Does Digital Nerve Injury Affect Range of Motion Recovery After Zone 2 Flexor Tendon Repair?

Hand ◽

10.1177/15589447211003187 ◽

2021 ◽

pp. 155894472110031

Author(s):

Grace Keane ◽

Macyn Stonner ◽

Mitchell A. Pet

Keyword(s):

Range Of Motion ◽

Nerve Injury ◽

Flexor Tendon ◽

Tendon Repair ◽

Digital Nerve ◽

Flexor Tendon Repair ◽

Motion Recovery ◽

Flexor Digitorum ◽

The Impact

Background Evidence surrounding the impact of concomitant digital nerve injury on the outcome of zone 2 flexor tendon repair is sparse and conflicting. The purpose of this study is to assess the impact of digital nerve injury on the range of motion recovery after zone 2 flexor tendon repair. We hypothesized that digital nerve injury is independently associated with decreased motion after zone 2 flexor digitorum profundus (FDP) repair. Methods This is a single-institution, multisurgeon retrospective analysis of patients treated with primary zone 2 FDP repair. Patients with or without digital nerve injuries were included. Patients with fracture, extensor tendon injury, dysvascularity, follow-up duration of less than 10 weeks, and younger than 15 years were excluded. The primary outcome measure was Strickland percentage at the last therapy visit. Bivariate analysis was performed using simple linear regression. These results were used to guide backward stepwise multivariable analysis of qualifying exploratory variables. Results Forty-one patients with a total of 54 zone 2 FDP injuries qualified. Mean follow-up duration was 24 ± 10 weeks, and mean age was 38 ± 18 years. Thirty-three digits had a concomitant digital nerve injury, 26 digits had multidigit involvement, and 42 digits had combined FDP and flexor digitorum superficialis (FDS) injuries. Both older age and concomitant FDS injury exhibited independent relationships with poorer range of motion outcomes ( P < .05). Digital nerve injury, follow-up duration, gender, and multidigit involvement did not influence final digital motion. Conclusions In patients undergoing zone 2 FDP repair, concomitant digital nerve injury is not independently associated with poorer postoperative active range of motion.

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

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414551682 ◽

2014 ◽

Vol 40 (3) ◽

pp. 250-258 ◽

Cited By ~ 51

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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Autonomous Patient-Controlled Mobilization Protocol After Flexor Tendon Repair: A Case Series

Hand ◽

10.1177/1558944720964961 ◽

2020 ◽

pp. 155894472096496

Author(s):

Bárbara Gómez ◽

María Rodríguez ◽

Luis García

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Flexor Tendon ◽

Tendon Repair ◽

Case Series ◽

Flexor Tendon Repair ◽

Active Motion ◽

Early Return ◽

The Mean

Background: Despite many publications on rehabilitation after repair of flexor tendon injuries of the hand, there is no consensus as to which method is superior. It is clear that nonadherence to postoperative therapy adversely affects the outcome after flexor tendon surgery. In the context of a developing country, the most important factor associated with poor outcome is late onset of rehabilitation therapy. An autonomous rehabilitation program is proposed, with the use of a low-cost splint and based on an online illustrative video with the expectation to improve adherence and patient compliance, thus ensuring satisfactory outcome. Methods: Twenty-two consecutive digits of 14 patients after flexor tendon repair in zone II were included. Autonomous early passive mobilization physical therapy and splinting started shortly after surgery, supported by an online available video depicting prescribed exercises; follow-up was continued until postoperative week 20. Patients were evaluated regarding range of motion, grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) disability scale. Results: Range of motion after 20 weeks according to the scoring system of the American Society of Surgery of Hand was excellent in 4, good in 11, and fair in 4 fingers. The mean total active motion score was 86% (95% confidence interval, 78%-93%). The mean grip strength at final follow-up was 86% of the contralateral hand. The mean QuickDASH score was 12.5 (2.3-31.8). Conclusion: This protocol achieves good results in range of motion and early return of function of the hand. We propose this simple, nonexpensive method to developing countries with less than optimal availability of health care.

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Functional Outcomes of Flexor Tendon Repair in the Fingers: A Comparison of Wide-Awake Local Anesthesia No Tourniquet Versus Traditional Anesthesia

Hand ◽

10.1177/15589447211064364 ◽

2022 ◽

pp. 155894472110643

Author(s):

Clay B. Townsend ◽

Tyler W. Henry ◽

Jonas L. Matzon ◽

Daniel Seigerman ◽

Samir C. Sodha ◽

...

