Thesis (M. Med. Sc.)--University of Hong Kong, 2007.

Thesis (M.Sc.)--York University, 2007. Graduate Programme in Kinesiology & Health Science. / Typescript. Includes bibliographical references (leaves 72-83). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR38803

Thesis (M.S.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains vii, 56 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 48-50).

Thesis (M.S.)--Rutgers University, 2009. / "Graduate Program in Biomedical Engineering." Includes bibliographical references (p. 52-54).

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The management of flexor tendon injuries in the hand is complex and requires skill not only on the part of the surgeon but also the rehabilitation therapists and compliance on the part of the patient. Anecdotally it is clear that therapists (occupational therapists and physiotherapists) gain their skills and knowledge as practitioners through hands-on experience, since very little specialized training is available in the field of hand therapy. Therapists should equip themselves with the knowledge of the surgical management of the patient, since post-operative rehabilitation depends on it. Ideally the hand surgeons should advise the therapists or dictate the post-operative management based on the surgical technique performed. The actual practices, attitudes and experiences of South African therapists in the management of flexor tendons are not known. The purpose of this study was to determine the practices, attitudes and experiences of the public sector physiotherapists and occupational therapists in the postoperative rehabilitation of patients post repair of flexor tendons surgery in the hand. The first part of the study consisted of a cross sectional survey which explored the postoperative rehabilitation practices, attitudes, and experiences regarding flexor tendon rehabilitation. The second part which was a focus group discussion sought in depth information on the attitudes and experiences of the therapists. Sixty three therapists from different public hospital settings in two districts of KwaZulu-Natal completed a validated questionnaire. The therapists were accessed from randomly selected hospitals located in two conveniently selected health districts in KwaZulu- Natal. The findings suggest that the use of the Kleinert-type and immobilisation protocols is widely used. Overall there was no significant differences in the choice of rehabilitation protocol, but this differed by hospital setting. Therapists in the tertiary hospital preferred the Duran protocol (53.6%, p = 0.003). Regional hospitals utilized the immobilization protocol (74.1%, p=0.045) and district hospitals treated presenting postoperative symptoms mostly (20% p=0.75).There was no statistical (p=0.196) difference on the decision to initiate therapy amongst different hospital settings. Frequency of therapy visits varied, but was not statistically different (p=0.16) amongst different hospital settings. More respondents (29.2%) reported typically initiating active ROM exercises on the fourth post-operative week. There was a significant difference (p=0.002) in the initiation of active range of movement amongst different hospital settings. Approximately 37% of the respondents discontinue protective splinting at five weeks. There was a significant difference (p=0.004) by hospital setting regarding when the protective splinting should be discontinued. Initiation of resistance exercises varied between four and six weeks. Nearly half (49%) of the therapists reported that they are sometimes apprehensive about how to progress patients through rehabilitation. The focus group revealed that there is poor communication between therapists and surgeons, lack of protocol guidance, lack of knowledge of the flexor tendon protocols of the newly qualified therapists and doctors. During the focus group discussion therapist’s attitudes and experiences were revealed through the eight themes that emerged namely challenges experienced during flexor tendon (FT) rehabilitation, the patient's socio-economic background, patient’s home environment, compliance with flexor tendon rehabilitation protocol, multidisciplinary team approach, clinical experience, university undergraduate curriculum on flexor tendon rehabilitation, outcomes of flexor tendon postoperative rehabilitation. Conclusion. The rehabilitation protocols that are commonly used include the Kleinert -type and the immobilisation protocols. Duran type protocol was used less frequently, only when it was the best option for that particular patient according to the surgeon or the surgical management of that patient. The focus group discussion revealed that rural hospital therapists modify the protocols, due to lack of resources and the poor compliance of the patients. rehabilitation practices, flexor tendon experiences, hospital settings / Thesis (M.Physio.)-University of KwaZulu-Natal, Westville, 2013.

The aim of this study was to investigate which protocols Occupational Therapists (OT’s) use when rehabilitating clients after flexor tendon repairs, and to investigate the therapist’s knowledge regarding these protocols, to guide therapists and institutions in using effective methods within the South African context. A questionnaire was sent to OT’s in South Africa. Of the 32 responses, 50% had more than 10 years experience and 50%, less experience. 81.2% were private practitioners and 28% worked in government. The trend of protocol use was as follows: 18.8% used a Duran-type passive mobilization protocol, 25% used a Kleinert-type protocol - a passive flexion protocol (but labelled an active mobilization protocol in literature as it allows active extension of the fingers), 28.1% used Early Active Mobilization and 3.1% used an Immobilization-type protocol. 64.5% of the sample used static splints, 9.7% used dynamic splints and 25.8% used a combination. Most (83.3%) continued the splint at 4 weeks but only 26.6% were using the splint at 6 weeks. At week 1, 30% allowed active flexion of the fingers, whereas at week 4 and 5, 60% allowed active flexion. The referring doctor and confidence in one’s own skills were the main factors influencing protocol choice. Resources available influenced the protocol choice, which can be problematic in South Africa. Access to literature was mostly through textbooks (90.6%), although journal articles were accessed (internet - 50%, hard copy - 62.5%). More than half of the sample attended courses regularly. Most therapists were happy with their outcomes, regardless of which protocol used. Therapists need to build their confidence, realising the efficacy of various protocols is similar, according to research. Thus whatever factors influence protocol choice, they will likely not be critical to good outcomes. / Thesis (M.O.T.)-University of KwaZulu-Natal, Durban, 2012.

