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Pag-aayos ng Flexor na Litid

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Isang plano sa maagang-aktibong-galaw na pagbawi pagkatapos ng pag-aayos ng flexor na litid sa daliri, gamit ang Manchester short splint upang dahan-dahan at ligtas na igalaw ang gumagaling na litid mula sa unang linggo habang pinoprotektahan ang pagkakaayos sa loob ng anim na linggo.

Ilustrasyon ng mga flexor na litid na tumatakbo sa panig ng palad ng mga daliri sa loob ng kanilang mga suot na balot.
Ang mga flexor na litid na nagpapaliko sa iyong mga daliri ay tumatakbo sa masisikip na balot sa panig ng palad ng kamay; ang isang naputol na litid ay inaayos at pagkatapos ay maingat na pinoprotektahan habang ito ay gumagaling. Kieran Hirpara 4.0

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

Ginagabayan ng protocol na ito ang iyong pagbawi pagkatapos ng surgical na pag-aayos ng isang flexor na litid sa daliri (ang kordon na tumatakbo pababa sa panig ng palad ng daliri at nagpapaliko nito papasok sa palad) kasama si Dr Kieran Hirpara sa Mater Private Hospital Rockhampton. Nagsisimula ito sa iyong home exercise program, na susundan ng nakaayos na klinikal na protocol na isinulat para sa iyong hand therapist: dalhin ang pahinang ito o ang PDF nito sa iyong unang pagbisita sa therapy upang manatiling koordinado ang iyong rehabilitasyon. Maaaring iakma ng iyong hand therapist ang plano depende sa kung paano umuusad ang iyong pagbawi.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa rooms. Kadalasan ay nakakatulong na kumuha ng larawan ng sugat at i-email ito para masuri.

Ano ang aasahan

Ang isang pag-aayos ng flexor na litid ay tinatahi ang mga naputol na dulo ng litid pabalik nang magkasama upang muling makapaliko ang daliri. Ang pagkakaayos ay sapat na malakas upang dahan-dahang igalaw kaagad, ngunit ito ay pinakamahina sa unang ilang linggo habang nagkakabit-kabit ang litid, kaya't ang buong plano ay itinayo sa paligid ng paggalaw nito nang sapat lamang upang mapanatili itong gumligaw, nang hindi ito kailanman pinapabigatan nang husto na sapat upang mapatid ang mga tahi.

Upang gawin ito, ang iyong kamay ay pinapahinga sa isang espesyal na magaang splint na tinatawag na Manchester short splint. Hindi tulad ng mga mas luma at mas malaking splint, ito ay maikli, nagtatapos sa linya ng pulso, kaya't ang iyong pulso ay iniiwang malaya. Pinapayagan nito ang iyong pulso na gumalaw nang buo pasulong at pabalik hanggang mga 45 degrees, habang ang isang maliit na hadlang ay pumipigil sa iyong malalaking buko na tumuwid lampas sa mga 30 degrees at iniiwang malaya na gumalaw ang mga kasukasuan ng iyong daliri. Isuot ito buong-panahon sa loob ng anim na linggo, tinatanggal lamang ito ayon sa tagubilin para sa mga ehersisyo at paglilinis.

Ang matalinong bahagi ay kung paano ginagamit ang pulso. Kapag ibinaluktot mo pasulong ang iyong pulso, ang iyong daliri ay tumutuwid nang halos kusa (ito ay tinatawag na tenodesis effect), at pinapayagan ka nitong buksan nang buo ang daliri nang hindi pinipilit ng sarili mong mga kalamnan. Kapag ibinaluktot mo pabalik ang iyong pulso, nagiging mas madali at mas ligtas na dahan-dahang pilikuhin ang daliri. Ang paggalaw sa ganitong paraan ay pinapanatili ang litid na gumligaw at, higit sa lahat, pumipigil sa daliri na pumiliko tungo sa isang matigas at baluktot na posisyon, ang pinakakaraniwang problema pagkatapos ng ganitong uri ng pag-aayos.

Ang maagang mga ehersisyo (mula sa mga araw 4–5) ay banayad at tiyak: unang pagpapaliko ng daliri nang passive, pagkatapos ay isang magaan na aktibong 'hook' na piliko na nagsisimula sa dulo ng daliri, pagkatapos ay pagtutuwid ng daliri habang nakabaluktot ang pulso. Walang matigas na paghawak at walang pinilit na paggalaw sa loob ng anim na linggo. Tinatanggal ang splint sa anim na linggo, nagsisimula ang magaan na pagpapalakas, at karamihan sa mga tao ay bumabalik sa buo at walang-restriksyong paggamit ng kamay sa sampu hanggang labindalawang linggo.

