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DOI: 10.4103/0970-0358.129629
Early ultrasound therapy for rehabilitation after zone II flexor tendon repair
Address for correspondence:
Publikationsverlauf
Publikationsdatum:
26. August 2019 (online)
ABSTRACT
Background: In our Institute, most of the patients treated for hand injuries were industrial workers with poor compliance. For rehabilitation after zone II flexor tendon repair, we had tried various early mobilization protocols. As these protocols demanded a degree of commitment from the patients, our results were suboptimal. Hence, to improve the results, we implemented a new rehabilitation protocol by administering the pulsed ultrasound therapy during the early phase of tendon healing. Materials and Methods: This is a prospective study done over a period of five years from January 2008 to January 2013. A total of 100 patients and 139 digits with zone II flexor tendon injuries were studied. After randomization, we administered pulsed ultrasound therapy of different frequencies and intensities for a total of 72 patients and 99 digits and formulated three groups. The results of ultrasound treated cases were compared with each other and with the results of cases treated by immobilization protocol. The results were analyzed using ‘Original Strickland’ criteria. Results: 72% excellent-good results in ultrasound (Group 1) protocol, 75% excellent-good results in ultrasound (Group 2) protocol, and 77% excellent-good results in ultrasound (Group 3) protocol were achieved. There was no case of rupture in the first two groups. The rupture rate was 7% in ultrasound (Group 3) protocol. Only 25% excellent-good results were obtained in the immobilization protocol. Conclusion: After zone II flexor tendon repair, pulsed ultrasound therapy during the early rehabilitation phase is safe and effective. The results are comparable to early mobilization protocols.
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Conflict of Interest
None declared
- 1 Harpaz D, Chen X, Francis CW, Marder VJ, Meltzer RS. Ultrasound enhancement of thrombolysis and reperfusion in vitro. J Am Coll Cardiol 1993; 2: 1507-11
- 2 Francis CW, Onundarson PT, Carstensen EL, Blinc A, Meltzer RS, Schwarz K. et al. Enhancement of fibrinolysis by ultrasound. J Clin Invest 1992; 90: 2063-8
- 3 Young SR, Dyson M. Macrophage responsiveness to therapeutic ultrasound. Ultrasound Med Biol 1990; 16: 809-16
- 4 Young SR, Dyson M. The effect of therapeutic ultrasound on angiogenesis. Ultrasound Med Biol 1990; 16: 61-9
- 5 Khanna A, Friel M, Gougoulias N, Longo UG, Maffulli N. Prevention of adhesions in surgery of the flexor tendons of the hand: What is the evidence?. Br Med Bull 2009; 90: 85-109
- 6 Maiti SK, Kumar N, Singh GR, Hoque M, Singh R. Ultrasound therapy in tendinous injury healing in goats. J Vet Med A Physiol Pathol Clin Med 2006; 53: 249-58
- 7 Frieder S, Weisberg J, Fleming B, Stanek A. A pilot study: The therapeutic effect of ultrasound following partial rupture of Achilles tendons in male rats. J Orthop Sports Phys Ther 1988; 10: 39-46
- 8 Byl NN, McKenzie AL, West JM, Whitney JD, Hunt TK, Scheuenstuhl HA. Low dose ultrasound effect on wound healing: A controlled study with Yucatan pigs. Arch Phys Med Rehabil 1992; 73: 656-64
- 9 Byl NN, McKenzie A, Wong T, West J, Hunt TK. et al. Incisional wound healing: A controlled study of low and high dose ultrasound. J Orthop Sports Phys Ther 1993; 18: 619-28
- 10 Low J, Read A. Therapeutic Ultrasound in John Low, Ann Read electrotherapy explained principles and practice. 2nd ed. United Kingdom: Butterworth-Heinmann Ltd; 1994: p. 160 and 168
- 11 Da Cunha A, Parizotto NA, Vidal Bde C. Laboratory of Electro-Thermo-Physiotherapy, Department of Physio, Federal University of Sao Carlos, Brazil. Ultra Sound Med Biol 2001; 27: 1691-6
- 12 A preliminary study on the effect of ultra sound therapy on the healing of surgically severed Achilles tendon in five dogs. J Vet Med A Physiol Pathol Clin Med 2002; 49: 321-8
- 13 Gan BS, Huys S, Sherebrin MH, Scilley CG. The effects of ultrasound treatment on flexor tendon healing in the chicken limb. J Hand Surg Br 1995; 20: 809-14
- 14 Enwemka CS, Rodriquez O, Mendosa S. Biomechanical effects of low intensity ultra sound on healing sounds. Ultra Sound Med Biol 1990; 16: 801-7