Trotz intensiver Forschung im Rahmen der Bänder- und Sehnenerkrankungen gelten bestimmte Fragestellungen hinsichtlich Erkrankungs- sowie Heilungsmechanismen als unbeantwortet. Verschiedenste Konzepte des Tissue Engineerings sollen helfen entsprechende Fragen zu beantworten und moderne Therapiekonzepte zu etablieren. Für grundlegende Untersuchungen zur Biologie der Tenogenese sowie zum Wirkmechanismus applizierter mesenchymaler Stromazellen (MSC), gewinnt die Anwendung von dezellularisiertem Sehnengewebe immer mehr an Bedeutung. Zudem erscheint der Einsatz dezellularisierter Sehnen- und Bandkonstrukte zur Wiederherstellung der betreffenden erkrankten Organe sehr vielversprechend. In der vorliegenden Arbeit sollte der Grundstein zur Entwicklung eines in vitro-Modells auf Grundlage equiner Beugesehnen gelegt werden. Primäres Ziel war es, ein optimales Dezellularisierungsprotokoll für intakte equine Beugesehnen (oberflächliche und tiefe Beugesehne) zu etablieren. Um die Zytokompatibilität der dezellularisierten Sehnen zu überprüfen, erfolgte nach Präparation von Sehnenstreifen die Besiedlung mit equinen MSC mit Kontrolle des Besiedlungserfolges. Materialien und Methoden: Oberflächliche und tiefe Beugesehnen (OBS und TBS) des Pferdes (n = 6) wurden nach vier verschiedenen Protokollen dezellularisiert. In zwei Protokollen (Protokolle A und B) erfolgte zunächst die Anwendung von Gefrier-Auftau- Zyklen mit anschließender Lagerung in hypertoner Lösung. Protokoll A sah danach eine Inkubation in 1 % Triton X 100 und Protokoll B eine Inkubation in 1 % Sodium-Dodecyl-Sulfat (SDS) enthaltender Lösung vor. Die beiden anderen Protokolle (Protokolle C und D) sahen ein Verbringen in hypertone Lösung ohne vorherige Gefrierzyklen vor. Anschließend erfolgte bei Protokoll C die Inkubation in Triton X 100 und bei Protokoll D die Inkubation in SDS enthaltender Lösung. Die Effektivität der angewandten Dezellularisierungsprotokolle wurde durch histologischer Färbung, Zellzählung nach Kollagenaseverdau, DNA-Quantifizierung und transmissionselektronenmikroskopischer Untersuchung ermittelt. Nach Evaluierung der Effektivität der Protokolle wurden oberflächliche Beugesehnen nach den Protokollen A und B dezellularisiert (n=3). Nach Präparation von Sehnenstreifen in definierter Größe erfolgte die Besiedelung mit Eisenoxid-markierten equinen MSC. Der Besiedlungserfolg wurde mit verschiedenen histologischen und Fluoreszenzfärbungen (Fluoreszenzmikroskopie) und MRT-Untersuchung kontrolliert. Die Prüfung auf statistische Unterschiede zwischen den Protokollen erfolgte mit dem Friedman-Test und im Falle eines statistisch signifikanten Unterschieds mit dem Wilcoxon-Rang-Test. Das Signifikanzniveau wurde mit p < 0,05 festgelegt. Die Auswertung des Besiedlungserfolges erfolgte deskriptiv. Ergebnisse: Für alle angewandten Protokolle konnte ein signifikanter Dezellularisie-rungseffekt in beiden Sehnenstrukturen (OBS und TBS) gezeigt werden. Die Anzahl der vitalen Zellen nach Kollagenaseverdau sowie die histologisch ermittelte Zellzahl der dezellularisierten Sehnen belief sich in Abhängigkeit des jeweiligen Dezellularisie-rungsprotokolls und der Sehne (OBS und TBS) auf 1 bis 21 % (Median) des nativen Gewebes. Der ermittelte DNA-Gehalt nach Anwendung der mit Gefrier-Auftau-Zyklen kombinierten Protokollen A und B entsprach < 24 % (Median) des nativen Gewebes. Die Anwendung der Protokolle C und D führte zu einem DNA-Gehalt von < 47 % (Median). Die Auswertung der transmissionselektronenmikroskopischen Untersuchung zeigte ebenfalls eine effektive Dezellularisierung des Sehnengewebes bei Erhalt der Struktur der extra-zellulären Matrix. Nach Anwendung der Protokolle A und B konnte wiederum tendenziell eine bessere Effektivität der Dezellularisierung festgestellt werden. Eine gelungene Besiedlung der Sehnenstreifen mit equinen MSC konnte anhand der mikroskopischen Untersuchung und MRT-Untersuchung gezeigt werden. Das beobachtete Zellwachstum bei beibehaltender Vitalität der Zellen sprechen für eine gute Zytokompatibilität. Die nach Protokoll A dezellularisierten und besiedelten Sehnenstreifen ließen ein besseres Zellwachstum über eine Kulturdauer von 14 Tagen erkennen. In der vorliegenden Arbeit konnte eine effektive Dezellularisierung von intakten equinen Beugesehnen gezeigt werden. Anhand der Ergebnisse der Besiedlung erwies sich die Dezellularisierung nach Protokoll A (Gefrier-Auftau-Zyklen und Triton X 100) als vielversprechende Grundlage zur Entwicklung eins in vitro Modells auf Grundlage dezellularisierter equiner Beugesehnen.

