View source for Post Operative Physiotherapy for Pronator Teres Tendon Transfer

== Post-Operative Treatment ==

==== Education ====
This includes information on post-operative guidelines, activity limitations, exercise programme, splints/ [[Introduction to Orthotics|orthosis]], and timeline for therapy.

==== Protection Phase Goals ====
This entails guarding the area with reduced sensitivity and securing the surgical site. Following tendon transfer surgery, the affected limb is immobilised in a bulky dressing with a plaster. Afterwards, the cast or a customised thermoplastic orthosis replaces it and lasts for three to five weeks. The extremity positioned in the orthosis depends on the surgical procedure and the clinical picture. The splint is assessed at regular intervals to ensure comfort and protection of the surgical site. To prevent the operating limb from swelling, it is advised to keep it elevated. Non-involved proximal joint movement helps to prevent secondary joint stiffness and decrease distal extremity oedema. <ref name=":0" /><ref name=":1" />

==== Phase of Transfer Activation ====
It also involves the transferred muscle's activation. Sessions are kept brief and within the limits of the patient's tolerance. In order to avoid fatigue and damage to the transferred muscle, the patients are advised to move slowly. The patient is instructed to wear an orthosis during the day at home and take it off for exercise. Soft tissue mobility techniques and oedema control are reinforced. Isolated movements are performed in a plane that is gravity-free during the first phase. The therapist uses the place-and-hold method if they are having trouble doing so. In order to do this, the therapist must gently place the limb in the new position while asking the patient to hold it. The transferred muscle's previous and current roles must be performed simultaneously in order for them to learn the new role. In order to activate the pronator teres muscle, which is used as a wrist extensor during surgery, the patient must simultaneously pronate their forearm and extend their wrist. Any jerky or forceful movements ought to be avoided. The forearm should be in a roughly 20-degree pronation; if the patient is experiencing difficulty activating the transfer, they are asked to perform pronation while receiving counter-pressure from the therapist. With the assistance of this resisted pronation, the transferred muscle will be stimulated to produce a wrist extension. Techniques for activating muscles include therapeutic whirlpool, mirror visual feedback, [[Neuromuscular and Muscular Electrical Stimulation (NMES)|NMES]], and [[biofeedback]].  <ref name=":0" /><ref name=":1" /> The flexor carpi ulnaris may be transferred to the extensor digitorum communis (EDC) to improve digit extension. If this surgery is carried out, the patient will be instructed to extend the MCP joints while flexing the wrist to neutral from an extended position during this phase. Patient is educated not to flex the wrist forcefully during this exercise. <ref name=":0" />

==== Rehabilitation Phase ====
[[File:Exercise Finger Extensions.png|thumb]]The orthosis may be stopped during this phase or worn at night following the surgeon's instructions. If, by the eighth week following surgery, the patient can activate the transferred muscle without assistance, then he is ready for functional task practice and strengthening. Upper extremity strengthening, resisted pinch, and grip exercises are added to the programme as per patient tolerance. It is also encouraged for the client to engage in everyday activities, recreational pursuits, and work-related activities. These training sessions are set up in a block, random, or serial format.  <ref name=":0" /><ref name=":1" />