ABSTRACT
OBJETIVOS: conocer la efectividad del Protocolo de Durán Modificado en las Lesiones Tendinosas Flexoras de la Mano determinando el grado de discapacidad funcional en pacientes atendidos por el Servicio de Medicina Física y Rehabilitación del Hospital de Clínicas en el periodo agosto diciembre de 2016. MATERIAL Y MÉTODOS: se incluyeron dos grupos paralelos: al primer grupo (9 pacientes) se aplicó el protocolo de Durán Modificado y al segundo (9 pacientes) el tratamiento rehabilitador convencional. La valoración de la funcionalidad fue a través de la fórmula de Strickland, el sistema de Bruck Gramcko y la Distancia Pulpejo-Palma. Se realizó en 36 sesiones de 30 minutos aproximadamente para cada modalidad terapéutica con la correspondiente evaluación al finalizar los 3 meses de terapia. RESULTADOS: los que realizaron el protocolo de Durán Modificado finalizaron el tratamiento con una funcionalidad excelente en 4 casos, bueno en 3 y regular en 2 según la fórmula de Strickland. Según el sistema de Buck Gramcko la funcionalidad fue excelente para 5 pacientes y regular para 4. Y finalmente con la evaluación de la distancia pulpejo - palma se determinó que 4 pacientes obtuvieron un rango excelente, 4 bueno y 1 regular. CONCLUSIONES: la aplicación del protocolo de Durán modificado como rehabilitación precoz en pacientes con lesiones tendinosas flexoras de la mano es de mayor efectividad que el tratamiento rehabilitador convencional siendo una herramienta que puede ser aplicada de manera temprana en pacientes postoperados por esta afección
OBJECTIVES: to determine the effectiveness of the Modified Duran Protocol on flexor tendon injuries of the hand determining the degree of functional disability in patients treated by the Department of Physical Medicine and Rehabilitation at the Hospital de Clinicas during term August - December 2016.MATERIAL AND METHODS: we included two parallel groups: The Duran Modified protocol was applied on the first group (9 patients) and the Conventional Rehabilitation (9 patients) Treatment on the second. The assessment of the functionality was carried out with the formula Stricklan, Bruck Gramcko System and Pulpejo-Palma Distance. It was conducted in 36 sessions of approximately 30 minutes for each treatment modality with the corresponding evaluation at the end of 3 months of therapy. RESULTS: those who carried out the Modified Duran protocol completed treatment with excellent functionality in 4 cases, good in 3 and fair in 2 according to the formula Strickland. According Gramcko Buck system functionality was excellent for 5 patients and Fair for 4. Finally the evaluation of the pulpejo - palm distance showed that four patients had an excellent range, 4 good and 1 fair. CONCLUSIONS: the application the Modified Duran protocol as immediate rehabilitation in patients with flexor tendon injuries of the hand is more effective than conventional rehabilitation treatment being a tool that can be applied early in patients after surgery for this injury
Subject(s)
Humans , Male , Female , Adolescent , Middle Aged , Splints , Hydrotherapy/methods , Tendon Injuries/diagnosis , Transcutaneous Electric Nerve Stimulation/methods , Trigger Finger Disorder/diagnostic imagingABSTRACT
Objective To observe the value of the high frequency color Doppler uItrasonography in emergency operation of flexor tendon injuries in the hand.Methods Totally 21 patients of flexor tendon injuries in the hand underwent surgical exploration with high frequency probe.The extent of the tendon injuries,the retracted parts of the ruptured tendon and the blood supply were observed.Results The extent of the tendon injuries,the poison of broken ends were clearly distinguished with high frequency probe.The continuous tendon fibrous of layered high echo and sheath thin layer low echo complete broke and replaced with low or no echo.Conclusion Intraoperative uhrasonography of flexor tendon iniuries is important tO shorten operation time,reduce the injury of surrounding tissues,relieve local adhesion and ensure vascular recanalization after operation.
ABSTRACT
OBJETIVO: Verificar a amplitude de movimento (ADM) em mãos que sofreram reparo tendinoso dos músculos flexores superficial e profundo dos dedos, comparando os dados de cada dedo na mão lesada e entre mãos lesadas e não lesadas. MÉTODOS: Foi realizada a goniometria ativa em 15 pacientes e 120 dedos, 60 dedos de mãos lesadas e 60 de mãos controle não lesadas. Os sujeitos foram avaliados no momento da retirada da tala gessada, tendo sido realizada a movimentação precoce pelo método de Duran modificado. A partir dos dados goniométricos, foram registrados os valores do índice TAM (Total Active Motion) dos dedos nas mãos lesadas e controle. Para análise dos dados, foi acessada a fórmula de índices funcionais proposta pela American Society for Surgery of the Hand (ASSH) e para cálculo estatístico, foi escolhido o Modelo de Efeitos Mistos. RESULTADOS: A fórmula da ASSH para os dedos lesados mostrou que 18,33 por cento tiveram a classificação do movimento "bom", 18,33 por cento, "regular" e 63,34 por cento, "pobre". Foram comparadas as médias das medidas em graus de todos os dedos entre si dentro de cada grupo, controle ou lesado, e as médias das medidas entre os grupos, encontrando-se um p-valor significante apenas entre os grupos controle e lesado. Não houve diferença estatística entre o TAM de cada dedo na mão lesada. CONCLUSÃO: Independente de quantos dedos tenham sofrido lesão tendinosa em uma mão, os dedos não lesados também terão suas ADMs ativas diminuídas no período logo após a retirada da imobilização.
OBJECTIVE: To assess the range of motion (ROM) in hands that underwent tendon repair in the flexor digitorum superficialis and flexor digitorum profundus muscles of the fingers, comparing the data between the fingers on the injured hand, and between the injured and uninjured hands. METHOD: Active goniometry was performed on 15 patients, making a total of 120 fingers (60 on injured hands and 60 on noninjured control hands). The patients were examined at the time of removing the plaster splint. Early mobilization was performed using the modified Duran method. Goniometric data were used for recording the TAM (total active motion) values of the fingers on the injured and uninjured (control) hands. To analyze the data, the functional index formula proposed by the American Society for Surgery of the Hand (ASSH) was utilized, and for statistical calculations the mixed-effect model was selected. RESULTS: The ASSH formula for the injured fingers classified the movement as "good" in 18.33 percent, "fair" in 18.33 percent and "poor" in 63.34 percent. The means, in degrees, of the measurements for all the fingers were compared with each other within each group (control and injured) and between the groups. A significant difference was found between control and injured groups. There was no statistical difference between the TAM of each finger on the injured hand. CONCLUSION: Independent of how many fingers on one hand had suffered tendon injuries, the uninjured fingers also presented diminished active ROM during the period immediately after removal of the immobilization.
Subject(s)
Humans , Male , Female , Finger Injuries , Range of Motion, Articular , Tendon InjuriesABSTRACT
Since 1985, authors have applied a cast ring around the reconstructed pully involving adjacent one normal digit and allowed early dynamic motion after one stage tenolysis or tendon graft in 24 digits of 16 patients with old flexor tendon injuries in zone II. With this ring technique, authors obtained satisfactory results in 80% of the patients, which proved to be as good as two stage flexor tendon reconstruction with silicone rodding. A cast ring allowed early active motion after tenolysis and early dynamic passive motion after tendon graft. It served as temporary external augmentation of the reconstructed pully and seemed to reduce the tension at the reconstruced tendon and pully. One stage flexor tendon reconstruction and early dynamic motion with ring technique was advantageous in shortening of morbidity and postoperative rehabilitation period, and eliminating complications from silicone rodding.