CHT exam prep - Hand Protocols questions and answers
2026\2027 A+ Grade
Saint John Early Active Protocol for flexor tendon repair
- correct answer - 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
- 4.5 weeks: out of orthosis for HEP (wrist/finger ROM), work toward full composite flexion
- 6 weeks: D/C orthosis, buddy tape if needed, passive extension, night ext splint/relative motion PRN,
joint blocking may begin (no SF)
- 8 weeks: light grip strengthening
- 12 weeks: heavy use and gripping
Zone 1-3 flexor tendon protocol modified duran
- correct answer - Orthosis: DBS wrist neutral to 20 degrees flex, MPs 70 degrees flex, IPs ext
- 1-2 weeks: Passive flexion/extension isolated PIP/DIP and composite
- 3.5 weeks: active flex/ext in orthosis (may start with place and holds)
- 4.5 weeks: out of orthosis for HEP, wrist/digital AROM (diff tendon gliding, comp fist with wrist
flex/ext, comp wrist/dig flex followed by wrist/digital ext)
- 6 weeks: D/C orthosis, joint blocking may begin (no SF)
- 8 weeks: light grip strengthening
- 12 weeks: Use hand in all ADLs
- 14-16 weeks: heavy use and gripping
Flexor tendon zones 1-4 delayed mobilization protocol
- correct answer - Orthosis: DBS wrist neutral to 20 degrees flex, MPs 70 degrees flex, IPs ext
- 3 weeks: PROM in orthosis (PIP/DIP isolated and comp flex) followed by AROM in orthosis
, - 4.5 weeks: HEP out of orthosis
- 6 weeks: D/C orthosis, begin passive ext, joint blocking
- 8 weeks: Light grip strengthening
- 10-12 weeks hand weights
Flexor tendon repair zones 4-5 protocol
- correct answer - Orthosis: DBS wrist 30 degrees flex, MPs 70 degrees flex, IPs full ext
- 1-2 weeks: Passive composite flex/ext 3-4x per day
- 3 weeks: AROM in orthosis
- 4 weeks: Gentle joint blocking
- 4.5 weeks HEP out of orthosis
- 6 weeks: D/C orthosis, begin passive ext, emphasize differential tendon gliding
- States at 6 weeks may initiate light strengthening - would start at 8 weeks
- 10-12 weeks: unrestricted use of hand
Early active zone 4-7 extensor tendon protocol
- correct answer - Orthosis: relative motion orthossis (15-20 degrees greater MCP ext relative to
adjacent digits), wrist cock-up in 20-25 degrees extension
- unrestricted AROM of digits with orthoses on
- 3 weeks: D/C wrist cock up
- 6 weeks: D/C relative motion orthosis
If needed: strengthening at 8 weeks post op. Typically do not need therapy after 6 weeks.
Early active motion protocol after central slip repair
- correct answer - 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)
2026\2027 A+ Grade
Saint John Early Active Protocol for flexor tendon repair
- correct answer - 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
- 4.5 weeks: out of orthosis for HEP (wrist/finger ROM), work toward full composite flexion
- 6 weeks: D/C orthosis, buddy tape if needed, passive extension, night ext splint/relative motion PRN,
joint blocking may begin (no SF)
- 8 weeks: light grip strengthening
- 12 weeks: heavy use and gripping
Zone 1-3 flexor tendon protocol modified duran
- correct answer - Orthosis: DBS wrist neutral to 20 degrees flex, MPs 70 degrees flex, IPs ext
- 1-2 weeks: Passive flexion/extension isolated PIP/DIP and composite
- 3.5 weeks: active flex/ext in orthosis (may start with place and holds)
- 4.5 weeks: out of orthosis for HEP, wrist/digital AROM (diff tendon gliding, comp fist with wrist
flex/ext, comp wrist/dig flex followed by wrist/digital ext)
- 6 weeks: D/C orthosis, joint blocking may begin (no SF)
- 8 weeks: light grip strengthening
- 12 weeks: Use hand in all ADLs
- 14-16 weeks: heavy use and gripping
Flexor tendon zones 1-4 delayed mobilization protocol
- correct answer - Orthosis: DBS wrist neutral to 20 degrees flex, MPs 70 degrees flex, IPs ext
- 3 weeks: PROM in orthosis (PIP/DIP isolated and comp flex) followed by AROM in orthosis
, - 4.5 weeks: HEP out of orthosis
- 6 weeks: D/C orthosis, begin passive ext, joint blocking
- 8 weeks: Light grip strengthening
- 10-12 weeks hand weights
Flexor tendon repair zones 4-5 protocol
- correct answer - Orthosis: DBS wrist 30 degrees flex, MPs 70 degrees flex, IPs full ext
- 1-2 weeks: Passive composite flex/ext 3-4x per day
- 3 weeks: AROM in orthosis
- 4 weeks: Gentle joint blocking
- 4.5 weeks HEP out of orthosis
- 6 weeks: D/C orthosis, begin passive ext, emphasize differential tendon gliding
- States at 6 weeks may initiate light strengthening - would start at 8 weeks
- 10-12 weeks: unrestricted use of hand
Early active zone 4-7 extensor tendon protocol
- correct answer - Orthosis: relative motion orthossis (15-20 degrees greater MCP ext relative to
adjacent digits), wrist cock-up in 20-25 degrees extension
- unrestricted AROM of digits with orthoses on
- 3 weeks: D/C wrist cock up
- 6 weeks: D/C relative motion orthosis
If needed: strengthening at 8 weeks post op. Typically do not need therapy after 6 weeks.
Early active motion protocol after central slip repair
- correct answer - 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)
