BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during ...BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during transfer.However,median nerve neuropathy has not been reported yet.We present a case of median nerve neuropathy caused by irritation of suture knots of the 4th FDS to the FPL tendon transfer with a review of the literature.CASE SUMMARY A 52-year-old male patient presented with paresthesia along median nerve distribution of right hand after tendon transfer.He complained of right thumb flexion limitation due to FPL function loss so authors performed the 4th FDS to FPL transfer using Pulvertaft weave technique.FPL function loss was due to adhesion resulting from repeated surgery of radius shaft.He had a history of radius shaft open fracture 9 years ago and nonunion 7 years ago.During surgery,FPL muscle was severely adhered and indistinguishable.However,tendon continuity remained intact.After tendon transfer,he experienced paresthesia along median nerve distribution upon movement of thumb.He was diagnosed with median nerve neuropathy caused by irritation of tendon suture knots.Exploration was then performed.The median nerve was irritated by suture knots of transferred tendon.Thus,knots were removed.Twelve months later,he demonstrated thumb flexion of 80°.Additionally,median nerve neuropathy symptoms fully resolved.CONCLUSION Median nerve neuropathy can occur after tendon transfer from irritation of suture knots.Covering knots using surrounding tissue is recommended.展开更多
Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent appr...Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent approaches favor early active mobilization with strong,multi-stranded core sutures to enhance outcomes.This study evaluated early active mobilization after eight-strand core repair in a tertiary care setting.Methods:In this prospective study,143 tendons from 30 patients who underwent surgery were followed up.The injured tendons were repaired using an eight-strand cross-locked cruciate technique with a double-stranded 4-0 suture,providing the tensile strength of eight strands with the same number of suture passes as in traditional four-core repairs,thereby reducing operative time without increasing bulk.Early active mobilization was initiated on postoperative day 2.The patients underwent digitally supervised physiotherapy and were monitored using a dedicated WhatsApp group,which enabled real-time guidance and compliance monitoring.The outcomes were measured in terms of total active motion,grip strength,pinch strength,time to return to work,postoperative pain,and complications.Results:Of the 30 patients,28(93.3%)had fair-to-excellent outcomes,whereas only 2(6.7%)had poor outcomes.Most patients(93.3%)returned to work within 12 weeks postoperatively.Four(13.3%)patients had complications,such as wound infection and skin necrosis.The patients showed significant changes in grip strength(45.2%)and pinch strength(70.7%)between weeks 8 and 12.No tendon ruptures were observed.Conclusion:The eight-core suturing technique used for flexor tendon repair withstood the forces of early active mobilization,which began on the second day after surgery,resulting in fair-to-excellent outcomes.It supports digitally supervised physiotherapy through app-based monitoring,enhancing patient compliance,and reducing reliance on in-person therapy sessions.This combination led to excellent functional recovery with minimal complications.展开更多
背景:随着生物力学、微创技术及再生医学的发展,手部肌腱修复技术不断创新,过去20年,研究关注传统修复技术的优化及新型修复材料应用,提高了手部肌腱修复效果与功能恢复水平。目的:通过文献计量学分析评估过去20年手部肌腱修复技术的全...背景:随着生物力学、微创技术及再生医学的发展,手部肌腱修复技术不断创新,过去20年,研究关注传统修复技术的优化及新型修复材料应用,提高了手部肌腱修复效果与功能恢复水平。目的:通过文献计量学分析评估过去20年手部肌腱修复技术的全球研究现状及发展趋势,识别研究热点及演变方向。方法:通过Web of Science核心合集数据库筛选2005-2024年手部肌腱修复领域的研究文献,采用文献计量学方法进行分析,数据通过Microsoft Excel整理,使用R语言Bibliometrix包分析出版趋势,使用VOSviewer可视化关键词共现及合作网络,CiteSpace用于识别研究热点及其时间演变。结果与结论:过去20年间,手部肌腱修复领域的研究呈现出波动增长趋势,其中美国、中国和欧洲为主要的研究贡献国家,美国在全球研究网络中占据中心地位。屈肌腱修复研究主要集中在生物力学和新修复材料的开发,而伸肌腱研究则重点关注术后功能恢复与复杂损伤修复。近年来,生物材料和再生医学逐渐成为研究热点,推动了精准医疗在肌腱修复中的应用。未来,跨学科合作与先进材料的结合将进一步优化手部肌腱修复技术。展开更多
We report a case of Ewings sarcoma(ES) involving the patella in a young female. ES of patella is a rare entity. The patient was presented with anterior knee pain and swelling arising from the patella. She was treated ...We report a case of Ewings sarcoma(ES) involving the patella in a young female. ES of patella is a rare entity. The patient was presented with anterior knee pain and swelling arising from the patella. She was treated with neoadjuvant chemotherapy followed by wide excision of the patella and reconstruction of the extensor mechanism using split tendoachilles auto graft. The patella is an uncommon site for primary or metastatic tumors of the bone. ES, though rare, should be included in the differential diagnosis of swellings arising from the patella. Auto graft from the tendoachilles is a good alternative for reconstructing the extensor mechanism of the knee.展开更多
