Tendon adhesions even with your best efforts and the help of the hand therapists extensor tendon repairs show an extreme tendency to stick to the surrounding tissues. Infection this is unusual in the hand less than 1% of cases if the wounds. Flexor tendon repairs therapy pediatric delayed mobilization duran protocol duran protocol thumb early dynamic mobilization louisville protocol early mobilization. Comparing three postoperative treatment protocols for. Extensor tendon injuries can result from trauma, burns, or arthritis. Distal triceps tendon repair university orthopedics.
Logan from the departments of physiotherapy and plastic surgery, west norwich hospital, norwich, uk dynamic splinting following extensor tendon repair gives better results than static splinting, but involves cumbersome splints and recommended protocols are often complicated. Extensor tendon repair zones ii, iii, iv rehabilitation protocol kelly holtkamp, m. Primary extensor tendon repair protocol orthosurgery. Please fax initial evaluation and progress notes to 815. Primary extensor tendon repair protocol edc, eip, edq, epl, ecrl, ecrb, ecu the intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone an extensor tendon repair. Initial care consists of ice and ice massage to the area 3 5 times a day for 10 15 minutes to control the pain and swelling of the tissue. Extensor tendon injuries are commonly diagnosed in the emergency department ed.
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. Joint blocking and prom of the ip joints with the mp joints supported at 0 degrees. Patients with distal triceps tendon ruptures are usually vigorous and. Zones 4 7 therapy guide opa at 10 days post op pop wrist and mcpj extended physio begins at 1st clinic appt volar splint, forearm based with ipjs free if there is an extensor lag then splint should include the ipjs mcpj slightly flexed and wrist in extended position exercises.
Achilles tendon repair rehab protocol below we outline the steps that we have our patients take to recover from achilles tendon repair surgery. It is not intended to be a substitute for ones clinical decision making. Flexor tendon repair protocol zones 25 physical therapy haven. The ehl tendon is prepared with suture to reapproximate the tendon ends below left, and the tendons ends are tied together with the suture which will allow the tendon the heal with scarring below right. Immediate controlled active motion following zone 47 extensor tendon repair. Flexor tendon repair therapy protocol sideline orthopedics. Flexor tendon repair protocol zone i passive motion. Flexor tendon repairs therapy pediatric delayed mobilization duran protocol duran protocol thumb early dynamic mobilization louisville protocol early mobilization belfast protocol frayed tendon protocol. Proper postoperative splinting, hand therapy, and excellent compliance with treatment plans are essential to the success of any tendon laceration repair xie, 2008. Treatment will follow the defined protocol below and be carried out by.
Greater understanding of tendon biology, advancements in surgical technique and evidence for early motion following flexor tendon repair 7, 8 have since. A teaching affiliate of harvard medical school 75 francis st. This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. This anatomic feature also predisposes the extensor mechanism. Pdf comparing three postoperative treatment protocols for. Extensor tendon repair surgery testimonial orlando ortho. Outcome of early active mobilization after extensor tendon repair. Rehabilitation guidelines for quadricepspatella tendon repair. Extensor tendon repair zones ii, iii, iv rehabilitation. Phase one maximum protection weeks 06 0 to 2 weeks brace locked in full extension for 6 weeks partial weight bearing for 2 weeks ice and modalities to reduce pain and inflammation aggressive patella mobility range of motion 0. Oct 02, 2019 these tendon lacerations can be easily missed because the remaining intact tendon can often maintain extensor function. Choe icam protocol following extensor tendon repair. Surgery may be necessary in cases of tendon separation, fracture, or malalignment. Therapist supervised wrist extension only with digits maintained in full passive.
