Functional and Disability Assessment Among Hispanics With Zone 2 Flexor Tendon Injuries: Comparative Study Between Flexor Digitorum Superficialis Repair and Flexor Digitorum Superficialis Excision

Abstract

Introduction: Flexor tendon lacerations in zone II have been reported to be the most complicated of all tendon injuries. Currently, there is no consensus on treatment in surgical management for patients with flexor tendon laceration of flexor digitorum profundus and flexor digitorum superficialis (FDS). The aim of this study was to evaluate whether the repair of FDS tendons provided superior functional outcomes compared with FDS excision in Hispanic patients. Methods: Total active motion, original Strickland criteria, and the disability of arm shoulder and hand questionnaire were provided postoperatively at 3 and 6 months to all consecutive Hispanic patients who underwent zone II flexor tendon repair. The cohort was divided into two groups, those who underwent FDS repair and those underwent FDS excision. Results: Functional and disability outcome analysis showed a notable improvement with FDS repair using total active motion, Strickland criteria, and disability of arm shoulder and hand score at the 3 months postoperative interval. No statistical differences were identified regarding functional and disability outcomes at the 6-month evaluation between both groups. Conclusions: Among Hispanics, the FDS-repaired group had similar functional and disability outcomes at their 6 months postoperative evaluation compared with the FDS-excised group. Increased awareness for tendon rerupture during the initial 3 months of index surgery is recommended for FDS-excised patients.

Variation in patient information and rehabilitation regimens after flexor tendon repair in the United Kingdom

“…[3][4][5][6][7] Restoration of movement and function after flexor tendon repair remains a challenge, particularly for zone II injuries. 8,9 Rehabilitation must find the balance of protecting the repair site from attenuation or rupture, while also enabling sufficient movement and tendon glide to prevent scar adhesions and joint contractures.…”

Relationship between pain, nerve injury and clinical outcomes after flexor tendon injuries in zones 1-2: a retrospective cohort study

“…We found a statistically significant relationship between pain during motion and the DASH up to one year after flexor tendon repair, while pain at rest did not show any association with hand function. Previous studies found generally low DASH scores after flexor tendon injuries, 12,26,32,[35][36][37] leaving little room for clinically important changes. For example, by scoring on average 17.0 points at week 13, achieving a clinically important change of 18.8 points 40 was not possible for our patients.…”

“…16,34 The DASH has previously been used in studies of patients after flexor tendon injury. 12,26,32,[35][36][37][38] In a study by Wong et al 39 patients at discharge after acute traumatic hand injuries achieved on average 14 (SD 15) DASH points. These results are comparable to our scores, as patients are typically discharged from therapy three months after flexor tendon surgery.…”

Medium-term clinical outcomes of Zone 2B/2C finger flexor tendon repairs: influence of management of flexor digitorum superficialis

“…Sadek (2020) found no significant difference in finger mobility after Zone 2B injuries between repairing and not repairing the FDS. Lastly, Natal-Albelo et al. (2020) recently published conclusive findings that FDS excision led to worse short-term functional outcomes (3 months), assessed by TAM, Strickland and DASH, but found no significant differences at 6 months.…”

“…Bilateral and comparative measurements of active and passive motion of the involved finger(s) were done with a goniometer on the metacarpophalangeal (MCP), PIP and DIP joints. The clinical outcomes were evaluated using: the total active motion (TAM), TAM percentage relative to the healthy contralateral finger (TAMc) (Natal-Albelo et al., 2020), PIP flexion deformity (degrees), Strickland’s formula (Strickland and Glogovac, 1980) by grouping the ‘excellent’/‘good’ categories and ‘fair’/‘poor’ categories, Tang score (Tang, 2007) by grouping the ‘excellent’/‘good’ categories and ‘fair’/‘poor’/‘failure’ categories. …”