New Concepts in Managing the Long Tendons of the Thumb After Primary Repair

Elliot, David; Southgate, C. M.

doi:10.1197/j.jht.2005.01.008

Cited by 28 publications

(21 citation statements)

References 69 publications

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“…The extensor tendons of the thumb are frequently injured, requiring surgical repair due to their exposed and superficial location. Despite this, the amount of literature on the rehabilitation and outcomes of thumb extensor tendon repair is small (Elliot and Southgate 2005, Khandwala et al 2004, Hunt 2000, Steward et al 2004. Most papers discuss thumb extensor tendon rehabilitation alongside finger extensors tendons, despite the tendons being anatomically and biomechanically different (Elliot and Southgate 2005).…”

Section: Introductionmentioning

confidence: 99%

Early Active Motion Rehabilitation Versus Immobilisation For Thumb Extensor Tendon Repairs: A Review Of Two Case Studies

Burr

Pratt

2006

The British Journal of Hand Therapy

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Following positive outcomes reported in recent literature, early active motion within a static splint is now a recognised rehabilitation regime for finger extensor tendons. This paper discusses the available literature on thumb extensor tendon rehabilitation, and the justification for introducing early motion for this injury. The early active motion regime for the thumb extensor tendon used at our unit is described and compared against the traditional static splint regime. Two case studies are presented to illustrate the problems associated with these regimes and the patient outcomes achieved. Outcomes were analysed utilising Total Active Motion (Kleinert and Verdan 1983), Kapandji's opposition (1992) and White's assessment of tendon repair (1956). Both patients made a full, uncomplicated recovery after their thumb extensor tendon repair, but the patient who followed the Early Active Motion regime regained motion and light function sooner than the patient who underwent four weeks of immobilisation. This enabled an earlier discharge (eight rather that 12 weeks) and less therapy intervention overall. These are all factors that need to be considered when deciding upon which rehabilitation regime to use.

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Section: Introductionmentioning

confidence: 99%

Early Active Motion Rehabilitation Versus Immobilisation For Thumb Extensor Tendon Repairs: A Review Of Two Case Studies

Burr

Pratt

2006

The British Journal of Hand Therapy

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“…It has been shown that hyperextension can often be lost after EPL repair in all injury zones. 3,5,9 According to White's criteria, 17 four of the five patients achieved 'excellent' IP joint extension by eight weeks postoperatively. In reference to Dargan's criteria, 16 two cases achieved 'excellent' and the remaining two 'good' results.…”

Section: Discussionmentioning

confidence: 98%

“…3,5 There is also limited recent literature specifically investigating splinting options for zone T II EPL tendon repairs. There has been a collection of studies in the last six years that have addressed the benefit of adopting an EAM regimen postoperatively with the aim of achieving strong tendon healing and optimal AROM.…”

Section: Discussionmentioning

confidence: 99%

“…Extensor tendon adherence by scar tissue largely explains the loss of thumb movement after EPL tendon repair. 3,5,9 A hand-based splint allows the wrist to mobilize freely without creating stress on the EPL repair to produce a rupture. The primary function of EPL is IP joint hyperextension, and by positioning the IP joint in hyperextension within the splint, tension is relieved from the distal aspect on the repair itself in zone T II.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9] Various factors for suitability of an EAM regimen are considered in the clinical reasoning process, including repairs compromised by infection, fragile repair as stated by the surgeon, compliance of the patient and experience of the therapist.…”

Section: Introductionmentioning

confidence: 99%

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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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Breier¹

2013

Handrehabilitation

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New Concepts in Managing the Long Tendons of the Thumb After Primary Repair

Cited by 28 publications

References 69 publications

Early Active Motion Rehabilitation Versus Immobilisation For Thumb Extensor Tendon Repairs: A Review Of Two Case Studies

Early Active Motion Rehabilitation Versus Immobilisation For Thumb Extensor Tendon Repairs: A Review Of Two Case Studies

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

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