Wyndell Merritt Immediate Controlled Active Motion (ICAM) Protocol following Extensor Tendon Repairs in Zone IV–VII: Review of Literature, Orthosis Design, and Case Study—A Multimedia Article

Burns, Mary; Derby, Brian; Neumeister, Michael W.

doi:10.1007/s11552-012-9488-z

Cited by 29 publications

(8 citation statements)

References 5 publications

(12 reference statements)

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“…Historically IM was the standard procedure following extensor tendon repairs 9 , however with a high risk of complications such as tendon adhesions, joint stiffness 5 , extensor lag and prolonged treatment 12 . As a result, decreased composite flexion occurred 14,15 . In response, both EPM and EAM protocols have been developed to reduce complications related to the IM protocol 13 .…”

Section: Rehabilitation Of Extensor Tendon Repairs From Zone IV To Viimentioning

confidence: 99%

“…In the mid 1980s, post-operative care for repaired extensor tendons in zones IV to VII began to move from IM to controlled EPM by using a dynamic extension splint 15 . While EPM prevents adhesions and preserves flexion, it was found that the bulkiness of the splint interferes with daily function, that it is costly to fabricate and cumbersome to use 15,16 .…”

Section: Rehabilitation Of Extensor Tendon Repairs From Zone IV To Viimentioning

confidence: 99%

“…This technique protects the repaired tendon by decreasing tension on it, positioning the injured digit in relative hyperextension to the uninjured digits through the use of a yoke splint 13 . The low profile of the splint makes it easy and less cumbersome to use and provides protected functional use which can increase patient adherence 15 .…”

Section: Immediate Controlled Active Mobilisation (Icam)mentioning

confidence: 99%

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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

Mottay

Govender

Mpanza

2020

S. Afr. j. occup. ther.

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Background: The ICAM splint programme was developed in the 1980s and is known to produce favourable results in the management of extensor tendon repairs from zone IV to zone VII. It has only become popular in South Africa over the past several years and to the authors' knowledge its application in South Africa has not previously been reported. Aim: The study sought to describe the use of the ICAM splint programme following an extensor tendon repair from zone IV to VII at a specialised hand unit in SA. Methods: The study followed a concurrent mixed methods design. In phase one, a retrospective file audit was conducted with a sample of patients following the ICAM programme (n=75). Phase two involved individual therapist interviews (n=3), surgeon interviews (n=2) and a focus group with physiotherapists and occupational therapists (n=7) that had experience with the ICAM splint programme. Microsoft excel was used to descriptively analyse phase one data and thematic analysis was used to analyse phase two data. Data were merged and represented in a joint display. Results: The majority of patients (83%) were male with 40% in the age range of 26-35 years old. The injuries were mainly violence related (69%) in comparison to accidental injuries (31%) with extensor tendon zone V (40%) and VI (47%) being the most commonly involved. Adherence was reportedly influenced by factors such as patients' financial status, education and language barriers. Conclusions: The results suggest that the ICAM splint programme is beneficial in managing extensor tendon repairs from zone IV to VII. Therapists should consider factors that affect non-adherence when selecting patients for the ICAM programme to determine its suitability. Educating patients on the ICAM splint programme is essential to facilitate adherence. Novice therapists to the ICAM programme should receive formal training to improve confidence and skill. Week 4 Post-Surgery Description of the wound (clean, slough, septic, macerated, dry, healed, other) Presence or absence of oedema (yes, no) Did the therapist provide education to the patient on the ICAM splint programme? (yes, no) If the patient reported pain or not? (yes, no) Reason for remoulding the yoke splint (tight, loose, broke, discomfort, incorrect position, lost yoke, other) Adherence with splint and exercises as recorded by the therapist (yes, no) Attendance to appointment or not (yes, no) Goniometric AROM readings of the affected digit Calculation of TAM Assessing extensor tendon function using Miller's criteria (Miller's total extensor lag classification, Miller's total flexion loss classification) Rated as excellent, good, fair and poor. Week 6-8 Post-Surgery Description of the wound (clean, slough, septic, macerated, dry, healed, other) Presence or absence of oedema (yes, no) Did the therapist provide education to the patient on the ICAM splint programme? (yes, no) If the patient reported pain or not? (yes, no) Reason for remoulding the yoke splint (tight, loose, broke, discomfort, incorrect position, lost yoke, oth...

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Section: Rehabilitation Of Extensor Tendon Repairs From Zone IV To Viimentioning

confidence: 99%

Section: Rehabilitation Of Extensor Tendon Repairs From Zone IV To Viimentioning

confidence: 99%

Section: Immediate Controlled Active Mobilisation (Icam)mentioning

confidence: 99%

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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

Mottay

Govender

Mpanza

2020

S. Afr. j. occup. ther.

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“…The RMO uses a thin (1 inch) strip of thermoplastic to keep the injured digit in relative extension at the MCP joint, and minimizes the inherent effect of shortening in all extensor tendon repairs. 40,44,45 …”

Section: Discussionmentioning

confidence: 99%

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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“…Extensor tendon repairs in zones V and VI can be managed postoperatively by immobilization, controlled passive motion, or through immediate controlled active motion. [19][20][21] Immobilization of the wrist and metacarpophalangeal joints Immobilization following simple zone V and VI extensor tendon repairs has been shown to produce excellent outcomes at 6 months after repair. 22 However, in complex injuries with multiple tendon involvement and/or metacarpal fractures, immobilization produces dense adhesion formation, which limits active and passive tendon glide during both digital flexion and extension.…”

Section: Complicationsmentioning

confidence: 99%

Management of Complications of Extensor Tendon Injuries

Lutz¹,

Pipicelli²,

Grewal³

2015

Hand Clinics

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Wyndell Merritt Immediate Controlled Active Motion (ICAM) Protocol following Extensor Tendon Repairs in Zone IV–VII: Review of Literature, Orthosis Design, and Case Study—A Multimedia Article

Cited by 29 publications

References 5 publications

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

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

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

Management of Complications of Extensor Tendon Injuries

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