Tendon Intactness !

[emad]

Hi all ;

no much here on somasimple ,practise orthopedic physio !!!:secret: :cry:


How do you assess the efficacy oh hand flexor tendon intactness???

Regards

Emad

[nari]

emad

You're right..at least I avoided orthopaedics as much as I could, and was fairly successful doing that, over the last 15 years or so.

Re flexor tendon integrity; can you tell me a bit more? is it just that the finger has very weak or no active flexion? Is the joint/are the joints full range? Which flexor muscle are you thinking of?

By the way, your English has improved greatly!!! :)

Nari

[bernard]

Emad,

I'm doing every day orthopaedic physio but I incorporated the neuro bits in the treatment.

BTW, even with orthopaedic PT, I'm not sure to measure tendon integrity without technological unit as echography...

[emad]

Nari ;

Thank you for expressing that my English is improving , i wait the test result :money:

Regarding the tendon ,i have around 3 cases ,some are usually clear for me manual to assess the tendon inactness/integrity.

post-surgical cases
I meet significant number of cases post-surgery ,who have no inact tendons ,surgons try to get rid of them ,so that they send them for physio ,most physios are illiterate ,money-collectors ,they go on with the patient ,no problem intact or not .

Through my work I try to isolate those patients ,however i creat enemies from doctors , but i do not care .

The main Point
Distingushing between tendon tactness and Sensory motor amnesia is difficult for me ??


Regards

Emad

[bernard]

Emad,

If a tendon is ruptured thus the patient is able to contract his muscle but the waited movement doesn't occur.

If a patient get a neurological problem then the muscle doesn't contract and muscle may be moved by both ends.

[emad]

Hi Bernard :

I encountered before a muscle cut injury case ,when i assessed the case , the pot-operative weakness(SMA) gave me the imperssion that tthe muscle is still cut, but after 3 weeks of working ,there was excellent outcome .

I do NOT want to give the patient the imperssion that the tendon is not intact ,beacuse i am not sure ,if this is just SMA postoperative .

Regards
Emad

[neuron]

Hi emad,
Although iam not practising in musculoskeltal, why don't you use Strength -Duration curve or stimulate the muscle with low intensity faradic current and lookout for the response. You can compare the with the sound side ( same muscle) muscle which might give you an idea about the tendon's intactness. Try do isolate action of the particular tendon which is affected. Intensity variation and the contraction of the muscle will give you the results.
cheers
neuron

[bernard]

I do NOT want to give the patient the impression that the tendon is not intact, because i am not sure, if this is just SMA postoperative.

Emad, such behaviour is common after a surgery. But a ruptured tendon is a ruptured tendon. There is often a muscle difference between the two sides and moving a part of the limb will normally move the tendon elsewhere. If the extremity isn't moving while perfoming this passive action, thus it is possible that it is ruptured.

BTW, it is better (IMHO) to ask the surgeon about its integrity than wait an improbable and miraculous tendon suture.

When the case is dubious, just ask and tell your findings.

[emad]

Hi :

Neuron ,

I do not know anything about the method you mentioned above , i do not belive so much in using faradic for treatement ,Will i use it for testing ????:confused:

Bernard :
you know the issue is difficult to differnate between postoperative SMA within the tendon and its muscle from one side and cut tendon from the other side .

IMHO ??

This is patient had gonna under surgery for 3 times( it is 8 moths old injury now ) , the second time was the most radiculus , the tendon worked perfectly following it , but that miscro-orthopedic surgeon performed something radiculus ,he used forced movement ,advised the patient to perform resisted flex , after that 4 days the tendon was cut ,then goona under another graft surgery by the same surgeon ,and reached me now ,all that according to the patient s narration .

Regards

Emad

[bernard]

IMHO = In My Humble Opinion

Yes, Emad it is difficult and need a bit of training but I think it may be often possible.

BTW, what tendon was ruptured?

[emad]

middle finger .emad

[bernard]

Extensor or flexor?

[emad]

oh , flexor .


Emad

[cedric]

so the flexor of the middle finger may be ruptured? (this should became an insulting sign ;) )
from my very humble point of view, only echography can show signs of rupture

you can test the muscle by using the second or third muscle's testing position (even if this test was made for neurological matters) it will give you some informations about the possiblity of the muscle (is he able to make the finger move or not, if not he may be ruptured)

[emad]

Hi Ce :

Bernard mentioned also that echography to detect tendon rupture .

We are trying to differenate between sensory motor amnesia floowing surgery of the tendon and the complete rupture .

Secondly , how is the reliability of that procedure , and if high , we do not have it here .


Emad

[slopoke]

:eek: resisted flexion 4 days after tendon repair... you surely have some dodgy surgeons in your area of practice.

[emad]

slop;

you are right !

Money money makes evil .

Regards

Emad