabilang sa mga huling yugto at hindi dapat simulan hangga't hindi ka espesipikong pinapayagan. Itigil ang anumang nagdudulot ng matulis na sakit sa likod ng daliri o kamay.

Ang iyong klinikal na protokol

Ang natitirang bahagi ng pahinang ito ay ang yugto-yugto na klinikal na protokol para sa rehabilitasyon pagkatapos ng pag-aayos ng extensor tendon (mga zona IV hanggang VII) gamit ang relative-motion extension (RME). Ang seksyong ito ay dapat ibigay sa iyong hand therapist, at bawat yugto ay nagsisimula sa isang paliwanag sa simpleng wikang Ingles kung ano ang nangyayari. Ang pag-aayos ay protektado ng yoke splint na nagpapanatili ng MCP ng naayos na daliri na 15 hanggang 20 degrees na mas extended kaysa sa mga katabing daliri, na nagpapababa ng aktibong paggalaw ng extensor sa pamamagitan ng quadriga effect at ang mga juncturae tendineae, kaya't ang agad na aktibong paggalaw ay ligtas.

Bago ang paggamot, suriin ang operation report at past medical history ng pasyente, at makipag-ugnayan sa treating surgeon tungkol sa mga zona na naayos, mga tendon na kinalibutan, lakas ng pag-aayos, at kung kailangan ba ng supplementary wrist orthosis. Ang default ni Dr. Hirpara para sa mga zona V at VI ay yoke-alone (relative-motion extension splint, ang naayos na MCP ay hawak na 15–20° na mas extended kaysa sa mga katabi). Isang wrist orthosis (~20–25° extension, sa unang ~3 linggo) ay idinadagdag para sa zona VII, mas mahinang mga pag-aayos, o mga hindi sumusunod na pasyente. Ang protokol na ito ay para sa mga dorsal extensor repairs zones IV–VII lamang, HINDI para sa mallet (mga zona I–II) o central-slip/boutonnière (zona III).

Yugto I — yoke (± wrist splint), agad na aktibong paggamit (linggo 0 hanggang 3)

Ang unang tatlong linggo ay nagpoprotekta sa repair gamit ang yoke habang ang pasyente ay aktibong gumagamit ng kamay agad-agad. Ang relative 15–20° extension offset ay nag-o-offload sa repair, kaya ang controlled active gliding ay inirerekomenda mula sa simula. Ang magaan na functional use sa splint ay pinapayagan; walang pag-angat o resisted grip.

Para sa iyong hand therapist:

Edukasyon at mga precaution - I-fit ang yoke / relative-motion extension splint: ang MCP ng repaired digit ay hawak sa 15–20° na mas extended kaysa sa mga adjacent digits; suot full-time - Magdagdag ng wrist orthosis (~20–25° extension) para sa unang ~3 linggo LANG para sa zone VII / mas mahinang repairs / mga pasyenteng hindi compliant (ang yoke-alone ang default para sa zones V–VI) - Ang magaan na paggamit ng kamay sa splint ay inirerekomenda; WALANG pag-angat, forced gripping o resisted work - Iwasan ang forced composite fisting; panatilihin ang mga range na controlled

Pamamahala - Sugat: surgical dressings ayon sa utos; monitor para sa infection - Oedema: elevation, gentle digital pump, ice kung kinakailangan - Mga ehersisyo (sa loob ng splint, bawat ~2 h): aktibong intrinsic-plus (MCP flexion kasabay ang IPs extended) at intrinsic-minus / hook (MCP extension kasabay ang IP flexion); passive IP extension araw-araw upang maiwasan ang IP stiffness - Simulan ang scar management kapag ang sugat ay gumaling na

Mga kriteriya para mag-progress - Gumagaling ang sugat; walang extensor lag na lumalabas; komportableng controlled active motion sa loob ng splint sa ~3 linggo

Yugto II — inalis ang wrist splint, patuloy ang yoke, coupled motion (linggo 3 hanggang 6)

Mula sa humigit-kumulang tatlong linggo, itatigil ang anumang supplementary wrist splint (patuloy ang yoke nang buong oras). Idadagdag ang coupled wrist-and-finger (tenodesis) motion at composite active flexion/extension, upang mapataas ang tendon excursion sa isang kontrolado at ligtas para sa repair na paraan.

