| SYMPOSIUM ON “HAND REHABILITATION” Editorial Restoring digital function after flexor tendon injury continues to be a challenge to the hand surgeon and hand therapist. In recent years, the improved results may be attributed to our better understanding of tendon healing and the application of this knowledge to the operative procedure and postoperative management. The rehabilitation of flexor tendon injuries requires a comprehensive knowledge of the bones, joints, muscles, nerves and vessels. Even the skin and subcutaneous tissues take on special importance in the hand. This issue begins with a review of flexor tendon anatomy and kinesiology. Along with the advancements in surgical techniques, a range of postoperative protocols has been developed. Some type of early mobilisation is the current accepted postoperative management after flexor tendon repair. Despite early controlled motion, adhesion formation remains the most common complication after flexor tendon surgery. Surgical tenolysis is the treatment of choice if an appropriate period of therapy has failed. Tenolysis demands immediate active range of motion. A flexor tendon laceration may include injury to the peripheral nerve. A treatment plan must be based on the pathologic healing of all the tissues involved. One of the biggest steps in tendon surgery in the past decades has been the reconstruction of a new tendon sheath by means of tendon implants. The implants, both passive and active, brought great hope to the “salvage digit”. However, severe flexor tendon injuries may require a compromise of the three-joint, two-tendon flexor system. The superficialis finger is an option to be considered early in the planning of a one-tendon, two-joint system. Motion is restored to the metacarpophalangeal and proximal interphalangeal joints with arthrodesis or tenodesis of the distal interphalangeal joint. Splinting the hand requires an in-depth understanding of the anatomy and biomechanics of the specific joint or joints to be mobilised or modified. Splints must be created individually, incorporating the above factors as well as principles of design, fit and construction. Finally, return-to-work conditioning has become a vital component of hand therapy. The concept of a comprehensive programme leading to the return of the injured worker to gainful employment is now an integral aspect of upper extremity rehabilitation. I want to thank all of the authors for their individual contributions and the patients with whom we have worked through the years to develop the concepts and techniques discussed in this issue and build a foundation for further advances in flexor tendon surgery and rehabilitation in the future. |
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