Management of extensor tendon injuries of the hand

Dargan, Everett L.; Woolf, Robert M.

doi:10.1097/00006534-196912000-00022

Cited by 18 publications

(36 citation statements)

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“…While the White system and one part of the Buck-Gramcko system were designed to assess the flexor pollicis longus (FPL) tendon, the TAM system was designed to assess finger flexor function. We also considered use of the Dargan system of assessment, which was introduced to assess the results of extensor tendon injuries of the fingers (Dargan, 1969) and has been used in one previous study which included EPL repairs (Ip and Chow, 1997). In a previous study (Khandwala et al, 2000), we found that the pulp to palm distances, which are the basis of the flexion assessment in this system, are so unreliable that we abandoned its use.…”

Section: Article In Pressmentioning

confidence: 99%

“…In the only other paper describing substantial numbers of patients, Ip and Chow (1997) reported a series of 37 complete EPL injuries in a paper predominantly concerned with injuries to the extensor tendons of the fingers. Several other authors also included the EPL in papers on the finger extensors but reported much smaller numbers of EPL injuries (Table 1) (Allieu et al, 1984(Allieu et al, , 1988Dargan, 1969;Evans et al, 1995;Evans, 1995;Hung et al, 1990;Lemke et al, 1984;Marin-Braun et al, 1989;Newport et al, 1990;Regnard et al, 1985).…”

Section: Introductionmentioning

confidence: 99%

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Immediate Repair and Early Mobilization of the Extensor Pollicis Longus Tendon in Zones 1 to 4

Khandwala

Blair

Harris

et al. 2004

Journal of Hand Surgery

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We present the results of repair and early mobilization of 100 extensor pollicis longus (EPL) tendon injuries in zones 1 to 4 in 100 patients using a dynamic outrigger splint which controlled metacarpophalangeal joint movements but allowed free movement of the interphalangeal joint. Eighty-two were complete divisions of the tendon and 18 were 80% to 99% tendon divisions. Analysis of measurements obtained routinely at 8 weeks showed 81% excellent and good results using the TAM system. There were 90% excellent and good results in the 72 patients, who were followed-up and received therapy for 12 weeks. Except on the rare occasion when the repair rupture, loss of thumb extension was not a common functional problem, but scar tethering of the repaired tendon could result in loss of thumb flexion. While loss of metacarpophalangeal joint flexion appeared to have little functional importance, loss of interphalangeal joint flexion and slowing of the movements of this joint could cause functional problems. When interphalangeal joint hyperextension is present before the injury, it is frequently lost but this generally goes unnoticed by the patients. The problems of analysing the EPL injury using the methods of assessment available are discussed.

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Section: Article In Pressmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immediate Repair and Early Mobilization of the Extensor Pollicis Longus Tendon in Zones 1 to 4

Khandwala

Blair

Harris

et al. 2004

Journal of Hand Surgery

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“…TAM, 15 Dargan's criteria 16 Tables 1-3. Baseline measures were also taken of the non-injured thumb.…”

Section: Methodsmentioning

confidence: 99%

Retrospective review of hand-based splinting for zone II extensor pollicis longus tendon repairs using an early active motion rehabilitation regimen

Veenendaal

Moate

2011

Hand Therapy

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Introduction. Forearm-based splints have been traditionally used for extensor pollicis longus (EPL) tendon repairs for zones T II-T V (T is used to represent thumb extensor tendon zones). Limited literature exists on hand-based splinting in the rehabilitation of zone T II EPL tendon repairs. This retrospective review of five case studies highlights the anatomical justification and the outcome of rehabilitation of zone T II EPL surgical repairs using a static hand-based thumb extension splint. Methods. In this study, five patients were retrospectively reviewed. All patients attended hand therapy for initial treatment within three days postoperatively. The postoperative interphalangeal joint mobilization regimen utilized in this study was early active motion (EAM). Outcomes measured in the study were reliable and valid, including goniometry measurement at week 4, week 6 and week 8 postoperatively for range of motion, total active motion (TAM), Dargan's criteria assessing extensor lag and White's assessment of interphalangeal joint range of motion. Results. The results demonstrated that a hand-based splint did not create undue stress on the EPL tendon repair, as there was no incidence of rupture. Hyperextension of EPL was within 88 compared with the noninjured thumb. 'Excellent' and 'good' categories were achieved when applying TAM criteria, White's assessment and Dargan's criteria. Conclusion. A hand-based splint with an EAM regimen is a viable treatment option for zone T II EPL surgical repairs instead of a long forearm-based splint. Further research is warranted with a larger sample and using a control group.

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“…23,24 The results of each study were examined with regard to ROM using TAM, Miller, Geldmacher, Strickland-Glogovac scales and grip strength. [25][26][27][28][29] The most common assessment scale among all studies over the past 15 years is TAM, which is defined by 24,25 The TAM classification of the American Society for Surgery of the Hand consists of four qualitative distinctions ('Excellent', 'Good', 'Fair' and 'Poor'), which correspond to the percentage of motion of the unaffected hand. Specifically, 'Excellent' was deemed to be a percent motion in the injured side that is similar to the uninjured side.…”

Section: Management Classification and Outcomes Measuresmentioning

confidence: 99%

A systematic review of rehabilitation protocols following surgical repair of the extensor pollicis longus

et al. 2013

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Introduction: The goal of this systematic review was to determine which rehabilitation protocol (static, dynamic or early active) yields the best outcomes following repair of the extensor pollicis longus (EPL) tendon in the following domains: total active motion (TAM), grip strength and range of motion. Methods: A comprehensive and systematic literature search was run. The retrieved abstracts and titles were screened by two independent reviewers. Rehabilitation protocols were classified as static, dynamic or early active. Methodological quality of included randomized controlled trials and cohort studies were assessed using the SIGN50 scale. Results: Fifteen articles were included in the final analysis ( ¼ 0.8). From this total, five studies employed static splinting, 12 dynamic splinting and two early active splinting. Static splinting yielded 'excellent'/'good' results ranging from 50% (minimum) to 60% (maximum) on the TAM classification system and a weighted mean TAM of 73.0 AE 24.0 (range 58. [75][76][77][78][79][80][81][82][83][84][85]. Dynamic splinting studies demonstrated 'excellent'/'good' results ranging from 64.4% (minimum) to 98% (maximum) and a weighted mean TAM of 111.2 AE 11.7 (range 89-134 ) (P < 0.001 and mean difference of 38.2 (95% confidence interval: 32.2-44.2). In one study, early active motion resulted in 83% of patients having 'excellent'/'good' ratings. Discussion: The available level II-IV evidence suggests better outcomes when using dynamic splinting over static splinting for rehabilitation of the EPL tendon repair. Further evidence is required to clinically confirm the differences between early active and dynamic rehabilitation protocols.

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Management of extensor tendon injuries of the hand

Cited by 18 publications

References 0 publications

Immediate Repair and Early Mobilization of the Extensor Pollicis Longus Tendon in Zones 1 to 4

Immediate Repair and Early Mobilization of the Extensor Pollicis Longus Tendon in Zones 1 to 4

Retrospective review of hand-based splinting for zone II extensor pollicis longus tendon repairs using an early active motion rehabilitation regimen

A systematic review of rehabilitation protocols following surgical repair of the extensor pollicis longus

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