AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
Once the fracture is reduced (set) the hand will be casted for 3-4 weeks.
3-4 Weeks (Once Clinically Healed)
Focus: edema control (compression gloves, sleeves)
AROM - Right now just focus on gentle movement. Focus on making a fist, bending at all joints of the finger.
PROM initiated for the PIP and DIP joints.
Distal head, neck, and shaft fractures need additional splinting with MCP's at 70 degrees of flexion and wrist at 15 degrees of extension. IP's are typically free from immobilization.
5-6 Weeks
If determined to be clinically healed, begin PROM for all joints of the effected digits including the MCP.
6-8 Weeks
Discontinue orthotic wear.
7-8 Weeks
If approved by Dr. Begin gentle progressive strengthening.
Terminology
AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
Once the fracture is reduced (set) the hand will be casted for 3-4 weeks.
2-3 Weeks (Once Clinically Healed)
Focus: edema control (compression gloves, sleeves)
AROM - Right now just focus on gentle movement. Focus on making a fist, bending at all joints of the finger. Also include extension as well.
PROM initiated for the PIP and DIP joints.
Distal head, neck, and shaft fractures need additional splinting with MCP's at 65 - 70 degrees of flexion and wrist at 15 degrees of extension. IP's are typically free from immobilization.
3-4 Weeks
Pins removed if healed sufficiently
5-6 Weeks
If determined to be clinically healed, begin PROM for all joints of the effected digits including the MCP.
6-8 Weeks
Discontinue orthotic wear.
7-8 Weeks
If approved by Dr. Begin gentle progressive strengthening.
Terminology
AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
2-3 days post op
Every 2 hours for 10 minute sessions:
focus on composite flexion and full extension of the digits.
Isolate AROM flexion of the MCP joint with PIP/DIP's extended (table top movement)
Splint should be worn between exercise sessions and at night.
2 Weeks post op
Sutures are usually removed.
Focus on finger extension AROM along with composite flexion.
Continue with the same exercises
Implement gentle scar tissue massage after sutures are removed.
Keep wearing orthotic between exercises and at night.
4-6 Weeks
Reduce wear time of orthotic to 1-2 hours a day.
Begin using hand in light activities.
Begin gentle progressive strengthening of hand with putty or hand exerciser.
Normally nothing over 5 lbs. (Check with your doctor)
6-8 Weeks
Discontinue orthotic wear.
Use hand in all activities, but AVOID heavy lifting until approved by your doctor.
Proximal Phalanx Protocols
Proximal Phalanx Fracture Protocol
Closed Reduction (no surgery)
Percutaneous Pins / K-Wire
ORIF
Terminology
AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
3-4 Weeks post reduction
AROM exercise for ALL digits 6-8 times a day for 10 minute sessions.
Focus on making a composite fist.
Blocking exercises to be performed as well for the PIP and DIP joints.
Hand based safe position splint is worn between exercises and at night.
5-6 Weeks
If the doctor determines that the fracture is clinically healed, PROM for all digits can begin.
Dynamic splinting is recommended 4-5 times a day for 45 minute sessions.
Talk to your doctor about this first
7-8 Weeks
If doctor determines that the fracture is clinically healed, begin gentle progressive strengthening with putty and hand exercisers.
10 weeks
Resume normal use of hand.
Considerations
Stay in contact with your doctor during this timeframe! If something seems unusual, don't hesitate to reach out!
Terminology
AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
3-4 Weeks post reduction
AROM exercise for ALL digits 6-8 times a day for 10 minute sessions.
Focus on making a composite fist.
Perform PROM for MCP flexion while actively extending the PIP joint.
Blocking exercises for PIP/DIP as well.
Hand based safe position splint is worn between exercises and at night.
5-6 Weeks
If the doctor determines that the fracture is clinically healed, Begin AAROM exercises.
6-7 Weeks
Begin PROM for all involved joints MCP/PIP/DIP 1 week after AAROM exercises begin.
Week 3-4 you're only doing PROM for the MCP! Now you get to involve all joints.
At this point, for distal head and neck fractures, the hand based splint can be reduced to a gutter splint.
Begin reducing splint wear throughout the day and continue to focus on AROM.
8 Weeks
Begin gentle progressive strengthening with putty or hand exerciser.
Splint wear should be discontinued around 10-12 weeks.
Considerations
Stay in contact with your doctor during this timeframe! If something seems unusual, don't hesitate to reach out!
Terminology
AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
1-3 Days Post Op
Once edema and swelling subside, begin AROM/PROM exercises.
Depending on the severity of the fracture, the doctor might not permit PROM at this time, so check with the doctor first!
Active and Passive Composite flexion and extension
Depending on the severity of the fracture, the doctor might not permit PROM at this time, so check with the doctor first!
Blocking of PIP and DIP joints.
Passively flex MCP and actively extend PIP joint.
Cycle through these movements for 10 minute sessions 8 times a day.
Hand based safe position splint is fabricated and worn between exercises and at night.
10-14 Days Post Op
Sutures removed
Focus on flexion AND extension AROM (and PROM if approved by your doctor)
Continue orthotic wear
If there is a flexion or extension lag present in the PIP, ask your doctor about dynamic flexion and extension orthotics.
4-6 Weeks Post Op
Begin gentle progressive strengthening with putty and hand exercisers.
Begin reducing time in orthotics throughout the day.
For head and neck fractures, the hand based splint can be reduced to a gutter splint
7-8 Weeks Post Op
Continue reducing wear time of the orthotics. Reduce to night time wear only.
