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 those cases with minimal tendon damage closed injury, immobilizing the fingers is the best conservative option. You risk re injury to your tendon if you extensor tendon repair. Postop rehab protocols arthroscopic slap repair new york, ny. Early active mobilization for extensor tendon injuries. As a general rule, the sooner tendon repair surgery is done after the injury. Peroneal and tibialis posterior tendon repairs rehabilitation. Flexor tendon repair protocol zones 25 physical therapy haven. You may learn more about how the stone clinic repairs achilles tendon ruptures without open surgery in our explanation.
In addition, a removable splint is fashioned protecting the a. Outcome of early active mobilization after extensor tendon repair. Unlike flexor tendons, which have good excursion that can help mobilize the flexor tendon allowing for repair of up to 1 cm gaps, extensor tendons only have 12 mm of excursion, especially in verdans extensor zones 1 to 5. University orthopedics mails out home remedy books to residents throughout the new england area. To assess the effects benefits and harms of different rehabilitation interventions after surgery for flexor tendon injuries of the hand. Extensor tendon repairs, zones 5 to 8 st thomas hospital. Prp therapy for tendon repair prp injection therapy.
Gillis, dvm, phd a carefully controlled rehabilitation program combined with a regular ultrasound examination provides the best chance for equine athletes to return to full performance following tendon or ligament injury. Tendon repairs can be very successful if theyre done along with proper physical therapy or occupational therapy. Infection this is unusual in the hand less than 1% of cases if the wounds. It will take a further eight weeks before you can return to unrestricted activities. Early active movement regime on removal of splint four weeks after your operation.
Please fax initial evaluation and progress notes to 815. 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. 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. Physiology of flexor tendon healing and rationale for treatment. Achilles tendon repair postop protocol penrose physical. Tendon grafting can be performed with a palmaris longus or toe extensor. This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. If unsure of the specific tendon repaired or location of repair relative to the juncturae tendinum, splint all mps in 0 degrees of.
Achilles tendon repair rehab protocol below we outline the steps that we have our patients take to recover from achilles tendon repair surgery. Extensor tendon repair zones ii, iii, iv rehabilitation. Choe icam protocol following extensor tendon repair. Achilles repair rehabilitation protocol key considerations. Rehabilitation after repair of extensor tendon injuries has been less addressed in the literature than that of flexor tendons. Extensor tendon repair zones ii, iii, iv rehabilitation protocol kelly holtkamp, m. Extensor tendon repair in the emergency department. Advice and exercises following your extensor tendon repair patient information clinical and diagnostic services centre hand therapy extensor tendons. She is presently the chief of occupational therapy, ireland army community hospital, fort knox, kentucky 401215520. Early mobilisation following achilles tendon repair has been reported to be beneficial in terms of postoperative recovery and improved tendon vascularity. Specific changes in the program will be made by the. Sometimes the repair is augmented or strengthened using fascia or tendon.
Gallandkirby patellar tendon repair postsurgical rehabilitation protocol postop days 1 14 dressing. Occasionally this requires more surgery later on to try and free up the repair tendon to glide again. Repetitive movements can strain tendons and cause pain, swelling, and difficulty in movement. Extensor tendon repair guide metro north hospital and. Nylon suture 40 or 50 for skin repair silk suture which has high tissue reactivity and chromic suture which dissolves before the tendon heals adequately should be avoided. By repairing the torn tendon, patients have a good chance at returning to highlevel sports.
Alhussein baghdad university alkindy college of medicine 2. Outcome of early active mobilization after extensor tendon. Cole,md,mba weight bearing brace rom exercises phase i 02 weeks as tolerated with crutches and brace locked in full extension for sleeping and all activity off for exercises and hygiene 02 weeks. It is not intended to be a substitute for ones clinical decision making. 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. Fashion a daytime extension splint with the following characteristics. 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.
Physiology of flexor tendon healing and rationale for treatment protocols. If it does, rest the patient until pain level is clearly decreasing. Oct 02, 2019 nylon suture 40 or 50 for skin repair silk suture which has high tissue reactivity and chromic suture which dissolves before the tendon heals adequately should be avoided. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. 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.
