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Selective release of the digital extensor hood to reduce intrinsic tightness in tetraplegia.

Reinholdt C, Fridén J - J Plast Surg Hand Surg (2011)

Bottom Line: Long fingers were consistently the most affected digits.The intrinsic tightness was released completely in all patients and the range of motion (ROM) was improved by 25%, and up to 45% in mild and severe cases, respectively.The good immediate effects of treatment as shown by increased ROM remained intact by 6 months postoperatively.

View Article: PubMed Central - PubMed

Affiliation: National Center of Reconstructive Hand Surgery in Tetraplegia, Department of Hand Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. carina.reinholdt@vgregion.se

ABSTRACT
Patients with tetraplegia may have various degrees of spasticity in the hand ranging from a completely clenched fist to reduced control of grip at triggered spasticity. The objective of the present study was to evaluate the functional effect of the distal ulnar intrinsic release procedure to reduce intrinsic tightness. Seventeen patients with tetraplegia (37 fingers) and with prominent intrinsic tightness were operated on for distal intrinsic release with a modification of the procedure to include only the ulnar side of the proximal phalanx. All the patients had more pronounced tightness on the ulnar than on the radial side of the affected finger. Long fingers were consistently the most affected digits. The intrinsic tightness was released completely in all patients and the range of motion (ROM) was improved by 25%, and up to 45% in mild and severe cases, respectively. The good immediate effects of treatment as shown by increased ROM remained intact by 6 months postoperatively. These data suggest that the distal ulnar intrinsic release procedure is a simple and valuable way of reducing intrinsic tightness and improving hand function and grip for patients with intrinsic tightness. This procedure can be added to other procedures such as lengthening and transfer of tendons.

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Related in: MedlinePlus

Mean (SD) passive range of motion of the PIP joints preoperatively compared with 6 months postoperatively in the mild group. There was a significant increase in the range of motion for the long finger. Red = before, and blue = after, operation.
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fig6: Mean (SD) passive range of motion of the PIP joints preoperatively compared with 6 months postoperatively in the mild group. There was a significant increase in the range of motion for the long finger. Red = before, and blue = after, operation.

Mentions: At follow-up 1, 3, and 6 months postoperatively, range of motion for all fingers was maintained at the immediate postoperative level or slightly increased (Figure 4). All patients logged their training sessions and the use of the splint according to the protocol. At 6 months follow-up, those with severe tightness responded with significant increases in the range of motion postoperatively for the long (p = 0.019) and ring (p = 0.037) fingers (Figure 5). The increases in the range of motion (ROM) were 35° and 45° for the long and ring fingers, respectively. In the mild cases, a significant difference was found for the long finger; it increased its ROM from 65° to 90° (p < 0.05, Figure 6).


Selective release of the digital extensor hood to reduce intrinsic tightness in tetraplegia.

Reinholdt C, Fridén J - J Plast Surg Hand Surg (2011)

Mean (SD) passive range of motion of the PIP joints preoperatively compared with 6 months postoperatively in the mild group. There was a significant increase in the range of motion for the long finger. Red = before, and blue = after, operation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3104283&req=5

fig6: Mean (SD) passive range of motion of the PIP joints preoperatively compared with 6 months postoperatively in the mild group. There was a significant increase in the range of motion for the long finger. Red = before, and blue = after, operation.
Mentions: At follow-up 1, 3, and 6 months postoperatively, range of motion for all fingers was maintained at the immediate postoperative level or slightly increased (Figure 4). All patients logged their training sessions and the use of the splint according to the protocol. At 6 months follow-up, those with severe tightness responded with significant increases in the range of motion postoperatively for the long (p = 0.019) and ring (p = 0.037) fingers (Figure 5). The increases in the range of motion (ROM) were 35° and 45° for the long and ring fingers, respectively. In the mild cases, a significant difference was found for the long finger; it increased its ROM from 65° to 90° (p < 0.05, Figure 6).

Bottom Line: Long fingers were consistently the most affected digits.The intrinsic tightness was released completely in all patients and the range of motion (ROM) was improved by 25%, and up to 45% in mild and severe cases, respectively.The good immediate effects of treatment as shown by increased ROM remained intact by 6 months postoperatively.

View Article: PubMed Central - PubMed

Affiliation: National Center of Reconstructive Hand Surgery in Tetraplegia, Department of Hand Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. carina.reinholdt@vgregion.se

ABSTRACT
Patients with tetraplegia may have various degrees of spasticity in the hand ranging from a completely clenched fist to reduced control of grip at triggered spasticity. The objective of the present study was to evaluate the functional effect of the distal ulnar intrinsic release procedure to reduce intrinsic tightness. Seventeen patients with tetraplegia (37 fingers) and with prominent intrinsic tightness were operated on for distal intrinsic release with a modification of the procedure to include only the ulnar side of the proximal phalanx. All the patients had more pronounced tightness on the ulnar than on the radial side of the affected finger. Long fingers were consistently the most affected digits. The intrinsic tightness was released completely in all patients and the range of motion (ROM) was improved by 25%, and up to 45% in mild and severe cases, respectively. The good immediate effects of treatment as shown by increased ROM remained intact by 6 months postoperatively. These data suggest that the distal ulnar intrinsic release procedure is a simple and valuable way of reducing intrinsic tightness and improving hand function and grip for patients with intrinsic tightness. This procedure can be added to other procedures such as lengthening and transfer of tendons.

Show MeSH
Related in: MedlinePlus