Extensor Tendon Repair at the MCP Joint: Postoperative Protocol
For extensor tendon repairs at the MCP joint (zones V-VI), immobilize the wrist in extension and the MCP joint in 30° flexion for 4 weeks, while allowing immediate active motion of the PIP and DIP joints to prevent stiffness. 1, 2
Immobilization Specifications
Position and Duration
- Wrist: Hold in extension 1
- MCP joint: Position in 30° flexion 2
- PIP and DIP joints: Keep free and mobile from day one 2
- Total immobilization period: 4 weeks 2
The 30° flexion position at the MCP joint optimally balances tension on the repair while preventing excessive stress on the healing tendon. 2
Early Mobilization Protocol
Immediate Phase (Day 1 onwards)
- Begin active PIP and DIP joint motion immediately while maintaining MCP immobilization 1, 2
- This prevents joint stiffness and maintains tendon gliding in the distal zones without compromising the repair 1
Week 4-5 Transition
- Remove immobilization at 4 weeks 2
- Progress to full fist closure by week 5 2
- Systematic reviews suggest that dynamic rehabilitation may not provide superior long-term benefit compared with static splinting, making this straightforward protocol appropriate 1
Critical Technical Considerations
Repair Technique at MCP Level
For zones V-VI (over the MCP joint and metacarpal), the tendon is thick enough to hold core sutures:
- Use 1-2 core sutures plus a supplementary running suture 1
- The running interlocking horizontal mattress technique has been found to be stiffer and faster to accomplish with good to excellent clinical results 1
- Handle the tendon delicately through the cut end rather than grasping the tendon substance itself 1
Zone VII Caveat
If the injury extends to zone VII (beneath the extensor retinaculum), consider windowing the extensor retinaculum to decrease adhesion formation and facilitate repair. 1
Expected Outcomes and Pitfalls
Success Rates
- Good to excellent function achieved in up to 64% of acute extensor tendon repairs when performed in a timely manner 1
- More fingers lose the ability to flex fully than lose the ability to extend, emphasizing the importance of early PIP/DIP mobilization 1
Common Pitfall to Avoid
Uninterrupted immobilization is critical—even brief removal of the splint during the 4-week period can compromise healing. 3 The MCP joint must remain protected in the prescribed position throughout the entire immobilization period, while the distal joints continue active motion.
When to Reassess
Patients should be instructed to return immediately if unremitting pain develops during the immobilization period, as this may indicate complications. 3