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BACKGROUND: Complex regional pain syndrome type II (CRPS-II) is a rare condition associated with peripheral nervous system lesions. Its localized distribution in the fingers is unique, and its treatment is unclear. CASE DESCRIPTION: A 56-year-old male presented to the emergency department with a saw-cut index finger injury with associated tendon and nerve injuries. After surgery, he was admitted to physical therapy (PT) with persistent pain, joint stiffness, allodynia, and trophic changes compatible with CRPS-II localized in the index finger. The diagnosis was confirmed after applying the Budapest Criteria, and PT was progressive and individualized according to the patient's needs, including graded motor imagery, mobilizations, exercises, and education. OUTCOMES: After 12 weeks of PT, a clinically significant decrease in pain intensity and improvements in mobility and index finger and upper limb functionality was observed, reducing CRPS symptomatology. DISCUSSION: This report provides information about a unique case of a localized form of CRPS-II. After reviewing the literature on clinical cases of both CRPS-II and localized forms of CRPS, we highlight that the clinical features of this patient and his positive therapeutic response support the importance of translating the scientific evidence on CRPS into clinical practice.

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BACKGROUND: Despite many publications on rehabilitation after repair of flexor tendon injuries of the hand, there is no consensus as to which method is superior. It is clear that nonadherence to postoperative therapy adversely affects the outcome after flexor tendon surgery. In the context of a developing country, the most important factor associated with poor outcome is late onset of rehabilitation therapy. An autonomous rehabilitation program is proposed, with the use of a low-cost splint and based on an online illustrative video with the expectation to improve adherence and patient compliance, thus ensuring satisfactory outcome. METHODS: Twenty-two consecutive digits of 14 patients after flexor tendon repair in zone II were included. Autonomous early passive mobilization physical therapy and splinting started shortly after surgery, supported by an online available video depicting prescribed exercises; follow-up was continued until postoperative week 20. Patients were evaluated regarding range of motion, grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) disability scale. RESULTS: Range of motion after 20 weeks according to the scoring system of the American Society of Surgery of Hand was excellent in 4, good in 11, and fair in 4 fingers. The mean total active motion score was 86% (95% confidence interval, 78%-93%). The mean grip strength at final follow-up was 86% of the contralateral hand. The mean QuickDASH score was 12.5 (2.3-31.8). CONCLUSION: This protocol achieves good results in range of motion and early return of function of the hand. We propose this simple, nonexpensive method to developing countries with less than optimal availability of health care.

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As lesões traumáticas dos membros que resultam em secções tendíneas são problemas comuns na clínica equina. Diversas complicações têm sido associadas à reparação dos tendões nessa espécie. O objetivo do presente trabalho foi avaliar biomecanicamente dois padrões de sutura e dois diferentes materiais aplicados às tenorrafias. Vinte e quatro peças de tendão flexor digital profundo de equinos foram seccionadas e suturadas em padrão locking loop duplo (grupo 1, com polipropileno; grupo 2, com poliglactina) ou em padrão locking loop simples associado à sutura de epitendão (grupo 3, com polipropileno; grupo 4, com poliglactina). Os corpos de prova foram submetidos a ensaios mecânicos de tração, em que se determinaram valores de força mínima, força máxima e pico de força, além do afastamento observado entre os cotos durante o pico máximo de força. Para avaliação dos resultados, foram utilizados os métodos ANOVA e os não paramétricos de Kruskal-Wallis e Mann-Whitney (P<0,05). Os maiores valores de força máxima foram documentados no grupo 3. Os valores de força mínima foram maiores nos grupos 3 e 4 que nos grupos 1 e 2, mas não diferiram significativamente entre os grupos 3 e 4. Os valores de pico de força foram maiores nos grupos 1 e 2 que no grupo 4, mas não diferiram significativamente no grupo 3. O afastamento foi maior nos grupos 1 e 2 quando comparados aos grupos 3 e 4. O padrão locking loop simples, com sutura de epitendão, atingiu maior resistência quando avaliado afastamento de até 3 milímetros entre os cotos tendíneos, sendo considerado padrão de escolha para aplicação clínica, tendo em vista os resultados obtidos neste trabalho.(AU)

Traumatic distal limb injuries resulting in tendon rupture are common in equine practice. Several complications have been associated with tendon repair in horses. The aim of this study was to compare the biomechanical properties of two tenorrhaphy techniques using two different suture materials. Twenty-four equine deep digital flexor tendon specimens were transected and sutured with the double locking loop pattern (polypropylene, group 1; polyglactin, group 2) or the single locking loop pattern with peripheral epitendon suture (polypropylene, group 3; polyglactin, group 4). Specimens were submitted to mechanical strain testing. Maximum, minimum and peak strain, and maximum, minimum and peak gap formation were evaluated. ANOVA and the non-parametric Kruskal-Wallis and Mann-Whitney tests were used (P<0.05). Higher maximum strength values were documented in group 3. Minimum strength values were higher in groups 3 and 4 than 1 and 2, but did not differ significantly between groups 3 and 4. Peak strength values were higher in groups 1 and 2 than 4, but did not differ significantly from group 3. Gap formation was greater in groups 1 and 2 than 3 and 4. The single locking loop pattern with epitendon suture performed with polypropylene had greater resilience, yielded lesser gap formation (3 mm) and is the pattern of choice for clinical application based on the results of this study.(AU)

