Rehabilitation Regimens Following Surgical Repair of Extensor Tendon Injuries of the Hand—A Systematic Review of Controlled Trials

Abstract

There is no consensus on the most effective rehabilitation regimen following extensor tendon repair of the hand. This systematic review evaluates the outcomes of the various regimens. The Cochrane, MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker databases were searched for any prospective randomised clinical trials comparing rehabilitation regimens for acute extensor tendon injuries in adults. Five papers met the inclusion criteria. The regimens were static immobilisation, dynamic splinting and early active motion (EAM). There was no standard format of reporting. The sample size ranged from 27 to 100 patients. The duration of follow-up ranged from 8 to 24 weeks. Overall, patients’ total active motion improved with time. Early mobilisation regimens (active and passive) achieve quicker recovery of motion than static immobilisation but the long-term outcome appears similar. Given the comparable outcomes between dynamic splinting and EAM, we therefore favour EAM which is simpler and more convenient.

Keywords

Extensor tendon - Immobilisation - Early active motion - Early passive motion - Dynamic splinting - Rehabilitation

• References

• 1 Rockwell WB, Butler PN, Byrne BA. Extensor tendon: anatomy, injury, and reconstruction. Plast Reconstr Surg 2000; 106 ((7)) 1592-1603 quiz 1604, 1673
• 2 Zilber S, Oberlin C. Anatomical variations of the extensor tendons to the fingers over the dorsum of the hand: a study of 50 hands and a review of the literature. Plast Reconstr Surg 2004; 113 ((1)) 214-221
• 3 von Schroeder HP, Botte MJ. Functional anatomy of the extensor tendons of the digits. Hand Clin 1997; 13 ((1)) 51-62
• 4 Evans RB. Therapeutic management of extensor tendon injuries. Hand Clin 1986; 2 ((1)) 157-169
• 5 Eissens MH, Schut SM, van der Sluis CK. Early active wrist mobilization in extensor tendon injuries in zones 5, 6, or 7. J Hand Ther 2007; 20 ((1)) 89-91
• 6 Boyer MI. Flexor tendon biology. Hand Clin 2005; 21 ((2)) 159-166
• 7 Tang JB. Clinical outcomes associated with flexor tendon repair. Hand Clin 2005; 21 ((2)) 199-210
• 8 Vucekovich K, Gallardo G, Fiala K. Rehabilitation after flexor tendon repair, reconstruction, and tenolysis. Hand Clin 2005; 21 ((2)) 257-265
• 9 Khandwala AR, Webb J, Harris SB, Foster AJ, Elliot D. A comparison of dynamic extension splinting and controlled active mobilization of complete divisions of extensor tendons in zones 5 and 6. J Hand Surg Br 2000; 25 ((2)) 140-146
• 10 Chester DL, Beale S, Beveridge L, Nancarrow JD, Titley OG. A prospective, controlled, randomized trial comparing early active extension with passive extension using a dynamic splint in the rehabilitation of repaired extensor tendons. J Hand Surg Br 2002; 27 ((3)) 283-288
• 11 Russell RC, Jones M, Grobbelaar A. Extensor tendon repair: mobilise or splint?. Chir Main 2003; 22 ((1)) 19-23
• 12 Talsma E, de Haart M, Beelen A, Nollet F. The effect of mobilization on repaired extensor tendon injuries of the hand: a systematic review. Arch Phys Med Rehabil 2008; 89 ((12)) 2366-2372
• 13 Sameem M, Wood T, Ignacy T, Thoma A, Strumas N. A systematic review of rehabilitation protocols after surgical repair of the extensor tendons in zones V-VIII of the hand. J Hand Ther 2011; 24 ((4)) 365-373
• 14 Higgins JPT, Green S (2011) Highly sensitive search strategies for identifying reports of randomized controlled trials in MEDLINE. In: Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.Q [updated March 2011]. The Cochrane Library. pp Available from www.cochrane-handbook.org
• 15 Handoll HHG, Vaghela MV (2004) Interventions for treating mallet finger injuries. Cochrane Database of Systematic Reviews: Issue 3. Art. No.: CD004574
• 16 Bulstrode NW, Burr N, Pratt AL, Grobbelaar AO. Extensor tendon rehabilitation a prospective trial comparing three rehabilitation regimes. J Hand Surg Br 2005; 30 ((2)) 175-179
• 17 Hall B, Lee H, Page R, Rosenwax L, Lee AH. Comparing three postoperative treatment protocols for extensor tendon repair in zones V and VI of the hand. Am J Occup Ther 2010; 64 ((5)) 682-688
• 18 Mowlavi A, Burns M, Brown RE. Dynamic versus static splinting of simple zone V and zone VI extensor tendon repairs: a prospective, randomized, controlled study. Plast Reconstr Surg 2005; 115 ((2)) 482-487
• 19 Kleinert HE, Verdan C. Report of the committee on tendon injuries (International Federation of Societies for Surgery of the Hand). J Hand Surg Am 1983; 8 ((5 Pt 2)) 794-798
• 20 Sauerland S, Lefering R, Bayer-Sandow T, Bruser P, Neugebauer EA. Fingers, hands or patients? The concept of independent observations. J Hand Surg Br 2003; 28 ((2)) 102-105