The Effect of early active Movement following Repair of Extensor Tendons in Zone IV using three different suture Techniques – A cadaveric Study

Purpose The aim of this study was to investigate the effects of early active movement on the area repaired with three different suture techniques used in extensor tendon injuries in zone IV. Materials and Methods A total of nine cadaver’s 35 extensor tendons from 9 intact upper extremities were used in this study. The proximal and distal borders of the extensor tendons in zone IV were marked. The distance between the proximal and distal border was measured with a 0.5 mm precision tape measure and the mid-point was marked. Intertendinous connections were dissected and loop sutures were prepared for each extensor digitorum. Afterwards, force was applied to each digit along the tendon axis from the loops inserted into the extensor tendons, to measure the extensor forces required to extend the MCP joints to 0˚ with a hand scale. The flexor tendons of the digits were dissected at zone III, and loop sutures were prepared individually for the tendons to enable independent flexion for each digit. The force required to fully flex the digits was measured with a hand scale. The extensor tendons were incised transversely and repaired at the mid-point in zone IV with three different suture techniques (double Kessler, double figure of eight, running interlocking horizontal mattress (RIHM)). The extenxor tendon lengths in zone IV were re-measured for all digits after suturing. The predetermined forces required for full flexion and extension of the digits were applied to the repaired digits. After force was applied 20 times to each tendon, the gap formation was checked. Totally 200 flexion and 200 extension movements were applied to each finger with the help of a hand-held scale. Formation of 2-mm gap was failure criteria. At the end of the movements the extent of the gaps was recorded. In the absence of insufficiency at the repair site, 50 additional flexion and extension movements with double the previously recorded forces were applied to the tendons. Results There was a significant shortening of the extensor tendons after repair independent from the used suture technique. No significant gap formation was detected in all three suture techniques. Conclusion All three suturing techniques are reliable for early active movements following the zone IV extensor tendon repairs. Therefore, surgeons can choose one of those three suture techniques to repair extensor tendon injuries in zone IV.

Hand therapy, rehabilitation, and rehabilitation following tendon injury

This chapter describes the principles and techniques applied by hand therapists in the management of hand conditions in general and specific details about protocols for rehabilitation of flexor and extensor tendon injuries.

Running Interlocking Horizontal Mattress—A New Technique versus Modified Kessler in Extensor Tendon Injuries: A Comparative Study

Introduction Pursuit for a new technique, which could be placed on flat extensor tendons and strong enough to withstand the tension forces of early mobilization to prevent stiffness, started few decades ago. We evaluated the new technique of tendon repair using running interlocking horizontal mattress (RIHM) sutures followed by early controlled motion protocol in traumatic extensor tendon injuries and compared it to modified Kessler technique. Materials and Methods We conducted a prospective randomized interventional study of 18 months’ duration, with 30 patients. A total of 103 tendons were repaired, of which 58 were repaired using modified Kessler technique and 45 were repaired using RIHM technique. Postoperatively, patients underwent the early controlled motion protocol and the results were evaluated using the criteria of Miller. Results Majority of the patients had excellent results (53.3%) and 46.67% had good results in the RIHM group while most of the patients in modified Kessler group had only fair results (80%), and only 20% had good results while none had excellent results. Conclusion RIHM suture is an easy-to-learn and effective technique for tendon repair with comparable operative duration and with better overall result than modified Kessler technique.

Pulley, Flexor, and Extensor Tendon Injuries of the Hand

Tendon injuries represent the second most common injury of the hand (after fractures) and are a common scanning indication in radiology. Pulley injuries are very frequent in rock climbers with the A2 pulley the most commonly affected. Tendon and pulley injuries can be reliably evaluated using ultrasound (US) and magnetic resonance imaging (MRI). US can be postulated as a first-line imaging modality, allowing dynamic examination. MRI is essential for cases with ongoing diagnostic doubt post-US and also for preoperative pulley reconstruction assessment.

Functional outcome of zone 5 to zone 8 extensor tendon injuries of hand managed with early active mobilization following repair using a static splint: an observational study

<p class="abstract"><strong>Background:</strong> Injuries to extensor tendons of the hand are underrepresented in the literature compared to flexor tendons. The concept of early mobilization following extensor tendon repair emerged as previous strategies of static immobilization lead to frequent adhesions and poor outcome. In our study we assessed the functional outcome of early active mobilization after extensor tendon repair using a static splint. </p><p class="abstract"><strong>Methods:</strong> In this observational study 42 patients with 48 extensor tendon severances of the hand from zone 5 to 8 were selected. Following repair, early active mobilization with a static splint was done and the functional outcomes were assessed using the Dargan criteria. <strong></strong></p><p class="abstract"><strong>Results:</strong> After mobilizing for 4 weeks, out of total 48 patients, 18 (43%) had good outcomes, 19 (45%) had fair and 5 patients (12%) had poor outcome. After 6 weeks 14 patients (33.3%) had excellent, 20 patients (48%) had good and 6 patients (14%) had fair outcomes whereas only one patient (2.4%) had poor outcome. This result was statistically significant with a p value of 0.000.</p><p class="abstract"><strong>Conclusions:</strong> Early active mobilization following extensor tendon repair from zone 5 to 8 prevents adhesion around the repair site, leads to better post-operative outcome and faster recovery. Using a static splint along with a patient friendly, easily comprehensible rehabilitation protocol offers results comparable to the use of dynamic splints and requires fewer post-operative follow ups. The static splints being cheap, easy to construct are financially beneficial to the patients. </p>