Extensor tendon repair: mobilise or splint?

Russell, Roland; Jones, Melissa; Grobbelaar, Adriaan O.

doi:10.1016/s1297-3203(02)00004-5

Cited by 24 publications

(13 citation statements)

References 10 publications

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“…Early total active motion (4–6 weeks) was greater with dynamic extension orthoses (191–214°) and relative motion orthoses (205–236°) compared to static orthoses (79–202°), though three studies found that there was no difference in long-term follow-up. 9,31,32 Grip strength was not as reliably measured in all studies, but, those that did measure it, found greater improvement in the EAM patients than those treated statically (DEO 35–38 kg/89% contralateral side; RMO 85–95% contralateral side; static 23–34 kg/59% contralateral side). 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.…”

Section: Resultsmentioning

confidence: 93%

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

Section: Resultsmentioning

confidence: 99%

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

Section: Discussionmentioning

confidence: 99%

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

Wong

Wilson

Girnary

et al. 2017

Journal of Hand Therapy

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Study Design Systematic review Purpose To determine the optimal combination of motion protocol and orthotic treatment for the rehabilitation of proximal extensor tendon injuries (zones IV–VIII). Methods A systematic review of English-language randomized clinical trials and cohort studies investigating extensor tendon rehabilitation from 1960–2016 was conducted in MEDLINE, Embase, Cochrane, CINAHL, PEDro, and OTseeker. Outcomes of total active motion, grip strength, return to work, patient attrition and patient reported outcomes were compared. Results Eleven studies of predominantly average quality (1 low, 8 average, 2 high) were included in the final review. Results were difficult to compare due to differences in reporting. Early total active motion and final grip strength was greater with dynamic extension orthoses (191–214°; 35–38 kg/89% contralateral side) and relative motion orthoses (205–236°; 85–95% contralateral side) compared to static orthoses (79–202°; 23–34 kg/59% contralateral side). Four studies excluded patients who did not follow-up and loss to follow-up was 12–33% in the other studies. Patient reported outcomes were not comparable, as they were only included in three studies, and each used a different assessment tool. Conclusion Average quality evidence supports the use of EAM as the superior motion protocol but optimal orthosis to deliver EAM could not be determined. Prospective research should focus on patient reported outcomes and the design of orthoses that facilitate use of the EAM.

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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

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

Wong

Wilson

Girnary

et al. 2017

Journal of Hand Therapy

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“…In the past, this approach has been applied to flexor tendons with good results 10,11 and is now increasingly being employed in extensor tendon rehabilitation. [12][13][14][15][16] Many of these studies indicate the benefits of early motion following surgical repair of extensor tendons in such parameters as total active motion (TAM), return to work, extensor or flexion deficit and grip strength. [16][17][18][19][20][21] Another approach, early active mobilization, capitalizes on the physiological gains afforded by early motion by giving the patient even more range of motion (ROM) by allowing the MCP joints to move freely as well as encouraging active flexion and extension immediately after the tendon repair.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of rehabilitation protocols following surgical repair of the extensor pollicis longus

et al. 2013

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Introduction: The goal of this systematic review was to determine which rehabilitation protocol (static, dynamic or early active) yields the best outcomes following repair of the extensor pollicis longus (EPL) tendon in the following domains: total active motion (TAM), grip strength and range of motion. Methods: A comprehensive and systematic literature search was run. The retrieved abstracts and titles were screened by two independent reviewers. Rehabilitation protocols were classified as static, dynamic or early active. Methodological quality of included randomized controlled trials and cohort studies were assessed using the SIGN50 scale. Results: Fifteen articles were included in the final analysis ( ¼ 0.8). From this total, five studies employed static splinting, 12 dynamic splinting and two early active splinting. Static splinting yielded 'excellent'/'good' results ranging from 50% (minimum) to 60% (maximum) on the TAM classification system and a weighted mean TAM of 73.0 AE 24.0 (range 58. [75][76][77][78][79][80][81][82][83][84][85]. Dynamic splinting studies demonstrated 'excellent'/'good' results ranging from 64.4% (minimum) to 98% (maximum) and a weighted mean TAM of 111.2 AE 11.7 (range 89-134 ) (P < 0.001 and mean difference of 38.2 (95% confidence interval: 32.2-44.2). In one study, early active motion resulted in 83% of patients having 'excellent'/'good' ratings. Discussion: The available level II-IV evidence suggests better outcomes when using dynamic splinting over static splinting for rehabilitation of the EPL tendon repair. Further evidence is required to clinically confirm the differences between early active and dynamic rehabilitation protocols.

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“…8 -12 However, some authors still recommend static splinting for zone IV and V injuries. 2,13,14 We hypothesized that dynamic splinting with early motion after zone IV and V and TI to TIII extensor tendon repair results in excellent range of motion with less morbidity than with static splinting. In the fingers, zone IV overlies the proximal phalanx, whereas zone V is at the metacarpophalangeal (MCP) joint.…”

mentioning

confidence: 99%

Dynamic Splinting With Early Motion Following Zone IV/V and TI to TIII Extensor Tendon Repairs

Neuhaus¹,

Wong²,

Russo³

et al. 2012

The Journal of Hand Surgery

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Extensor tendon repair: mobilise or splint?

Cited by 24 publications

References 10 publications

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

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

A systematic review of rehabilitation protocols following surgical repair of the extensor pollicis longus

Dynamic Splinting With Early Motion Following Zone IV/V and TI to TIII Extensor Tendon Repairs

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