Arom of the nger interphalangeal joints while wearing the dynamic splint. Post repair therapy protocols page 1 of 10 l019d hand therapy protocols following are representative protocols for each of the three basic approaches to flexor tendon post repair management. Aartelonrtelon tissue reinforcementtissue reinforcement. The greater the number of tissues involved in the injury, the more challenging it is to restore the hand function. Oct 02, 2019 nylon suture 40 or 50 for skin repair silk suture which has high tissue reactivity and chromic suture which dissolves before the tendon heals adequately should be avoided. The use of antiinflammatories for the first couple of weeks as prescribed your physician is also effective in controlling the inflammation.
Specific changes in the program will be made by the. Boston, massachusetts 02115 department of rehabilitation services physical therapy zones 25 flexor tendon repair protocol timeline splint therapeutic exercise precautions other week 03 dorsal blocking splint a. Advice and exercises following your extensor diagnostic. Early active mobilization for injuries the norwich regime extensor tendon e sylaidis, m.
Place hold for isolated fds glide of involved digits. Dynamic traction after extensor tendon repair in zones 6, 7 and 8. Comparing three postoperative treatment protocols for extensor tendon repair in zones v and vi of the hand you will receive an email whenever this article is corrected, updated, or cited in the literature. Furthermore, the lacerated tendon retracts with extension of the digit from its injured flexed position, thus masking or hiding the injured tendon from visualization through the laceration. Dec 14, 2012 staged reconstruction of a flexor tendon repair following initial surgery is often necessary for complex cases and results in prolonged incapacitation.
Nwo therapy department rehabilitation guidelines for quadricepspatella tendon repair. Pectoralis major tendon repair postop physical therapy. Flexor tendon repair zones 25 protocolbrigham and womens hospital phase i. Primary upper extremity and hand extensor tendon repair protocol this protocol is not intended to be a substitute for ones clinical decision making regarding the progression of a patients postoperative course based on their physical examfindings. Presented at the american society for hand surgery annual meeting, phoenix az. You may learn more about how the stone clinic repairs achilles tendon ruptures without open surgery in our explanation of achilles tendon injury, diagnosis and treatment. After quadriceps tendon repair the arlington group. Extensor tendons are found at the back of the hand, fingers and thumb. Clinical application of controlled stress to the healing extensor tendon. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. This protocol was developed for patients who have had a primary repair of the distal triceps tendon. Hand extensor tendon lacerations statpearls ncbi bookshelf.
Pectoralis tendon repair postop protocol 20191021t15. Flexor tendon repair therapy protocol 1 of 5 bart eastwood d. Phase one maximum protection weeks 06 0 to 2 weeks brace locked in full extension for 6 weeks partial weight bearing for 2 weeks ice and modalities to reduce pain and inflammation aggressive patella mobility range of motion 0 degrees to 30 degrees flexion. Physical therapy 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. The extensor tendons of the hand are in a relatively superficial position. After surgical repair a plaster case is applied to the hand to protect the repairs until a thermoplastic splint can be made by the occupational therapist.
They allow you to straighten your fingers and thumb and bend your wrist back. Another case of a primarily repair ehl tendon after rupture. We searched pubmed and cochrane library databases to identify articles involving flexor tendon injury, repair, and rehabilitation protocols. Occasionally this requires more surgery later on to try and free up the repair tendon to glide again. Sep 15, 2012 historically immobilisation has been the mainstay of therapy following extensor tendon injuries as the repair site is protected from excessive motion which could threaten the repair. Internal tendon tension transmitted to the repair site with specific joint angles and external loads splinting configurationsexercise positions g. It is by no means intended to be a substitute for ones clinical decisionmaking regarding the progression of a. Tendon injury repair may include primary repair, secondary repair, immediate reconstruction with a tendon graft, staged tendon reconstruction, and tendon transfer. Extensor tendon repair guide metro north hospital and. Advice and exercises following your extensor tendon repair patient information clinical and diagnostic services centre hand therapy extensor tendons. The repair of zone ii flexor tendon injuries is an evolving topic in hand surgery with current literature suggesting the use of a 4strand repair. Patellarquadriceps tendon repair protocol northwestern medical. Early active movement regime on removal of splint four weeks after your operation. It will take a further eight weeks before you can return to unrestricted activities.
