Flexor Subzone II A–D Range of Motion Progression during Healing on a No-Splint, No-Tenodesis Protection, Immediate Full Composite Extension Regimen

Abstract

Background: The objective was to study the hypotheses that an advanced zone II flexor tendon rehabilitation protocol would avoid rupture, achieve a high range of excursion, and minimize interphalangeal contracture during both the early phases and at the conclusion of healing. We also proposed the null hypothesis of no difference between any two of the zone II subdivisions. Methods: Fifty-one consecutive adult patients with zone II flexor tendon repairs of a single finger were retrospectively evaluated on an active contraction rehabilitation protocol with no splint, no tenodesis protection, and immediate full composite extension. There were 38 males and 13 females with a mean age of 39 years (range 18–69) involving 15 index, 7 long, 6 ring, and 23 small fingers. Repairs were located in flexor subzone IIA for 8 fingers; subzone IIB, 14; subzone IIC, 19; and subzone IID, 10. Differences in outcome between any two subzones were compared by T-test with p < 0.05. Results: Mean active arcs of motion in degrees at 3 weeks post repair were PIP 1-93; DIP 0-44; and total active motion (TAM) 221. At 6 weeks PIP 2–98; DIP 1–51; and TAM 236. At 10–12 weeks PIP 1–101; DIP 1–56; and TAM 246. Final TAM by flexor subzone IIA was 243; IIB, 251; IIC, 246; and IID, 246. There were no significant differences between any two subzones. Mean final DASH score was 5. There were no ruptures. Conclusions: The results support the hypotheses. Outcomes of the therapy protocol demonstrated the lack of interphalangeal joint flexion contractures, high range of total active motion achieved early and sustained, and no ruptures. No differences were identified between and two of the flexor subzones.

Variation in patient information and rehabilitation regimens after flexor tendon repair in the United Kingdom

“…The available range of motion also differed depending on the splint position, as discussed above. None of the guidelines advocated full active composite extension of the MCPJs and IPJs within the first 4 weeks of surgery, as prescribed in the study by Henry et al 33 Across the identified guidelines, the greatest range of finger movement was available with the RMF splint and short DBS.…”

“…Future advances in flexor tendon rehabilitation may dispense with full-time splint use altogether. Henry et al reported a retrospective case series of 51 flexor tendon patients when a splint was used ‘as a defensive shield only in particularly dangerous environments (p407)’ 33 . The splint was positioned in wrist extension and MCPJ flexion, although joint angles were not reported.…”