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Tendon injuries of the hand managed by occupational therapists and physiotherapists in South Africa (SA) can be difficult as they often respond poorly to treatment and therefore require prolonged rehabilitation1. Extensor tendon injuries can cause significant impairment, yet the assessment and management of these injuries have not been widely reviewed in comparison to flexor tendon injuries2,3,4. These injuries may be challenging to manage due to the complex anatomy of the extensors as any minimum discrepancies in tendon length and tension can cause significant functional deficits following injury and repair5. In addition to the complex anatomy, there are various contextual factors within SA that makes rehabilitation of upper limb injuries different to that of developed countries6. As a result, this may influence the rehabilitation of extensor tendon repairs. Rehabilitation programmes for extensor tendon repairs can be perplexing, making it difficult for occupational therapists striving towards excellence in clinical practice7. Post-operative rehabilitation programmes include immobilisation (IM), early passive motion (EPM) and early active motion (EAM)7,8 and more recently the Immediate Controlled Active Motion (ICAM) splint programme to manage extensor tendon repairs from zone IV to VII9. The ICAM splint comprises of a wrist extension splint positioning the wrist in 20°-25° extension and a yoke positioning the MCPJ’s in 15°-20° of relative hyperextension9 (Figure 1 on page 24). This technique protects the repaired tendon by decreasing the tension on it and positioning the injured digit in relative hyperextension to the uninjured digits through the use of the yoke splint9. A study conducted in the United States of America (USA) showed that the ICAM splint produced 96 percent ‘excellent’ and 93 percent ‘good’ results according to The use of the ICAM Splint Programme in Zone IV to VII Extensor Tendon Repairs: Patient outcomes and clinician experiences in a specialised hand unit in SA

south african journal of occupational therapy

The use of the ICAM Splint Programme in Zone IV to VII Extensor Tendon Repairs: Patient outcomes and clinician experiences in a specialised hand unit in SA