Zone II Flexor Tendon Therapy: Mobilize or Immobilize?

1989 ◽  
Vol 56 (1) ◽  
pp. 15-20
Author(s):  
Robin Shear ◽  
Jane Bear-Lehman
Keyword(s):  
Current Practice ◽  
Flexor Tendon ◽  
Postoperative Management ◽  
Patient Specific ◽  
Management Approach ◽  
Active Motion ◽  
Passive Motion ◽  
Pip Joint ◽  
Zone Ii ◽  
Management Approaches

This study investigated the postoperative management approaches used in the treatment of flexor tendon repairs in Zone II of the hand. The therapists and the hand surgeons who treat patients with acute hand injuries in the Metropolitan Toronto area were surveyed to detect their current practice trends and preferences in flexor tendon postoperative management. The survey focused on the following four protocols: 1. immobilization for at least three weeks, 2. the Kleinert program of controlled active motion, 3. the Duran program of controlled passive motion, and 4. combination of controlled active and passive motion. Although the results suggested that mobilization is the preferred postoperative management amongst the majority of responding therapists and hand surgeons, the type of mobilization program preferred differed. The therapists demonstrated a trend towards a combination of early controlled active and passive motion; whereas, the trend amongst the surgeons was that of early controlled active motion. The decision to use one specific management approach over another was found to be very “patient specific”. As well, a wide variation on the preferences given for the splinting positions at the wrist, metacarpalphalangeal (MCP) joint, and the proximal interphalangeal (PIP) joint was noted.

Zone-II Flexor Tendon Repair: A Randomized Prospective Trial of Active Place-and-Hold Therapy Compared with Passive Motion Therapy

2010 ◽  
Vol 92 (6) ◽  
pp. 1381-1389 ◽  
Author(s):  
Thomas E Trumble ◽  
Nicholas B Vedder ◽  
John G Seiler ◽  
Douglas P Hanel ◽  
Edward Diao ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Prospective Trial ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Passive Motion ◽  
Randomized Prospective Trial ◽  
Zone Ii

Efficacy of Adcon-T/N After Primary Flexor Tendon Repair in Zone II: A Controlled Clinical Trial

2003 ◽  
Vol 28 (2) ◽  
pp. 113-115 ◽  
Author(s):  
A. GOLASH ◽  
A. KAY ◽  
J. G. WARNER ◽  
F. PECK ◽  
J. S. WATSON ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Flexor Tendon Repair ◽  
Double Blind ◽  
Active Motion ◽  
Zone Ii

A prospective double-blind, randomized, controlled clinical trial was conducted to assess the use of ADCON-T/N after flexor tendon repair in Zone II. Forty-five patients with 82 flexor tendon repairs in 50 digits completed the study. ADCON-T/N was injected into the tendon sheath after tenorrhaphy in the experimental group while the control group was not treated with ADCON-T/N. ADCON-T/N had no statistically significant effect on total active motion at 3, 6 and 12 months but the time taken to achieve the final range of motion was significantly shorter in treated patients. ADCON-treated patients had a higher rupture rate but this was not significant.

scholarly journals Silicone Foley’s catheter as an effective alternative to Hunter’s rod in staged flexor tendon reconstruction of the hand

2016 ◽  
Vol 49 (03) ◽  
pp. 322-328 ◽  
Author(s):  
Tawheed Ahmad ◽  
Sheikh Adil Bashir ◽  
Mohammad Inam Zaroo ◽  
Adil Hafeez Wani ◽  
Saima Rashid ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Treatment Method ◽  
Effective Alternative ◽  
Reconstruction Procedure ◽  
Active Motion ◽  
Tendon Reconstruction ◽  
Total Active Motion ◽  
Zone Ii ◽  
Foley’S Catheter

ABSTRACT Context: Staged flexor tendon reconstruction is most suitable treatment method for extensive zone II tendon injuries. The Hunter’s rod used in this procedure is costly and not easily available, which adds to the miseries of both patients as well as treating surgeon. Aims: The aim of this study is to evaluate the results of staged zone II flexor tendon repair using silicone Foley’s catheter as a cheaper and readily available alternative to Hunter’s rod. Settings and Design: This was a prospective study. Materials and Methods: Seventy digits in 35 patients were treated by the staged flexor tendon reconstruction using silicone Foley’s catheter in place of Hunter’s rod, and the patients were followed for an average period of 18 months. Early controlled motion exercise protocol was instituted in all cases. Results: As per the Strickland scale, total active motion obtained was excellent in 70%, good in 20%, fair in 7.1% and poor in 2.9% of patients. Conclusions: Silicone Foley’s catheter is cheaper, easily available and an effective alternative to Hunter’s rod in staged flexor tendon reconstruction procedure, yielding high rates of excellent and good results with fewer complications.

