A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in fulfillment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg, June 2017 / This study explores the implementation of two different synergistic wrist motion approaches in the treatment of flexor tendon injuries, the excursion-based approach and the force-based approach. A prospective, quantitative, comparative intervention research design was used to compare the two approaches and determine their effectiveness in a public hospital in South Africa. The five participants’ range of motion, independence in activities of daily living and satisfaction levels were measured throughout the 12 week treatment programme. The excursion-based group showed significant improvement in passive Strickland and Glogovac scores over the rehabilitation period. The excursion-based group also achieved better final place-and-hold and active Strickland and Glogovac scores than the force-based group which showed a decline in these scores over the 12 weeks. Both groups had a poor result for active movement at the final session due to the development of adhesions, but were found to have an improvement in their upper limb function measured on the Disabilities of the Hand, Shoulder and Arm questionnaire in all activities except for those related to work. These results were not statistically significant. The poor results may be attributed to the unique challenges experienced by patients with flexor tendon injuries, living in under-resourced South African communities. The small sample and the fact that the excursion-based group received isolated flexor digitorum profundus tendon repairs while the force-based group received combined flexor digitorum profundus and flexor digitorum superficialis repairs may also have had an impact on the results. The outcomes of this study indicate that despite yielding successful results in research studies performed in developed countries, it is unlikely that either of these approaches will be suitable in the rehabilitation of patients with flexor tendon repairs in a public hospital in South Africa. / MT2017

No description available.

Fibrotic diseases account for an estimated 45% of the total number of deaths in the developed world (Wynn 2007). Tendons are an excellent model for studying the dysregulated response which leads to fibrosis, as tendons have an organized, parallel matrix, in which tissue defects could easily be distinguished. Wong et al. (2006b) demonstrated the presence of a bell-shaped region around sutures in tendons that was devoid of cells in histological sections. The mechanisms of the formation of this acellular zone, that was also noted in cornea and cartilage (Matsuda et al. 1999; Hunziker and Stähli 2008), were unknown. It was hypothesized that the acellular zone was formed by cell death and that suturing caused alterations to the extracellular matrix of sutured regions of tendon, which made the acellular zone refractory to cellular re-population. The acellular zone was tracked in sutured tendons for up to a year to determine the temporal properties of the acellular zone. Electron microscopic and time lapse studies were carried out to determine if the acellular zone formed by cell migration or cell death. Microarray analysis was conduced to confirm this and to reveal potential molecular targets for future studies. The extracellular matrix of sutured tendons was studied by electron, atomic, scanning and polarized light microscopy and mechanical measurements were obtained using nanoindentation. It was concluded that the acellular zone formed within 24 hours and persisted for up to a year. Tension and size of the suture's grasp were also shown to be important for acellular zone formation. Cell death was the main effector of acellular zone formation. Microarray analysis showed evidence of upregulation of inflammatory mediators and programmed necrosis pathways. The sutured extracellular matrix was denser, more disorganized and had a lower Young's modulus than unsutured regions of the same tendon. These differences in the properties of the extracellular matrix of sutured tendons may be the cause of the persistence of the acellular zone.

