Evaluation and Functional Assessment of Flexor Tendon Repair in the Hand

Abstract

Seventeen patients with 28 flexor tendon injuries were examined after tendon repair. The current most frequently used evaluation systems, including grip and pinch strength, were compared with functional outcome as assessed by a questionnaire, evaluating Disabilities of Arm, Shoulder and Hand (DASH). Good correlation was found between Total Active Motion (TAM) and the Original Strickland test (kappa = 0.85), however with reduced categories. Only limited correlation was found between the DASH-score and TAM (r = -0.33) as well as between the DASH-score and pinch strength (r = -0.35). We suggest reporting the average Range of Motion (ROM) of the complete finger as a percentage of the contralateral finger, instead of reporting the classified result, and to include assessment of pinch strength. It would be very useful to have an accurate functional outcome assessment, but DASH proves to be insufficiently sensitive.

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

“…The work of Libberecht et al 10 was the only report in which the DASH score of patients with flexor tendon repairs of mostly zone II and zone V injuries treated according to Klienert system was 8.5 with a average time after operation of 40 mos (range, 12Y89 mos). They found limited correlation between the DASH score and the TAM in percentage(r = j0.330).…”

Avulsion of flexor digitorum profundus secondary to enchondroma of the distal phalanx. Case report and literature review

“…3). The percentage of total active motion in the ring finger was 87.5%, which corresponds to an excellent result according to the American Society for Surgery of the Hand [1].…”

“…Six months later, the result was considered good according to Strickland's criteria [1]. There were no radiological signs of tumor recurrence.…”

(vi) Flexor tendon injuries

“…Although functional questionnaires have proved to be very useful tools in evaluating the results of many diseases, a specific questionnaire has not yet been used for flexor tendon repair. 24 …”

“…Good correlation has been found between the Total Active Motion (TAM) and the original Strickland test (kappa ¼ 0.85). 24 Subsequently, hand specialists identified the requirement for a greater breadth of the evaluation tools to more accurately determine the functional success of flexor repairs. Grip strength, pinch strength, finger dexterity (Nine Hole Peg Test e NHPT), DASH (Disabilities of Arm, Shoulder and Hand) score, hand disability in daily living activities and quality of motion including flexion arc, digital coordination and speed of movement were all additional suggested outcome measures for flexor tendon repair.…”