Review Question - QID 58

The rehabilitation protocol depicted in Figure A is the Kleinert protocol which is categorized as a low force and low excursion rehabiliation. This uses a dorsal blocking splint with the wrist in 45° of flexion and elastic bands secured to the patient’s nails and a more proximal point on the splint. Once the interphalangeal (IP) joints are actively fully extended, recoil of the elastic bands flexes them down passively. The Duran protocol (Illustration A) is similar but the wrist is in 20° of flexion and relies on the patient to alternately passively extend the DIP and PIP joints with the other joints of the finger flexed. Early active motion protocols that include "place and hold" finger exercises are considered moderate force and potentially high excursion protocols.

The review article by Lilly and Messer reports that synergistic motion protocols are low force and high tendon excursion and are the best at minimizing peritendonous adhesions. In this splint, passive digit flexion is combined with active wrist extension, followed by active digit extension coupled with active wrist flexion (Illustration B and C).