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

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Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 6 uppsatser.

Thesis (MScIng)--University of Stellenbosch, 2008. / Bibliography. Also available via the Internet.

Thesis (MHSc--Health Science) -- AUT University, 2008. / Includes bibliographical references. Also held in print ( viii, 75 leaves ; 30 cm.) in the Archive at the City Campus (T 617.584062 JOH)

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The goal of this project is to advance the understanding of tendon disease and injury through the design and validation of a new model of tendon injury. Controlled, mechanically-induced traction injury was created in rat Achilles’ tendons with a tensioning apparatus through a minimally invasive surgical approach. Tendons were tensioned to subailure loads. Assessments of damage to tendons included gross morphology, evaluation of biomechanical of load strain curves, histopathology under light microscopy (H&E), collagen fibril structure and disruption under scanning electron microscopy, and immunohistochemical study of MMP-13 expression under confocal laser microscopy. Tendon injuries were found to be more severe with respect to loads placed upon them. Differences between treatment groups were identified subjectively in microscopic appearance (H&E), in collagen fibril organization (SEM), and in MMP-13 expression. However, analysis of the numerical data did not provide definitive evidence that this model for acute tendon injury is consistent and repeatable.

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<p dir="ltr">These pre-clinical data suggest elevated AGE, as seen with diabetes, could impact tendon healing <i>in vivo</i>. If, with a large sample size, we find that RAGE inhibition limits the impact of AGEs on tendon healing, then local RAGE inhibition could be a viable therapeutical approach to improve tendon properties in individuals with elevated AGEs. While additional work is needed to define the role of RAGE in regulating tendon properties, our preliminary results provide a premise for detailed mechanistic studies. Our initial work in mice provides a framework to evaluate the potential of lowering serum AGEs to improve tendon healing.</p>

Injuries to the equine distal limb are common and often involve synovial, tendinous and/or ligamentous structures. Historically, lacerations involving the equine digital flexor tendons carried a poor prognosis for return to athletic function due to contamination of the site at presentation, involvement of multiple anatomic structures and the need for immediate weight bearing after surgery. The need for weight bearing after surgery places strain on the tenorrhaphy site that exceeds the strength of the repair itself. Extrapolation of complex, stronger tenorrhaphy patterns from human literature and applying them to equine patients has been challenging. Human tenorrhaphy techniques initially focused on strong repairs, which are able to match or exceed the strength of tendon itself. Adhesion formation is problematic in human flexor tenorrhaphies, as most injuries occur to tendons surrounded by synovial structures. Human literature now focuses on using repairs that provide initial strength, minimal damage to intrinsic tendon architecture, and allow for early mobilization. This treatment protocol has greatly improved the functional outcome of human tenorrhaphies. Recent studies have evaluated the strength of complex tenorrhaphy patterns in equine superficial digital flexor tendons, using modifications of the Savage technique. The newly evaluated patterns are stronger than previously tested and commonly used techniques, such as the three-loop pulley (3LP). A review of tendon vasculature across species and healing characteristics of tendons highlights the importance of intrinsic tendon vasculature in the healing process. Using tenorrhaphy techniques that preserve this vasculature may improve the clinical outcome in these cases. Only one study has previously evaluated the effect of tenorrhaphy patterns on intrinsic tendon vasculature in equine superficial digital flexor tendon. This study compared perfusion of intrinsic tendon vasculature of equine superficial digital flexor tendon (SDFT) after 3LP and six-strand Savage (SSS) tenorrhaphies. We hypothesized that the SSS technique would significantly decrease vascular perfusion compared to the 3LP technique. Under general anesthesia, eight pairs of forelimb SDFTs were transected and either SSS or 3LP tenorrhaphy was performed on each forelimb. The horses were heparinized, euthanatized, and forelimbs perfused with barium sulfate solution then fixed with formalin under tension. The tendons were transected every 5mm and microangiographic images were obtained using a Faxitron X-ray cabinet with computed radiography imaging. Microvascular analysis of sections proximal to the tenorrhaphy, throughout the tenorrhaphy and distal to the tenorrhaphy was completed using Image J software and a custom macro. A significant reduction in the number of perfused vessels was seen in the SSS compared to the 3LP at two locations within the tenorrhaphy (p=0.004 and 0.039). The SSS technique took on average 4.7 ± 0.9 times longer to place. The SSS technique causes a reduction in tendon perfusion compared to the 3LP, which may limit its clinical use. Further research is required to elucidate the clinical significance of this difference. / Master of Science