Purpose: To describe how improvements in radiographic imaging can be applied to earlier detection and differentiation of extensor tendon injuries and to define the best postoperative therapy for patients on an individualized basis.

Methods: A literature review since 1990.

Results: Cadaveric dissection and intraoperative confirmation have found sonography to be more accurate than physical exam and MRI in the detection of extensor tendon injuries.

Early motion postoperative protocols are superior to traditional static splinting based on grip strength, T.A.M. classification and ratio of “excellent/fair” results utilizing the Dargan scale. Early passive tendon motion, utilizing the dynamic outrigger splint and early active motion have shown equivalent results. Passive tendon mobilization by a therapist plus dynamic therapy shows the best return to function in certain digits and zones of injury.

Conclusion: High-resolution sonograms today allow earlier initiation of therapy in hard to diagnose cases. Identification of the variables that influence the effectiveness of either postoperative motion based protocols is essential in choosing the best form of therapy.