scholarly journals Evaluation of Rehabilitation of Surgically Repaired Flexor Hand Tendons and Ultrasonographic Follow up of Their Healing

2021 ◽  
pp. 64-72
Author(s):  
Nourhan Elsayed Hebeshi ◽  
Nagat Mohamad El-Gazzar ◽  
Amal Mohamad El-Barbary ◽  
Marwa Ahmed Abo El-Hawa
Keyword(s):  
Grip Strength ◽  
Surgical Repair ◽  
Assessment Tool ◽  
Tendon Repair ◽  
Tendon Healing ◽  
High Frequency Ultrasound ◽  
Active Motion ◽  
Flexor Tendons

Objectives: To evaluate the role of early rehabilitation of surgically repaired flexor hand tendons in improvement of clinical outcome and the role of musculoskeletal ultrasound in follow up of their healing. Patients and methods: Thirty patients with 31 repaired flexor tendons. Assessment was done after 2nd, 4th,8th and 12th weeks of rehabilitation by visual analogue scale (VAS), total active motion of injured fingers (TAM), grip strength, hand assessment tool (HAT) score and ultrasound (US). Results: There was a significant development in pain assessed by VAS, TAM, grip strength and HAT score of the affected hand (p<0.001). Ultrasonographic assessment of healing flexor tendons showed significant improvement in defect size, thickness, vascularity, echogenicity and margination. There was positive correlation between margination of healing flexor tendon with VAS, hand grip and HAT score. Conclusions: Application of proper rehabilitation programs has a great impact on improving the functional outcome after surgical repair of flexor hand tendons. High-frequency ultrasound is used to follow up tendon healing after surgical repair and to assess the state of tendon repair in relation to clinical result.

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

Hand ◽  
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.

Reduction of Grip Strength, Finger Flexion Pressure, Finger Pinch Pressure and Key Pinch Following Flexor Tendon Repair

1987 ◽  
Vol 12 (2) ◽  
pp. 182-184
Author(s):  
D. T. GAULT
Keyword(s):  
Grip Strength ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Pollicis Longus ◽  
Flexor Tendon Repair ◽  
Flexor Tendons ◽  
Finger Flexion

67 patients with 176 repaired flexor tendons have been reviewed after a mean follow-up interval of 26.4 months. After repair, mean grip strength was 74.5%, mean finger flexion pressure 76.8% and mean finger pinch pressure 74.7% of that of the opposite uninjured hand or digit. For 16 patients with repaired flexor pollicis longus tendons, mean key pinch was 78.7%. Grip strength was reduced after injury to tendons alone, but was especially reduced when there was concomitant damage to the median or ulnar nerves.

scholarly journals Intramedullary Screws versus Kirschner Wires for Metacarpal Fixation, Functional, and Patient-Related Outcomes

2018 ◽  
Vol 04 (01) ◽  
pp. e29-e33 ◽  
Author(s):  
Jose Couceiro ◽  
Higinio Ayala ◽  
Manuel Sanchez ◽  
Maria De la Red ◽  
Olga Velez ◽  
...  
Keyword(s):  
Return To Work ◽  
Grip Strength ◽  
Kirschner Wire ◽  
Kirschner Wires ◽  
Active Motion ◽  
Contralateral Hand ◽  
Total Active Motion ◽  
Quick Dash ◽  
Dash Questionnaire

Purpose The purpose of our study is to compare the intramedullary fixation of metacarpal fractures with cannulated headless screws and antegrade Kirschner wires in terms of final total active motion, grip strength, patient-related outcomes, need for casting, and return to work times. Methods The authors performed a retrospective review of the hospital records. Thirty fractures were included in the study, 19 in the screw fixation group, and 11 in the Kirschner wire group. Grip strength, and total active motion, was measured at the latest follow-up for both the injured and contralateral hand. Pain was measured on the visual analog scale. Patients were requested to fill a Quick disabilities of the arm and hand score (DASH) questionnaire at the latest follow-up. Satisfaction was measured on a scale from 0 to 10. The time to return to work was quantified from the accident to the point when the patient was back to active duty. Postoperative casting time was also quantified. Results The authors did not find any differences between the two groups in total active motion, grip strength, pain, satisfaction, or Quick DASH scores. We did find a difference in the return to work and casting times; these appeared to be shorter in the screw group. Conclusion Due to the small number of cases, we have been unable to clearly conclude that there were any benefits in the application of one particular technique when compared with the other.

