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Immediate Postoperative Mobilization Following Tendon Transfer for Claw Deformity Appears Safe, Effective
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Posted on: 11/30/1999
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Standard management following a tendon transfer for management of claw deformity of the hand is to immobilize the wrist and metacarpophalangeal (MCP), or knuckles, that are in the middle of each finger. A cast is put on for four weeks and then there is another four weeks of "re-education" of the hand to strengthen it for use. One of the problems observed with the immobilization is the stiffness that results and this may delay return of function.
The author of this study showed in an earlier study that not immobilizing the flexor digitorum superficialis, the tendon that help you point your finger, and used active immobilization instead, provided a 40 percent reduction in time needed for rehabilitation. This study was undertaken to see if the same could be said for the claw deformity correction.
Thirty-one patients (32 hands with claw deformity total) had the surgery followed by active immobilization (group A) and researchers looked back at the records of 32 hands that underwent standard immobilization (group B) to use as the control/comparison group.
The patients were a mean age of 27 years in group A and 31 years in group B. In group A, the patients had experienced hand paralysis for a mean of 5.5 years and in group B, 4.2 years.
Following the surgery, both groups followed the same protocols with the exception of immobilization. On Day 2 following surgery, the patients in group A began active mobilization, which was only begun at Week 4 in group B. The patients in group A were encouraged to do active bending of the hand and opening and closing of the fist. Joint blocks were provided at various angles during the rehabilitation period to prevent overstretching of the hand.
After introduction of transfer strengthening to the hand for group A, they began occupational therapy at Week 3 following surgery. A splint was used at night for three months. As the patients were discharged fro therapy, they were able to perform daily activities, such as dressing and grooming.
Follow-up was monthly for three months following surgery and then every three months for a year. If patient recovery was satisfactory, they were permitted to return to sedentary work at eight weeks following surgery and they were permitted unrestricted activities at 12 weeks.
To assess the effectiveness of the non-immobilizing procedure, the researchers looked for tendon transfer pullout, comparisons with the control group, and the angle at which the fingers open. The researchers found that there were no incidences of transfer pullout in any patient in group A and, in terms of physical comparisons with patients in group B, the hands in group A healed faster and required shorter immobilization for many patients (39 percent shorter).
There are some drawbacks to this study, which include that there was no way to compare claw correction outcome and because the groupings were done according to criteria for "good, fair," and "poor," the wide range has limited accuracy. Another issue was the use of a prospective trial (group A) to compare with a retrospective trial (group B). This limited the ability to ensure that the same surgical techniques, positioning, etc, were the same in all patients.
Despite the drawbacks, the author recommends future trials examining all the aspects involved to see if the findings are replicated.
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References:
Santosh Rath, MS. Immediate Postoperative Active Mobilization Versus Immobilization Following Tendon Transfer for Claw Deformity in the Hand. In Journal of Hand Surgery. Feb. 2008. Vol. 33A. Pp. 232-240.
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