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Early mobilisation of tendon repairs

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Early mobilisation of tendon repairs

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  1. Early active motion following surgery in the spastic upper extremityWASEEM R SAEED FRCS (Plast)Consultant Plastic Reconstructive and Hand SurgeonJO DOWLEY (Senior Occupational Therapist)MICHELLE DOLAN (Physiotherapist)JOANNA BURDON (Occupational Therapist)THE HAND CLINICST JAMES’S UNIVERSITY HOSPITAL, LEEDS, UK June 2003

  2. Early mobilisation of tendon repairs • Established in flexor tendon surgery • Leeds routine for extensors zones 3 – 7 June 2003

  3. Leeds cerebral palsymultidisciplinary team Detailed pre assessment Surgery Early active mobilisation Detailed post assessment at 12 months June 2003

  4. Is early active mobilisation safe in surgery for upper extremity spasticity? • Is early mobilisation more effective in surgery for upper extremity spasticity? June 2003

  5. Patients • 24 patients • Mean age: 21y (range 6 – 57y) • Mean follow up Wrist / finger: 10 mths (1 – 28 mths) Thumb: 6 mths (2 wk – 24 mths) • Cerebral palsy 17 • Others 7 June 2003

  6. Indications (57 procedures) • Wrist (22 procedures) • No extension 14 • Flexed + weak extension 8 • Finger (17 procedures) • No extension 10 • Weak extension 7 • Thumb (18 procedures) • Thumb-in-palm 18 June 2003

  7. Procedures • FCR to ECRB 7 • FDS to ECRB 12 • FCU to ECRB/L 3 • FDS to EDC 17 • Matev EPB APL 9 • FDS to EPB/APL 6 • Thumb others 3 June 2003

  8. Regimen • Wrist, fingers, thumb • Day 1, removable OT splint • Active and passive exercises • Discard splint 4 – 6 weeks June 2003

  9. Results: wrist (22 procedures) Correction maintained 20 • With useful active range 13 • Poor active range / immobile 7 • Failed 2 • Reoperations 2 • Tenolysis 1 • Arthrodesis 1 • Complications 2 June 2003

  10. Results: fingers (17 procedures) Correction maintained • With useful active range 11 • Poor active range / immobile 6 • Complications 1 June 2003

  11. Results: thumb (18 procedures) Correction maintained 14 • With useful active range 12 • Failed 4 • Reoperations 2 (2) • BR to EPB 1 • Considering / had arthrodesis 3 • Complications 0 June 2003

  12. Complications (3 /24) • RSD 1 • Wound infection 1 • Haematoma (drained OPC) 1 • Ruptures 0 June 2003

  13. Procedures and results • FCR to ECRB 7 7 • FDS to ECRB 12 5 • FCU to ECRB/L 3 1 • FDS to EDC 17 11 • Matev EPB APL 9 8 • FDS to EPB/APL 6 2 • Thumb others 3 2 June 2003

  14. Conclusions • The majority of corrections were maintained at the wrist and thumb • Early mobilisation did not result in permanent complications • These results suggest that early mobilisation is safe for the procedures used in this series June 2003

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