Comparison between early active and passive mobilization programs after hand flexor tendon repair in zone II

Abstract

Objective: The objective of this study was to study the efficacy of an early active mobilization program in comparison with passive mobilization on the range of motion (ROM) and grip strength after flexor tendon repair in zone II., Patients and methods: The Modified Kessler technique, followed by a continuous epitenon suture was used to repair 21 digits in 18 patients with hand flexor tendon injury in zone II (which extends from the distal palmar crease to the middle of the intermediate phalanx of the digit). Early active mobilization of the repaired digit was started 1 day postoperatively in nine digits (group I), whereas early passive mobilization with the use of elastic bands was started in the other 12 digits (group II). ROM was monitored and compared in the two groups at 4, 8, and 12 weeks using the Total Active Motion (TAM) Score of the American Society for Surgery of the Hand, whereas hand grip strength was assessed at 8 weeks., Results: There were better improvements in the TAM score in the early active mobilization group than in the passive mobilization group (11.1% excellent grade compared with 0%, 33.3% good grade compared with 8.3%, 55.6% fair grade compared with 58.3%, 0% poor grade compared with 33.3%, respectively). Comparison between progression of the TAM score at 4, 8, and 12 weeks postoperatively showed a highly significant improvement in the early active mobilization group (P=0.002, 0.0001, and 0.002, respectively), whereas improvement in the passive mobilization group was found to be significant (P=0.012) only between 4 and 12 weeks. There were highly significant differences in grip strength between the normal and the affected side in both groups but the mean average grip strength was higher among the patients in the early active mobilization group., Conclusion: An early active mobilization program after flexor tendon repair in zone II leads to better results in terms of the total active ROM. Progressive improvement occurred earlier than that in the passive mobilization program. The mean average grip strength was higher among the patients in the early active mobilization group., (C) 2013 by Lippincott Williams & Wilkins, Inc.