Relative motion extension management of zones V and VI extensor tendon repairs: Does international practice align with the current evidence?

Abstract

Electronic Web-based survey. Therapists participating in an international survey selected relative motion extension (RME) as the "most used" approach for the postoperative management of zones V and VI extensor tendon repairs. A subgroup of respondents identified RME as their preferred approach and were asked about their routine RME practices. The purpose of this study was to capture data from routine RME users about their practices and compare this with the RME evidence. An English-language survey was distributed to 36 International Federation of Societies for Hand Therapy full-member countries. Participation required therapists to have postsurgically managed at least one extensor tendon repair within the previous year. Those who selected RME as their "most used" approach were asked to identify which variation of the RME approach they favored: RME plus (with wrist orthosis), RME only, or "both" RME plus and RME only, and then were directed to additional questions related to their choice. Respondents from 28 International Federation of Societies for Hand Therapy full-member countries completed the survey. RME users (N = 368; 41.5% of sample) contributed to this secondary data. Respondents favored the RME variation "RME plus" (47%), followed by "both" (44%), then "RME only" (9%) with most managing single digit/simple injuries (n = 287, 81%) versus multiple digit/complex injuries (n = 96, 27%), and partial repairs (n = 278, 79%). Practices not aligning with limited level II-IV evidence includes half of RME only users not adding/substituting an overnight orthosis; use of RME plus versus RME only for both repairs of independent extensor tendons and repairs proximal to the juncturae tendinum; fabrication of three not four-finger orthotic design; and restricting use to only repairs of one or two fingers. RME plus and RME only are used interchangeably depending on surgeon preferences and patient/tendon factors. Compared with RME plus, from this survey, it appears that the RME only approach yields similar uncomplicated, early return of motion and hand function.