Para sa iyong hand therapist:

Pagsusuri - Aktibo at pasibong ROM (MCP at IP), extensor lag, sakit at pamamaga; pagsusuri sa sugat/ganda

Edukasyon at mga paalala - Itigil ang supplementary wrist splint (kung may ginamit); patuloy ang yoke nang buong oras - Unahin ang unti-unting pag-unlad ng galaw; pa rin walang resisted grip o strengthening

Pamamahala - Mga ehersisyo: idagdag ang coupled wrist-and-finger motion (tenodesis) at composite active flexion/extension; patuloy ang intrinsic-plus / intrinsic-minus gliding at pasibong IP extension; magamit ang magaan na functional use habang naka-yoke - Patuloy ang scar massage kapag gumaling na

Mga pamantayan para mag-advance - Composite active ROM na umuunlad hanggang ~6 hanggang 8 linggo; walang extensor lag; umuunlad ang sakit

Yugto III — unti-unting tanggalin ang yoke, palakasin, at bumalik (linggo 6 hanggang 12)

Mula mga linggo 5 hanggang 6, unti-unting tanggalin ang yoke. Nagsisimula ang progressive na pagpapalakas ng grip at pinch mula mga linggo 8 kapag solid na ang repair, na unti-unting nagtatapos sa buong aktibidad sa linggo 10 hanggang 12.

Para sa iyong hand therapist:

Mga Pagsusuri - Buong aktibo at pasibong ROM, extensor lag, lakas ng grip/pinch kumpara sa kabilang bahagi; functional at work-specific testing kung angkop

Edukasyon at mga paalala - Unti-unting tanggalin ang yoke mula ~linggo 5, ganap na tanggalin sa mga linggo 6 depende sa galaw at kontrol - Ipakilala ang progressive na pagpapalakas ng grip/pinch mula linggo 8 (hindi bago pa) - Unti-unting dagdagan ang resistance patungo sa buong aktibidad sa linggo 10 hanggang 12

Pamamahala - Mga ehersisyo: graded pagpapalakas ng grip at pinch (pagpi-piga ng bola/putty, pinch) mula linggo 8; progressive resistance; patuloy na anumang natitirang mobility at IP-extension work - Isaalang-alang ang discharge kapag ang galaw at lakas ay halos symmetrical at naabot na ang functional return - Isaalang-alang ang referral pabalik sa treating doctor kung nananatili ang extensor lag, huminto ang galaw, o maganda ang outcome

Mga pamantayan para sa pagbabalik sa buong aktibidad - Buong painless ROM na walang malaking extensor lag; halos symmetrical na grip/pinch; ~linggo 10 hanggang 12

Pagbabalik sa trabaho at gawain

Ang magaan na pang-araw-araw na paggamit ng kamay sa yoke splint (pagkain, pagsulat, paghahanda ng damit, magaan na sariling pag-aalaga) ay inirerekomenda mula sa simula, hangga't komportable ito, basta't hindi ito kasama ang pag-angat, pilit na pagkapit o trabahong may resistensya. Ang pagpapalakas ng kalamnan ay nagsisimula sa humigit-kumulang walong linggo, at ang buo at walang limitasyong pagbabalik sa mga gawain ay nangyayari sa pagitan ng sampung hanggang labindalawang linggo kapag ang repair ay matibay na at naibalik ang galaw at lakas, na pinapasiya ni Dr. Hirpara at ng iyong hand therapist, hindi lamang base sa kalendaryo.

Pagmamaneho: ang magaan na paggamit ng kamay sa yoke ay okay, kaya't hindi ganap na bawal ang pagmamaneho, ngunit kailangan mong makapagkapit sa manibela at makapangasiwa ng sasakyan nang ligtas, kasama na sa mga emergency. Para sa karamihan, ito ay nangangahulugang pagbabalik sa pagmamaneho habang binabawasan ang paggamit ng yoke (humigit-kumulang anim na linggo); maaari itong mas maaga kung kaya mong kontrolin ang sasakyan nang komportable, at kumpirmahin ng iyong surgeon kung kailan ito ligtas para sa iyo.

Pagkatapos ng iyong protocol

Ang protocol na ito ay kasabay ng pangkalahatang payo para sa paggaling ng klinika: tingnan ang pamamahala ng post-operative na sakit, pag-aalaga sa sugat, at pamamahala ng peklat. Ang naka-phase na plano sa itaas ay sumasalamin sa publikadong gabay sa rehabilitasyon pagkatapos ng pagkumpuni ng extensor tendon gamit ang relative-motion extension, at ang iyong patuloy na paggaling ay indibidwal na pinamumunuan ni Dr. Hirpara at ng iyong hand therapist ayon sa pag-unlad ng iyong kamay.

Reviewed by Dr Kieran Hirpara · 20 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Extensor Tendon Repair — Procedure Outcomes & Post-operative Rehabilitation (Relative-Motion Extension, Zones IV–VII)

Topic scope: post-operative rehabilitation after primary repair of an extensor tendon on the dorsum of the finger, hand or wrist — zones IV to VII — managed by relative-motion extension (RME / Merritt yoke splint, the ICAM family of regimens). This is a tendon repair (a construct that must heal under controlled load), but the relative-motion approach lets that load be applied immediately and actively rather than after weeks of immobilisation. This page does not cover mallet finger (zones I–II) or central-slip / boutonnière repair (zone III), which follow different regimens.

