Follow-up treatment according to Kleinert
The follow-up treatment by Kleinert (named after Harold Earl Kleinert , American hand surgeon) describes the procedure for hand rehabilitation after flexor tendon injuries to the hand. During the healing phase, permanent deficits in movement and tearing of the tendon should be prevented. The follow-up treatment takes place in three phases.
Phase I, 1st - 3rd week
The dorsal forearm plaster splint (after two days thermoplastic (see photo) or a pre-assembled splint) fulfills the following conditions:
- The wrist is fixed in 30–40 ° flexion to relieve all flexor tendons.
- The fingers are fixed in the base joint in 60–70 ° (BUKH 30–40 °) flexion. Complete extension of the middle and end joints must be possible.
- A rubber band, which is attached to the fingernail or fingertip with a nylon loop, pulls the operated fingers into a flexed position.
The patient can now actively stretch his fingers. As soon as he lets go, the finger is passively flexed through the rubber. As an alternative to the nylon loop, an eyelet can also be glued to the fingernail. If nerves were also affected by the injury, the plaster splint is only replaced after a week. The threads are pulled after the wound has healed in approx. 8-10 days.
The physiotherapeutic or occupational therapy follow-up treatment begins at the latest on the first postoperative day with the explanation of the patient:
- Do not actively flex fingers during the three weeks,
- Move elbows and shoulders,
- Raise your arm slightly when sitting or lying down.
During inpatient treatment, the patient goes to hand therapy 3 to 4 times a day , in which all joints are mobilized by the hand and fingers while relieving the flexor tendons by the occupational therapist . Any swellings are reduced by manual lymphatic drainage . Following the inpatient treatment, the patient goes to occupational therapy up to three times a week . In addition, the patient must exercise himself every hour, in which he extends the affected fingers and holds the extension for a few seconds.
Phase II, 4th - 5th week
The splint is removed and replaced with a wrist cuff. This is intended to keep the patient from actively bending and stretching the wrist and fingers at the same time. The wrist may be moved with the fist closed.
Furthermore, all joints are mobilized by the occupational therapist and the patient exercises every hour. In this phase, the scar massage and loosening as well as the careful, assistive flexion begins.
Phase III, 6th - 12th week
In the 6th week the elastic band and wrist cuff are removed.
During this phase, active flexion is practiced more and more intensively, but the tendons are not yet fully resilient. In addition, there is self-strengthening with hand trainers and functional training, also in occupational therapy . If the movement in the direction of flexion is not complete , a squeeze splint can be used.
Complications
- There is a risk of rupture up to the 12th week. Only then can normal resilience be assumed.
- Despite mobilization, adhesions can form in the area of the tendons, which are surgically loosened after 4 - 6 months at the earliest (so-called tenolysis ).
swell
- Birgit Schröder: hand therapy. Thieme, 2008, p. 126, ISBN 978-3-13-117642-4 .
