Please confirm you are human (Sign Up for free to never see this)
← Back to Search
Pyramid Of Progressive Force Exercises To The Injured Flexor Tendon.
G. N. Groth
Published 2004 · Medicine
Save to my Library
Download PDFAnalyze on Scholarcy
Postoperative rehabilitation for patients who have sustained a laceration to their flexor tendon apparatus is an important factor in maximizing functional outcome. Quality rehabilitation is characterized by the development of a tailored exercise regimen. There is currently no model available to tailor an exercise regimen for a person with an atypical physiologic response pattern. If rehabilitation protocols were classified according to the criteria of forces applied across a tendon juncture and/or excursion, and a clinical method were available to assist in the identification of optimal tendon loading and/or excursion application, then those individuals with atypical response patterns could be treated more efficiently and effectively. The author conducted a literature review and case study. A model for systematic application of progressive loading exercises to the intrasynovial flexor tendon injury and repair is conceptually developed. The model consists of a pyramidal series of eight specific rehabilitation exercises in the following sequence: passive protected extension, place and hold, active composite fist, hook and straight fist, isolated joint motion, resistive composite fist, resistive hook and straight fist, and resistive isolated joint motion. Concepts are developed to implement a three-point clinical adhesion-grading system. Clinical application of the system is highlighted. An excellent outcome was considered 112% total active motion. A model for systematic application of progressive loading exercises has been conceptually developed in concert with a method for determination of optimal tendon loading. Further substantiation is necessary to validate the proposed theory.
This paper references
The effect of flexor tendon repair bulk on tendon gliding during simulated active motion: an in vitro comparison of two-strand and six-strand techniques.
D. Sanders (2001)
The vascularization of human flexor tendons within the digital synovial sheath region--structureal and functional aspects.
G. Lundborg (1977)
The importance of controlled passive mobilization on flexor tendon healing. A biomechanical study.
S. Woo (1981)
Cyclical testing of zone II flexor tendon repairs.
J. Choueka (2000)
The application of force to the healing tendon.
Roslyn B. Evans (1993)
Elongation of the repair configuration following flexor tendon repair.
H. Seradge (1983)
Wrist and digital joint motion produce unique flexor tendon force and excursion in the canine forelimb.
R. Lieber (1999)
Effect of flexor sheath integrity on tendon gliding: A biomechanical and histologic study
W. Peterson (1986)
The excursion and deformation of repaired flexor tendons treated with protected early motion.
R. Gelberman (1986)
Tendon excursion and moment arm of index finger muscles.
K. An (1983)
Elongation in profundus tendon repair. A clinical and radiological study.
A. Ejeskär (1981)
Flexor tendon gliding in the hand. Part I. In vivo excursions.
M. Wehbé (1985)
An experimental model for the study of canine flexor tendon adhesions.
D. M. Rothkopf (1991)
Primary tendon healing: a review.
L. Ketchum (1977)
Effect of pulley integrity on excursions and work of flexion in healing flexor tendons.
J. Tang (2001)
Relationship between joint motion and flexor tendon force in the canine forelimb.
R. Lieber (1996)
The revascularization of healing flexor tendons in the digital sheath. A vascular injection study in dogs.
R. Gelberman (1991)
Factors in the adherence of flexor tendon after repair: an experimental study in the rabbit.
P. Matthews (1976)
Flexor tendon healing and restoration of the gliding surface. An ultrastructural study in dogs.
R. Gelberman (1983)
Two new methods of tendon repair: an in vitro evaluation of tensile strength and gap formation.
K. L. Silfverskiöld (1993)
The effect of immediate constrained digital motion on the strength of flexor tendon repairs in chickens.
T. Hitchcock (1987)
Effects of tenorraphy on the gliding function and tensile properties of partially lacerated canine digital flexor tendons.
N. D. Boardman (1999)
The effects of multiple-strand suture methods on the strength and excursion of repaired intrasynovial flexor tendons: a biomechanical study in dogs.
S. C. Winters (1998)
Comparative flexor tendon excursion after passive mobilization: an in vitro study.
E. Horii (1992)
EXPERIMENTAL EVALUATION OF FACTORS AFFECTING THE STRENGTH OF TENDON REPAIRS
L. Ketchum (1977)
THE RATE OF HEALING OF TENDONS: AN EXPERIMENTAL STUDY OF TENSILE STRENGTH
M. Mason (1940)
Excursion of the flexor digitorum profundus tendon: A kinematic study of the human and canine digits
S. Horibe (1990)
The modified Kleinert splint in zone II flexor tendon injuries.
P. Slattery (1988)
Tendon excursion and dehiscence during early controlled mobilization after flexor tendon repair in zone II: an x-ray stereophotogrammetric analysis.
L. Hagberg (1991)
Primary repair of flexor tendons in no-man's land using the Becker repair.
