Immediate controlled active motion following zone 4-7 extensor tendon repair.
ABSTRACT This article describes a splint management program for zone 4-7 extensor tendon repairs that allows for immediate controlled active motion (ICAM) of the repair and greater arcs of motion for adjacent digits. The splint is designed to relieve tension on the tenorrhaphy by positioning the involved digit in slight metacarpophalangeal joint hyperextension relative to the uninvolved digits with a simple yoke splint designed to control the metacarpophalangeal joints and a second splint to control wrist position. Cadaver and intraoperative trials support this technique, and 140 patient cases managed over 20 years. The majority of patients achieved a rating of excellent for both digital extension and flexion as judged by Miller's criteria. There were very few extension lags and no tendon ruptures. Patients returned to work in the ICAM splint on average in 18 days. The average time to complete the program was seven weeks after repair, and required an average of eight therapy visits. The results of this study demonstrate that the ICAM splinting technique is safe, simple to manage, decreases the morbidity associated with immobilization, is cost effective, and has high patient compliance when compared to other early motion programs.
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ABSTRACT: Background Controlled post-operative motion of extensor tendon repairs in zones IV–VII is intended to facilitate tendon excursion and minimize adhesion formation. The Wyndell Merritt “relative motion” digital yoke orthosis provides a low-profile option allowing for immediate controlled active motion (ICAM) of the extensor tendon repair. The addition of a multimedia manuscript demonstrating the manufacturing of the Wyndell Merritt digital yoke orthosis may complement current literature on this topic. Methods Two case studies demonstrating the use of the Wyndell Merritt ICAM digital yoke orthosis without wrist immobilization following zone V extensor tendon repair are presented. A literature review was completed. A video was produced highlighting fabrication of the digital yoke orthosis as well as video documentation of case study 1. Results Case study 1 demonstrated mild limitations in metacarpophalangeal (MP) flexion at 5-week follow-up that resolved by 6 weeks. MP hyperextension was attainable for all digits at 5 weeks. Grip strength was comparable to the contralateral uninjured hand at 10 weeks. The second patient achieved normal composite flexion/extension by 4 weeks. Attainment of normal hyperextension at the MP joints and grip strength for case study 2 was unknown, as the patient was lost to follow-up. Conclusion The Wyndell Merritt ICAM digital yoke orthosis, fabricated with or without wrist immobilization, appears to facilitate the return of normal extensor tendon function after repair in zones IV through VII while minimizing morbidity to adjacent digits. This protocol provides a safe, low-profile, cost-effective alternative for post-operative treatment of zone IV–VII extensor tendon repairs.Hand 03/2013; 8(1).
- Hand Therapy 11/2013;
Article: Tendon Repair and Reconstruction[Show abstract] [Hide abstract]
ABSTRACT: Exciting new developments in flexor tendon repair made possible by the tourniquet-free, sedation-free, pain-free wide-awake approach are covered in detail in this chapter. This approach permits minimal sheath destruction, as flexor tendons are repaired through small transverse sheathotomy incisions. Active intraoperative flexion by the patient allows surgical adjustments to be made before the skin is closed to ensure that there is no gapping of the flexor repair and that the repair glides nicely in the sheath to get an optimal range of motion. Intraoperative patient teaching by the surgeon and the hand therapist present allows the patient to practice the postoperative movement regime in a pain-free comfortable environment. Risks and inconveniences of general anesthesia are avoided in almost all patients. Very functional differential gliding splints allow patients who have undergone dorsal hand extensor tendon repair to return to work 2–3 days after surgery and use the fingers of their operated hand with very little risk of tendon rupture.