Jul 18, 2016 for size, our local plastic surgeon group recommends the largest suture that the tendon can tolerate to maximize retention strength. I also discuss, briefly, the application of certain aspects of occupational therapy s domain as outlined in the otpf. Extensor tendons are found at the back of the hand, fingers and thumb. Extensor tendon repair zones v, vi rehabilitation protocol. Obviously, the choice between one protocol and another is a matter. Upper extremity extensor tendon repair protocol brigham and.
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. The joints are moved passively in supervised therapy sessions with simultaneous maximum wrist extension and mp flexion to 40. Hand extensor tendon lacerations statpearls ncbi bookshelf. 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.
Tendon snap the tendon is split and part used to stabilise itself. 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. If other soft tissues have been repaired in the surgical procedure, the duration of immobilization may be prolonged to allow for sufficient healing of these tissues. Dec 14, 2012 this is a presentation i did for the otat program at cuyahoga community college on flexor and extensor tendon lacerations. Injuries can occur from both sharp and blunt trauma. Primary extensor tendon repair protocol orthosurgery. There are significant differences in treatment for extensor tendon injuries involving the finger zones versus the hand. Feb 01, 2009 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. Complications of extensor tendon repairs at the extensor retinaculum. Extensor tendon anatomy and approaches zelouf 2004 view video 384.
The idea of this protocol is that the tendinous junctures will take tension off the extensor tendon repair if the adjacent digits are maintained in a flexed position relative to the. Extensor tendon injuries are commonly diagnosed in the emergency department ed. For those cases with minimal tendon damage closed injury, immobilizing the fingers is the best conservative option. These exercises help to prevent your tendons becoming stuck in your scar tissue. At 6 weeks start passive flexion exercises as needed to regain flexion. Many extensor tendon injuries, including those of the extensor digitorum longus and extensor digitorum brevis, can be effectively repaired in the emergency department. Choe icam protocol following extensor tendon repair.
Immediate controlled active motion following zone 47 extensor tendon repair. Advice and exercises following your extensor diagnostic. Extensor tendon repair in fingers newport 2004 note. An extensor tendon injury is a cut or tear to one of the extensor tendons. Extensor tendon repair guide metro north hospital and. After surgery, your forearm and hand will be in a large bandage and plaster splint. Fashion a daytime extension splint with the following characteristics. You should make sure the therapist you go to has worked with this type of repair and knows the protocol. Extensor tendon repair zones v, vi rehabilitation protocol kelly holtkamp, m. The palmaris longus was transferred and attached to the extensor pollicis longus.
The remaining tendon could snap causing loss of finger extension. Remove splint, evaluate wounds for infection, dehiscence. After primary repair of severed extensor tendons, various methods are used to limit tendon adhesions and avoid rupture. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact approach depends on the extensor zone. When the extensor tendons are cut they need to be repaired or the finger will not straighten again properly. Inflammation of the inside or outside extensor or flexor tendons of the elbow, often called tennis elbow, is very common. 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. Arom out of the splint to the operated joint 2 weeks no extensor centralization or 4 weeks with extensor centralization.
Postoperative physical therapy management of tendon transfer for digitalwrist extension due to multifocal motor neuropathy. Presented at the american society for hand surgery annual meeting, phoenix az. Advice and exercises following your extensor tendon repair patient information clinical and diagnostic services centre hand therapy extensor tendons muscle belly your extensor tendons straighten your fingers. The flexor carpi radialis was transferred and attached to the extensor digitorum communis. Extensor tendon repair and rehabilitation surgical indications and considerations anatomical considerations. 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. For size, our local plastic surgeon group recommends the largest suture that the tendon can tolerate to maximize retention strength. Surgery and therapy, to obtain further information regarding rehabilitation of extensor tendon repairs. Advice and exercises following your thumb extensor tendon repair patient information clinical and diagnostic services centre hand therapy your extensor tendons straighten your thumb. After surgical repair, it is critical that you follow your surgeons orders postoperatively. Pdf management of extensor tendon injuries researchgate. Untreated extensor tendon injuries can result in significant functional impairment and potential longterm permanent deformities of the hand. Extensor tendon lacerations are relatively common injuries and, when not treated appropriately, may result in a lasting impairment of hand function. These muscles are attached to the arm bones by extensor tendons.
