Immobilization after tendon transfers has been the conventional postoperative management. A recent study indicated beneficial effects of an immediate active motion protocol (IAMP) after tendon transfer for claw deformity correction compared with effects in a historical cohort. In this study, we further tested this hypothesis in a randomized clinical trial comparing the effectiveness of the IAMP with that of conventional immobilization.
Fifty supple claw hand deformities were randomized postoperatively into 2 equal groups for IAMP and immobilization. Therapy began on the second postoperative day for the IAMP group and on the twenty-second postoperative day for the immobilization group. The primary outcome measures were deformity correction, active range of motion of digits, tendon transfer insertion pullout, and time until discharge from rehabilitation. Secondary outcome measures were swelling, pain, hand strength, and dexterity. Both groups were compared at discharge from rehabilitation and at the last clinical follow-up (at least 1 year postoperatively).
Assessments were available for all 50 patients at discharge and for 23 patients in each group at follow-up. The average follow-up was 18 months for the IAMP group and 17 months for the immobilization group. Deformity correction, range of motion, swelling, dexterity, and hand strength were similar for both groups at discharge and a follow-up. There was no evidence of tendon insertion pullout in any patient of either group. Relief of pain was achieved significantly earlier with IAMP. Morbidity was reduced by, on average, 22 days with IAMP.
We found that the immediate active motion protocol is safe and has similar outcomes compared with those of immobilization, with the added advantage of earlier pain relief and quicker restoration of hand function. Immediate motion after tendon transfer can significantly reduce morbidity and speed up the rehabilitation of paralytic limbs, and it may save expense for the patients.
Type of study/level of evidence
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- The scientific basis for advances in flexor tendon surgery.J Hand Ther. 2005; 18: 94-110
- The surgical management of the deformities of the hand in leprosy.J Bone Joint Surg. 2006; 88B: 290-294
- Immediate postoperative active mobilization versus immobilization following tendon transfer for claw deformity correction in the hand.J Hand Surg. 2008; 33A: 232-240
- Immediate active mobilization versus immobilization for opposition tendon transfer in the hand.J Hand Surg. 2006; 31A: 754-759
- Ulnar nerve palsy.in: Green D.P. Hotchkiss R.N. Pederson W.C. Wolfe S.C. Green's operative hand surgery. 5th ed. Elsevier Churchill Livingstone, Philadelphia2005: 1161-1196
- Claw-finger correction.J Hand Surg. 1992; 17B: 615-621
- Intrinsic paralysis of the ulnar nerve—physiopathology of the claw hand.in: Zancolli E. Structural and dynamic bases of hand surgery. 2nd ed. JB Lippincott, Philadelphia1979: 159-206
- Clinical assessment recommendations.in: 2nd ed. American Society of Hand Therapists, Garner, NC1992: 13-14
- Early dynamic motion versus postoperative immobilization in patients with extensor indicis proprius transfer to restore thumb extension: a prospective randomized study.J Hand Surg. 2001; 26A: 1111-1115
- Early active motion after transfer of the extensor indicis tendon—a randomized prospective trial.Handchir Mikrochir Plast Chir. 2008; 40: 156-159
- Early postoperative active mobilisation versus immobilisation following tibialis posterior tendon transfer for foot-drop correction in patients with Hansen's disease.J Plast Reconstr Aesthet Surg. 2009; (in press)
Accepted: November 14, 2008
Received: July 5, 2008
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
© 2009 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.