Optimal early active mobilisation protocol after extensor tendon repairs in zones V and VI: A systematic review of literature

Abstract

IntroductionEarly 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.MethodsAn 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.ResultsTwelve 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.DiscussionThe 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.

Functional Recovery Measurement: Comparing Early Active Mobilization Versus Immobilization after Extensor Tendon Repair in Zones IV to VIII

“…Conventionally, the protocol of ETI treatment included static splinting and immobilization for period of 6 weeks with standard rehabilitation. 7 However, after repairing extensor tendon, immobilization time span plausibly promotes the development of strong fibrous tissues at site of repair, which lessens the risk of breakage. The prospective pitfall is of forming adhesions near to repair site that leads to restricted flexion.…”

“…6 Early active mobilization (EAM) requires to be in a restrained way to enhance the advantages of mobilization while ignoring the harms of unlimited motion. 7 Various studies have been conducted that have shown better results for early active mobilization but there are some limitations of these studies such as some studies were conducted retrospectively, some studies enrolled clubbed cases, criteria for assessment, proportions of patients came back for follow-up and tendon numbers are not uniform. Various prospective studies do not have a control group.…”

Relative Motion Extension Splint after Extensor Tendon Reconstruction

“…Early mobilization protocols have been proposed to apply controlled stress to a repair, limit adhesions, and provide better outcomes than immobilization. 5 6 7 8…”

Hand Transplants, Daily Functioning, and the Human Capacity for Limb Regeneration

“…Post-operative hand therapy is critical to successful restoration of extrinsic hand function while protecting tendon transfers. Numerous published protocols exist to direct hand therapists in the care of flexor (Starr et al, 2013) and extensor tendon repairs (Collocott et al, 2018) alongside dedicated hand transplant rehabilitation protocols (Bueno et al, 2014). With 120 or so hand transplants documented by the International Registry on Hand and composite tissue transplantation (Petruzzo et al, 2010), rehabilitation programs have been described across the globe, including India (Iyer et al, 2017), United States (Bueno et al, 2014), Australia, Poland and the United Kingdom (United Kingdom).…”