Lesions of the distal deep digital flexor tendon (DDFT) are frequently diagnosed using magnetic resonance imaging (MRI) in horses with foot pain. The prognosis for horses with DDFT lesions to return to previous levels of performance is poor. Treatment options are limited; consisting of conservative therapy, desmotomy of the accessory ligament of the deep digital flexor tendon, injection of the digital sheath or navicular bursa, navicular bursoscopy or intralesional injection. Intralesional injection of biologic therapeutics shows promise in tendon healing, with increased number of experimental and clinical studies finding positive results. However, accurate injection of DDFT lesions within the hoof is difficult and requires general anesthesia. The Hallmarq open, low-field MRI unit was used to develop an MRI-guided technique to inject structures within the hoof. This procedure has been previously reported for injecting the collateral ligaments of the distal interphalangeal joint. Four clinical cases of deep digital flexor tendinopathy have been treated with MRI-guided injections using a similar technique. The aim of this study was to evaluate accuracy of a technique for injection of the deep digital flexor tendon within the hoof using MRI-guidance, which could be performed in standing patients. We hypothesized that injection of the DDFT within the hoof could be accurately guided using open low-field MRI to target either the lateral or medial lobe at a specific location. Ten cadaver limbs were positioned in an open, low-field MRI unit to mimic a standing horse. Each DDFT lobe was assigned to have a proximal (adjacent to the proximal aspect of the navicular bursa) or distal (adjacent to the navicular bone) injection. A titanium needle was inserted into each tendon lobe, guided by T1-weighted transverse images acquired simultaneously during injection. Oil-based colored dye was injected as a marker. Post-injection MRI and gross sections were assessed by three blinded investigators experienced in equine MRI. The success of injection as evaluated on gross section was 85% (70% proximal, 100% distal). The success of injection as evaluated by MRI was 65% (60% proximal, 70% distal). There was no significant difference between the success of injecting the medial versus lateral lobe. The major limitation of this study was the use of cadaver limbs with normal tendons. The authors concluded that injection of the DDFT within the hoof is possible using MRI guidance. Future work should be focused on using the techniqe in live horses with tendon lesions, and more clinical studies are needed to determine the most efficacious biologic therapeutic for tendon healing. / Master of Science

Para avaliar a eficácia do laser de arsenito de gálio em acelerar a cicatrização tendínea em cavalos PSI de corrida com lesão no tendão flexor digital superficial, foram realizados dois experimentos, primeiro (E1) com 14 casos clínicos onde as lesões foram decorrentes do esporte em um dos membros torácicos, o segundo (E2) com cinco casos experimentais, onde as lesões foram induzidas com colagenase em ambos os membros torácicos. No E1, após a detecção da lesão no tendão flexor digital superficial por exame ultra-sonográfico, todos os animais receberam antiinflamatório não esteróide associado à dimetilsulfóxido por via intravascular, crioterapia no local da lesão, e caminharam ao passo duas vezes ao dia por 15 minutos durante os 30 dias de acompanhamento. Os membros tratados pertenceram a onze animais que receberam uma sessão diária de laser de arsenito de gálio na dose de 20 J/cm2, realizadas durante 10 dias consecutivos, após término do antiinflamatório e da crioterapia. Os membros controle pertenceram a três animais, os quais não foram tratados com laser. No E2, após identificação das lesões, foram escolhidos aleatoriamente um membro torácico controle e outro a ser tratado por laser em cada animal. Da mesma forma, estes animais foram mantidos a passo e receberam o mesmo protocolo de laserterapia que os membros tratados do E1. Todos os membros foram avaliados através de exames ultra-sonográficos, utilizando-se como parâmetros o paralelismo das fibras tendíneas em corte longitudinal; a ecogenicidade, a área do tendão, a área da lesão e a porcentagem de ocupação da lesão em corte transversal. No E1, os membros controle não apresentaram diferença significativa (P>0,05) nos parâmetros avaliados entre os dias 0 e 30. Nos membros tratados, a área do tendão também não apresentou diferença significativa (P>0,05) entre os dias analisados, porém houve diminuição muito significativa nos escores de ecogenicidade e paralelismo (P<0,001), assim como diminuição no tamanho da lesão (P<0,05) e na porcentagem de ocupação da lesão (P<0,05). No E2 também não houve diferença significativa entre os dias em todos os critérios avaliados nos membros controles (P>0,05). Nos membros tratados a ecogenicidade, o paralelismo e o tamanho do tendão, não sofreram alterações significativas (P>0,05) entre os dias avaliados, porém o tamanho da lesão (P<0,05) e a porcentagem de ocupação da lesão (P<0,01) apresentaram diminuição significativa. O laser de arsenito de gálio na dose de 20 J/cm2 