Severe ulnar nerve entrapment at the elbow: functional outcome after minimally invasive in situ decompression

2012 ◽  
Vol 37 (2) ◽  
pp. 115-122 ◽  
Author(s):  
K. Karthik ◽  
R. Nanda ◽  
S. Storey ◽  
J. Stothard
Keyword(s):  
Minimally Invasive ◽  
Grip Strength ◽  
Ulnar Nerve ◽  
Nerve Compression ◽  
Ulnar Nerve Compression ◽  
Pinch Grip ◽  
Simple Decompression

The role of in situ decompression in patients with severe ulnar nerve compression is still controversial. Thirty patients with severe ulnar nerve compression confirmed clinically and electrophysiologically underwent simple decompression. The mean age of the patients was 58 (range 26–87) years. Through incisions ≤4 cm the nerves were fully visualized and decompressed. Outcome was measured prospectively using Modified Bishop’s score (BS), grip and pinch strengths and two-point discrimination (2PD). Significant improvement in power (p = 0.01) and pinch grip (p = 0.001) was noted at 1 year. The grip strength continued to improve up to 1 year. According to the BS, 24 patients (80%) had good to excellent results at 1 year. Minimally invasive in situ decompression is technically simple, safe and gives good results in patients with severe nerve compression. The BS and 2PD were more reliable than grip strength in assessing these patients at follow-up.

scholarly journals Dual Antegrade Intramedullary Headless Screw Fixation for Treatment of Unstable Proximal Phalanx Fractures

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 494-499 ◽  
Author(s):  
Michael P. Gaspar ◽  
Shiv D. Gandhi ◽  
Randall W. Culp ◽  
Patrick M. Kane
Keyword(s):  
Grip Strength ◽  
Proximal Phalanx ◽  
Retrospective Chart Review ◽  
Active Motion ◽  
Minimally Invasive Surgical ◽  
Number Of Patients ◽  
Total Active Motion ◽  
Minimally Invasive Surgical Treatment ◽  
Study Inclusion

Background: Although intramedullary headless screw (IMHS) fixation is a promising minimally invasive surgical treatment option for unstable proximal phalanx fractures, a single IMHS may provide inadequate fixation for certain fracture patterns. The purpose of this study was to evaluate the short-term clinical outcomes in a pilot series of patients with proximal phalanx fractures treated with dual antegrade IMHS fixation. Methods: We performed a retrospective chart review of proximal phalanx fractures treated with dual antegrade IMHS fixation with a minimum 1 year of follow-up. Demographic information including patient age, sex, occupation, workers’ compensation status, mechanism of injury, hand dominance, and injured digit were obtained. Postoperative outcomes measured included range of motion, grip strength, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome scores, return to full-duty work interval, and complications. Results: Ten fractures in 10 patients (4 male, 6 female) satisfied study inclusion. The mean age of patients was 39 years (range, 20-62), and average follow-up duration was 84 weeks (range, 61-106). Final postoperative total active motion was 258° (range, 245°-270°), mean grip strength was 97% (range, 84%-104%) of the uninjured side, and QuickDASH score was 3.9 (range, 0-13.6). No complications occurred, and no patients required additional intervention. Conclusions: Dual antegrade IMHS fixation of proximal phalanx fractures resulted in excellent postoperative motion, near-normal grip strength, positive self-reported patient outcomes, and no complications with follow-up of at least 1 year. Further study in a larger number of patients is warranted to determine if this promising technique is superior to other modes of fixation.

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

Results of heterodigital flexor digitorum profundus hemi-tendon transfer for 23 flexor tendon injuries in zones 1 or 2

2017 ◽  
Vol 43 (5) ◽  
pp. 487-493 ◽  
Author(s):  
Aude Bommier ◽  
Duncan McGuire ◽  
Patrick Boyer ◽  
Asan Rafee ◽  
Sami Razali ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Flexor Tendon Injuries ◽  
Flexor Digitorum

We report outcomes of reconstruction of zone 1 or 2 flexor tendon injuries using a heterodigital hemi-tendon transfer of the flexor digitorum profundus in 23 fingers of 23 patients. At mean follow-up of 57 months, the mean total active motion of the three finger joints including the metacarpophalangeal joint was 128 degrees preoperatively and 229 degrees at final follow up. According to Strickland criteria, the function was excellent for 14 fingers, good for seven fingers and poor for two fingers. The subgroup analysis showed that the results were better in cases of primary surgery, children, and for the index and little fingers. Complications included stiffness of three fingers, and rupture in one finger that was converted to a two-stage tendon reconstruction. We conclude that this technique restores good function in most patients with zone 1 and 2 flexor tendon injuries, in which primary tendon repair has not been performed or was unsuccessful, and where pulley reconstruction is not required. Level of evidence: IV

Outcomes of the six-strand M-Tang repair for zone 2 primary flexor tendon repair in 54 fingers

