FESSH LisbonJune 2003 Early active motion following surgery in the spastic upper extremity WASEEM R SAEED FRCS (Plast) Consultant Plastic Reconstructive and Hand Surgeon JO DOWLEY (Senior Occupational Therapist) MICHELLE DOLAN (Physiotherapist) JOANNA BURDON (Occupational Therapist) THE HAND CLINIC ST JAMES’S UNIVERSITY HOSPITAL, LEEDS, UK

FESSH LisbonJune 2003 Early mobilisation of tendon repairs Established in flexor tendon surgery Leeds routine for extensors zones 3 – 7

FESSH LisbonJune 2003 Leeds cerebral palsy multidisciplinary team Detailed pre assessment Surgery Early active mobilisation Detailed post assessment at 12 months

FESSH LisbonJune 2003 Is early active mobilisation safe in surgery for upper extremity spasticity? Is early mobilisation more effective in surgery for upper extremity spasticity?

FESSH LisbonJune 2003 Patients 24 patients Mean age: 21y (range 6 – 57y) Mean follow up Wrist / finger:10 mths(1 – 28 mths) Thumb:6 mths(2 wk – 24 mths) Cerebral palsy17 Others7

FESSH LisbonJune 2003 Indications (57 procedures) Wrist (22 procedures) No extension14 Flexed + weak extension8 Finger (17 procedures) No extension10 Weak extension7 Thumb (18 procedures) Thumb-in-palm18

FESSH LisbonJune 2003 Procedures FCR to ECRB7 FDS to ECRB12 FCU to ECRB/L3 FDS to EDC17 Matev EPB APL9 FDS to EPB/APL6 Thumb others3

FESSH LisbonJune 2003 Regimen Wrist, fingers, thumb Day 1, removable OT splint Active and passive exercises Discard splint 4 – 6 weeks

FESSH LisbonJune 2003 Results: wrist (22 procedures) Correction maintained20 With useful active range13 Poor active range / immobile7 Failed2 Reoperations 2 –Tenolysis 1 –Arthrodesis1 Complications2

FESSH LisbonJune 2003 Results: fingers (17 procedures) Correction maintained With useful active range11 Poor active range / immobile6 Complications1

FESSH LisbonJune 2003 Results: thumb (18 procedures) Correction maintained14 With useful active range12 Failed4 Reoperations 2 (2) –BR to EPB1 –Considering / had arthrodesis3 Complications0

FESSH LisbonJune 2003 Complications (3 /24) RSD1 Wound infection 1 Haematoma (drained OPC)1 Ruptures0

FESSH LisbonJune 2003 Procedures and results FCR to ECRB77 FDS to ECRB125 FCU to ECRB/L31 FDS to EDC1711 Matev EPB APL98 FDS to EPB/APL62 Thumb others32

FESSH LisbonJune 2003 Conclusions The majority of corrections were maintained at the wrist and thumb Early mobilisation did not result in permanent complications These results suggest that early mobilisation is safe for the procedures used in this series