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Management of a Patient With Lacerations of the Tendons of the Extensor Digitorum and Extensor Indicis Muscles to the Index Finger

KR Flowers, PT, CHT, is Director, Valley Forge Hand Rehabilitation, NovaCare, Radnor, Pa 19087.
PW McClure, PT, OCS, is Assistant Professor, Department of Physical Therapy (MS 502), Medical College of Pennsylvania and Hahnemann University, Broad and Vine Sts, Philadelphia, PA 19102 (USA) (mmclurep@hal.hahnemann.edu).
C McFadden, OTR, is Occupational Therapist, Pottstown Medical Center, Pottstown, PA 19102.

The purpose of this report is to describe the management of a 30-year-old male truck driver following a zone-VI (metacarpal level) laceration of the tendons of the extensor digitorum and extensor indicis muscles to the index finger. Surgical repair was performed 6 days after the injury and was followed by a 32-day period of short-arm cast immobilization. Physical therapy was begun immediately following cast removal. At about 8 to 10 days into the rehabilitation process, we became concerned about an increasing extensor lag (active extension less than passive extension), which affected the treatment program. We hypothesized that the scar at the tendon repair site had become excessively lengthened, and we therefore discontinued all flexion stretching and emphasized active extension. Additionally, we rested the joint in extension using a static splint except during exercise. As the patient's extensor lag improved, we increased the vigor of active extension exercise to promote tendon gliding and elongate restricting adhesions. The patient regained full range of motion and was able to return to work at full duty. The immobilization period implemented postoperatively in this case represents a traditional, conservative approach. The case emphasizes the need for careful monitoring and interpretation of both active and passive range of motion following tendon repair.

Key Words: Immobilization • Joints • Metacarpophalangeal joint • Muscle • Tendon injuries • Upper extremity, hand and wrist

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