tendon injury rehab of hand Flashcards
diagnosis of tendon injury
Open wound or trauma over the pathway of a tendon
Resting posture of the hand is altered compared to the other hand, despite the absence of a wound
In ability to actively flex or extend the joint distal to laceration
trauma considerations for the tendon
Multiple system trauma
Timing of the repair
Psychological factors
Mechanism of laceration
strength of the repaired tendon decreases
10-60% between days 5-21 post op
as tendon sutures are absorbed and the strength is dependent on the integrity of the tendon
flexor tendon zone five
Distal forearm up to the wrist
neuro vascular involvement injuries often occur in region
often multiple tendons
moi- self inflicted or from pushing hand through window
flexor tendon zone four
Directly over the carpal tunnel
Vascular injuries often accompany lacerations in this region
flexor tendon zone three
Injuries in the Palmar region
May involve the intrinsic muscles as well
moi- knife accidents
flexor tendon zone two
Begins at the distal palmar crease extends to the middle phalanx
no mans land due to the complicated repair and rehabilitation rehabilitation necessary to restore tendon gliding in this region
Injury often includes the pulleys and may also involve a digital nerve zone
flexor tendon zone one
Begins at the middle phalanx and extends to the fingertip
good prognosis
A ring finger avulsion occurs here
tenons are made up of how much collagen
70%
With a linear collagen arrangement
three primary approaches for flexor tendon rehabilitation
kleinert protocol
duran protocol
Early active motion protocol
kleinert protocol
dynamic finger flexion orthosis
-wrist at 10 to 30° flexion, MCPjt at 70 flexion, IPjts at 0
Movement
Active finger extension with dynamic tension to passively flex the fingers
PROM of Individual joints within the orthosis, 4 to 6 times a day
duran protocol
dorsal blocking orthosis
-wrist at 10 to 30° flexion, MCPjt 30-70 flexion, IPjts at 0
No dynamic component
Movement
PROM of individual joints within the orthosis 4 to 6 times a day
Begin AROM 4 to 6 weeks
early active motion protocol
Dorsal blocking orthosis
Wrist in 0 to 20°
MPjts 30-70
IPjts 0
Movement wrist in 20° of dorsiflexion
3-5 days postop; PROM within the orthosis, and controlled active half fisted motion
HEP progressively allows for increased flexion
Extensor tendon zone seven
Extensor retinaculum across the dorsum of the wrist
Extensor tendon zone 3-6
common area for injury spanning the region from the dorsal wrist to the proximal phalanx
The result of a fist going through or a knife accident
extensor tendon zone one
Where avulsions of the terminal extensor tendon occur
mallet finger
Extensor tendon rehab approaches
gapping and rupture are rarely an issue and carefully applied to postoperative regimen
Immobilization
Short arc motion
Controlled active motion
Dynamic extension protocols
injury in zone one immobilization protocol
mallet finger
Rupture of the terminal tendon at the distal phalanx
Static DIP joint extension 6-8 wks
Conservative treatment is as effective as surgical treatment
zone two immobilization protocol
Static PIP and DIP joint extension six weeks
Short arc motion at 3 to 4 weeks
short arc motion
Common for zone three
Immobilization - PIP and DIP jt in full extension
Short arc blocking splints used for HEP
Controlled active motion protocol
common for zones 4 to 7
1 to 3 weeks = wrist cock up in 25-30 and a finger yoke orthosis supporting 15-20 hyper extension
wrist cock up discontinued at 4 wks
progress to the finger yoke only until six weeks postop
Dynamic extension protocol
Applied to zones 3-7
Rheumatoid arthritis tendon ruptures
Multiple digits and soft tissue trauma
Concept allows for controlled active function with passive extension provided by elastic tension
Goals for all tendon injuries
protect against a tendon rupture
Prevent flexion contractures and extensor lags
Facilitate a functional grasp
Scar management
prevent adhesions
Edema management
