Hand range of motion

Therapy involving various combinations of active and passive ROM is initiated unless there is a specific contraindication. Early ROM, both active and passive, decreases the incidence of joint contracture, facilitates edema reduction, and decreases adhesion formation. With regard to flexor tendon protocols, early ROM leads to earlier recovery of tensile strength and better tendon nutrition than do protocols that immobilize tendons. Early passive motion protocols were advocated by both Duran and Kleinert for the treatment of flexor tendon repairs in zone II. In a randomized clinical trial, Bulstrode et al demonstrated improved early motion in patients with extensor tendon injuries following two different protocols that encouraged early active and passive ROM versus ROM begun at 4 weeks.

Following tendon repair, passive ROM may encourage tendon gliding, but it also has the potential for placing a repaired structure at risk for rupture. Aggressive passive motion should be avoided in patients with complex pain regional syndrome (CPR) because of the potential for increased inflammation and edema. For these patients, active motion may be preferred because it may place less stress on the extremity than does passive motion. Numerous protocols for the management of both surgically and nonsurgically treated distal radius fractures advocate early passive and active ROM of the fingers or wrist. A systematic review confirmed improved outcomes after early mobilization following extra-articular metacarpal and phalangeal fractures.