The Rambam Protocol for Very Early Active Mobilization after Flexor Tendon Repair by Modified Brunelli Pullout Technique

Rehabilitation following digital flexor tendon repair requires mobilization of the fingers to reduce adhesion rate, while attempting to avoid over-exertion which may result in tendon rupture. A recently described technique of robust flexor tendon repair using a volar pullout button, allows aggressive mobility protocols while ensuring integrity of the repair.

We describe the Rambam protocol for very early active mobilization which was developed in collaboration between the Occupational Therapy Department and Hand and Microsurgery Unit.

This protocol has been in use in our hospital since October 2020, and was introduced to the Occupational Therapists from the community health services in northern Israel, to promote and ensure therapeutic sequence.

We present live examples from our patients' clinical results and delineate key improvements to the protocol based on our experience from the past year.

Very early active mobilization following repair by modified Brunelli pullout technique is now our preferred method of rehabilitation, for patients with ruptures of the flexor digitorum profundus or flexor pollicis longus tendons, according to our experience.

(A separate presentation will detail the surgical technique for modified Brunelli volar pullout tendon repair).