Documenti di Didattica
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– Flexor digitorum
superficialis
– Flexor digitorum
profundus
Early passive
mobilization
Early active
mobilization
Approaches to Rehabilitation
Considerations in choice of
approach:
– Pt. compliance
– Surgeon preference
– Type of injury
– Location and zone of injury
– Strength of repair
Approaches to Rehabilitation
Phases of all post-op
tendon protocols
– Phase I
• Day 1 to Week 3-4
• Tendon immobilized or
mobilized in controlled way
• Includes inflammatory and
fibroplasia phases of wound
healing
• Repair is at its weakest
Approaches to Rehabilitation
Phase II: Intermediate Phase
– Week 4
– Increase stress on tendon
– Mobilize for the first time, or
decrease protection during
mobilization
– Includes scar maturation phases of
wound healing
Approaches to Rehabilitation
Phase III: Late Stage
– Week 6-8
– Repair can withstand
resistance
– Continued scar
maturation
Factors Affecting Healing and
Rehab
Traction applied to
fingernail
– Placing a suture through the
nail in surgery
– Gluing to fingernail
• Dress hook
• Velcro
• Soft leather
• Moleskin
• Rubber band
Early Passive Mobilization
– Passively mobilize tendon repair
within first 24 hours to 1 week.
– Indicated for delayed referral to
therapy > 1 week
– Passive mobilization by
therapist, pt and/or dynamic
flexion traction
– Passive flexion pushes tendon
proximally; limited active or
passive extension pulls the
tendon distally
– Begin active motion at 4 weeks
Kleinert vs. Duran
0-3 days post op 0-3 days post op
– DBS – DBS with velcro
– Remove compressive straps
dressings from
fingers and allow
passive flexion to
palm within DBS
– Rubber band on
involved digit
attached to volar
forearm
Kleinert vs. Duran
First 3 weeks First 4 ½ weeks
8 reps full passive flexion
Patient encouraged to and extension of PIP joint
actively extend the finger 8 reps of full passive flexion
and allow elastic band to and extension of DIP joint
passively flex digit 8 reps of passive flexion and
10x’s each hour extension of in a composite
manner to MCP, PIP and
DIP joints
Do passive motions to the
uninvolved digits to prevent
stiffness
Remove velcro straps for the
above exercises on hourly
basis
Kleinert vs. Duran
3-6 Weeks 4 ½ Weeks
Continue with 1-4 ½ week
DBS removed exercises
Pt’s hand is maintained 10 reps of active flexion of
in a wrist band with wrist with digits flexed
rubber band traction followed by extension of
(full active extension of wrist and digits
IP and MCP joints 10 reps of composite
against rubber band active flexion and
with wrist in neutral extension MCP, PIP and
Active digital flexion is DIP joints
still not permitted (bend/straighten)
Exercises are performed
once every hour
throughout the day with
DBS worn b/w exercises
and at night
Kleinert vs. Duran
Change of protocol 5 ½ Weeks
at 6 weeks DBS no longer used tx
plan changes:
– 12 reps of active flexion
of wrist with digits flexed,
followed with active
extension of wrist and
digits
– 12 reps of composite
active digital flexion and
extension
– 12 reps of blocking
exercises for PIP joint (5
sec hold)
– 12 reps of blocking
exercises for DIP joint (5
sec hold)
Kleinert vs. Duran
6 Weeks 6 Weeks
Revisions:
Wrist band removed – Passive extension of
wrist and digits is
and active flexion allowed
can commence and – Splinting: full
tendon gliding extension gutter or
exercises or extension resting pan
blocking may be initiated
– Active and passive
range of motion
exercises and
blocking exercises
are permitted on an
hourly basis
Kleinert vs. Duran
8-10 Weeks 8 Weeks
– Progressive – Progressive strength
strengthening is building may be
initiated starting with initiated
mild resistive exercises
followed by sustained
grip
3 Months 10 Weeks
– Heavy resistive – Aggressive use of
exercises and return to hand with sports or
heavy labor activities heavy lifting is allowed
Early Active Mobilization
Key Points
– Actively mobilize the tendon within
first 24 hrs to 3 days post-op
– Only appropriate if both therapist and
surgeon possess skill and experience
in tendon management,
communicate closely with one
another and suture utilized is
adequate in strength.
– Indicated for physically and
cognitively competent patients
– Most aggressive approach