Resistance to motion of flexor tendons and digital edema:: An in vivo study in a chicken model

Purpose: Tissue edema contributes to resistance to motion of flexor tendons during postsurgical exercises. We assessed edema formation and resistance of injured subcutaneous tissue and sheath to motion of the digital flexor tendon in a chicken model. Methods: Ninety-four toes of 47 white Leghorn chickens were divided into 6 surgical groups and 1 nonsurgical control. Subcutaneous tissue and the sheath were incised, and the skin incision and the subcutaneous tissue were closed surgically. The toes were evaluated morphologically for severity of edema and tested for the force and work required to move the tendon. The evaluation time points were 1, 2, 3, 4, 5, and 7 days after surgery. Edema in the toes was scored according to severity and extent. The force and energy required to move the tendon were measured at the first and sixth cycles after cyclic loading in a testing machine with customized software and were statistically analyzed. Results: The force and work increased progressively for the first 4 days, and were relatively consistent from days 4 to 7. The severity of edema peaked at the third and fourth days. At each postsurgical day, edema scores corresponded to increases in the force and work. The force and work were reduced drastically (30%-50%) after the first 6 cycles of toe motion. Conclusions: Resistance to tendon motion increased for the initial 4 days after surgery and remained comparatively consistent from the fourth to the seventh days. The severity of digital edema peaks at the third and fourth postoperative days. Motion of the digits for several cycles greatly reduces the resistance to the subsequent movement. We believe that tendon mobilization should not necessarily be started within the initial postoperative days, the optimum time to begin probably is the period from the fourth to the seventh day after surgery, and that judgment of edema helps to determine how aggressive exercise should be.