gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Article

Send article

Identifying and minimizing secondary complications associated with flexor tendon repairs in zones I and II

Meeting Abstract

Search Medline for

  • presenting/speaker Juliana Larocerie - Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health care London, London, Canada
  • Shrikant Chinchalkar - Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health care London, London, Canada

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSHT19-1252

doi: 10.3205/19ifssh1458, urn:nbn:de:0183-19ifssh14588

Published: February 6, 2020

© 2020 Larocerie et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Clinical issue/s: Despite the number of rehabilitation guidelines developed to maximize gliding excursion of repaired tendons, secondary complications, such as decreased range of motion and stiffness associated with adhesions, commonly arise. If inadequately treated, secondary complications may lead to fixed deformities and reduced function. An appropriate treatment regimen, therefore, must not only include strategies to maintain the integrity of the repaired tendon, but also avoid secondary complications.

The purpose of this paper is to present a case series, in which rehabilitation of flexor tendon injuries combined various existing guidelines optimizing tendon gliding and strategies minimizing secondary complications.

Clinical reasoning: Patients with flexor tendon injuries in zones I and II were considered for this case series. They were provided with a traditional Dorsal Block Orthosis with the wrist positioned at approximately 30° of extension, and instructed in a rehabilitation regimen combining concepts of synergistic wrist motion, maximum differential tendon gliding, and active mid-range flexion within the constraints of the orthosis. Secondary complications were identified and addressed in a timely fashion. Measurements of range of motion were taken.

Innovative, analytical or new approach: A total of eight patients with flexor tendon injuries in zones I (5 patients) and II (3 patient) were treated with a combined rehabilitation regimen in our Centre. Patients age range from 15 to 56, 2 female and 6 males.

In average, patients were seen for 4 months. At the time of the last follow-up visit, patients had a mean of 101° of proximal interphalangeal (PIP) joint flexion and 58°of distal interphalangeal (DIP) joint flexion.

Contribution to advancing HT practice: Combining rehabilitation guidelines seem to provide adequate protection to the healing tendon, while minimizing adhesion formation and secondary complications leading to potential fixed deformities.Early detection of secondary complications associated with tendon adhesions may prevent the need for secondary surgery.