Extensor tendon repair, Zone IV to VI – Modified Norwich Regime

Extensor Tendon Repair, Zone IV to VI - Modified Norwich Regime Advice and Exercises 

Patient information 

Therapy Department

Injury to your extensor tendon

You have injured the tendon(s) on the back of your hand between your knuckle(s) and your wrist.  These tendons work to straighten your fingers. 

Surgical Repair

The injured tendon(s) have been repaired in surgery. The two ends of the tendon(s) have been stitched back together, allowing you to start moving your fingers under the guidance of hand therapy. However, the tendon will not be fully strong until 12 weeks after surgery. 

Your hand and wrist will be in a backslab after your operation.  This will be removed at your first appointment with the hand therapist, usually within a week of your operation.

Treatment

Splintage

Once your tendon has been repaired, it is important to protect it while it heals.  Your therapist will fit you with a custom-made splint. 

Your splint needs to be worn at all times for the first 4 weeks following your operation. The splint stops the knuckles and wrist bending fully, protecting the repaired tendon(s) from being overstretched. 

Please note – You are at risk of re-injuring your tendon if you remove the splint before you are advised to.

Exercise

It is important to do the exercises (wearing your splint), as advised by the hand therapist.  This helps to prevent stiffness in your fingers, reduces swelling, aids healing and improves the movement and functioning of your hand. 

Exercises / Advice

Weeks 0 – 4

Remove strap over fingers and hand.

Complete 5 repetitions of each of the exercises below, 5 times per day.  When you are not doing your exercises, rest your hand in your splint.

• Using your other hand, help straighten each finger away from the splint

• Actively straighten all fingers together away from the splint

• Use your other hand to help bend your wrist backwards, and then with your wrist in this position, actively bend the middle and end joints of your fingers into a hook position

Important information

• You must wear your splint at all times
• Keep your splint clean and dry.  When having a bath / shower, cover your splint to keep it dry
• Regularly elevate your operated hand higher than your heart to reduce swelling
• Regularly bend and straighten your elbow to stop it becoming stiff
• When shown by your hand therapist, massage your scar for about 5 minutes with unscented cream. Do this about 3 times per day.  This stops the tendon getting stuck to the scar tissue

Contact the Hand Unit if: -

• You suddenly cannot straighten your finger(s)
• You are having problems with your splint(s)

Attend the Emergency Department if: -

You have any signs of a wound infection e.g.

• Increased redness / swelling / pain
• Discharge with a bad odour 
• Discolouration
• Fever or generally feeling unwell

Exercises / Advice

Weeks 4-6 

 Complete the above exercises little and often throughout the day.

Important information

• You can now remove your splint during the day to complete light activities
• Use your hand for light use only, such as eating, dressing, using phone and typing 
• Wear your splint at night-time when in bed
• Do not force your fingers and / or wrist into a bent position
• Do not push your fingers and / or wrist back against resistance

Contact the Hand Unit if: -

• You suddenly cannot straighten your finger(s)

Week 6

You can now stop wearing your splint at night-time.

You can drive if the range of movement and strength in your hand is sufficient to control the car in an emergency situation.

Weeks 8-10

You may gradually return to normal activity. You should wear your splint for heavy activity.

Week 10-12

You may return to heavy manual activities and contact sports.

If you have any problems, please contact your hand therapist.

Wigan Infirmary Hand Therapy Department

Fracture Clinic

01942 822103

Wrightington Therapy Department 

01257 488272 

wwl-tr.therapyadmin@nhs.net 

08:00-16:30 Monday to Friday 

Leigh Health Centre Therapy Department 

0300 707 1597 

wwl-tr.leighphysio@nhs.net 

08:00-16:30 Monday to Friday 

Boston House Therapy Department 

0300 707 1113 

wwl-tr.mskphysio-bostonhouse@nhs.net 

08:00-16:30 Monday to Friday 

References

https://fifevirtualhandclinic.co.uk   

Acknowledgments

Thank you to NHS Scotland for allowing free access / use of their images.