Search

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 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. Type of study/level of evidence: Therapeutic I. [Copyright &y& Elsevier]

Purpose: Grip strength and pinch strength measurements are often used to assess hand function. However, both measure a number of muscle groups in combination, and grip strength in particular is dominated by extrinsic hand muscles. The Rotterdam Intrinsic Hand Myometer (RIHM) was recently introduced to measure the force that individual fingers and thumb can exert in different directions. The aim of this study was to establish the reliability of these measurements with use of the RIHM in children. Methods: Sixty-three healthy children between 4 and 12 years of age participated in this study. The RIHM was used to measure thumb palmar abduction, thumb opposition, thumb flexion at the metacarpal-phalangeal (MP) joint, index finger abduction, and little finger abduction. A retest was performed with an average test-retest interval of 26 days. Results: For the thumb, palmar abduction strength had intraclass correlation coefficients (ICCs) of .98 for both hands. For both thumb opposition and flexion at the MP joint, ICCs were .97 for the dominant hands and .98 for the nondominant hands. Index finger abduction had ICCs of .94 and .95 and little finger abduction had ICCs of .90 and .92 for the dominant and nondominant hands, respectively. The smallest detectable differences for dominant and nondominant hands respectively were thumb palmar abduction, 15% and 15%; thumb opposition, 12% and 9%; thumb flexion (at the MP joint), 12% and 9%; abduction of the index finger, 17% and 17%; and little finger abduction, 26% and 26%. Conclusions: We found that the RIHM was reliable for use in children. Intraclass correlation coefficients and smallest detectable differences were comparable with those obtained with use of the RIHM in adults and with values found for pinch and grip strength in children. Because the RIHM measures more specific aspects of hand function than grip and pinch, adding the RIHM to measurement protocols may contribute to a more complete overview of a child''s hand function. [Copyright &y& Elsevier]