- 15 Ng GY, Fung DT. The effect of Ultra sound intensity on the ultra structural morphology of tendon repair. Ultra Sound Med Biol 2007; 33: 1750-4
- 16 PeterLorenz H, Michael T. Longaker Wound healing: Repair, biology and wound and scar treatment. In Mathes SJ. Editor Plastic surgery, 2 nded Vol. 1. Philadelphia, Saunders: Elsevier; 2006: p. 215
- 17 Gelberman RH, Steinberg D, Amiel D, Akeson W. Fibroblast chemotaxis after tendon repair. J Hand Surg Am 1991; 16: 686-93
- 18 Tim Watson Ultrasound treatment dose calculations. http://www.electrotherapy.org [Last accessed on 15.06.2013]
- 19 Merrick MA, Bernard KD, Devor ST, Williams MJ. Identical 3-MHz ultrasound treatments with different devices produce different intramuscular temperatures: Current treatment parameters may not be adequate. J Orthop Sports Phys Ther 2003; 33: 379-85
- 20 Tang JB. Clinical outcomes associated with flexor tendon repair. Hand Clin 2005; 21: 199-210
Address for correspondence:
- 1 Harpaz D, Chen X, Francis CW, Marder VJ, Meltzer RS. Ultrasound enhancement of thrombolysis and reperfusion in vitro. J Am Coll Cardiol 1993; 2: 1507-11
- 2 Francis CW, Onundarson PT, Carstensen EL, Blinc A, Meltzer RS, Schwarz K. et al. Enhancement of fibrinolysis by ultrasound. J Clin Invest 1992; 90: 2063-8
- 3 Young SR, Dyson M. Macrophage responsiveness to therapeutic ultrasound. Ultrasound Med Biol 1990; 16: 809-16
- 4 Young SR, Dyson M. The effect of therapeutic ultrasound on angiogenesis. Ultrasound Med Biol 1990; 16: 61-9
- 5 Khanna A, Friel M, Gougoulias N, Longo UG, Maffulli N. Prevention of adhesions in surgery of the flexor tendons of the hand: What is the evidence?. Br Med Bull 2009; 90: 85-109
- 6 Maiti SK, Kumar N, Singh GR, Hoque M, Singh R. Ultrasound therapy in tendinous injury healing in goats. J Vet Med A Physiol Pathol Clin Med 2006; 53: 249-58
- 7 Frieder S, Weisberg J, Fleming B, Stanek A. A pilot study: The therapeutic effect of ultrasound following partial rupture of Achilles tendons in male rats. J Orthop Sports Phys Ther 1988; 10: 39-46
- 8 Byl NN, McKenzie AL, West JM, Whitney JD, Hunt TK, Scheuenstuhl HA. Low dose ultrasound effect on wound healing: A controlled study with Yucatan pigs. Arch Phys Med Rehabil 1992; 73: 656-64
- 9 Byl NN, McKenzie A, Wong T, West J, Hunt TK. et al. Incisional wound healing: A controlled study of low and high dose ultrasound. J Orthop Sports Phys Ther 1993; 18: 619-28
- 10 Low J, Read A. Therapeutic Ultrasound in John Low, Ann Read electrotherapy explained principles and practice. 2nd ed. United Kingdom: Butterworth-Heinmann Ltd; 1994: p. 160 and 168
- 11 Da Cunha A, Parizotto NA, Vidal Bde C. Laboratory of Electro-Thermo-Physiotherapy, Department of Physio, Federal University of Sao Carlos, Brazil. Ultra Sound Med Biol 2001; 27: 1691-6
- 12 A preliminary study on the effect of ultra sound therapy on the healing of surgically severed Achilles tendon in five dogs. J Vet Med A Physiol Pathol Clin Med 2002; 49: 321-8
- 13 Gan BS, Huys S, Sherebrin MH, Scilley CG. The effects of ultrasound treatment on flexor tendon healing in the chicken limb. J Hand Surg Br 1995; 20: 809-14
- 14 Enwemka CS, Rodriquez O, Mendosa S. Biomechanical effects of low intensity ultra sound on healing sounds. Ultra Sound Med Biol 1990; 16: 801-7
- 15 Ng GY, Fung DT. The effect of Ultra sound intensity on the ultra structural morphology of tendon repair. Ultra Sound Med Biol 2007; 33: 1750-4
- 16 PeterLorenz H, Michael T. Longaker Wound healing: Repair, biology and wound and scar treatment. In Mathes SJ. Editor Plastic surgery, 2 nded Vol. 1. Philadelphia, Saunders: Elsevier; 2006: p. 215
- 17 Gelberman RH, Steinberg D, Amiel D, Akeson W. Fibroblast chemotaxis after tendon repair. J Hand Surg Am 1991; 16: 686-93
- 18 Tim Watson Ultrasound treatment dose calculations. http://www.electrotherapy.org [Last accessed on 15.06.2013]
- 19 Merrick MA, Bernard KD, Devor ST, Williams MJ. Identical 3-MHz ultrasound treatments with different devices produce different intramuscular temperatures: Current treatment parameters may not be adequate. J Orthop Sports Phys Ther 2003; 33: 379-85
- 20 Tang JB. Clinical outcomes associated with flexor tendon repair. Hand Clin 2005; 21: 199-210