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Ultrasonographic Assessment of Flexor Tendon Mobilization: Effect of Different Protocols on Tendon Excursion

Korstanje, Jan-Wiebe H. MSc, PhD; Soeters, Johannes N.M.; Schreuders, Ton A.R. PhD; Amadio, Peter C. MD, PhD; Hovius, Steven E.R. MD, PhD; Stam, Henk J. MD, PhD; Selles, Ruud W. PhD

Journal of Bone & Joint Surgery - American Volume: 7 March 2012 - Volume 94 - Issue 5 - p 394–402
doi: 10.2106/JBJS.J.01521
Scientific Articles

Background: Different mobilization protocols have been proposed for rehabilitation after hand flexor tendon repair to provide tendon excursion sufficient to prevent adhesions. Several cadaver studies have shown that the position of the neighboring fingers influences tendon excursions of the injured finger. We hypothesized that the positions of adjacent fingers influence the long finger flexor digitorum profundus tendon excursion, measured both absolutely and relative to the surrounding tissue of the tendon.

Methods: Long finger flexor digitorum profundus tendon excursions and surrounding tissue movement were measured in zone V in eleven healthy subjects during three different rehabilitation protocols and two experimental models: (1) an active four-finger mobilization protocol, (2) a passive four-finger mobilization protocol, (3) a modified Kleinert mobilization protocol, (4) an experimental modified Kleinert flexion mobilization model, and (5) an experimental modified Kleinert extension mobilization model. Tendon excursions were measured with use of a frame-to-frame analysis of high-resolution ultrasound images.

Results: The median absolute long finger flexor digitorum profundus tendon excursions were 23.4, 17.8, 10.0, 13.9, and 7.6 mm for the active four-finger mobilization protocol, the passive four-finger mobilization protocol, the modified Kleinert mobilization protocol, the experimental modified Kleinert flexion mobilization model, and the experimental modified Kleinert extension mobilization model, respectively, and these differences were all significant (p ≤ 0.041). The corresponding relative flexor digitorum profundus tendon excursions were 11.2, 8.5, 7.2, 10.4, and 5.6 mm. Active four-finger mobilization protocol excursions were significantly (p = 0.013) greater than passive four-finger mobilization protocol excursions but were not significantly greater than experimental modified Kleinert flexion mobilization model excursions (p =0.213).

Conclusions: The present study demonstrated large and significant differences among the different rehabilitation protocols and experimental models in terms of absolute and relative tendon displacement. More importantly, the present study clearly demonstrated the influence of the position of the adjacent fingers on the flexor tendon displacement of the finger that is mobilized.

Clinical Relevance: The positions of adjacent fingers in tendon mobilization protocols have a large influence on both absolute and relative tendon excursions. The most commonly used protocols after flexor tendon repair may not lead to optimal tendon excursions.

1Department of Rehabilitation Medicine and Physical Therapy, Rooms Ee16.22 (J.-W.H.K.), Ca 001k (J.N.M.S.), H 014 (T.A.R.S. and R.W.S.), H 028 (H.J.S.), and HS 501 (S.E.R.H.), Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for J.-W.H. Korstanje:

2Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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