The Significance of Extensor Tendon Tethering and Dorsal Joint Capsule Tightening After Injury to the Hand

Abstract

This paper examines the clinical problem of extensor tendon tethering and/or dorsal joint capsule tightening secondary to hand injury. One hundred and forty-one patients were examined 13 to 51 months after hand injuries of varying severity. Fifty-six patients (40%) had suffered simple and eighty-five patients (60%) complex injuries. Seventy-four (52%) of the 141 patients had no extensor tendon tethering and/or dorsal joint capsule tightening. In 30 (21%), the extensor tendon tethering and/or dorsal joint capsule tightening was considered to be "obvious" in that it was easily seen on examination using various commonly used clinical tests of finger flexion and extension. In 37 (26%), the extensor tendon tethering and/or dorsal joint capsule tightening was considered to be of "lesser degree" because it was only evident on application of specific tests which are described in this paper. Of the 37, 21 (56%) described themselves as being unable to make a "proper" fist with the injured hand, 33 (89%) had pain or discomfort on the dorsum of the injured hand and/or fingers on gripping (P < 0.01) and 25 (70%) had weakness of power of gripping (P < 0.01). Thirty-two (87%) complained of functional problems at work, with activities of daily living or with the pursuit of their hobbies.

The Effect of the Severity of the Dupuytren’s Contracture on the Function of the Hand Before and After Surgery

“…We would have expected this to be reversed by surgical correction of the deformity, but median value of grip strength was slightly worse 12 months after surgery. This can be explained by the effect of extensor tethering, which affects most of these patients significantly in the first few months (Kulkarni et al, 2006). Many do not have full roll-up of both the operated fingers and the adjacent fingers, even at 12 months.…”

The Gliding Force and Work of Flexion in the Early Days after Primary Repair of Lacerated Flexor Tendons: an Experimental Study

“…Apparently, adhesions do not form very early and, therefore, it is questionable whether we should start motion of fingers with repaired digital flexor tendons very early. Tethering of the extensor mechanism and tightening of the capsules of the finger joints do appear to increase the resistance to active finger flexion (Kulkarni et al, 2006), but to what extent this contributes to overall resistance to active motion of the digital flexor tendons and how soon the fingers should be moved to prevent extensor tethering and joint stiffness remain undetermined. Given that adhesions do not form so early, we can find no particular reason, experimental or clinical, to start mobilisation as early as the first to the third postoperative day.…”

Avoidance of unfavourable results following primary flexor tendon surgery

“…Although the injury in these cases is on the palmar surface of the hand, movement of oedema onto the dorsum carries the fibrin glue with it and the movement of the digits into flexion is then restricted by fibrin tethering of the extensor tendons, preventing their distal movement to allow finger flexion. [ 1 ] The extensor tendons, moving between interstitial tissue layers and without synovial sheaths, are more susceptible to this problem after any oedema-inducing episode in the hand and are responsible for much of the failure of flexor tendon surgery to restore a full range of digital motion. This can be identified by loss of passive flexion of the fingers.…”