The Influence of Wrist Position on the Minimum Force Required For Active Movement of the Interphalangeal Joints

1988 ◽  
Vol 13 (3) ◽  
pp. 262-268
Author(s):  
R. SAVAGE
Keyword(s):  
Flexor Tendon ◽  
Muscle Tension ◽  
Tendon Repair ◽  
Active Movement ◽  
Finger Movement ◽  
Passive Tension ◽  
Active Tension ◽  
Flexor Tendon Repair ◽  
Passive Muscle ◽  
Minimum Force

Active and passive muscle tension is discussed in relation to finger flexor and extensor tendons. Minimising active tension required to produce finger movement is seen as an important part of post-operative finger mobilisation following flexor tendon repair in which active movement is used. It is argued that “minimal active tension” in the flexors is equal to, or just exceeds, the passive tension in the extensors. A method of measuring passive tension in finger tendons has been described. In 24 volunteers, it has been used to determine that if the metacarpo-phalangeal joints are held flexed, there is least “minimal active tension” in the flexor tendons when the wrist is splinted in extension.

FLEXOR TENDON REPAIR, HEALING AND REHABILITATION: A BRIEF COMMENTARY

Hand Surgery ◽  
2002 ◽  
Vol 07 (01) ◽  
pp. 29-31 ◽  
Author(s):  
John A. McAuliffe
Keyword(s):  
Flexor Tendon ◽  
Primary Repair ◽  
Muscle Tension ◽  
Tendon Repair ◽  
Tendon Healing ◽  
Tissue Reaction ◽  
Rate Of Change ◽  
Clinical Approach ◽  
Flexor Tendon Repair ◽  
Flexor Tendons

Twenty years ago, we concluded that it was useless to use suture material strong enough to allow early mobilisation, since material of this sort creates problems in the form of connective tissue reaction and even tendon necrosis. It is better to use what is called "the blocked suture", which abolishes muscle tension on the repair, and, therefore, makes it possible to bring the tendon ends accurately together by fine sutures too weak to resist any muscle fore.19 This statement, from Claude Verdan's Founders Lecture to the American Society for Society of the Hand only 30 years ago, highlights the dramatic rate of change in our understanding and clinical approach to flexor tendon repair. At the time these words were spoken, Verdan and some of his more adventurous contemporaries were challenging the currently accepted dictum that repair of flexor tendons divided in the digit should not be attempted. This early work on the primary repair of flexor tendons by Verdan,20 Kleinert and associates,12 and Kessler and Nissim,11 among others, forever changed the landscape of Bunnell's "no man's land",and paved the way for the clinical advances and explosion of research into flexor tendon healing and repair that have occured in the last several decades.

Avoiding Flexor Tendon Repair Rupture with Intraoperative Total Active Movement Examination

2010 ◽  
Vol 126 (3) ◽  
pp. 941-945 ◽  
Author(s):  
Amanda Higgins ◽  
Donald H. Lalonde ◽  
Michael Bell ◽  
Daniel McKee ◽  
Jan F. Lalonde
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Active Movement ◽  
Flexor Tendon Repair

scholarly journals Wide-Awake Flexor Tendon Repair Under Tumescent Injection

2019 ◽  
Vol 1 (1) ◽  
pp. 39-51
Author(s):  
Hanan Abid ◽  
Sabah Naji
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Active Movement ◽  
Flexor Tendon Repair ◽  
Examination Result ◽  
Flexor Tendon Injuries ◽  
Zone Ii ◽  
No Tourniquet

Background. Flexor tendon injuries are frequent, due to variable hand activities, and the repair is challenging to hand surgeons, especially in zone II, because of the coexistence of two tendons within a tight fibro-osseous tunnel. Flexor tendon repair under tumescent infiltration provides anesthesia and a bloodless field, so that no tourniquet or sedation is needed. Aim of study. The goal of this study was to identify a surgical adjustment and intraoperative total active movement examination of the repaired tendon so that no gapping is formed, and smooth gliding is obtained, avoiding tendon rupture and producing an optimal range of motion. Patients and method. From January 2016 to April 2017, 9 patients (17 tendons), with a mean age of 31.8 years, presented within 3 to 14 days of injury to zone I or zone II of their flexor tendons. Tendon repair was done under tumescent infiltration (lidocaine 1% with adrenaline 1:200,000) only, with no tourniquet or sedation, and with an intraoperative total active movement examination. Result. After 6 months of follow up, all the patients had excellent range of motion according to the Boyes outcome scale, and none showed signs of postoperative tendon rupture. Conclusion. Tumescent infiltration for flexor tendon repair allows intraoperative surgical adjustment and total active movement examination, which will minimize postoperative rupture and adhesion. This procedure will also facilitate the surgeon’s work by eliminating the need for general anesthesia or sedation; however, this procedure is not applicable for children, major trauma, or those who are mentally challenged.

