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The Most Rule-Bound Rehab in Hand Therapy, and Why Every Rule Exists
Expect about 12 weeks before a repaired flexor tendon is trusted with real gripping, and 3 to 6 months before the hand is close to full use. The splint stays on day and night for about 6 weeks. It comes off over weeks 6 to 8. Light use returns around week 8, strengthening starts somewhere between weeks 8 and 12, and heavy work and sport wait until at least week 12.
A cut across the palm side of your finger or wrist can divide the tendons that bend your fingers. They get repaired with stitches finer than thread, and then you spend three months in a protocol that will feel absurdly over-cautious.
It isn’t over-cautious. It’s built between two specific failures, and there’s very little room between them.
Move it too little and the tendon glues itself to the sheath around it. Move it too hard and the repair pulls apart.
One of those gives you a stiff finger that needs another operation. The other gives you a finger that stops working, weeks after you thought you were past the worst.
This page is the hub for the whole flexor repair journey. The splint has its own page: the dorsal blocking splint after flexor tendon repair. Where your cut was matters too: flexor tendon injuries and the finger zones. And if the tendon was ripped off the fingertip bone rather than cut, read jersey finger as well.
What’s actually happening in there
You have two flexor tendons to each finger. The deep one (FDP) bends the fingertip joint. The shallow one (FDS) bends the middle joint. Both run from muscles in your forearm, through the wrist and palm, into the finger. More on the layout in hand tendon anatomy.
Your flexor tendons don’t run loose through the finger.
They run inside a narrow sheath, held tight against the bone by a series of pulleys, gliding through it like a cable through a housing. That tight fit is what makes your fingers precise.
It’s also the whole problem after a repair.
A repaired tendon has a bulge of suture and swollen tissue at the repair site, sitting inside a tunnel that had no spare room to begin with. Healing tissue is sticky. If that repair sits still, it bonds to the sheath wall, and a tendon bonded to its housing cannot glide…so the finger won’t bend even though the tendon is perfectly intact.
The zone between the palm crease and the middle of the finger is where this is hardest. Surgeons have called it no man’s land for decades, because both tendons run together through the tightest part of the sheath there and the results have always been the least forgiving.
Meanwhile the repair itself is not strong. It’s stitches holding two cut ends together, and for the first weeks the stitches are doing nearly all the work.
How do you know a flexor tendon is cut?
- The finger sits straighter than its neighbors. Relaxed fingers fall into a gentle curve that increases from index to little finger. A finger lying flat out of that curve is a giveaway.
- You can’t bend the fingertip on its own. Hold the middle joint straight and try to bend the tip. Nothing means the deep tendon (FDP) is likely cut.
- You can’t bend the middle joint with the other fingers held flat. That tests the shallow tendon (FDS).
- Numbness down one side of the finger. The digital nerves run right beside the tendons, so a cut deep enough for one often reaches the other. See nerve repair recovery.
- The surgeon confirms it in the operating room. Ultrasound sometimes helps with partial cuts, but most are diagnosed on these tests and then seen directly during the repair.
Timing matters before surgery too. Flexor tendons are usually repaired within days. Wait longer and the cut end pulls back up the finger or into the palm, the muscle shortens, and a direct repair gets harder. After a few weeks a tendon graft may be needed instead. Any cut on the palm side of a finger that won’t bend properly deserves a same-day check. See hand and finger cuts.
The week 3 trap
Here’s the thing nobody feels coming.
In the first weeks, the body softens the tissue at the repair site before it starts rebuilding it. The tendon ends actually get weaker before they get stronger. The low point lands somewhere around week 2 to 3.
Which is exactly when the swelling has settled, the wound looks healed, the pain has faded, and the hand feels basically fine.
The repair is at its weakest on the day it first feels strong.
Ruptures don’t usually happen doing something reckless. They happen catching a falling object, pulling a door, pushing up off a chair…one reflex, before the thought arrives.
A rupture means going back to the operating room, and a re-repair does worse than the first one did.
Flexor tendon repair recovery week by week
Think of the first 12 weeks as your window. Weeks 0 to 6, it’s wide OPEN: what you do every day decides how freely that tendon slides for the rest of your life. Weeks 6 to 12, it’s closing, as the scar around the repair matures. By around 3 to 6 months it has largely shut for therapy alone, and the goal changes from gliding to deciding whether a second operation is worth it. Your surgeon’s dates beat these, always.
Days 0 to 5: splint on, therapy starts
- What happens: the bulky post-op dressing is swapped for a molded splint along the back of your forearm and hand, wrist and big knuckles bent, finger joints straight.
- Your job: hand above your heart, splint on 24 hours a day, exercises exactly as taught. See sleeping after hand surgery.
- Normal: swelling, a sore wound, fingers that feel fragile. Because they are.
Weeks 1 to 3: the highest-risk stretch
- What happens: the controlled movement program runs many times a day. Stitches usually come out around day 10 to 14.
- Normal: the hand feels more normal every day while the repair gets structurally weaker. That mismatch is the trap.
- Watch for: a finger that bends less this week than last week. That’s early sticking, and it’s fixable if it’s caught now.
Weeks 3 to 6: still full-time splint
- What happens: exercises progress, often to more active bending. Scar work starts once the wound is fully closed. See scar management after hand surgery.
- Still no: gripping, lifting, carrying, pushing up from a chair, or using the hand for tasks.
