EARLY MOTION AFTER EXTENSOR TENDON SURGERY

Abstract Introduction We review the benefits of early motion protocols following replantation of a total right hand amputation at 1 and 2 years after replantation, and provide recommendations for postoperative management. Materials and Methods Replantation of the entire right hand in zone-4 was performed and supported by rigid external fixation spanning the forearm and hand. An early active “place-and-hold” motion protocol was initiated within the first 3 postoperative days. Metacarpophalangeal joint extensors were tethered by the pins, limiting full excursion. This resulted in stiffness and extensor adhesions that required a staged extensor tenolysis; however, all joints remained supple. The early motion protocol prevented the need for significant flexor tenolysis and joint releases. Results Early motion rehabilitation protocols can produce very successful results in complex replantation. The enhanced stability afforded by external fixation of the wrist allowed us to perform aggressive early rehabilitation. Conclusion This case highlights the benefits of early active motion (limiting the need for complex joint and flexor tendon releases) and demonstrates the degree of extensor adhesions caused by even minor extensor tendon tethering. This aggressive rehabilitation approach can produce excellent range of motion, and likely limit the need for secondary tenolysis and joint release procedures.

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Extensor tendon surgery in rheumatoid arthritis

Operative Techniques in Orthopaedics ◽

10.1016/s1048-6666(06)80024-8 ◽

1993 ◽

Vol 3 (4) ◽

pp. 324-329

Author(s):

Louis M. Jurist

Keyword(s):

Rheumatoid Arthritis ◽

Extensor Tendon ◽

Tendon Surgery

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A Comparison of Results of Extensor Tendon Repair Followed by Early Controlled Mobilisation Versus Static Immobilisation

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(89)90005-3 ◽

1989 ◽

Vol 14 (1) ◽

pp. 18-20 ◽

Cited By ~ 67

Author(s):

J. A. Chow ◽

S. Dovelle ◽

L. J. Thomes ◽

P. K. Ho ◽

J. Saldana

Keyword(s):

Tendon Repair ◽

Extensor Tendon ◽

Functional Results ◽

Consecutive Series ◽

Extensor Tendons ◽

Dynamic Splinting ◽

Tendon Surgery ◽

Tendon Ruptures ◽

Controlled Motion ◽

Extensor Lag

To compare the functional results of early controlled mobilisation and static immobilisation following repair of extensor tendons, we conducted a comparative study between two centres. In one, a consecutive series of tenorrhaphy patients was treated post-operatively by the dynamic splinting technique. In the other, a consecutive group was treated by static splinting. All patients treated by dynamic splinting were graded excellent within six weeks following surgery; no tendon ruptures occurred and no secondary corrective tendon surgery was required. After static splinting, 40% were graded excellent, 31% good, 29% fair, and none poor; six fingers treated by static splintage subsequently required tenolysis. Following surgical repair of extensor tendons of the hand, patients treated by early controlled motion regain better flexion function in terms of grip strength and pulp-to-palm distance. Dynamic splinting is a more effective technique than static splinting in the prevention of extensor lag.

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