A Review of Three Flexor Tendon Repair Protocols

Document Type

Peer-Reviewed Article

Publication Date



Rehabilitation of flexor tendon lacerations after a repair has challenged surgeons and occupational therapists for decades from a healing and functional outcome perspective. Over the past 3 to 4 decades, researchers have investigated tendon biomechanics, surgical and suture techniques, tendon and wound healing, and early motion in an effort to treat flexor tendon repairs more effectively (Strickland, 2005). Evidence suggests that early mobilization, be it passive or active, is the most common rehabilitation tendon protocol utilized by occupational therapists and surgeons today (Groth, 2005; Pettengill, 2005; Pettengill & Van Strien, 2011). However, Groth (2005) suggested that most occupational therapists do not follow the exact protocols as outlined in the literature but modify them according to the surgeon’s orders and their specific client needs.

This article provides an outline of the three most common evidence-supported Zone II flexor tendon protocols used in occupational therapy practice. Depending on the zone of injury your treatment protocol will vary. A brief review of flexor tendon anatomy, and tendon repair and healing, is provided to assist in understanding these protocols. For the purpose of this article, only the extrinsic flexors are discussed, and the description of the surgical repair and healing are superficial at best. Please explore other resources for an in-depth understanding of flexor tendon anatomy and repair,


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