Mga pag-iingat at limitasyon

  • Isuot ang Manchester short splint buong-panahon sa loob ng anim na linggo: tanggalin lamang ito para sa iyong mga ehersisyo at paglilinis, ayon sa tagubilin.
  • HUWAG gumawa ng matigas at masikip na kamao at HUWAG humawak, magbuhat, humila o magbitbit ng anuman gamit ang inoperahang kamay sa unang anim na linggo: ang mabigat na pagbibigat ay maaaring makasira sa pagkakaayos.
  • HUWAG piliting tumuwid ang daliri o pilitin itong bumaluktot; panatilihing banayad ang bawat galaw, sa loob ng saklaw na ipinakita sa iyo.
  • Maaari mong gamitin ang kamay para sa napakagaan at ligtas na mga gawain maliban sa nasugatang daliri, hangga't walang humihila o nakakapigtal dito.
  • Ang isang paglagutok o biglaang 'pagbigay' na may pagkawala ng pagpaliko ng daliri ay maaaring mangahulugang naputol ang litid: makipag-ugnayan agad sa rooms kung mangyari ito.
  • HUWAG magmaneho habang ikaw ay nasa splint; magpapatuloy ang pagmamaneho pagkatapos matanggal ang splint (mga anim na linggo), kapag sapat na ang iyong paghawak at kontrol at nabigyan ka na ng pahintulot.

Para sa pangangalaga ng sugat, pamamaga at peklat, tingnan ang gabay ng praktis sa pangangalaga ng sugat.

Ang iyong mga ehersisyo

Ito ang mga ehersisyo mula sa iyong handout. Simulan ang mga ito ayon lamang sa gabay ni Dr Hirpara at ng iyong hand therapist, na nananatili sa loob ng anumang saklaw at limitasyon na ibinigay sa iyo. Ang bawat sesyon ay sumusunod sa parehong ligtas na pagkakasunod-sunod: unang dahan-dahang baluktutin ang daliri nang passive, pagkatapos ay gawin ang iyong aktibong 'hook' na piliko at tendon glides, pagkatapos ay ituwid ang daliri habang nakabaluktot ang pulso upang hindi ito matigas tungo sa isang piliko. Panatilihing magaan ang lahat ng ito: ito ay gliding, hindi pagpapalakas. Ang place-and-hold at blocking ay nabibilang sa mga huling yugto at dapat lamang simulan kapag ipinakilala ang mga ito ng iyong hand therapist. Ihinto ang anumang nagdudulot ng matalim na sakit sa ibabaw ng pagkakaayos, at huwag kailanman gumawa ng matigas na kamao bago ka mabigyan ng pahintulot.

Ang iyong klinikal na protocol

Ang natitirang bahagi ng pahinang ito ay ang nakahakbang na klinikal na protocol para sa rehabilitasyon pagkatapos ng pag-aayos ng flexor na litid gamit ang Manchester short splint at isang early-active-motion (EAM) na regimen. Ang seksyong ito ay ibibigay sa iyong hand therapist, at ang bawat yugto ay nagbubukas ng isang paliwanag sa simpleng Ingles kung ano ang nangyayari. Ang pagkakaayos ay pinakamahina sa unang mga linggo at pinapabigatan ng aktibo at nareresistahang flexion ng daliri (isang matigas na kamao); kaya't pinoprotektahan ng protocol laban sa mapuwersang flexion habang sinasadyang nagtutulak ng excursion ng litid at aktibong IP extension upang maiwasan ang flexion contracture na siyang pangunahing nakakaabalang komplikasyon.

Bago ang paggamot, suriin ang operation report ng pasyente at nakaraang kasaysayang medikal, at makipag-ugnayan sa tumatrato na surgeon tungkol sa zone ng pinsala, ang core-suture configuration at lakas ng pagkakaayos, anumang pulley venting, at kasabay na pag-aayos ng digital nerve. Ang mga flexor repair ni Dr Hirpara ay pinamamahalaan sa isang Manchester short dorsal splint (nagtatapos sa linya ng pulso) na pinapayagan ang buong wrist flexion at extension hanggang 45°, na may MCP joints na naka-block sa 30° ng flexion at ang mga IP joint na malaya, isinusuot buong-panahon sa loob ng anim na linggo. Ang mga night extension gutter ay idinaragdag lamang kung nabuo ang isang IP flexion deformity.

