Immediate Post-Surgery Phase (Days 0-3)
Your hand emerges from surgery in a bulky dressing with a plaster splint holding specific joint positions. Flexor tendon repairs position the wrist at 20-30 degrees flexion with fingers slightly bent, while extensor repairs maintain the wrist at 30-45 degrees extension with fingers straight. The surgical nerve block wears off within 12-24 hours, and patients transition to oral pain medications.
Swelling peaks at 48-72 hours post-surgery. Elevating the hand above heart level reduces fluid accumulation, while gentle movement of non-immobilised joints prevents stiffness. The surgical dressing remains dry and intact until your first follow-up appointment, typically scheduled 3-5 days after the operation.
Signs requiring immediate medical attention include:
- Fever above 38.5°C
- Increasing pain despite medication
- Numbness or tingling in fingertips
- Colour changes in fingers
- Foul odour from the dressing
Early Protection Phase (Days 4-21)
The bulky dressing gets replaced with a thermoplastic splint at your first follow-up. This splint maintains protective positioning while allowing supervised movement exercises. Zone II flexor repairs (the area between the palm creases and middle finger joints) begin controlled passive motion within the splint, while other zones may start earlier or later based on repair strength.
Hand therapy starts during this phase with specific protocols:
Duran Protocol for flexor tendons involves passive finger bending 10 times every hour while awake. The therapist moves each finger joint through its range while you keep the muscles completely relaxed.
Early Active Motion Protocol allows gentle muscle activation for select repairs with surgical techniques. You’ll perform “place and hold” exercises in which the therapist positions your finger, and you maintain that position with minimal force.
Relative Motion Splinting for extensor tendons uses a splint design that allows adjacent fingers to guide the repaired tendon through safe ranges of motion.
Your therapist measures progress using goniometry (joint angle measurement) and documents any lag between active and passive motion. Scar massage begins once the incisions have completely closed, typically around days 10-14.
Strengthening Phase (Weeks 8-12)
Protective splinting ends for most repairs by week 8, although night splinting may continue for extensor repairs that are prone to lengthening. Progressive resistance exercises start with therapy putty and progress through colour-coded resistance levels. Grip strength typically declines at week 8, then improves by week 12.
Specific strengthening exercises target:
- Individual finger flexion against elastic bands
- Pinch strengthening with various grasp patterns
- Intrinsic muscle strengthening for fine coordination
- Wrist stabilisation exercises
Work simulation activities prepare for a return to occupation. Office workers practice sustained typing and mouse use, while manual workers begin tool handling with graduated weights. Two-handed activities emphasise protecting the healing tendon from sudden overload.
⚠️ Important Note
Forcing movement or strengthening too aggressively can cause tendon rupture even at 12 weeks. The repair site remains weaker than a normal tendon for 6-12 months despite functional recovery.
Return to Full Activity (Week 12 and Beyond)
Most patients achieve functional range of motion by 12 weeks, though maximum improvement continues for 6-12 months. Flexor tendon repairs typically recover most total active motion compared to the uninjured side, while extensor repairs often achieve good extension recovery.
Sport-specific training begins after week 12 for athletes:
- Racquet sports require graduated ball impact progression
- Weight training starts at reduced capacity
- Contact sports need additional protective taping for 6 months
- Musical instruments require modified practice schedules
Outcomes depend on multiple factors:
- Injury zone: Zone II flexor and Zone I extensor injuries have more complications
- Associated injuries: Fractures or nerve damage may slow recovery
- Therapy compliance: Missed sessions directly impact motion recovery
- Scar formation: Excessive scarring limits tendon gliding
Putting This Into Practice
- Follow your splint schedule as prescribed – wear times decrease gradually based on tendon zones and repair strength, not comfort level.
- Perform exercises hourly during waking hours – set phone alarms for consistency, as frequent gentle motion is more effective than infrequent intense sessions.
- Monitor swelling patterns – measure finger circumference weekly at the middle joint, as persistent swelling indicates excessive activity.
- Document your progress – photograph hand positions weekly and maintain an exercise diary to share with your therapist.
- Prepare your environment – arrange commonly used items at shoulder height and use built-up handles on utensils during the protection phase.
When to Seek Professional Help
- Sudden loss of motion after previous gains
- Sharp pain during previously comfortable movements
- Visible gaps or irregularities along the tendon path
- Swelling that persists beyond the morning hours
- Inability to achieve positions demonstrated by your therapist
- Clicking or catching sensations during movement
- Night pain disrupting sleep beyond week 4
Commonly Asked Questions
Can I drive during recovery?
Driving requires reliable grip strength and reaction time. Most patients resume driving between weeks 6 and 8 for automatic transmissions, although manual transmissions require 10-12 weeks. Your surgeon provides specific clearance based on the extent of involvement in your dominant hand and the stability of the repair.
When can I return to work?
Desk work typically resumes at 2-3 weeks with splint modifications. Light manual work begins around week 8, while heavy labour or repetitive hand use requires 12-16 weeks. Job-specific assessments determine exact timing.
Will my hand look normal after healing?
Surgical scars fade significantly over 12-18 months. Initial redness and thickness typically improve with scar massage and the use of silicone sheets. Slight enlargement at the repair site occasionally persists but rarely affects function.
How do I know if my tendon re-ruptured?
Re-rupture causes immediate loss of active movement in the direction of the affected tendon. Unlike stiffness from scar tissue, a ruptured tendon allows passive movement but no active pull. This requires prompt surgical evaluation.
Can I exercise other body parts during recovery?
Lower body exercise continues immediately post-surgery. Upper body workouts can be modified to avoid gripping – use machine straps around the wrists instead of holding weights. Swimming is typically allowed after week 8-10, when the incisions have fully matured.
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Hand tendon repair recovery requires strict adherence to rehabilitation protocols during three distinct phases over a 12-week period. The immediate post-surgery phase protects the repair site, the early protection phase introduces controlled movement, and the strengthening phase restores functional capacity. Success depends on striking a balance between tendon protection and progressive mobilization under the guidance of a professional.
Suppose you’re experiencing a sudden loss of finger movement. In such cases, persistent pain during hand use or visible gaps along the tendon path, a hand and upper limb specialist can provide a comprehensive evaluation and recommend surgical repair options.
