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Rehabilitation nach Beugesehnenverletzungen an der Hand

Rehabilitation after flexor tendon injuries of the hand

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Zusammenfassung

Hintergrund

Fortschritte in der Grundlagenforschung bezüglich Nahtmaterial, Nahtverfahren und Belastungsgrenzen unterstützen die Wahl der Behandlungsprotokolle nach Beugesehnenverletzungen.

Fragestellung

Die Wahl des Nachbehandlungsregimes in Abhängigkeit des Verletzungsmusters sowie der Kenntnis von Einflussfaktoren auf die operativ versorgte Sehne wird dargestellt und das klinischen Outcome nach Beugesehnenverletzung ausgewertet und beurteilt.

Material und Methode

Die Fragestellung werden anhand aktueller Literatur und Grundlagenstudien untersucht.

Ergebnisse

Verletzungsmuster, operative Versorgung und Compliance des Patienten sowie Forschungsergebnisse bezüglich der Sehnen- und Nahtmaterialbelastung helfen bei der Wahl der Nachbehandlungskonzepte. Passive Nachbehandlungen (z. B. nach Duran-Houser und Kleinert) liefern im Literaturvergleich vorwiegend gute bis befriedigende Ergebnisse. Die frühe, aktive Bewegungstherapie (z. B. nach Small) zeigt ein besseres Bewegungsausmaß der Finger und liefert vermehrt auch exzellente Behandlungsergebnisse klassifiziert nach dem Hand-Functional-Score der American Society for Surgery of the Hand. Neben der spezifischen Therapie der entsprechenden Verletzungszonen ist auch das Erkennen von Fehlerquellen inklusive der korrekten Schienenanpassung essenziell für das Behandlungsergebnis und von der intensiven Betreuung inklusive der Narben- und Weichteilbehandlung durch fachkundiges Personal abhängig.

Schlussfolgerungen

Beugesehnenverletzungen der Hand, v. a. in der Verletzungszone 2 gelten nach wie vor sowohl operativ als auch in der Rehabilitation als Herausforderung mit unvorhersehbarem Outcome. Weitere Erkenntnisse bezüglich Nahttechnik und -material können voraussichtlich in Zukunft den Einsatz früher, aktiver Bewegungsprotokolle fördern und damit die Ergebnisse verbessern.

Abstract

Background

Advances in basic research evaluating suture material, techniques, and maximum tendon load with regard to repair site failure help to decide between rehabilitation protocols after the repair of flexor tendon injuries.

Objectives

The presentation and choice of rehabilitation protocols depending on the mechanism of injury and knowledge of the influencing factors concerning tendon load. Expected outcome after flexor tendon repair.

Methods

Evaluating recent literature and basic research investigations, and presenting expert opinions.

Results

Based on the mechanism of injury, the suture technique, the compliance of the patient, and the latest knowledge on tendon capacity help to choose from the basic principles of rehabilitation protocols: passive or early motion protocols, such as those described by Duran–Houser and Kleinert, in the majority of cases lead to good and fair results according to the Hand Functional Score of the American Society for Surgery of the Hand. A larger number of excellent functional results are seen after the rehabilitation of flexor tendon injuries using combined passive/active or completely active motion protocols, e.g., according to Small. In addition to choosing a specific protocol and considering different zones of injury, it is essential to thoroughly supervise therapy and to monitor the adjustment of splints. It is widely recommended that patients should be provided with additional scar treatment and physical therapy throughout their entire rehabilitation.

Conclusions

Flexor tendon injuries, especially in zone 2, are still a challenge with regard to operative treatment and rehabilitation, with an unpredictable outcome. Further knowledge and advances in suture techniques and material will support the use of active motion protocols and improve functional results in the future.

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Authors and Affiliations

  1. Hand und funktionelle Mikrochirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruchstr., 17475, Greifswald, Deutschland

    A. Asmus, S. Kim, J. Jodkowski, A. Ekkernkamp & A. Eisenschenk

  2. Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Deutschland

    M. Millrose, A. Ekkernkamp & A. Eisenschenk

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  1. A. Asmus
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  2. S. Kim
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  4. J. Jodkowski
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  6. A. Eisenschenk
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Correspondence to A. Asmus.

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A. Asmus, S. Kim, M. Millrose, J. Jodkowski, A. Ekkernkamp und A. Eisenschenk geben an, dass kein Interessenkonflikt besteht.

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Asmus, A., Kim, S., Millrose, M. et al. Rehabilitation nach Beugesehnenverletzungen an der Hand. Orthopäde 44, 786–802 (2015). https://doi.org/10.1007/s00132-015-3160-6

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