mostrou-se eficaz em acelerar a reparação da lesão tendínea nos membros tratados em relação aos membros controle, tanto no grupo de casos clínicos quanto no grupo experimental, quando comparados aos 30 dias do aparecimento da lesão. Esses resultados sugerem a participação positiva do laser de arsenito de gálio nos resultados e a validação do mesmo no tratamento da tendinite do flexor digital superficial de cavalos Puro Sangue Inglês de corrida. / This study conducted two trials to evaluate the efficacy of Gallium Arsenide Laser in the speed of the healing process of superficial digital flexor tendon (SDFT) lesions in thoroughbred horses. One trial group (T1) comprises 14 horses with lesions, which resulted from the sport, in the SDFT in one of the front limbs. The other trial group (T2) was formed by five horses that had lesions induced in both front limbs by collagenase injection. In the T1, after the detection of the lesion in the SDFT by ultrasonography all horses were treated by intravenous injection, once a day, over five days, with an association of two AINS: phenylbutazone and dimethylsulfoxide. Cryotherapy was also applied on the affected tendon (three times a day over five days) and the horses were kept in stalls and allowed controlled exercise (hand-walked twice daily for 15 minutes) during the 30 days of the study. The treated limbs belong to 11 horses that received laser sessions once a day for ten days at a dosage of 20J/cm2. These sessions started after the AINS association and cryotherapy. The control limbs belong to the other three horses that received the same treatment, except by the laser sessions. In the T2, after the detection of the lesion, a limb from each horse was randomly chosen to be the control limb and the other limb was treated by laser. These horses were also kept in stall under controlled exercise and the treated limb was under the same laser protocol that T1. All horses were evaluated by two ultrasonographic exams with a 30-day interval. The parameters evaluated were: the fiber alignment, the echogenicity, the tendon area, the lesion area and the proportion of the cross sectional area involved. In the T1, the control limbs showed no significant difference (p>0,05) in the echogenicity, the fiber alignment, the tendon area, the lesion area or the proportion of the cross sectional area involved, between the day 0 and 30. The treated limb, didn´t show any significant difference of the tendon area, but showed a significant difference on the echogenicity (P<0,001), the fiber alignment (P<0,001), the lesion area (P<0,05) and the proportion of the cross sectional area involved (P<0,05). In the T2, only one limb received the laser treatment, the other limb acted as a control. The control limbs showed no significant difference (P>0,05) in the echogenicity, the fiber alignment, the tendon area, the lesion area and the proportion of the cross sectional area involved between the day 0 and 30. The treated limbs showed no significant difference (P>0,05) in the echogenicity, the fiber alignment and the tendon area, but showed significant difference in the lesion area (P<0,05) and the proportion of the cross sectional area involved (P<0,01). The treatment dose of 20J/cm2 of gallium arsenide laser was efficient in speeding the healing process of SDFT lesions of the laser treated limbs in both groups (T1 and T2), when compared with the control limbs, at 30 days of the onset of the lesion. The group which lesions occurred due to the sport (T1) had a better response to the treatment than the group which lesions were induced by collagenasis (T2). The limbs treated by laser showed a positive response which validates the use of the Gallium Arsenide laser for the treatment of tendinitis in the Superficial Digital Flexor in race horses.

Flexor tendon injuries in zone II of the hand (i.e. between the distal volar crease and the distal interphalangeal joint) can be costly for both the afflicted individual and society because of the high cost of a long rehabilitation period, complicated by tendon ruptures or scarring with adhesion formation, causing impaired range of motion. The aim of the present thesis was to characterize more fully the deep flexor tendon, the tendon sheath and their response to injury in a rabbit model in order to find potential targets to improve the outcome of repair. The intrasynovial rabbit deep flexor tendon differed from the extrasynovial peroneus tendon in the expression of collagens and transforming growth factor-β1 gene expression. Differences were also found in collagen III and proteoglycans between regions of the flexor tendon subjected to either compressive or tensile load. After laceration and subsequent repair of the flexor tendon, a shift in collagen gene expression from type I to type III occurred. Proteoglycans were generally increased with the notable exception of decorin, a potential inhibitor of the profibrotic transforming growth factor-β1 which was markedly increased during the first two weeks after repair in tendon tissue but remained unaltered in the sheaths. Both vascular endothelial growth factor and basic fibroblast growth factor mRNA levels remained essentially unaltered, whereas insulin-like growth factor-1 increased later in the healing process, suggesting potential beneficial effects of exogenous addition, increasing tendon strength through stimulating tenocyte proliferation and collagen synthesis. Matrix metalloproteinase-13 mRNA levels increased and remained high in both tendon and sheath, whereas there was only a transient increase of matrix metalloproteinase-3 mRNA in tendon. We could also demonstrate a significant increase of the proportion of myofibroblasts, mast cells and neuropeptide containing nerve fibers in the healing tendon tissue, all components of the profibrotic myofibroblast-mast cell-neuropeptide pathway. / Biomolecular aspects of flexor tendon healing