Defining principle of the rehab here: a yoke (relative-motion) splint holds the repaired digit's MCP joint 15–20° more extended than its neighbours. By the quadriga effect and the juncturae tendineae, this small relative offset offloads the repaired tendon — it reduces the active extensor excursion demanded of the healing repair (from roughly 12 mm of excursion in normal active extension to about 6 mm within the splint). That residual ~6 mm is enough to keep the tendon gliding and prevent adhesions, but too little to rupture the repair — which is why immediate active motion is safe. The single common branch point is whether a supplementary wrist orthosis (~20–25° extension, first ~3 weeks) is added for zone VII, weaker repairs, or non-compliant patients; the yoke alone is the default for zones V–VI.

A. PROCEDURE / REPAIR OUTCOMES (relative-motion vs immobilisation)

Extensor tendon repair on the back of the hand is reliable; the principal modern question is how to rehabilitate it — protected immobilisation versus an early-active programme such as relative-motion extension — not whether repair works.

  • The mechanism that makes immediate active motion safe is well established. The 15–20° relative MCP-extension offset offloads the repair via the quadriga effect and the juncturae tendineae, cutting active extensor excursion from ~12 mm (normal) to ~6 mm within the splint — enough to prevent adhesions, too little to rupture. Cadaveric and mechanistic work underpins this rationale [Merritt, Wong & Lalonde 2020]. Strong (mechanistic + cadaveric).
  • Relative-motion regimens match or improve on traditional early-active and immobilisation pathways. A randomised controlled trial in zones V–VI found relative-motion extension delivered earlier return of hand function and higher patient satisfaction with equivalent total active motion (TAM) versus the comparator early-active programme [Collocott RCT 2020]. A systematic review reported earlier return to work with equivalent range of motion and complication rates [Collocott review 2017]. Moderate–strong (1 RCT + SR; RME studies of generally lower methodological quality).
  • Yoke-alone (no wrist splint) is supported for the common zones. Case series of relative-motion extension without a supplementary wrist orthosis for zones IV–VI report no ruptures, supporting yoke-alone as the default for these zones with the wrist orthosis reserved for zone VII / weaker / non-compliant repairs [Hirth 2021; Howell ICAM]. Moderate.
  • The functional gain over immobilisation is large and practical. Early-active relative-motion programmes report return to work at roughly 17–25 days, versus the 3–4 months typical of immobilisation regimens — the headline advantage that has driven adoption [Collocott review 2017; Howell ICAM]. Moderate.

B. REHABILITATION / THERAPY EVIDENCE

The central rehab questions are (1) immobilise or move early, (2) is a wrist splint needed in addition to the yoke, and (3) how long must the splint stay on. The evidence favours early relative motion, supports yoke-alone for zones V–VI, and suggests splint duration can be shorter than the traditional six weeks without penalty.

  • Early active motion via relative-motion extension is the modern default. The original technique description [Merritt 2014] and the clinical scheduling / yoke construction work [Lutz 2015] established a reproducible programme: immediate active intrinsic-plus and intrinsic-minus motion in the yoke, progressing to coupled (tenodesis) motion, weaning, then strengthening. Moderate (technique + cohort).
  • A supplementary wrist splint is optional, not mandatory. Yoke-alone case series for zones IV–VI report no ruptures; the wrist orthosis (~20–25° extension, first ~3 weeks) is added selectively for zone VII, weaker repairs, or poor compliance [Hirth 2021; Howell ICAM]. Moderate (selective use).
  • Splint duration may be shortened. A comparison of 4-week versus 6-week splinting found no difference in outcome, suggesting the traditional six-week full-time period can be safely abbreviated in selected patients [Svens 2015]. This page keeps full-time wear ~6 weeks (weaned from ~wk 5) as the conservative default while acknowledging the shorter option. Moderate (1 comparative study).
  • The field is moving toward wider use of relative motion. A recent international consensus endorses broader application of relative-motion rehabilitation, including beyond its original zone V–VI indication [Tang consensus 2025]. Consensus.

