- Protect the Repair Site:-
- Immobilization: Initial post-operative phase typically involves splinting (e.g., dynamic splints, static progressive splints to protect the repaired tendon and allow initial healing.
- Restore Range of Motion (ROM)
- Controlled Passive Range of Motion (PROM): Gentle, pain-free passive movements of the affected finger, often initiated early in the rehabilitation process to prevent stiffness and adhesions.
- Controlled Active Range of Motion (AROM): Gradual introduction of active finger movements within prescribed limits, progressing from gentle isolated movements to more complex composite movements (e.g., hook fist, full fist).
- Tendon Gliding Exercises: Specific exercises to promote differential gliding of the extensor tendons, preventing adhesions and improving overall hand function.
- Dynamic Splinting: Used to apply continuous, gentle tension to promote ROM while protecting the repair.
- Strengthen Muscles:
- Isometric Exercises: Gentle contractions of the extensor muscles without movement, to start activating muscles early.
- Isotonic Strengthening: Progressive resistance exercises using light weights, resistance bands, or therapeutic putty as healing progresses. This includes exercises for finger extensors, wrist extensors, and intrinsic hand muscles.
- Functional Strengthening: Incorporating exercises that mimic daily activities and work-related tasks to improve functional strength and endurance.
- Improve Coordination
- Fine Motor Control Exercises: Activities requiring precision and dexterity, such as picking up small objects, buttoning, or manipulating tools.
- Proprioceptive Exercises: Activities that help re-educate the hand’s sense of position and movement, improving coordination.
- Scar Management:
- Scar Massage: Gentle massage techniques to soften the scar tissue and prevent adhesions which can restrict tendon gliding and overall movement.
- Compression: Using compressive garments or wraps to minimize swelling and promote optimal scar healing.
- Modalities: Therapeutic modalities like ultrasound may be used to aid in scar tissue remodeling and reduce inflammation.
Manual Therapy Techniques
Manual therapy is an integral part of advanced physiotherapy for extensor hood rupture. These hands-on techniques are used by the therapist to address soft tissue restrictions, joint stiffness, and pain.
Specific manual therapy techniques include:
- Soft Tissue Mobilization:
- Effleurage, Petrissage, Friction Massage: Applied around the surgical incision and surrounding tissues to reduce swelling, improve circulation, and break down adhesions.
- Transverse Friction Massage: Applied directly to the tendon and scar tissue (once appropriate healing has occurred) to promote collagen alignment and prevent adhesions.
- Joint Mobilization:
- Accessory Glide Mobilizations: Gentle, oscillatory movements applied to the MCP, PIP (proximal interphalangeal), and DIP (distal interphalangeal) joints to restore normal joint play and improve range of motion, especially if stiffness develops. These are performed with careful consideration of the healing tendon.
- Distraction: Gentle pulling of the joint surfaces apart to reduce joint compression and improve mobility.
- Neural Mobilization: If there is any associated nerve irritation or impingement, gentle nerve glides may be performed to improve nerve mobility and reduce symptoms.
- Tendon Mobilization: Direct mobilization of the extensor tendons, carefully guided by the therapist, to ensure smooth gliding within their sheaths and prevent adhesion formation. This often involves specific gliding exercises.
- Myofascial Release: Techniques to release tension in the fascia surrounding the muscles and tendons of the hand and forearm, which can impact overall hand function.
