From the Guidelines
Extensor tendon subluxation treatment should be done with a splint for 2 to 4 weeks postoperatively, allowing for mobilization and limiting dorsiflexion to protect the repair. This recommendation is based on the study by 1, which suggests the use of a protective device that allows mobilization by 2 to 4 weeks postoperatively, graded as Moderate. The study found that patients in the mobilization group had a splint or modified cast device that limited dorsiflexion to protect the repair, and all five level II studies randomized the patients into two groups, with either 6 weeks in a cast or early motion with a modified splint device.
Some key points to consider when treating extensor tendon subluxation include:
- Immobilizing the affected finger in a custom-made or prefabricated splint with the metacarpophalangeal (MCP) joint flexed at approximately 15-30 degrees to maintain proper tendon alignment
- Avoiding activities that could cause the tendon to subluxate again during the immobilization period
- Starting a gradual rehabilitation program after the initial immobilization period, with gentle active range of motion exercises while avoiding positions that might cause re-subluxation
- Considering surgical intervention if conservative treatment fails after 3 months, which could involve reconstruction of the sagittal bands or creation of a soft tissue pulley to stabilize the tendon, as noted in the general treatment of extensor tendon subluxation, although not specifically addressed in the study by 1.
The goal of treatment is to allow the torn or stretched sagittal bands to heal in the proper position, preventing the tendon from slipping to the side of the joint during finger movement, and the study by 1 provides evidence for the use of a protective device that allows mobilization by 2 to 4 weeks postoperatively.
From the Research
Extensor Tendon Subluxation Treatment Time in Splint
- The treatment time for extensor tendon subluxation using a splint can vary depending on the severity of the injury and the individual patient's response to treatment 2.
- A study published in 2006 found that patients with acute sagittal band injuries treated with a customized splint had an average follow-up period of 14 months, with all patients having full range of motion in flexion and extension at the time of final evaluation 2.
- Another study published in 2011 reported a case of an acute traumatic extensor carpi ulnaris tendon subluxation treated with a short-arm cast for 4 weeks, followed by a long-arm cast for an additional 4 weeks, and then a rigid wrist brace for 3 weeks 3.
- A systematic review published in 2021 found that acute sagittal band injuries can be successfully treated by splinting the injured digit in neutral or hyperextension, but noted that the variability in reported outcome measures precluded meta-analysis 4.
Treatment Duration
- The duration of treatment with a splint can range from several weeks to several months, depending on the severity of the injury and the individual patient's response to treatment 2, 3.
- A study published in 2006 reported that patients treated with a customized splint wore the splint for an average of 6-8 weeks 2.
- Another study published in 2011 reported that the patient wore a rigid wrist brace for 3 weeks after being treated with a short-arm and long-arm cast 3.