Rehabilitation of tendon and ligament injuries carol l. Obviously, the choice between one protocol and another is a matter. Pool therapy flutter kicks from hip with knee in extension 3 goal rom 0110 degrees weeks 8 12. Reading books holding a glass using scissors combing hair shaving buttons unscrewing jar lids holding a cup. Flexor tendon repair protocol zones iiii early active, modified duran program. Another case of a primarily repair ehl tendon after rupture. Tendons connect muscles to bones and enable movement at joints. Lateral epicondyle release 2 manual therapy transverse friction at common extensor tendon at 6 weeks. Extensor tendon repair protocol brigham and womens hospital. Your hand therapist will instruct you when you can take them off.
Flexor tendon repair therapy protocol sideline orthopedics. Treatment will follow the defined protocol below and be carried out by. Presented at the american society for hand surgery annual meeting, phoenix az. Placehold for hook, full and straight fist with wrist extended. Flexor tendon repair zones 25 protocol brigham and womens hospital. Brigham and womens hospital a teaching affiliate of. Extensor tendons are found at the back of the hand, fingers and thumb. Your tendons are becoming stronger but are still not fully healed. May 19, 2015 repair of extensor tendon defects or gap injuries often require complicated surgical techniques. 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. Physical therapist, athletic trainer andor physical therapy assistants. Try prp therapy for tendon repair that heals the tough tissue instead of simply masking the pain and causing longterm damage like in conventional treatments. A short informational video for patients recovering from hand surgery affecting their flexor tendon. Comparing three postoperative treatment protocols for extensor tendon repair in zones v and vi of the hand.
Rehabilitation after repair of the patellar and quadriceps tendon the patellar tendon attaches to the tibial tubercle on the front of the tibia shin bone just below the front of the knee. 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. We conducted a study to observe and record the results of early. Flexor tendon repair protocol zone i passive motion 0 to 3 weeks postop. Rehabilitation guidelines for quadricepspatella tendon repair. When an injured tendon is placed in 15 to 20 less relative motion than adjacent tendons from a shared muscle. Logan from the departments of physiotherapy and plastic surgery, west norwich hospital, norwich, uk dynamic splinting following extensor tendon repair gives better results than static splinting, but involves cumbersome splints and recommended protocols are often complicated.
Distal biceps tendon repair rehabilitation protocol. When the tendons in our hands or forearms are cut, there is an immediate threat of permanent function loss of the hand. In several research projects, nelly andarawispuri is studying the mechanisms responsible for tendon damage and repair, including the actions of physical therapy, pursuit of scarless healing, and potential for tissue engineering. Troum, md, facs texas health southlake hospital southlake, tx introduction. Upper extremity extensor tendon repair protocol brigham and.
Brace locked at 0 degrees for ambulation for 68 weeks with use of bilateral axillary crutches. Dec 14, 2012 staged reconstruction of a flexor tendon repair following initial surgery is often necessary for complex cases and results in prolonged incapacitation. Comparing three postoperative treatment protocols for. Repair of the injured flexor tendon in the hand to achieve normal. To achieve good tendon excursion in the early postop days will make it easy to maintain the excursion through the final weeks of. Pectoralis tendon repair postop protocol this protocol is intended to be a general outline only.
Extensor tendon injuries are commonly diagnosed in the emergency department ed. Waltham clinical protocols therapy guidelines in waltham 02451. Rehabilitation of extensor tendon injury of the hand by. Adapted from achilles tendon repair rehab protocol of stone clinic orthopedic. A primary repair of the two ends of the tendon is performed by stitching them together. Early physical therapy and splinting after flexor tendon repair in zone ii is very important to improve tendon healing, increase tensile strength, decrease adhesion formation, early return of function and less stiffness and deformity. Bakkers postop protocol important instructions following surgery. Immediate controlled active motion following zone 47 extensor tendon repair. Distal biceps tendon repair rehabilitation protocol michael b.
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. Early active mobilization for injuries the norwich regime extensor tendon e sylaidis, m. The surgeon should apprise the therapist of the quality of the repair, the type of repair, alterations in tendon length, the integrity of the tissue, the status of surrounding tissues, and any additional. It may be that at this stage further hand therapy andor splinting is required to regain full range of movement andor function. This video uses a model to demonstrate suturing techniques for grasping the ends of a severed tendon. Extensor tendon repair zones vii, viii rehabilitation protocol. 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.
