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.

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.

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.

Risk Factors and Prophylactic Tenosynovectomy for Extensor Tendon Ruptures in the Rheumatoid Hand

1998 ◽  
Vol 23 (5) ◽  
pp. 658-661 ◽  
Author(s):  
J. RYU ◽  
S. SAITO ◽  
T. HONDA ◽  
K. YAMAMOTO
Keyword(s):  
Risk Factors ◽  
Tendon Rupture ◽  
Wrist Joint ◽  
Extensor Tendon ◽  
Clinical Findings ◽  
Prophylactic Surgery ◽  
Separate Study ◽  
Distal Ulna ◽  
X Ray ◽  
Tendon Ruptures

The cases histories of 51 rheumatoid arthritis patients (58 hands) were examined retrospectively with respect to the incidence of tendon rupture. Factors that were associated with tendon rapture such as X-ray changes in the wrist joint and clinical findings of the hand preceding the tendon rupture were statistically analysed. In a separate study, prophylactic tenosynovectomy and wrist synovectomy were performed on 42 joints in 35 patients who had two or more risk factors. This group of patients was then analysed for subsequent tendon rupture and recurrent synovitis. The risk factors for the extensor tendon rupture in the dorsal wrist joint were found to be: dorsal dislocation of the distal ulna; a scallop sign on X-ray; and tenosynovitis persisting for at least 6 months. Prophylactic surgery effectively prevented rupture of the tendons in patients who had two or more risk factors for extensor tendon rupture.

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.

scholarly journals Reconstruct Flexor and Extensor tendon in Severe Hand Injury Using Allogenic tendon: A Retrospective study

2019 ◽  
Author(s):  
Gu Heng Wang ◽  
Tian Mao ◽  
Shu Guo Xing ◽  
Ya Lan Chen ◽  
Yu Xuan Zhang ◽  
...  
Keyword(s):  
T Cell ◽  
Grip Strength ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Hand Injury ◽  
Pinch Strength ◽  
Active Motion ◽  
Flexor Tendon Rupture ◽  
Total Active Motion

Abstract Background To evaluate the effective and safety of reconstruction of flexor and extensor tendon in hand using allogenic tendon with 2- to 7.6-year fellow-up. Methods Between August 2007 and July 2014, we performed tendon allografts for 14 patients who suffered from severe hand injury with 2 or more tendon defects. 10 patients have been followed-up, 6 cases of flexor tendon rupture with defect, 3 cases of extensor tendon rupture with defect, 1 case with flexor and extensor tendon rupture with defect. Tendon allografts were used to repair tendon defects in order to reconstruct the function of flexion or extension. At the final follow-up visit, the total active motion (TAM), grip strength, pinch strength, DASH and the degree of satisfaction were measured. The WBC, C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Total T cell and CD4+T/CD8+T were measured to evaluate the response related to immune and infection. Results The average follow-up period was 50.0 months (range 24-82 months). The mean motion of TAM was 129.9°(rang 12-259°), pinch strength was 0.76Kg (rang 0-4.5Kg), grip strength was 18.67Kg (rang 4-46Kg), the score of DASH was 14.25 (rang 3.3-30.8), 7 patients were satisfied and 3 patients were partially satisfied with the results. The results of WBC, CRP, ESR, Total T cell and CD4+ T/CD8+ T were mostly in normal field. Conclusion In severe hand injuries with multiple tendon defects, reconstruction of flexor and extensor tendon in hand using allogenic tendon is an effective and safe treatment.

A Prospective, Controlled, Randomized Trial Comparing Early Active Extension with Passive Extension Using a Dynamic Splint in the Rehabilitation of Repaired Extensor Tendons

2002 ◽  
Vol 27 (3) ◽  
pp. 283-288 ◽  
Author(s):  
D. L. CHESTER ◽  
S. BEALE ◽  
L. BEVERIDGE ◽  
J. D. NANCARROW ◽  
O. G. TITLEY
Keyword(s):  
Controlled Trial ◽  
Extensor Tendon ◽  
Active Motion ◽  
Prospective Randomized Controlled Trial ◽  
Total Active Motion ◽  
Dynamic Splint ◽  
Group A ◽  
Active Mobilization ◽  
Group B

This prospective, randomized, controlled trial compared two methods of rehabilitating extensor tendon repairs in zones IV–VIII. Group A patients followed an early active mobilization regimen and Group B patients followed a dynamic splintage regimen. Data on 19 patients in Group A and 17 patients in Group B were collected at 4 weeks and at final follow-up (3 months median follow-up for both groups). Extension lag, flexion deficit and total active motion (TAM) were measured. At 4 weeks, patients in Group B had a better TAM (median 87%, range 56–102%) compared to patients in Group A (median 77%, range 52–97%). At final follow-up, there were no significant differences in the results of the two groups. There were no ruptures in either group.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Clinical Outcomes After Aggressive Active Early Motion and Modified Kleinert Regimens: Comparison of 2 Consecutive Cohorts

Hand ◽  
2021 ◽  
pp. 155894472110172
Author(s):  
Kaisa Jokinen ◽  
Arja Häkkinen ◽  
Toni Luokkala ◽  
Teemu Karjalainen
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Hand Grip Strength ◽  
Active Motion ◽  
Hand Grip ◽  
Active Range Of Motion

Background Modern multistrand repairs can withstand forces present in active flexion exercises, and this may improve the outcomes of flexor tendon repairs. We developed a simple home-based exercise regimen with free wrist and intrinsic minus splint aimed at facilitating the gliding of the flexor tendons and compared the outcomes with the modified Kleinert regimen used previously in the same institution. Methods We searched the hospital database to identify flexor tendon repair performed before and after the new regimen was implemented and invited all patients to participate. The primary outcome was total active range of motion, and secondary outcomes were Disabilities of Arm, Shoulder, and Hand; grip strength; globally perceived function; and the quality of life. Results The active range of motion was comparable between the groups (mean difference = 14; 95% confidence interval [CI], −8 to 36; P = .22). Disabilities of Arm, Shoulder, and Hand; grip strength; global perceived function; and health-related quality of life were also comparable between the groups. There was 1 (5.3%) rupture in the modified Kleinert group and 4 (15.4%) in the early active motion group (relative risk = 0.3; 95% CI, 0.04-2.5; P = .3). Conclusions Increasing active gliding with a free wrist and intrinsic minus splint did not improve the clinical outcomes after flexor tendon injury at a mean of 38-month follow-up.

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