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.

scholarly journals Early active mobilisation versus immobilisation after extrinsic extensor tendon repair: A prospective randomised trial

2012 ◽  
Vol 45 (01) ◽  
pp. 029-037 ◽  
Author(s):  
Patil R. K. ◽  
Koul A. R.
Keyword(s):  
Return To Work ◽  
Randomised Trial ◽  
Tendon Repair ◽  
Extensor Tendon ◽  
Active Motion ◽  
Prospective Randomised Trial ◽  
Early Return ◽  
Total Active Motion ◽  
Group A ◽  
Group B

ABSTRACT Background: Whether to splint the extensor tendon repairs or to mobilise them early is debatable. Recently, mobilisation has shown favourable results in a few studies. This study was aimed to compare the two favoured protocols (immobilisation vs. early active motion) in Indian population. Patients and Methods: Between June 2005 and June 2007, patients with extensor tendon injuries in zones V-VIII were randomly distributed in two groups: Group A, early active motion; and group B, immobilisation. Their results at 8 and 12 weeks and 6 months were compared. Results: Patients in early active motion group were found to have better total active motion and early return to work. This difference was statistically significant up to 12 weeks, but not at 6 months. Conclusion: Early active motion following extensor tendon repair hastens patients′ recovery and helps patients to gain complete range of motion at earlier postoperative period. With improved grip strength, the early return to work is facilitated, though these advantages are not sustained statistically significantly over long term.

Retrospective review of hand-based splinting for zone II extensor pollicis longus tendon repairs using an early active motion rehabilitation regimen

Hand Therapy ◽  
2011 ◽  
Vol 16 (4) ◽  
pp. 95-101 ◽  
Author(s):  
Penelope M van Veenendaal ◽  
Fiona A Moate
Keyword(s):  
Range Of Motion ◽  
Retrospective Review ◽  
Tendon Repair ◽  
Extensor Tendon ◽  
Interphalangeal Joint ◽  
Control Group ◽  
Active Motion ◽  
Extensor Pollicis Longus ◽  
Total Active Motion ◽  
Joint Range

Introduction Forearm-based splints have been traditionally used for extensor pollicis longus (EPL) tendon repairs for zones T II–T V (T is used to represent thumb extensor tendon zones). Limited literature exists on hand-based splinting in the rehabilitation of zone T II EPL tendon repairs. This retrospective review of five case studies highlights the anatomical justification and the outcome of rehabilitation of zone T II EPL surgical repairs using a static hand-based thumb extension splint. Methods In this study, five patients were retrospectively reviewed. All patients attended hand therapy for initial treatment within three days postoperatively. The postoperative interphalangeal joint mobilization regimen utilized in this study was early active motion (EAM). Outcomes measured in the study were reliable and valid, including goniometry measurement at week 4, week 6 and week 8 postoperatively for range of motion, total active motion (TAM), Dargan's criteria assessing extensor lag and White's assessment of interphalangeal joint range of motion. Results The results demonstrated that a hand-based splint did not create undue stress on the EPL tendon repair, as there was no incidence of rupture. Hyperextension of EPL was within 8° compared with the non-injured thumb. ‘Excellent’ and ‘good’ categories were achieved when applying TAM criteria, White's assessment and Dargan's criteria. Conclusion A hand-based splint with an EAM regimen is a viable treatment option for zone T II EPL surgical repairs instead of a long forearm-based splint. Further research is warranted with a larger sample and using a control group.

scholarly journals Intramedullary Screws versus Kirschner Wires for Metacarpal Fixation, Functional, and Patient-Related Outcomes

2018 ◽  
Vol 04 (01) ◽  
pp. e29-e33 ◽  
Author(s):  
Jose Couceiro ◽  
Higinio Ayala ◽  
Manuel Sanchez ◽  
Maria De la Red ◽  
Olga Velez ◽  
...  
Keyword(s):  
Return To Work ◽  
Grip Strength ◽  
Kirschner Wire ◽  
Kirschner Wires ◽  
Active Motion ◽  
Contralateral Hand ◽  
Total Active Motion ◽  
Quick Dash ◽  
Dash Questionnaire

Purpose The purpose of our study is to compare the intramedullary fixation of metacarpal fractures with cannulated headless screws and antegrade Kirschner wires in terms of final total active motion, grip strength, patient-related outcomes, need for casting, and return to work times. Methods The authors performed a retrospective review of the hospital records. Thirty fractures were included in the study, 19 in the screw fixation group, and 11 in the Kirschner wire group. Grip strength, and total active motion, was measured at the latest follow-up for both the injured and contralateral hand. Pain was measured on the visual analog scale. Patients were requested to fill a Quick disabilities of the arm and hand score (DASH) questionnaire at the latest follow-up. Satisfaction was measured on a scale from 0 to 10. The time to return to work was quantified from the accident to the point when the patient was back to active duty. Postoperative casting time was also quantified. Results The authors did not find any differences between the two groups in total active motion, grip strength, pain, satisfaction, or Quick DASH scores. We did find a difference in the return to work and casting times; these appeared to be shorter in the screw group. Conclusion Due to the small number of cases, we have been unable to clearly conclude that there were any benefits in the application of one particular technique when compared with the other.

