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

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.

Sonography of tendon pathology in the hand and wrist

Traumatic and non-traumatic tendon lesions are common at the wrist and hand. For the diagnosis, therapy management, and long-term prognosis of tendon lesions, a detailed understanding of the complex anatomy and knowledge of typical injury patterns is crucial for both radiologists and clinicians. Improvements in high-resolution ultrasound are producing high quality images of the superficial tendinous and peritendinous structures. Thus, ultrasound is a valuable first-choice tool for visualizing traumatic, inflammatory, and degenerative conditions of the extensor and flexor tendons, particularly with the advantage of possible dynamic examination. The additional use of duplex-Doppler and power Doppler ultrasound imaging is recommended for detection of tenosynovitis in overuse injury, inflammatory disease, infection, and after traumatic conditions. In traumatic tendon injuries, knowing the precise injury zone is important for treatment decision-making. In cases of tendon rupture, the radiologist should report the tear type (i.e., complete or partial-thickness) and assess the degree of tendon retraction and associated avulsion injury, including the degree of fragment displacement. The function of intact flexor tendons may be impaired by thickening, strain, or rupture of corresponding annular pulleys. This review describes in detail the typical ultrasound imaging features of common pathologies of hand and wrist tendons, including annular pulley lesions.

On rehabilitation of patients with severe traumatic hand injury (case history)

Reconstruction of flexor tendons anatomic continuity at the level of osteofibrous canals is one of the most challenging in hand surgery. Due to the complex anatomy of the hand and a high risk of developing postoperative adhesions choosing the optimal treatment protocol remains crucial during flexor tendons rehabilitation period. Surgeons and rehabilitation specialists agree that a number of poor results of flexor tendon surgery can be caused by a wrong postoperative treatment, violation of treatment protocols or just by the lack of adequate rehabilitation measures. The aim of this study is analysis and the description of the case history of treating the teenager with concomitant hand injury after staged reconstructive and restorative nerve and tendon surgery. Materials and methods. The study analyses the use of intratissual electric stimulation (ITES) combined with the complex of special exercises for recovery of upper extremity function at the outpatient rehabilitation stage in patients who underwent nerve and tendon surgery. The objective pain syndrome and trophic innervation of the injured extremity assessment was performed by measuring skin surface electric potential using Gerasimov’s method. The results were interpreted according to “Personalized system of assessing the results of treating trauma and orthopedic patients”. Results. “Combination treatment in the rehabilitation of the upper extremity” proved to be effective to fight pain syndrome and trophic dysfunction of the nervous system. It allows the patient to do the complex of special exercises to prevent limb contracture if used during the late rehabilitation period. It is an efficient method of preventing and treating neurotrophic dysfunctions. Conclusion. The pathogenetically substantiated method of treating upper extremity, the use of intratissual electric stimulation at the outpatient rehabilitation stage of humerus fractures prove to be effective.

A Rare Case of Bilateral Spaghetti Injuries in Children due to Assault by Mother and Analysis of Functional Outcome at Three Years

Management of child abuse with flexor tendons, neurovascular injuries, and life-threatening conditions is challenging. It needs a multisectoral coordinated and synchronized team effort for successful outcomes. We present a case series of children abused by a parent with a sharp object. The children sustained multiple flexor tendon injuries, neurovascular injuries in upper limbs, and tracheal injury compromising respiration. We performed a tracheostomy to save a child and subsequently repaired numerous flexor tendons, nerves, and arteries. During follow-up, these children required secondary reconstruction (tenolysis, tendon lengthening, nerve reconstruction) for flexor contractures, stiffness, and sensory loss in distal forearms. We measured the range of movements and assessed the children’s functional outcome using the Strickland score at 3-year follow-up. The range of movement and functional outcome was excellent in both children in our series. A timely performance of surgery, aided with efficient intensive care, therapy, and consistent posttraumatic psychosocial rehabilitation, produced excellent results in our series.

1101 Closed Traumatic Avulsion of Both Flexor Digitorum Tendons: A Novel Treatment Method

Case Report Closed tendon avulsion of both flexor tendons (Flexor Digitorum profundus [FDP] and Flexor Digitorum superficialais [FDS]) in the same finger is an extremely rare condition. We are proposing this subtype of injury be added as a type VI to the current Leddy and Packer classification for FDP avulsion injuries. The objective of this being an increase in awareness to avoid misdiagnosis and to aid in the subsequent management if encountered. We present the case of a 27-year-old male who presented with an avulsion of both flexor tendons from their respective insertions in the ring finger following a sporting injury causing hyperextension against an actively flexed distal interphalangeal joint. This condition has previously been reported twelve times in the literature. We propose a novel treatment method not described for previous cases and examine the successful method of treatment in this case.

A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

Percutaneous release of the A1 pulley has been introduced as a therapeutic approach for trigger fingers and is suggested as an effective and safe alternative, where conservative treatments fail. The aim of the current study was to determine if percutaneous release with a 15° stab knife can effectively result in acceptable efficacy and lower complication rate. Methods In the present study, the percutaneous release of the A1 pulley was evaluated by percutaneous release using a 15° stab knife in 20 fresh-frozen cadaver hands (10 cadavers). One hundred fingers were finally included in the present study. The success rate of A1 pulley release as well as the complications of this method including digital vascular injury, A2 pulley injury, and superficial flexor tendon injury was evaluated, and finally, the data were analyzed by the SPSS software. Results The results showed a success rate of 75% for A1 pulley release in four fingers, followed by eleven fingers (90%) and eighty-five fingers (100%). Therefore, the A1 pulley was found to be completely released in eighty-five fingers (100%). Overall, the mean of A1 pulley release for these fingers was determined as 97.9%, indicating that percutaneous trigger finger release can be an effective technique using a 15° stab knife. Furthermore, our findings revealed no significant difference in the amount of A1 pulley release in each of the fingers in the right and left hands. Additionally, 17 fingers developed superficial scrape in flexor tendons, while 83 fingers showed no flexor tendons injuries and no other injuries (i.e., vascular, digital nerve, and A2 pulley injuries). Conclusions Percutaneous release of the A1 pulley using a 15° stab knife was contributed to acceptable efficacy and a relatively good safety in the cadaveric model.