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

STUDY

DESIGN

Systematic review.

INTRODUCTION

Controversy 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 STUDY: To 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.

METHODS

A 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.

RESULTS

Seventeen 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.

CONCLUSIONS

The 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 EVIDENCE: 2.