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As lesões traumáticas dos membros que resultam em secções tendíneas são problemas comuns na clínica equina. Diversas complicações têm sido associadas à reparação dos tendões nessa espécie. O objetivo do presente trabalho foi avaliar biomecanicamente dois padrões de sutura e dois diferentes materiais aplicados às tenorrafias. Vinte e quatro peças de tendão flexor digital profundo de equinos foram seccionadas e suturadas em padrão locking loop duplo (grupo 1, com polipropileno; grupo 2, com poliglactina) ou em padrão locking loop simples associado à sutura de epitendão (grupo 3, com polipropileno; grupo 4, com poliglactina). Os corpos de prova foram submetidos a ensaios mecânicos de tração, em que se determinaram valores de força mínima, força máxima e pico de força, além do afastamento observado entre os cotos durante o pico máximo de força. Para avaliação dos resultados, foram utilizados os métodos ANOVA e os não paramétricos de Kruskal-Wallis e Mann-Whitney (P<0,05). Os maiores valores de força máxima foram documentados no grupo 3. Os valores de força mínima foram maiores nos grupos 3 e 4 que nos grupos 1 e 2, mas não diferiram significativamente entre os grupos 3 e 4. Os valores de pico de força foram maiores nos grupos 1 e 2 que no grupo 4, mas não diferiram significativamente no grupo 3. O afastamento foi maior nos grupos 1 e 2 quando comparados aos grupos 3 e 4. O padrão locking loop simples, com sutura de epitendão, atingiu maior resistência quando avaliado afastamento de até 3 milímetros entre os cotos tendíneos, sendo considerado padrão de escolha para aplicação clínica, tendo em vista os resultados obtidos neste trabalho.(AU)

Traumatic distal limb injuries resulting in tendon rupture are common in equine practice. Several complications have been associated with tendon repair in horses. The aim of this study was to compare the biomechanical properties of two tenorrhaphy techniques using two different suture materials. Twenty-four equine deep digital flexor tendon specimens were transected and sutured with the double locking loop pattern (polypropylene, group 1; polyglactin, group 2) or the single locking loop pattern with peripheral epitendon suture (polypropylene, group 3; polyglactin, group 4). Specimens were submitted to mechanical strain testing. Maximum, minimum and peak strain, and maximum, minimum and peak gap formation were evaluated. ANOVA and the non-parametric Kruskal-Wallis and Mann-Whitney tests were used (P<0.05). Higher maximum strength values were documented in group 3. Minimum strength values were higher in groups 3 and 4 than 1 and 2, but did not differ significantly between groups 3 and 4. Peak strength values were higher in groups 1 and 2 than 4, but did not differ significantly from group 3. Gap formation was greater in groups 1 and 2 than 3 and 4. The single locking loop pattern with epitendon suture performed with polypropylene had greater resilience, yielded lesser gap formation (3 mm) and is the pattern of choice for clinical application based on the results of this study.(AU)

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Introduction This research is based on the results of the surgeries of tenorraphy, which have been improved due to the association between strong and not voluminous sutures and physiotherapic protocols, which preconize the early active motion to the postoperative period. Objective To evaluate the healing process in vivo in different types of tenorraphies. Methods Thirty-six rabbits that underwent early active motion after tenorraphy. The sample was constituted of 3 groups of 12, in accordance with the 3 different types of suture (Brasil, Indiana and Tsai). Results On the 15th and 30th days after the surgery, thermographic and histological analyses revealed similar results that all groups showed similar behaviors in the same time of surgical repair, just differentiating between the periods. On the 30th day analysis were observed that collagen fibers being more exuberant thickening, thus being able to offer higher tensile strength to the tendon. Conclusion That suggests early active motion may be increased gradually to around the 30th day taking this as clinical relevance. .

Introdução Esta pesquisa é baseada nos resultados das cirurgias de tenorrafia, as quais têm evoluído em virtude da associação de suturas fortes e não volumosas e protocolos fisioterápicos, os quais preconizam mobilização ativa precoce no período pós-operatório. Objetivo Avaliar o processo de cicatrização in vivo em diferentes tipos de tenorrafias. Método Trinta e seis coelhos foram submetidos a mobilidade ativa precoce após tenorrafia. A amostra foi constituída por 3 grupos de 12, de acordo com os 3 tipos de sutura utilizados (Brasil, Indiana e Tsai). Resultados No 15º e 30º dia após a cirurgia, as análises termográficas e histológicas revelaram resultados similares evidenciando que todos os grupos apresentaram comportamentos semelhantes no mesmo tempo do reparo cirúrgico, diferenciando-se apenas entre os períodos. No trigésimo dia os estudos evidenciaram que as fibras de colágeno mostravam um exuberante afilamento, sendo assim, capazes de oferecer maior resistência tensil ao tendão. Conclusão Isto sugere que o movimento ativo precoce pode ser gradativamente aumentado em torno do trigésimo dia, o que é de grande relevância clínica. .