Immediate Repair and Early Mobilization of the Extensor Pollicis Longus Tendon in Zones 1 to 4

Abstract

We present the results of repair and early mobilization of 100 extensor pollicis longus (EPL) tendon injuries in zones 1 to 4 in 100 patients using a dynamic outrigger splint which controlled metacarpophalangeal joint movements but allowed free movement of the interphalangeal joint. Eighty-two were complete divisions of the tendon and 18 were 80% to 99% tendon divisions. Analysis of measurements obtained routinely at 8 weeks showed 81% excellent and good results using the TAM system. There were 90% excellent and good results in the 72 patients, who were followed-up and received therapy for 12 weeks. Except on the rare occasion when the repair rupture, loss of thumb extension was not a common functional problem, but scar tethering of the repaired tendon could result in loss of thumb flexion. While loss of metacarpophalangeal joint flexion appeared to have little functional importance, loss of interphalangeal joint flexion and slowing of the movements of this joint could cause functional problems. When interphalangeal joint hyperextension is present before the injury, it is frequently lost but this generally goes unnoticed by the patients. The problems of analysing the EPL injury using the methods of assessment available are discussed.

The benefits of early active motion on thumb range of motion following extensor pollicis longus tendon repair in zones TIII–TV: A prospective comparison pilot study

“…There may be the potential to increase this range without adverse effects 16,28 and this would be particularly important for repairs in zone TV. 40 Similarly, increased frequency and repetition of active motion is also possible.…”

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

“…It has been shown that hyperextension can often be lost after EPL repair in all injury zones. 3,5,9 According to White's criteria, 17 four of the five patients achieved 'excellent' IP joint extension by eight weeks postoperatively. In reference to Dargan's criteria, 16 two cases achieved 'excellent' and the remaining two 'good' results.…”

“…Extensor tendon adherence by scar tissue largely explains the loss of thumb movement after EPL tendon repair. 3,5,9 A hand-based splint allows the wrist to mobilize freely without creating stress on the EPL repair to produce a rupture. The primary function of EPL is IP joint hyperextension, and by positioning the IP joint in hyperextension within the splint, tension is relieved from the distal aspect on the repair itself in zone T II.…”

“…To rectify this, we have included a direct comparison to the unaffected thumb as a baseline measure. Furthermore, Khandwala et al 9 consider measuring hyperextension as insignificant. Their rationale was that a loss of hyperextension results in minimal functional disturbance when compared with the loss of flexion.…”

“…[3][4][5][6][7][8][9] Various factors for suitability of an EAM regimen are considered in the clinical reasoning process, including repairs compromised by infection, fragile repair as stated by the surgeon, compliance of the patient and experience of the therapist.…”