Advanced Wrist and Hand Tendon Repair Rehabilitation

Program Overview This is a 24-week, four-days-a-week, 30-minute-per-session advanced rehabilitation guide for people recovering from wrist and hand tendon repair, particularly when carpal tunnel, distal radius, and ulna areas are involved. It combines splinting, guided exercise, manual therapy, ultrasound and electrical stimulation, and functional grip training using therapy putty and a barbell. Sessions are short but consistent, and the plan moves through four phases that gradually increase what your wrist and hand can do.

Who This Program Is For and Its Goal This program is for people who have had wrist or hand tendon repair surgery and have been cleared by their surgeon and therapist to begin structured, advanced rehabilitation. The goal is to protect the repair early, then steadily restore wrist and finger movement, strength, sensation, and everyday hand function. It is designed to be done under clinician supervision, with progress matched to your own healing rather than a fixed calendar date.

Before You Start Before beginning, confirm with your surgeon and physical therapist that your repair is stable enough for this level of work and that your splint plan is current. Your therapist should check your splint fit, your incision, swelling, sensation, and circulation. Have your therapy putty and barbell ready, pick a clear space, and plan your four weekly sessions so you can stay consistent.

Safety Notes and When to Stop Do not start or continue if you have active inflammation, severe pain, a recent fracture, or a known risk of deep vein thrombosis; your clinician must clear these first. Stop and call your clinician right away if you notice sudden loss of movement, a pop or snap, new numbness or tingling, spreading redness or warmth, calf swelling or pain, or pain that keeps getting worse despite rest. Always warm up before and cool down after sessions.

Weekly Structure Plan on four sessions each week, about 30 minutes each, for 24 weeks. Each session includes a warm-up, the main work for your current phase, and a cool-down. Keep the same days each week where possible, and leave rest days between sessions so your tissues can recover.

How the 24-Week Plan Is Organized The plan has four phases. Phase 1 (around week 1) focuses on protection, splinting, swelling control, and gentle passive finger movement. Phase 2 (around week 4) adds active finger and limited wrist motion, scar work, and light grip. Phase 3 (around week 8) adds progressive wrist motion, low-resistance strengthening, and nerve glides. Phase 4 (around week 12 and beyond) builds strength, dexterity, and full hand use, with testing along the way. You move forward based on meeting criteria, not just time.

What a Typical Session Looks Like A typical session starts with a gentle warm-up, moves into the main exercises for your phase, and ends with a calm cool-down. Your therapist may add manual therapy or ultrasound and electrical stimulation during the main portion. Therapy putty and the barbell are used for grip, finger, and resistance work as your phase allows.

Warm-Up, Main Work, and Cool-Down Warm up with gentle, pain-free finger and wrist movements and light putty squeezes to prepare the tissues. The main work follows your phase: splinting checks, tendon and nerve glides, scar and manual therapy, ultrasound or electrical stimulation, then putty and barbell strengthening and grip or dexterity tasks as cleared. Cool down with slow, easy motion and rest, and report any swelling or pain that lingers.

Tracking Progress Your clinician will track grip strength with a Jamar dynamometer, pinch grip (key and tip), wrist range of motion by goniometry, and hand function with the Nine-Hole Peg Test. You will also complete the Boston Carpal Tunnel Questionnaire and the DASH score to capture symptoms and daily function. Keep a simple log of sessions, pain, and swelling to share at visits.

How Progression Criteria and Outcome Measures Work You move between phases when you meet the listed criteria, such as adequate grip or pinch strength compared with your other side, restored motion, normal sensation, and no signs of tendon rupture or nerve compression. Outcome measures give your clinician objective checkpoints alongside your daily reports. If a criterion is not met, you stay in your current phase and keep working safely rather than pushing ahead.

Recovery and Self-Care Recovery depends on balancing activity with rest. Follow your splint schedule, keep the incision clean and protected as advised, and elevate the hand to manage swelling. Do your home exercises as prescribed, avoid heavy or repetitive gripping beyond your phase, and keep follow-up appointments. Good sleep, hydration, and pacing support healing.

Pain Management Cautions and Red Flags Some mild soreness during exercise is common, but sharp or rising pain is a signal to ease off and check in with your clinician. Do not use this guide to manage medications; ask your clinician or pharmacist about pain relief. Seek urgent care for sudden loss of movement, a snap, new or worsening numbness, spreading redness, fever, or calf swelling or pain.