Flexor Tendon Repair: A Comparison of Two Protocols

Flexor tendons are the structures that enable us to flex our fingers and thumbs can be damaged by various mechanisms, such as lacerations, avulsions, ruptures or separations. Flexor tendon injuries impair the function and mobility of the hand and require surgical intervention to restore movement and prevent complications.

However, surgery alone is not enough to ensure a successful recovery. Flexor tendon injuries also need proper rehabilitation to prevent scarring and adhesions that can limit tendon gliding and range of motion. There are different protocols for rehabilitating flexor tendon repair, each with its own advantages and disadvantages. In this blog post, we will compare two of the most common protocols: the Duran protocol and the Early Active Motion protocol.

The Duran protocol is a conservative approach that focuses on protecting the surgical repair site while gradually introducing movement to the affected area. This protocol involves immobilizing the injured hand in a splint for a period of time, followed by gentle passive exercises and eventually active exercises to promote range of motion.

The advantages of the Duran protocol are that it reduces the risk of rupture or gapping of the repaired tendon, and it allows time for intrinsic healing of the tendon by tenocytes (cells within the tendon). The disadvantages are that it may result in stiffness and reduced mobility of the joints, and it may prolong the recovery time.

The Early Active Motion protocol is a more aggressive approach that emphasizes early mobilization of the affected hand after surgery. This protocol involves immediate movement of the repaired tendon, with patients being instructed to perform a series of exercises on their own as soon as possible after surgery.

The advantages of the Early Active Motion protocol are that it enhances extrinsic healing of the tendon by stimulating blood flow and synovial fluid production, and it prevents adhesions and contractures that can impair tendon gliding and range of motion. The disadvantages are that it may increase the risk of rupture or gapping of the repaired tendon, and it may require more patient compliance and motivation.

Both of these protocols are important in the rehabilitation of flexor tendon repair, as they help patients regain strength and range of motion in their injured hand. By following these protocols, patients can improve their chances of a successful recovery and return to their daily activities with minimal complications.

However, there is no one-size-fits-all protocol for flexor tendon rehabilitation. The choice of protocol depends on several factors, such as the type and location of injury, the quality of repair, the patient's age and health status, and the surgeon's preference. Therefore, it is essential to consult with your surgeon and certified hand therapist before starting any rehabilitation program.

If you want to learn more about flexor tendon repair and rehabilitation, you can watch this video by Joanna Spivack, an Occupational Therapist and Certified Hand Therapist, who demonstrates two previously mentioned protocols for rehabilitating flexor tendon repair.

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