Introduction: This paper details a retrospective review of patients' records diagnosed with de Quervain's syndrome following a traumatic event but no history of repetitive strain. Methods: Data analysis of 41 patients was performed. The inclusion criteria were pain over first dorsal compartment, pain on resisted extensor pollicis brevis and/or abductor pollicis longus, and a positive Finkelstein's test. The assessment included a subjective history to establish a repetitive activity or a traumatic incident and diagnostic tests to establish possible instability or osteoarthritis. Results: There were 13 men and 28 women with an age range from 20 to 72 years. Statistical analysis was undertaken using Fisher's Exact tests. 46.3% (n ¼ 19) of 41 patients had a ligament injury diagnosed after the de Quervain's. 94.7% (n ¼ 18) of 19 patients with ligament instability had a history of trauma, and this was statistically significant. Clinically significant was that 82.9% (n ¼ 34) of 41 patients demonstrated extensor carpi ulnaris (ECU) muscle weakness, but there was no statistical significant correlation between ECU weakness and ligament instability. Patients could have ECU weakness without ligament instability; however, patients with ligament instability appeared more likely to have ECU weakness. Conclusions: The results would suggest that de Quervain's syndrome, in a proportion of patients, could be secondary to underlying wrist pathology due to previous trauma. If the patient does not report a true repetitive strain history, a more thorough assessment may need to be undertaken to establish if there is any underlying pathology.

Background: A previously reported audit of use of the Manchester Short Splint versus the traditional dorsal forearm-based splint for rehabilitation of zone II flexor tendon repairs suggested that patient outcomes were enhanced by use of Manchester Short Splint. Specifically, there was less flexion contracture at the proximal interphalangeal joints at 6 and 12 weeks with greater final range of motion (Strickland assessment). Importantly, there was no evidence of excess tendon ruptures complicating use of the new splint. Methods: The present study is designed as a single-centre randomized controlled trial to compare the two splints [Clinical Evidence Level 2 as patient and treating therapists are aware of which splint is in use. Surgery is standardized with respect to the type of repair used. Inclusion criteria for the trial include single finger flexor tendon injury of zone II with up to one but not two simultaneous digital nerve injuries operated on within 4 days of the injury date. Exclusions include children, more complex injuries, those unable to give consent or otherwise co-operate with the trial protocol. Patients are recruited at their first hand therapy visit having been provided with information about the trial by one of the Site Investigators during their hospital admission. The consenting patient is randomized into one of two splint groups. Assessments recorded in the Case Report Form include range of joint motion (Strickland), PROMs (Quick Dash), visual analogue pain scales, tendon rupture event and need for further surgical intervention. Data is captured weekly for first 6 weeks and again at 12 weeks. At 12 weeks grip strength and fatigue of grip strength are also measured. Discussion: The present study aims to determine the efficacy of the short splint versus the traditional splint in rehabilitation of Zone II flexor tendon repair. Our earlier published audit on the potential advantages of the short splint generated considerable interest internationally with numbers of hand therapy departments adopting the short splint in the absence of more substantive evidence. Clearly it is desirable that such evidence is forthcoming and the present study seeks to provide such evidence and inform development of a multi-centre study.

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Background: A previously reported audit of use of the Manchester Short Splint versus the traditional long dorsal forearm splint for rehabilitation of zone II flexor tendon repairs suggested that patient outcomes were enhanced by use of the short splint. Specifically, there was less flexion contracture at the proximal interphalangeal joints at 6 and 12 weeks with greater final range of motion (Strickland assessment). Importantly, there was no evidence of excess tendon ruptures complicating use of the short splint.Methods: The present study is designed as a single-centre randomized controlled trial to compare the two splints [Clinical Evidence Level 2 as patient and treating therapists are aware of which splint is in use]. The study is framed to demonstrate superiority of the short splint intervention over the long splint. Surgery is standardized with respect to the type of repair used. Inclusion criteria for the trial include single finger flexor tendon injury of zone II with up to one but not two simultaneous digital nerve injuries operated on within 4 days of the injury date. Exclusions include children, more complex injuries, those unable to give consent or otherwise co-operate with the trial protocol. Patients are recruited at their first hand therapy visit having been provided with information about the trial by one of the Site Investigators during their hospital admission. The consenting patient is randomized into one of two splint groups. Assessments at 6 and 12 weeks include range of interphalangeal joint motion (TAM), patient reported outcomes (PEM, Quick Dash, pain scales) and grip strength (12 weeks only). Adverse events related and unrelated are documented in line with GCP protocols and patients managed according to clinical indications.Discussion: The present study aims to determine the efficacy of the short splint versus the traditional splint in rehabilitation of Zone II flexor tendon repair. Previous work was in the form of an audit and it is clearly desirable that a more rigorous study is undertaken to address the efficacy or otherwise of the short splint in the context of a clinical trial and to inform development of a multi-centre study.Trial registration: ClinicalTrials.gov Identifier: NCT0385021021.2.19 Retrospectively registeredhttps://clinicaltrials.gov/ct2/results?cond=&term=NCT03850210&cntry=&state=&city=&dist= See website for WHO Trial Registration Data SetTrial Status: Recruitment of first patient 31.3.15. Recruitment completed 6.4.20 subsequent to first submission of manuscript 3.4.20. Study is ongoing for subsequent patient review and measurements as protocol for the subsequent 12 week period and will conclude 29.6.20.