Abstract
Study Design
Systematic review.
Introduction
Controversy exists as to which rehabilitation protocol provides the best outcomes
for patients after surgical repair of the extensor tendons of the hand.
Purpose of the Study
To determine which rehabilitation protocol yields the best outcomes with respect to
range of motion and grip strength in extensor zones V–VIII of the hand.
Methods
A comprehensive literature review and assessment was undertaken by two independent
reviewers. Methodological quality of randomized controlled trials and cohort studies
was assessed using the Scottish Intercollegiate Guidelines Network scale.
Results
Seventeen articles were included in the final analysis (κ=0.9). From this total, seven evaluated static splinting, 12 evaluated dynamic splinting,
and four evaluated early active splinting. Static splinting yielded “excellent/good”
results ranging from 63% (minimum) to 100% (maximum) on the total active motion (TAM)
classification scheme and TAM ranging from 185° (minimum) to 258° (maximum) across
zones V–VIII. Dynamic splinting studies demonstrated a percentage of “excellent/good”
results ranging from 81% (minimum) and 100% (maximum) and TAM ranging from 214° (minimum)
and 261° (maximum). Early active splinting studies showed “excellent/good” results
ranging from 81% (minimum) and 100% (maximum). Only one study evaluated TAM in zones
V–VIII, which ranged from 160° (minimum) and 165° (maximum) when using two different
early active modalities.
Conclusions
The available level 3 evidence suggests better outcomes when using dynamic splinting
over static splinting. Additional studies comparing dynamic and early active motion
protocols are required before a conclusive recommendation can be made.
Level of Evidence
2.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Extensor tendon rehabilitation a prospective trial comparing three rehabilitation regimens.J Hand Surg Br. 2005; 30: 175-179
- Extensor tendon injuries.J Hand Surg Am. 2010; 35: 854-861
- Clinical application of controlled stress to the healing extensor tendon: a review of 112 cases.Phys Ther. 1989; 69: 1041-1049
- Effect of wrist position on extensor mechanism after disruption separation.J Hand Surg Am. 1994; 19: 584-589
- The effect of mobilization on repaired extensor tendon injuries of the hand: a systematic review.Arch Phys Med Rehabil. 2008; 89: 2366-2372
- Repair of severed tendons of the hand and wrist.Surg Gynecol Obstet. 1942; 75: 693-698
- Duration of splinting after repair of extensor tendons in the hand.J Bone Joint Surg Br. 1965; 47: 72-79
- Early protected motion after extensor tendon repair.J Hand Surg Am. 1999; 24: 1061-1070
- Early active mobilization for extensor tendon injuries. The Norwich regime.J Hand Surg Br. 1997; 22: 594-596
- Extensor tendon repair: mobilise or splint?.Chir Main. 2003; 22: 19-23
- Dynamic splinting after extensor tendon repair in zones V to VII.J Hand Surg Br. 2003; 28: 224-227
- Advances in extensor tendon diagnosis and therapy.Plast Reconstr Surg. 2009; 123: 727-728
- Report of the committee on tendon injuries (International Federation of Societies for Surgery of the Hand).J Hand Surg Am. 1983; 8: 794-798
- Management of extensor tendon injuries of the hand.Surg Gynecol Obstet. 1969; 128: 1267-1273
- Digital function following flexor tendon repair in Zone II: a comparison of immobilization and controlled passive motion techniques.J Hand Surg Am. 1980; 5: 537-543
- Handchir Mikrochir Plast Chir. 1986; 18 ([in German]): 23-29
- Methodology checklist 3: cohort studies.in: SIGN 50: a guideline developers’ handbook. The Scottish Intercollegiate Guidelines Network, Edinburgh, UK2004 (Available at:) (Accessed Jan 22, 2006)
Wells G, Shukla V, Bai A, Milne S. Systematic review of quality assessment instruments for randomized controlled trials. In: Canadian Cochrane Symposium; Edmonton, Alberta, Canada; March 7, 2008.
- Early controlled active mobilization with dynamic splintage for treatment of extensor tendon injuries.J Hand Surg Am. 1990; 15: 251-257
- Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation.Arch Orthop Trauma Surg. 2007; 127: 115-119
- Long-term results of extensor tendon repair.J Hand Surg Am. 1990; 15: 961-966
- Static splinting of extensor tendon repairs.J Hand Surg Br. 2000; 25: 180-182
- Results of dynamic splintage following extensor tendon repair.J Hand Surg Br. 1997; 22: 283-287
- Dynamic traction after extensor tendon repair in zones 6, 7, and 8: a retrospective study.J Hand Surg Br. 1989; 14: 21-22
- Ann Chir Main. 1989; 8 ([in French]): 7-21
- Early dynamic splinting for extensor tendon injuries.J Hand Surg Am. 1989; 14: 72-76
- Dynamic versus static splinting of simple zone V and zone VI extensor tendon repairs: a prospective, randomized, controlled study.Plast Reconstr Surg. 2005; 115: 482-487
- 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: 283-288
- Simplified functional splinting after extensor tenorrhaphy.J Hand Surg Am. 1997; 22: 445-451
- Ann Chir Main. 1985; 4 ([in French]): 55-63
JHT Read for Credit
Quiz: Article #207
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.Methodological quality of papers under review was assessed using the
- a.DASH
- b.SIGN50 scale
- c.ANOVA
- d.ICC
- a.
- #2.The primary outcome measure in assessing effectiveness of intervention was most often
- a.patient satisfaction
- b.PROM
- c.AROM
- d.TAM
- a.
- #3.The results support the use of
- a.cast immobilization for 4 weeks
- b.early AROM over both dynamic and static splints
- c.dynamic splints over static splints
- d.static splints over dynamic splints
- a.
- #4.An important limitation of the study was the
- a.research was not carried out by a CHT
- b.small sample size
- c.research was conducted outside the US
- d.technique of measuring outcomes was not reliable
- a.
- #5.This study revealed a clear difference in outcomes comparing early active motion and dynamic splinting protocols
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: September 02, 2011
Footnotes
Competing interests: none.
Identification
Copyright
© 2011 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