Objective To study the objectivity and reliability of needle electromyography and nerve conduction for detection of musculus extensor digitorum brevis strength, which may provide a basis for establishing a quantitativ...Objective To study the objectivity and reliability of needle electromyography and nerve conduction for detection of musculus extensor digitorum brevis strength, which may provide a basis for establishing a quantitative detection of muscle strength in forensic clinical study. Methods Forty-four healthy people were enrolled as the subjects, and during toe dorsiflexion, the following items including needle electromyography indexes, motor unit potential(MUP) amplitude, MUP count, recruitment reaction type, and nerve conduction detection indexes, compound muscle action potential(CMAP) amplitude, CMAP latent period and motor nerve conduction velocity(MNCV), were simultaneously detected under the cooperation and disguise condition. Results Under the cooperation condition, regardless of the same operator or different operators, there were good test-retest reliabilities in MUP amplitude, CMAP amplitude, CMAP latent period and MNCV, while there were normal test-retest reliabilities in MUP count and recruitment reaction type and the repeatability of the same operator was slightly better than the repeatability between different operators. Under the disguise condition, test-retest reliabilities of MUP amplitude, CMAP amplitude, CMAP latent period and MNCV were relatively high, while test-retest reliabilities of MUP count and recruitment reaction type were relatively low. Conclusion There are good test-retest reliabilities in MUP amplitude, CMAP amplitude, CMAP latent period and MNCV, which can be conducive to comparison between different operators and results at various times; MUP count and recruitment reaction type, which can be easily affected by subjectivity of operators and examinees, can be used to differentiate whether an examinee disguises or not. The indexes used to objectively judge muscle strength remain to be further investigated.展开更多
Although the flexor pollicis longus is known to show the additional head of the origin, the occurrence of its additional tendons in the carpal tunnel are seldom reported. The presence of such additional tendons in the...Although the flexor pollicis longus is known to show the additional head of the origin, the occurrence of its additional tendons in the carpal tunnel are seldom reported. The presence of such additional tendons in the carpal tunnel cannot be overlooked during the radiological and surgical procedures in this region. Herein, we report a rare case of additional muscle belly of flexor pollicis longus. The additional muscle belly after a short course divided into three tendons. All three tendons entered the carpal tunnel along with flexor pollicis longus, passing deep to the flexor retinaculum. Within the carpal tunnel, two of these tendons fused and terminated by merging with the undersurface of the flexor retinaculum. The third tendon terminated by joining the flexor digitorum superficialis tendon for the index finger, in the palm. An additional slip of the first lumbrical muscle took origin from the third tendon of the additional muscle belly of flexor pollicis longus. Further, the embryological basis and clinical significance of current case is discussed.展开更多
The simultaneous traumatic rupture of the patellar tendon and the quadricipital tendon is a rare lesion entity. We report the case of a bipolar rupture of the extensor knee system in a young adult following sports tra...The simultaneous traumatic rupture of the patellar tendon and the quadricipital tendon is a rare lesion entity. We report the case of a bipolar rupture of the extensor knee system in a young adult following sports traumatism. Magnetic Resonance Imaging allowed the assessment of associated lesions. The management of this “floating” kneecap was surgical associated with rehabilitation. A functional assessment at 02 years of follow-up was performed. The functional prognosis is related on the one hand to the difficulties of positioning of the patella and on the other hand to the associated lesions (meniscus-ligamentous knee injuries).展开更多