Primary Flexor Tendon Repair: The Mechanical Limitations of the Modified Kessler Technique

1986 ◽  
Vol 11 (1) ◽  
pp. 71-76
Author(s):  
P. J. F. WADE ◽  
I. F. K. MUIR ◽  
L. L. HUTCHEON
Keyword(s):  
Mechanical Testing ◽  
Structural Component ◽  
Flexor Tendon ◽  
Narrow Range ◽  
Tendon Repair ◽  
Active Movement ◽  
Gap Formation ◽  
Primary Suture ◽  
Flexor Tendon Repair ◽  
Core Part

The aim of primary suture of flexor tendons in the hand is to achieve full function as soon as possible with a one stage operation. Much interest has been aroused by this subject and more recently by the possibility of improving results by postoperative active movement of the repaired tendon. We report the results of mechanical testing of the modified Kessler suture which suggests that the peripheral stitch is an important structural component of the suture. It is not merely a 'tucking in' stitch, but is essential to prevent very early gap formation. Steel is the best material for the central or core part of the suture. Cautious active postoperative movements may be possible using the modified Kessler suture, but within a narrow range of safety and with careful supervision.

scholarly journals Ischaemic contracture of the hand

2006 ◽  
Vol 39 (01) ◽  
pp. 94-102
Author(s):  
G. Balakrishnan
Keyword(s):  
Suture Material ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Hypodermic Needle ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Custom Made

ABSTRACTStronger flexor tendon repairs facilitate early active motion therapy protocols. Core sutures using looped suture material provide 1 ½ to twice the strength of Kessler′s technique (with four strand and six strand Tsuge technique respectively). The technique is well-described and uses preformed looped sutures (supramid). This is not available in many countries and we describe a technique whereby looped sutures can be introduced in flexor tendon repair by the use of 23 G hypodermic needle and conventional 4.0 or 5.0 sutures. This is an alternative when the custom made preformed sutures are not available. This can be practiced in zone 3 to zone 5 repairs. Technical difficulties limit its use in zone 2 repairs.

Methods of Evaluation of the Functional Results of Flexor Tendon Repair of the Fingers

1985 ◽  
Vol 10 (1) ◽  
pp. 60-61 ◽  
Author(s):  
A. B. NIELSEN ◽  
P. Ø. JENSEN
Keyword(s):  
Functional Outcome ◽  
Standard Method ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Functional Results ◽  
Functional Evaluation ◽  
Flexor Tendon Repair ◽  
Methods Of Evaluation ◽  
Method Of Measurement ◽  
No Man's Land

The methods used by Buck-Gramcko, Kleinert and Tsuge in evaluating the functional results of flexor tendon repair were each applied to assess the functional outcome in sixty-seven fingers where both tendons had been severed in “no man's land”. The method of Buck-Gramcko gave the highest rating, and the three methods showed evident differences in the results of evaluation after surgery. The study suggests a need for one standard method of measurement and recording, if a comparison of results after flexor tendon repair is to be of value. We found that the method of Buck-Gramcko incorporated the most essential features in the functional evaluation.

Looped suture properties: implications for multistranded flexor tendon repair

2015 ◽  
Vol 40 (3) ◽  
pp. 234-238 ◽  
Author(s):  
R. Haddad ◽  
T. Peltz ◽  
N. Bertollo ◽  
W. R. Walsh ◽  
S. Nicklin
Keyword(s):  
Mechanical Properties ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Relative Effect ◽  
Flexor Tendon Repair ◽  
Polypropylene Monofilament ◽  
Single Suture ◽  
Biomechanical Strength ◽  
Standard Techniques ◽  
Repair Techniques

Multiple-strand repair techniques are commonly used to repair cut flexor tendons to achieve initial biomechanical strength. Looped sutures achieve multiple strands with fewer passes and less technical complexity. Their biomechanical performance in comparison with an equivalent repair using a single-stranded suture is uncertain. This study examined the mechanical properties of double-stranded loops of 3-0 and 4-0 braided polyester (Ticron) and polypropylene monofilament (Prolene). Double loops were generally less than twice the strength of a single loop. Ticron and Prolene had the same strengths, but Ticron was stiffer. The 4-0 double loops had significantly higher stiffness than 3-0 single loops. Increasing the size of sutures had a larger relative effect on strength than using a double-stranded suture. However, a double-strand loop had a larger effect on increasing stiffness than using a single suture of a larger equivalent size. Looped suture repairs should be compared with standard techniques using a thicker single suture.

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