Recovery trajectory (expected, evidence-anchored)

Phase Window Splint / restraint Hand use / therapy focus Strength / load Notes
I — Yoke (± wrist splint), immediate active use Week 0–3 Yoke full-time (repaired MCP 15–20° more extended); wrist orthosis ~20–25° ext only for zone VII / weak / non-compliant Active intrinsic-plus (MCP flex, IPs straight) and intrinsic-minus / hook every ~2 h; passive IP extension daily; light use in the splint Light functional use only; no lifting / resisted grip Relative offset offloads repair (~12 mm → ~6 mm excursion); active motion is safe from day one
II — Wrist splint off, yoke continues Week 3–6 Discontinue any wrist splint; yoke continues full-time Add coupled wrist-and-finger (tenodesis) motion + composite active flexion/extension; light functional use; scar massage once healed Still no resisted grip Composite active ROM building; watch for extensor lag
III — Wean yoke, strengthen, return Week 6–12 Yoke weaned from ~wk 5, off ~wk 6 Progress full active motion; commence grip/pinch strengthening from week 8 Graded strengthening from wk 8 → full activity ~10–12 wk Return to work as early as ~17–25 days reported; full unrestricted activity ~10–12 wk

(Phase windows mirror the precautions and recovery structure in the patient protocol; they are typical guides, not trial-derived deadlines. Splint duration may be safely shortened toward 4 weeks in selected patients.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Relative motion vs traditional immobilisation / other early-active regimens. One RCT (zones V–VI) and a systematic review favour relative-motion extension for earlier hand function, earlier return to work, higher satisfaction, with equivalent TAM and complications — though RME studies are generally of lower methodological quality, so the effect size is moderately rather than strongly certain. Moderate–strong.
  2. Wrist splint: needed or not? Yoke-alone gives good results with no ruptures in zone IV–VI series; the supplementary wrist orthosis is selective (zone VII / weaker / non-compliant). The defensible default is yoke-alone for the common zones — hence the page wording that the hand therapist will advise if a wrist splint also applies. Moderate.
  3. How long to splint. Traditional full-time wear is ~6 weeks; a 4-vs-6-week comparison showed no difference, so duration can be individualised and potentially shortened. Moderate.
  4. The 15–20° offset itself. The specific relative-extension increment is consensus-derived (it must offload enough to protect but leave enough excursion to glide); it rests on sound mechanism rather than a dose-finding trial. Consensus.
  5. Extending relative motion beyond zones V–VI (e.g. to sagittal-band injury and selected boutonnière/central-slip cases). The 2025 consensus endorses wider use, but evidence outside the core zones is weak–moderate, which is why this page deliberately scopes to zones IV–VII and excludes zone III. Weak–moderate.

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG: the mechanism — relative 15–20° MCP-extension offset offloads the repair (quadriga + juncturae tendineae; ~12 mm → ~6 mm active excursion) making immediate active motion safe (mechanistic + cadaveric).
  • MODERATE–STRONG: relative-motion extension is at least as good as other early-active-motion regimens (1 RCT zones V–VI: earlier hand function, higher satisfaction, equal TAM; SR: earlier return to work, equal ROM/complications) — tempered by the lower methodological quality of RME studies.
  • MODERATE: wrist-splint-optional (yoke-alone, no ruptures in zone IV–VI series); 4-vs-6-week splint duration (no difference); return to work ~17–25 days vs 3–4 months for immobilisation.
  • CONSENSUS: the specific 15–20° offset increment; broader application of relative motion (Tang 2025).
  • WEAK–MODERATE: extension of the technique to sagittal-band / boutonnière (central-slip) injuries outside the core zones.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Merritt WH. Relative motion splint: active motion after extensor tendon injury and repair. J Hand Surg Am. 2014. DOI: 10.1016/j.jhsa.2014.03.015
  • Merritt WH, Wong AL, Lalonde DH. Recent developments are changing extensor tendon management (relative motion / quadriga mechanism). Plast Reconstr Surg. 2020. DOI: 10.1097/prs.0000000000006556
  • Lutz K, et al. Relative motion extension splinting for extensor tendon repair — clinical schedule and yoke. Hand Clin. 2015. DOI: 10.1016/j.hcl.2014.12.006
  • Collocott SJF, et al. Relative motion flexion versus relative motion extension / early active motion after extensor tendon repair (zones V–VI): a randomized controlled trial. J Hand Ther. 2020. DOI: 10.1016/j.jht.2018.10.003
  • Collocott SJF, Kelly E, Ellis RG. A systematic review of relative-motion orthoses for the management of extensor tendon repairs. Hand Ther. 2017. DOI: 10.1177/1758998317729713
  • Svens B, et al. Four-week versus six-week immobilisation comparison after extensor tendon repair. J Hand Ther. 2015. DOI: 10.1016/j.jht.2014.07.006
  • Hirth MJ, et al. Relative-motion approaches in extensor tendon rehabilitation. J Hand Ther. 2021. DOI: 10.1016/j.jht.2019.12.016
  • Tang JB, et al. International consensus on relative-motion rehabilitation and extensor tendon management. J Hand Surg (Eur Vol). 2025. DOI: 10.1177/17531934251363138

Extensor tendon rehabilitation literature (URLs)

  • Howell JW, Merritt WH, Robinson SJ. Immediate Controlled Active Motion (ICAM) following zone 4–7 extensor tendon repair. J Hand Ther / PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3574475/

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c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.