Patients › Rehabilitation
伸肌腱修复
修复手指或手背伸肌腱（IV至VII区）后的康复计划，采用相对运动（夹板）支具，可在保护修复部位的同时立即使用手部，随后逐步停用支具并分阶段增强力量。
本方案由基兰·希尔帕拉（Kieran Hirpara）医生在罗克汉普顿 Mater 私人医院为您提供，用于指导伸肌腱（手指或手背侧负责伸直手指的肌腱之一）手术修复后的康复过程。本方案涵盖手指、手背及腕部背侧的修复（即外科医生所称的 IV 至 VII 区）。本方案不包括锤状指（指尖处的修复）或中央束/纽扣畸形（中节指骨关节处）的修复；后者遵循不同的康复计划。本方案首先介绍您的家庭锻炼计划，随后是为您手治疗师制定的结构化临床方案。请在首次治疗访视时携带此页面或其 PDF 版本，以确保您的康复过程协调一致。您的治疗师可能会根据您的康复进展调整计划。
如果您对术后伤口有任何疑虑，请联系诊室。拍摄伤口照片并通过电子邮件发送以供审查通常很有帮助。
预期情况¶
伸肌腱修复术是将手指或手背侧断裂的肌腱重新缝合在一起。过去保护该修复术的方法是用手夹板固定手部数周，但这常导致手指僵硬且恢复缓慢。相反，您的康复采用了一种巧妙的现代方法，称为相对运动康复（Merritt 法）。
关键是一个称为夹板（yoke）的小型夹板，佩戴在手背侧。它使修复后手指的大指关节比两侧手指的指关节伸直多 15 至 20 度。这一微小的差异可悄然减轻愈合肌腱的负荷，因此您可以立即开始使用手部，在舒适范围内轻柔活动，而无需像过去那样固定数周。以这种受保护的方式早期活动可保持肌腱滑动，防止其粘连，同时偏移设计可防止其过度牵拉。
对于大多数修复术（手指和手背侧的常见区域），仅使用夹板即可。对于某些修复术（靠近腕部、修复强度较弱或需要额外保护的情况），在前几周还需增加腕部夹板。您的手部治疗师会告知您是否也配有腕部夹板。
随后计划分阶段逐步展开：夹板需全天佩戴约六周，并从第五周开始逐渐减少佩戴时间；在中期的数周中增加腕部和手指的联合活动；从大约八周开始进行力量训练；一旦修复牢固，在大约十至十二周时恢复全部活动。
注意事项与限制¶
- 在最初约六周内全天佩戴夹板，包括进行锻炼和日常活动时，仅在您的手部治疗师指导下拆除或逐渐减少佩戴时间。您的手部治疗师会告知您是否还需要佩戴腕部夹板。
- 从开始起，在舒适范围内，轻度使用戴有夹板的手进行日常活动。最初数周内，严禁提重物、用力握持或进行抗阻训练。
- 未经治疗师许可前，不要开始握力或捏力强化训练，通常在术后约八周后获准。
- 不要早期强行握紧硬拳或用力活动手指；仅按照治疗师示范的轻柔、可控范围活动。
- 保持较小指间关节的活动度，以防止僵硬；轻柔的被动伸直有助于此目的。
关于伤口、肿胀和瘢痕管理，请参阅诊所的伤口护理指南。
您的锻炼¶
这些是您讲义中的锻炼项目。仅在 Hirpara 医生和您的手部治疗师的指导下开始锻炼，并严格遵循您被允许的关节活动范围和限制。早期锻炼需在佩戴 Yoke 夹板的情况下进行：轻柔的指关节屈曲和手指屈曲，使修复的肌腱在安全、可控的范围内滑动，避免对其造成牵拉。腕指联动运动以及握力/捏力强化训练属于后期阶段，在您获得明确许可前不得开始。如果手指或手背出现尖锐疼痛，请立即停止任何相关动作。
您的临床方案¶
本页面其余部分为使用相对运动伸展位（RME）进行伸肌腱修复（IV至VII区）后的分阶段康复临床方案。本节内容需提供给您的手部治疗师，每个阶段均以通俗易懂的语言解释当前的治疗原理。修复部位通过夹板（yoke splint）进行保护，使修复指节的掌指关节（MCP）比相邻指节多伸展15至20度，从而通过四头肌效应（quadriga effect）和腱联合（juncturae tendineae）卸载主动伸肌活动，因此早期主动活动是安全的。
治疗前，请查阅患者的手术记录和既往病史，并与主刀医生沟通修复的分区、受累肌腱、修复强度以及是否需要附加腕部支具。Hirpara医生对V区和VI区的默认方案为仅使用夹板（相对运动伸展位夹板，修复的MCP关节比相邻指节多伸展15–20°）。对于VII区、修复强度较弱或不依从的患者，会增加腕部支具（约20–25°伸展，持续前3周）。本方案仅适用于背侧伸肌腱修复（IV–VII区），不适用于锤状指（I–II区）或中央束/纽扣畸形（III区）。
第一阶段 — 夹板（±腕部夹板），立即主动活动（第0至3周）¶
最初三周通过夹板保护修复部位，同时患者立即开始主动使用手部。相对15–20°的背伸偏移可减轻修复部位负荷，因此从一开始即鼓励受控的主动滑动。允许在夹板内进行轻度功能性使用；禁止提重物或抗阻握力。