Acute calcific tendinitis of the shoulder is a well-known condition, but it is rare in the hand or finger. It is often misdiagnosed when it occurs outside the shoulder. We report an unusual case of acute calcific tend...Acute calcific tendinitis of the shoulder is a well-known condition, but it is rare in the hand or finger. It is often misdiagnosed when it occurs outside the shoulder. We report an unusual case of acute calcific tendinitis of the flexor digitorum superficialis insertion of the 4th finger in a young female martial art athlete after minor trauma history, and discuss with a review of the literature.展开更多
Despite early cautions against the primary repair of zone II flexor tendon injuries, recent advances in surgical technique and suture materials have allowed such repairs to become commonplace. The 6-strand repair tech...Despite early cautions against the primary repair of zone II flexor tendon injuries, recent advances in surgical technique and suture materials have allowed such repairs to become commonplace. The 6-strand repair technique is rarely applied to the young pediatric population, however, to our knowledge, no English-language articles have described this method of primary repair in zone II of children less than 2 years old. A 13-month-old male presented flexor digitorum profundus repair after lacerating it in zone II on a sharp aluminum can. The tendon was repaired with a 6-strand technique, using a 4.0 Fiberloop for the core suture and 6.0 Prolene for the epitendinous suture. Approximately four months after surgery, the patient developed a palmar collection at the level of his middle phalanx and a serosanguinous sinus tract at the distal interphalangeal crease. During the revision surgery, the inspection of the repaired tendon revealed a small gap filled with scar tissue. There was no evidence of new fistula formation at his final visit one month after the second procedure. After the revision, the patient could move his digit with minimal loss of range of motion at the distal interphalangeal joints. Unfortunately, he was subsequently lost to follow up. This surgical technique was selected to provide a strong repair that would allow the early postoperative movement. In retrospect, a 6-strand repair with braided suture is not ideal in young children as the bulky suture can cause a foreign-body reaction and possibly extrude through the skin. Additionally, the immobilization with a long-arm cast remains a valuable tool after tendon repair in infants who cannot voluntarily restrict their movements.展开更多
Flexor tendon repair has conventionally been done by suturing techniques. However, in recent times, there have been attempts of using fibrous braided structures for the repair of ruptured tendons. In this regard, the ...Flexor tendon repair has conventionally been done by suturing techniques. However, in recent times, there have been attempts of using fibrous braided structures for the repair of ruptured tendons. In this regard, the numerical analysis of the flexural stiffness of a braided structure under bending moments is vital for understanding its capabilities in the repair of flexor tendons. In this paper, the bending deflection, curvature, contact stresses and flexural bending stiffness in the braided structure due to bending moments are simulated using Finite Element (FE) techniques. Three dimensional geometry and FE models of five sets of biaxial braided structures were developed using a python programming script. The FE models of the hybrid biaxial braids were imported into ABAQUS (v17) for post-processing and analysis. It was established that the braided fabric with largest braid angle, <em>θ</em> = 52.5<span style="white-space:nowrap;">°</span> had the highest flexural deflection while the lowest deflection was seen in the results of the braided structure with the least braid angle, <em>θ</em> = 38.5<span style="white-space:nowrap;">°</span>. The results in this study also portrayed that the curvature in biaxial braids will increase with a decrease in the angle between the braided yarns. This was also consistent with the change of bending angle of the biaxial structures under a bending moment. The deformation of the structures increased with increase in the braid angles. This implies that the flexural bending stiffness decreased with increase in braid angle. The stress limits during bending of the braided structures were established to be within the range that could be handled by flexor tendons during finger bending.展开更多