Phase I — maagang aktibong galaw sa Manchester short splint (mga linggo 0 hanggang 6)

Ang unang anim na linggo ay pinoprotektahan ang nagkakabit-kabit na pagkakaayos habang pinapanatiling gumligaw ang litid at pinipigilan ang daliri na tumigas tungo sa isang flexion contracture. Ang kamay ay naka-splint buong-panahon sa Manchester short splint (buong wrist flexion, extension hanggang 45°, MCP block sa 30°, malaya ang mga IP). Nagsisimula ang aktibong galaw sa mga araw 4–5. Ang bawat sesyon ay tumatakbo sa isang tiyak na pagkakasunod-sunod: unang passive IP flexion, pagkatapos ay aktibong hook na kamao na nagsisimula sa DIP habang nakaunat ang pulso, pagkatapos ay aktibong IP extension habang nakabaluktot ang pulso (synergistic, anti-contracture). Walang pinilit na end-range at walang nareresistahang flexion.

Para sa iyong hand therapist:

Edukasyon at mga pag-iingat - Splint buong-panahon sa Manchester short splint: buong wrist flexion, extension hanggang 45°, MCP naka-block sa 30°, malaya ang mga IP; tanggalin lamang para sa mga ehersisyo at kalinisan - Simulan ang EAM sa araw 4–5 - Walang pinilit na end-range flexion at walang nareresistahang flexion; walang paghawak, pagbuhat o paghila - Magaang "ligtas" na paggamit ng kamay maliban sa nasugatang daliri - Night extension gutter lamang kung nagsimulang mabuo ang isang IP flexion deformity

Pamamahala - Sugat: mga surgical dressing ayon sa gabay; subaybayan para sa impeksyon - Oedema: elevation, banayad na kontrol ng digital oedema, pamahalaan ang panganib ng adhesion - Pagkakasunod-sunod ng ehersisyo sa bawat sesyon: (1) unang buong passive IP flexion; (2) aktibong hook na kamao na nagsisimula sa DIP habang nakaunat ang pulso hanggang 45°; (3) aktibong finger extension habang nakabaluktot ang pulso (synergistic / tenodesis, anti-contracture); idagdag ang place-and-hold sa isang magaan na kamao ayon sa gabay - Pagsusuri sa hand-therapy lingguhan sa buong yugtong ito

Pamantayan upang umusad - Gumaling ang sugat; buo ang pagkakaayos sa anim na linggo; napanatili ang gliding ng litid; walang malubhang IP flexion contracture

Phase II — labas ng splint, gawain sa soft-tissue at peklat (linggo 6)

Sa anim na linggo tinatanggal ang splint. Ang pokus ay lumilipat sa pagbawi ng buong passive at aktibong saklaw, pagpapaluwag ng anumang maagang paninigas, at pamamahala sa peklat. Hindi pa nagsisimula ang pagpapalakas; ang isang night extension splint ay ginagamit lamang kung may natitirang flexion deformity.

Para sa iyong hand therapist:

Mga pagtatasa - Aktibo at passive na ROM sa MCP/PIP/DIP; pagkakaroon ng anumang IP flexion contracture; kalidad ng tendon-gliding (tasahin para sa adhesion); pagsusuri sa peklat at sugat

Edukasyon at mga pag-iingat - Ihinto ang splint sa anim na linggo (night extension splint lamang para sa natitirang IP flexion deformity) - Isulong ang magaang functional na paggamit; wala pa ring nareresistahang paghawak o pagbibigat

Pamamahala - Pag-unat ng soft-tissue upang maibalik ang buong composite flexion at extension; simulan ang pamamahala ng peklat kapag gumaling na - Ipagpatuloy ang tendon glides; ipakilala ang blocking kung ang mga adhesion ay naglilimita sa differential glide - Isulong ang magaang functional na paggamit ng kamay

Pamantayan upang umusad - Nanahimik ang sugat at peklat; halos-buong passive na ROM; napanatili ang gliding; handa na para sa graded na pagpapalakas

Phase III — pagpapalakas at pagbabalik (mga linggo 6 hanggang 12)

Sa mas mature na pagkakaayos, nagsisimula ang graded na pag-unat at progresibong pagpapalakas at itinatayo nang tuloy-tuloy tungo sa walang-restriksyong paggamit. Ang pagbabalik sa buo at walang-restriksyong aktibidad ay inaasahan sa mga sampu hanggang labindalawang linggo, batay sa pamantayan.

