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[Tendon injuries].

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Hand Injuries↗

Tendon injuries.

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Adolescent↗

Rehabilitation of tendon injuries in sport.

Clinicians are faced with a growing number of athletes with injured tendons. Treatment of both acute and chronic injuries has proven to be quite complex. It is difficult to maintain the balance between resting the injured tendon and preventing atrophy of the surrounding muscles and joints. Questions also arise as to when the tendon should be strengthened and when the athlete is ready to return to full activity in sport. Through an awareness of the structural and mechanical properties of the tendon, an exercise programme for the rehabilitation of tendon injuries has been developed. It is recommended that this programme be used in combination with ice and other physical modalities. This approach will resolve most tendon injuries within 6 weeks of its implementation. The use of anti-inflammatory medications and surgery can only be recommended in select situations where more conservative measures are inadequate.

Acute Disease↗

Unusual patellar tendon injury in an adolescent runner with generalised ligamentous laxity.

A case is reported of an acute traction injury of the patellar tendon in a boy of 14 with joint hypermobility. Such injuries are unusual but early diagnosis and surgical repair lead to a good long term outcome. In adolescents participating in sports, the awareness of the possibility of a rare knee extensor mechanism injury is essential for a successful outcome.

Adolescent↗

Results of acute zone III extensor tendon injuries treated with dynamic extension splinting.

Motivated by the favorable results of dynamic splinting in the treatment of more proximal extensor tendon injuries, we explored the use of dynamic splinting in the treatment of zone III extensor tendon lacerations. Twenty-two tendon repairs in 19 patients were available for review. On the basis of degree of extension lag and pulp-to-palm distance, 14 repairs were rated as excellent, 6 as good, and 2 as fair. Using total active motion at 10 weeks, the proximal interphalangeal and distal interphalangeal joints averaged 170 degrees. There was one mild boutonniere deformity. The results of this prospective study show that carefully monitored dynamic splinting is safe in the treatment of zone III lacerations. When results were compared with the results of our method of static splinting used prior to this prospective study, patients returned to full activities with good-to-excellent results 8 weeks earlier instead of at 16 to 18 weeks.

Acute Disease↗

The Washington Regimen: rehabilitation of the hand following flexor tendon injuries.

This article describes the use of the "Washington Regimen" of early controlled motion in the rehabilitation of flexor tendon injuries of the hand. This regimen is derived from a combination of Kleinert's controlled active extension with rubber-hand passive flexion, Duran's controlled passive techniques, and the modification of the Kleinert orthosis that uses a palmar pulley system. Based on results of clinical investigations, this regimen of early controlled motion appears effective in inhibiting peritendinous scarring, joint contractures, and other complications that commonly occur secondary to flexor tendon repairs. A six-week staged regimen of postoperative rehabilitation is presented. Splint design, exercise regimen, and rationale for treatment are reviewed.

Biomechanical Phenomena↗

Flexor tendon injuries: the result of primary management: a retrospective review of 50 cases treated at Whiston Hospital, England.

A retrospective review of 50 cases treated over a 12-month period with 95 tendon injuries was carried out. Post-operative management utilising a modified Kleinert method was used for cases over eight years of age, while those under eight were immobilised in plaster cast. Our results after a mean follow up period of 14 weeks compared well with other series using the Kleinert method. Zone II injuries gave an unexpected better results than those in other zones.

Adolescent↗

A tissue explant system for assessing tendon overuse injury.

Tendon overuse injuries are common athletic and occupational problems. When studying mechanisms that cause these injuries, inherent complexities associated with controlling in vivo loading necessitates alternative approaches such as in vitro organ culture. Current devices for loading explants in organ culture, whether custom-built or commercial, have various deficiencies in their loading capability, control mechanism and strain assessment. To overcome these shortcomings, an advanced tissue loading device with video strain analysis capabilities was developed for investigating overuse injuries and its performance/calibration were evaluated. Two tests were used to assess the ability of the system to create and monitor mechanical changes with overuse. Overuse loading significantly increased strains and decreased strength, showing the ability of this system to create and monitor tissue damage. Furthermore, the device design allows for its use in a standard incubator. Coupled with custom loading and data collection programs, this system is suitable for long-term overuse injury studies.

Animals↗

Development of polyvinyl alcohol-hydrogel (PVA-H) shields with a high water content for tendon injury repair.

The main problem in tendon repair is adhesion formation between the tendon and surrounding tissue. To prevent this, we have developed adhesion preventive shields using polyvinyl alcohol hydrogel (PVA-H) with 90% water content. This implant experiment used the deep flexor tendon of the 3rd toe of the domestic fowl. Injured tendons shielded with PVA-H healed within about 3 weeks without adhesion to the surrounding tissues. Neither breakage of the PVA-H shield itself nor infection or degeneration in the surrounding tissue was observed. These results show that tendon is capable of intrinsic repair, and was able to regenerate using synovial nutrition through the PVA-H. The high water content of PVA-H may be clinically useful and applicable to adhesion preventive shields for tendon repair.

Animals↗