Zone II Flexor Tendon Therapy: Mobilize or Immobilize?

Abstract

This study investigated the postoperative management approaches used in the treatment of flexor tendon repairs in Zone II of the hand. The therapists and the hand surgeons who treat patients with acute hand injuries in the Metropolitan Toronto area were surveyed to detect their current practice trends and preferences in flexor tendon postoperative management. The survey focused on the following four protocols: 1. immobilization for at least three weeks, 2. the Kleinert program of controlled active motion, 3. the Duran program of controlled passive motion, and 4. combination of controlled active and passive motion. Although the results suggested that mobilization is the preferred postoperative management amongst the majority of responding therapists and hand surgeons, the type of mobilization program preferred differed. The therapists demonstrated a trend towards a combination of early controlled active and passive motion; whereas, the trend amongst the surgeons was that of early controlled active motion. The decision to use one specific management approach over another was found to be very “patient specific”. As well, a wide variation on the preferences given for the splinting positions at the wrist, metacarpalphalangeal (MCP) joint, and the proximal interphalangeal (PIP) joint was noted.