Resumo: Nesta pesquisa foram investigados aspectos anatômicos e biométricos da face flexora dos dígitos de 20 novilhas mestiças da raça Nelore, com idades entre 24 e 36 meses, criadas em sistema extensivo. O material foi proveniente de matadouro sob Fiscalização do Serviço de Inspeção Oficial e mantido sob congelamento a -18°C até o momento da dissecação. Após tricotomia e limpeza das regiões distais ao metacarpo e metatarso, as faces palmar e plantar dos dígitos foram dissecadas in natura e as estruturas anatômicas identificadas e medidas com auxílio de paquímetro universal. As mensurações foram feitas em milímetros (mm) e incluíram o comprimento, a largura e a espessura das estruturas anatômicas digitais. A técnica de dissecação in natura foi considerada útil para a execução deste estudo e as estruturas identificadas e mensuradas incluíram os ligamentos acessórios distais dos paradígitos, ligamentos anulares palmares e plantares, bainha digital tendínea, ligamentos anulares proximais e distais, ligamentos interdigitais distais, tendões flexores digitais superficiais e profundos e a manica flexoria. Os dados biométricos obtidos indicam diferenças (p≤0,05) entre membros, antímeros e dígitos, especialmente nas estruturas anatômicas localizadas distalmente. Devido à escassez de estudos biométricos sobre o assunto, os achados deste trabalho podem servir como valores de referência para a faixa etária de novilhas avaliadas e contribuir em pesquisas morfológicas futuras / Abstract: In the present work anatomic and biometric studies of the distal aspect in the flexor aspect of digits were carried out for 20 cross-breed heifer of Nelore breed aging around 24-36 months raised in an extensive regiment. The materials came from shamble under the Official Fiscalization of Inspect Service and were kept under freezing at -18°C until dissection. After the clipper and cleaning the distal areas, from metacarpus to metatarsus, the structures were dissected and measured by using a universal caliper rule (mm) on length (proximal-distal), widht (abaxial-axial) and thickness (dorso-palmar or dorso-plantar). The dissected structures included the paradigits distal accessories ligaments, palmar and plantar annular ligaments and tendon digital sheath, proximal and distal annular ligaments, interdigital distal ligament, superficial digital flexor tendon and deep digital flexor tendon and manica flexoria. The measured data indicate differences (p≤0,05) among the limb, right, left and respective digits mainly in the more distal analyzed structures. Due to scarcity of biometric studies about this topic, the data found in this work might be useful as a reference for the analyzed group, as well in the anatomic detailed structures which are essential to understanding many of the pathological process of locomotor apparatus in cattle / Orientador: José Wanderley Cattelan / Coorientador: Silvana Martinez Baraldi Artoni / Banca: Julio Carlos Canola / Banca: Claudia Acosta Duarte / Mestre

As the incidence of diagnosed carpal tunnel syndrome continues to increase, an understanding of the mechanism(s) of insult to the median nerve which leads to its development becomes ever more imperative. Knowledge of the exact cause of CTS could lead to improved diagnostic and treatment methods, or more importantly, to better preventative measures. The goal of this study was to investigate movements and interactions of structures within the carpal tunnel during wrist flexion and hand loading in order to obtain information about a specific mechanism of insult to the median nerve. Symptomatic and normal subjects were compared to observe differences in the interactions of the median nerve and its surrounding structures. A new methodology was developed to facilitate the evaluation of these populations.