The treatment approach for hand injuries can vary depending on the severity of the injury, the duration since the injury occurred, and the level of contamination involved. Notably, injuries that involve both tendon and nerve lacerations carry increased significance. While various systems have been developed to establish treatment principles, the current prevailing method emphasizes the need to have comprehensive knowledge of all available treatment modalities and select the most appropriate approach for each specific injury. It is important to recognize that no two injuries are identical.
The primary objective of treatment is to restore the hand to its maximum possible functional capacity. Tendons, which are fibrous structures resembling white bands or strips, extend between muscles and bones. They facilitate the transmission of force generated by muscle contraction and shortening to the corresponding bone, enabling movement. When a tendon is severed, this transmission of movement is disrupted. However, it is essential to acknowledge that other factors also contribute to the transmission of movement to the bone, such as the integrity of the bone tissue, the condition of the joint, the integrity of the overlying skin, and the continuity of the nerve responsible for conveying muscle movement signals. Therefore, to achieve complete tendon functionality, it is imperative that all other factors are in a healthy state.
Hand injuries resulting from lacerations caused by sharp objects, whether in the fingers, hand, or forearm, can lead to the manifestation of symptoms associated with cuts or tears in the intricate and complex structures within the hand or arm. Consequently, the initial examination performed for hand injuries holds significant importance. This examination should encompass a comprehensive evaluation of all hand functions. Of utmost importance in hand injuries is assessing the circulation of the hand, ensuring adequate blood flow. Measures should be taken to control any existing bleeding. The examination of hand functions can be categorized into two main groups: sensory functions and motor functions. Sensory examination involves employing appropriate methods to determine the presence or absence of intact sensory nerves. Motor examination, on the other hand, entails assessing finger and hand movements. Ultimately, the amalgamation of all findings allows for the determination of which structures have been injured or severed, forming the basis for an appropriate surgical plan. It is worth noting that the hand and fingers contain multiple tendons, each with its distinct functions. Therefore, based on the identified symptoms during the examination, it becomes possible to ascertain the specific tendons that have been cut.
Surgery:
The approach to treating hand injuries varies depending on the severity of the injury, the time elapsed since the injury, and the degree of contamination. In cases involving tendon and nerve lacerations, the importance of appropriate management is heightened. Despite the existence of various systems for determining treatment principles, the current prevailing method emphasizes the need to select the most suitable model for each injury by considering all available treatment options. It is crucial to recognize that no two injuries are exactly alike.
The primary principle is to restore the hand to its maximum possible functionality through the employed treatment method. Tendons are fibrous, white-colored structures that extend between muscles and bones. They transmit the force generated by muscle contraction and shortening to the bone, allowing for movement. When a tendon is severed, this transfer of movement is disrupted. However, other factors also contribute to the transmission of movement to the bone, such as the integrity of the bone tissue, the condition of the joint, the integrity of the overlying skin, and the integrity of the nerves that convey muscle movement signals. Therefore, for optimal tendon function, all other factors must also be in a healthy state.
Symptoms arise from cuts or avulsions in the complex and intricate structures within the hand or forearm resulting from injuries involving sharp objects. Consequently, the initial examination conducted for hand injuries is of paramount importance. This examination should comprehensively assess all hand functions. The assessment begins with the evaluation of the hand’s blood supply, as circulation is of urgent concern in hand injuries. It is essential to stop any existing bleeding. The examination of hand functions is divided into two main groups: sensory functions and motor functions. Sensory examination is performed using appropriate methods to determine whether sensory nerves have been severed. In the motor examination, finger and hand movements are analyzed. By consolidating all findings, the injured structures and the need for surgery can be identified, leading to the formulation of a surgical plan. Different tendons with distinct functions exist within the fingers and hand. Based on the identified signs, it is determined which tendons have been severed.
Post-Surgery:
Following the surgical procedure, the hand is carefully dressed with a dressing, paying particular attention to the repaired tendon and the adjacent joints. Immobilization of the affected joints is crucial during the initial stages of tendon healing. However, after a specified period, controlled passive motion is gradually introduced. Passive mobilization involves the application of external forces, such as elastic bands or springs, to induce tendon movement without the patient’s active involvement. This therapeutic approach aims to prevent adhesion formation between the tendon and surrounding tissues while promoting the functional recovery of the involved joints. Subsequently, upon the surgeon’s discretion, the initiation of active exercises is implemented during the appropriate timeframe. Active exercises involve voluntary movements of the tendon, allowing the patient to actively flex and extend the affected fingers or hand. Throughout the postoperative period, close monitoring and collaboration with a specialized Physical Therapy professional are essential. It is important to avoid premature initiation of movements before sufficient tendon healing has occurred, as it can jeopardize the surgical outcome and potentially lead to tendon ruptures. Therefore, diligent postoperative follow-up and adherence to the prescribed rehabilitation protocol are paramount.
