Acta Scientific Orthopaedics (ASOR) (ISSN: 2581-8635)

Case Report Volume 3 Issue 8

Early Controlled Mobilization Following Extensor Pollicis Longus Repair: A Case Report

Shrikant J Chinchalkar1* and Laura Yurkowski2

1Department of Hand Therapy, Roth-McFarlane Hand and Upper Limb Center, St. Joseph’s Health Care London, Ontario, Canada
2St. Boniface Hospital, Winnipeg, Manitoba, Canada

*Corresponding Author: Shrikant J Chinchalkar, Department of Hand Therapy, Roth-McFarlane Hand and Upper Limb Center, St. Joseph’s Health Care London, Ontario, Canada.

Received: May 08, 2020; Published: July 20, 2020

×

Abstract

 Adhesion formation causing the loss of tendon excursion after a digital extrinsic extensor tendon injury near or within the extensor retinaculum is common. Extensor pollicis longus (EPL) injuries, repairs and management near the extensor retinaculum have been limitedly described both surgically and post-operatively. When considering necessary tendon gliding and tendon excursions at, distal or proximal to the extensor retinaculum, the size and location of EPL laceration is important in the rehabilitation and patient outcome. The patient in this case study was treated by means of a dynamic hinge orthotic with an out trigger for the thumb and hinge for the wrist. Post-operative rehabilitation management consisted of a controlled mobilization program and was progressed according to the stages of healing and the principles of EPL tendon gliding resistance with respect to the wrist position. Full thumb flexion and extension combined with wrist motion and full grip and pinch strength was attained.