Made available in DSpace on 2014-06-11T19:30:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-23Bitstream added on 2014-06-13T19:39:58Z : No. of bitstreams: 1 salate_acb_dr_botfm.pdf: 3019127 bytes, checksum: cbb2d9eb05383282d0fb472d53fb21a1 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Nas últimas três décadas muitas pesquisas têm sido realizadas com o objetivo de compreender o processo cicatrização dos tendões flexores e ainda hoje, a reabilitação envolve processos complexos e não compreendidos totalmente. As incertezas em colocar a sutura central na face dorsal vascularizada ou na face palmar avascularizada, persistem ainda na prática clínica e nos experimentos das técnicas de reparo dos tendões flexores dos dedos da mão na região da bainha digital. O objetivo deste estudo foi analisar as propriedades mecânicas e histopatológicas da colocação de um ponto de sutura simples no tendão flexor profundo dos dedos do pé de coelhos, verificando os efeitos na interface sutura-tendão e comparar a colocação deste ponto na região do tendão fibroso, vascularizada e na região do tendão fibrocartilaginoso avascular. Foram estudados 88 coelhos machos divididos em dois grupos de acordo com o local de colocação do ponto de sutura e em mais três subgrupos de acordo com o tempo de seguimento pós- operatório de sete, 14 e 21 dias. O procedimento cirúrgico consistiu na colocação de um único ponto na região de tendão fibroso (Grupo TF) e na região de tecido fibrocartilaginoso (Grupo TFC) no tendão flexor profundo dos dedos do pé do coelho. Em ambos os grupos, os tendões estavam íntegros, sem lesão e os animais permaneceram livres de imobilização. As propriedades mecânicas estudadas foram carga máxima, tensão na carga máxima, módulo de elasticidade, energia na carga máxima e energia por área. Três tendões de cada grupo foram submetidos à análise histológica descritiva por meio de microscopia óptica com ênfase no progresso das etapas da cicatrização tendinosa. A análise das propriedades mecânicas demonstrou comportamento semelhante em ambos... / In the last three decades many studies have been undertaken with the aim of understanding the process of flexor tendon healing and even now, the rehabilitation involves a complex and not fully understood process. The doubts concerning placing the core suture in the vascularized dorsal region than of the palmar avascularized region remain in clinical practice and in the experimental techniques in the repair of flexor tendons of the finger in the digital sheath. The aim of this study was to evaluate the mechanical and histopathologic properties of placing a single suture on the deep flexor tendon in rabbit toes, examining the effects on suture-tendon interface and compare the placement of this point at normal vascularized tendon as well as at the avascular fibrocartilagenous tendon. Eighty-eight male rabbits were studied and divided into two groups according to the local of the point of suture and in three subgroups according to the time of postoperative segment of seven, fourteen and twenty-one days. The surgical procedure was inserting a single point in the region of fibrous tendon (TF Group) and the region of fibrocartilagenous tissue (TFC Group) in deep flexor tendon in rabbit toes. In both groups, the tendons were intact without injury and the animals were allowed free movement. The mechanical properties were maximum load, stress at maximum load, elasticity modulus (Young modulus), energy at maximum load and energy per area. Three tendons from each group were subjected to descriptive histological analysis by an optical microscopy emphasizing the process of tendon healing stages. The analysis of mechanical properties showed similar trend in both groups, with increasing values in accordance with the periods of seven, fourteen and twenty-one days in most of the variables. The control group showed relative similarity than operated group except in TFC twenty one days group that operated... (Complete abstract click electronic access below)

