Immediate active mobilization versus immobilization for opposition tendon transfer in the hand.

PURPOSE: To test the hypothesis that immediate postoperative active mobilization of the hand after opposition tendon transfer will achieve outcomes similar to those of the standard practice of cast immobilization.
METHODS: Five hands with isolated lower median nerve paralysis prospectively had opposition tendon transfer followed by immediate postoperative active mobilization for rehabilitation of the transfer. Historical records of 7 identical paralyses with opposition tendon transfers immobilized after surgery in a cast for 3 weeks were used for comparison. Outcomes were assessed by (1) the status of tendon transfer attachment to the thumb during immediate mobilization to detect tendon pullout, (2) the results of the opposition transfers for both groups using identical outcome measures (range of postoperative active abduction of the thumb, pinch pattern, pinch strength), and (3) comparison of the results from both groups.
RESULTS: There were no incidences of tendon pullout during immediate active mobilization of opposition tendon transfer. There were no differences in outcome between the 2 groups at late follow-up evaluations, with all opposition transfers achieving good results. Immediate postoperative active mobilization reduced rehabilitation time by an average of 19 days. An earlier return to activities of daily living was a further benefit to patients.
CONCLUSIONS: This study supports the hypothesis and suggests that similar outcomes can be achieved in reduced time by immediate active mobilization of opposition tendon transfer. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.