scholarly journals Outcome of Early Motion Protocol for Total Hand Replantation: 1- and 2-Year Postoperative Results

2019 ◽  
Vol 12 (S 01) ◽  
pp. S70-S74
Author(s):  
Lucas M. Harrison ◽  
Spencer R. Anderson ◽  
Sunishka M. Wimalawansa
Keyword(s):  
External Fixation ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Postoperative Management ◽  
Active Motion ◽  
Early Motion ◽  
Right Hand ◽  
Rehabilitation Protocols ◽  
Hand Amputation ◽  
Hand Replantation

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.

Spontaneous Dislocation of the Extensor Tendons with Flexion and Ulnar Deviation Contracture of the Metacarpophalangeal Joint: A Case Report

Hand Surgery ◽  
2003 ◽  
Vol 08 (01) ◽  
pp. 97-101
Author(s):  
Masaharu Makino
Keyword(s):  
Case Report ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Ulnar Deviation ◽  
Metacarpophalangeal Joints ◽  
Extensor Tendons ◽  
Right Hand ◽  
Intrinsic Muscles

A case with spontaneous extensor tendon dislocation was treated operatively. Right hand was more severely affected with contracture of the metacarpophalangeal joints. Centralisation of the extensor tendons and sectioning of ulnar intrinsic muscles sufficed correction of the pathology. No recurrence occurred in the last 24 months.

Extrinsic versus intrinsic hand muscle dominance in finger flexion

2016 ◽  
Vol 41 (4) ◽  
pp. 392-399 ◽  
Author(s):  
A. Al-Sukaini ◽  
H. P. Singh ◽  
J. J. Dias
Keyword(s):  
Motion Tracking ◽  
Tendon Repair ◽  
Metacarpophalangeal Joint ◽  
Active Motion ◽  
Early Motion ◽  
Finger Flexion ◽  
Distal Interphalangeal ◽  
Intrinsic Hand Muscle ◽  
Hand Muscle ◽  
Intrinsic Muscles

This study aims to identify the patterns of dominance of extrinsic or intrinsic muscles in finger flexion during initiation of finger curl and mid-finger flexion. We recorded 82 hands of healthy individuals (18–74 years) while flexing their fingers and tracked the finger joint angles of the little finger using video motion tracking. A total of 57 hands (69.5%) were classified as extrinsic dominant, where the finger flexion was initiated and maintained at proximal interphalangeal and distal interphalangeal joints. A total of 25 (30.5%) were classified as intrinsic dominant, where the finger flexion was initiated and maintained at the metacarpophalangeal joint. The distribution of age, sex, dominance, handedness and body mass index was similar in the two groups. This knowledge may allow clinicians to develop more efficient rehabilitation regimes, since intrinsic dominant individuals would not initiate extrinsic muscle contraction till later in finger flexion, and might therefore be allowed limited early active motion. For extrinsic dominant individuals, by contrast, initial contraction of extrinsic muscles would place increased stress on the tendon repair site if early motion were permitted.

scholarly journals Optimal early active mobilisation protocol after extensor tendon repairs in zones V and VI: A systematic review of literature

Hand Therapy ◽  
2017 ◽  
Vol 23 (1) ◽  
pp. 3-18 ◽  
Author(s):  
Shirley JF Collocott ◽  
Edel Kelly ◽  
Richard F Ellis
Keyword(s):  
Systematic Review ◽  
Relative Motion ◽  
Methodological Quality ◽  
Tendon Repair ◽  
Case Series ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Extensive Literature ◽  
Active Motion ◽  
Randomised Controlled

Introduction Early mobilisation protocols after repair of extensor tendons in zone V and VI provide better outcomes than immobilisation protocols. This systematic review investigated different early active mobilisation protocols used after extensor tendon repair in zone V and VI. The purpose was to determine whether any one early active mobilisation protocol provides superior results. Methods An extensive literature search was conducted to identify articles investigating the outcomes of early active mobilisation protocols after extensor tendon repair in zone V and VI. Databases searched were AMED, Embase, Medline, Cochrane and CINAHL. Studies were included if they involved participants with extensor tendon repairs in zone V and VI in digits 2–5 and described a post-operative rehabilitation protocol which allowed early active metacarpophalangeal joint extension. Study designs included were randomised controlled trials, observational studies, cohort studies and case series. The Structured Effectiveness Quality Evaluation Scale was used to evaluate the methodological quality of the included studies. Results Twelve articles met the inclusion criteria. Two types of early active mobilisation protocols were identified: controlled active motion protocols and relative motion extension splinting protocols. Articles describing relative motion extension splinting protocols were more recent but of lower methodological quality than those describing controlled active motion protocols. Participants treated with controlled active motion and relative motion extension splinting protocols had similar range of motion outcomes, but those in relative motion extension splinting groups returned to work earlier. Discussion The evidence reviewed suggested that relative motion extension splinting protocols may allow an earlier return to function than controlled active motion protocols without a greater risk of complication.

