Should we think about wrist extensor after flexor tendon repair?

Abstract

Objective:To evaluate the activity of wrist extensor muscle, correlating with wrist motion during gripping after flexor tendon repair.Design:Cross-sectional clinical measurement study.Setting:Laboratory for biomechanics and rehabilitation.Subjects:A total of 11 patients submitted to rehabilitation by early passive motion of the fingers with wrist flexion position were evaluated after 8 weeks of fingers flexor tendon repair and 11 healthy volunteers, all ranging from 20 to 37 years of age.Intervention:Volunteers performed an isometric standardized gripping task.Main measures:We used electrogoniometry to analyze wrist range of motion and surface electromyography, considering 100% maximum voluntary contraction to represent the amplitude of electromyographic activity of the extensor carpi radialis and flexor digitorum superficialis.Results:Patients with flexor tendon repair showed co-activation deficit between wrist extensor (extensor carpi radialis) and flexor finger muscles (flexor digitorum superficialis) during gripping in the intermediate phase of rehabilitation, despite some recovering mobility for wrist extension (p ≤ 0.05). A moderate correlation between range of motion and extensor carpi radialis was present only for injured group (r = 0.32). Total active motion score, which represents finger active excursion, was regular or poor in 65% of cases, all with nerve repair associated.Conclusion:Wrist extensors have an important synergist role at handgrip, although some imbalance can be present after flexor tendon repair. These preliminary findings suggest that emphasis could be directed to add synergistic wrist motion in rehabilitation protocols after flexor tendon repair. Future studies with early active rehabilitation are necessary.

Fadiga dos músculos extensores do punho diminui a força de preensão palmar

“…Even with a wide variety of studies, we can observe that there is still no consensus on the positioning of electrodes and the influence of different wrist angles in the palmar grip task 32,34,38,39 . The muscular physiological processes can be analyzed by electromyographic signal during standardized activities.…”

Influence of volar and dorsal static orthoses in different wrist positions on muscle activation and grip strength in healthy subjects

“…In the present study, we used surface electromyography as a muscle activation assessment tool 4 with electrode sites defined through palpation, 35 analysing the ECRB/L, EDC and ECU as synergistic muscles of the wrist and hand, which are often affected by the inflammatory and/or degenerative process in LE. There are many studies in the literature that use surface EMG analyses on forearm muscles; 6,38–43 even so, there is still no consensus on electrode placement. In addition, we conducted an initial pilot study and found high test–retest reliability of the positioning ( r = 0.81).…”

Influência da órtese estática de punho na atividade muscular e amplitude de movimento de ombro e cotovelo durante uma tarefa funcional: estudo biomecânico

“…The upper limb is an important segment for contact with the external environment, and the joint sensorimotor system and the peripheral sensory nerve fibers are essential for proper movement skills, enabling to perform the activities of daily living (ADLs) 1-3 such as grasping and handling of objects, feeding or dressing, directly depending on the proper stability of the wrist 4 , mainly represented by the synergistic action of the extensor and flexor muscles of the wrist and fingers 5,6 . While performing a functional task with the fingers, the stabilizers of the wrist, elbow and shoulder help prevent compensatory movements and, therefore, are closely related 7 .…”