Keywords: Extensor Pollicis Longus (EPL); Mobilization; Dynamic Hinge

×

References

  1. Chinchalkar SJ., et al.“Postoperative management of extensor pollicis longus repairs within close vicinity to or within the extensor retinaculum”. Journal of Hand Therapy4 (2010): 412-419.
  2. Brand PW and Hollister A. “Clinical Mechanics of the Hand”. 2nd St Louis, MO: Mosby (1993).
  3. Boyes WH. “Bunnell’s Surgery of the Hand”. Philadelphia, PA: JB Lippincott (1970).
  4. Steindler A. “Kinesiology of the Human Body Under Normal and Pathological Conditions”. Springfield, MA: Charles C Thomas (1964).
  5. Duran RJ and Houser RG. “Controlled passive motion following flexor tendon repair in zone 2 and 3”. The American Academy of Orthopaedic Surgeons: Symposium on Tendon Surgery in the Hand. St. Louis, MO: Mosby (1975): 105-114.
  6. Chen M., et al. “Gliding distance of the extensor pollicis longus tendon with respect to wrist positioning: observation in the hands of healthy volunteers using high resolution ultrasonography”. Journal of Hand Therapy22 (2009): 44-48.
  7. Verdan CE. “Primary and secondary repairs of flexor and extensor tendon injuries”. In: Flynn JE (ed). Hand Surgery. Baltimore: Williams and Wilkins (1996): 20-75.
  8. Purcell T., et al. “Static splinting of extensor tendon repairs”. Journal of Hand Surgery25 (2000): 180-182.
  9. Lee VH. “Rehabilitation of extensor tendon injuries”. In: Hunter JM (ed). Rehabilitation of the Hand. 2nd St Louis, MO: Mosby (1984): 353-357.
  10. Elliot D and Southgate CM. “New concepts in managing the long tendons of the thumb after primary repair”.Journal of Hand Therapy18 (2005): 141-156.
  11. Khandwala AR., et al. “Immediate repair and early mobilization of the extensor pollicis longus tendon in zones 1 to 4”. Journal of Hand Surgery29 (2004): 250-258.
  12. Chinchalkar SJ and Pipicelli JG. “Complications of extensor tendon repairs at the extensor retinaculum”. Journal of Hand Microsurgery1 (2010): 3-12.
  13. Chinchalkar SJ. “Dynamic splinting for the repair of the first extensor compartment tendons”.Journal of Hand Therapy3 (2008): 292-296.
  14. Bunnell S. “Surgery of the Hand”. Philadelphia, PA: JB Lippincott (1948): 340-346.
  15. In: Warwick R, Williams PL, Moore RE (eds). Gray’s Anatomy. 35thedition. Great Britain: Longman Group Ltd. (1973): 550-553.
  16. Brand PW and Hollister A. “Clinical Mechanics of the Hand”. 2nd St Louis, MO: Mosby (1993).
  17. Kapanji I. “Biomechanics of the thumb”. In: Tubiana, ed. The Hand. Philadelphia, PA: WB Saunders1 (1981): 404-422.
  18. Kapanji A. “The Physiolohgy of the Joints: The Upper Limb”. 6th Edinburg: Churchill Livingstone1 (2007): 198-322.
  19. Kutsumi K., et al. “Measurement of gliding resistance of the extensor pollicis longus and extensor digitorum communis II tendons within the extensor retinaculum”. Journal of Hand Surgery2 (2004): 220-224.
  20. Newport ML., et al. “Long-term results of extensor tendon repair”.Journal of Hand Surgery6 (1990): 961-966.
  21. Evans RB and Thompson DE. “The application of force to the healing tendon”. Journal of Hand 4 (1993): 266-284.
  22. Guimberteau JC., et al. “The microvascular system: how connective tissue sliding works”. Journal of Hand Surgery8 (2010): 614-622.
  23. Tang JB., et al. “Tendon Surgery of the Hand”. Philadelphia, PA: Saunders (2012): 27-30.
  24. Sylaidis P., et al. “Early active mobilization for extensor tendon injuries, The Norwich regime”. Journal of Hand Surgery5 (1997): 594-596.
  25. Browne EZ and Christine AR. “Early Dynamic Splinting for extensor tendon injuries”. Journal of Hand Surgery14A (1989): 72-76.
  26. Newport ML and Shukla A. “Electrophysiologic basis of dynamic extensor splinting”. Journal of Hand Surgery17A (1992): 272-277.
  27. Khandwala AR., et al. “A comparison of dynamic extension splinting and controlled active mobilization of complete divisions of extensor tendons in zone 5 and 6”. Journal of Hand Surgery2 (2000): 140-146.
  28. Chester DL., et al. “A prospective, controlled randomized trial comparing early active extension with passive extension using a dynamic splint in the rehabilitation or repaired extensor tendons”. Journal of Hand Surgery27 (2002): 283-288.
  29. Mowlavi A., et al. “Dynamic versus static splinting of simple zone V and zone VI extensor tendon repairs: a prospective, randomized, controlled study”. Plastic and Reconstructive surgery2 (2005): 482-487.
  30. Bulstrode NW., et al. “Extensor Tendon rehabilitation a prospective trial comparing three rehabilitation regimes”. Journal of Hand Surgery2 (2005): 175-179.
  31. Kleinert HE and Verdan C. “Report of the committee on tendon injuries”. Journal of Hand Surgery 8 (1983): 794-798.
  32. Strickland JW and Glogovac SV. “Digital function following extensor tendon repair zone II: A comparison of immobilization and controlled passive motion techniques”.Journal of Hand Surgery5 (1980): 537-543.
  33. Miller H. “Repair of severed tendons of the hand and wrist. Statistical analysis of 300 cases”. Surgery, Gynecology and Obstetrics 75 (1942): 693-698.
  34. Dargan EL. “Management of extensor tendon injuries of the hand”. Surgery, Gynecology and Obstetrics128 (1969): 1269-1273.
  35. Pettengill K and Gwendolyn VS.“Postoperative Management of Flexor Tendon Injuries”. In: Skirven TM, Osterman AL, Fedorczyk JM, Amadio PC (ed). Rehabilitation of the Hand and Upper Extremity. 6th ed. Philadelphia, PA: Mosby (2002): 457-461.
×

Citation

Citation: Shrikant J Chinchalkar and Laura Yurkowski. “Early Controlled Mobilization Following Extensor Pollicis Longus Repair: A Case Report". Acta Scientific Orthopaedics 3.8 (2020): 26-32.




Metrics

Acceptance rate33%
Acceptance to publication20-30 days

Indexed In



News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is December 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"

Contact US