Flexor Tendons Flashcards
(29 cards)
Describe the splint used in the rehabilitation of flexor tendons
Ezeform flexor hood, wrist 0-30 degrees extension, MCPJs 45 degrees flexion, IPJs neutral. Use elastic with alpha for top strap. Wear full time - can remove for exercises if patient compliant
What are the aims of the exercises in the flexor tendon protocol?
- Differential glide of repaired tendons without attenuation at repair site
-Regaining passive flexion, decreasing oedema
-Regaining extension - blocked or to splint
-Active flexion to comfortable mid range without resistance
-Aim to increase flexion gradually over first four weeks
What are the primary exercises in flexor tendon rehab?
-Passive flexion of individual digits - fist and hook for 30 seconds
-Tenodesis
-Blocked active IPJ extension (10x hourly for zones 1/2) OR active extension of fingers to splint for zones 3,4,5 or those without PIPJ contractures
-Fully mobilise everything else
What are the secondary exercises in flexor tendon rehab?
- Active flexion, all digits together, fist, hook, flat fist
-Flat fist for FDS rehab - can be done individually due to separate muscle bellies
-Abduction / adduction for zone 3-4 repairs / significant oedema
-Consider place and hold exercises for those struggling with active flexion
Why should you see flexors after 3-5 days?
To allow inflammation to settle before starting an exercise regime.
How frequently should a flexor be seen initially?
Weekly for the first 4 weeks, unless progressing exceptionally well.
Name some techniques to try if the patient is anxious to move
-Reassurance and encouragement
-massage of upper forearm
-bilateral movements
-imagined movement
-simplify exercise regime
How should your regime change at week 4?
-Wean splint to NT and protection
-Continuation of previous HEP - aiming for full AROM of all fingers / joints + normal tenodesis
- resistance into extension if extension poor
-VERY light function
How should your regime change at week 6?
-Discontinue NT splint
-Light resistance into flexion
What approaches can help if the patient develops a marked FFD?
-?volar splint during the day
-?continue with dorsal block splint with top strap at night
-?protected passive extension - pt must understand this well
-If poor flexion: ?lateral blocked flexion if patient has good understanding
How should your regime change at week 8?
-Introduce passive extension
-Gentle blocked active flexion acceptable
-increase resistance
-increase function (driving)
How should your regime change at week 10?
-Increase blocked active flexion
-Increase resistance
Describe the extension-flexion test that the surgeon should perform
1: Full extension to see if gapping occurs
2: Mild to moderate flexion of the digit to observe whether the tendon can passively glide
3: Marked / full flexion of the digit to ensure the repair site doesn’t impinge on the pulley / sheath - this is done actively or passively dependant on whether or not WALANT was used
Why do we begin exercise after 3 days?
Collagen will not form at this point so adhesions will not have formed.
When should passive and active exercises be started?
Passive: 3 days ideally
Active: 2-3 days after active
What complications can severe oedema cause in the initial stages post-repair? What can be done about this?
increased risk of rupture / gapping.
Consider coflex and a few days rest. If this continues consider a passive gliding program
How should passive and active exercises relate to one another?
Passive exercises should be seen as a “warm up” - do these until the finger feels supple and then start active exercises.
Why should tenodesis be encouraged?
To support active tendon glide
Why do we limit the arc of flexion initially?
This limits force on the flexor tendons allowing for active excursion through the pulleys.
Furthermore, increased force and strain may cause gapping of the tendon or tendon rupture
Why might you encourage exercises with wrist extension / slight MCPJ flexion?
To overcome the force of the extrinsic extensors
What must be promoted to prevent adherence of the FDS to the FDP?
Differential glide
Which exercises promote differential glide?
Flat fist, Active hook, Full fist
In zone 2 flexor tendon repairs, what impact does flexion of the MCPJ have?
None - it does not produce glide in zone 2.
Describe the different flexor zones.
Zone 4: Over the carpals and carpal tunnel
Zone 3+: The distal crease of the palm, where the tendons exit the carpal tunnel and enter the fingers.
Zone 2: (No Man’s Land): The proximal phalanx, where the tendons pass through a fibro-osseous digital canal and interweave with each other. This zone is notorious for its complexity and difficulty in repair due to the risk of adhesion formation and limited mobility.
Zone 1: The distal phalanx, where the tendons insert onto the distal phalanges.