2017 ◽  
Vol 42 (5) ◽  
pp. 462-468 ◽  
Author(s):  
X. Zhou ◽  
X.R. Li ◽  
J. Qing ◽  
X.F. Jia ◽  
J. Chen
Keyword(s):  
Full Range ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Active Motion ◽  
A2 Pulley ◽  
Male Patients ◽  
Early Passive ◽  
One Year

We repaired complete divisions of flexor tendons in zone 2 in 54 fingers using a six-strand core M-Tang repair method. Partial active digital motion started with early passive digital motion carried out first in the first 3–4 weeks after surgery and full range of active motion in later weeks. The patients were followed for 4–27 months. According to Strickland criteria or Tang criteria, 24 (83%) had excellent or good, four fair and one poor results in 28 fingers with follow-up of more than one year. In the other 25 fingers which were followed for less than 12 months, 19 (76%) had excellent and good, four fair and two poor results. There were no repair ruptures. We analysed outcomes against ages, gender, pulley integrity, accompanied injuries and follow-up times. The patients younger than 37 years old, male patients and with their A2 pulley(s) vented there were significantly better outcomes. The patients with longer than one year follow-up had significantly smaller extension deficits than those with less than one year follow-up. Level of evidence: IV

CLINICAL RESULTS OF EARLY ACTIVE MOBILISATION AFTER FLEXOR TENDON REPAIR

Hand Surgery ◽  
2008 ◽  
Vol 13 (01) ◽  
pp. 45-50 ◽  
Author(s):  
C. H. Yen ◽  
W. L. Chan ◽  
J. W. C. Wong ◽  
K. H. Mak
Keyword(s):  
Grip Strength ◽  
Tendon Repair ◽  
Clinical Results ◽  
Flexor Digitorum Profundus ◽  
Pinch Strength ◽  
Paired Samples ◽  
Full Flexion ◽  
Zone Ii ◽  
Flexor Digitorum

Between 2005 and 2006, ten patients with flexor digitorum profundus zone II injuries were included. The mean age was 41 (19–84) years. One thumb, two index, four middle, one ring and two little fingers were injured. Repair method comprised four-strand core suture and 6-0 circumferential sutures. Post-operative rehabilitation included immediate active extension, progressive passive full flexion and active hold in dorsal block splint. Follow-up was four (three to seven) months. Grip strength, pinch strength, ROM was 90% (70%–90%), 90% (60%–110%) and 90% (80%–100%) of normal digit, respectively. Mayo wrist scores were five excellent, two good and three fair. All patients were satisfied. Compared with another group of ten patients with the same suture method and Kleinert splintage, grip strength, pinch strength and ROM were 50%, 40% and 40% of normal side, respectively. All differences between these two groups were statistically significant (p < 0.01) by paired samples T-test. There was no re-rupture.

A Comparison of Two Monofilament Suture Materials for Repair of Partial Flexor Tendon Lacerations: A Controlled In-vitro Study

2017 ◽  
Vol 22 (01) ◽  
pp. 18-22
Author(s):  
Abhinav Gulihar ◽  
Thomas Whitehead-Clarke ◽  
Ladan Hajipour ◽  
Joseph J. Dias
Keyword(s):  
Surgical Repair ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
In Vitro Study ◽  
Suture Repair ◽  
Suture Materials ◽  
Flexor Tendons ◽  
Before And After ◽  
Materials Used

Background: Surgical repair is advocated for flexor tendon lacerations deeper than 70%. Repair can be undertaken with different suturing techniques and using different materials. Different materials used for tendon repair will have a different gliding resistance (GR) at the joint. Previous studies have compared strength of repair and gliding resistance for various braided suture materials and for 100% laceration of flexor tendons. We directly compare the GR of two monofilament sutures when used for a peripheral running suture repair of partially lacerated tendons. Methods: Sixteen flexor tendons and A2 pulleys were harvested from Turkey feet. They were prepared, partially lacerated to 50% depth, and then repaired with a core suture (modified Kessler technique with 4-0 Ethibond) as well as an additional superficial running suture of either 6-0 Prolene or Nylon (half randomised to each). Gliding resistance was measured for all tendons before and after repair, at different flexion angles (40 and 60 degrees) and for different loads (2N and 4N). Results: After surgical repair, gliding resistance was increased for all tendons (P < 0.01). The tendons repaired with Prolene had a higher mean gliding resistance than those repaired with Nylon (P = 0.02). Increased flexion angle and load amplified the gliding resistance (both P < 0.01). Conclusions: 6-0 Nylon was associated with a lower gliding resistance than 6-0 Prolene but the minor differences bare unknown clinical significance.

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