www. treatment2go. com & www. handtherapy. com Flexor Tendons Get a Grip on Flexor Tendons This course has active links. The index is linked so you can just click and go (page 5). To access a website click the link. To return to the course close the website by clicking the X. To navigate within the course, you can advance to the next page by any of the following options: 1) Click the arrows on the navigation panel at the bottom of the PDF page 2) Click the arrow within the course when present 3) Click the enter button on your keyboard 4) Use the arrow keys on your keyboard 5) Use your mouse to scroll down using the slide bar on the right side of page During the course, you are asked to study and participate in writing labs or thinking about the exercise. This lab time is figured into the course hours with a total of 1 hour. To return to the course index page, click course index at the end of each section/ page. To return to section home page, click This Section Home link. If a link is down, contact info@treament2go.com Welcome to Treatment2Go s digital E-Books. Treatment2Go is a registered trademark of Exploring Hand Therapy. We are an AOTA approved provider. Our digital E-Books allows you to enjoy education with ease and comfort. You will read, learn and earn CEUs in the comfort of your home. After you have completed this course you are required to take an exam. Upon successful (75%) completion of the exam you will immediately be emailed your certificate. Sit back, relax, and begin.
Chapter 2 Biomechanics Treatment2Go Next stop on our journey to enlightenment is in the Physics Department. We have discussed all of the structures involved in flexor tendon injury and rehab and now it is time to understand how they interact with one another and also how they are affected by outside factors. In this chapter we will discuss the following topics: Physics terminology Biomechanical principles of the flexor tendon system Function of the flexor tendon pulley system Forces acting on the flexor tendons Before we proceed any further with this chapter we need to get in the mind-set of Sir Isaac Newton. This brilliant man had a good understanding of the flexor tendons. Just think about the 3 laws of motion! Besides, if he had not been sitting under that tree trying to understand the function of the flexors in the hand he would have never been hit in the head with that apple! Here is a quick review of relevant terminology related to physics. In the literature these terms are used often so it is helpful to be familiar with their definition. Before we review the definitions let s look at a short video about NEWTON s LAWS Enjoy 33
Testing of Tendon Function: If tendon integrity compromise is suspected, the physician will perform more focused testing to determine tendon function. The following tendons can be tested independently: FDS FDP FPL FDS Testing: Remember that the tendons of the FDS function independently. To test the FDS, the adjacent fingers are held in an extended position while the patient is asked to flex the finger. This method allows for evaluation of the FDS as the affected finger is observed for PIP flexion. FDS testing is demonstrated below. Video of FDS testing click to view Point of Interest: 20% of patients have an absent FDS in the small finger so patients may have limited or no PIP flexion during testing. 54
Section III Rehab of the Flexor Tendon Chapter 9 Primary Rehab Considerations Just as surgical techniques have evolved over the last few decades, so has the various approaches to rehab. When reviewing literature regarding flexor tendon rehab one will often read the names Kleinert and Duran. These two individuals have been the pioneers of flexor tendon rehab giving therapists the foundation to build upon. Over time surgical technique has advanced in terms of handling techniques, suture material / type, and a better understanding of the tendon healing process. All of these advancements have resulted in further variations in rehab protocols to provide the optimal approach to maximize function following repair. The process of determining optimal therapy approaches has been difficult to attain due to a number of factors. The primary reason it has been difficult is due to the fact that most therapists treat flexor tendons using a protocol which is determined by 2 factors: 1) Clinical Expertise of the Therapist 2) Preference of the Surgeon Before discussing the different categories of tendon management it is important to grasp some of the primary rehab considerations used in flexor tendon rehab. These considerations will serve as a foundation for further advancement. Therapists treating flexor tendon injuries must understand the following 8 primary considerations of rehab in order to be successful: 87
Modified Duran Repairs in Zone 1; 2; 3: 3-4 days Post-op: Bulky compressive dressing is removed. A light compressive dressing is applied. Digital tubigrip, finger-socks, or light coban can be used to manage edema. Splint: DBS is fabricated and fitted for continual wear with positions: Wrist: 20 degrees flexion MP: 70 degrees flexion IP: Full extension (Unless digital nerve involved) If a digital nerve is involved, a dorsal PIP splint may be applied positioning the digit PIP in 20-30 degrees flexion, depending on the physician. No dynamic flexion traction is used. The digits are strapped in extension between exercises and at night. Modified Duran DBS (Chapter 11 Image 20) 113
Chap 11 Home Pg 97-147 Treatment2Go INDEX Patient then performs 25 reps of passive flexion and extension of digits in a composite manner. Passive Composite Flexion Passive IPJ Exercise Demonstration Video 116
Steps for Fabricating Dynamic Flexion Traction Line: Apply the DBS. During fabrication, it should have been determined if the palmar pulley was incorporated into the thermoplastic splint or externally applied. The easiest method for a palmar pulley is a strap with a safety pin for the pulley. With the splint applied, align the palmar pulleys to the line of pull of the digit. Once this position is obtained, mark on the strap so each application will be consistent. Before measuring for the line and reapplying the DBS, some mode of line fixation should have been determined for the fingertip. Some options include Velcro, Dressing Hook Glued to Finger nail, or 3PP finger traps. 191