Postoperative mobilization regimens following digital nerve repair: a systematic review

Currently there is a multiplicity of postoperative mobility-based rehabilitation protocols following isolated digital nerve repair. The regime chosen appears to be dependent on the preference of the surgeon and unit rather than being evidence based. We aim to systematically review the current evidence to provide an insight toward formulating guidelines for best practice.

The study was carried out in accordance to the PRISMA statement for systematic reviews. Medline, Embase, CINAHL, Google Scholar, and Cochrane databases were searched from inception to June 2013. Key search terms used were as follows: "digital nerve," "rehabilitation," "mobilization/mobilization," "immobilization/immobilization," "splinting," "non-splinting," "brace," "repair," and "coaptation."

Four studies met the inclusion criteria and compared 2 of 3 regimens: complete immobilization, protected mobilization, and free mobilization. The primary outcome measured sensibility via 2-point discrimination and Semmes-Weinstein monofilament testing. There was no statistically significant difference in sensibility between either of the regimens. Secondary outcome measures included subjective measures such as cold intolerance and hyperesthesia, which also showed no significant difference between protocols. One study found that stiffness was increased, and return to work delayed, when a splinting protocol was employed.

Current evidence suggests that all 3 protocols are equivalent in their outcomes. The stiffness and delayed return to work associated with splinting protocols indicate that free mobilization protocols may have an advantage over them. However, the limitations of current evidence mean that the hand surgeon and therapist should choose a regimen from those discussed earlier, which is tailored to the needs of each individual patient until further evidence is gathered.