Rehabilitation Techniques for Applying Immediate Active Tension to the Repaired Extensor System

Abstract

A HISTORICAL PERSPECTIVEProblems that accompany the complex extensor tendon injury or the mismanagement of the simple extensor injury are well known to the hand specialist. Complications of insufficient tendon excursion, extensor lag, and associated joint stiffness (20,21,44) following extensor repair in both synovial and extrasynovial regions combined with the experience of early motion programs with the flexor system havc inspired early motion programs for the repaired extensor system at all levels except zonesThe shift from total immobilization for 4-6 weeks following extensor repair in zones V, VI, and VII to early passive motion programs began in the mid-1980s (2,20) and has gained acceptance in the 1990s. The concept of passive motion and immediate active short arc motion for the repaired central slip (17,21,33,47,50,55,59) has been introduced in this decade as has the concept of the application of immediate active tension following extensor repair (1 9,22,23). The rationale for these early motion programs is that some stress at a tendon repair site is beneficial both biochemically and biomechanically to the repaired tendon and that some degree of controlled motion will reduce complications associated with immobilization by maintaining homeostasis in the adjacent connective tissues (1,3-5,24,26-28,30,43,49,5 1,60-63). The application of immediate active tension at a tendon repair site has been supported by recent experimental studies (35) and early clinical work.The purpose of the present report is to provide the hand clinician with a detailed description of my techniques for applying immediate active tension to the repaired extensor system in zones 111-VII for the digits and zones TIV and TV for the thumb and to demonstrate that these techniques are reliable, repeatable, and capable of producing results that are clinically superior to those with postoperative immobilization.

Extensor Tendon Injuries

“…Evans has reported better results with an early active short arc motion protocol compared to static splinting. 15 Pratt retrospectively reviewed his more aggressive post-operative protocol that consisted of static extension immobilization for 3 weeks, followed by controlled mobilization in a Capener coil splint for an additional 3 weeks. His 27 patients (31 fingers) demonstrated good to excellent results, but 5 fingers had extension deficits.…”

Lesiones de los tendones extensores

“…En cuanto a su tratamiento, la mayoría de los autores abogan por un tratamiento conservador, inmovilizando con una férula la IFP y dejando libre IFD y la MCF, durante un periodo de 6 sema-nas de una manera continua y otras 6 solo por la noche 12 , aunque otros defienden la movilización precoz en un arco corto de movilidad frente a la inmovilización clásica 13 .…”