Effect of Myofascial Release on Pain, Grip Strength, Manual Dexterity, and Quality of Life in Late-Term Rehabilitation of Hand Flexor Tendon Repairs

Overview

The aim of this study was to investigate the effectiveness of myofascial release exercises performed in the late period compared to classical physiotherapy training in individuals with hand flexor tendon repair.

The hand is the organ we use most in our daily activities, sports activities, expressing ourselves, and performing our jobs. Flexor tendon injuries are among the most common injuries to the hand. The incidence of flexor tendon injuries is estimated at 7-14 per 100,000 people. The flexor tendon can be injured by a blunt or sharp instrument, crushed, or torn by avulsion. It is difficult for tendons to heal without surgery after an injury. Because tendons are composed of living cells and connective tissue, healing begins with cells from both inside and outside the tendon when the tendon ends are brought together. However, scar tissue that forms after surgery adheres the repaired tendons to the surrounding area, limiting movement. Therefore, rehabilitation protocols implemented to ensure proper gliding again and postoperative splinting are essential for tendon healing in tendon injuries are crucial. Tendon Rehabilitation Extension block splints should place the wrist in 30 degrees of flexion to reduce tension in flexor tendon repairs and minimize the risk of postoperative tendon rupture, with the metacarpophalangeal joints at 45-70 degrees of flexion and the interphalangeal joints held in near full extension or slight flexion (15 degrees). Sutures are removed two weeks postoperatively. Thanks to advances in biomechanics and clinical research, there is a general understanding that early therapy-guided tendon release is more beneficial than strict immobilization in efforts to achieve maximum functional recovery. Mobilization promotes intrinsic tendon healing, increases tensile strength, and improves tendon glide while reducing adhesion formation. All of this translates to optimized joint motion, fewer flexion contractures, and overall improved functional outcomes. Tendon repair rehabilitation programs are ideally structured to improve overall hand function while facilitating diverse soft tissue injuries. Flexor tendon rehabilitation protocols are broadly divided into three groups: immobilization, early passive mobilization, and early active mobilization. The selection of a rehabilitation protocol should be determined by considering factors such as the patient's age, ability to comply with treatment, and suture strength. Current techniques in flexor tendon repair have led to advancements in rehabilitation practice, encouraging a shift from passive methods to early, controlled, and more active approaches. Optimal flexor tendon surgery and treatment outcomes depend on a patient-centered protocol rather than a strictly structured protocol. Individuals aged 18-65 who have suffered a flexor tendon injury and have undergone related surgery, and who have no neurological symptoms in the repaired extremity will be included in the study. Individuals who have previously undergone hand surgery for any reason other than this injury, who have a comorbid mental, physical, or neurological chronic illness, who have cognitive problems that impede communication, or who have any other problems that impede cooperation will not be included in the study. When we divided the included individuals into two groups, the control group will receive only conventional physiotherapy, while the study group will additionally receive myofascial release exercises. Pre- and post-treatment evaluations will be conducted. The aim of our randomized controlled trial was to investigate the effects of myofascial release on pain, dexterity, function, and quality of life in the late-stage rehabilitation of hand flexor tendon repairs.

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Outcomes

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