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.