Immediate controlled active motion following zone 4-7 extensor tendon repair

This article describes a splint management program for zone 4-7 extensor tendon repairs that allows for immediate controlled active motion (ICAM) of the repair and greater arcs of motion for adjacent digits. The splint is designed to relieve tension on the tenorrhaphy by positioning the involved digit in slight metacarpophalangeal joint hyperextension relative to the uninvolved digits with a simple yoke splint designed to control the metacarpophalangeal joints and a second splint to control wrist position. Cadaver and intraoperative trials support this technique, and 140 patient cases managed over 20 years. The majority of patients achieved a rating of excellent for both digital extension and flexion as judged by Miller's criteria. There were very few extension lags and no tendon ruptures. Patients returned to work in the ICAM splint on average in 18 days. The average time to complete the program was seven weeks after repair, and required an average of eight therapy visits. The results of this study demonstrate that the ICAM splinting technique is safe, simple to manage, decreases the morbidity associated with immobilization, is cost effective, and has high patient compliance when compared to other early motion programs.