We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis(EPB) to fully hyperextend the thumb interphalangeal ...We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis(EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus(EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension.展开更多
BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anat...BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anatomic variants including split tendons and variations in tendon arrangement.AIM To characterize the anatomy of the EIP at the level of the extensor retinaculum,where tendon harvest is often performed,and share our preferred technique for EIP to EPL transfer.METHODS Twenty-nine fresh-frozen cadaveric forearms without history of forearm or hand injury or surgery were dissected.Tendon circumference and relationship of the EIP and extensor digitorum communis to the index(EDCI)at the metacarpophalangeal(MCP)joint and the distal extensor retinaculum were recorded.Distance from the distal extensor retinaculum to the EIP myotendinous junction was measured.RESULTS EIP was ulnar to the EDCI in 96.5%of specimens(28/29)at the distal edge of the extensor retinaculum.In the remaining specimen,EIP was volar to EDCI.Tendon circumference at the distal extensor retinaculum averaged(9.3 mm±1.7 mm)for EDCI and 11.1 mm(±2.7 mm)for EIP(P=0.0010).The tendon circumference at the index MCP joint averaged 11.0 mm(±1.7 mm)for EDCI and 10.6 mm(±2.1 mm)for EIP(P=0.33).EIP had a greater circumference in 76%(22/29)of specimens at the distal extensor retinaculum whereas EIP had a greater circumference in only 31%(9/29)of specimens at the MCP joint.CONCLUSION The EIP tendon is frequently ulnar to and greater in circumference than the EDCI at the distal extensor retinaculum,which can be taken into consideration for tendon transfers involving EIP.展开更多
<div style="text-align:justify;"> <strong>Background: </strong><span "="">To determine whether muscle contraction-induced leg blood flow (LBF) during exercise may be al...<div style="text-align:justify;"> <strong>Background: </strong><span "="">To determine whether muscle contraction-induced leg blood flow (LBF) during exercise may be altered in a patient with an ischemic limb due to peripheral arterial disease (PAD) compared with the non-PAD limb. <b>Case Presentation: </b>A 66-year-old male patient with intermittent claudication due to PAD in the right leg (ankle brachial pressure index, 0.69) showed complete obstruction in both common iliac arteries including internal/external segments with collaterals above the femoral artery and popliteal artery with collaterals, and in the healthy left non-PAD-leg (1.06). He attempted unilateral repeat isometric knee extensions at a target contraction rhythm with each leg at incremental contraction intensities (5%, 10%, and 30% of maximum voluntary contraction [MVC] for 3 min at each intensity). Blood velocity/flow (Doppler ultrasound) in the femoral artery, blood pressure, and leg vascular conductance (LVC) were measured. Isometric thigh MVC strength pre-exercise was similar between the PAD-leg (48.0 kg) and non-PAD-leg (48.7 kg). Pre-exercise LBF (ml/min) was also similar between the PAD-leg (316) and non-PAD-leg (327). Blood pressure increases were similar during exercise. Average exercising LBF in ml/min in the last 1 min at each intensity was higher in the PAD-leg than the non-PAD-leg: 1087 vs. 471 at 5%, 2097 vs. 712 at 10%, and 2656 vs. 1517 at 30% MVC with a close positive linear relationship between LBF and %MVC in the non-PAD-leg (r = 0.999, P</span> <span "="">< 0.01), in agreement with previous findings, but less significant in the PAD-leg (r = 0.879, P = NS), indicating intense vasodilation (increasing LVC) in the PAD-leg compared with the non-PAD-leg. <b>Conclusion: </b>Knee extensor exercising LBF in the femoral artery was dissimilar between the PAD-leg and non-PAD-leg at the same exercise intensity, even though pre-exercising LBF was the same. Further research on the time-course in hemodynamics during leg exercise in PAD might potentially provide insight for the cardiovascular adjustment in severity of arteriosclerosis, stenosis and/or collaterals reserve.</span> </div>展开更多
BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor te...BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported.Here,we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review.CASE SUMMARY A 48-year-old man who had been a rice-field farmer for 7–8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints.The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma.Exploratory surgery was performed,and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed,which was pathologically diagnosed as an osteochondroma.CONCLUSION One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.展开更多
