A COTA in an outpatient setting is treating a client who underwent repair of multiple flexor tendons in Zones 2 and 3 approximately 6 weeks ago. The dorsal blocking splint has been removed, and the client is beginning to actively move the digits. The client is eager to return to work as a carpenter, and the COTA and OTR are collaborating to revise the goals with the client. Which goal for this time period is most appropriate?

• A. Increase passive wrist and digit composite extension to improve flexor tendon length
• B. Increase digital active range of motion to facilitate holding a washcloth during bathing
• C. Increase grip strength to maintain grasp on woodworking tools
• D. String 25 beads of various sizes and shapes to improve fine motor coordination

Answer: (B)

After flexor tendon repair, the early rehabilitation focus shifts to promoting active movement within a protected range to support tendon gliding and prevent adhesions. At about six weeks, once the dorsal blocking splint is removed, the goals should align with recovering active digit motion so the hand can perform functional tasks again, especially those related to the patient’s work and daily activities.

Choosing a goal that targets increasing digital active range of motion makes sense because it directly supports the ability to perform a common functional task, such as holding a washcloth during bathing. This kind of activity requires coordinated active flexion and extension of the fingers and thumb, and practicing it helps ensure the tendon heals with good glide while restoring practical hand use. It also reflects progress in active control rather than passive motion or isolated strength, which are less appropriate at this stage.

Why the others fit less well at this time: focusing on passive extension would move away from the current emphasis on active motion as the splint is removed and healing progresses; concentrating on grip strength too soon can risk stressing the repair and delaying healing, whereas the priority now is restoring active motion and functional tasks; working on fine motor coordination with beads is valuable, but does not address the immediate need to regain active motion for functional, work-related activities, which is the primary goal at this stage.