Schmidt flexor tendon repair zones early mobilization. Outcome of early active mobilization after extensor tendon. Your tendons are becoming stronger but are still not fully healed. Our objective was to compare the results of patients treated with an active therapy program and those treated with a passive motion protocol following zone ii flexor. At 23 weeks home estim unit if needed for quadriceps muscle reed. Rehabilitation regimens following surgical repair of extensor. Suite 224a blacksburg, va 24060 54055273 postoperative phase i 24 hours to 34 weeks goals fa br icati o nfcu s tmmm ilizati pli i nst ructi oinprom andptected arom i ncreased tendoexcursio ed ema co ntrl andsar ag ent independenceinhep precautions. Obviously, the choice between one protocol and another is a matter. Historically immobilisation has been the mainstay of therapy following extensor tendon injuries as the repair site is protected from excessive motion which could threaten the repair. The physician reserves the right to either advance or delay this protocol as. Extensor tendon repair protocol brigham and womens hospital.
After surgery, your forearm and hand will be in a large bandage and plaster splint. Your tendon will take up to 12 weeks to completely heal and it is important to follow all advice to avoid rupturing your tendon. Nylon suture 40 or 50 for skin repair silk suture which has high tissue reactivity and chromic suture which dissolves before the tendon heals adequately should be avoided. The physician reserves the right to either advance or delay this protocol as deemed necessary. Bakkers postop protocol important instructions following surgery. Brace locked at 0 degrees for ambulation for 68 weeks with use of bilateral axillary crutches. Procedure specific hand cpm therapy flexor tendon repair 1,2,5,6,7,8,9,10,12,16,17,18,21 setup if possible the patient should be instructed on hand cpm use preoperatively to improve compliance. Physical therapist, athletic trainer andor physical therapy assistants. Extensor tendon injuries cause loss of movement, pain, and swelling. The hand to elbow clinic 29a james street west bath ba1 2bt. Fashion a daytime extension splint with the following characteristics. Flexor tendon repair protocol zone 25 brigham and womens. B efore the 1970s, most flexor tendon repair rehabilitation protocols focused on immobilization during the first 3 weeks following repair, as research had shown tendon tensile strength to be low with most ruptures occurring during this time period. In addition, a removable splint is fashioned for the a.
Phase i postop day 1 2 weeks watch for skin breakdown. When the tendons in our hands or forearms are cut, there is an immediate threat of permanent function loss of the hand. You may learn more about how the stone clinic repairs achilles tendon ruptures without open surgery in our explanation. The extensor tendon repair surgery is meant to reconnect the tendons and allow full function to return to the hand but it takes a skilled, fellowship trained hand surgeon, a quality team of physical therapists and a bit of time to heal properly and regain strength. Staged reconstruction of a flexor tendon repair following initial surgery is often necessary for complex cases and results in prolonged incapacitation. Depending on the extent of the symptoms, we have found the use. Dorsal blocking splint w wrist in neutral, mcps at 50 flexion, ips in full extension. Early active mobilization for extensor tendon injuries. Extensor tendon repair zones v, vi rehabilitation protocol kelly holtkamp, m. Peroneal and tibialis posterior tendon repairs rehabilitation. To minimize swelling, you must keep your hand lifted up to your shoulder level.
Remove splint, evaluate wounds for infection, dehiscence. Rehabilitation regimens following surgical repair of. Some extensor tendon injuries are treated with splinting and hand therapy. Orthopedics physical therapy department 401 443 5000. Hand therapy rehabilitation following extensor tendon injuries splinting, tendon glide, scar management, functional range of motion,muscle strength slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Extensor tendon repair zones v, vi rehabilitation protocol. Placehold for hook, full and straight fist with wrist extended. The extensor mechanisms of the hand are in a superficial position, not enclosed in tendon sheaths as flexor tendons are, and often have limited retraction after injury.