The benefits of early active motion on thumb range of motion following extensor pollicis longus tendon repair in zones TIII–TV: A prospective comparison pilot study

Abstract

Introduction Extensor pollicis longus (EPL) is the most commonly injured extensor tendon in the hand. Following repair of this tendon, whilst early active motion within a volar orthosis is simple and inexpensive, it is not known whether it is more effective at regaining thumb motion than immobilisation. Methods A prospective comparison pilot study including 20 outpatients with repaired EPL tendon lacerations in zones TIII–TV was undertaken. Participants were non-randomly allocated to either immobilisation group or early active motion. The primary outcome measure was thumb interphalangeal joint active extension–flexion. Secondary outcome measures were metacarphalangeal joint active extension–flexion, composite active thumb opposition and retropulsion, the patient-rated wrist/hand evaluation and return to work. Results At 8 weeks, the mean between-group differences for interphalangeal joint extension (−10°; 95% CI −1 to −19), metacarphalangeal joint extension (−12°; 95% CI −23 to −0.4) and composite thumb retropulsion as a percentage of uninjured side (42%; 95% CI 3–81) were all clinically important. There were no other significant between-group differences at 6 or 8 weeks, and no ruptures in either group. Conclusion This pilot comparison study indicated that early active motion has an effect on thumb interphalangeal joint extension, metacarphalangeal joint extension and composite thumb retropulsion by 8 weeks post-operatively. This study lends weight to the need for a properly conducted randomised controlled trial.