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Resumen Introducción: Las lesiones de la mano son uno de los padecimientos más frecuentemente atendidos en el Servicio de Cirugía Plástica y Reconstructiva del Hospital Central Militar, dentro de la amplia variedad de estas lesiones se encuentran las lesiones del sistema flexor. Objetivo: Estimar la incidencia, funcionalidad y tiempo de reintegración laboral en pacientes con lesiones de sistema flexor de la mano tratados en el Hospital Central Militar en el periodo del 1º de marzo del 2020 al 1º de marzo del 2022. Metodología: Estudio observacional, retrospectivo, longitudinal descriptivo en pacientes adultos con lesión de sistema flexor de la mano, en los cuales la causa de la lesión no haya condicionado un trauma complejo de la mano. Se utilizó como referencia los criterios de recuperación funcional de Strickland y Goglovac. Resultados: A pesar de que las lesiones de la zona II flexora en la literatura presentan un peor pronóstico para la recuperación de la función normal de la mano, los resultados demuestran que la mayor parte de los pacientes se encuentra en una escala funcional buena. Limitaciones del estudio: El estudio fue llevado a cabo durante el periodo comprendido por la pandemia COVID, por lo que las consultas subsecuentes con tiempos más alargados y el inicio tardío de las consultas de rehabilitación pudieron haber contribuido hacia una recuperación más deficiente de la recuperación funcional de los pacientes.
Abstract Introduction: Hand injuries are one of the conditions most frequently treated in the Plastic and Reconstructive Surgery Service of the Hospital Central Militar, within the wide variety of these injuries are injuries to the flexor system. Objective: To estimate the incidence, functionality and labor reintegration time in patients with hand flexor system injuries treated at the Hospital Central Militar in the period from March 1, 2020 to March 1, 2022. Methodology: Observational, retrospective, longitudinal, descriptive study in adult patients with injury to the flexor system of the hand, in whom the cause of the injury did not result in complex trauma to the hand. The Strickland and Goglovac functional recovery criteria were used as reference. Results: Despite the fact that flexor zone II lesions in the literature present a worse prognosis for the recovery of normal hand function, the results show that most of the patients are in a good functional scale. Limitations of the study: The study was carried out during the period covered by the COVID pandemic, so that subsequent consultations with longer times and the late start of rehabilitation consultations could have contributed to a poorer recovery of functional recovery. from the patients.
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Objective To explore the effects of early active mobilization on hand function after zone 5 flexor tendon and ulnar nerve repair.Methods Fifty-five patients who had received primary repair in zone 5 of a flexor tendon and the ulnar nerve were randomly divided into an observation group (26 cases, 88 digits) and a control group (27 cases, 91 digits).Both groups were given routine treatment after the operation, and started to do active and passive exercise 4 weeks later.The observation group was additionally forced to do active range of motion exercise training starting 8 days after the operation.Twelve weeks after the operation, the hand function of both groups was assessed using the total active motion (TAM) scoring system of the American Society for Surgery of the Hand, peripheral nerve function evaluation and the disabilities of arm-shoulder-hand (DASH) scale.Results At the end of the treatment, the average TAM score of the observation group was significantly better than that of the control group.The average active movement range of the wrist in palm flexion, dorsal extension, ulnar deviation and in radial deviation were all significantly better than in the control group.Grip strength, overall hand function and DASH score were also significantly better on average.Conclusion Early active mobilization following flexor tendon and ulnar nerve repair can effectively promote the recovery of hand function.
