It would also greatly lessen the chances of your hand recovering fully. Flexor tendon reconstructions and salvage procedures randall w. Flexor tendon repair or advancement, single, in no mans land. In addition, a removable dorsal blocking splint is fashioned. In contrast, immediate mobilization resulted in signi.
The tendons on the top of the hand straighten the fingers. Pdf evaluation and functional assessment of flexor tendon. Flexor tendon repair protocol zone i passive motion 0 to 3 weeks postop. Sometimes, a second surgery is required to free up scar tissue and to help the patient regain motion.
Suite 224a blacksburg, va 24060 54055273 postoperative phase i 24 hours to 34 weeks. Flexor tendon injuries can be challenging, especially in zone ii. Why is it important to protect my repaired tendon s. Remove postop dressings within 1 to 3 days postop wound care and edema reduction techniques as needed fabricate thermoplastic dorsal blocking splint o wrist at 30 degrees flexion o mp joints at 50 degrees flexion o ip joints at neutral. Active flexor tendon protocol week 0 6 one or more of the tendons that bend your fingers have been repaired. Patient information flexor tendon repair amazon s3. Elbow common flexor tendon repair technique arthroscopy. The most important concern about flexor tendon repair is avoiding use of the injured hand for any type of gripping. The patient is positioned supine with the operative extremity prepared and draped on a hand table over a nonsterile tourniquet. Postoperative instructions for flexor tendon repair purpose of surgery the goal of the operation is to repair or reattach lacerated or detached flexor tendons.
Flexor tendon repairs 6 weeks postoperatively you may now take your splint off and leave it off. These tendons enable you to bend your fingers and thumb. Many injuries to the flexor tendons involve lacerations that cut into the tendon. Walant anesthesia, strong sutures, a slightly bulky repair, intraoperative testing of active movement, and judicious venting of the a2 and a4 pulleys improve results in flexor tendon repair. In all cases, a doctor will explain the operation to. Despite extensive therapy, some patients have longterm stiffness after flexor tendon injuries. Exercises must still be done 5 times per day more if possible.
It is by no means intended to be a substitute for ones. Flexor tendon repair therapy protocol sideline orthopedics. Long tendons extend from these muscles through the wrist and attach to the small bones of the fingers and thumb. Zone 5 injuries are often associated with concurrent neurovascular compromise which requires surgical intervention and impacts rehabilitation 53.
Finger flexor tendon repair patient postoperative instructions laith alshihabi, md 01 week postop dressings. In all cases, a doctor will explain the operation to you and answer any questions you may have. When surgery is required, a splint and hand therapy may be used after the procedure to protect you and to aid in recovery. You will have a firm splint covering your forearm and the back of your. The repair will be weak and will require protection in a thermoplastic splint to prevent movements and. The evidencebase for the management of flexor tendon. The digital flexor tendon of forepaw petmassage training. Prevention of adhesions in surgery of the flexor tendons of. All flexor tendon injuries need supervised rehabilitation with the therapists for at least 6 weeks and often longer. Flexor tendon repair therapy protocol 1 of 5 bart eastwood d. Flexor tendon reconstructions and salvage procedures.
Primary repair was deemed unsuitable which led to recommendations to graft, principally to regain finger function3. Oct 15, 2019 despite being a common site for flexor tendon injury, there are few reports on the outcomes of primary tendon repair in zone 5 injuries 55,56. Other injuries to the digital flexor tendons are result of tiny tears to the tendon that happen over time. Place hold for isolated fds glide of involved digits. Flexor tendon repair protocol zone i passive motion. It will take at least 8 weeks following your surgery for the tendons to heal and 12 weeks until you can return to unlimited activities. Repair of the damaged tendons is necessary to restore normal movement in the wrist and hand. Controlled mobilization after flexor tendon repair in zone ii. Zone 1, fdp flexor tendon repair protocol the intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone a flexor tendon repair. Primary or delayed flexor tendon repairs in the hand have become standard practice over the past 30 years. A cut in any of these tendons is a serious injury and will require.
Chief of orthopaedicsurgery brigham and womens faulkner hospital vicechair of clinical operations brigham and womens hospital frontiers in upper extremity surgery tampa, florida november 4, 2017 complications of flexortendonrepair complications of flexortendonrepair. Pdf controlled mobilization after flexor tendon repair in. A strong repair using at least a 4strand core suture and an associated epitendinous suture will allow for early rehabilitation, which can minimize the risk of adhesion formation. Nov 22, 2017 many injuries to the flexor tendons involve lacerations that cut into the tendon. If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor. Placehold for hook, full and straight fist with wrist extended. The repair strength is the most important factor as the main function of the tendon is to transmit force, hence a repair must withstand the high forces applied by early active mobilisation15. Flexor tendon repair zones iv,v rehabilitation protocol. Any loss of range of motion of the finger after flexor tendon repair is an impairment. Remove postop dressings within 1 to 3 days postop wound care and edema reduction techniques as needed fabricate thermoplastic dorsal blocking splint o wrist at 30 degrees flexion o mp joints at.
