A randomized clinical trial comparing immediate active motion with immobilization after tendon transfer for claw deformity.
OBJECTIVE
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 IAMP 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.
Rath
Santosh
S
LEPRA Funded Leprosy Reconstructive Surgery Unit, HOINA, Muniguda, Orissa, India. handsurgery.rath@gmail.com
Selles
Ruud W
RW
Schreuders
Ton A R
TA
Stam
Henk J
HJ
Hovius
Steven E R
SE
D000203:Activities of Daily Living; D000328:Adult; D002370:Casts, Surgical; D004487:Edema / Q000473:pathology; D005260:Female; D006227:Hand Deformities, Acquired / Q000209:etiology / Q000628:therapy*; D018737:Hand Strength; D006801:Humans; D007103:Immobilization; D007918:Leprosy / Q000150:complications; D008297:Male; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013165:Splints; D013709:Tendon Transfer