From the Guidelines
For a patient with cut flexor tendons of two digits 2 months post-injury, surgical repair followed by specialized hand therapy is the recommended treatment. At this stage, primary repair may be challenging due to tendon retraction and scarring, so a two-stage reconstruction might be necessary 1. The first stage involves placing a silicone rod to create a new tendon sheath, followed by a second surgery 3-6 months later to replace the rod with a tendon graft, typically harvested from the palmaris longus or plantaris tendon.
Some key considerations for treatment include:
- Tendon retraction and scarring, which can make primary repair challenging
- The potential need for a two-stage reconstruction
- The importance of postoperative rehabilitation, including protected motion and progressive strengthening exercises
- The risk of complications, such as adhesions, rupture, or joint contractures
Postoperatively, a structured rehabilitation protocol is essential, including protected motion with a dorsal blocking splint for 4-6 weeks, followed by progressive strengthening exercises 1. The patient should expect a recovery period of 3-6 months before achieving functional improvement. Early intervention with a hand surgeon is crucial as delayed treatment leads to poorer outcomes due to muscle contracture and tendon scarring. The goal of treatment is to restore digital flexion while maintaining joint mobility, though patients should be counseled that they may not regain full pre-injury function despite optimal treatment.
It's worth noting that the provided study 1 discusses the use of digital flexor tenotomy in the treatment of plantar or apex ulcers on flexible claw or hammer toe deformities, but it does not directly address the treatment of cut flexor tendons. However, the principles of surgical repair and rehabilitation may still be applicable.
From the Research
Treatment Options for Cut Flexor Tendons
The treatment options for a patient with cut flexor tendons of two digits 2 months post-injury include:
- Surgical repair of the tendons, followed by a rehabilitation program 2, 3, 4
- Use of orthoses, such as an exoskeleton or continuous passive motion device, to facilitate mobilization 2
- Exercise regimens, including early active flexion, controlled passive exercise, and active exercise, to improve range of motion and strength 2, 3
- Modalities such as laser therapy, ultrasound therapy, and motor imagery treatment to promote healing and reduce adhesions 2
- Scar management and strengthening exercises to improve functional outcomes 4
Rehabilitation Interventions
Rehabilitation interventions after surgery for flexor tendon injuries may include:
- A combination of an exercise regimen and an orthosis, plus other rehabilitation treatments 2
- Early motion treatment, such as Kleinert's early motion treatment in the rubber-hand-protected flexion position 3
- Supervised programs of early motion, utilizing either active or passive techniques 4
Complications and Prevention
Complications after flexor tendon injuries, such as adhesions and tendon ruptures, can be prevented and treated with proper surgical technique, postoperative rehabilitation protocols, and patient motivation 5, 4