Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study

Document Type: RESEARCH PAPER

Authors

Rothman Institute of Orthopedics, Thomas Jefferson University, Philadelphia, PA, USA

Abstract

 
 Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient. An extensor indicis proprius to extensor digitorum communis transfer was performed in a 73 year old musician. A controlled active motion therapy protocol was followed. The patients musical practice regimen was incorporated into the therapy. The patient was able to independently extend her ring and small fingers in order to play her instrument and resumed play within one month postoperatively.
A patient’s functional goals including avocations need to be considered when selecting the appropriate surgical and therapeutic approach

Keywords


  1. Vaughan-Jackson OJ. Rupture of extensor tendons by attrition at the inferior radio-ulnar joint; report of two cases. J Bone Joint Surg Br. 1948; 30B(3):528-30.
  2. Evans, Roslyn B., and William E. Burkhalter. A study of the dynamic anatomy of extensor tendons and implications for treatment. J Hand Surg Am. 1986;11(5):774-9.
  3. Evans RB. Clinical Management of Extensor Tendon Injuries: The Therapist’s         Perspective.  In: Skirven T, Osterman AL, Fedorczyk J, & Amadio P, editorss.  Rehabilitation          of the hand and upper extremity.  Philadelphia, PA: Elsevier Mosby; 2011.P.544                                               
  4. Ward AR, Shkuratova N. Russian electrical stimulation: the early experiments. Phys Ther. 2002; 82(10):1019-30.
  5. Schkade, Janette K., and Sally Schultz.. Occupational adaptation: toward a holistic approach for contemporary practice, Part 1. Am J Occup Ther. 1992; 46(9):829-37.
  6. Schultz, Sally, and Janette K. Schkade .Occupational adaptation: toward a holistic approach for contemporary practice, Part 2. Am J Occup Ther. 1992; 46(10):917-25.
  7. Jack, Jada, and Rebecca I. Estes. Documenting progress: hand therapy treatment shift from biomechanical to occupational adaptation. Am J Occup Ther. 2010; 64(1):82-7.