A Randomized Clinical Trial Comparing Immediate Active Motion With Immobilization After Tendon Transfer for Claw Deformity

S (Santosh) Rath, Ruud Selles, Ton Schreuders, Henk Stam, Steven Hovius

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Abstract

Purpose 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. Methods 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). Results 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 LAMP 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. Conclusions 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. (J Hand Surg 2009;34A:488-494. Copyright (C) 2009 by the American Society for Surgery of the Hand. All rights reserved.)
Original languageUndefined/Unknown
Pages (from-to)488-494
Number of pages7
JournalJournal of Hand Surgery-American Volume
Volume34A
Issue number3
Publication statusPublished - 2009

Research programs

  • EMC MUSC-01-46-01
  • EMC NIHES-01-50-01-A

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