Rehabilitation following surgery for flexor tendon injuries of the hand.
Ontology highlight
ABSTRACT:
SUBMITTER: Peters SE
PROVIDER: S-EPMC8094509 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Quality of life is enhanced by engagement in meaningful activities and participation using our hands. In African countries, people rely predominantly on the use of their hands to engage in economic productive activities, including agricultural, fishing, mining and construction, that are largely performed by machines in high-income contexts. Anecdotal evidence suggests a high incidence of flexor tendon injuries that are managed using protocols that were adopted from high-income countries and implemented without considering contextual differences. African therapists use discretion in selecting protocols thereby presenting inconsistency in tendon management. This result in challenges with ascertaining the most effective protocol, factors that influence protocols and the extent of evidence about flexor tendon rehabilitation in Africa. Therefore, this scoping review aims to provide evidence currently available on the rehabilitation of flexor tendons in African countries. This will synthesise the advantages and disadvantages of the current protocols and make proposals that are contextually relevant and cost-effective for rehabilitation of tendon injuries. METHODS AND ANALYSIS: The research will follow the scoping review methodological framework developed by Arksey and O'Malley (2005). The search strategy was developed and will be used to retrieve articles from eight databases. Further literature will be searched in the bibliography of the identified eligible articles. Grey literature will be searched in scientifically reliable websites, organisations and other sources. Articles will be reviewed by two independent researchers and opinion will be sought from a third reviewer when disagreement prevails on the inclusion quality of an article. All relevant articles that meet the criteria will be analysed using Weft QDA. ETHICS AND DISSEMINATION: The scoping review paper will be discussed with local therapists. Thereafter, findings will be published in the year 2021 and sent to rehabilitation associations in respective African countries.
| S-EPMC8055119 | biostudies-literature
Project description:This population-based study aimed to define how time to hand therapy following isolated zone II flexor tendon repairs impacts complications and secondary procedures.MethodsInsurance claims from the Truven MarketScan Databases were used to evaluate outcomes after isolated zone II flexor tendon repairs between January 2009 and October 2015. Cohorts differing in time to hand therapy were compared to evaluate the impact on complications, reoperation, and number of therapy sessions. Secondary outcomes analyzed how the number of therapy sessions affected rates of reoperation.ResultsHand therapy was identified in 82% of patients (N = 2867) following tendon reconstruction. Therapy initiation occurred within 1 week, 1-4 weeks, and after 4 weeks in 56%, 35%, and 9% of patients, respectively. Univariate analysis showed no difference in non-tendinous complications (27%, 30%, 29%; P = 0.29) or tendon rupture rates (13%, 13%, 10%; P = 0.42) within 90 days between cohorts. Multivariable analysis showed no difference in rates of tenolysis (6.3%, 6%, 4.4%; P > 0.01). In the early initiation cohort, >23 hand therapy sessions were associated with the highest rates of tenolysis (19%).ConclusionsDespite being a common fear of hand surgeons, early initiation of hand therapy was not associated with increased tendon rupture rates. Although delayed therapy is a concern for tendon scarring, it did not confer a higher risk of tenolysis. Complication rates do not appear to correlate with timing of hand therapy. Therefore, hand surgeons should promote early mobility following isolated flexor tendon injuries given the known functional outcome benefits.
| S-EPMC7787324 | biostudies-literature
Project description:There is no consensus on the most effective rehabilitation regimen following extensor tendon repair of the hand. This systematic review evaluates the outcomes of the various regimens. The Cochrane, MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker databases were searched for any prospective randomised clinical trials comparing rehabilitation regimens for acute extensor tendon injuries in adults. Five papers met the inclusion criteria. The regimens were static immobilisation, dynamic splinting and early active motion (EAM). There was no standard format of reporting. The sample size ranged from 27 to 100 patients. The duration of follow-up ranged from 8 to 24 weeks. Overall, patients' total active motion improved with time. Early mobilisation regimens (active and passive) achieve quicker recovery of motion than static immobilisation but the long-term outcome appears similar. Given the comparable outcomes between dynamic splinting and EAM, we therefore favour EAM which is simpler and more convenient.
