The goal of repair is to restore tendon continuity and function, with a secondary goal of allowing early motion of. The common extensor tendon that originates from the lateral epicondyle of the elbow is directly involved. This booklet is designed to help you understand your ongoing care and. It will take at least 6 weeks for your tendons to heal and at least 12 weeks until they are strong enough for your return to unlimited activities.
Extensor pollicis longus repair, zone ii to viii weeks 612. Iii extensor tendon injuries compared as two groups. These are now being consistently challenged with laboratory and outcomes analysis. The large muscles on the back of your forearm are attached to tendons that cross the wrist. It is by no means intended to be a substitute for ones clinical decisionmaking regarding. After surgical repair a plaster case is applied to the hand to protect the repairs until a thermoplastic splint can be made by the occupational therapist. Fashion a shortarm splint holding the wrist in 30 degrees of extension and the mp joints. Application of hand therapy extensor tendon protocol to. Use of a semitendinosus tendon autogenous graft for rupture of the patellar ligament after total knee arthroplasty. Specific risks of extensor tendon surgery tendon scarring. After surgery, your forearm and hand will be in a large bandage and plaster splint. Repair extensor retinaculum to avoid bowstringing if cannot repair primarily then options include edl, plantaris, pb grafts, ehl transfer, vy. Extensor tendon repair zones ii, iii, iv rehabilitation.
When the extensor tendons are cut they need to be repaired or the finger will not straighten again properly. Zone v extensor tendon repair icam protocol phase i 021 days o postoperative dressings removed and replaced with light dressings o maintain wrist and digit in protected position during orthosis. Extensor tendon repairs surgery extensor tendon repairs surgery. Immediate controlled active motion following zone 47. We have utilized a technique for protection and repair of extensor tendon injuries that are distal to the myotendinous juncture and proximal to the metacarpophalangeal joint by performing a. You have had surgery to repair one or more of the tendons which straighten your thumb.
Immediate controlled active motion following zone 47 extensor tendon repair. Extensor tendon repair guide metro north hospital and. This comprehensive compilation of the suture repair techniques will. The extensor carpi radialis brevis ecrb and longus, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris come together to form the common extensor tendon. Extensor tendon repair zones v, vi rehabilitation protocol kelly holtkamp, m. When the extensor tendon becomes shortened or adherent, tenodesis restraint can occur.
Please fax initial evaluation and progress notes to 815. Extensor mechanism allograft reconstruction for extensor mechanism failure following total knee arthroplasty. Use of tenoglide tendon protector sheet to protect an. Advice and exercises following your extensor tendon repair. Treatment of extensor tendon injuries may require operative intervention, depending on the complexity of the injury and the zone of the hand involved. Injuries to extensor tendons also affect other structures necessary for proper tendon function. This article describes a splint management program for zone 47 extensor tendon repairs that allows for immediate controlled active motion icam of the repair and greater arcs of motion for. One approach advocated by doyle is a dermotenodesis suture that involves passing a large 3. Extensor tendon repair metro north hospital and health. Thumb extensor tendon repair oxford university hospitals. Advice and exercises following your extensor tendon repair patient information clinical and diagnostic services centre hand therapy extensor tendons muscle belly your extensor tendons straighten your fingers. The pursuit of the ultimate repair has led to many repair methods being described. Tendon grafting can be performed with a palmaris longus or toe extensor. Primary extensor tendon repair protocol edc, eip, edq, epl, ecrl, ecrb, ecu the intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone an extensor tendon repair.
Extensor tendons are found at the back of the hand, fingers and thumb. Splint keep the splint on at all times, we will remove this during your first visit to the clinic. Your tendon will take up to 12 weeks to completely heal and it is important to follow all advice to avoid rupturing your tendon. They allow you to straighten your fingers and thumb and. Extensor tendon repair zone iv and above information for patients. Repair and rehabilitation of extensor hallucis longus and. Extensor mechanism repair quad tendon, patellar tendon. Tendon injury in the hand can frequently be complicated by scarring and adhesions that interfere with excursion and function of the repaired tendons. Bakkers postop protocol important instructions following surgery. An innovative application of a hand extensor tendon repair protocol was applied by the hand therapy service to toe extensors when the hand surgery service was called in to repair toe extensor lacerations. Disruption of terminal extensor tendon distal to or at the dip joint of the fingers and ip joint of the thumb epl mallet finger. Tendinopathy, as opposed to tendinitis or tendinosis, is the best generic. Long extensor repairzones iv to vii after long extensor tendon repair, a thermoplastic yoke. Extensor zone 1 lacerations can be challenging to manage due to the thinness of the tendon mechanism at this level.
