Rehabilitation of Digital Nerve Repair: Is Splinting Necessary?

Abstract

Forty isolated, sharp digital nerve divisions, which had been repaired by microsurgical techniques, were reviewed between 12 and 36 months postoperatively (mean, 20 months). Half of the repairs had been splinted beyond the immediate postoperative period and half had not. Non-splinted patients returned to work significantly quicker than those who were splinted. Splinted patients reported more stiffness and cold intolerance but splinting made no difference to either the measured sensibility or movement of the digit. We would conclude that, after repair of sharp, uncomplicated digital nerve divisions, splinting beyond the immediate postoperative period is at least unnecessary and may be deleterious.

Resistance of primary microsurgical repair of palmar digital nerves to finger mobilization: A cadaver study

“…Immediate active mobilization of PPDN repairs after transection at various levels has been evaluated clinically. A comparison of splinting and mobilization found that discrimination was the same but cold intolerance, stiffness, and return to work and activities of daily living were better when the fingers were not immobilized [2]. Two other studies confirmed these results, but the number of patients was limited [9,11].…”

“…Following this principle, most authors recommend immobilizing PPDN repairs for 3 weeks, enough time for collagen scarring to occur [5,6]. Recently this dogma was reconsidered because of the negative impact of immobilization on patients' daily life [2,[7][8][9].…”

“…Primary repairs of proper palmar digital nerves (PPDN) are frequently immobilized for 3 weeks because of the fear of rupture in the sutured area [1]. But one study concluded that this was useless [2]. The aim of our study was to test the resistance to mobilization after microsurgical repair of the PPDN.…”

A comparison between complete immobilisation and protected active mobilisation in sensory nerve recovery following isolated digital nerve injury

“…Clinical outcomes have been evaluated in two studies following digital nerve repair. Clare et al (2004) report on 40 isolated digital nerve repairs in which the effects of splinting were assessed with return to work and sensory recovery endpoints. They found that while cold intolerance and stiffness was reported in the splinted group, no significant difference was noted in sensory recovery or ROM.…”

Rehabilitation of the Upper Extremity Following Nerve and Tendon Reconstruction: When and How

“…In some cases, surgeons have advocated only the initial operative dressing following digital nerve repair. 2 Because nerve transfers and grafts are performed with laxity, the immobilization is less rigid and of shorter duration (typically 7-10 days). If other soft tissues have been repaired in the surgical procedure, the duration of immobilization may be prolonged to allow for sufficient healing of these tissues: For example, in a tendon repair, the rehabilitation would adhere to a tendon repair protocol; in a brachial plexus exploration and pectoralis major reattachment, 4 weeks immobilization with the shoulder in adduction and internal rotation is required.…”