The purpose of this study is to evaluate the impact of Transfer Energy Capacitive and Resistive therapy (TECAR) on pain and range of motion (ROM) after hand flexor tendon repair.
Ages of patients will be ranged from 20 to 35 years.
All patients underwent flexor tendon primary direct repair
All patients will be referred by a surgeon before starting the study procedure.
Patient with digital nerve repairs.
Patients with associated vascular injuries requiring arterial repair.
Patients with associated crush injuries and soft tissue loss.
Patients with associated bone fractures.
Parallel
Transfer Energy Capacitive and Resistive (TECAR) therapy
DeviceBefore each session, cables will be checked, the therapist will explain the procedure, the patient will be positioned comfortably, and conductive cream will be applied. The active electrode will be moved in circular motions over the injured tendon while the inactive electrode will be placed under the forearm. Intensity will be set to a comfortable, moderate level based on patient sensation. Radio-frequency (RF) energy will be delivered via capacitive mode for 2 minutes per digit, then resistive mode for 4 minutes per digit (total 6 minutes per digit). Treatment will include 8 sessions, twice weekly.
Early mobilization protocol
Other interventionThe dorsal splint/cast will position the wrist at neutral or 15-30° extension with metacarpophalangeal (MCP) joints at 70-90° flexion, featuring low edges for exercise without removal. It will be worn full-time for the first 3 weeks post-surgery, then based on environmental safety (only during sleep and outside home if safe) for weeks 4-6. Patients will begin outpatient physical therapy from week 1 with active mobilization and home exercises every 2 hours. Dressings will be changed every other day. During weeks 1-2, passive/active flexion/extension will follow the Duran protocol (25-50% range of motion) with splint worn during therapy. Weeks 3-4 will progress to 75-100% range of motion, with splint removal at week 4 for active tenodesis exercises. Weeks 5-6 will add tendon gliding, blocking exercises, and light activities while avoiding strenuous lifting or gripping. This progressive protocol will ensure safe healing while gradually restoring function.
Active range of motion (ROM) of the proximal interphalangeal (PIP) joint
Active ROM of the PIP joint will be assessed, at the 2nd, 4th, and 6th postoperative weeks using a finger goniometer, with the patient sitting, forearm mid-position and supported on a plinth. The therapist will stabilize the metacarpophalangeal (MCP) joint in 90° flexion at the injured phalanx. The goniometer's axis will be placed over the upper surface of the PIP joint, with the stationary arm aligned to the proximal phalanx's longitudinal axis and the movable arm aligned to the middle phalanx's longitudinal axis. The patient will be instructed to actively flex and then extend the PIP joint through its full range (normally 0°-100°), and the measured ROM will be recorded.
Active range of motion (ROM) of the distal interphalangeal (DIP) joint
Active ROM of the DIP joint will be assessed with the patient seated, forearm in mid-position and supported on the plinth. From a neutral wrist position, the therapist will stabilize the metacarpophalangeal (MCP) joint in 90° flexion and the middle phalanx in extension. The goniometer axis will be placed over the upper surface of the DIP joint, with the stationary arm aligned to the middle phalanx's longitudinal axis and the movable arm aligned to the distal phalanx. The patient will actively flex and extend the DIP joint through its full range (0°-90°), and the ROM will be recorded.
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