Orientador: Edson Rosa Pimentel / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-17T20:41:39Z (GMT). No. of bitstreams: 1 Vieira_CristianoPedrozo_M.pdf: 2180870 bytes, checksum: 84839495dd54341c9219c9aca477f0aa (MD5) Previous issue date: 2011 / Resumo: Os tendões podem ser acometidos por lesões, infecções e inflamações, seguidas ou não de ruptura, podendo ser decorrentes de atividades desportivas, como exercícios e alongamentos, ou de atividades diárias de muitos trabalhadores. Em situações patológicas a matriz extracelular (MEC) do tendão passa por um processo de reorganização de seus componentes, visando à regeneração e homeostasia do tecido. A inflamação pode ser desencadeada por diferentes fatores, entre os principais causadores desse processo estão injúrias mecânicas e químicas, agentes infecciosos, queimadura, radiação e supressão de oxigênio. Pouco é conhecido na literatura sobre as possíveis alterações que a inflamação instalada em tecidos próximos pode ocasionar em tendões. Desse modo, o presente estudo teve por objetivo analisar as alterações bioquímicas e morfológicas do tendão flexor digital profundo (TFDP) após indução da inflamação aguda em pata. Os períodos de análises foram 4 horas, período em que ocorre o pico da inflamação, 12 e 24 horas. Ratos Wistar (140-160g) foram separados em três grupos experimentais: os que receberam aplicação da carragenina (1%), os que receberam NaCl (0,9%), e os que não receberam nada, sendo utilizados como controle. O TFDP foi dividido conforme suas diferentes regiões (distal, intermediária, proximal). Para análises bioquímicas, os tendões foram processados e analisados de acordo com as seguintes técnicas: SDS-PAGE, para observação do perfil de proteínas, eletroforese em gel de agarose para análise de glicosaminoglicanos sulfatados; zimografia para detecção de metaloproteínase (MMP) 2 e 9; e dosagem de proteínas não colagênicas e hidroxiprolina. Para análises morfológicas, os cortes foram corados com hematoxilina-eosina, azul de toluidina e ponceau SS. De acordo com nossos resultados, no pico da inflamação aguda foi observada menor quantidade de proteínas e glicosaminoglicanos nas três regiões do TFDP dos animais tratados com carragenina. A concentração de hidroxiprolina foi maior nas duas regiões de tensão do tendão do grupo inflamado. A presença da MMP-9 foi detectada na região distal e foi evidenciado o epitendão mais espesso com células inflamatórias nas três regiões do TFDP no grupo com carragenina. Uma melhor organização dos feixes de colágeno foi observada nas duas regiões de tensão desse mesmo grupo. Após o período de pico da inflamação foi evidenciado a presença da isoforma latente e ativa da MMP-9 em 12 horas após a indução da inflamação. Houve maior quantidade de hidroxiprolina na região intermediária e proximal no grupo de 12 horas e, na região distal no grupo de 24 horas no grupo tratado com carragenina. A concentração de proteínas foi menor na região distal do grupo tratado com carragenina em 12 horas e maior em 24 horas nessa mesma região e grupo. A presença de um epitendão mais espesso com infiltrado de células foi observado nas regiões do TFDP dos animais com carragenina em 24 horas e, a organização dos feixes de colágeno foi menor na região proximal em 12 e 24 horas foram mostradas nos animais que receberam o veículo e a carragenina. Nenhuma diferença foi encontrada durante 4, 12 e 24 horas nos géis de SDS-PAGE. Nossos resultados mostram que embora o tendão não esteja inflamado, durante o pico do processo inflamatório agudo na pata de rato, alterações marcantes são evidenciadas. Contudo, podem ser ressaltados que o período posterior ao pico da inflamação também desencadeia alterações nos elementos estruturais e bioquímicos da MEC do TFDP / Abstract: The tendons are often affected by injuries, infections and inflammations, followed or not by rupture, which may occur during sport activities such as exercise and stretching, or during other daily activities. In pathological situations the extracellular matrix of tendons undergoes a reorganization process of their components, aimed at the improvement, regeneration and tissue homeostasis. Inflammation can be triggered by different factors, among the main causes of this process are mechanical and chemical injuries, infectious agents, burns, radiation and suppression of oxygen. Little is known in the literature on possible changes that the inflammation may trigger in near tissues where it is installed. This study aims to examine biochemically and morphologically the deep digital flexor tendon (DDFT) after induction of acute inflammation in rat paw (140-160g). The analysis was performed in the peak of inflammation (4 hours) and after that period (12 and 24 hours). Rats Wistar were divided into three groups: those who received application of (1%) carrageenan, those receiving 0.9% NaCl, and those who received nothing and were used as control. The DDFT was analyzed according to their regions (distal, intermediate and proximal). The DDFT was analyzed according to its different regions (distal, intermediate, proximal). For biochemical analysis, the tendons were processed and analyzed in accordance with the following techniques: SDS-PAGE, to observe the profile of proteins, agarose gel electrophoresis to analysis of sulfated glycosaminoglycans; zymography for detection of metalloproteinases 2 and 9, and dosage of non collagenous proteins and hydroxyproline. For morphological analysis, sections were stained with hematoxylin-eosin, toluidine blue and Ponceau SS. At the peak of acute inflammation was observed lower amount of proteins and glycosaminoglycans in the