Primary Flexor Tendon Repair in Zones 1 and 2: Early Passive Mobilization Versus Controlled Active Motion

2014 ◽  
Vol 39 (7) ◽  
pp. 1344-1350 ◽  
Author(s):  
Florian Samuel Frueh ◽  
Viviane Sylvie Kunz ◽  
Isaac Joseph Gravestock ◽  
Leonhard Held ◽  
Mathias Haefeli ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Passive Mobilization ◽  
Early Passive

SPLINTING FLEXOR TENDON INJURIES

Hand Surgery ◽  
2002 ◽  
Vol 07 (01) ◽  
pp. 101-108 ◽  
Author(s):  
Elaine Ewing Fess
Keyword(s):  
Classification System ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Flexor Tendon Injuries ◽  
Early Passive

Frequently used zone 2 flexor tendon repair splints are reviewed and classified according to the Amercian Society of Hand Therapists' Splint Classification System. These splints both restrict and mobilise digital motion and fall into two main groups: (1) splints that incorporate the wrist and digital joints as primary joints to allow predetermined increments of early passive or active motion at both the wrist and digital joints; and (2) splints that include the wrist as a secondary joint and the digital joints as primary joints, allowing early passive or active motion at digital joints but not at the wrist.

A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL OF CONTROLLED PASSIVE MOBILIZATION VS. PLACE AND ACTIVE HOLD EXERCISES AFTER ZONE 2 FLEXOR TENDON REPAIR

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 53-59 ◽  
Author(s):  
Maryam Farzad ◽  
Fereydoun Layeghi ◽  
Ali Asgari ◽  
David C. Ring ◽  
Masoud Karimlou ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Flexor Tendon ◽  
Controlled Trial ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Total Active Motion ◽  
Passive Mobilization

Purpose: The rehabilitation program after flexor tendon repair of zone II laceration varies. We designed a Prospective Randomized Controlled Trial of controlled passive mobilization (modified Kleinert) vs. Place and active hold exercises after zone 2-flexor tendon repair by two-strand suture (Modified kessler). Methods: Sixty-four fingers in 54 patients with zone 2 flexor tendon modified Kessler repairs were enrolled in a prospective randomized controlled trial comparing place and active hold exercises to controlled passive mobilization (modified Kleinert). The primary outcome measure was total active motion eight weeks after repair as measured by an independent and blinded therapist. Results: Patients treated with place and active hold exercises had significantly greater total active motion (146) eight weeks after surgery than patients treated with controlled passive mobilization (114) (modified Klinert). There were no ruptures in either group. Conclusions: Place and hold achieves greater motion than controlled passive mobilization after a two-strand repair for zone 2 flexor tendon repairs.

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.

The effect of flexor tendon repair bulk on tendon gliding during simulated active motion: An in vitro comparison of two-strand and six-strand techniques

2001 ◽  
Vol 26 (5) ◽  
pp. 833-840 ◽  
Author(s):  
David W. Sanders ◽  
Andrew D. Milne ◽  
James A. Johnson ◽  
Cynthia E. Dunning ◽  
Robert S. Richards ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
In Vitro Comparison

Incidence of tenolysis and features of adhesions in the digital flexor tendons after multi-strand repair and early active motion

2018 ◽  
Vol 44 (4) ◽  
pp. 354-360 ◽  
Author(s):  
Koji Moriya ◽  
Takea Yoshizu ◽  
Naoto Tsubokawa ◽  
Hiroko Narisawa ◽  
Yutaka Maki
Keyword(s):  
Flexor Tendon ◽  
Full Range ◽  
Tendon Repair ◽  
The Other ◽  
Flexor Digitorum Superficialis ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Active Motion ◽  
Active Mobilization ◽  
Flexor Digitorum

