Extensor tendon injuries in the dorsal hand are prevalent due to the superficial location of the tendons and limited surrounding soft tissue. Early active mobilization (EAM) protocols are increasingly being adopted; however, comparative data with traditional immobilization methods remain scarce.

This study aims to compare the short-term functional outcomes and return-to-work times between EAM and immobilization following zone 5–6 extensor tendon repairs.

A retrospective cohort study.

We analyzed twenty-six patients with isolated zone 5–6 extensor tendon injuries (EAM: n = 12; immobilization: n = 14). Range of motion was assessed using a goniometer, while grip strength was measured with a hand dynamometer. Data on return-to-work times and physiotherapy sessions were collected. Statistical analyses included parametric and non-parametric tests, effect sizes (Cohen’s d), and interaction analyses based on occupation type and dominant hand involvement. A post-hoc power analysis was performed for total active motion.

The EAM group exhibited significantly higher values for metacarpophalangeal, distal interphalangeal, and total active motion at discharge compared to the immobilization group (p = 0.035, p = 0.001, p = 0.007), with large effect sizes. However, there were no significant differences in grip strength, return-to-work times, or the number of physiotherapy sessions (p > 0.05). Additionally, occupation type and hand dominance did not significantly influence return-to-work outcomes. The post-hoc power for total active motion was calculated at 91.2%. Importantly, no tendon ruptures were reported.

Early active mobilization following zone 5–6 extensor tendon repair significantly enhances short-term range of motion without increasing complication rates. Grip strength and return-to-work outcomes remain comparable to those observed with immobilization. These findings advocate for early active mobilization as a safe and effective rehabilitation approach.