Managing the injured tendon: current concepts.
Despite advances in understanding of the mechanical aspects of tendon management with improved suture technique and early stress application with postoperative therapy, clinical results remain inconsistent after repair, especially within the synovial regions. Complementary research to enhance the intrinsic pathway of healing, suppress the extrinsic pathway of healing, and manipulate frictional resistance to tendon gliding is now the focus of current basic science research on tendons. In the future, application of these new biologic therapies may increase the "safety zone" (or tolerance for load and excursion without dysfunctional gapping) as therapists apply stress to healing tendons and may alter future rehabilitation protocols by allowing greater angles of motion (and thus tendon excursion), increased external load, and decreased time in protective orthoses (splints). However, at this time, the stronger repair techniques and the application of controlled stress remain the best and most well-supported intervention after tendon injury and repair in the recovery of functional tendon excursion and joint range of motion. The hand therapist's role in this process remains a critical component contributing to satisfactory outcomes.
Indian River Hand and Upper Extremity Rehabilitation, Vero Beach, Florida 32960, USA. rosevans@gate.net
Roslyn B
RB
Evans
D017276:Friction / Q000502:physiology; D006230:Hand Injuries / Q000628:therapy; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use; D019637:Orthopedic Procedures; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D012421:Rupture / Q000209:etiology; D013165:Splints; D013536:Suture Techniques; D013708:Tendon Injuries / Q000628:therapy*; D013718:Tensile Strength / Q000502:physiology; D013997:Time Factors; D023822:Tissue Engineering; D014945:Wound Healing / Q000502:physiology; D014954:Wrist Injuries / Q000628:therapy
D036341:Intercellular Signaling Peptides and Proteins