Flexor tendons are required to glide large distances to allow the digits full composite flexion and extension, running within a tight pulley system to maximize their efficiency fig. Patellar tendon repair revised august 2008 postop days 1 14 dressing pod 1. Early active motion protocol following triple kessler repair. A dorsal blocking splint obs is fitted to be worn at all times except during the active place and hold exercises. Remove postop bulking dressings, inspect the wound and replace with a light dressing allow wound to breathe. Typically, any additional injured structures are repaired at the same time as the tendon.
When an outside sharp or blunt force is struck on the plantar surface of the hand, a complete or partial rupture of the flexor tendon andor retinaculum can occur. Patient information flexor tendon repair this sheet answers common questions about a flexor tendon repair. Flexor tendon injuries do not heal by themselves and frequently require surgery to put the injured tendon back to its normal position. Flexor tendon repair therapy protocol 3 of 5 continue dbs, unless patient shows unresponsive flexion lag watch for pip flexion contracture. In 1918, bunnell described his experiences in attempting primary repair of severed flexor tendons in zone ii of the finger. Klika flexor tendon repair zones 14 delayed mobilization 1160 kepler drive 1 page green bay, wi 54311 920. Fabricate and fit the involved hand in a dorsal block splint positioned at. It is by no means intended to be a substitute for ones clinical decisionmaking regarding the progression of a.
Flexor tendon injuries, however, can be very challenging to treat. Clinical opinions regarding the value of flexor tendon sheath repair have been widely varied. With severe laceration, tendon exposure and swelling maybe observed. Flexor tendon repair zones i ii iii day 23 remove protective splint making sure to keep hand postured in a protective position. Zone 5 injuries are often associated with concurrent neurovascular compromise which requires surgical intervention and impacts rehabilitation. Remove protective splint, making sure to keep wrist postured in a protective positions. Stepbystep demonstration of common flexor tendon repair in right elbow.
Pdf flexor tendon repair postoperative rehabilitation. Meticulous exposure, careful tendon retrieval, and atraumatic repair are extremely important. At your first therapy visit, some of your wound dressings may be removed. Why is it important to protect my repaired tendons. Sutures out, dc ted hose when effusion resolved brace x 8 weeks locked in extension for ambulation crutches partial weight bearing pwb. Bend your wrist with your fingers bent, then straighten your wrist and fingers 12 times. The adhesions are part of the healing process and almost inevitably produce functional disability following the biological response of the tendon to injury. While in the dbs the modified duran exercise program is performed. The flexor tendons run from the muscles in your forearm into the. Your tendon will take up to 12 weeks to completely heal and it is important to follow all advice to avoid rupturing your tendon. Please fax initial evaluation and progress notes to 815. Tendon ends must be debrided direct repair for defects of 12 cm avoid undue tension vy advancement defects 25 cm tendon must be mobile inverted v in gastroc fascia arms of v should be 2x the defect. This occurs as a result of gradual wear and tear of the tendon from overuse or aging. Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation.
Tendon ends must be debrided direct repair for defects of 12 cm avoid undue tension vy advancement defects 25 cm tendon must be mobile inverted v in. The flexor tendons muscles are responsible for flexing bending your fingers. Each finger has two tendons that help to bend the finger into a fist. Full, normal function of the finger is rarely obtained after a flexor tendon injury, but close aher nc tob il. Fashion a shortarm dorsal blocking splint with the wrist in 20 degrees of exion, the. The repair will be weak and will require protection in a thermoplastic splint to prevent movements and activity that will risk rupturing your tendon. Some authors recommending repair of the membranous tendon sheath. Remove postop bulking dressings, inspect the wound and replace with a light dressing. The repair of flexor tendons zones i and ii is a techniqueintensive surgical undertaking. Adhesions formed as the repair healed, resulting in total loss of movement in the digit. Flexor tendon repair protocol zones iiii early active.
Postoperative instructions for flexor tendon repair. Instructions this is an informedconsent document that has been prepared to help inform you of flexor tendon surgery, its. After surgery, the wrist and hand will be in a light dressing or possibly splint. It requires a strong understanding of the anatomy of the tendon sheath and the normal relationship between the pulleys and the flexor digitorum superficialis and flexor digitorum profundus tendons in the digit. Physical therapy zones 25 flexor tendon repair protocol timelinesplint therapeutic exercise precautionsother week 3 may initiate serial static pip extension splints at night if needed. Any repetitive actions are more likely to damage a tendon. Despite being a common site for flexor tendon injury, there are few reports on the outcomes of primary tendon repair in zone 5 injuries 55,56. Gripping can cause the tendon to rupture, which would require another surgery. Change dressing, keep wound covered, continue ted hose pod 710. Evaluation and functional assessment of flexor tendon repair in the hand. A short informational video for patients recovering from hand surgery affecting their flexor tendon. There are a number of factors that have been shown to affect the outcomes of tendon repair. Full, normal function of the finger is rarely obtained after a.
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