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.

No description available.

Diss. (sammanfattning) Umeå : Umeå universitet, 2007. / Härtill 7 uppsatser.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2005. / Also held in print (xvi, 130 leaves, ill., 30 cm.) in Akoranga Theses Collection. (T 613.718 DOM)

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 75-81).

Thesis (M.S. in civil engineering)--Washington State University, May 2006. / Includes bibliographical references (p. 147-151).

Um dos maiores desafios da ortopedia moderna é recuperar o tecido ósseo que tenha sido perdido por motivo de doença ou acidente. Na busca de substitutos para os enxertos, tem-se utilizado comumente biomateriais para recuperação desse tecido. Um dos vários tipos de biomateriais usados são os preparados à base de colágeno. Além de desempenhar papel importante na estrutura dos tecidos, o colágeno é capaz de orientar a formação de tecidos em desenvolvimento fato altamente favorável na sua utilização como biomaterial. Uma nova vertente de pesquisa do processo de mineralização de matrizes colagênicas que vem sendo desenvolvida é a analise de como a organização do tecido interfere no modo como ocorre esse processo de deposição. O uso do tendão vem sido pesquisado devido ao fato de ser um tecido extremamente organizado, com as fibras colagênicas alinhadas por toda a sua extensão. Este trabalho teve como objetivo a preparação e caracterização de matrizes de colágeno tipo I, oriundas de tendão bovino (TB) e avestruz (TA) após a hidrólise alcalina e mineralização. Os tendões foram colocados em solução alcalina contendo sais de K+, Na+ e Ca2+ por 72, 96 e 120 h a 25°C e depois equilibrados em solução de sais, lavados em H3BO3, EDTA e água. As matrizes resultantes foram então mineralizadas em soluções de CaCl2 0,2 mol L-1, pH = 7,4 e de Na2HPO4 0,12 mol L-1 pH = 9,0 durante 6 h, ocorrendo a troca de soluções a cada 30 min. As matrizes antes e após mineralização foram congeladas, liofilizadas e submetidas à análise termogravimétrica (TG), calorimetria exploratória diferencial (DSC), microscopia eletrônica de varredura (MEV), espectroscopia no infra-vermelho (FT-IR) e dispersão de energia por raios-X (EDX). DSC mostrou que não houve desnaturação do colágeno durante o processo de tratamento alcalino e mineralização. A análise termogravimétrica mostrou que houve deposição de fosfato de cálcio, com o valor dependendo do número de ciclos de mineralização. MEV mostrou que essa mineralização não é uniforme, ocorrendo a formação de aglomerados. FT-IR e EDX mostrou que o fosfato de cálcio depositado provavelmente seja hidroxiapatita, mas não em sua estrutura estequiométrica. / One of greatest challenges of modern orthopedics is to restore bone tissue that has been lost due to sickness or accident. Searching for substitutes for grafts, biomaterials have been commonly used for recovery of bone tissue. Between different types of biomaterials, several are based on collagen. In addition to have important role in tissue structure, collagen is able to guide the formation of tissues, a highly favorable fact in its use as biomaterial. A possible research in collagen scaffolds mineralization is the analysis of how tissue organization interferes in deposition process. The tendon has been used because it is a highly organized tissue, with collagen fibers lined on its structure. This research aims the preparation and characterization of type I collagen scaffolds, prepared from bovine tendon (TB) and ostrich tendon (TA) after alkaline hydrolysis and mineralization. Tendons were maintained in alkaline solution containing K+, Na+ and Ca2+ ions for 72, 96 and 120 hours at 25°C and then equilibrated in salt solution, washed with H3BO3, EDTA and water. The resulting matrices were then mineralized in 0.2 mol L-1, pH = 7.4 CaCl2 solution and 0.12 mol L-1 Na2HPO4 pH = 9.0 for 6 h, changing solutions after 30 minutes. The matrices before and after mineralization were frozen, lyophilized and subjected to thermogravimetric analysis (TG), differential scanning calorimetry (DSC), scanning electron microscopy (SEM), infrared spectroscopy (FT-IR) and energy dispersive X-ray spectroscopy (EDS). DSC showed that the collagen was not denaturated by alkaline treatment process and mineralization. TG analysis showed deposition of calcium phosphate on the scaffolds, with values depending on the number of mineralization cycles. SEM showed that the mineralization is not uniform, forming clusters of phosphate crystals. FT-IR and EDS showed that the deposited calcium phosphate is probably hydroxyapatite, but not in its stoichiometric structure.

As dense connective tissues, tendons play a vital role in the transmission of contractile forces from muscle to bone. This link between muscles and bones provides the means in transferring tensile forces produced by muscles on to the connected bone. During movement, tendons slide over surrounding bony and articular surfaces and are thus commonly subjected to shear and compression forces in addition to tensile force. Fibrillar collagen, proteoglycan and various glycoproteins make up the composition of tendinous tissue and contribute to its ability to withstand these forces. Tendons contain a distinct population of cells, called tenocytes. Tenocytes undertake a flattened morphology within the tendon matrix and contain cytoplasmic projections which extend longitudinally and laterally towards other tenocytes. An intercellular network of cells thus maintains the extracellular environment of the tendon and allows a coordinated response to external mechanical stimuli. Defects to load-bearing connective tissue elements such as tendons whether due to trauma, overuse, age-related diseases or degenerative diseases, are often limited in their healing potential and thus contributes often to persistent, chronic clinical symptoms. Chronic disease, overuse or acute injuries damages the tendon. This damage compromises the transmission of tensile forces and because of the hypovascularity of some tendinous tissues and many other reasons, a healing response often is severely insufficient in regenerating tissue back to its original constitution. Even the best treatment options for such tendinopathies, supplemented with the body’s own healing response fail to produce quality outcomes. An understanding of the molecular, cellular and mechanical characteristics of tenocytes, tendon matrix and the tendon system as a whole will be vital for the development of effective therapies for all tendinopathies. It is the goal of this current work to outline the current molecular, cellular, mechanical and clinical understanding of tendons. A broad address to tendon biology should help illustrate the key dimensional aspects that must be considered when attempting the effective translation of research into useful clinical therapies.