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BACKGROUND: Current examination methods to assess the anatomical variations of flexor digitorum superficialis (FDS) tendon in the little finger necessitate a strong external force applied by the examiner and cause false negatives. A new examination method was designed to detect the variations more accurately. METHODS: We examined the little fingers of 220 adult hands (110 subjects) by 2 methods: the expanded examination method advocated by Tan et al., and a new examination method. Variations of the FDS in the little finger were examined by both methods and categorized separately as having independent FDS function, FDS connection to the tendons of the ring finger or of the multiple adjacent fingers, and functional substitution of the flexor digitorum profundus (FDP) with or without tendinous connection to the ring or multiple adjacent fingers. By our new method, we could further divide the FDS connection or FDP substitution with connection to the ring finger into 2 subtypes: loose and close connections. Data were reported as case numbers and percent. Date on symmetry were statistically analyzed by matched case-control studies. RESULTS: Among 220 hands, 113 hands (51.4%) had independent FDS function by the new examination method, which was lower than the incidence (55.5%) detected with the existing expanded examination method. In the hands with connections between FDS tendons of the little and the ring fingers, 32 hands (14.5%) demonstrated loose and 37 (16.8%) close connections. Three hands (1.4%) had loose and 19 (8.6%) had close FDP substitution with tendinous connection to the ring finger. Among 110 hands without independent FDS function, variants of 42 hands (38.2%) were asymmetric. There was no statistical significance in symmetry of variations. CONCLUSIONS: This new examination method offers other assessment variations of FDS tendon in the little finger. We recommend using this test to assess the variations and function of the FDS of the little finger.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Anatomic Variation , Fingers/anatomy & histology , Physical Examination/methods , Tendons/anatomy & histologyABSTRACT
La rehabilitación de las lesiones de los tendones flexores de los dedos de la mano es uno de los grandes retos que enfrentan los fisioterapeutas por lo impredecible de los resultados de su inter-vención y por el gran número de técnicas quirúrgicas y de rehabilitación que se utilizan, señal de la importancia del tema. El objetivo de la investigación es identificar estudios e investigaciones sobre los resultados de los procesos de rehabilitación fisioterapéutica después de la reparación quirúrgica de los tendones flexores. Se incluyen estudios sobre la reparación quirúrgica y re-habilitación de tendones flexores en cualquier zona de la mano, la búsqueda se realiza en bases de datos utilizando palabras claves como tenorrafia, tendones flexores y rehabilitación. En los estudios revisados no hay unanimidad en los resultados encontrados en cuanto a los protocolos de movilización activa y/o pasiva, tiempo de inicio y la prolongación de los mismos. Los datos encontrados no son concluyentes sobre que técnica de movilización arroja los mejores resulta-dos. Como hallazgo importante para la promoción de hábitos saludables, se encontró que el ta-baquismo influía como factor negativo en la reparación del tendón flexor, al igual que la lesión concomitante del nervio. Como técnica nueva de intervención se utilizó la representación mental de movimientos limitados, nuevo enfoque que necesita más investigación.
Rehabilitation of flexor tendon injuries of the fingers, is one of the greatest challenges faced by physiothe-rapists due to the unpredictability of the action results and the large number of surgical and rehabilitation techniques that are used, signal of the topic importance. The objective of this research is to identify studies and researches on the results in physiotherapy rehabilitation process after surgical repair of flexor tendons. Some studies are included on the surgical repair and rehabilitation of flexor tendons in any area of the hand, the search was done in databases using keywords like tenorrhaphy, flexor tendons and rehabilita-tion. In the reviewed studies there is no unanimity in the findings in terms of active mobilization protocols and / or passive, start time and the extension thereof. The data found are inconclusive on mobilization technique that yields the best results. As important finding for the promotion of healthy habits, it was found that smoking influenced as a negative factor in the flexor tendon repair, as well as concomitant nerve injury. As new intervention technique, it was used the mental representation of limited movement, which needs to be delved
Subject(s)
Humans , Hand , Rehabilitation , Tendons , Wounds and InjuriesABSTRACT
PURPOSE: To evaluate the clinical results of acquired claw toe deformities that had been treated with proximal lengthening of the long toe flexor tendons. MATERIALS AND METHODS: Seventeen patients with a claw toe deformity due to contracture of the long flexor tendons were treated with proximal lengthening of the long toe flexor tendons from January 1993 to January 2003 and were followed up for at least 1 year. The average age at the time of the operation was 42 years and the average follow-up period was 34 months. Achilles tendon lengthening was also performed in 14 cases with an equinus deformity. At the final follow-up, a residual toe deformity, toe pain during walking, patient's satisfaction, and limitation of the shoe-wear were assessed. RESULTS: At the final follow up, all cases showed a complete correction of a claw toe deformity, and did not have callosity at the toe tip or dorsal aspect of the toes. Toe pain during walking was found in 1 case, and a limitation of the shoe-wear was noted in 6 cases. At the final evaluation, 10 cases were graded as excellent, 6 good, and 1 fair. There was no recurrence of the claw toe deformity or limitation of the toe motion. CONCLUSION: Proximal lengthening of the long toe flexor tendons is recommended for treating flexible claw toe deformities. The procedure produced excellent results regarding the deformity correction and pain relief.