TY - JOUR
T1 - Ultrasonographic assessment of flexor tendon mobilization
T2 - Effect of different protocols on tendon excursion
AU - Korstanje, Jan Wiebe H.
AU - Soeters, Johannes N.M.
AU - Schreuders, Ton A.R.
AU - Amadio, Peter C.
AU - Hovius, Steven E.R.
AU - Stam, Henk J.
AU - Selles, Ruud W.
N1 - Funding Information:
This study has been supported by a Fonds Nuts-Ohra grant (SNO 0901-47). The funds received from Fonds Nuts-Ohra were directly paid to the Department of Rehabilitation Medicine and Physical Therapy at the clinic where the work was performed.
PY - 2012/3/7
Y1 - 2012/3/7
N2 - Background: Different mobilization protocols have been proposed for rehabilitation after hand flexor tendon repair to provide tendon excursion sufficient to prevent adhesions. Several cadaver studies have shown that the position of the neighboring fingers influences tendon excursions of the injured finger. We hypothesized that the positions of adjacent fingers influence the long finger flexor digitorum profundus tendon excursion, measured both absolutely and relative to the surrounding tissue of the tendon. Methods: Long finger flexor digitorum profundus tendon excursions and surrounding tissue movement were measured in zone V in eleven healthy subjects during three different rehabilitation protocols and two experimental models: (1) an active four-finger mobilization protocol, (2) a passive four-finger mobilization protocol, (3) a modified Kleinert mobilization protocol, (4) an experimental modified Kleinert flexion mobilization model, and (5) an experimental modified Kleinert extension mobilization model. Tendon excursions were measured with use of a frame-to-frame analysis of high-resolution ultrasound images. Results: The median absolute long finger flexor digitorum profundus tendon excursions were 23.4, 17.8, 10.0, 13.9, and 7.6 mm for the active four-finger mobilization protocol, the passive four-finger mobilization protocol, the modified Kleinert mobilization protocol, the experimental modified Kleinert flexion mobilization model, and the experimental modified Kleinert extensionmobilizationmodel, respectively, and these differences were all significant (p ≤ 0.041). The corresponding relative flexor digitorum profundus tendon excursions were 11.2, 8.5, 7.2, 10.4, and 5.6mm. Active four-fingermobilization protocol excursions were significantly (p = 0.013) greater than passive four-finger mobilization protocol excursions but were not significantly greater than experimental modified Kleinert flexion mobilization model excursions (p =0.213). Conclusions: The present study demonstrated large and significant differences among the different rehabilitation protocols and experimental models in terms of absolute and relative tendon displacement. More importantly, the present study clearly demonstrated the influence of the position of the adjacent fingers on the flexor tendon displacement of the finger that is mobilized. Clinical Relevance: The positions of adjacent fingers in tendon mobilization protocols have a large influence on both absolute and relative tendon excursions. The most commonly used protocols after flexor tendon repair may not lead to optimal tendon excursions.
AB - Background: Different mobilization protocols have been proposed for rehabilitation after hand flexor tendon repair to provide tendon excursion sufficient to prevent adhesions. Several cadaver studies have shown that the position of the neighboring fingers influences tendon excursions of the injured finger. We hypothesized that the positions of adjacent fingers influence the long finger flexor digitorum profundus tendon excursion, measured both absolutely and relative to the surrounding tissue of the tendon. Methods: Long finger flexor digitorum profundus tendon excursions and surrounding tissue movement were measured in zone V in eleven healthy subjects during three different rehabilitation protocols and two experimental models: (1) an active four-finger mobilization protocol, (2) a passive four-finger mobilization protocol, (3) a modified Kleinert mobilization protocol, (4) an experimental modified Kleinert flexion mobilization model, and (5) an experimental modified Kleinert extension mobilization model. Tendon excursions were measured with use of a frame-to-frame analysis of high-resolution ultrasound images. Results: The median absolute long finger flexor digitorum profundus tendon excursions were 23.4, 17.8, 10.0, 13.9, and 7.6 mm for the active four-finger mobilization protocol, the passive four-finger mobilization protocol, the modified Kleinert mobilization protocol, the experimental modified Kleinert flexion mobilization model, and the experimental modified Kleinert extensionmobilizationmodel, respectively, and these differences were all significant (p ≤ 0.041). The corresponding relative flexor digitorum profundus tendon excursions were 11.2, 8.5, 7.2, 10.4, and 5.6mm. Active four-fingermobilization protocol excursions were significantly (p = 0.013) greater than passive four-finger mobilization protocol excursions but were not significantly greater than experimental modified Kleinert flexion mobilization model excursions (p =0.213). Conclusions: The present study demonstrated large and significant differences among the different rehabilitation protocols and experimental models in terms of absolute and relative tendon displacement. More importantly, the present study clearly demonstrated the influence of the position of the adjacent fingers on the flexor tendon displacement of the finger that is mobilized. Clinical Relevance: The positions of adjacent fingers in tendon mobilization protocols have a large influence on both absolute and relative tendon excursions. The most commonly used protocols after flexor tendon repair may not lead to optimal tendon excursions.
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U2 - 10.2106/JBJS.J.01521
DO - 10.2106/JBJS.J.01521
M3 - Article
C2 - 22398732
AN - SCOPUS:84858604411
SN - 0021-9355
VL - 94
SP - 394
EP - 402
JO - Journal of Bone and Joint Surgery
JF - Journal of Bone and Joint Surgery
IS - 5
ER -