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

Abstract

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.

The use of the ICAM Splint Programme in Zone IV to VII Extensor Tendon Repairs: Patient outcomes and clinician experiences in a specialised hand unit in SA

“…Patient education provided by the MDT helps improve insight into the condition and the effects of non-adherence and education at each follow-up visit reinforces patient understanding. Patients' ability to recall medical information may be poor but deeper insight into the risks and consequences are said to improve knowledge 8 . Patient education from the MDT was deemed essential when following the ICAM programme.…”

“…While the ICAM programme allows more freedom to use the hand in comparison to other programmes, it was noted by therapists that patients were more likely to remove the yoke due to ease of removal. In a systematic review by Wong and colleagues 8 , it was found that a focus on improvement in patient adherence to EAM splints and rehabilitation protocols are essential. Reasons for splint non-adherence may be attributed to poor appearance, discomfort, interference with function, failure to decrease pain, and hygiene 8 .…”

“…In a systematic review by Wong and colleagues 8 , it was found that a focus on improvement in patient adherence to EAM splints and rehabilitation protocols are essential. Reasons for splint non-adherence may be attributed to poor appearance, discomfort, interference with function, failure to decrease pain, and hygiene 8 . Therapists reported initial challenges in fabricating the yoke and the main reason for remoulding was due to discomfort.…”

“…Rehabilitation programmes for extensor tendon repairs can be perplexing, making it difficult for occupational therapists striving towards excellence in clinical practice 7 . Post-operative rehabilitation programmes include immobilisation (IM), early passive motion (EPM) and early active motion (EAM) 7,8 and more recently the Immediate Controlled Active Motion (ICAM) splint programme to manage extensor tendon repairs from zone IV to VII9. The ICAM splint comprises of a wrist extension splint positioning the wrist in 20°-25° extension and a yoke positioning the MCPJ's in 15°-20° of relative hyperextension 9 ( Figure 1 on page 24).…”

Zone V Extensor Tendon Repair with a Palmaris Longus Tendon Autograft and Human Umbilical Membrane

“…Recently, early mobilization protocols for extensor tendon repairs have been developed in efforts to improve outcomes. The use of early mobilization and dynamic splints has yielded a higher percentage of good and excellent outcomes and increased active range of motion [27,28]. Yet, in cases where only static splinting is used, 17-30% of patients still required secondary tenolysis [29].…”