致手部治疗师：
教育与注意事项 - 佩戴夹板/相对运动背伸夹板：修复指掌指关节（MCP）保持比相邻手指多15–20°背伸；全天佩戴 - 仅在最初约3周内为VII区修复/较弱的修复/依从性差的患者增加腕部支具（约20–25°背伸）（V–VI区默认仅使用夹板） - 鼓励在夹板内轻度使用手部；禁止提重物、强制握持或抗阻训练 - 避免强制性的复合握拳；保持活动范围受控
管理 - 伤口：按医嘱进行外科敷料处理；监测感染迹象 - 水肿：抬高患肢，轻柔的指泵运动，必要时冰敷 - 练习（在夹板内，每约2小时一次）：主动内在肌正位（掌指关节屈曲，指间关节伸直）和内在肌反位/钩状（掌指关节伸直，指间关节屈曲）；每日进行被动指间关节背伸以防止指间关节僵硬 - 伤口愈合后开始瘢痕管理
进展标准 - 伤口稳定；无伸肌滞后出现；约3周时在夹板内舒适地进行受控的主动活动
第二阶段——拆除腕部夹板，继续佩戴指套，进行联动运动（第3至6周）¶
约在术后3周时，停用任何辅助腕部夹板（指套需全天佩戴）。开始进行腕指联动（腱固定）运动和复合主动屈伸运动，以受控且对修复安全的方式增加肌腱滑动。
供手部治疗师参考：
评估 - 主动和被动关节活动度（MCP和IP）、伸肌滞后、疼痛和肿胀；伤口/瘢痕复查
教育和注意事项 - 停用辅助腕部夹板（如曾使用）；全天继续佩戴指套 - 逐步增加运动；仍禁止抗阻握力或力量训练
管理 - 练习：增加腕指联动运动（腱固定）和复合主动屈伸运动；继续内在肌加位/减位滑动及被动IP伸展；在指套保护下进行轻度功能使用 - 瘢痕愈合后继续瘢痕按摩
进阶标准 - 复合主动关节活动度在约6至8周内逐步改善；无伸肌滞后；疼痛缓解
第三阶段——逐步停用夹板、加强训练、恢复活动（第6至12周）¶
从第5至6周左右开始，逐步停用夹板。一旦修复牢固，从第8周左右开始进行渐进性握力和捏力强化训练，并逐渐增加强度，直至第10至12周恢复完全活动。
供手部治疗师参考：
评估 - 主动和被动关节活动度（ROM）、伸肌滞后、握力/捏力（与健侧对比）；根据需要进行功能性和工作特异性测试
教育和注意事项 - 从第5周左右开始逐步停用夹板，在第6周左右根据关节活动度和控制能力完全停用 - 从第8周开始引入渐进性握力/捏力强化训练（不得提前） - 第10至12周逐渐增加阻力，直至恢复完全活动
管理 - 练习：从第8周开始进行分级握力和捏力强化训练（球类/黏土挤压、捏力）；渐进性抗阻训练；继续进行任何残留的活动度训练和指间关节（IP）伸展训练 - 当关节活动度和力量接近对称，且功能恢复达到要求时，可考虑出院 - 若伸肌滞后持续存在、关节活动度停滞或预后不良，可考虑转诊回主治医生
恢复完全活动的标准 - 无痛且无显著伸肌滞后的完全关节活动度；握力/捏力接近对称；约第10至12周
重返工作与活动¶
在佩戴夹板期间，鼓励尽早开始进行轻柔的日常手部活动（如进食、书写、穿衣、轻度自我护理），前提是感到舒适，且不涉及提举、强力抓握或抗阻工作。强化训练大约从术后八周开始，当修复牢固且活动度与力量恢复后，通常在十至十二周时可完全恢复无限制的活动。是否恢复由Hirpara医生及您的手部治疗师根据功能评估决定，而非仅依据术后时间。
驾驶： 在佩戴夹板期间进行手部轻度活动是可以的，因此驾驶并未被完全禁止，但您必须能够握住方向盘并安全控制车辆，包括在紧急情况下。对大多数人而言，这意味着在夹板逐渐停用期间（约六周时）即可恢复驾驶；如果您能舒适地控制车辆，且您的外科医生确认对您而言是安全的，则可能更早恢复。
您的康复方案之后¶
本方案与诊所的一般术后恢复建议并行：请参阅术后疼痛管理、伤口护理和瘢痕管理。上述分阶段计划反映了基于相对运动伸指法进行伸肌腱修复后的已发表康复指南，您的持续康复过程将由Hirpara医生和您的手部治疗师根据您手部的恢复进展进行个体化指导。
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¶
- 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.
- 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.
- 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.
- 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.
- 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/