Culturally Tailored Rehabilitation Approach "After zone III Flexor Tendon Tenolysis in the Index and Middle Fingers: A Case Report.

Considerable challenges may occur with neglected zone III flexor tendon injuries due to muscle weakness, adhesion formation, and functional impairment. Surgical tenolysis often is required to restore tendon gliding and hand function We report a 32-year-old man with severe disability of the right hand following a childhood flexor tendon injury at age 2. Absence of follow-up rehabilitation resulted in dense adhesions in the index and middle fingers and marked muscle weakness. The patient underwent tenolysis followed by a staged rehabilitation program incorporating early mobilization, progressive strengthening, and culturally adapted exercises, including prayer-related gestures (Tasbeeh) and the "Arabic Coffee Protocol" to enhance engagement, dexterity, and fine motor coordination. Intraoperatively, full active finger flexion was achieved successfully and demonstrated on the operating table before wound closure. Following rehabilitation, the patient was able to perform a full fist, reflecting a transition from reliance on the ring and little fingers to the involvement of all digits. At follow-up, the patient reported subjective improvement in confidence and social participation. This case highlights the value of integrating culturally relevant interventions within structured rehabilitation for neglected hand injuries.