• J Hand Ther · Oct 2011

    Review

    A systematic review of rehabilitation protocols after surgical repair of the extensor tendons in zones V-VIII of the hand.

    • Mojib Sameem, Thomas Wood, Teegan Ignacy, Achilleas Thoma, and Nick Strumas.
    • Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
    • J Hand Ther. 2011 Oct 1;24(4):365-72; quiz 373.

    Study DesignSystematic review.IntroductionControversy exists as to which rehabilitation protocol provides the best outcomes for patients after surgical repair of the extensor tendons of the hand.Purpose Of The StudyTo determine which rehabilitation protocol yields the best outcomes with respect to range of motion and grip strength in extensor zones V-VIII of the hand.MethodsA comprehensive literature review and assessment was undertaken by two independent reviewers. Methodological quality of randomized controlled trials and cohort studies was assessed using the Scottish Intercollegiate Guidelines Network scale.ResultsSeventeen articles were included in the final analysis (κ=0.9). From this total, seven evaluated static splinting, 12 evaluated dynamic splinting, and four evaluated early active splinting. Static splinting yielded "excellent/good" results ranging from 63% (minimum) to 100% (maximum) on the total active motion (TAM) classification scheme and TAM ranging from 185° (minimum) to 258° (maximum) across zones V-VIII. Dynamic splinting studies demonstrated a percentage of "excellent/good" results ranging from 81% (minimum) and 100% (maximum) and TAM ranging from 214° (minimum) and 261° (maximum). Early active splinting studies showed "excellent/good" results ranging from 81% (minimum) and 100% (maximum). Only one study evaluated TAM in zones V-VIII, which ranged from 160° (minimum) and 165° (maximum) when using two different early active modalities.ConclusionsThe available level 3 evidence suggests better outcomes when using dynamic splinting over static splinting. Additional studies comparing dynamic and early active motion protocols are required before a conclusive recommendation can be made.Level Of Evidence2.Copyright © 2011 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

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