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

Abstract

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.

'The hand belongs to someone': a therapist perspective on patient compliance

“…Another South African flexor tendon injury longitudinal observational study reported a 49.5% rate of follow-up of non-attendance. Patients who received a controlled active motion protocol achieved better results than patients who received passive motion protocols but outcomes for both protocols were markedly worse than those achieved internationally 5 . A number of factors were statistically related to these poor outcomes including a language barrier.…”

“…Therapy-related factors included the use of meaningful activity in intervention, splints that are comfortable and look acceptable, and strategies for the management of pain 16 . Local evidence suggests that the absence of a language barrier in hand rehabilitation supports compliance 5 , implying the need for use of South African languages (or appropriate alternatives) that are accessible to patients 32 .…”

“…It is reasonable to assume that the pre-dominance of English and Afrikaans-speaking therapists, typical within the hand rehabilitation community 46 and occupational therapy profession, contributes to communication difficulties between patients and therapists 23 . The impact that language barriers have on compliance 5 reiterate the need to address communication difficulties. The need for training in language and cultural competencies at an undergraduate and continuous professional development (CPD) level has been emphasized 23 .…”

Cinesioterapia aplicada após a cirurgia no tendão da mão: estudo de qualidade metodológica

“…Os ensaios clínicos apresentaram pacientes com lesões tendinosas com idade que variou de 15 a 75 anos. Em geral, todos os pacientes que participaram dos estudos tiveram a zona de lesão da mão classificada, a mais prevalente no estudo de Spark et al [9] foi a zona V com (40%) dos participantes sendo acometidos pela lesão. Porém, nos estudos de Farzad et al [8] houve uma predominância maior na zona 2, entretanto, no estudo de Rigó et al [10] não teve uma relevância entre as zonas, apenas uma variação entre as zonas de I a III.…”

Effect of extracorporeal shockwave therapy on palmar fibromatosis

“…More, Much more!") until grip strength increased to the top, then said, "enough stop" grip strength was recorded, rounded to the nearest pound and the sign has been returned to zero [10] (Figure 4).…”