Modified Duran’s Protocol is the post-operative rehabilitation protocol after the repair of flexor tendon injuries.
Dorsal Blocking Splint (DBS):
Wrist– 20-degrees flexion
MPs– 70-degrees flexion
PIPs/ DIPs– full extension
Modified Duran’s protocol steps in subsequent postoperative days
3rd Post-Operative Day
- Bulky dressing
- PROM exercises are initiated within the restrain of DBS each [2 hr/day]
- 25 repetitions of passive flexions and extensions of PIP, DIP, and entire digits
10th-14th Post-Operative day
- Within 48 hr following suture removal scar massage with lotion can be initiated
- PROM continued
31/2 weeks Post-Operative
- PROM is continued
- Active flexion and extension exercises may be initiated with the splint
4th-weeks Post-Operative
- Neuromuscular electrical stimulation may be added to therapy after the patient is performing active flexion exercises for 3-5 days
- USG may be added if the dense scar is present and/or limited tendon excursion is concerned
41/2 weeks Post-Operative
- DBS is removed each hour/ two to begin
- AROM exercises outside splint
- Wrist and fingers flexion followed by their extension
- Composite fist followed by MP extension with IP flexed followed by IP extension
- Composite fist with wrist extension and flexion
- DBS continued during exercises session and at night
51/2 weeks Post-Operative
- DBS discontinued
- AROM continues
- Extension splint may be initiated in full active extension
- Preferably worn at night only
- In day buddy strapping with adjacent fingers
6-weeks Post-Operative
- Passive extension exercises are initiated
- A dynamic extension splint may be initiated if a PIP joint flexor contracture develops
8-weeks Post-Operative
- Strengthening may be initiated to the hand beginning with a hand exerciser
10-12 weeks Post-Operative
- All activities
14-16 weeks Post-Operative
- Weight resistance to hand and extremity is permitted