8-10 Weeks Post op
Resume full use of hand
Considerations
Keep in communication with your doctor throughout this entire process! Before you progress, check with them first to make sure it's ok!
Middle Phalanx Protocols
Middle Phalanx Fracture Protocol
Closed Reduction (no surgery)
Percutaneous Pins/ K-Wire
ORIF
Terminology
AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
3-4 Weeks Post Reduction (set)
AROM exercises are to be performed 6-8 times a day for 10 minute sessions.
Composite fist
Safe position orthotic is to be worn between exercises and at night.
5-6 Weeks
AAROM and PROM are initiated to all joints once Dr. decides that fractures are appropriately healed.
Focus on digit extension as well.
Gradually decrease wear of the orthotic.
7-8 Weeks
Once determined to be clinically healed, begin gentle progressive strengthening.
Putty and hand exercisors
Wear splint only at night time
Terminology
AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
3-4 Weeks Post Op
AROM initiated to all digits 6-8 times a day for 10 minute sessions
Composite fist and extension
Safe position splint to be worn between exercises and at night.
5-6 Weeks
Base, Head/Neck fractures - Pins removed if Dr. determines that it's clinically healed.
If removed, begin AAROM exercises in addition to other exercises.
If a mid-shaft fracture, stick with the AROM for a little longer until pins are removed.
6-7 Weeks
Begin PROM exercises for all joints of the finger.
Continue safe position splint wear at night.
7-8 Weeks
Once doctor decides that the fracture is clinically healed, begin gentle progressive strengthening.
Putty and hand gripping exercises.
Slowly decrease amount of time spent in the splint. Should be working out of it by week 8-10.
Terminology
AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
48-72 Hours Post-Op
Dressings removed, lighter dressings applied.
Fitted with a safe position hand based orthotic to be worn between exercise sessions and at night.
AROM/PROM exercises begin for all digits of the effected hand.
6-8 times a day for 10 minute sessions.
Focus on making a composite fist and full extension of the fingers.
It's important to keep the fingers moving so that the extensor tendon does not become adhered to the scar tissue. If this happens, the tendon will not glide properly, and the surgeon will have to go back in to release it. This is why focusing on extension as well as flexion is so important.
10-14 Days
Sutures removed
Keep fingers moving! No lifting yet though!
It's important to keep the fingers moving so that the extensor tendon does not become adhered to the scar tissue. If this happens, the tendon will not glide properly, and the surgeon will have to go back in to release it. This is why focusing on extension as well as flexion is so important.
4-6 Weeks
Begin gentle progressive strengthening with putty or hand exercisors.
Splint reduced to a gutter splint involving just the digits.
wear between exercises and at night
6-8 Weeks
Continue with strengthening, wear a dynamic extension splint if there is still limited extension in the effected digit.
Discontinue day wear of splint by 8 weeks.
Considerations
Keep in contact with your doctor throughout the healing process. Tell them everything you're feeling that seems out of the ordinary.
Discontinue night wear by 10 weeks.
Distal Phalanx Protocols
Distal Phalanx Fracture Protocol
Distal Phalanx Fx
Bony Mallet
Terminology
AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
With distal phalanx fractures, check with your doctor to make sure there is no tendon avulsion, if so then the doctor will want you to follow a different protocol to avoid tendon rupture.
<Week 1
Fit digit with a tip protector immobilizing the DIP.
Begin AROM/PROM for all unaffected digits and joints (MCP/PIP)
10-14 Days Post Op
Begin gentle AROM of the entire digit 6 times a day for 10 minute sessions.
3 Weeks Post Op
If there was a pin placed, then the pin is removed.
Perform gentle AROM 1-2 weeks before initiating gentle PROM to avoid tendon rupture.
Continue with tip protector wear.
4-6 Weeks
If determined by doctor to be clinically healed:
Discontinue tip protector and resume normal use of the hand.
Considerations
Stay in communication with your doctor throughout this process.
Hypersensitivity is common, and should subside after 2-3 months.
Keep focus on balancing flexion and extension exercises.
Terminology
AROM- Active Range of Motion, where the digit moves under it's own power with no assistance from the other hand.
PROM - Passive Range of Motion, where the digit moves with ONLY the assistance of the other hand. The appendage being stretched does none of the work, the work comes from the opposite hand.
AAROM - Active Assist Range of Motion is when the opposite hand does half of the work helping the effected digit into the desired amount of flexion or extension.
Composite flexion - Making a fist
3-5 Days Post Op
For a closed reduction repair - mallet splint is fabricated with DIP in slight hyperextension.
For ORIF, a tip protector is provided.
Both orthotics should be worn at all times except for bathing.
AROM/PROM exercises initiated daily for the MCP and PIP joints.
If there is a pin in the finger, clean it daily with hydrogen peroxide mixed with saline.
6 Weeks Post Op
Splint and pin is removed.
AROM begin 6 times a day for 10 minute sessions.
focus on composite flexion
Wear mallet splints between exercises and at night.
7 Weeks Post Op
Gentle PROM are initiated to the DIP joint (ONLY if there is an extensor lag under 10 degrees)
Consult with doctor before beginning this step.
Continue with splint wear.
Keep an eye on the DIP to make sure an extension lag doesn't occur. (5-10 degrees is normal)
8 Weeks Post Op
Reduce orthotic wear 1 hour each day. Wear orthotic at night only after 10-14 days.
10-12 Weeks Post Op
Discontinue mallet splint.
Considerations
Stay in contact with your doctor throughout the process.
