Article Review: Relative Motion for Extensor Tendon Repair zone V-VI? Is a night-time resting hand orthosis beneficial?

Hirth, M. J., Hunt, I.,  Briody, K.,  Milner, Z., Sleep, K., Chu, A., Donovan, E. &  O’Brien, L. (2021). Comparison of two relative motion extension orthotic programs following surgical repair of finger extensor tendons in zones V-VI: A randomized equivalence trial. Journal of Hand Therapy-to be published.

The Skinny:  Following a zone V-VI tendon repair, relative motion splint is an effective option in providing adequate protection and preventing tendon rupture/attenuation.  There is variability in relative motion splinting approaches, including replacing the relative motion orthosis with a larger orthosis overnight or adding a wrist orthosis.  Due to this variability, the authors looked to determine if the splinting regime mattered.  The study compared two splinting regimes following an extensor tendon repair in zone V-VI.  Group one was a relative motion orthosis alone, and group two was a relative motion orthosis and a night-time orthosis.   

In the Weeds: The study compared two splinting regimes (relative extension splint) following an extensor tendon repair in zone V-VI.  Group one was a relative motion orthosis alone, and group two was a relative motion orthosis and a night-time orthosis following.   They termed the groups as follows RME and wrist orthoses worn at the same times are terms ‘RME plus,’ and without a wrist, orthosis was termed‘ RME only.’  A total of 32 subjected were enrolled in the study and 17 were randomized into the RME and night-time splinting group, and 15 were enrolled in the RME at all times groups.  

Outcomes measures included a range of motion, grip strength, return to work, pain, hand function, satisfaction, and orthotic adherence. 

Bringing it Home:  Both interventions produced similar outcomes and with no increase in rupture rate and similar results in the outcome measures.  

Rating: The authors recommenced tailoring therapy interventions based on patient needs rather than being protocol-based.  The study limitations include a small sample size.  Also, it was a multisite study, so difficult to control for variations in therapeutic approaches and surgical techniques.  A night-time resting hand orthosis may provide more comfort for patients.