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Timely Rehabilitation for Extensor Tendon Repairs: The Burden of Delays
Victor T. Hung, M.D.
1, Tantien Nguyen, BS
2, Nicholas Bostrom, M.D.
3, Collin Chase, M.D.
3, Michael C Doarn, MD
4; James J. Creighton III, MD
5(1)Foundation for Orthopaedic Research and Education, Tampa, FL, (2)Foundation For Orthopaedic Research and Education, Tampa, FL, (3)USF Health Morsani College of Medicine, Tampa, FL, (4)Hand and Upper Extremity Surgery, Florida Orthopaedic Insititue, Tampa, FL, (5)Florida Orthopaedic Institute, Temple Terrace, FL
Introduction:Timely surgical repair followed by appropriate postoperative rehabilitation is crucial for restoring extensor tendon function in the upper extremity after injury. For this study, we hypothesized that 1) the complication and reoperation rates, as well as the overall surgical treatment cost will be lower for those with adequate post-op rehabilitation; 2) the functional outcomes will be more improved with those that underwent post-operative rehabilitation with a certified hand therapist (CHT) for extensor tendon repairs of the upper extremity.
Methods:109 patients who underwent surgical treatment for extensor tendon injuries were retrospectively reviewed (Table 1). Patients with surgical treatment in the thumb and zones 5-7 of the upper extremity were included, given the same timeline for the first phase (post-op day 0 to 21) of post-operative rehabilitation for these injuries at our institution (immediate controlled active motion protocol), which was how patients were categorized into three groups: adequate, delayed, and inadequate therapy groups. Patients with inadequate follow-up and those under 18 or over 89 years of age were excluded. We assessed the postoperative complications, need for additional surgery, associated costs, as well as the timeliness to the start of post-operative rehabilitation and improvement in QuickDASH score from baseline.
Results (Table 2):There were significantly higher rates of additional surgery due to complications and subsequent surgical costs for the delayed and inadequate therapy groups when compared to the adequate therapy group. There were no differences in the post-operative complication rates between all groups. The average time from surgery to the start of post-operative rehabilitation with a CHT was significantly lower for the adequate compared to the delayed group. The improvement in QuickDASH scores from baseline to the final follow-up was significantly higher for the adequate and the delayed groups versus the inadequate group, while the adequate and delayed groups were similar.
Conclusions:Adherence to appropriate post-operative rehabilitation guided by a CHT after extensor tendon injury treatment results in lower rates of repeat surgery and subsequently decreases the total surgical cost burden on patients and the healthcare system. Patients demonstrate improved outcomes with CHT-guided rehabilitation despite a delayed start after surgery.
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