Vanderbilt University Rehabilitation Approach to Zone 2 Tendon Repairs in the Hand

Zone 2 of the hand, which stretches from the region between the A1 pulley at the distal palmar crease to the insertion of the FDS tendon at the end of the A4 pulley, is notable for its high complication rate following surgery. Many of these complications, such as adhesions, contractures, and tendon rupture, can be avoided through adequate rehabilitation. We document the rehabilitation protocol at Vanderbilt University Medical center, which is characterized by 4 phases. An initial postoperative phase emphasizes shielding the flexor tendons with little motion, a second phase focuses on an orthosis to keep the metacarpophalangeal joints flexed at 45 degrees, a third phase focuses on strengthening exercises, and a fourth phase that focuses on transitioning to normal activities without restriction.