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.

Range of Motion Following Extensor Tendon Splitting vs. Tendon Sparing Approaches for Plate Osteosynthesis of Proximal Phalangeal Fractures – A Systematic Review and Meta-Analysis

2020 ◽  
Vol 25 (04) ◽  
pp. 462-468
Author(s):  
Brahman S. Sivakumar ◽  
Vincent VG. An ◽  
Kevin Phan ◽  
David J. Graham ◽  
James Ledgard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Preliminary Evidence ◽  
Active Motion ◽  
Total Active Motion ◽  
Randomised Controlled

Background: Several approaches to plate fixation of the proximal phalanx have been proposed, such as the dorsal extensor splitting approach and the lateral or dorso-lateral extensor sparing approach, which aims to minimise invasiveness to promote native extensor tendon glide. This study aimed to meta-analyse the outcomes of these two approaches. Methods: A systematic review of electronic databases was undertaken, and the outcomes of comparative studies meta-analysed. Results: Three studies were included for meta-analysis. Total active motion (TAM) was significantly greater in the extensor sparing group compared to the extensor splitting (Mean difference 8.52 degrees, 95%CI 0.8–16.36, p = 0.03). Conclusions: This study demonstrates that there is preliminary evidence favouring the use of extensor sparing approaches when fixing proximal phalanxes – however, this result requires validation with randomised controlled trials.

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.

Complex Extensor Tendon Injuries: Early Active Motion Following Single-Stage Reconstruction

2008 ◽  
Vol 33 (6) ◽  
pp. 753-759 ◽  
Author(s):  
A. R. KOUL ◽  
R. K. PATIL ◽  
V. PHILIP
Keyword(s):  
Extensor Tendon ◽  
Early Postoperative Period ◽  
Tendon Injuries ◽  
Single Stage ◽  
Retrospective Evaluation ◽  
Cost Of Treatment ◽  
Active Motion ◽  
Normal Hand ◽  
Total Active Motion ◽  
Extensor Tendon Injuries

This study presents a retrospective evaluation of patients managed with single-stage repair following complex extensor tendon injuries. Over a 2-year period, 21 extensor tendons were reconstructed in 18 patients with complex hand injuries in zones V–VII. All eight patients needed soft tissue cover. Active mobilisation was started in the first week. Total active motion (TAM) at 4 weeks was a mean of 159° (SD 21.57) and at 6 weeks it was 202.6° (SD 13.26). Average TAM at 8 weeks was 223.8° (SD 16.46) and 249.5° (SD 14.38) at 12 weeks. Grip strength at 12 weeks and 6 months was around 75% and 90% of the contralateral normal hand in most of the patients. Single-stage reconstruction of complex extensor tendon injuries seems to reduce morbidity in terms of hospitalisation, and reduced cost of treatment. It also helps to achieve better functional outcome in the early postoperative period.

The Use of an Adipofascial Flap to Prevent Extensor Tendon Adhesions After Plating of the Proximal Phalanx of the Fingers: A Comparative Study

Hand ◽  
2020 ◽  
pp. 155894472096389
Author(s):  
Stefano Lucchina ◽  
Angelo D’Ambrosio ◽  
Cesare Fusetti ◽  
Marco Guidi
Keyword(s):  
Adverse Effects ◽  
Grip Strength ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Active Motion ◽  
Adipofascial Flap ◽  
Vas Score ◽  
Total Active Motion ◽  
Sample Characteristics ◽  
Dorsal Plating

Background: Extensor tendon adhesions occurring after proximal phalangeal (P1) fractures are not uncommon. A previous report described the use of an adipofascial flap (AFF) to prevent adhesions after dorsal plating of the P1. The purpose of the study is to examine the results of open reduction and internal fixation with the use of an AFF (F group) and without (N group, that is, no flap used) in a larger group of patients. Methods: A retrospective study involving a period of 11 years was conducted involving results of 21 unstable fractures of the P1 of the fingers in 18 patients. In all, 12 fingers were treated without any flap (N group) and 9 fingers were treated with the AFF (F group). For each patient, the total active motion (TAM) ratio, and the grip strength (Jamar) ratio were assessed, and adverse effects and the 10-point visual analogue scale (VAS) score were recorded. For statistical analysis, sample characteristics were described using mean ± standard deviation and median, and a Bayesian approach was used for inferential analysis. Results: In the F group, the TAM ratio (84% ± 13% vs 65% ± 17%) was higher with a lower rate of adverse effects (OR: 0.067, 95% CI, 0.0035-0.58,) and a lower VAS score with evidence of the positive effect of the AFF. The Jamar ratio was similar in the 2 groups (F group 80% ± 25% vs N group 79% ± 19%) with no associated effect of the AFF on grip strength. Conclusions: The AFF is a reliable tool to reduce adhesions between plates and the extensor apparatus of the P1 and may be useful to improve finger function after plating of P1 fractures. Type of study/LOE: Therapeutic, Retrospective, Level IV

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