Rehabilitation of Flexor Tendons in Zone II: What Aspects Should We Take into Account When Assisting These Patients? Literature Review
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Published:
Oct 10, 2021
Keywords:
Flexor tendons., rehabilitation, hand therapist, protocols, early active motion
Main Article Content
Abstract
The treatment of flexor tendons is a topic of interest and creates a constant challenge for both surgeons and rehabilitators. Numerous surgical techniques and treatments have been described in order to improve functional results, although nowadays there is no ideal protocol. The objective of this article is to analyze the relevant information in order to plan the rehabilitation of patients with flexor tendon injuries in zone II. Among other aspects, we will take into account the strenght of the suture, the edema, the scar, the type of immobilization and the tendon gliding. Good teamwork is required between the surgeon, the hand therapist, and the patient in order to plan the most appropriate rehabilitation for each case.
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How to Cite
Ortiz, J. (2021). Rehabilitation of Flexor Tendons in Zone II: What Aspects Should We Take into Account When Assisting These Patients? Literature Review. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(5), 696-704. https://doi.org/10.15417/issn.1852-7434.2021.86.5.1346
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Rehabilitación
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References
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2013;29(2):167-78. https://doi.org/10.1016/j.hcl.2013.02.002
2. Amadio PC. Friction of the gliding surface: implications for tendon surgery and rehabilitation. J Hand Ther
2005;18(2):112-9. https://doi.org/10.1197/j.jht.2005.02.005
3. Evans RB. Managing the injured tendon: current concepts. J Hand Ther 2012;25(2):173-89.
https://doi.org/10.1016/j.jht.2011.10.004
4. Hsiao PC, Yang SY, Ho CH, Chou W, Lu RL. The benefit of early rehabilitation following tendon repair of the hand: a population-based claims database analysis. J Hand Ther 2015;28(1):20-5. https://doi.org/10.1016/j.jht.2014.09.005
5. Tang JB. Flexor tendon injuries. Clin Plast Surg 2019;46(3):295-306. https://doi.org/10.1016/j.cps.2019.02.003
6. Skirven T, Osterman A, Fedorczyk J, Amadio P, Feldscher S, Shin E. Therapy techniques. En: Rehabilitation of the
hand and upper extremity. 7th ed. Philadelphia: Elsevier; 2020:1393-478.
7. Colditz J. Regaining flexor tendon glide within zone 2. HandLab 2016;40:1-2. Disponible en:
https://bracelab.com/clinicians-classroom/regaining-flexor-tendon-glide-within-zone-2
8. Giesen T, Reissner L, Besmens I, Politikou O, Calcagni M. Flexor tendon repair in the hand with the M-Tang
technique (without peripheral sutures), pulley division, and early active motion. J Hand Surg Eur 2018;43(5):474-9.
https://doi.org/10.1177/1753193418758269
9. Athlani L, Detammaecker R, Touillet A, Dautel G, Foisneau A. Effect of different positions of splinting on flexor
tendon relaxation: a cadaver study. J Hand Surg Eur 2019;44(8):833-7. https://doi.org/10.1177/1753193419865123
10. Savage R. The influence of wrist position on the minimum force required for active movement of the
interphalangeal joints. J Hand Surg Br 1988;13(3):261-8. https://doi.org/10.1016/0266-7681(88)90082-4
11. Peck FH, Roe AH, Ng CY, Duff C, McGrouther DA, Lees VC. The Manchester short splint: a change to splinting
practice in the rehabilitation of zone II flexor tendon repairs. J Hand Ther 2014;19(2):47-53.
https://doi.org/10.1177/1758998314533306
12. Woythal L, Holmer P, Brorson S. Splints, with or without wrist immobilization, following surgical repair of flexor tendon lesions of the hand: a systematic review. Hand Surg Rehabil 2019;38(4):217-22.
