You have had an injury to 1 or 2 of your extensor tendons on the back of your hand, between your knuckles. Fashion a shortarm splint holding the wrist in 30 degrees of extension and the mp joints. Tendon reconstruction an overview sciencedirect topics. Immediate controlled active motion following zone 47 extensor tendon repair. Choe icam protocol following extensor tendon repair. Norwich week 0 6 post operation you have recently had surgery on the tendons that assist in straightening your fingers. Troum, md, facs texas health southlake hospital southlake, tx introduction. Use of a semitendinosus tendon autogenous graft for rupture of the patellar ligament after total knee arthroplasty. Tendon repair is done to bring back normal movement to a joint. This article describes a splint management program for zone 47 extensor tendon repairs that allows for immediate controlled active motion icam of the repair and greater arcs of motion for. Extensor tendon repair zone iv and above oxford university. An innovative application of a hand extensor tendon repair protocol was applied by the hand therapy service to toe extensors when the hand surgery service was called in to repair toe extensor lacerations. Tendinopathy, as opposed to tendinitis or tendinosis, is the best generic. Repair and rehabilitation of extensor hallucis longus and.
Extensor tendon repair techniques are not as complicated as flexor tendon repairs, this is due to the. Immediate controlled active motion following zone 47. Long extensor repairzones iv to vii after long extensor tendon repair, a thermoplastic yoke. This protocol is not intended to be a substitute for ones clinical decision making regarding. Over the past five decades we have seen numerous iterations of suture repair methods for tendon. Your tendon has now healed enough to cope with normal daily activities but your thumb and hand will feel weak. What are your extensor tendons and why have these been repaired. These are now being consistently challenged with laboratory and outcomes analysis. Extensor mechanism repair quad tendon, patellar tendon, patella fracture rehabilitation guidelines phase i for immobilization and rehabilitation. Treatment of extensor tendon injuries may require operative intervention, depending on the complexity of the injury and the zone of the hand involved. Repair extensor retinaculum to avoid bowstringing if cannot repair primarily then options include edl, plantaris, pb grafts, ehl transfer, vy. A 30yearold dancer sustained complete laceration of her extensor hallucis longus and extensor hallucis brevis tendons. This helps prevent scarring and tightening of the tendon in a shortened position, as these tendons rarely heal on their own. Injuries to extensor tendons also affect other structures necessary for proper tendon function.
Extensor tendon repair activity you may not bear weight or use the operated hand until permitted by your surgeon. It is by no means intended to be a substitute for ones clinical decisionmaking regarding. Tendon grafting can be performed with a palmaris longus or toe extensor. When the extensor tendons are cut they need to be repaired or the finger will not straighten again properly. Brigham and womens hospital a teaching affiliate of. Repair, tendon sheath, extensor, forearm and or wrist, with free graft includes graft harvest 25275 extensor tendon repair, dorsum of hand, single, primary or secondary. 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. The hand therapist modified the hand extensor tendon repair protocol since there was no known protocol for repairs of the foot and toe extensor tendon. Scarring can occur within the tendon repair itself or in nearby structures to prevent the return of normal tendon function. They allow you to straighten your fingers and thumb and.
The common extensor tendon that originates from the lateral epicondyle of the elbow is directly involved. The large muscles on the back of your forearm are attached to tendons that cross the wrist. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact approach depends on the extensor zone. Application of hand therapy extensor tendon protocol to. Extensor tendons are easily injured, even by a minor cut. However, fractures, infection, or damage to numerous tendons can make it harder to recover complete finger and hand function. The patient was placed in an ankle foot orthosis with a toe extension device created by heating and.
Iii extensor tendon injuries compared as two groups. We have utilized a technique for protection and repair of extensor tendon injuries that are distal to the myotendinous juncture and proximal to the metacarpophalangeal joint by performing a. You have been referred to the hand therapy department for your ongoing care and treatment. This booklet is designed to help you understand your ongoing care and.
Tendon injury may occur anywhere in the body where there are tendons. After surgery, your forearm and hand will be in a large bandage and plaster splint. Extensor tendon repair surgery testimonial orlando ortho. Please fax initial evaluation and progress notes to 815. Tendon disorders are frequent and are responsible for substantial morbidity both in sports and in the workplace.
