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

Abstract

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.

The optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII: A systematic review

“…The orthosis is kept in place for at least 3 weeks, after which the patient gradually begins mobilizing the previously restricted joints 5,8 This method limits the tension on the tendon and therefore poses the least risk for tendon rupture, but may contribute to tendon adhesions at all levels. 9–12 Early motion following tendon repair has become a tenet of tendon rehabilitation, as it promotes healing and decreases tissue adhesions. 13–15 EPM, also known as early controlled motion, involves the careful movement of the injured digit the contralateral hand, a therapist, or a specialized dynamic extension orthosis (Fig.…”