REVIEW:THE DIFFERENT FLEXOR

TENDON REHABILITATION PROTOCOLS

Amir LabibPlastic surgery resident, Ain Shams university Hospitals

Intended Learning Outcomes (ILOs) Anatomy and nutrition of flexor tendons. Tendon healing and biomechanics. Factors affect surgical repair strength. Different methods of rehabilitation.

Anatomy

Anatomy

Tendon healing and biomechanics

Early inflammation Cellular proliferation:1970s : intrinsic tendon healing capacity….early mobilization Remodeling

• Extrinsic healing• Intrinsic healingNo…filmy…loose…moderate…dense

Adhesions:

Factors affect surgical repair strength

Locking vs. grasping

Different methods of rehabilitation

Immobilization Children Non compliant Any contraindication for early

mobilization: e.g. replantation cases, fracture with unstable fixation.

Early controlled mobilizationKleinert and Chow

Wrist: 30 degree flexion

MPJ: 50- 70 degree flexion

IPJ: fully extended

3rd- 4th week: wrist extended

6th week: remove the splint

Early controlled mobilizationDuran and Houser

Wrist: 20 degree flexion

MPJ: 50 degree flexion IPJ: fully extended

Pros:• Better differential

gliding• Less PIP flexion

deformity

Cons:Greater tension on repair site

Active mobilization (Place and Hold) At least 4 strand

repair

Tenodesis splint

Starr et al systematic review, 2013

Take home message Tendon immobilization protocols have

increased risk of adhesions. Early active rehabilitation protocols

have lower risk of adhesions, but higher rupture rate than early passive rehabilitation

For early active mobilization: at least 4 strand repair.

All elements to increase tendon repair strength should be considered.

References1. Neligan, P. Plastic Surgery (hand and

upper extremity). (Elsevier, 2013).2. Starr, H. M., Snoddy, M., Hammond, K. E.

& Seiler, J. G. Flexor tendon repair rehabilitation protocols: A systematic review. J. Hand Surg. Am. 38, (2013).

3. Mohammed Aljodah. Hand rehabilitation after flexor tendon repair. 10–47 (2015).