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

Abstract

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.

The optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII: A systematic review

“…11,30–32 Three studies investigated EAM using RMO compared to static or with no control group. 10,33,34 …”

“…9–11,21,30,31,34 The timing of return to work was not reported all studies, but in three studies investigating a specific EAM protocol – the immediate relative motion protocols (IRAM) using the RMO – patients returned to light duties at work around 3 weeks postoperative (3.2–3.9) compared to 9.4 weeks for static orthoses. 10,33,34 Only one study 28 (of 100 subjects) experienced tendon ruptures, with one in the EAM group and 2 in the dynamic extension orthosis group. Patient adherence was not consistently reported, and only three studies measured patient reported outcomes.…”

“…The aim of this review was to more closely examine how orthotic factors affect patient outcomes. 11,23,30,33,34 …”

“…There are still only three clinical trials, but the results are promising as they demonstrate excellent TAM, grip strength, and return to work as early as 18 days, without increasing the risk of tendon rupture. 10,33,34 Patient adherence to the RMO has not yet been formally tested, so future studies need to measure this outcome to ensure if it can achieved while simultaneously allowing adequate protection and the tendon. 10,33,34,40 …”

Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand: A Systematic Review

“…Risk of bias was assessed for all studies using published criteria for intervention studies (Higgins & Altman, 2008) and systematic reviews (Shea et al, 2007). The quality of included RCTs varied, with common problems being a lack of participant blinding, poorly described randomization methods, study dropout, and lack of longterm follow-up (Supplemental Table 2, online).…”