Learn about physical therapy standards of care and protocols from the rehabilitation services at brigham and womens hospital. If there is an extensor lag, modify exercise program to emphasize active extension functional activity. We have utilized a technique for protection and repair of extensor tendon injuries that are distal to the myotendinous juncture and proximal to the metacarpophalangeal joint by performing a. 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. If unsure of the specific tendon repaired or location of repair relative to. 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. Flexor tendon repair therapy protocol 2 of 5 o active digital extension with wrist flexed o fds blocking to uninvolved digits and tendons o fdp blocking to uninvolved digits, if fdp is not involved o 10 times, each, every 2 hours. Sam zone iii,iv extensor tendon mp extension transmits force to the edc in zones iii and iv because the sagittal bands glide proximal with mp extension. Pdf complications of extensor tendon repairs at the.
Optimal early active mobilisation protocol after extensor tendon. Primary closure of extensor tendon lacerations can occur within 72 hours. Total immobilization method may be necessary for the very young or noncompliant. Extensor tendon repairs surgery extensor tendon repairs surgery. The forearm consists of eight main extensor muscles, which are used to raise the wrist and fingers. When you access the book, rehabilitation of the hand, information on how to access the videos is located inside the cover. Rehabilitation of the upper extremity following nerve and tendon reconstruction.
Extensor tendon lacerations greater than 50% of its cross sectional area should be repaired. Because of their superficial location, the extensor tendons are often involved with inuries to the dorsum of the hand and are very likely to form adhesions with injuries to the bone. Extensor tendon repair and rehabilitation surgical indications and considerations. Order form for hss physicians, alumni, and staff and rehabilitation network members if you are an hss physician, alumnus, or rehab network member, and need assistance with the online ordering form, please contact dana gallagher at 212. You will be referred to physical or occupational therapy to follow a tendon repair protocol. Active and passive rom exercises to pip and dip joints within. Flexor tendon repair therapy protocol sideline orthopedics. Extensor tendon repair surgery testimonial orlando ortho. Controlled passive motion o durand and houser protocol allows 3 to 5 mm of tendon excursion after repair o on 3rd postoperative day, patient begins twicedaily exercise regimen of passive flexion and extension 6 to 8 motions per tendon o keep wrist flexed and mcps in 70. Light compression with coban, elevation and manual edema. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact. Extensor tendon injuries of the fingers and hand physiopedia. If an extensor lag 10 degrees redevelops, resume use of the splint fulltime for two weeks.
Early mobilisation protocols after repair of extensor tendons in zone v and vi. While wearing your splint you will need to check your skin on a regular basis for red or sore. Extensor tendon repair zones ii, iii, iv rehabilitation protocol kelly holtkamp, m. Mar 25, 2020 extensor tendon lacerations are relatively common injuries and, when not treated appropriately, may result in a lasting impairment of hand function. The inflammation can arise from overuse such as playing multiple sets of tennis in one day or from a direct injury such as hitting a ball hard and feeling sudden pain at the elbow. Comparing three postoperative treatment protocols for. Primary upper extremity and hand extensor tendon repair protocol. This includes patients who have not been able to have a formal repair of the tendon due to infection. 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. Nerve injury damage to local nerves can leave you with small patches of numbness. The patient underwent static and dynamic splinting and a modified tendon transfer protocol starting at 3 weeks and ending at 16. Your tendon will take up to 12 weeks to completely heal and it is important to follow all advice to avoid rupturing your tendon. For example, in a tendon repair, the rehabilitation would adhere to a tendon repair protocol. Once the decision for surgical intervention has been made, the general principles of definitive wound debridement, early tendon repair, and early range of motion hand therapy guide the treatment plan for all extensor tendon injuries.