文摘BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during transfer.However,median nerve neuropathy has not been reported yet.We present a case of median nerve neuropathy caused by irritation of suture knots of the 4th FDS to the FPL tendon transfer with a review of the literature.CASE SUMMARY A 52-year-old male patient presented with paresthesia along median nerve distribution of right hand after tendon transfer.He complained of right thumb flexion limitation due to FPL function loss so authors performed the 4th FDS to FPL transfer using Pulvertaft weave technique.FPL function loss was due to adhesion resulting from repeated surgery of radius shaft.He had a history of radius shaft open fracture 9 years ago and nonunion 7 years ago.During surgery,FPL muscle was severely adhered and indistinguishable.However,tendon continuity remained intact.After tendon transfer,he experienced paresthesia along median nerve distribution upon movement of thumb.He was diagnosed with median nerve neuropathy caused by irritation of tendon suture knots.Exploration was then performed.The median nerve was irritated by suture knots of transferred tendon.Thus,knots were removed.Twelve months later,he demonstrated thumb flexion of 80°.Additionally,median nerve neuropathy symptoms fully resolved.CONCLUSION Median nerve neuropathy can occur after tendon transfer from irritation of suture knots.Covering knots using surrounding tissue is recommended.
文摘Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent approaches favor early active mobilization with strong,multi-stranded core sutures to enhance outcomes.This study evaluated early active mobilization after eight-strand core repair in a tertiary care setting.Methods:In this prospective study,143 tendons from 30 patients who underwent surgery were followed up.The injured tendons were repaired using an eight-strand cross-locked cruciate technique with a double-stranded 4-0 suture,providing the tensile strength of eight strands with the same number of suture passes as in traditional four-core repairs,thereby reducing operative time without increasing bulk.Early active mobilization was initiated on postoperative day 2.The patients underwent digitally supervised physiotherapy and were monitored using a dedicated WhatsApp group,which enabled real-time guidance and compliance monitoring.The outcomes were measured in terms of total active motion,grip strength,pinch strength,time to return to work,postoperative pain,and complications.Results:Of the 30 patients,28(93.3%)had fair-to-excellent outcomes,whereas only 2(6.7%)had poor outcomes.Most patients(93.3%)returned to work within 12 weeks postoperatively.Four(13.3%)patients had complications,such as wound infection and skin necrosis.The patients showed significant changes in grip strength(45.2%)and pinch strength(70.7%)between weeks 8 and 12.No tendon ruptures were observed.Conclusion:The eight-core suturing technique used for flexor tendon repair withstood the forces of early active mobilization,which began on the second day after surgery,resulting in fair-to-excellent outcomes.It supports digitally supervised physiotherapy through app-based monitoring,enhancing patient compliance,and reducing reliance on in-person therapy sessions.This combination led to excellent functional recovery with minimal complications.
文摘背景:随着生物力学、微创技术及再生医学的发展,手部肌腱修复技术不断创新,过去20年,研究关注传统修复技术的优化及新型修复材料应用,提高了手部肌腱修复效果与功能恢复水平。目的:通过文献计量学分析评估过去20年手部肌腱修复技术的全球研究现状及发展趋势,识别研究热点及演变方向。方法:通过Web of Science核心合集数据库筛选2005-2024年手部肌腱修复领域的研究文献,采用文献计量学方法进行分析,数据通过Microsoft Excel整理,使用R语言Bibliometrix包分析出版趋势,使用VOSviewer可视化关键词共现及合作网络,CiteSpace用于识别研究热点及其时间演变。结果与结论:过去20年间,手部肌腱修复领域的研究呈现出波动增长趋势,其中美国、中国和欧洲为主要的研究贡献国家,美国在全球研究网络中占据中心地位。屈肌腱修复研究主要集中在生物力学和新修复材料的开发,而伸肌腱研究则重点关注术后功能恢复与复杂损伤修复。近年来,生物材料和再生医学逐渐成为研究热点,推动了精准医疗在肌腱修复中的应用。未来,跨学科合作与先进材料的结合将进一步优化手部肌腱修复技术。
文摘We report a case of Ewings sarcoma(ES) involving the patella in a young female. ES of patella is a rare entity. The patient was presented with anterior knee pain and swelling arising from the patella. She was treated with neoadjuvant chemotherapy followed by wide excision of the patella and reconstruction of the extensor mechanism using split tendoachilles auto graft. The patella is an uncommon site for primary or metastatic tumors of the bone. ES, though rare, should be included in the differential diagnosis of swellings arising from the patella. Auto graft from the tendoachilles is a good alternative for reconstructing the extensor mechanism of the knee.
