Treatment and Intervention
Match the dose to the healing stage
Treatment items test whether you can stress tissue without re-injuring it. Inflammation (roughly days 0–5): protect, elevate, gentle AROM, no heat. Proliferation (about day 5 to week 6): controlled stress, splinting, scar and edema management. Remodeling (weeks to a year): progressive loading, strengthening, work conditioning.
Splint logic
Static splints immobilize or rest; serial static splints are remolded to gain slow length; static progressive splints apply adjustable low-load, prolonged stretch; dynamic splints provide motion or assist. Three-point fixation is the principle behind fracture and contracture splinting, and the antideformity (intrinsic plus) position protects the hand when edema or inflammation is the priority.
Tendon protocols
After flexor tendon repair, early controlled motion starts within the first several days in a dorsal blocking splint (wrist ~20–30° flexion, MCP 50–70°, IP joints extended), using a program such as place-and-hold or early active motion. After extensor repair, the MCP joint is often held in relative extension/flexion to reduce tension at the repair site, depending on zone.
Modalities and the sensory system
Superficial heat and ultrasound at 3 MHz reach 1–2 cm; 1 MHz reaches 3–5 cm; intensities typically 0.5–2.0 W/cm², pulsed for acute tissue. Sensory re-education moves from protective awareness to discriminative tasks once protective sensation returns.
Traps
Applying heat or aggressive stretch to an acutely inflamed joint; advancing a protocol by the calendar rather than by edema and tendon glide; selecting a dynamic splint for a joint that needs low-load prolonged stretch; ignoring edema and scar care when asked for the "best initial intervention."
Rule of thumb
Red, hot, swollen means protect and elevate; cool, stiff, and stable means graded stress and stretch.