Clinical implications of cerebral reorganisation after primary digital flexor tendon repair.
After flexor tendon injury, most attention is given to the quality of the tendon repair and postoperative early passive dynamic mobilisation. Schemes for active mobilisation have been developed to prevent tendon adhesions and joint stiffness. This paper describes five patients to demonstrate the cerebral consequences of immobilisation allowing only passive movements, which implies a prolonged absence of actual motor commands. At the end of such immobilisation, PET imaging revealed reduced blood flow in specific motor areas, associated with temporary loss of efficient motor control. Effective motor control was regained after active flexion exercises which was reflected in normalised cerebral activations. This suggests that temporary, reversible cerebral dysfunction may affect the outcome of flexor tendon injuries.
Coert
J H
JH
Department of Plastic Surgery, Erasmus MC, Rotterdam, The Netherlands. j.coert@erasmusmc.nl
Stenekes
M W
MW
Paans
A M J
AM
Nicolai
J-P A
JP
De Jong
B M
BM
D000328:Adult; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004292:Dominance, Cerebral / Q000502:physiology; D004576:Electromyography; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005383:Finger Injuries / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008662:Metacarpophalangeal Joint / Q000294:innervation; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation; D009416:Nerve Regeneration / Q000502:physiology*; D009434:Neural Pathways / Q000503:physiopathology; D026741:Physical Therapy Modalities; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000534:rehabilitation; D016059:Range of Motion, Articular / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D013165:Splints; D013708:Tendon Injuries / Q000503:physiopathology* / Q000601:surgery*; D055815:Young Adult