J. Pribaz (1989)
Early active motion following a beveled technique of flexor tendon repair: report on fifty cases.
H. Becker (1979)
Flexor tendon forces: in vivo measurements.
F. Schuind (1992)
Digital function following flexor tendon repair in Zone II: A comparison of immobilization and controlled passive motion techniques.
J. Strickland (1980)
Controlled mobilization after flexor tendon repair in zone II: a prospective comparison of three methods.
E. J. May (1992)
Symposium on Tendon Surgery in the Hand
K. Heiple (1976)
Primary flexor tendon repair followed by immediate controlled mobilization
G. Lister (1977)
Intrasynovial Flexor Tendon Repair: An Experimental Study Comparing Low and High Levels of in Vivo Force During Rehabilitation in Canines
M. Boyer (2001)
A Comparison of Post-Operative Mobilization of Flexor Tendon Repairs with “Passive Flexion–Active Extension” and “Controlled Active Motion” Techniques
L. Bainbridge (1994)
The early stages of flexor tendon healing: a morphologic study of the first fourteen days.
R. Gelberman (1985)
Tendon healing in vivo. An experimental model.
S. Abrahamsson (1989)
Effect of cyclic tension on lacerated flexor tendons in vitro.
H. Tanaka (1995)
Effect of pulley excision on flexor tendon biomechanics
W. Peterson (1986)
Tendon And Nerve Surgery In The Hand: A Third Decade
J. M. Hunter (1997)
Flexor digitorum profundus tendon-to-bone repair: an ex vivo biomechanical analysis of 3 pullout suture techniques.
M. Silva (1998)
Early active mobilization after flexor tendon repairs.
P. Gratton (1993)
Results of flexor tendon surgery in zone II.
J. Strickland (1985)
Controlled Active Motion Following Primary Flexor Tendon Repair: A Prospective Study Over 9 Years
C. Kitsis (1998)
Techniques in Hand and Upper Extremity Surgery
A. Weiland (1997)
CRITICAL EVALUATION OF FLEXOR-TENDON HEALING AND ADHESION FORMATION WITHIN ARTIFICIAL DIGITAL SHEATHS.
Austin D. Potenza (1963)
Gliding function following flexor-tendon injury. A biomechanical study of rat tendon function.
J. Lane (1976)
Early active mobilization for flexor tendons repaired using the double loop locking suture technique.
G. N. Groth (1995)
A randomized biomechanical study of zone II human flexor tendon repairs analyzed in an in vitro model.
T. Stein (1998)
Method for the measurement of friction between tendon and pulley
S. Uchiyama (1995)
In vivo finger flexor tendon force while tapping on a keyswitch
J. Dennerlein (1999)
A Comparative Study of Two Methods of Controlled Mobilization of Flexor Tendon Repairs in Zone 2
F. Peck (1998)
The effect of variations in applied rehabilitation force on collagen concentration and maturation at the intrasynovial flexor tendon repair site.
C. Goldfarb (2001)
Flexor tendon-pulley interaction after tendon repair. A biomechanical study.
J. Coert (1995)
The effect of gap formation at the repair site on the strength and excursion of intrasynovial flexor tendons. An experimental study on the early stages of tendon-healing in dogs.
R. Gelberman (1999)
Work of Flexion after Tendon Repair with Various Suture Methods
M. Aoki (1995)
A combined regimen of controlled motion following flexor tendon repair in "no man's land".
J. A. Chow (1987)
Gliding characteristics of tendon repair in canine flexor digitorum profundus tendons
C. Zhao (2001)
Biomechanical and histologic characteristics of canine flexor tendon repair using early postoperative mobilization.
M. Aoki (1997)
Intrinsic restoration of the flexor tendon surface in the nonhuman primate.
P. Manske (1985)
Gap formation after flexor tendon repair in zone II. Results with a new controlled motion programme.
K. L. Silfverskiöld (1993)
Flexor Tendon Excursions in “No-Man's Land”
D. Mcgrouther (1981)
Intrinsic flexor-tendon repair. A morphological study in vitro.
P. Manske (1984)
Early postoperative mobilization of flexor tendon injuries using a modification of the Kleinert technique.
M. Edinburg (1987)
Flexor tendon nutrition.
P. Manske (1985)
THE AMERICAN Academy of Orthopaedic Surgeons.
Charles A. Rockwood (1955)
Biologic rationale, clinical application, and results of early motion following flexor tendon repair
J. Strickland (1989)
Early active mobilisation following flexor tendon repair in zone 2.
J. Small (1989)
Effects of increased in vivo excursion on digital range of motion and tendon strength following flexor tendon repair
M. Silva (1999)
Effect of Synergistic Wrist Motion on Adhesion Formation After Repair of Partial Flexor Digitorum Profundus Tendon Lacerations in a Canine Model in Vivo
C. Zhao (2002)
Flexor tendon healing.