| S-EPMC3509285 | biostudies-literature
Project description:BackgroundPostoperative adhesions constitute a substantial clinical problem in hand surgery. Fexor tendon injury and repair result in adhesion formation around the tendon, which restricts the gliding function of the tendon, leading to decreased digit mobility and impaired hand recovery. This study evaluated the efficacy and safety of the peptide PXL01 in preventing adhesions, and correspondingly improving hand function, in flexor tendon repair surgery.MethodsThis prospective, randomised, double-blind trial included 138 patients admitted for flexor tendon repair surgery. PXL01 in carrier sodium hyaluronate or placebo was administered around the repaired tendon. Efficacy was assessed by total active motion of the injured finger, tip-to-crease distance, sensory function, tenolysis rate and grip strength, and safety parameters were followed, for 12 months post-surgery.ResultsThe most pronounced difference between the treatment groups was observed at 6 months post-surgery. At this timepoint, the total active motion of the distal finger joint was improved in the PXL01 group (60 vs. 41 degrees for PXL01 vs. placebo group, p = 0.016 in PPAS). The proportion of patients with excellent/good digit mobility was higher in the PXL01 group (61% vs. 38%, p = 0.0499 in PPAS). Consistently, the PXL01 group presented improved tip-to-crease distance (5.0 vs. 15.5 mm for PXL01 vs. placebo group, p = 0.048 in PPAS). Sensory evaluation showed that more patients in the PXL01 group felt the thinnest monofilaments (FAS: 74% vs. 35%, p = 0.021; PPAS: 76% vs. 35%, p = 0.016). At 12 months post-surgery, more patients in the placebo group were considered to benefit from tenolysis (30% vs. 12%, p = 0.086 in PPAS). The treatment was safe, well tolerated, and did not increase the rate of tendon rupture.ConclusionsTreatment with PXL01 in sodium hyaluronate improves hand recovery after flexor tendon repair surgery. Further clinical trials are warranted to determine the most efficient dose and health economic benefits.Trial registrationClinicalTrials.gov NCT01022242; EU Clinical Trials 2009-012703-25.
| S-EPMC4207831 | biostudies-literature
Project description:To determine the benefit of antibiotic prophylaxis on postoperative mobility in flexor tendon repairs, case notes of 72 flexor tendon injuries in twenty four patients were analyzed retrospectively (2001-2003). Only patients with non-contaminated injuries from sharp instruments in flexor zone 2 were included in the study; 57% were male, average age was 31 years, and 24% were smokers. The majority of injuries were caused by metal blades (45%). Most tendons were repaired with modified Kessler technique (69%). Twenty-five percent received intravenous flucloxacillin or co-amoxiclav perioperatively. Reduced total active motion (TAM, found in 25% of patients more than 7 weeks after surgical repair) significantly complicated patients without perioperative intravenous flucloxacillin cover. The use of intravenous perioperative flucloxacillin is a plausible adjunct in surgery to prevent postoperatively reduced mobility.
| S-EPMC2584217 | biostudies-other
Project description:The correct management of partially divided flexor tendon injuries is still controversial. Opinions vary regarding whether partially divided flexor tendon injuries should be repaired. Flexor tendon injuries are common because the tendons lie close to the skin. The tendons are therefore exposed to injuries like lacerations and crush injuries, and occasionally they can rupture from where they are joined to the bone. Tendon injuries are the second most common hand injuries in orthopedic patients.
| S-EPMC5553474 | biostudies-other
Project description:Adhesion formation after flexor tendon repair remains a clinical problem. Early postoperative motion after tendon repair has been demonstrated to reduce adhesion formation while increasing tendon strength. It is hypothesized that during mobilization, tendon cells experience mechanical shear forces that alter their biology in a fashion that reduces scar formation but also activates key genes involved in tendon healing. To test this hypothesis, primary intrinsic tenocyte cultures were established from flexor tendons of 20 Sprague-Dawley rats and sheared at 50 rpm (0.41 Pa) using a cone viscometer for 6 and 12 hours. Total RNA was harvested and compared with time-matched unsheared controls using cDNA microarrays and Northern blot analysis. Microarray analysis demonstrated that mechanical shear stress induced an overall "antifibrotic" expression pattern with decreased transcription of collagen type I and collagen type III. Shear stress down-regulated profibrotic molecules in the platelet-derived growth factor, insulin-like growth factor, and fibroblast growth factor signaling pathways. In addition, shear stress induced an overall decrease in transforming growth factor (TGF)-beta signaling pathway molecules with down-regulation of TGF-beta2, TGF-beta3, TGF-RI, and TGF-RII expression. Moreover, sheared tendon cells increased expression of matrix metalloproteinases and decreased expression of tissue inhibitors of metalloproteinase, an expression pattern consistent with an antifibrotic increase in extracellular matrix degradation. However, up-regulation of genes implicated in tendon healing, specifically, vascular endothelial growth factor-A and several bone morphogenetic proteins. Interestingly, the known mechanoresponsive gene, TGF-beta1, also implicated in tendon healing, was differentially up-regulated by shear stress. Northern blot validation of our results for TGF-beta1, TGF-beta2, TGF-beta3, and collagen type I demonstrated direct correlation with microarray data. Groups of assays that are related as part of a time series. Keywords: time_series_design
2006-01-28 | GSE4096 | GEO
Project description:Medial epicondylitis, also known as "golfer's elbow," is a common orthopaedic condition that typically results from overuse of the flexor pronator mass. Repetitive eccentric loading of the muscles responsible for wrist flexion and forearm pronation leads to microtrauma and subsequent degeneration of the flexor pronator tendon. Patients with medial epicondylitis typically present in the fourth to sixth decade of life and have an insidious onset of medial elbow pain. Occasionally, medial epicondylitis may result from an acute traumatic event, such as an acute avulsion of the common flexor tendon. Patients should be examined for concomitant elbow pathologies, including ulnar neuritis and ulnar collateral ligament injury. T2-weighted magnetic resonance imaging can show increased signal intensity in the common flexor tendon or a complete rupture. Nonsurgical management is the mainstay of treatment; however, surgical treatment may be indicated in elite athletes and patients with persistent symptoms after conservative treatment. This technique article with accompanying video describes open debridement and repair of the flexor pronator tendon, with an emphasis on restoration of the anatomic footprint and compression across the repair site to promote biological healing.
