Roslyn B. Evans and Terri M. Skirven have compiled a special edition of the Journal of Hand Therapy devoted to “Connecting Art and Science: How Far Have We Come?” The editors have compiled a series of experts covering the advances in the treatment of injured tendons and nerves. This issue is remarkable and contains updated information regarding everything from wound healing to tendon repair to nerve repair to rehabilitation. This article on flexor tendon healing represents the lead manuscript and is one of many excellent articles within this special addition. The combination of basic science research and clinical protocols has greatly enhanced the concepts of flexor tendon repair and their respective rehabilitation. Initially, greater forces across the repair site lead to gap formation and poor results. However, enhancing the strength of the repair site has introduced the concept of early postoperative movement to allow for better healing characteristics. Increasing the core suture strands and the size of the core suture increases the repair strength. The technique of repair should be strong but not bulky to allow excursion of a flexor tendon sheet through the tight confines of the flexor tendon sheath. This allows an increase load across the repair site, which affords the benefits of early immobilization. In addition, the therapy must be carefully monitored to prevent excess excursion, which leads to excess force and tendon disruption.
This article reviews the scientific and clinical basis for application of force. The article highlights the concept that an increase in stress across the repaired flexor tendon leads to improvement in the quality of the repair response and decreased adhesion formation. The authors highlight the studies that lend support to the concept that stress applied to the repair site in the immediate postoperative period improves healing efficiency. The ultimate range of motion has been enhanced using early immobilization and the need tenolysis has decreased. The authors highlight the need to use a rehabilitation scheme that produces tendon excursion within the concept of a low applied force. The application of a low applied force will minimize the formation of intrasynovial adhesions. Currently, the authors utilize an eight-strand, locked repair supplemented by epitendinous running repair within 10-14 days of injury. Therapy commences on postoperative day one with early motion using a hinged splint. Early place and hold exercises are utilized with close coordination between the therapist and surgeon and patient.
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