First of all thanks for the answers!
So, Cliff, I have never been using Shockwave, but I have seen this machine.. isn't it too big and strong for such a small and delicate structure as the proximal phalanx of the small finger? Is it appropriate in the acute postoperative phase. Can you link some of the studies you mentioned? Here is a link on early US on flexor tendon repairs in zone 2 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075224/
For me what these people did is quite brave, but I tried it (with written consent) on a complicated case of second reconstruction of a flexor tendon in zone 3. Today was the end of the fourth postoperative week for this patient and it looks promising, but I'll be quiet about that until the rehab is over.
Anyway, Alison, I am aware of the basics and I agree with you about the small bits, this is the usual practice, but this doesn't work for some patients - those who don't have "the nerves" to be so strict with the rehab regimen (this is why the Indian therapists from the link above tried the early US - their patients simply couldnt understand and follow the complex early mobilization protocols). Parrafin wax is good idea.. I am using hot packs for the fingers since they are the easiest thing to do, but the wax could be more efficient. The other problem in this particular patient that I am talking about is that his tendon doesnt have sinovial sheath (very damaged from the first operation and has to be removed and the canal to be reconstructed with tendon graft) and this leads to excessive adhesions. About the US parameters - I basicly try to increase the temperature of the tissue to a degree that I can clearly feel. It takes 10 minutes. Since my transducer is 5cm2 ( I am waiting for the 1,5 cm2 one) I use water bath for application technique for the fingers. For most of the patients this is sufficient to achieve immediate increase of the ROM - the younger the scar, the bigger the increase. And with this patient was the same but it looks like the scar became too strong very quickly (2 days) after his last visit. So I am looking for some "special" technique to influence the adhesions .That's it. I hope this long post makes the picture clear.
Thanks one more time for your thoughts and ideas on that.
Now I am going to check the WALT recommendations about LLLT.