https://doi.org/10.1016/j.hansur.2019.05.004
13. Klifto CS, Bookman J, Paksima N. Postsurgical rehabilitation of flexor tendon injuries. J Hand Surg Am
2019;44(8):680-6. https://doi.org/10.1016/j.jhsa.2019.02.010
14. Venkatramani H, Varadharajan, Bhardwaj P, Vallurupalli A, Sabapathy R. Flexor tendon injuries. J Clin Orthop
Trauma 2019;10(5):853-61. https://doi.org/10.1016/j.jcot.2019.08.005
15. Chang M, Lim Z, Wong Y, Tay S. A review of cyclic testing protocols for flexor tendon repairs. Clin Biomech
2019;62:42-9. https://doi.org/10.1016/j.clinbiomech.2018.12.007
16. Vucekovich K, Gallardo G, Fiala K. Rehabilitation after flexor tendon repair, reconstruction, and tenolysis. Hand Clin 2005;21(2):257-65. https://doi.org/10.1016/j.hcl.2004.11.006
17. Strickland JW, Schmidt CC. Repair of flexor digitorum profundus lacerations: The Indiana method. Op Tech Orthop 1998;8(2):73-80. https://doi.org/10.1016/S1048-6666(98)80004-9
18. Higgins A, Lalonde D. Flexor tendon repair postoperative rehabilitation: the Saint John Protocol. Plast Reconstr Surg Global Open 2016;4(11):e1134. https://doi.org/10.1097/GOX.0000000000001134
19. Tang JB, Zhou X, Pan Z, Qing J, Gong K, Chen J. Strong digital flexor tendon repair, extension-flexion test, and
early active flexion: experience in 300 tendons. Hand Clin 2017;33(3):455-63.
https://doi.org/10.1016/j.hcl.2017.04.012
20. Tang JB, Amadio P, Guimberteau JC, Chang J. Clinical primary flexor tendon repair and rehabilitation. En: Tendon surgery of the hand. Philadelphia: Elsevier; 2012:116-8.
21. Giesen T, Calcagni M, Elliot D. Primary flexor tendon repair with early active motion: experience in Europe. Hand Clin 2017;33(3):465-72. https://doi.org/10.1016/j.hcl.2017.03.001
22. Colditz J. Protecting flexor tendon repairs. HandLab 2017;43:1-2. Disponible en:
https://bracelab.com/clinicians-classroom/protecting-flexor-tendon-repairs
23. Morrell NT, Hulvey A, Elsinger J, Zhang G, Shafritz AB. Team approach: repair and rehabilitation following flexor tendon lacerations. J Bone Joint Surg Rev 2017;5(1):1-7. https://doi.org/10.2106/JBJS.RVW.16.00013
24. Colditz J. Protective action of the lumbrical muscle to a healing flexor tendon repair during active finger extension. HandLab 2015;36:1-2. Disponible en: https://bracelab.com/media/magefan_blog/New/CP36-Lumbrical-Muscle-Healing-Flexor-Tendon-Repair-During-Active-Finger-Extension.pdf
25. Groth GN. Pyramid of progressive force exercises to the injured flexor tendon. J Hand Ther 2004;17(1):31-42.
https://doi.org/10.1197/j.jht.2003.10.005
2013;29(2):167-78. https://doi.org/10.1016/j.hcl.2013.02.002
2. Amadio PC. Friction of the gliding surface: implications for tendon surgery and rehabilitation. J Hand Ther
2005;18(2):112-9. https://doi.org/10.1197/j.jht.2005.02.005
3. Evans RB. Managing the injured tendon: current concepts. J Hand Ther 2012;25(2):173-89.
https://doi.org/10.1016/j.jht.2011.10.004
4. Hsiao PC, Yang SY, Ho CH, Chou W, Lu RL. The benefit of early rehabilitation following tendon repair of the hand: a population-based claims database analysis. J Hand Ther 2015;28(1):20-5. https://doi.org/10.1016/j.jht.2014.09.005
5. Tang JB. Flexor tendon injuries. Clin Plast Surg 2019;46(3):295-306. https://doi.org/10.1016/j.cps.2019.02.003
6. Skirven T, Osterman A, Fedorczyk J, Amadio P, Feldscher S, Shin E. Therapy techniques. En: Rehabilitation of the
hand and upper extremity. 7th ed. Philadelphia: Elsevier; 2020:1393-478.
