Should we think about wrist extensor after flexor tendon repair?

Abstract

Objective: To evaluate the activity of wrist extensor muscle, correlating with wrist motion during gripping after flexor tendon repair.

Design: Cross-sectional clinical measurement study.

Setting: Laboratory for biomechanics and rehabilitation.

Subjects: A total of 11 patients submitted to rehabilitation by early passive motion of the fingers with wrist flexion position were evaluated after 8 weeks of fingers flexor tendon repair and 11 healthy volunteers, all ranging from 20 to 37 years of age.

Intervention: Volunteers performed an isometric standardized gripping task.

Main measures: We used electrogoniometry to analyze wrist range of motion and surface electromyography, considering 100% maximum voluntary contraction to represent the amplitude of electromyographic activity of the extensor carpi radialis and flexor digitorum superficialis.

Results: Patients with flexor tendon repair showed co-activation deficit between wrist extensor (extensor carpi radialis) and flexor finger muscles (flexor digitorum superficialis) during gripping in the intermediate phase of rehabilitation, despite some recovering mobility for wrist extension (p ≤ 0.05). A moderate correlation between range of motion and extensor carpi radialis was present only for injured group (r = 0.32). Total active motion score, which represents finger active excursion, was regular or poor in 65% of cases, all with nerve repair associated.

Conclusion: Wrist extensors have an important synergist role at handgrip, although some imbalance can be present after flexor tendon repair. These preliminary findings suggest that emphasis could be directed to add synergistic wrist motion in rehabilitation protocols after flexor tendon repair. Future studies with early active rehabilitation are necessary.

Keywords: Wrist; electromyography; rehabilitation; tendon injuries.

Figure 1.

Subject’s position during the procedure.

Figure 2.

SEMG activity during gripping: (a) ECR muscle by group and (b) FDS muscle by group. SEMG: surface electromyographic; ECR: extensor carpi radialis; FDS: flexor digitorum superficialis.

Figure 3.

Wrist extension ROM during gripping by group. ROM: range of motion.

Figure 4.

Correlation between wrist extension ROM and the electromyographic activity by group of (a) the ECR muscle and (b) the FDS muscle during gripping. ECR: extensor carpi radialis; FDS: flexor digitorum superficialis; ROM: range of motion.

Figure 5.

Visual comparison of wrist position during the gripping task between (a) injured and (b) noninjured hand of a patient after 8 weeks of flexor tendon repair.