Regarding rehabilitation of tendon injuries:
The Belfast regime is a ‘CAM’ regime, i.e. controlled active motion. Small and colleagues, in Belfast, proposed and published their protocol of controlled early active mobilization of flexor tendons 48 hours following repair using a Kessler core suture. Its original format has been modified many times since.
References:
1. Small JO, Brennen MD, Colville J. Early active mobilisation following flexor tendon repair in zone 2. J Hand Surg [Br] 1989; 14 (4): 383-91.
A Stener lesion occurs when:
The ulnar collateral ligament is obstructed by the adductor pollicis aponeurosis. The ulnar collateral ligament of the MCP joint of the thumb is normally covered by the adductor aponeurosis. With marked radial angulation, the collateral ligament ruptures and the aponeurosis edge advances distal to the flail end of the ligament. Upon realignment, the aponeurosis edge sweeps the ulnar collateral ligament proximally and prevents reapproximation with its distal insertion point. Stener lesions therefore require surgical reduction and repair.
The most appropriate angles for fusion of the digits are:
Index - 5° DIP joint, 40° PIP joint, 25° MCP joint. Whilst the most appropriate angles for individual small joints of the digits is debated in the literature and are patient-specific, answer A offers the best of the available choices. The recommended position for the PIP joint varies between approximately 40 and 55° depending on the finger. The recommended DIP joint position varies between neutral (0°) and 25° by author(s). The MCP joint angle should generally increase from 25° of flexion for the index to 40° for the little.
References: 1. Shin AY, Amadio PC. Stiff finger joints. In: Green’s operative hand surgery, 5th ed. Green DP, Pederson WC, Hotchkiss RN, Wolfe SW, Eds. Philadelphia, USA: Elsevier Churchill Livingstone, 2005: 417-59.
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