The Application of Force to the Healing Tendon

Evans, Roslyn B.; Thompson, David E.

doi:10.1016/s0894-1130(12)80328-0

Cited by 101 publications

(58 citation statements)

References 89 publications

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“…However, these forces are relatively small. Evans et al 41,42 reported the estimate of force in the relaxed position of the FDP tendon was 0.8 N. The maximum force that we measured during finger motion was of similar magnitude to the in vivo human study of Schuind et al 33 Of note, neither our study nor that of Schuind et al's looked at the forces generated by motion of repaired tendons. It is likely that because of swelling of the repaired tendon, adhesions, and postoperative joint stiffness, such forces would be greater, and could approach the limit of tendon repair strength.…”

Section: Discussionsupporting

confidence: 75%

Flexor Digitorum Profundus Tendon Tension during Finger Manipulation

Tanaka

Amadio

Zhao

et al. 2005

Journal of Hand Therapy

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The purpose of this study was to measure the tension in the flexor digitorum profundus (FDP) tendon in zone II and the digit angle during joint manipulations that replicate rehabilitation protocols. Eight FDP tendons from eight human cadavers were used in this study. The dynamic tension in zone II of the tendon and metacarpophalangeal (MCP) joint angle were measured in various wrist and digit positions. Tension in the FDP tendon increased with MCP joint extension. There was no tension with the finger fully flexed and wrist extended (synergistic motion), but the tendon force reached 1.77 ± 0.43 N with the MCP joint hyperextended 45 degrees with the distal interphalangeal and proximal interphalangeal joints flexed. The combination of wrist extension and MCP joint hyperextension with the distal interphalangeal and proximal interphalangeal joints fully flexed, what the authors term ''modified synergistic motion,'' produced a modest tendon tension and may be a useful alternative configuration to normal synergistic motion in tendon rehabilitation.Flexor tendon injury is common and often results in disability, especially in the zone II region of the hand. 1-3 Early mobilization, either passive or active, starting within a few days of repair, has been shown to produce superior results to postoperative immobilization. 4-7 Early mobilization after tendon repair decreases adhesion formation and improves repair site strength, permitting more complete recovery of tendon excursion and digital range of motion. 6,8,9 Early mobilization is thought to inhibit or disrupt adhesion formation and also to promote intrinsic healing and synovial diffusion, to produce stronger tissue than with immobilization. 8-11

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Section: Discussionsupporting

confidence: 75%

Flexor Digitorum Profundus Tendon Tension during Finger Manipulation

Tanaka

Amadio

Zhao

et al. 2005

Journal of Hand Therapy

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“…If the hand transplant recipient's native extrinsic flexor and extensor muscles are present and functioning, we start early active motion (EAM) of the metacaprophalangeal (MP) and interphalangeal (IP) joints with emphasis on assisted motion within the confines of the dynamic crane orthosis by the end of post-operative week 1. Active tension at tendon repair sites is recommended to allow proximal movement that may not happen with passive motion alone [11]. Physical therapy for out-of-bed activities starts in week 2, especially important in hand transplant recipients who also have lower extremity amputations and use prostheses.…”

Section: Initial Phase (Days 0 To 14)mentioning

confidence: 99%

Rehabilitation Following Hand Transplantation

Bueno

Benjamin

Sisk

et al. 2013

Hand (New York, N,Y.)

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Background Hand allotransplantation can restore motor, sensory and cosmetic functions to upper extremity amputees. Conclusions Rehabilitation therapy after hand transplantation follows a progressive increase in activity in parallel with wound healing and nerve regeneration. Careful documentation of progress and outcomes is essential to demonstrate the utility of interventions and to optimize therapy protocols.

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“…28 Early protected motion protocols have demonstrated a clear benefit in tendon healing. 29,30 Actively mobilized tendons have been found to heal with decreased adhesions or large tendon calluses that are commonly found in immobilized tendons. 31 However, early protected motion protocols depend on strong repair techniques, which are required to withstand at least 30 -51 N of force.…”

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confidence: 99%