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Roslyn B. Evans, otr/l, cht

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Extensor Tendon Research

 

 

 

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Extensor Tendon Injury


Evans, RB.  Managing the Injured Tendon: Current Concepts.   Journal of Hand Therapy. 2012; 25:173-90. Invited paper for special edition on Basic Science JHT. 

 

Hand Rehabilitation Update

Evans, RB.  An Update on Hand Rehabilitation.  In:  Manske P. et al.  Hand Surgery Update.  American Society for Surgery of the Hand.  Vol 1:  44-1;44-14; 1994

 

Evans, RB.  Early Active short Arc Motion for the repaired central slip J Hand Surg. 19A:991; 1994 

Patients in group II were instructed to remove the protective splint, and apply a digital template splint which allowed 30 degrees of PIP motion and to exercise the PIP joint 10-20 times per waking hour. The prescribed exercise position was 30 degrees wrist flexion and 0 degrees MP extension. The anatomical position of wrist flexion reduces the viscoelastic resistance of the extrinsic flexors thus reducing the workload of the EDC. The position of MP extension further reduces the EDC workload through contribution of lumbrical and interossei, in this position proximal migration of the sagittal bands allows ED force to be transmitted to the repair site. The second template splint is utilized to allow DIP flexion with the PIP held manually at 0 degrees. This position creates distal migration in the zone IV tendon while reducing tension in zone III through the action of the lateral bands. If the lateral bands were repaired, DIP flexion to 30 only was allowed. (26 digits in 25 patients; 20 male 5 female; age 12-68, mean 42.2 years).


Zone III and IV

Based on the assessment of problems associated with the immobilized zone III and IV repair, I developed an early motion protocol in 1988 that uses immediate active short arc motion for the repaired central slip.  The study included anatomic considerations, excursion studies, and mathematical measurements of force transmitted to the repair site with early active motion.  This aspect of the study was done by a biomechanical engineer Dave Thompson.

 

Evans, RB.  Early Active short Arc Motion for the repaired central slip J Hand Surg. 19A:991; 1994   Clinical work

Evans, RB, Thompson DE.  An analysis of factors that support early short arc motion of the repaired central slip.  J Hand Ther 5:187, 1992  Theoretical work


Evans, R.B., and Burkhalter, W.E.: A Study of the Dynamic Anatomy of Extensor Tendons and Implications for Treatment. Journal of Hand Surgery,
September 1986. IIA: 774‑779.

Immediate active tension has now become fairly accepted practice for all levels of extensors except zone I and II and is supported by basic science and clinical experience….surgeons are beginning to realize the concept of “controlled motion”…and that their therapy colleagues can move all tissues in a range compatible with injury and repair to prevent additional injury to connective tissue from immobilization.

 

Evans, RB.  Clinical management of extensor tendon injuries: the therapists perspective.   In Skirven TM, Osterman AL, Fedorczyk, Amadio PC, eds. Rehabilitation of the Hand and Upper Extremity. ed 6. Elsevier (Mosby), 2011, pp 521-554. 

 

 

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