Houston Methodist. Leading Medicine

Hand FAQ

Question:

I sliced through the back of my hand while helping a friend re-roof his house. Had to have surgery to reconnect two of the tendons. Then I went to a hand therapist for rehab, but she was pregnant and left on maternity leave after the first few days. The new therapist gave me a completely different program to do. It involves much more movement than before. I'm a little nervous that I might tear something I shouldn't. Is it really safe to move so much so soon after surgery?

Answer:

The best approach in rehab for surgically repaired extensor tendon injuries is still up in the air. For a long time, immobilization (no movement) was the standard treatment. Patients were splinted or casted to keep them from moving until the surgeon gave the go-ahead. Then it became clear that no movement causes scar formation and loss of motion. The healing tendon(s) got bound down and no longer slid smoothly through the sheath covering them. Hand therapists started using movement early on after surgery. There are two ways to approach mobilization after tendon repairs. One is early but controlled motion (some guided movement). The other is early and active (full movement). But what works best: immobilization (no movement), early but controlled mobilization (some movement), or early and active mobilization (full movement)? There are some studies out there comparing these treatment approaches. And a group of researchers from the University of Amsterdam in the Netherlands took the time to review and summarize them. What they found was that early controlled mobilization results in better range-of-motion at the end of six weeks (compared with immobilization). At the end of 12 weeks, there was no difference in motion between the two groups. Grip strength comes back faster and stronger with controlled mobilization compared with immobilization. Overall results are better at the end of six weeks with mobilization (compared to immobilization). But by the end of six months, both groups had the same final results in terms of motion and strength. There is conflicting evidence about the short-term effects of early controlled mobilization versus active mobilization. But all studies agreed that the long-term results are the same. All in all, it looks like early controlled mobilization is the superior approach for postoperative rehab following surgical repair of extensor tendon injuries. Even though there are no apparent long-term benefits of active motion, an earlier return to full function and strength may get you back to work sooner and improve your quality of life and satisfaction. Eelkje Talsma, MSc, et al. The Effect of Mobilization on Repaired Extensor Tendon Injuries of the Hand: A Systematic Review. In Archives of Physical Medicine and Rehabilitation. December 2008. Vol. 89. No. 12. Pp. 2366-2372.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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