| S-EPMC6926370 | biostudies-literature
Project description:Adhesion formation after flexor tendon repair remains a clinical problem. Early postoperative motion after tendon repair has been demonstrated to reduce adhesion formation while increasing tendon strength. It is hypothesized that during mobilization, tendon cells experience mechanical shear forces that alter their biology in a fashion that reduces scar formation but also activates key genes involved in tendon healing. To test this hypothesis, primary intrinsic tenocyte cultures were established from flexor tendons of 20 Sprague-Dawley rats and sheared at 50 rpm (0.41 Pa) using a cone viscometer for 6 and 12 hours. Total RNA was harvested and compared with time-matched unsheared controls using cDNA microarrays and Northern blot analysis. Microarray analysis demonstrated that mechanical shear stress induced an overall "antifibrotic" expression pattern with decreased transcription of collagen type I and collagen type III. Shear stress down-regulated profibrotic molecules in the platelet-derived growth factor, insulin-like growth factor, and fibroblast growth factor signaling pathways. In addition, shear stress induced an overall decrease in transforming growth factor (TGF)-beta signaling pathway molecules with down-regulation of TGF-beta2, TGF-beta3, TGF-RI, and TGF-RII expression. Moreover, sheared tendon cells increased expression of matrix metalloproteinases and decreased expression of tissue inhibitors of metalloproteinase, an expression pattern consistent with an antifibrotic increase in extracellular matrix degradation. However, up-regulation of genes implicated in tendon healing, specifically, vascular endothelial growth factor-A and several bone morphogenetic proteins. Interestingly, the known mechanoresponsive gene, TGF-beta1, also implicated in tendon healing, was differentially up-regulated by shear stress. Northern blot validation of our results for TGF-beta1, TGF-beta2, TGF-beta3, and collagen type I demonstrated direct correlation with microarray data. Groups of assays that are related as part of a time series. Computed
2006-01-27 | E-GEOD-4096 | biostudies-arrayexpress
Project description:Introduction:Severe hand trauma, leading to extensive skeletal and tissue defects, requires plastic surgical reconstruction of the highest level aiming at maximizing function and aesthetics. The intention of this study was to investigate clinical parameters and resource consumption connected with severe hand injuries, with specific emphasis on a follow-up evaluation of quality of life after the reconstruction process. Materials and methods:In this retrospective study, we evaluated patients with severe hand injuries from 2013 to 2016 who had completed surgical and non-surgical treatment. Measures included total period of therapy (TPT) in days, total duration of operations including anesthesia (TOA), total duration of all operations (TO), and total number of operations (TNO). We also determined total inpatient stay (TIS), total number of clinic presentations with interventions (TNPI), initial hand injury severity score (iHISS), and inpatient proceeds (IPP) in Euros (€). Correlation was assessed between iHISS and TOA, TNO, and TIS. Finally, these patients were reexamined in a follow-up inquiry and the life quality was assessed with the five-level version of the EuroQol five-dimensional (EQ-5D) descriptive system (EQ-5D-5L). Results:We analyzed 12 patients with an average age of 44 years (min. 24 years, max. 75 years). Patients receiving reconstructive surgery experienced median ( x˜ ) TPT of 175 days [interquartile range (IQR), 51-499], TOA of 13 h (IQR, 6-37), TO of 9 h (IQR, 4-25), and TNO of 5 (IQR, 3-11). Further, the patients' median TIS was 22 days (IQR, 9-86), TNPI was 4 (IQR, 2-8), and iHISS was 77 (IQR, 44-162). The median IPP was 14.595 € (IQR, 5.541-33.709 €). IHISS was positively correlated with Pearson's r for TIS (0.817), TOA (0.857), and TNO (0.871). The EQ-5D-5L index value resulted in a high level of life quality with a median of 0.898 (min. 0.8, max. 1). Conclusion:Severe hand injuries are related to high efforts for surgical and functional reconstructions, which result in high quality of life measured with the EQ-5D-5L assessment. However, for a defined collective of patients, myoelectric prosthetic functional replacement should be considered. Further studies are necessary to examine functional outcomes and quality of life after bionic prosthetic replacement. Also, a bionic reconstruction score to define hard criteria for taking an acute treatment decision is necessary.
| S-EPMC6604571 | biostudies-literature