MANAGEMENT OF FLEXOR TENDON INJURIES — PART 2: CURRENT PRACTICE IN AUSTRALIA AND GUIDELINES FOR TRAINING YOUNG SURGEONS

Hand Surgery ◽  
2014 ◽  
Vol 19 (02) ◽  
pp. 305-310 ◽  
Author(s):  
Sarah K. Tolerton ◽  
Richard D. Lawson ◽  
Michael A. Tonkin
Keyword(s):  
New Jersey ◽  
Current Practice ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Active Motion ◽  
Polyester Suture ◽  
Active Flexion ◽  
Flexor Tendon Injuries ◽  
Materials Used

Introduction: This study aims to gain a better understanding of current practice for the surgical management and rehabilitation of flexor tendon injuries in Australia, with the intent of establishing common guidelines for training of young surgeons. Methods: A survey was distributed to the membership of the Australian Hand Surgery Society to determine whether a consensus could be obtained for: suture material and gauge; core and epitenon suture techniques; sheath and pulley management; and post-operative protocols for primary flexor tendon repair. Results: The predominant materials used for core suture are TicronTM Suture (Tyco Healthcare Group LP, Norwalk, Connecticut, USA) (34%) and EthibondTM Polyester Suture (Ethicon, Somerville, New Jersey, USA) (24%). The two core suture configurations commonly used are the Adelaide (45%) and Kessler (32%) repair. The predominant materials used for epitendinous sutures are 6-0 ProleneTM Polypropylene Suture (Ethicon, Somerville, New Jersey, USA) (56%), 5-0 ProleneTM (21%) and 6-0 EthilonTM Nylon Suture (Ethicon, Somerville, New Jersey, USA) (13%); and the majority (63%) use a running epitendinous technique. The management of critical pulleys is variable, with 89% prepared to perform some release of A2 and A4 pulleys. Rehabilitation protocols vary widely, with 24% of respondents using the same method for all patients, while 76% tailor their approach to each patient. Some component of active motion was used by most. Discussion: There exists some consensus on the management of flexor tendon injuries in Australia. However, the management of critical pulleys and methods of post-operative rehabilitation remain varied. For the training of young surgeons, a majority advise a 3-0 gauge braided polyester core suture of four strands, combined with a 6-0 ProleneTM simple running epitendinous suture for increased tendon repair strength and smooth glide. Trainees should attempt to retain the integrity of the A2 and A4 pulleys. Post-operative rehabilitation should include a component of active flexion.

Flexor Subzone II A–D Range of Motion Progression during Healing on a No-Splint, No-Tenodesis Protection, Immediate Full Composite Extension Regimen

2019 ◽  
Vol 24 (04) ◽  
pp. 405-411
Author(s):  
Mark Henry ◽  
Forrest H. Lundy
Keyword(s):  
Flexor Tendon ◽  
Dash Score ◽  
Active Motion ◽  
Rehabilitation Protocol ◽  
Single Finger ◽  
Total Active Motion ◽  
Joint Flexion ◽  
Zone Ii ◽  
Therapy Protocol ◽  
High Range

Background: The objective was to study the hypotheses that an advanced zone II flexor tendon rehabilitation protocol would avoid rupture, achieve a high range of excursion, and minimize interphalangeal contracture during both the early phases and at the conclusion of healing. We also proposed the null hypothesis of no difference between any two of the zone II subdivisions. Methods: Fifty-one consecutive adult patients with zone II flexor tendon repairs of a single finger were retrospectively evaluated on an active contraction rehabilitation protocol with no splint, no tenodesis protection, and immediate full composite extension. There were 38 males and 13 females with a mean age of 39 years (range 18–69) involving 15 index, 7 long, 6 ring, and 23 small fingers. Repairs were located in flexor subzone IIA for 8 fingers; subzone IIB, 14; subzone IIC, 19; and subzone IID, 10. Differences in outcome between any two subzones were compared by T-test with p < 0.05. Results: Mean active arcs of motion in degrees at 3 weeks post repair were PIP 1-93; DIP 0-44; and total active motion (TAM) 221. At 6 weeks PIP 2–98; DIP 1–51; and TAM 236. At 10–12 weeks PIP 1–101; DIP 1–56; and TAM 246. Final TAM by flexor subzone IIA was 243; IIB, 251; IIC, 246; and IID, 246. There were no significant differences between any two subzones. Mean final DASH score was 5. There were no ruptures. Conclusions: The results support the hypotheses. Outcomes of the therapy protocol demonstrated the lack of interphalangeal joint flexion contractures, high range of total active motion achieved early and sustained, and no ruptures. No differences were identified between and two of the flexor subzones.

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