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Journal of Hand Surgery (European Volume)
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Articles

Clinical Implications of Cerebral Reorganisation after Primary Digital Flexor Tendon Repair

J. H. COERT
M. W. STENEKES
A. M. J. PAANS
J.-P. A. NICOLAI
B. M. DE JONG

From the Department of Plastic Surgery, Erasmus MC, Rotterdam, The Netherlands, and the Department of Plastic SurgeryDepartment of Neurology, PET Center, University Hospital Groningen, Groningen, The Netherlands

Correspondence: J. H. Coert, MD, PhD, Department of Plastic and Reconstructive Surgery, Erasmus University, Medical Center, Room HS-511, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Tel.: +31-10-7034638; fax: +31-84-2248080. E-mail:j.coert{at}erasmusmc.nl.

After flexor tendon injury, most attention is given to the quality of the tendon repair and postoperative early passive dynamic mobilisation. Schemes for active mobilisation have been developed to prevent tendon adhesions and joint stiffness. This paper describes five patients to demonstrate the cerebral consequences of immobilisation allowing only passive movements, which implies a prolonged absence of actual motor commands. At the end of such immobilisation, PET imaging revealed reduced blood flow in specific motor areas, associated with temporary loss of efficient motor control. Effective motor control was regained after active flexion exercises which was reflected in normalised cerebral activations. This suggests that temporary, reversible cerebral dysfunction may affect the outcome of flexor tendon injuries.

Key Words: cerebral • relearning • flexor • tendon • injury

This version was published on August 1, 2009

Journal of Hand Surgery (European Volume), Vol. 34, No. 4, 444-448 (2009)
DOI: 10.1177/1753193408099827
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