Anatomic and Functional Improvements Achieved by Rehabilitation in Zone II and Zone V Flexor Tendon Injuries

Bal, Serpil; Oz, Bengi; Gürgan, Alev; Memiş, Asuman; Demirdöver, Cenk; Sahin, Baris; Öztan, Yücel

doi:10.1097/phm.0b013e3181fc7a46

Cited by 28 publications

(19 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The total score represents how much dysfunction is present in patients after treatment and a minimal detectable change was determined to be at least 12.7 points. 31 Even though we analysed a small sample (96 fingers), our findings are consistent with results reported by Bal et al 32 They compared grip strength percentage and total active motion recovery with Quick DASH scores and found their results moderately correlated (r ¼ 20.435; r ¼ 20.541), similar to our results (r ¼ 20.3809 -to 20.5815).…”

Section: Discussionsupporting

confidence: 95%

Is there a correlation between patient-reported outcome assessed by the Disabilities of the Arm, Shoulder and Hand Questionnaire and total active motion after flexor tendon repair?

et al. 2012

View full text Add to dashboard Cite

Introduction. Gliding without adhesion is imperative to regain full range of motion after flexor tendon repair. The purpose of this study was to find assessment tools that represent these outcomes and to explore their relationship with hand function. Methods. Ninety-six flexor tendon injuries in 24 patients were assessed at 12 weeks after flexor tendon repair. Total active motion (TAM) and total passive motion (TPM) were recorded with a goniometer. For patientreported upper extremity function, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used. Results. A moderate negative correlation was found between total active motion and DASH score (r ¼ 20.3809 to 20.5815, P , 0.0001). While TAM and TPM improved over the 12-week period, mean values did not reach those of the uninjured hand. Mean DASH scores improved from 46.05 points at four weeks to 23.5 points at 12 weeks. Conclusion. Despite early flexor tendon rehabilitation in this sample, after 12 weeks, some degree of dysfunction and loss of active ability for finger flexion still persisted. The DASH appears to be an appropriate outcome tool after flexor tendon repair. The combination of patient-reported questionnaire and measures of impairment such as TAM and TMP give a more comprehensive picture of functional outcome.

show abstract

Section: Discussionsupporting

confidence: 95%

Is there a correlation between patient-reported outcome assessed by the Disabilities of the Arm, Shoulder and Hand Questionnaire and total active motion after flexor tendon repair?

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Like ROM, grip strength also improves for the first six months and reaches a steady state at one year post FTR, as described by May and Sifverskiold, 37 and Libberecht et al 13 For power grip strength, Kitis et al's findings 38 were a mean of 85% of the unaffected hand at 12 weeks post FTR, much higher than this sample at six months post FTR, but their study only looked at zone II injuries, where median or ulnar nerve injuries were not a factor that could affect the grip strength. Bal et al 39 found a mean of 62% (71% in zone II and 53% in zone V) of the unaffected hand with a median follow-up period of 72 weeks, an identical result to this study, and they included patients with peripheral nerve injury.…”

Section: Discussionsupporting

confidence: 80%

Range of movement, power and pinch grip strength post flexor tendon repair

Spark¹,

Godlwana²,

Ntsiea³

2018

SA orthop. j.