Elevation 252 longer if needed patient not to be discharged until seen by hand physiotherapist or if bank holiday then referred to hand physio next working day with daytime telephone number. Terms should be explained standard protocols employ a dorsal shell with the wrist, mcps, and ips flexed. Nwo therapy department rehabilitation guidelines for quadricepspatella tendon repair. After surgical repair, it is critical that you follow your surgeons orders postoperatively. Medial collateral ligament mcl reconstructionrepair postop rehabilitation protocol. The ehl tendon is prepared with suture to reapproximate the tendon ends below left, and the tendons ends are tied together with the suture which will allow the tendon the heal with scarring below right. You may learn more about how the stone clinic repairs achilles tendon ruptures without open surgery in our explanation of achilles tendon injury, diagnosis and treatment. The patient is allowed to return to full duty status if the job requirements have.
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. Physical therapy new york knee surgery shoulder surgery. Report of the committee on tendon injuries international federation of societies for surgery of the hand. 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. Proper postoperative splinting, hand therapy, and excellent compliance with treatment plans are essential to the success of any tendon laceration repair xie, 2008. Rehabilitation of extensor tendon injury of the hand by means of early controlled motion. The symptom of tendon injury is the finger no longer bends or straightens. Rehabilitation guidelines for achilles tendon repair.
Shoulder exercise descriptions for combined labrum repair shoulder. Use of tenoglide tendon protector sheet to protect an. Acl bonepatellar tendonbone autograft rehab protocol. You will need to wear the fin ger part of the splint for a further 2 weeks. Advice and exercises following your extensor diagnostic. Rehabilitation guidelines for patellar tendon and quadriceps tendon repair the knee consists of four bones that form three joints. Our treatment can help patients reduce tendon paininflammation, dissolve the scar tissue and calcifications and help get complete healing of tendonitis, tendonosis, tendon injuries such as. We offer an assortment of downloadable guidelines and clinical protocol information for your. They allow you to straighten your fingers and thumb and bend your wrist back. You should make sure the therapist you go to has worked with this type of repair. Rehabilitation following surgery for flexor tendon. You will be referred to physical or occupational therapy to follow a tendon repair protocol.
Patellarquadriceps tendon repair protocol northwestern medical. Once the tendon has healed, starting hand therapy with a physical or occupational therapist is recommended. Pool therapy aquajogger in deep water goals 10 degrees df normal gait. Enhancing metabolism to accelerate biosynthesis of collagen for new tendon regeneration. Patellar and quad tendon repair info boston sports medicine. The physician reserves the right to either advance or delay this protocol as deemed necessary.
Eric strauss offers arthroscopic slap repair in new york, ny. At 23 weeks home estim unit if needed for quadriceps muscle reed. Flexor tendon repair protocol zone i passive motion. Primary extensor tendon repair protocol orthosurgery. 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. Tendon adhesions even with your best efforts and the help of the hand therapists extensor tendon repairs show an extreme tendency to stick to the surrounding tissues. 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. Remove postop dressings within 1 to 3 days postop wound care and edema reduction techniques as needed fabricate thermoplastic dorsal blocking splint o wrist at 30 degrees flexion o mp joints at. Avoid all passive motion into df for 1st 6 weeks postop 3. Extensor tendon repair surgery testimonial orlando ortho. Despite the increasing supported for accelerated rehabilitation regimes, there is still no consensus regarding the most preferable protocol. The type used will depend on the surgeon, the type of rupture, and tissue quality.
After surgery, your forearm and hand will be in a large bandage and plaster splint. The extensor tendons of the hand are in a relatively superficial position. Once a tendon is injured, it almost never fully recovers. There are many different stitching techniques to repair the 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. It also is attached to the bottom of the patella kneecap. Place hold for isolated fds glide of involved digits.
Extensor tendon repair zones vii, viii rehabilitation protocol kelly holtkamp, m. Extensor tendon repair zones v, vi rehabilitation protocol. This evidencebased achilles tendon repair is criterionbased. Flexor tendon repair protocol zones iiii early active. Physical therapy and splinting after flexor tendon repair. Joint mobilization of elbow after 8 weeks only if prescribed by surgeonjoint mobilization to address shoulder hypomobility only if prescribed by surgeonsoft tissue techniques to upper trapeziuslevator scapulapect minor are permitted. Avoid creating pain discomfort is okay but pain should not occur and persist 3 days in a row.
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