Optimizing the sequence of zone 1 extensor tendon repair. It will take at least 6 weeks for your tendons to heal and at least 12 weeks until they are strong enough for your return to unlimited activities. Control pain and inflammation maintain patellar mobility maintain hamstring strength of the ipsilateral. Extensor tendons are found at the back of the hand, fingers and thumb. 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. Results and outlook of extensor tendon repair surgery. Fresh injuries should ideally be repaired within a week of the injury. This comprehensive compilation of the suture repair techniques will. Pdf management of extensor tendon injuries researchgate. Advice and exercises following your extensor tendon repair patient information clinical and diagnostic services centre hand therapy extensor tendons muscle belly your extensor tendons straighten your fingers. Surgical outcome is better if the repair is done early after the injury.
Zone v extensor tendon repair icam protocol phase i 021 days o postoperative dressings removed and replaced with light dressings o maintain wrist and digit in protected position during orthosis. Advice and exercises following your extensor tendon repair. You have had surgery to repair one or more of the tendons in your hand arm. Extensor tendon repairs surgery extensor tendon repairs surgery. Extensor tendon repair zones v, vi rehabilitation protocol. Thumb extensor tendon repair oxford university hospitals. Extensor tendon repair and rehabilitation surgical indications and considerations anatomical considerations. One approach advocated by doyle is a dermotenodesis suture that involves passing a large 3. Upper extremity extensor tendon repair protocol brigham and. The first of these is overstretch of the repair by moving too far into extension following a flexor tendon repair or too far into flexion following an extensor tendon repair. The authors have described numerous methods to repair the extensor tendon in zone 1. Specific risks of extensor tendon surgery tendon scarring. Presented at the american society for hand surgery annual meeting, phoenix az. Complications can occur after extensor tendon repair including, loss of flexion due to extensor tendon shortening, loss of flexion and extension resulting from adhesions and patients can notice a weakened grip.
Advice and exercises following your extensor diagnostic. The extensor carpi radialis brevis ecrb and longus, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris come together to form the common extensor tendon. Because of their superficial location, the extensor tendons are often involved with inuries to the dorsum of the hand and are very likely to form adhesions with injuries to the bone. Extensor pollicis longus repair, zone ii to viii weeks 612. Primary upper extremity and hand extensor tendon repair protocol this protocol is not intended to be a substitute for ones clinical decision making regarding the progression of a patients postoperative course based on their physical examfindings. Early motion inspired by complications associated with immobilization.
Extensor tendon repair guide metro north hospital and. The second is an excessive internal pull on the tendon by the muscle during active or resisted motion in. Bakkers postop protocol important instructions following surgery. If the affected tendon can recover its normal length with sufficient strength, then proper function is achievable. Internal tendon tension transmitted to the repair site with specific joint angles and external loads splinting configurationsexercise positions. Epl repair, zone ii to viii weeks 612 rehabilitation it is now 6 weeks since your operation. Splint keep the splint on at all times, we will remove this during your first visit to the clinic. Use of tenoglide tendon protector sheet to protect an. Common extensor tendon an overview sciencedirect topics. Extensor tendon repair zone iv and above information for patients. The wrist is placed in approximately 20 to 25 extension with a separate. The pursuit of the ultimate repair has led to many repair methods being described.
When the extensor tendon becomes shortened or adherent, tenodesis restraint can occur. Extensor tendon repair zones v, vi rehabilitation protocol kelly holtkamp, m. Your tendon will take up to 12 weeks to completely heal and it is important to follow all advice to avoid rupturing your tendon. The goal of repair is to restore tendon continuity and function, with a secondary goal of allowing early motion of. Jamming a finger may cause the tendon to tear from the attachment to bone. They allow you to straighten your fingers and thumb and bend your wrist back. Extensor mechanism allograft reconstruction for extensor mechanism failure following total knee arthroplasty. 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.
You have had surgery to repair one or more of the tendons which straighten your thumb. In addition, a removable splint is fashioned protecting the a. Extensor zone 1 lacerations can be challenging to manage due to the thinness of the tendon mechanism at this level. Extensor tendon repair metro north hospital and health. Disruption of terminal extensor tendon distal to or at the dip joint of the fingers and ip joint of the thumb epl mallet finger. Mammoth orthopedic institute 85 sierra park road mammoth lakes, ca 93546 760. This booklet gives you important information about your rehabilitation. Tendon injury in the hand can frequently be complicated by scarring and adhesions that interfere with excursion and function of the repaired tendons. Extensor tendon repair zones ii, iii, iv rehabilitation. Extensor mechanism repair quad tendon, patellar tendon. Primary upper extremity and hand extensor tendon repair protocol.
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