Keyword(s):

Range Of Motion ◽

Local Anesthesia ◽

Functional Outcomes ◽

Flexor Tendon ◽

Tendon Repair ◽

Complication Rates ◽

Flexor Tendon Repair ◽

Wide Awake ◽

No Tourniquet

Background: Flexor tendon lacerations in the fingers are challenging injuries that can be repaired using the wide-awake local anesthesia no tourniquet (WALANT) technique or under traditional anesthesia (TA). The purpose of our study was to compare the functional outcomes and complication rates of patients undergoing flexor tendon repair under WALANT versus TA. Methods: All patients who underwent a primary flexor tendon repair in zone I and II without tendon graft for closed avulsions or open lacerations between 2015 and 2019 were identified. Electronic medical records were reviewed to record and compare patient demographics, range of motion, functional outcomes, complications, and reoperations. Results: Sixty-five zone I (N = 21) or II (N = 44) flexor tendon repairs were included in the final analysis: 23 WALANT and 42 TA. There were no statistical differences in mean age, length of follow-up, proportion of injured digits, or zone of injury between the groups. The final Quick Disabilities of the Arm, Shoulder, and Hand score in the WALANT group was 17.2 (SD: 14.4) versus 23.3 (SD: 18.5) in the TA group. There were no statistical differences between the groups with any final range of motion (ROM) parameters, grip strength, or Visual Analog Scale pain scores at the final follow-up. The WALANT group was found to have a slightly higher reoperation rate (26.1% vs 7.1%; P = .034) than the TA group. Conclusions: This study represents one of the first clinical studies reporting outcomes of flexor tendon repairs performed under WALANT. Overall, we found no difference in rupture rates, ROM, and functional outcomes following zone I and II flexor tendon repairs when performed under WALANT versus TA.

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A Modified Kleinert Controlled Mobilization Splint Following Flexor Tendon Repair

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(84)80039-x ◽

1984 ◽

Vol 9 (2) ◽

pp. 217-218 ◽

Cited By ~ 36

Author(s):

P. G. SLATTERY ◽

D. A. McGROUTHER

Keyword(s):

Range Of Motion ◽

Flexor Tendon ◽

Tendon Repair ◽

Interphalangeal Joint ◽

Flexor Digitorum Profundus ◽

Distal Interphalangeal Joint ◽

Normal Range ◽

Flexor Tendon Repair ◽

Distal Interphalangeal ◽

Flexor Digitorum

The Controlled Mobilization Splint as described by Kleinert for use following flexor tendon repair has been modified to more closely simulate the normal range of motion of the fingers and in particular to increase the range of motion at the distal interphalangeal joint and so enhance the relative gliding of the flexor digitorum superficialis and flexor digitorum profundus tendons and hence possibly to reduce potential intertendinous adhesions.

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

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193418809796 ◽

2018 ◽

Vol 44 (4) ◽

pp. 354-360 ◽

Cited By ~ 11

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

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Gross and Histological Analysis of Healing After Dog Flexor Tendon Repair with the Teno Fix™ Device

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2006.01.006 ◽

2006 ◽

Vol 31 (5) ◽

pp. 524-529 ◽

Cited By ~ 13

Author(s):

B. W. SU ◽

F. J. RAIA ◽

H. M. QUITKIN ◽

M. PARISIEN ◽

R. J. STRAUCH ◽

...

Keyword(s):

Flexor Tendon ◽

Weight Bearing ◽

Tendon Repair ◽

Tendon Healing ◽

Full Weight Bearing ◽

Cast Immobilization ◽

Flexor Tendon Repair ◽

The Common ◽

Flexor Digitorum

The purpose of this study was to examine the in vivo characteristics of the stainless-steel Teno Fix™ device used for flexor tendon repair. The common flexor digitorum superficialis tendon was transected in 16 dogs and repaired with the device. The animals were euthanized at 3, 6, or 12 weeks postoperatively. Difficulties with cast immobilization led nine of 16 animals to be full weight bearing too early, leading to rupture of their repairs. The seven tendons with successful primary repairs (gap <2 mm) underwent histological examination. This in vivo study demonstrates that use of the Teno Fix™ in “suture” of dog flexor tendons did not lead to scarring at the tendon surface, does not cause an inflammatory reaction within the tendon and does not interfere with tendon healing.

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