Guidelines tendon surgery therapy

TYPE OF REPAIR

In general, tendon fixation may be estimated by the surgeon intraoperatively to be weak or strong. Weak repairs are end-to-end or nonwoven repairs, or judged to be so for other technical reasons. Strong repairs refer to technically satisfactory strong junctions - such as a tendon weave or tendon passed through bone. Strong repairs tolerate greater loads earlier in the recovery period. Tendon grafts may be judged strong or weak.

WEAK REPAIRS: GENERIC SCHEDULE

0 - 4 weeks:

The hand is immobilized in a position which puts slack in the repair or the transfer.

4 - 6 weeks:

The patient is started on active range of motion exercises four to six times daily. Protective splinting is continued. Transfer exercises with biofeedback may be instituted as needed. Scar massage is instituted when sutures are removed.

6 weeks:

The blocking splint is discontinued. Active range of motion against the transfer, passive range of motion, electrical stimulation with or without dynamic splinting against the transfer are instituted as needed. Passive range of motion exercises are withheld if there is a lag in the action of the transfer.

8 - 12 weeks:

Functional exercises and progressive strengthening are initiated. Anticipate return to unrestricted work activities at 12 weeks.

STRONG REPAIRS: GENERIC SCHEDULE

0 - 4 weeks:

The patient is placed in an immediate dynamic mobilization splint, in which the dynamic portion of the splint acts in the direction of the tendon repair or transfer.

4 - 6 weeks:

Active range of motion and/or transfer exercises are initiated. The splint if often modified to free up one of the joints crossed by the tendon. Biofeedback is instituted as needed for the exercises. Scar massage is started when sutures are removed.

6 weeks:

Active range of motion against the repair or the transfer is started as well as passive range of motion as needed. Dynamic splinting against the transfer is initiated as needed unless there is a lag in the action of the transfer. The blocking splint is discontinued. Electrical stimulation may be initiated as needed.

8 - 12 weeks:

Functional activities and progressive strengthening exercises are initiated.

Weak repairs are generally managed by dynamic protective splinting, place-and-hold exercises or immobilization.

Strong repairs are generally allowed full active nonresisted exercises immediately, progressing to passive range of motion and resisted exercises at six weeks.

Anticipate return to unrestricted work activities at 12 weeks.

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