Highlights
- •The excursion distance and tension of bilateral long finger FDP tendon were measured in vivo in 20 healthy students using Ultrasound System.
- •It is suggested that if the surgical repair was strong and without any complications, the active flexion protocol might work best to regain tension excursion. However, if there are complex problems involved, then the Kleinert approach or Duran approach would be chosen.
- •Based on previous studies, the tension generated on FDP tendon by active finger flexion was safe for repaired tendons with good quality. The corresponding SWE value was 391 ± 66.03 kPa measured in our research, and this value could be used as a safe reference during postsurgery treatment.
Abstract
Study design
Interpretive description study.
Purpose
In management of patients with flexion tendon injuries, passive, control active and
active motion protocols were proposed after repair to minimize tendon adhesion. The
purpose of this study was to compare the excursion distance and the tension of Flexor
Digitorum Profundus (FDP) during simulated active and passive motion using ultrasonography
techniques using normal subjects.
Methods
Ultrasonographic assessment of FDP tendon of the middle finger was performed at the
wrist level on 20 healthy college students using 3 types of treatment protocols: modified
Kleinert protocol, modified Duran protocol, and active finger flexion protocol. The
excursion distance was measured following the musculotendinous junction of FDP using
the B mode ultrasound system. The elasticity of FDP tendon was measured using the
shear wave elastography technique. The excursion distance and the elasticity value
were compared among 3 protocols using one-way ANOVA analysis.
Results
Twelve male and 8 female students with mean age of 22.6 ± 1.8 years were invited to
join the study. The excursion distance of FDP was 21.82 ± 3.77 mm using the active
finger flexion protocol, 8.59 ± 2.59 mm using the modified Duran protocol, and 12.26
± 2.71 mm using the modified Kleinert protocol. The elasticity was significantly higher
in extension position when compared to passive flexion positions, but found lower
than active flexion position.
Discussion
The active finger protocol was found to require strongest tension of the tendon and
with longest excursion. There was similar tension generated using both passive motion
protocols. The modified Duran protocol appeared to create less excursion upon movements
than the modified Kleinert approach using the objective ultrasonic evaluation. It
is suggested that if the surgical repair was strong and without any complications,
the active flexion protocol might work best to regain tension excursion. However,
if there are complex problems involved, then the Kleinert approach or Duran approach
would be chosen.
Keywords
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JHT Read for Credit
Quiz: # 910
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.It is assumed by the authors that the primary goal of current approaches for therapy following flexor tendon repair is to
- a.decrease the girth of the tendon at the repair site
- b.increase the strength of the repair
- c.minimize adhesion formation
- d.speed the rate of healing
- a.
- # 2.The subjects were
- a.all normals
- b.all actual patients
- c.a 50-50 mix of normals and patients
- d.cadaveric samples
- a.
- # 3.The protocols studied were
- a.modified Duran
- b.controlled active motion
- c.modified Kleinert
- d.all of the above
- a.
- # 4.The authors recommend
- a.combining the Kleinert and Duran methods
- b.the Duran method in most cases
- c.the controlled AROM method if there are no other mitigating considerations
- d.the Kleinert method unless the patient is a child
- a.
- # 5.The Kleinert technique resulted in more excursion than the Duran
- a.not true
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: January 25, 2021
Accepted:
January 22,
2021
Received in revised form:
December 29,
2020
Received:
July 12,
2019
Footnotes
Declaration of competing interest: No conflict of interest exists in the submission of this manuscript, and manuscript is approved by all authors for publication.
Funding: The study was supported by the Wuxi Science and Technology Development Fund (N20192012) and Wuxi Modern Industry Development Fund Project (WX18IIAN011).
Identification
Copyright
© 2021 Published by Elsevier Inc.
