Rehabilitation following surgery for flexor tendon injuries of the hand

Treatment of hand injuries: experience of the Republic of Kazakhstan

OBJECTIVE

Aim: The aim of the present study is to analyse and summarize the experience of the Department of Reconstructive and Plastic Microsurgery of the National Scientific Center of Surgery named after A.N. Syzganov in the field of treatment of hand injuries..

PATIENTS AND METHODS

Materials and Methods: The study sample included 295 patients who applied to the Department of Reconstructive and Plastic Microsurgery of the National Scientific Center of Surgery named after A.N. Syzganov from the beginning of 2021 to the end of 2022, in relation to which general clinical methods of research, including the method of dynamic observation and innovative microsurgical techniques, were applied. Innovative minimally invasive surgical techniques were developed and successfully applied to the flexor tendons of the fingers, ensuring precise juxtaposition of tendon ends, reducing tissue trauma, and facilitating smooth passage of the repaired tendons in bone-fibrous canals.

RESULTS

Results: The application of the developed methods demonstrated high clinical efficacy, as evidenced by the high percentage of good and satisfactory treatment results - 98.8% in one group and 93.7% in the other. Nevertheless, in 3.4% of cases, the development of flexion contractures of fingers of different severity was observed, which was associated with insufficient intensity of rehabilitation, lack of proper dynamic control and indiscipline of some patients.

CONCLUSION

Conclusions: The result of the work was a comprehensive analysis of the experience of microsurgery of the hand obtained in the Republic of Kazakhstan during the study period.

Relationship between pain, nerve injury and clinical outcomes after flexor tendon injuries in zones 1-2: a retrospective cohort study

Introduction

The influence of pain and a concomitant digital nerve injury on the course of rehabilitation after flexor tendon injury remains ambiguous. The objectives of the study were to: i) analyse the evolution of pain spanning one year after a primary flexor tendon repair in zones 1-3; ii) examine the differences in pain levels in patients with and without digital nerve injury; and iii) evaluate the relationship between pain, digital nerve injury and pain medication, total active motion (TAM), DASH scores and patient satisfaction.

Methods

Data from 189 patients were retrieved from a flexor tendon registry between 2014 and 2020. Differences in pain, TAM, DASH and patient satisfaction were analysed. Multiple linear and binary logistic regression analyses were performed to determine the relationship between clinical outcomes.

Results

Pain significantly decreased in the course of rehabilitation (p < 0.001 to 0.006). No relationship could be identified between nerve injury and pain (p = 0.21-0.97). In week 6, the presence of pain and a nerve injury were significantly associated with lower TAM scores (p = 0.001). In week 13, pain during motion (p < 0.001) and the presence of a nerve injury (p = 0.036) were significantly associated with worse DASH scores. Patient satisfaction was significantly inversely correlated to pain during motion in weeks 13 and 26 (p < 0.001).

Conclusion

We found a significant relationship between pain during motion and pain medication intake, TAM, DASH scores and patient satisfaction. It is therefore advisable to closely monitor this parameter after flexor tendon injuries.

Study registration

This multi-center cohort study is registered under https://clinicaltrials.gov: NCT04312412.