Fresh injuries should ideally be repaired within a week of the injury. Once the tendon has healed, starting hand therapy with a physical or occupational therapist is recommended. Rehabilitation of extensor tendon injury zone v vi vii early phase 1 immobilization protocol. Surgery and therapy, to obtain further information regarding rehabilitation of. This protocol is not intended to be a substitute for. Postoperative physical therapy management of tendon transfer.
Physical therapy standards of care and protocol the following standards of care and protocols are the property of bwh and should not be copied or otherwise used without the permission of the director of rehabilitation services. When the tendons in our hands or forearms are cut, there is an immediate threat of permanent function loss of the hand. Please fax initial evaluation and progress notes to 815. This is even more likely over the joints since the dorsal skin is particularly thin there. Pain and tenderness along the tendon, especially within close proximity to the ankle and foot stiffness of the foot and inability to stretch without pain swelling around the tendon pain at night 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. Extensor tendon, rehabilitation, early active motion. Therapy for singlestage tendon grafting is essentially the same as that for postoperative stage ii of a twostage tendon reconstruction. The extensor tendons of the hand are in a relatively superficial position.
Postoperative physical therapy management of tendon. Flexor tendon repair therapy protocol 2 of 5 o active digital extension with wrist flexed o fds blocking to uninvolved digits and tendons o fdp blocking to uninvolved digits, if fdp is not involved o 10 times, each, every 2 hours scar management. Sep 11, 2017 many extensor tendon injuries, including those of the extensor digitorum longus and extensor digitorum brevis, can be effectively repaired in the emergency department. Extensor tendon injury mcp level hammock protocol therapy. Repair would be necessary to recover this function. The extensor tendon is round and thick proximally, resembling a flexor tendon, and becomes thin and flat more distally. Followed by an intensive exercise regime to regain rom. Coban, digit sleeves, ace wrap, edema modalities per therapist. To minimize swelling, you must keep your hand lifted up to your shoulder level. By hospital for special surgery rehabilitation department. Brigham and womens hospital a teaching affiliate of.
Place hold for isolated fds glide of involved digits. Physical therapy 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. Bakkers postop protocol important instructions following surgery. Rehabilitation of extensor tendon injury zone v vi vii. Comparing three postoperative treatment protocols for extensor. Extensor tendon repair zone iv and above oxford university. The patient underwent static and dynamic splinting and a modified tendon transfer protocol starting at 3 weeks and ending at 16 weeks postsurgery. 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. Oct 02, 2019 extensor tendon injuries are often more difficult to treat than flexor tendon injuries, owing to several issues specific to extensor tendons. Stiffness some loss of joint movement is possible because of scarring. Rehabilitation of the upper extremity following nerve and. Due to this injury, there is an inability to fully and forcefully extend the wrist andor fingers. Extensor tendon repair and rehabilitation amazon s3. Because of their location on the dorsum of the hand, the extensor tendons are particularly vulnerable to injury.
Fashion a removable shortarm thumb spica splint holding the wrist in 30 degrees of extension, thumb cmc joint in full radial abduction and extension, mcp joint in neutral, and ip joint in neutral to slight hyperextension. Isolated edc exercises taping ip joints in flexion as needed to. Jun 26, 2018 once the decision for surgical intervention has been made, the general principles of definitive wound debridement, early tendon repair, and early range of motion hand therapy guide the treatment plan for all extensor tendon injuries. 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. It is not an exhaustive source, and should be used in conjunction with the referenced materials and any new research which may emerge in the future. Tendon reconstruction an overview sciencedirect topics. Placehold for hook, full and straight fist with wrist extended. The postoperative rehabilitation protocol is similar to the one for the dorsal hand laceration. They allow you to straighten your fingers and thumb and bend your wrist back. The size of extensor tendons varies widely along their course from the forearm to the distal phalanx. Extensor tendon repair zones ii, iii, iv rehabilitation. Postsurgical rehabilitation guidelines for orthopedists. Zone v extensor tendon repair icam protocol phase i 021 days o postoperative dressings removed and replaced with light dressings o maintain wrist and digit in protected position during orthosis.
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