Relative Motion Extension Splint after Extensor Tendon Reconstruction

Egemen Ayhan; Ozge Buket Arslan; Kadir Cevik; Cigdem Oksuz

doi:10.1055/s-0043-1761222

Journal of Hand and Microsurgery, Table of Contents

J Hand Microsurg
DOI: 10.1055/s-0043-1761222

Surgical Technique

Relative Motion Extension Splint after Extensor Tendon Reconstruction

Egemen Ayhan

¹Department of Orthopedics and Traumatology, Hand Surgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey

,

Ozge Buket Arslan

²Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey

,

Kadir Cevik

³Department of Orthopedics and Traumatology, Hand Surgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

,

Cigdem Oksuz

²Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey

› Author Affiliations

Abstract

Recently, the wide-awake local anesthesia no tourniquet (WALANT) technique and relative motion extension (RME) splint changed practice in extensor tendon reconstruction and therapy. We wanted to share our approach for zones 5 to 8 extensor tendon management following the up-to-date developments. The impacts of surgery under WALANT and early active motion therapy with RME splinting were explained frankly and shown in several videos throughout the article.

Keywords

WALANT - relative motion splint - yoke splint - extensor tendon - hand therapy

Full Text

References

References
1 Boudoulas KD, Triposkiadis F, Stefanadis C, Boudoulas H. The endlessness evolution of medicine, continuous increase in life expectancy and constant role of the physician. Hellenic J Cardiol 2017; 58 (05) 322-330
2 Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am 2005; 30 (05) 1061-1067
3 Merritt WH, Howell J, Tune R, Saunders S, Hardy M. Achieving immediate active motion by using relative motion splinting after long extensor tendon repair and sagittal band ruptures with tendon subluxation. Operative Tech Plast Reconstr Surg 2000; 7: 31-37 . Accessed on January 13, 2023, at: https://www.infona.pl/resource/bwmeta1.element.elsevier-47d7f321-eb63-38cc-8b90-28d26afaa2cc
4 Newport ML, Blair WF, Steyers Jr CM. Long-term results of extensor tendon repair. J Hand Surg Am 1990; 15 (06) 961-966
5 Evans RB, Burkhalter WE. A study of the dynamic anatomy of extensor tendons and implications for treatment [published correction appears in J Hand Surg [Am] 1086 Nov;11(6):914]. J Hand Surg Am 1986; 11: 774-779
6 Newport ML, Tucker RL. New perspectives on extensor tendon repair and implications for rehabilitation. J Hand Ther 2005; 18 (02) 175-181
7 Collocott SJ, Kelly E, Ellis RF. Optimal early active mobilisation protocol after extensor tendon repairs in zones V and VI: a systematic review of literature. Hand Ther 2018; 23 (01) 3-18
8 Collocott SJF, Kelly E, Foster M, Myhr H, Wang A, Ellis RF. A randomized clinical trial comparing early active motion programs: earlier hand function, TAM, and orthotic satisfaction with a relative motion extension program for zones V and VI extensor tendon repairs. J Hand Ther 2020; 33 (01) 13-24
9 Howell JW, Merritt WH, Robinson SJ. Immediate controlled active motion following zone 4-7 extensor tendon repair. J Hand Ther 2005; 18 (02) 182-190
10 Hirth MJ, Howell JW, Brown T, O'Brien L. Relative motion extension management of zones V and VI extensor tendon repairs: does international practice align with the current evidence?. J Hand Ther 2021; 34 (01) 76-89
11 Merritt WH. Relative motion splint: active motion after extensor tendon injury and repair. J Hand Surg Am 2014; 39 (06) 1187-1194
12 Hirth MJ, Bennett K, Mah E. et al. Early return to work and improved range of motion with modified relative motion splinting: a retrospective comparison with immobilization splinting for zones V and VI extensor tendon repairs. Hand Ther 2011; 16 (04) 86-94
13 Svens B, Ames E, Burford K, Caplash Y. Relative active motion programs following extensor tendon repair: a pilot study using a prospective cohort and evaluating outcomes following orthotic interventions. J Hand Ther 2015; 28 (01) 11-18 , quiz 19
14 Burns MC, Derby B, Neumeister MW. Wyndell merritt immediate controlled active motion (ICAM) protocol following extensor tendon repairs in zone IV-VII: review of literature, orthosis design, and case study-a multimedia article. Hand (N Y) 2013; 8 (01) 17-22
15 Merritt WH, Wong AL, Lalonde DH. Recent developments are changing extensor tendon management. Plast Reconstr Surg 2020; 145 (03) 617e-628e
16 Love GJ, MacLean JG. Ulnar subluxation of the extensor tendons in elderly osteoarthritic females: a neglected diagnosis. J Hand Surg Eur Vol 2007; 32 (01) 45-49
17 Carroll IV C, Moore JR, Weiland AJ. Posttraumatic ulnar subluxation of the extensor tendons: a reconstructive technique. J Hand Surg Am 1987; 12 (02) 227-231
18 McCoy FJ, Winsky AJ. Lumbrical loop operation for luxation of the extensor tendons of the hand. Plast Reconstr Surg 1969; 44 (02) 142-146
19 Wheeldon FT. Recurrent dislocation of extensor tendons in the hand. J Bone Joint Surg Br 1954; 36-B (04) 612-617
20 Lalonde DH. How to inject local anesthetic so that it does not hurt. In: Lalonde DH. ed. Wide Awake Hand Surgery and Therapy Tips. 2nd ed. New York, NY: Thieme; 2021: 43-55
21 O'Broin ES, Earley MJ, Smyth H, Hooper AC. Absorbable sutures in tendon repair. A comparison of PDS with prolene in rabbit tendon repair. J Hand Surg [Br] 1995; 20 (04) 505-508
22 Lalonde DH, Flewelling LA. Solving hand/finger pain problems with the pencil test and relative motion splinting. Plast Reconstr Surg Glob Open 2017; 5 (10) e1537
23 Hirth MJ, Howell JW, Feehan LM, Brown T, O'Brien L. 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; 34 (01) 58-75
24 Tuna Z, Ayhan E. Potential clinical benefits of wide-awake hand surgery from the therapist's perspective. Hand Surg Rehabil 2019; 38 (02) 139
25 Hirth MJ, Howell JW, O'Brien L. Relative motion orthoses in the management of various hand conditions: a scoping review. J Hand Ther 2016; 29 (04) 405-432
26 Lalonde DH, Ayhan E, Gueffier X. et al. Extensor tendon repair of the finger (zone 1 mallet to zone 5 MP joint). In: Lalonde DH. ed. Wide Awake Hand Surgery and Therapy Tips. 2nd ed. New York: Thieme; 2022: 183-196
27 Lalonde DH, Ayhan E, Ahmad AA. et al. Tendon transfers. In: Lalonde DH. ed. Wide Awake Hand Surgery and Therapy Tips. 2nd ed. New York: Thieme; 2022: 209-216