Para sa iyong hand therapist:

Mga pagtatasa - Composite ROM at anumang natitirang contracture; grip at pinch kumpara sa kabilang panig; tugon ng pagkakaayos sa graded na pagbibigat

Edukasyon at mga pag-iingat - Simulan ang graded na pag-unat at progresibong pagpapalakas mula sa mga anim na linggo; itayo ang bigat nang unti-unti - Iwasan ang biglaang maximal na grip o nareresistahang pagbibigat hanggang sa maitayong muli ang lakas

Pamamahala - Progresibong pagpapalakas ng grip at pinch (putty → graded na resistensya); ipagpatuloy ang pag-unat para sa anumang natitirang paninigas; ipagpatuloy ang gawain sa peklat kung kinakailangan - Sumulong tungo sa buo / walang-restriksyong aktibidad sa 10–12 linggo - Isaalang-alang ang discharge kapag functional na ang ROM at lakas at nakamit ang angkop na pagbabalik ng aktibidad; i-refer pabalik sa tumatrato na surgeon kung ang pagbawi ay tumigil o nagpatuloy ang isang flexion contracture

Pamantayan para sa pagbabalik sa buong aktibidad - Functional na composite ROM; sapat at halos-simetrikong lakas ng grip at pinch; walang-sakit na walang-restriksyong paggamit, karaniwan sa 10–12 linggo

Pagbabalik sa trabaho at aktibidad

Ang magaan at ligtas na paggamit ng kamay (maliban sa nasugatang daliri) ay hinihikayat mula sa simula sa loob ng splint, hangga't walang humihila, humahawak o nakakapigtal sa pagkakaayos. Magplano para sa tulong sa mga unang linggo, dahil walang paghawak, pagbuhat o pagbitbit gamit ang inoperahang kamay sa unang anim na linggo. Tinatanggal ang splint sa mga anim na linggo, at nagsisimula ang magaang pagpapalakas mula noon.

Dahil hindi ka dapat magmaneho habang ikaw ay nasa dorsal splint, ayusin ang transportasyon para sa unang anim na linggo. Magpapatuloy ang pagmamaneho pagkatapos matanggal ang splint (mga anim na linggo), kapag sapat na ang iyong paghawak at kontrol ng daliri at nabigyan ka na ng pahintulot sa iyong pagsusuri. Ang pagbabalik sa buo at walang-restriksyong aktibidad, kabilang ang matibay na paghawak at mas mabibigat na gawain, ay inaasahan sa mga sampu hanggang labindalawang linggo, itinayo nang unti-unti at hinusgahan ni Dr Hirpara at ng iyong hand therapist batay sa kung paano gumagalaw ang daliri at kung gaano ito kalakas, hindi sa pamamagitan ng kalendaryo lamang.

Pagkatapos ng iyong protocol

Ang protocol na ito ay gumagana kasabay ng pangkalahatang payo sa pagbawi ng praktis; tingnan din ang pamamahala ng sakit pagkatapos ng operasyon, pangangalaga ng sugat at pamamahala ng peklat. Ang nakahakbang na plano sa itaas ay sumasalamin sa nailathalang gabay sa maagang-aktibong-galaw na rehabilitasyon pagkatapos ng pag-aayos ng flexor na litid, at ang iyong patuloy na pagbawi ay ginagabayan nang isa-isa ni Dr Hirpara at ng iyong hand therapist ayon sa kung paano umuusad ang iyong daliri.

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

Flexor Tendon Repair — Procedure Outcomes & Post-operative Rehabilitation (Manchester Short-Splint Early Active Motion)

Topic scope: post-operative rehabilitation after primary surgical repair of a flexor tendon in the finger (especially zone II) with a robust multi-strand core repair, mobilised on an early-active-motion (EAM) regimen using the Manchester short splint. This is a repair of a divided structure that is at its weakest in the first weeks, so — unlike a decompression — the rehab is a carefully graded protected-but-moving pathway: enough controlled tendon excursion to prevent adhesion and flexion contracture, without the forceful flexion that ruptures the construct.

