Extensor Tendon Injury
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
An Update on Hand
Manske P. et
Society for Surgery
of the Hand.
Early Active short Arc
Motion for the repaired
J Hand Surg. 19A:991;
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
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
Early Active short
Arc Motion for the repaired
central slip J Hand Surg.
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
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.
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.