7. Colditz J. Regaining flexor tendon glide within zone 2. HandLab 2016;40:1-2. Disponible en:
https://bracelab.com/clinicians-classroom/regaining-flexor-tendon-glide-within-zone-2
8. Giesen T, Reissner L, Besmens I, Politikou O, Calcagni M. Flexor tendon repair in the hand with the M-Tang
technique (without peripheral sutures), pulley division, and early active motion. J Hand Surg Eur 2018;43(5):474-9.
https://doi.org/10.1177/1753193418758269
9. Athlani L, Detammaecker R, Touillet A, Dautel G, Foisneau A. Effect of different positions of splinting on flexor
tendon relaxation: a cadaver study. J Hand Surg Eur 2019;44(8):833-7. https://doi.org/10.1177/1753193419865123
10. Savage R. The influence of wrist position on the minimum force required for active movement of the
interphalangeal joints. J Hand Surg Br 1988;13(3):261-8. https://doi.org/10.1016/0266-7681(88)90082-4
11. Peck FH, Roe AH, Ng CY, Duff C, McGrouther DA, Lees VC. The Manchester short splint: a change to splinting
practice in the rehabilitation of zone II flexor tendon repairs. J Hand Ther 2014;19(2):47-53.
https://doi.org/10.1177/1758998314533306
12. Woythal L, Holmer P, Brorson S. Splints, with or without wrist immobilization, following surgical repair of flexor tendon lesions of the hand: a systematic review. Hand Surg Rehabil 2019;38(4):217-22.
https://doi.org/10.1016/j.hansur.2019.05.004
13. Klifto CS, Bookman J, Paksima N. Postsurgical rehabilitation of flexor tendon injuries. J Hand Surg Am
2019;44(8):680-6. https://doi.org/10.1016/j.jhsa.2019.02.010
14. Venkatramani H, Varadharajan, Bhardwaj P, Vallurupalli A, Sabapathy R. Flexor tendon injuries. J Clin Orthop
Trauma 2019;10(5):853-61. https://doi.org/10.1016/j.jcot.2019.08.005
15. Chang M, Lim Z, Wong Y, Tay S. A review of cyclic testing protocols for flexor tendon repairs. Clin Biomech
2019;62:42-9. https://doi.org/10.1016/j.clinbiomech.2018.12.007
16. Vucekovich K, Gallardo G, Fiala K. Rehabilitation after flexor tendon repair, reconstruction, and tenolysis. Hand Clin 2005;21(2):257-65. https://doi.org/10.1016/j.hcl.2004.11.006
17. Strickland JW, Schmidt CC. Repair of flexor digitorum profundus lacerations: The Indiana method. Op Tech Orthop 1998;8(2):73-80. https://doi.org/10.1016/S1048-6666(98)80004-9
18. Higgins A, Lalonde D. Flexor tendon repair postoperative rehabilitation: the Saint John Protocol. Plast Reconstr Surg Global Open 2016;4(11):e1134. https://doi.org/10.1097/GOX.0000000000001134
19. Tang JB, Zhou X, Pan Z, Qing J, Gong K, Chen J. Strong digital flexor tendon repair, extension-flexion test, and
early active flexion: experience in 300 tendons. Hand Clin 2017;33(3):455-63.
https://doi.org/10.1016/j.hcl.2017.04.012
20. Tang JB, Amadio P, Guimberteau JC, Chang J. Clinical primary flexor tendon repair and rehabilitation. En: Tendon surgery of the hand. Philadelphia: Elsevier; 2012:116-8.
21. Giesen T, Calcagni M, Elliot D. Primary flexor tendon repair with early active motion: experience in Europe. Hand Clin 2017;33(3):465-72. https://doi.org/10.1016/j.hcl.2017.03.001
22. Colditz J. Protecting flexor tendon repairs. HandLab 2017;43:1-2. Disponible en:
https://bracelab.com/clinicians-classroom/protecting-flexor-tendon-repairs
23. Morrell NT, Hulvey A, Elsinger J, Zhang G, Shafritz AB. Team approach: repair and rehabilitation following flexor tendon lacerations. J Bone Joint Surg Rev 2017;5(1):1-7. https://doi.org/10.2106/JBJS.RVW.16.00013
24. Colditz J. Protective action of the lumbrical muscle to a healing flexor tendon repair during active finger extension. HandLab 2015;36:1-2. Disponible en: https://bracelab.com/media/magefan_blog/New/CP36-Lumbrical-Muscle-Healing-Flexor-Tendon-Repair-During-Active-Finger-Extension.pdf
25. Groth GN. Pyramid of progressive force exercises to the injured flexor tendon. J Hand Ther 2004;17(1):31-42.
https://doi.org/10.1197/j.jht.2003.10.005