Postoperative hand therapy management of zones V and VI extensor tendon repairs of the fingers: An international inquiry of current practice

Melissa J Hirth; Julianne W Howell; Lynne M Feehan; Ted Brown; Lisa O'Brien

doi:10.1016/j.jht.2019.12.019

Postoperative hand therapy management of zones V and VI extensor tendon repairs of the fingers: An international inquiry of current practice

J Hand Ther. 2021 Jan-Mar;34(1):58-75. doi: 10.1016/j.jht.2019.12.019. Epub 2020 Mar 9.

Authors

Melissa J Hirth¹, Julianne W Howell², Lynne M Feehan³, Ted Brown⁴, Lisa O'Brien⁴

Affiliations

¹ Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia; Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia. Electronic address: [email protected].
² Saint Joseph (Self-employed), MI, USA.
³ Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia.

PMID: 32165052
DOI: 10.1016/j.jht.2019.12.019

Abstract

Study design: Electronic Web-based survey.

Introduction: Evidence supports early motion over immobilization for postoperative extensor tendon repair management. Various early motion programs and orthoses are used, with no single approach recognized as superior. It remains unknown if and how early motion is used by hand therapists worldwide.

Purpose of the study: The purpose of this study was to determine if there is a preferred approach and identify practice patterns for constituents of International Federation of Societies for Hand Therapy full-member countries.

Methods: Participation in this English-language survey required respondents to have postoperatively managed at least one extensor tendon repair within the previous year. Approaches surveyed included programs of immobilization, early passive (EPM), and early active (EAM) with motion delivered by resting hand, dynamic, palmar/interphalangeal joints (IPJs) free, or relative motion extension (RME) orthoses. Survey flow depended on the respondent's answer to their "most used" approach in the previous year.

Results: There were 992 individual responses from 28 International Federation of Societies for Hand Therapy member countries including 887 eligible responses with an 81% completion rate. The order of most used program was EAM (83%), EPM (8%), and immobilization (7%). The two most used orthoses for delivery of EAM were RME (43%) and palmar/IPJs free (25%). The RME orthosis was preferred for earlier recovery of hand function and motion. Barriers to therapists wanting to use the RME/EAM approach related to preference of surgeon (70%) and clinic (24%).

Discussion: In practice, many therapists select from multiple approaches to manage zone V and VI extensor tendon repairs. Therapists believed TAM achieved with the RME/EAM approach was superior to the other approaches. Contrary to the literature, in practice, many therapists modify forearm-based palmar/IPJs free orthosis to exclude the wrist to manage this diagnosis.

Conclusions: The RME/EAM approach was identified as the favored approach. Practice patterns and evidence did not always align.

Keywords: Extensor tendon; Hand therapy; Orthosis; Relative motion; Splint; Survey.

MeSH terms

Fingers
Hand Injuries* / surgery
Humans
Range of Motion, Articular
Tendon Injuries* / surgery
Tendons