We report seven patients requiring tenolysis after primary or delayed primary flexor tendon repair and early active mobilization out of 148 fingers of 132 consecutive patients with Zone 1 or 2 injuries from 1993 to 2017. Three fingers had Zone 2A, two Zone 2B, and two Zone 2C injuries. Two fingers underwent tenolysis at Week 4 or 6 after repair because of suspected repair rupture. The other five fingers had tenolysis 12 weeks after repair. Adhesions were moderately dense between the flexor digitorum superficialis and profundus tendons or with the pulleys. According to the Strickland and Tang criteria, the outcomes were excellent in one finger, good in four, fair in one, and poor in one. Fingers requiring tenolysis after early active motion were 5% of the 148 fingers so treated. Indications for tenolysis were to achieve a full range of active motion in the patients rated good or improvement of range of active motion of the patients rated poor or fair. Not all of our patients with poor or fair outcomes wanted to have tenolysis. Level of evidence: IV

The Effect of Delay to Surgery on Major Complications after Primary Flexor Tendon Repair

2019 ◽  
Vol 24 (02) ◽  
pp. 161-168 ◽  
Author(s):  
Aleksi Reito ◽  
Mari Manninen ◽  
Teemu Karjalainen
Keyword(s):  
Flexor Tendon ◽  
Multivariable Analysis ◽  
Tendon Repair ◽  
Significant Risk ◽  
Mechanism Of Injury ◽  
Flexor Tendon Repair ◽  
Major Complications ◽  
Increased Risk ◽  
Early Passive ◽  
Surgery Delay

Background: Flexor tendon repair carries a significant risk for complications, which often leads to revision surgery. The purpose of this study was to assess the effect of different factors on the risk for major complications patients undergoing a primary end-to-end flexor tendon repair and early passive mobilization regimen (Kleinert protocol). Methods: Between January 2000 and September 2009, a total of 312 patients underwent a flexor tendon repair at out institution. We excluded patients whose injury was self-inflicted or secondary to a rheumatic disease or a fall leaving 187 patients with 325 injured tendons for the study. Results: 152 (81.7%) patients were male and 34 (18.3%) females. Mean age of the patients was 32.7 years (SD 14.4, range 11 to 73). The fifth ray was most commonly affected. The majority of the injuries were located in zone II. Median delay to surgery was 3 days. Complications were observed in 34 patients (18.2%). Univariable analysis showed that patient age, mechanism of injury, injured ray, delay to surgery between three and seven days, and greater suture thickness were associated with increased risk of complications. In the subsequent multivariable analysis, only the mechanism of injury and delay to surgery remained as significant risk factors for major complications. Conclusions: We conclude that complications after flexor tendon repair may be reduced by appropriate timing of the surgery. Delay to surgery lasting between three and seven days seems to be associated with increased risk for major complications.

Is there a correlation between patient-reported outcome assessed by the Disabilities of the Arm, Shoulder and Hand Questionnaire and total active motion after flexor tendon repair?

Hand Therapy ◽  
2012 ◽  
Vol 17 (2) ◽  
pp. 37-41 ◽  
Author(s):  
Paola Errera Magnani ◽  
Aline Miranda Ferreira ◽  
Eula Katucha da Silva Rodrigues ◽  
Rafael Inácio Barbosa ◽  
Nilton Mazzer ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Patient Reported Outcome ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Patient Reported ◽  
Total Active Motion

Clinical outcomes of early active mobilization following flexor tendon repair using the six-strand technique: short- and long-term evaluations

2014 ◽  
Vol 40 (3) ◽  
pp. 250-258 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
Y. Maki ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Superficialis ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Total Active Motion ◽  
Active Mobilization ◽  
Flexor Digitorum

We evaluated the factors influencing outcomes of flexor tendon repair in 112 fingers using a six-strand suture with the Yoshizu #1 technique and early postoperative active mobilization in 101 consecutive patients. A total of 32 fingers had injuries in Zone I, 78 in Zone II, and two in Zone III. The mean follow-up period was 6 months; 16 patients (19 fingers) participated in long-term follow-up of 2 to 16 years. The total active motion was 230° SD 29°; it correlated negatively with age. The total active motion was 231° SD 28° after repair of the lacerated flexor digitorum superficialis tendon, and was 205° SD 37° after excision of the flexor digitorum superficialis tendon ends ( p = 0.0093). A total of 19 fingers showed no significant increases in total active motion more than 2 years after surgery. The rupture rate was 5.4% in our patients and related to surgeons’ level of expertise. Five out of six ruptured tendons were repaired by inexperienced surgeons. Level of Evidence IV

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