three regions of animals tendons with carrageenan. The hydroxyproline concentration was higher in the two tension regions of tendon of inflamed group. The presence of MMP-9 was detected in the distal region and was shown a thicker epitendon with inflammatory cells in the three regions of the DDFT in the group with carrageenan. Better organization of collagen bundles were observed within two regions of tension in the mentioned group. After the peak of inflammation was evidenced the presence of the latent and active isoform of the MMP-9 in 12 hours after induction of inflammation. A higher amount of hydroxyproline was detected in the intermediate and proximal region in the 12 hours and in the distal region in 24 hours in group treated with carrageenan. The protein concentration was lower in the distal region of the inflamed group at 12 hours and higher in 24 hours on the same region in the group treated with carrageenan. The presence of a thicker epitendon with cell infiltration was observed in the animals with DDFT of carrageenan animals as well as, a smaller organization of collagen bundles in the proximal region in 12 and 24 hours were shown in rats treated with vehicle and carrageenan. No difference was found for 4, 12 and 24 hours in SDS-PAGE gels. Our results show that although the tendon is not inflamed, during the peak of acute inflammation in rat paw, the most marked changes are evident. However, it can be emphasized that the period after the inflammation also triggers changes in the structural and biochemical components of the extracellular matrix of the deep digital flexor tendon / Mestrado / Biologia Celular / Mestre em Biologia Celular e Estrutural

Para avaliar a eficácia do laser de arsenito de gálio em acelerar a cicatrização tendínea em cavalos PSI de corrida com lesão no tendão flexor digital superficial, foram realizados dois experimentos, primeiro (E1) com 14 casos clínicos onde as lesões foram decorrentes do esporte em um dos membros torácicos, o segundo (E2) com cinco casos experimentais, onde as lesões foram induzidas com colagenase em ambos os membros torácicos. No E1, após a detecção da lesão no tendão flexor digital superficial por exame ultra-sonográfico, todos os animais receberam antiinflamatório não esteróide associado à dimetilsulfóxido por via intravascular, crioterapia no local da lesão, e caminharam ao passo duas vezes ao dia por 15 minutos durante os 30 dias de acompanhamento. Os membros tratados pertenceram a onze animais que receberam uma sessão diária de laser de arsenito de gálio na dose de 20 J/cm2, realizadas durante 10 dias consecutivos, após término do antiinflamatório e da crioterapia. Os membros controle pertenceram a três animais, os quais não foram tratados com laser. No E2, após identificação das lesões, foram escolhidos aleatoriamente um membro torácico controle e outro a ser tratado por laser em cada animal. Da mesma forma, estes animais foram mantidos a passo e receberam o mesmo protocolo de laserterapia que os membros tratados do E1. Todos os membros foram avaliados através de exames ultra-sonográficos, utilizando-se como parâmetros o paralelismo das fibras tendíneas em corte longitudinal; a ecogenicidade, a área do tendão, a área da lesão e a porcentagem de ocupação da lesão em corte transversal. No E1, os membros controle não apresentaram diferença significativa (P>0,05) nos parâmetros avaliados entre os dias 0 e 30. Nos membros tratados, a área do tendão também não apresentou diferença significativa (P>0,05) entre os dias analisados, porém houve diminuição muito significativa nos escores de ecogenicidade e paralelismo (P<0,001), assim como diminuição no tamanho da lesão (P<0,05) e na porcentagem de ocupação da lesão (P<0,05). No E2 também não houve diferença significativa entre os dias em todos os critérios avaliados nos membros controles (P>0,05). Nos membros tratados a ecogenicidade, o paralelismo e o tamanho do tendão, não sofreram alterações significativas (P>0,05) entre os dias avaliados, porém o tamanho da lesão (P<0,05) e a porcentagem de ocupação da lesão (P<0,01) apresentaram diminuição significativa. O laser de arsenito de gálio na dose de 20 J/cm2 mostrou-se eficaz em acelerar a reparação da lesão tendínea nos membros tratados em relação aos membros controle, tanto no grupo de casos clínicos quanto no grupo experimental, quando comparados aos 30 dias do aparecimento da lesão. Esses resultados sugerem a participação positiva do laser de arsenito de gálio nos resultados e a validação do mesmo no tratamento da tendinite do flexor digital superficial de cavalos Puro Sangue Inglês de corrida. / This study conducted two trials to evaluate the efficacy of Gallium Arsenide Laser in the speed of the healing process of superficial digital flexor tendon (SDFT) lesions in thoroughbred horses. One trial group (T1) comprises 14 horses with lesions, which resulted from the sport, in the SDFT in one of the front limbs. The other trial group (T2) was formed by five horses that had lesions induced in both front limbs by collagenase injection. In the T1, after the detection of the lesion in the SDFT by ultrasonography all horses were treated by intravenous injection, once a