scholarly journals Newly developed dynamic splint vs. dynamic outrigger splint for postoperative treatment of extensor tendon rupture in patients with rheumatoid wrists - a preliminary study

2019 ◽  
pp. 24-29
Keyword(s):  
Clinical Outcomes ◽  
Tendon Rupture ◽  
Wrist Joint ◽  
Extensor Tendon ◽  
Subjective Assessment ◽  
Metacarpophalangeal Joint ◽  
Postoperative Treatment ◽  
Active Motion ◽  
Subjective Assessments ◽  
Dynamic Splint

Aim and object of the study: Extensor tendon rupture in patients with rheumatoid wrists causes dysfunction of the hand and necessitates tendon reconstruction and surgical treatment of the wrist joint. Dynamic outrigger splints using rubber bands have been used for early postoperative mobilization of the fingers. However, these splints are bulky and cause discomfort. We developed a new dynamic splint, which is compact and uses torsion springs instead of the rubber bands used in conventional outrigger splints. The splint extends the metacarpophalangeal joints using a volar finger bar. The objective of this study was to compare the clinical outcomes and subjective assessments between patients treated with the two types of splint. Methodology: Fourteen wrists (14 patients) were included. Clinical outcomes (range of active motion of the metacarpophalangeal joint) and subjective assessments were investigated in patients treated with either an outrigger splint or our new dynamic splint. Results: There were no differences in clinical outcomes between patients treated with the two kinds of splint. The new splint performed better in terms of the subjective assessment of changing clothes and bulkiness. Conclusions: The new splint yielded equivalent clinical outcomes and better subjective assessments compared to conventional outrigger splints due to its reduced size.

Extensor Tendon Rehabilitation a Prospective Trial Comparing Three Rehabilitation Regimes

2005 ◽  
Vol 30 (2) ◽  
pp. 175-179 ◽  
Author(s):  
N. W. BULSTRODE ◽  
N. BURR ◽  
A. L. PRATT ◽  
A. O. GROBBELAAR
Keyword(s):  
Prospective Trial ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Tendon Injuries ◽  
Interphalangeal Joint ◽  
Hand Therapy ◽  
Active Motion ◽  
Joint Mobilization ◽  
Total Active Motion ◽  
Extensor Tendon Injuries

Forty-two patients with 46 complete extensor tendon injuries were prospectively allocated to one of three rehabilitation regimes: static splintage; interphalangeal joint mobilization with metacarpophalangeal joint immobilization or; the “Norwich” regime. All 42 patients were operated on by one surgeon and assessed by one hand therapist. At 4 weeks the total active motion in the static splintage group was significantly reduced but by 12 weeks there was no difference between the regimes. There was no difference in total active motion between the repaired and uninjured hand at 12 weeks, with all patients achieving good or excellent results. However, grip strength at 12 weeks was significantly reduced compared to the uninjured hand after static splintage. There was no difference in hand therapy input between the regimes.

Early return to work and improved range of motion with modified relative motion splinting: a retrospective comparison with immobilization splinting for zones V and VI extensor tendon repairs

Hand Therapy ◽  
2011 ◽  
Vol 16 (4) ◽  
pp. 86-94 ◽  
Author(s):  
Melissa J Hirth ◽  
Kate Bennett ◽  
Eldon Mah ◽  
Hamish C Farrow ◽  
Andrew V Cavallo ◽  
...  
Keyword(s):  
At Risk ◽  
Return To Work ◽  
Range Of Motion ◽  
Relative Motion ◽  
Extensor Tendon ◽  
Postoperative Management ◽  
Active Motion ◽  
Average Return ◽  
Early Return ◽  
Total Active Motion

Introduction There is a lack of evidence on the best method for rehabilitating extensor tendon injuries in zones V and VI. The purpose of this study was to evaluate the outcomes of modified relative motion splinting compared with immobilization following repair of extensor tendons in zones V and VI. Methods A retrospective analysis compared the outcomes of relative motion splinting with immobilization. Sixteen patients (16 fingers) were treated by conventional immobilization splinting for four weeks (immobilization group) followed by mobilization with avoidance of ‘at-risk/heavy’ activities for a further 4–6 weeks. Twenty-three patients (23 fingers) were treated with the modified relative motion splint (mRMS group) during the day and a resting splint worn overnight for the first four weeks. The relative motion splint was continued for ‘at-risk/heavy’ activities for a further 4–6 weeks. Results The mRMS group demonstrated statistically significant improvement in range of motion compared with the immobilization group. This effect was most marked at six weeks ( P = 0.0194, two-way mixed ANOVA) with the mRMS group achieving a 12% higher mean percentage total active motion ( P = 0.0076, Mann-Whitney U test). Results were similar for both groups 12 weeks postoperatively. Differences in return to work times between groups were statistically significant ( P = 0.0062, Mann-Whitney U test). Average return to work was 9.4 weeks for the immobilization group and 3.3 weeks for the mRMS group, equating to a 42 days earlier return to work for the mRMS group. There was no incidence of tendon rupture in either group. Conclusion This study demonstrates that modified relative motion splintage (finger based without wrist component) can be applied in the postoperative management of single zone V or VI extensor tendon repairs. The main advantages of this protocol, compared with immobilization include the small simple splint design, and straightforward patient instructions that enable earlier mobilization, functional hand use and return to both daily living and work.

