active range of motion is built on the foundation of the goals just described,
with the prerequisite of painless stable passive range of motion and the
most powerful tool of early active motion. Secondary salvage with tenolysis,
joint releases, tendon transfers, and in rare cases free functional muscle
transfers may be indicated, but are unlikely to achieve the potential made
possible with primary healing and early active motion. Such procedures
are contraindicated for patients who have persistent local pain or who
have developed a strong pattern of disuse of the hand.