The hand therapist modified the hand extensor tendon repair protocol since there was no known protocol for repairs of the foot and toe extensor tendon. The surgeon should apprise the therapist of the quality of the repair, the type of repair, alterations in tendon length, the integrity of the tissue, the status of surrounding tissues, and any additional. Mammoth orthopedic institute 85 sierra park road mammoth lakes, ca 93546 760. The second is an excessive internal pull on the tendon by the muscle during active or resisted motion in. Jamming a finger may cause the tendon to tear from the attachment to bone. Extensor tendon repair activity you may not bear weight or use the operated hand until permitted by your surgeon.
Extensor tendons are easily injured, even by a minor cut. Upper extremity extensor tendon repair protocol brigham and. Troum, md, facs texas health southlake hospital southlake, tx introduction. The wrist is placed in approximately 20 to 25 extension with a separate. This helps prevent scarring and tightening of the tendon in a shortened position, as these tendons rarely heal on their own. Extensor tendon repair techniques are not as complicated as flexor tendon repairs, this is due to the. Results and outlook of extensor tendon repair surgery. This protocol is not intended to be a substitute for ones clinical decision making regarding. You have had surgery to repair one or more of the tendons in your hand arm. Tendon disorders are frequent and are responsible for substantial morbidity both in sports and in the workplace. You have had an injury to 1 or 2 of your extensor tendons on the back of your hand, between your knuckles.
Over the past five decades we have seen numerous iterations of suture repair methods for tendon. Extensor mechanism repair quad tendon, patellar tendon, patella fracture rehabilitation guidelines phase i for immobilization and rehabilitation. The patient was placed in an ankle foot orthosis with a toe extension device created by heating and. Scarring can occur within the tendon repair itself or in nearby structures to prevent the return of normal tendon function. Extensor tendon repair zone iv and above oxford university. Tendon injury may occur anywhere in the body where there are tendons. However, fractures, infection, or damage to numerous tendons can make it harder to recover complete finger and hand function.
Brigham and womens hospital a teaching affiliate of. Pdf management of extensor tendon injuries researchgate. Extensor tendon repair and rehabilitation surgical indications and considerations anatomical considerations. Control pain and inflammation maintain patellar mobility maintain hamstring strength of the ipsilateral. Early motion inspired by complications associated with immobilization. Advice and exercises following your extensor diagnostic. Repair, tendon sheath, extensor, forearm and or wrist, with free graft includes graft harvest 25275 extensor tendon repair, dorsum of hand, single, primary or secondary.
Internal tendon tension transmitted to the repair site with specific joint angles and external loads splinting configurationsexercise positions. Tendon reconstruction an overview sciencedirect topics. What are your extensor tendons and why have these been repaired. Extensor tendon repair surgery testimonial orlando ortho. The authors have described numerous methods to repair the extensor tendon in zone 1. Complications can occur after extensor tendon repair including, loss of flexion due to extensor tendon shortening, loss of flexion and extension resulting from adhesions and patients can notice a weakened grip. Your tendon has now healed enough to cope with normal daily activities but your thumb and hand will feel weak. If the affected tendon can recover its normal length with sufficient strength, then proper function is achievable. Common extensor tendon an overview sciencedirect topics.
Primary upper extremity and hand extensor tendon repair protocol this protocol is not intended to be a substitute for ones clinical decision making regarding the progression of a patients postoperative course based on their physical examfindings. They allow you to straighten your fingers and thumb and bend your wrist back. Primary upper extremity and hand extensor tendon repair protocol. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact approach depends on the extensor zone. Epl repair, zone ii to viii weeks 612 rehabilitation it is now 6 weeks since your operation. Extensor tendon repair zones v, vi rehabilitation protocol. A 30yearold dancer sustained complete laceration of her extensor hallucis longus and extensor hallucis brevis tendons. This booklet gives you important information about your rehabilitation. Because of their superficial location, the extensor tendons are often involved with inuries to the dorsum of the hand and are very likely to form adhesions with injuries to the bone. In addition, a removable splint is fashioned protecting the a. Optimizing the sequence of zone 1 extensor tendon repair.