CHT exam prep - Hand Protocols Questions and Answers
Early active motion protocol after central slip repair Correct Ans-- Orthosis: Palmar resting
finger splint with PIP/DIP in full extension (straps over PIP and DIP), template splint fabricated
to allow 30 degrees PIP and DIP flexion
During HEP: wrist in 30 degrees flex and MCP in ext
- Week 1: 20 reps hourly flex to 30 degrees with template splint, Isolated DIP joint blocking
(limit to 30 degrees if lateral bands repaired)
- Week 2: increase splint to allow 40 degrees flexion
- Week 3: Increase splint to allow 50 degrees flexion (as long as there is no ext lag)
- Week 4: can increase splint to 60-70 degrees or perform without splint. Wean from orthosis
during the day (may buddy loop) but wear at night
- Week 5: progress to full composite flexion
- Week 6: D/C night orthosis
MP arthroplasty RA Protocol Correct Ans-- Orthoses: Resting pan orthosis for night (wrist
0-15 ext), finger full ext (not hyperext) with finger dividers PRN, MPs in neutral to slight RD,
forearm based dynamic MP ext with wrist in 0-15 deg ext, do not allow MP hyper ext, joint
fusions with individual finger gutters
- 1-3 weeks: AROM 10 reps hourly in orthosis (MP flex to fist to straight), PROM 2x per day 15
reps each (start with SF as it is usually most limited). Pt with limited passive flexion (<50
degrees) can be 4-6x per day as long as extensor lag >30 is not present. If patient easily has
80-90 degrees active flexion do not perform PROM
- 4 weeks: gentle active 1/2 fist out of orthosis
, CHT exam prep - Hand Protocols Questions and Answers
- After 1-2 weeks may add dynamic flexion splinting and increase PROM if passive flexion is
<50 degrees
- 6 weeks: light activities outside of dynamic orthosis 3-4x per day for 30 minute sessions (no
tight or sustained pinch/grip) if fingers are wanting to UD try soft anti UD splint
- 8 weeks: TGE (Dr. F pts)
- 10-12 weeks: RA orthosis D/C, light strengthening with foam or putty but do not complete if
patient has UD as this can encourage it
Night orthosis may be used up to one year (per MD)
Extensor tendon repair zones 2-4 protocol Correct Ans-- Orthosis: Gutter orthosis with
PIP/DIP in full extension
- 4 weeks: AROM initiated, PIP/DIP joint blocking, composite flexion, reverse blocking 6-8x per
day 10 minute sessions
- 6 weeks: PROM initiated if extensor lag is 10 degrees or less
- 7 weeks: Dynamic flexion splinting (monitor for lag)
- 8 weeks: D/C gutter orthosis during day, gentle strengthening
- 9 weeks: D/C gutter orthosis at night
Saint John Early Active Protocol for flexor tendon repair Correct Ans-- Orthosis: Dorsal
blocking wrist up to 45 degrees ext, MPs flexed 30 degrees, IP ext
- 3 days post op: passive comp flex, 1/3-1/2 fist, reverse blocking
- 2 weeks: short splint for tenodesis up to 45 degrees wrist ext
- 3-4 weeks: work up to 3/4 of a fist
Early active motion protocol after central slip repair Correct Ans-- Orthosis: Palmar resting
finger splint with PIP/DIP in full extension (straps over PIP and DIP), template splint fabricated
to allow 30 degrees PIP and DIP flexion
During HEP: wrist in 30 degrees flex and MCP in ext
- Week 1: 20 reps hourly flex to 30 degrees with template splint, Isolated DIP joint blocking
(limit to 30 degrees if lateral bands repaired)
- Week 2: increase splint to allow 40 degrees flexion
- Week 3: Increase splint to allow 50 degrees flexion (as long as there is no ext lag)
- Week 4: can increase splint to 60-70 degrees or perform without splint. Wean from orthosis
during the day (may buddy loop) but wear at night
- Week 5: progress to full composite flexion
- Week 6: D/C night orthosis
MP arthroplasty RA Protocol Correct Ans-- Orthoses: Resting pan orthosis for night (wrist
0-15 ext), finger full ext (not hyperext) with finger dividers PRN, MPs in neutral to slight RD,
forearm based dynamic MP ext with wrist in 0-15 deg ext, do not allow MP hyper ext, joint
fusions with individual finger gutters
- 1-3 weeks: AROM 10 reps hourly in orthosis (MP flex to fist to straight), PROM 2x per day 15
reps each (start with SF as it is usually most limited). Pt with limited passive flexion (<50
degrees) can be 4-6x per day as long as extensor lag >30 is not present. If patient easily has
80-90 degrees active flexion do not perform PROM
- 4 weeks: gentle active 1/2 fist out of orthosis
, CHT exam prep - Hand Protocols Questions and Answers
- After 1-2 weeks may add dynamic flexion splinting and increase PROM if passive flexion is
<50 degrees
- 6 weeks: light activities outside of dynamic orthosis 3-4x per day for 30 minute sessions (no
tight or sustained pinch/grip) if fingers are wanting to UD try soft anti UD splint
- 8 weeks: TGE (Dr. F pts)
- 10-12 weeks: RA orthosis D/C, light strengthening with foam or putty but do not complete if
patient has UD as this can encourage it
Night orthosis may be used up to one year (per MD)
Extensor tendon repair zones 2-4 protocol Correct Ans-- Orthosis: Gutter orthosis with
PIP/DIP in full extension
- 4 weeks: AROM initiated, PIP/DIP joint blocking, composite flexion, reverse blocking 6-8x per
day 10 minute sessions
- 6 weeks: PROM initiated if extensor lag is 10 degrees or less
- 7 weeks: Dynamic flexion splinting (monitor for lag)
- 8 weeks: D/C gutter orthosis during day, gentle strengthening
- 9 weeks: D/C gutter orthosis at night
Saint John Early Active Protocol for flexor tendon repair Correct Ans-- Orthosis: Dorsal
blocking wrist up to 45 degrees ext, MPs flexed 30 degrees, IP ext
- 3 days post op: passive comp flex, 1/3-1/2 fist, reverse blocking
- 2 weeks: short splint for tenodesis up to 45 degrees wrist ext
- 3-4 weeks: work up to 3/4 of a fist
