None listed
Conditions
Brief summary
Patients who have undergone surgical repair of lacerated extensor tendons on the dorsum of the hand at Counties Manukau District Health Board (CMDHB) are rehabilitated with an early mobilisation protocol known as ‘extensor CAM (Controlled Active Motion)’. An audit of CMDHB patients showed similar joint range of motion outcomes to those reported by other centres using comparable protocols following extensor tendon repair. However, reports from centres where an alternative early mobilisation protocol, Relative Motion Extension Splinting (RMES), has been used show patients returning to work earlier. These reports (Hirth et al., 2011; Howell, Merritt, & Robinson, 2005) suggest that patients rehabilitated with the RMES protocol have an earlier ability to use their hand functionally. To date there are no reports of prospective trials comparing the RMES to other early mobilisation protocols. This study will prospectively compare outcomes of patients managed with an extensor CAM protocol to those managed with an RMES protocol; with the hypothesis that those in the RMES group will demonstrate an earlier return to hand function.
Interventions
Patients who have undergone extensor tendon repair in zone V and/or VI will be randomised post-operatively into either a group who receive the usual rehabilitation protocol of controlled active motion, or an experimental group who will be treated using a relative motion extension splinting protocol- this uses an alternative splint and exercise programme.
The splint in the intervention group includes only the MCP joints rather than the MCPs, wrist and forearm, and positions the injured MCP joint
Patients who have undergone extensor tendon repair in zone V and/or VI will be randomised post-operatively into either a group who receive the usual rehabilitation protocol of controlled active motion, or an experimental group who will be treated using a relative motion extension splinting protocol- this uses an alternative splint and exercise programme. The splint in the intervention group includes only the MCP joints rather than the MCPs, wrist and forearm, and positions the injured MCP joint (s) in 15-20 degrees relative extension to the other digits. In the first 4 weeks no specific exercises are provided, the patient is advised to move the hand and use it for light activities in the splint. From 4 weeks the patient will be provided with customised exercises to reduce a lag if one exists, such as active MCP extension and place and hold in extension, and tendon gliding exercises if there is a limitation in flexion. These are usually around 10 repetitions 5 times per day but will be adapted to the patient. From 8 weeks passive flexion stretches 5 times per day may be included if necessary to regain flexion. Patients will also be advised on the use of heat and massage at home The hand therapist (OT or physio) will teach the exercises and advise the patient on the use of the hand at home; they may use modalities such as heat and massage in therapy sessions. Consultation will be one-on-one sessions. Usually the first session will be for 1 hour and subsequent sessions 30 minutes each, 1 -2 times per week for the first 4-6 weeks and then once every 1-2 weeks after this until approximately 8 -10 weeks post-operatively. Frequency and duration of sessions will be customised to the individual patients needs and are not dictated by the study protocol. Adherence to splinting will be assessed by the therapist treating the participant and a splinting questionnaire will be completed at the 4 week mark.
Sponsors
Shirley Collocott
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients undergoing extensor tendon repair to at least one digit in zone V and/or VI through CMDHB Simple tendon lacerations of 50-100% of the tendon substance as assessed intra-operatively by surgeon Participants must be able to attend follow-up Participants must be able to understand English or have an interpreter available
Exclusion criteria
Complex injuries involving unstable fractures or concurrent flexor tendon injury Extensor tendon repairs to three or more digits ‘Fight bites’ or infected injuries which cannot be primarily repaired Thumb extensor tendon repairs Any factor which would make the patient unsuitable for inclusion in the view of the treating surgeon or investigator such as a tenuous tendon repair or concerns over patients’ ability to adhere to protocol .
Outcome results
None listed