Recovery Protocol for Ulnar Sagittal Band Repair
Immediate Post-Operative Management (0-3 Weeks)
For acute sagittal band injuries recognized and treated within 3 weeks, immobilization in extension is the cornerstone of successful recovery. 1, 2
- Splint the MCP joint in full extension continuously for 3-4 weeks to allow the repaired sagittal band to heal without tension from extensor tendon deviation 1, 2
- Apply ice at 3 and 5 days post-operatively for symptomatic relief and reduction of inflammation 3, 4
- Begin active finger motion exercises of the interphalangeal joints immediately while maintaining MCP extension to prevent stiffness in adjacent joints 4
- Cryotherapy during the first week can reduce pain and inflammation at the surgical site 5
Early Mobilization Phase (3-6 Weeks)
Transition to protected motion after 3-4 weeks of strict immobilization, as the sagittal band requires adequate healing time before stress application. 1, 2
- Remove the extension splint and begin gentle active MCP flexion exercises with the hand in a protected position 1
- Progress to active-assisted range of motion exercises focusing on controlled MCP flexion without forcing end-range motion 5
- Avoid forceful gripping or resistance exercises during this phase as the repair remains vulnerable to re-injury 2
- Use a removable extension splint between exercise sessions and at night for continued protection 2
Strengthening Phase (6-12 Weeks)
Initiate progressive strengthening only after demonstrating pain-free active range of motion and absence of extensor tendon subluxation. 1, 6
- Begin closed kinetic chain exercises (weight-bearing through the hand) before progressing to open chain activities 5
- Implement low-resistance strengthening with higher repetitions (8-10 repetitions at 60-70% maximum effort) 2-3 times per week 5
- Progress grip strengthening gradually, monitoring for any signs of tendon subluxation or pain with ulnar deviation stress 2, 6
- Neuromuscular training combined with progressive strengthening improves functional outcomes 5
Return to Activity Phase (12+ Weeks)
Use objective functional criteria rather than time-based protocols to determine readiness for unrestricted activity. 3, 5
Functional Discharge Criteria:
- No pain or swelling with resisted MCP extension 3
- Full MCP range of motion without extensor tendon subluxation on dynamic examination 7, 8
- Grip strength symmetry >90% compared to contralateral hand 3
- Ability to perform sport-specific or work-specific activities without pain or tendon instability 1, 6
Critical Pitfalls to Avoid
The most common cause of surgical failure is inadequate immobilization duration or premature return to forceful gripping activities. 1, 2
- Never advance range of motion if pain, swelling, or tendon subluxation occurs during rehabilitation 5
- Do not rely solely on time-based progression; chronic injuries with fibrosis may appear stable but require full healing time 7
- Avoid activities involving forceful ulnar deviation of the fingers during the first 12 weeks, as this stresses the repair maximally 2, 6
- Monitor for extensor tendon subluxation at each visit using dynamic examination with MCP flexion, as this indicates repair failure 1, 8
Special Considerations
For chronic sagittal band tears requiring reconstruction (rather than direct repair), the rehabilitation timeline may extend by 2-4 weeks due to the need for graft incorporation 6. In cases where ulnar sagittal band tears occur without extensor instability, the same immobilization protocol applies as chronic injury with fibrosis can provide false stability 7.
Electroestimulation of the extensor mechanism during weeks 4-8 can facilitate voluntary muscle reactivation if extension lag develops 5. However, this should only be implemented after the initial 3-4 week immobilization period to avoid disrupting the repair 1.