Defining principle of the rehab here: a repaired flexor tendon must glide to heal well but must not be loaded hard while it is weak. The two competing failures are rupture (from forceful or resisted flexion) and adhesion / PIP flexion contracture (from too little controlled motion). The Manchester short splint resolves this tension by leaving the wrist free: holding the wrist in 45° of extension minimises the work of flexion (Savage) so a gentle active hook fist glides the tendon at low tension, while permitting wrist flexion harnesses the extensor tenodesis effect to drive active IP extension — the single most effective lever against the PIP flexion contracture that is the characteristic nuisance complication of zone II repair. The deliberate sequence each session (passive IP flexion → active hook fist from the DIP, wrist extended → active IP extension, wrist flexed) is what makes the regimen safe and anti-contracture.

A. PROCEDURE / REPAIR OUTCOMES (early active motion vs passive mobilisation)

Flexor tendon repair is technically demanding and historically complication-prone (rupture and adhesion). Modern multi-strand core repairs combined with early active motion have shifted outcomes decisively toward better motion, with the central trade-off being a small rupture risk against markedly better range and function.

  • Early active motion gives better finger motion than passive mobilisation, at a small rupture cost. A systematic review of controlled mobilisation after zone II repair found EAM regimens produced better total active motion than passive (Kleinert/Duran) protocols, with a modest increase in rupture (~5% vs ~4%) [Starr 2013]. The contemporary consensus favours active regimens with robust repairs. Moderate–strong (SR).
  • The Manchester short splint specifically improves IP extension without increasing rupture. A clinical audit comparing the Manchester short splint (MSS) with a traditional full-length dorsal splint in uncomplicated zone II repairs found less PIP extension deficit (median 15° vs 28° at 6 weeks, p=0.003; 6° vs 18° at 12 weeks), a greater DIP flexion arc (59° vs 30°), and more excellent/good Strickland grades with the MSS. Rupture was not significantly different (2/45, 4.4% MSS vs 3/76, 3.9% traditional) [Peck 2014]. The headline advantage is the reduction in PIP flexion contracture. Moderate (single-centre non-randomised audit, Level III–IV).
  • Forearm-based (wrist-blocking) splints constrain the very motion that prevents contracture. A comparison of splint designs found the Manchester short splint allowed greater PIP extension than forearm-based splints [Newington 2021], consistent with the mechanistic rationale that freeing the wrist enables the synergistic IP-extension move. Moderate.
  • Mechanistic basis. Positioning the wrist in ~45° extension minimises the work of flexion required for active digital flexion, lowering the tension on the repair during the active hook fist [Savage 1988]; allowing wrist flexion recruits the extensor tenodesis effect to achieve full active IP extension at low cost — the anti-contracture engine of the regimen. Mechanistic.

B. REHABILITATION / THERAPY EVIDENCE

The rehab questions are (1) active vs passive early mobilisation, (2) splint design, and (3) how to structure the session to prevent both rupture and contracture. The evidence supports a robust repair mobilised with early active motion, a short wrist-free splint, and a fixed safe exercise sequence delivered through formal hand therapy.

  • Early active motion is the modern default for robust repairs. Active regimens (partial-range combined passive/active, place-and-hold, true active flexion) outperform passive-only protocols on motion and are now standard where the core repair is strong enough to tolerate active glide [Tang 2021; Starr 2013]. Moderate–strong.
  • A defined, low-tension active sequence is what makes EAM safe. Therapy guidance emphasises passive flexion first (preconditioning the joints), place-and-hold / active hook fist to glide the tendon at minimal tension, and synergistic wrist-flexion finger-extension to recover IP extension — the explicit structure of the Manchester regimen [Neiduski & Powell 2019; Saint John protocol]. Moderate (consensus + protocol cohorts).
  • Splint design materially changes the contracture outcome. Shorter, wrist-free splinting that permits the synergistic extension move yields greater PIP extension than traditional or forearm-based dorsal splints [Peck 2014; Newington 2021]. Moderate.
  • All flexor repairs are routed through formal hand therapy. The regimen is exercise-order- and tension-sensitive and is delivered with weekly hand-therapy review through the six-week splinted phase; it is not a self-directed pathway. Consensus / standard of care.