day, over five days, with an association of two AINS: phenylbutazone and dimethylsulfoxide. Cryotherapy was also applied on the affected tendon (three times a day over five days) and the horses were kept in stalls and allowed controlled exercise (hand-walked twice daily for 15 minutes) during the 30 days of the study. The treated limbs belong to 11 horses that received laser sessions once a day for ten days at a dosage of 20J/cm2. These sessions started after the AINS association and cryotherapy. The control limbs belong to the other three horses that received the same treatment, except by the laser sessions. In the T2, after the detection of the lesion, a limb from each horse was randomly chosen to be the control limb and the other limb was treated by laser. These horses were also kept in stall under controlled exercise and the treated limb was under the same laser protocol that T1. All horses were evaluated by two ultrasonographic exams with a 30-day interval. The parameters evaluated were: the fiber alignment, the echogenicity, the tendon area, the lesion area and the proportion of the cross sectional area involved. In the T1, the control limbs showed no significant difference (p>0,05) in the echogenicity, the fiber alignment, the tendon area, the lesion area or the proportion of the cross sectional area involved, between the day 0 and 30. The treated limb, didn´t show any significant difference of the tendon area, but showed a significant difference on the echogenicity (P<0,001), the fiber alignment (P<0,001), the lesion area (P<0,05) and the proportion of the cross sectional area involved (P<0,05). In the T2, only one limb received the laser treatment, the other limb acted as a control. The control limbs showed no significant difference (P>0,05) in the echogenicity, the fiber alignment, the tendon area, the lesion area and the proportion of the cross sectional area involved between the day 0 and 30. The treated limbs showed no significant difference (P>0,05) in the echogenicity, the fiber alignment and the tendon area, but showed significant difference in the lesion area (P<0,05) and the proportion of the cross sectional area involved (P<0,01). The treatment dose of 20J/cm2 of gallium arsenide laser was efficient in speeding the healing process of SDFT lesions of the laser treated limbs in both groups (T1 and T2), when compared with the control limbs, at 30 days of the onset of the lesion. The group which lesions occurred due to the sport (T1) had a better response to the treatment than the group which lesions were induced by collagenasis (T2). The limbs treated by laser showed a positive response which validates the use of the Gallium Arsenide laser for the treatment of tendinitis in the Superficial Digital Flexor in race horses.

Flexor tendon repair of the hand and rehabilitation are frequently discussed between hand surgeons and therapists. This is mainly due to the poor outcomes commonly achieved after this type of surgery. There are many patients in public hospitals in South Africa who require flexor tendon repair surgery. They are regularly sent to therapists for rehabilitation, where the early passive motion protocol is commonly implemented. Although the early active motion protocol has yielded improved results globally, there is limited evidence on the comparison of the outcomes of these two protocols in the South African context. The aim of the study was to compare the outcomes of an early active motion protocol to the outcomes of an early passive motion protocol in patients with zone II to IV flexor tendon repairs of the hand, attending rehabilitation at Chris Hani Baragwanath Academic Hospital. The study was a quantitative single-blinded comparative controlled trial. Forty-six patients who sustained a zone II-IV flexor tendon injury were recruited for the study and equally distributed between the two groups (early active motion and early passive motion). Out of these participants, 11 did not return for the initial assessment at four weeks post-surgery and were therefore excluded. There were 19 participants in the early active motion group and 16 participants in the early passive motion group. Results were collected and classified at 4, 8 and 12 weeks post-surgery. Data collection took place from December 2014 to January 2016 in the Chris Hani Baragwanath Academic Hospital Hand Unit. At 12 weeks post-surgery, the total active motion, fingertip to table, and distal palmar crease measurements were similar between the two groups. Tendon rupture occurred in 8.57% (n=3, early active motion = 5.71%, early passive motion = 2.86%) of patients. This study found that there was no difference in outcomes between the two groups. Therefore, either protocol could be implemented in South African public hospitals. However, since the early active motion protocol takes less time to implement, this protocol is recommended. A study with a greater magnitude would be necessary to determine a significant comparison between the two groups; however, this is challenging due to poor patient compliance. / Dissertation (MOccupational Therapy)--University of Pretoria, 2017. / Occupational Therapy / MOccupational Therapy / Unrestricted