Rehabilitation following tendon repairs

Extension tendon repair post-op rehabilitation

Mallet injury –

  • Complete full time immobilization for 8 weeks.

Zone III injury (closed rupture of central slip)–

  • Complete full time immobilization for 8 weeks.

Zone VIII & IX –

  • Immobilization

Zone III – V –

  • Immobilization protocols have greater chances of adhesions
  • Limited early active motion protocol (given by Evans) – also called “Short arc motion” – reduces chances of adhesion.
  • Three splints are used. One for rest and two for exercise.

At rest –

  • Affected digit immobilized with wrist in extension and 0° extension of DIP & PIP

During exercise –

  • Splint used – which blocks PIP flexion to 30° and DIP flexion to 20-25°.
  • 20 repetitions of active and passive movement.
  • Third splint is now used – which fixes PIP in 0° extension and allows only DIP movement.
  • Patient now actively extends and flexes DIPJ x 20 times.

Exercise continued for 3 weeks. During 2nd and 3rd week – PIPJ flexion gradually increased to 40-50°.

Zone V-VIII –

  • Passive extension by rubber band system with active flexion of the affected digits
  • Protocol termed – Reverse Washington or Reverse-Kleinert.

Active flexion by patient and passive extension by rubber band – 10 times per hour for 3 weeks

Flexion of MP joint restricted first to 30° and then gradually increased to 60° at end of 3 weeks

Active motion initiated after 3 weeks

Splint removed after 6 weeks.

Short arc motion regimen based on –

  • Short amount of tendon excursion prevents adhesion formation – a 3-5 mm tendon excursion is required to prevent adhesion
  • A 60° PIPJ flexion achieves 5mm excursion.
  • Earlier immobilization protocols were/are based on theory that –
  • Extrasynovial nature of extensor tendon limits adhesion formation.
  • Close proximity to bone and tissue in zone III – VIII increases chances of adhesion and are better rehabilitated with active motion protocol.

Relative motion splint –

  • Relative tendon extensor splint – affected finger in 15-20° “extra” MCP extension than other fingers.
  • Relative tendon flexor splint – affected finger in 15-20° “extra” MCP flexion than other fingers.
  • Allows early active use of hand.
  • Relative splinting gives rest to the tendon repair during motion as the extensor tendons are joined/conjoint and acts as one unit.

Pages: 1 2 3 4 5

Blog at WordPress.com.

Up ↑