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Advances in extensor tendon diagnosis and therapy.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Identify clinical situations in which hand sonography can result in the detection of partial extensor tendon tears. 2. Identify the limitations of magnetic resonance imaging in diagnosing extensor tendon tears. 3. Understand the various postoperative therapeutic protocols for extensor tendon repair. 4. Choose the appropriate surgical repair and postoperative therapeutic protocol for a specific extensor tendon injury. 5. Identify the social and economic variables that may influence the availability and efficacy of the various postoperative therapeutic protocols.

BACKGROUND: This article describes how the application of radiographic imaging facilitates the earlier detection and differentiation of extensor tendon injuries. Furthermore, it defines the best surgical procedure and postoperative therapy for a specific injury.

METHODS: A literature review was performed of extensor tendon injury articles published since 1989.

RESULTS: High-resolution sonography was more accurate than physical examination and magnetic resonance imaging in detecting extensor tendon injuries. Traditional postoperative static splinting was equivalent to early motion protocols for all uncomplicated thumb injuries and zone 1 to 3 injuries of the second through fifth digits. The only definable benefit of early motion therapy compared with static splinting was a quicker return to final function for proximal zones of injury in the second through fifth digits. The results of early active and passive motion, measured at 6 months, were comparable to those from static splinting. A higher rupture rate for early active motion and greater cost for early active and passive motion were noted compared with static splinting.

CONCLUSIONS: High-resolution sonography allows identification of difficult to diagnose partial and complete extensor tendon injuries. Static splinting should remain the postoperative standard of care for extensor tendon injuries to the thumb and distal zones of injury for digits 2 through 5. The best therapy protocol for proximal zones of injury should be individualized based on social and economic variables.

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