P. Manske (1988)
Gap formation during controlled motion after flexor tendon repair in zone II: a prospective clinical study.
K. L. Silfverskiöld (1992)
Nutrient pathways of flexor tendons in primates
P. Manske (1982)
Measurement of friction between pulley and flexor tendon.
K. An (1993)
Effects of early intermittent passive mobilization on healing canine flexor tendons.
R. Gelberman (1982)
Biochemical Evidence of Flexor Tendon Participation in the Repair Process—An in Vitro Study
P. Manske (1984)
Postoperative management of functionally restrictive muscular adherence, a corollary to surgical tenolysis: a case report.
C. D. Alba (2001)
Early progressive resistance following immobilization of flexor tendon repairs
Diane Cifaldi Collins (1991)
Dynamic analysis of profundus tendon function.
D. Greenwald (1994)
Flexor tendon gliding in the hand. Part II. Differential gliding.
M. Wehbé (1985)
Tensions of the flexor digitorum superficialis are higher than a current model predicts.
J. Dennerlein (1998)
The Washington Regimen: rehabilitation of the hand following flexor tendon injuries.
S. Dovelle (1989)
A New Type of Flexor Tendon Repair
R. Williams (1995)
Rehabilitation techniques for applying immediate active tension to zone I and II flexor tendon repairs.
Roslyn B. Evans (1997)
Development of flexor tendon surgery: twenty-five years of progress.
J. Strickland (2000)
This paper is referenced by
Rehabilitation after flexor tendon repair, reconstruction, and tenolysis.
Kathy Vucekovich (2005)
Zone II flexor tendon rehabilitation: a proposed algorithm.
S. Sueoka (2008)
Chapter 18 – Flexor Tendon Reconstruction
Kerstin Waltz (2016)
Commentary: Rehabilitation for Rural and Remote Residents Following a Traumatic Hand Injury *
Gail A. Kingston (2017)
The Wrist and Hand: Physical Therapy Patient Management Using Current Evidence
M. Erickson (2016)
The inclusion of activities of daily living in flexor tendon rehabilitation: a survey.
R. Powell (2014)
Chapter 51 – Common Orthopedic Dysfunction of the Wrist and Hand
Darren Gustitus (2017)
IN PRESS Connecting Art and Science How Far Have We Come ?
Roslyn B. Evans ()
Evaluation of the role of unconjugated hyaluronic acid repetitive injection during the primary repair of flexor tendons in no man’s land: a randomized control trial
O. Nouh (2019)
Primary Care of Flexor Tendon Injuries
J. Taras (2011)
Short-term assessment of optimal timing for postoperative rehabilitation after flexor digitorum profundus tendon repair in a canine model.
C. Zhao (2005)
Two Methods for Improvement of Short Hamstrings in Healthy Individuals
M. A. Khalili (2014)
Chapter 10 – Hand, Wrist, and Digit Injuries
J. B. Green (2016)
Connecting art and science.
Roslyn B. Evans (2005)
Flexor tendon repair outcomes with fat grafting
A. A. Taha (2020)
Therapy: Flexor Tendon Rehabilitation
B. Jane Freure (2011)
Comparison of therapeutic activities with therapeutic exercises in the rehabilitation of young adult patients with hand injuries.
U. Guzelkucuk (2007)
Evidence based post-operative treatment of flexor tendons
Sarah G. Ewald (2015)
Flexor Tendon Repair, Rehabilitation, and Reconstruction
Brinkley K. Sandvall (2013)
Verletzungen der Beugesehnen
S. Breier (2013)
Influence of Wrist Joint Position and Metacarpophalangeal Joint Range of Motion on Extensor Digitorum Communis (edc) Activity: An Electromyographic Study
D. Sakellariou (2006)
Acute Finger Injuries
M. Martín-Ferrero (2013)
Hand therapy services for rural and remote residents: Results of a survey of Australian occupational therapists and physiotherapists.
G. Kingston (2015)
Advances in Understanding of Tendon Healing and Repairs and Effect on Postoperative Management
P. Amadio (2011)
A prospective randomized controlled trial of controlled passive mobilization vs. place and active hold exercises after zone 2 flexor tendon repair.
M. Farzad (2014)
Individualized Rehabilitation Program for Flexor Tendon Repair: From Pyramid to Algorithm
P. Steelman (2007)
Flexor Tendon Injury
L. Klein (2020)
Managing the injured tendon: current concepts.
Roslyn B. Evans (2012)
Primary Flexor Tendon Repair with Early Active Motion: Experience in Europe.
T. Giesen (2017)
Postoperative Management of Flexor Tendon Injuries
K. Pettengill (2011)
Principles of Musculoskeletal Repair in Extremity Replantation
S. Kempton (2015)
What's new in hand surgery.
P. Amadio (2005)See more