Recovery trajectory (expected, evidence-anchored)

Phase Window Restraint Hand use / therapy focus Strength / load Notes
I — Early active motion (in MSS) Week 0–6 Manchester short splint full-time (full wrist flexion, extension to 45°, MCP block 30°, IPs free) Start day 4–5; each session: passive IP flexion → active hook fist from the DIP (wrist extended) → active IP extension (wrist flexed); place-and-hold as guided; weekly therapy No resisted flexion, no gripping/lifting; light safe use excluding the injured finger EAM drives glide + anti-contracture; rupture risk highest now
II — Splint off, soft-tissue / scar Week 6 Splint discontinued (night extension gutter only for residual IP flexion deformity) Restore full passive/active ROM; scar management; tendon glides; blocking if adhesions Still no resisted loading PIP flexion contracture is the complication to chase down here
III — Strengthen / return Week 6–12 Restrictions progressively lifted Graded stretching; progressive grip/pinch strengthening (putty → resistance) Build grip/pinch gradually Return to full / unrestricted activity 10–12 weeks, criterion-based

(Phase windows mirror the precautions in the patient protocol; they are typical guides, not trial-derived deadlines.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Active vs passive early mobilisation. EAM gives better motion than passive Kleinert/Duran regimens at a small rupture-rate cost (~5% vs ~4%); it is the contemporary default for strong core repairs [Starr 2013; Tang 2021]. Moderate–strong.
  2. Manchester short splint vs traditional dorsal splint. The MSS audit shows clearly better IP extension and DIP flexion arc with no significant increase in rupture, but it is a single-centre, non-randomised audit (Level III–IV) — the authors themselves call for an RCT. The improvement is consistent with the mechanism (wrist-free synergistic extension), which raises confidence above the study design alone. Moderate; RCT recommended.
  3. The PIP flexion contracture is the outcome that discriminates protocols. Rupture rates are broadly similar across modern regimens; what separates them is residual PIP extension loss, and that is where the short, wrist-free splint and the synergistic-extension move earn their place [Peck 2014; Newington 2021]. Moderate.
  4. Repair strength gates the regimen. EAM is only safe with a robust multi-strand core repair; the protocol assumes that and is surgeon-confirmed per case (zone, suture configuration, pulley venting, concurrent nerve repair). Consensus.

D. EVIDENCE STRENGTH FLAGS (summary)

  • MODERATE–STRONG (SR): early active motion produces better finger motion than passive mobilisation after zone II repair, at a small rupture-rate increase (~5% vs ~4%) [Starr 2013]; modern partial-range active regimens are the contemporary standard [Tang 2021].
  • MODERATE: the Manchester short splint reduces PIP extension deficit (15° vs 28° at 6 wk, p=0.003) and improves DIP flexion arc without significantly increasing rupture (4.4% vs 3.9%) [Peck 2014]; greater PIP extension than forearm-based splints [Newington 2021]; defined low-tension exercise sequence [Neiduski & Powell 2019; Saint John].
  • MECHANISTIC / CONSENSUS: wrist 45° extension minimises work of flexion [Savage 1988]; wrist flexion harnesses the extensor tenodesis effect for active IP extension (anti-contracture); exact phase timings are typical guides, not trial-derived; single-centre non-randomised MSS evidence — an RCT is recommended.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Peck FH, et al. A comparative study of two methods of controlled mobilization of flexor tendon repairs in zone 2 (the Manchester short splint). Hand Ther. 2014. DOI: 10.1177/1758998314533306
  • Starr HM, et al. Flexor tendon repair rehabilitation protocols: a systematic review. J Hand Surg Am. 2013. DOI: 10.1016/j.jhsa.2013.06.025
  • Neiduski RL, Powell RK. Flexor tendon rehabilitation in the 21st century: a systematic review. J Hand Ther. 2019. DOI: 10.1016/j.jht.2018.06.001
  • Tang JB. Rehabilitation after flexor tendon repair and others: a safe and efficient update. J Hand Surg Eur Vol. 2021. DOI: 10.1177/17531934211037112
  • Tang JB, et al. (IFSSH flexor tendon committee report). J Hand Surg Eur Vol. 2014. DOI: 10.1177/1753193413500768
  • Newington L, et al. Splinting after flexor tendon repair: comparison of the Manchester short splint with forearm-based splinting on PIP joint extension. Hand Ther. 2021. DOI: 10.1177/17589983211017584

Flexor tendon rehabilitation literature (URLs)

  • Saint John flexor tendon protocol — early active motion regimen for zone II repair (protocol description and outcomes). PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142498/
  • Savage R. The influence of wrist position on the minimum force required for active movement of the interphalangeal joints. J Hand Surg Br. 1988 (mechanistic basis: wrist extension minimises the work of flexion). https://doi.org/10.1016/0266-7681(88)90258-2

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Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

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.