Introduction The aim of this study was to analyze primary flexor tendon repair results in zones I and II, comparing the rupture rate and clinical outcomes of the controlled active motion (CAM) protocol with the modified Kleinert/Duran (mKD) protocol. Materials and methods Patients who underwent surgery with traumatic flexor tendon lacerations in zones I and II were divided in three groups according to the type of rehabilitation protocol and period of management: group 1 included patients who underwent CAM rehabilitation protocol with six-strand Lim and Tsai suture after May 2014. Group 2 and 3 included patients treated by six-strand Lim Tsai suture followed by a modified Kleinert/Duran (modK/D) protocol with additional place and hold exercises between 2003 and 2005 (group 2) and between 2011 and 2013 (group 3). Results Rupture rate was 4.7% at 12 weeks in group 1 (3/63 flexor tendon repairs) compared to 2% (1/51 flexor tendon repairs) in group 2 and 8% in group 3 (7/86 flexor tendon repairs). The grip strength at 12 weeks was significantly better in group 2 compared to the group 1 (35 kg/25 kg, p = 0.006). The TAM in group 1 [113° (30–175°)] was significantly worse (p < 0.001) than the TAM in group 2 [141° (90–195°)] but with similar extension deficits in both groups. The assessment of range of motion by the original Strickland classification system resulted in 20% excellent and 15% good outcomes in the CAM group 1 compared with 42% and 36% in the modK/D group 2. Subanalysis demonstrated improvement of good/excellent results according to Strickland from 45% at 3 months to 63.6% after 6-month follow-up in the CAM group. Conclusion The gut feeling that lead to change in our rehabilitation protocol could be explained by the heterogenous bias. A precise outcome analysis of group 1 could underline that in patients with complex hand trauma, nerve reconstruction, oedema or early extension deficit, an even more intensive and individual rehabilitation has to be performed to achieve better TAM at 6 or 12 weeks. Our study explicitly demonstrated a significant better outcome in the modK/D group compared to CAM group. This monocenter study is limited by its retrospective nature and the low number of patients.

Zusammenfassung Ziel: Die Studie untersucht anhand klinikbasierter Daten die Wiederaufnahme der Arbeit und die Dauer der Arbeitsunf?higkeit (AUF) von Patienten nach offenen Handverletzungen und wertet m?gliche beeinflussende Faktoren quantitativ aus. Methode: Eingeschlossen in die retrospektive Erhebung wurden 18?65 j?hrige Patienten mit akuten Handverletztungen (n=435), die 2008 und 2009 in unserer Klinik operativ versorgt wurden. Durch versandte Fragebogen in 2011 wurden zu den Angaben aus der Krankengeschichte zus?tzliche demografische, arbeitsbezogene und pers?nliche Informationen erhoben. In Gruppenvergleichen und multivariablen linearen Regressionen wurden Zusammenh?nge zwischen m?glichen beeinflussenden Faktoren und der Dauer der AUF ermittelt. Ergebnisse: Die Stichprobe umfasste 290 Patienten mit einem durchschnittlichen Alter von 38,9 (SD 13,2) Jahren. 98,6% der Handverletzten nahmen nach einer Zeitdauer von 45,5 Tagen (Median) ihre T?tigkeit wieder auf. Klinische, soziodemografische und arbeitsbezogene Faktoren waren in den einfachen Gruppenvergleichen mit der Dauer der AUF assoziiert. Die Verletzungsregion, die Anzahl der betroffenen Regionen, das Aufkommen von Sekund?reingriffen, das Alter und die berufliche T?tigkeit waren die einzigen Variablen, die in der multivariablen linearen Regression einen statistisch signifikanten Zusammenhang mit der Dauer der AUF aufwiesen. Schlussfolgerung: Verletzungsbezogene Faktoren und das Alter beeinflussen die Zeitdauer bis zur Wiederaufnahme der Arbeit nach einer Handverletzung ma?gebend. Da sich beide nicht modifizieren lassen, kommt der Pr?vention von Handverletzungen, gefolgt von einer fr?hen sachgem??en klinischen und therapeutischen Rehabilitation gr??te Bedeutung zu. Eine ebenso wesentliche Rolle f?r die Zeitdauer bis zur Arbeitsaufnahme kommt den Anforderungen der jeweiligen beruflichen T?tigkeit zu. Durch eine verbesserte Kommunikation zwischen medizinischem Behandlungsteam, Arbeitgeber, Versicherer und dem Handverletzten lie?en sich bereits zu einem fr?hen Zeitpunkt entscheidende Weichenstellungen in der Rehabilitation vornehmen. Ob diese eine graduelle und fr?here Arbeitswiederaufnahme erm?glicht, bleibt Gegenstand weiterer Untersuchungen.

Background: The purpose of this study is to assess outcomes in flexor pollicis longus tendon repairs with 6-strand core sutures with and without circumferential sutures. Methods: A 6-strand core suture technique with and without circumferential sutures was used. Thirty-three patients were summarized in the C group (circumferential group) and 16 patients in the NC group (non-circumferential group). After the surgery, the wrist was stabilized with a dorsal blocking splint and a controlled early active motion protocol was applied. At weeks 6, 13, and 26 data on demographics, type of injury, surgery, postoperative rehabilitation, complications such as re-rupture and the following outcome measurements were collected: range of motion and its recovery according to the Tang criteria, Kapandji score, thumb and hand strengths, Disabilities of the Arm, Shoulder and Hand score, and satisfaction. Results: There were no significant differences in range of motion and strength between the 2 treatment groups. In both groups, the outcome measurements increased over time and they expressed similar satisfaction with the surgical treatment. In 4 patients of the C group tendon repair ruptured and in 1 patient of the NC group. Conclusions: Six-strand repair technique is an effective procedure to assure early active motion after flexor pollicis longus tendon injuries and good results can also be achieved by omitting the circumferential suture.

The treatment of neuropathic pain challenges not only doctors but also hand therapists, since a majority of patients don't experience a significant pain relief despite systemic pain treatment. Early diagnosis of neuropathic pain and a therapeutic concept is crucial to meet the individual needs of the patient. The complexity of a pain syndrome calls for a multidisciplinary approach using patient education, pharmacological and non-pharmacological therapies, such as graded motor imagery or somatosensory rehabilitation, behavioral therapy and physical measures. The evidence of the above mentioned therapies with regards to neuropathic pain is not yet completely established. Possible reasons are the lack of complete understanding of the pain causing mechanisms and the fact of treating the symptoms rather than the cause.