Rehabilitation Of Tendon Injuries Research Articles

Contrast therapy: Tissue heating and cooling properties within the equine distal limb.

Rehabilitation of tendon injuries in horses often involves cryotherapy to reduce inflammation and occasionally tissue heating to increase collagen extensibility. The application of alternating cold and hot (ie contrast therapy) is widely used in human physical therapy; however, its utility in equine rehabilitation is largely unknown. The objectives of this study were to (a) assess if the equipment could achieve therapeutic tissue temperatures (<15 and >40°C) at different tissue depths relative to the digital flexor tendons and (b) evaluate the time-temperature profiles during serial heating and cooling cycles using a contrast therapy device. In vivo experiment. In 4 adult horses with normal forelimb digital flexor tendons, fine-wire temperature probes were placed superficially on the skin and implanted subcutaneously, deep to the superficial digital flexor tendon (SDFT) and deep to the deep digital flexor tendon (DDFT). Temperatures were recorded over three complete thermal (hot-cold) cycles. Minimum and maximum temperatures were recorded and the rate of temperature changes and the areas underneath the time-temperature curves (ie thermal load) were calculated. Minimum and maximum tissue temperatures (°C) included: superficial skin [12.6±1.0; 42.4±2.4], subcutaneous tissues [14.1±0.8; 42.3±2.2], deep to the SDFT [15.6±0.8; 41.7±2.6] and deep to DDFT [25.1±2.0; 38.0±3.5]. An initial rapid rate of tissue temperature change between 3.2 and 4.3°C/min occurred within tissues to the depth of the DDFT. Tissue thermal loads during heating ranged from 255 to 607°C*second and from 309 to 780°C*second during tissue cooling, with the lower values noted deep to the DDFT. Unknown clinical efficacy in diseased tissues. The applied contrast therapy was consistently able to induce cooling and heating of tissues to the depth of the DDFT.

The status of hand therapy in Turkey

Objectives: The aims of this study are; firstly, to investigate professional profiles and working conditions of hand therapists who are the member of Hand Therapists Association (HTA) (El Terapistleri Dernegi - ETD). Secondly, to put forward their opinions on the field of hand rehabilitation assessment and treatment. Thirdly, to determine whether a standard treatment protocol established in the hand therapists` applications. Methods: This study was completed through a survey sent to member physiotherapists of ETD via electronic mail. The survey consists of thirty-three questions prepared in the form of multiple-choice and open-ended. Questions are for determining demographical information and searching for evaluation and treatment approaches used during interventions by hand therapists. Results: Evaluation methods were examined which became their standard in the rehabilitation of tendon injuries; it was determined that 44 (93.6%) of them evaluate the range of motion, 34 (72.3%) of them evaluate the pain. It was determined that Kleinert Protocol (n = 31, %70.5) was the most preferred method in post-operative rehabilitation program of flexor tendon injuries and Controlled Active Movement Protocol (n = 31, %70.5) was the most preferred method in post-operative rehabilitation program of extensor tendon injuries. Conclusion: Like all over the world, in Turkey, the hand rehabilitation is one of the fields in which physiotherapist and occupational therapists specialize in. The development of hand rehabilitation, more scientific and standardized evaluation and treatment protocols are not yet completed. From this perspective, under nowadays` conditions learning evaluation and treatment methods used by hand therapists is very important for developing the appropriate algorithm in hand rehabilitation field.

Evidence based post-operative treatment of flexor tendons

Flexor Tendon injuries require surgical repair and intensive therapy post-operatively for optimal outcomes. “The repair technique is important but it is the way the tendon is managed afterwards that determines the outcome” ([1], page 112). Multiple protocols exist for the post-operative rehabilitation of tendon injuries. Currently four main options for post-operative treatment are utilized: immobilization, early passive mobilization, early active-passive mobilization and earlyactive mobilization. Early protected movement has been shown to decrease adhesion formation and stimulate tendon healing [2]. It is well established that protected early movement of the tendon results in a better outcome than immobilization [3-5]. There is less risk of tendon rupture with early passive motion protocols, but an increased risk for decreased range of motion in the final outcome, in comparison to early active motion protocols [6]. “The goal of tendon repair and rehabilitation is to achieve a normally gliding and functioning tendon.”([1], p 115). To achieve this goal the surgeon, the therapist and the patient must work closely together. The surgeon must create a repair that is strong enough to withstand the rehabilitation phase. The therapist must have a thorough understanding of: tendon anatomy, the mechanical limitations of the repair, the healing process and the biomechanical forces at work during the healing process. Additionally the therapist must understand the tendon’s response to the chosen treatment and continually adjust the treatment accordingly. The patient too must participate in the treatment; this requires that the patient receives sufficient instruction that allows him or her to understand the injury and participate in the subsequent rehabilitation process. In many clinics, flexor tendon rehabilitation is protocol driven; a standard post-operative protocol is implemented routinely for flexor tendon injury cases. This approach may work well when the patient meets the standard inclusion criteria. However when the patient does not meet the criteria for the prescribed protocol for post-operative treatment, treatment of acute flexor tendon injuries can be a challenge and if not adjusted for may result in less than optimal outcomes. “Functional outcomes do not depend on following a prescribed protocol, but on progressing each patient individually with the available evidence-based information and on observation of the individual’s healing process” [7]. There is ample evidence available to guide therapists and physicians in clinical decision making when patient characteristics do not fit the protocol. A review of evidence that supports and guides the therapist’s clinical decision making in rehabilitation of the flexor tendon will be presented. Options for clinical situations such as: delayed initiation of post-operative treatment, concomitant injuries and or conditions that require rest vs. movement, patients that cannot follow complex treatment programs and other clinical scenarios that require an adapted approach to obtain an optimal outcome, will be discussed.