View full text Add to dashboard Cite

Background: Flexor tendon injuries (FTI) are common hand injuries that pose a challenge to the multidisciplinary team. Despite being the most researched topic in hand literature, the optimal surgical and post-operative treatment of FTI remains unclear and results after flexor tendon repair (FTR) continue to be unpredictable. Purpose: The purpose of this study was to determine the range of movement (ROM), power and pinch grip strength post FTR and to establish factors that may affect these. Method: The study was conducted at an academic hospital in Gauteng, South Africa, between January 2013 and September 2015. At one, three and six months post FTR, the ROM of the injured and contralateral finger(s) were measured. At three and six months post FTR the participants' bilateral power and pinch grip strength were also measured. Results: One hundred and twenty-six participants (n=126) enrolled in the study. There was a drop-out rate of 48%, leaving 65 participants that completed six months' follow-up: 41 males (63%) and 24 females (37%) with mean age of 32 years (SD±10, n=65). Out of 65 participants, 2% (n=1) had an excellent outcome, 32% (n=21) a good outcome, 32% (n=21) a fair outcome and 34% (n=22) a poor outcome with regard to ROM. At six months post FTR the average power grip was 60% (SD±25, n=65) of the unaffected hand, while the average pinch grip was 52% (SD±42, n=65) of the unaffected hand. Sixty-eight per cent (n=44) of patients had post-operative complications: the most common complication was tenodesis/ adhesions (25%, n=16), followed by contracture (22%, n=14). Four patients (6%) had ruptures and 11 (17%) underwent further surgery. Factors that had a positive effect on outcome at six months post FTR were: younger age, no associated injury, less duration between injury and surgery, having controlled active motion instead of passive motion occupational therapy protocol, and not having a language barrier. Injury in zone IV was associated with worse ROM and power grip strength than other zones. Conclusion: Although there were some promising outcomes, during this period participants did not consistently achieve the good or excellent outcomes that are achieved in some developed countries.

show abstract

“…Despite the human and economic impact of this problem, there are presently no pharmacologic or biologic agents available for the prevention of tendon adhesions [5]. In fact, the only accepted means of preventing adhesion formation in flexor tendons remains physical therapy [5], but even with physical therapy, the strength of healed tendons is markedly less than prior to injury, and debilitating adhesions have been reported to occur in as many as 50% of zone II flexor tendon injuries [6].…”

Section: Introductionmentioning

confidence: 99%

Gene Expression Analysis of the Pleiotropic Effects of TGF-β1 in an In Vitro Model of Flexor Tendon Healing

et al. 2012

View full text Add to dashboard Cite

Flexor tendon injuries are among the most challenging problems for hand surgeons and tissue engineers alike. Not only do flexor tendon injuries heal with poor mechanical strength, they can also form debilitating adhesions that may permanently impair hand function. While TGF-β1 is a necessary factor for regaining tendon strength, it is associated with scar and adhesion formation in the flexor tendons and other tissues as well as fibrotic diseases. The pleiotropic effects of TGF-β1 on tendon cells and tissue have not been characterized in detail. The goal of the present study was to identify the targets through which the effects of TGF-β1 on tendon healing could be altered. To accomplish this, we treated flexor tendon tenocytes cultured in pinned collagen gels with 1, 10 or 100 ng/mL of TGF-β1 and measured gel contraction and gene expression using RT-PCR up to 48 hours after treatment. Specifically, we studied the effects of TGF-β1 on the expression of collagens, fibronectin, proteoglycans, MMPs, MMP inhibitors, and the neotendon transcription factors, Scleraxis and Mohawk. Area contraction of the gels was not dose-dependent with the TGF-β1 concentrations tested. We observed dose-dependent downregulation of MMP-16 (MT3-MMP) and decorin, and upregulation of biglycan, collagen V, collagen XII, PAI-1, Scleraxis, and Mohawk by TGF-β1. Inter-gene analyses were also performed to further characterize the expression of ECM and MMP genes in the tenocyte-seeded collagen gels. These analyses illustrate that TGF-β1 tilts the balance of gene expression in favor of ECM synthesis rather than the matrix-remodeling MMPs, a possible means by which TGF-β1 promotes adhesion formation.

show abstract

Anatomic and Functional Improvements Achieved by Rehabilitation in Zone II and Zone V Flexor Tendon Injuries

Cited by 28 publications

References 19 publications

Is there a correlation between patient-reported outcome assessed by the Disabilities of the Arm, Shoulder and Hand Questionnaire and total active motion after flexor tendon repair?

Is there a correlation between patient-reported outcome assessed by the Disabilities of the Arm, Shoulder and Hand Questionnaire and total active motion after flexor tendon repair?

Range of movement, power and pinch grip strength post flexor tendon repair

Gene Expression Analysis of the Pleiotropic Effects of TGF-β1 in an In Vitro Model of Flexor Tendon Healing

Contact Info

Product

Resources

About