Microfracture for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Survey of International Cartilage Regeneration & Joint Preservation Society

Cartilage ◽  
2020 ◽  
pp. 194760352095450
Author(s):  
Jesus Medina ◽  
Ignacio Garcia-Mansilla ◽  
Peter D. Fabricant ◽  
Thomas J. Kremen ◽  
Seth L. Sherman ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Regional Differences ◽  
Current Practice ◽  
Cartilage Regeneration ◽  
Postoperative Management ◽  
Cartilage Lesions ◽  
Significant Difference ◽  
Rehabilitation Protocols ◽  
Joint Repair ◽  
Vertical Walls

Objective The purpose of this study was to describe the current practice trends for managing symptomatic cartilage lesions of the knee with microfracture among ICRS (International Cartilage Regeneration & Joint Repair Society) members. Design A 42-item electronic questionnaire was sent to all ICRS members, which explored indications, surgical technique, postoperative management, and outcomes of the microfracture procedure for the treatment of symptomatic, full thickness chondral and osteochondral defects of the knee. Responses were compared between surgeons from different regions and years of practice. Results A total of 385 surgeons answered the questionnaire. There was a significant difference noted in the use of microfracture among surgeons by region ( P < 0.001). There was no association between the number of years in practice and the self-reported proportion of microfracture cases performed ( P = 0.37). Fifty-eight subjects (15%) indicated that they do not perform microfracture at all. Regarding indication for surgery, 56% of surgeons would limit their indication of microfracture to lesions measuring 2 cm2 or less. Half of the surgeons reported no upper age or body mass index limit. Regarding surgical technique, 90% of surgeons would recommend a formal debridement of the calcified layer and 91% believe it is important to create stable vertical walls. Overall, 47% of surgeons use biologic augmentation, with no significant difference between regions ( P = 0.35) or years of practice ( P = 0.67). Rehabilitation protocols varied widely among surgeons. Conclusions Indications, operative technique, and rehabilitation protocols utilized for patients undergoing microfracture procedures vary widely among ICRS members. Regional differences and resources likely contribute to these practice pattern variations.

Dynamic Splinting After Extensor Tendon Repair in Zones V to VII

2003 ◽  
Vol 28 (3) ◽  
pp. 224-227 ◽  
Author(s):  
S. BRÜNER ◽  
M. WITTEMANN ◽  
A. JESTER ◽  
K. BLUMENTHAL ◽  
G. GERMANN
Keyword(s):  
Retrospective Study ◽  
Surgical Complication ◽  
Tendon Repair ◽  
Extensor Tendon ◽  
Tendon Injuries ◽  
Active Motion ◽  
Evaluation Systems ◽  
Dynamic Splinting ◽  
Extensor Tendon Injuries

This retrospective study evaluates a dynamic active motion protocol for extensor tendon repairs in zones V to VII. Fifty-eight patients with 87 extensor tendon injuries were examined. Using Geldmacher’s and Kleinert and Verdan’s evaluation systems, the results were graded as “excellent” and “good” in more than 94%, and as “satisfactory” in the remainder. The need for secondary tenolysis was low (6%), and no other surgical complication occurred.

ROTATORY SUBLUXATION OF THE METACARPOPHALANGEAL INDEX FINGER JOINT: A CASE REPORT

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 103-105 ◽  
Author(s):  
Ken Teo ◽  
Anthony Berger
Keyword(s):  
Case Report ◽  
Index Finger ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Clinical Suspicion ◽  
Collateral Ligament ◽  
Open Injury ◽  
Complete Tear ◽  
Rotatory Subluxation ◽  
High Level

We report a case of rotatory subluxation of the metacarpophalangeal joint (MCPJ) of the finger. A 40-year-old man sustained an open injury to his index finger following an explosive injury. Radiographs showed rotatory subluxation of the index finger MCPJ. The index finger extensor digitorium was found interposed in the MCPJ, with a complete tear of the radial collateral ligament. Treatment was by open reduction and repair of the collateral ligament and the extensor tendon. A high level of clinical suspicion is needed to diagnose this entity.

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