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 Synopsis

Anatomy - Flexor Tendon Zones

Clinical Significance – Flexor Tendon zone II

Intrinsic Vs Extrinsic Healing

Rehab Protocols – Flexor Tendon zone II Repair

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FLEXOR TENDON ZONES OF INJURIES

ZONE I
Insertion of (FDS)  to insertion of (FDP)

ZONE II
Distal palmar crease to FDS insertion.

ZONE III
Distal edge of carpal tunnel to the DPC

ZONE IV
Within  Carpal Tunnel
 

ZONE V
Musculotendinous junction –proximal carpal tunnel
  (Kleinart and Verdan,1983)
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 CLINICAL SIGNIFICANCE : ZONE II
No man’s land
• Adhesions

• proximity of fixed anatomy

• Deficient vascularity

Poor clinical outcome in zone II:

  (Tubiana,1999)
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INTRINSIC VS EXTRINSIC HEALING

• Extrinsic healing

• Intrinsic healing

Early Controlled motion

Goal

  (Rust and Eckersley,2008)

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REHAB PROTOCOLS – FLEXOR TENDON ZONE 2 REPAIR

TECHNIQUES OF EARLY MOBILISATION

• EARLY PASSIVE MOBILISATION TECHNIQUE

• EARLY ACTIVE MOBILISATION TECHNIQUE

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 • DBS - wrist 20° flexion, MP joints 50° flexion, IP joints in extension

• Exercises twice daily 6 to 8 repetitions / exercise / session.

  (Karen M Pettengill,2005)
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 EAM

Wrist – 0-30° Flexion

MP Joints – 60-70° Flexion

IP Joints - Extended

Exercises every 4 hours within orthosis, included all digits

Two repetitions of full passive flexion, active flexion & active extension.

  (Fereydoun Layeghi and Maryam Farzad,2012)

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 4 to 6 Weeks
GLIDING EXERCISES

BLOCKING EXERCISES

ADL Training

6 to 8 Week
– Progressive resisted exercises

– Functional Activities

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 QUESTIONS

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 QUESTIONS

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