Weeks 6 to 8: the splint comes off
- What happens: the splint is weaned, usually off for exercises and light tasks in the day, often still on at night and in crowds.
- Light use only: eating, writing, buttons, a keyboard. No resistance.
- The second danger week: the splint is gone, the hand feels free, and confidence arrives before tendon strength does.
Weeks 8 to 12: strengthening, gradually
- What happens: soft putty and light grip first, when your therapist says so. Then progressively firmer.
- Normal: grip feels clearly weaker than the other side for a while. That’s expected, not a failure.
Months 3 to 6: back to full use
- What happens: heavy work, lifting and sport, built up over weeks. Grip strength keeps climbing across this whole period and often beyond.
What exercises do you do after flexor tendon repair?
Hand therapy starts within the first few days. Not weeks. This is one of the few post-surgical hands where waiting for the first appointment costs you range you don’t get back.
Inside the splint, you’ll be given movement to do. Which movement depends on your surgeon’s protocol and how the repair was done…some use passive bending with the other hand, some use very light active holding, and stronger modern repairs allow more early activity than older ones did.
(This is why I won’t give you an exercise program here. The right one depends on how many strands of suture are holding your tendon together, and only your surgeon and treating hand therapist would know that.)
What I can do is show you the building blocks, so the sheet you were handed makes sense. Do your sheet, not this list.
- Passive bending. Your other hand gently pushes the finger down towards the palm, then lets it return to the splint. The tendon slides without working. Commonly 10 reps per joint.
- Place and hold. Your other hand places the fingers in a partial fist, then you hold the position with the lightest possible effort for about 5 seconds. Commonly 10 reps.
- Early active bending. You bend the finger yourself, often only a third to half of a fist at first, with light effort.
- Straightening to the splint. Finger joints flat against the splint each session, so the middle joint doesn’t stiffen bent.
- Dose. A common pattern is a set every 1 to 2 hours while you’re awake. Missing days is how adhesions form.
- After the splint (around week 6 to 8): tendon glides and blocking exercises, then putty. See tendon glides, but only when your therapist moves you on to them.
The rules that protect the repair
What is universal, and what I’d tattoo on people if I could:
- The splint does not come off. Not to wash, not to sleep, not to show someone, not for a second. (Unless your therapist has taught you a specific removal routine.)
- Nothing gets gripped, lifted, carried or pulled with that hand. A mug counts. A kettle counts. A seatbelt counts.
- You do not test it. Not once. “Just seeing if it works yet” is a genuine cause of rupture.
- You do the exercises you were given, at the frequency you were given. Missing days is how adhesions form.
- Bring the splint to every visit. As swelling drops it loosens, and a loose splint stops blocking.
When can I drive, work and go to the gym?
- Desk work, one-handed: often 1 to 2 weeks, if the commute and the job allow it.
- Driving: not in the splint. Most people need the splint off and enough grip to control the car in an emergency, rarely before 8 weeks. Check with your surgeon and your insurer. See driving after a hand injury.
- Light manual work: around 8 to 10 weeks.
- Heavy manual work, lifting: around 12 weeks at the earliest, built up gradually. See returning to work after a hand injury.
- Gym, climbing, contact and ball sports: 12 weeks at the earliest, often closer to 4 months for full grip and catching. Catching a ball is the exact reflex grab that ruptures repairs.
Will my finger bend fully again?
Honest expectation: a lot of people don’t get back to a completely full fist. Some permanent tightness, particularly at the fingertip joint, is common even after a technically perfect repair and perfect rehab.
If your finger is stiff at month 4 despite doing everything right, that isn’t a moral failure and it isn’t necessarily the end…a release operation for adhesions (tenolysis) is a real option once the repair itself is solid, usually not before 3 to 6 months. It comes with its own early-movement rehab, cos the tendon that was freed will happily glue itself down again.
A finger that bends well but won’t straighten is a different problem, usually a tight middle joint. See can’t straighten a finger after surgery. And if the whole hand is stiff, see stiff hand after a cast or surgery.
What a hand therapist does differently
- Measures the gap. How far the finger bends when pushed versus how far it bends on its own. A widening gap is the earliest sign the tendon is sticking, and the program changes that week.
- Refits the splint as swelling drops, so it keeps blocking the stretch that matters.
- Loosens each rule on evidence, based on how your tendon is behaving, not the calendar alone.
- Treats the scar and the swelling, which are what the tendon has to glide through.
Call your surgeon today if
- A pop or snap, then a finger that no longer bends the way it did yesterday. A ruptured repair is easier to fix early.
- The whole finger turns red, swollen and sausage-like, held slightly bent, with pain when anyone straightens it. That’s a sheath infection pattern. See flexor tendon sheath infection.
- Spreading redness, warmth, discharge from the wound, or a fever.
- A finger that turns pale, blue or cold, or new numbness.
- The splint is cracked, broken or no longer holds the knuckles bent.
Get it checked if
- The finger bends less this week than it did last week.
- The middle joint won’t straighten fully against the splint.
- You haven’t seen a hand therapist within the first week after the repair.
- Pain, swelling and color changes are getting worse after week 2 instead of settling. See CRPS.
The rules aren’t caution. They’re the treatment, built for a repair that gets weaker right when your hand starts feeling fine.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Follow your own surgeon’s and therapist’s protocol over anything here, always.
Part of: Recovery after hand, wrist and elbow surgery: every week-by-week guide
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.