文摘Objective To study the objectivity and reliability of needle electromyography and nerve conduction for detection of musculus extensor digitorum brevis strength, which may provide a basis for establishing a quantitative detection of muscle strength in forensic clinical study. Methods Forty-four healthy people were enrolled as the subjects, and during toe dorsiflexion, the following items including needle electromyography indexes, motor unit potential(MUP) amplitude, MUP count, recruitment reaction type, and nerve conduction detection indexes, compound muscle action potential(CMAP) amplitude, CMAP latent period and motor nerve conduction velocity(MNCV), were simultaneously detected under the cooperation and disguise condition. Results Under the cooperation condition, regardless of the same operator or different operators, there were good test-retest reliabilities in MUP amplitude, CMAP amplitude, CMAP latent period and MNCV, while there were normal test-retest reliabilities in MUP count and recruitment reaction type and the repeatability of the same operator was slightly better than the repeatability between different operators. Under the disguise condition, test-retest reliabilities of MUP amplitude, CMAP amplitude, CMAP latent period and MNCV were relatively high, while test-retest reliabilities of MUP count and recruitment reaction type were relatively low. Conclusion There are good test-retest reliabilities in MUP amplitude, CMAP amplitude, CMAP latent period and MNCV, which can be conducive to comparison between different operators and results at various times; MUP count and recruitment reaction type, which can be easily affected by subjectivity of operators and examinees, can be used to differentiate whether an examinee disguises or not. The indexes used to objectively judge muscle strength remain to be further investigated.
文摘Although the flexor pollicis longus is known to show the additional head of the origin, the occurrence of its additional tendons in the carpal tunnel are seldom reported. The presence of such additional tendons in the carpal tunnel cannot be overlooked during the radiological and surgical procedures in this region. Herein, we report a rare case of additional muscle belly of flexor pollicis longus. The additional muscle belly after a short course divided into three tendons. All three tendons entered the carpal tunnel along with flexor pollicis longus, passing deep to the flexor retinaculum. Within the carpal tunnel, two of these tendons fused and terminated by merging with the undersurface of the flexor retinaculum. The third tendon terminated by joining the flexor digitorum superficialis tendon for the index finger, in the palm. An additional slip of the first lumbrical muscle took origin from the third tendon of the additional muscle belly of flexor pollicis longus. Further, the embryological basis and clinical significance of current case is discussed.
文摘The simultaneous traumatic rupture of the patellar tendon and the quadricipital tendon is a rare lesion entity. We report the case of a bipolar rupture of the extensor knee system in a young adult following sports traumatism. Magnetic Resonance Imaging allowed the assessment of associated lesions. The management of this “floating” kneecap was surgical associated with rehabilitation. A functional assessment at 02 years of follow-up was performed. The functional prognosis is related on the one hand to the difficulties of positioning of the patella and on the other hand to the associated lesions (meniscus-ligamentous knee injuries).
文摘Acute calcific tendinitis of the shoulder is a well-known condition, but it is rare in the hand or finger. It is often misdiagnosed when it occurs outside the shoulder. We report an unusual case of acute calcific tendinitis of the flexor digitorum superficialis insertion of the 4th finger in a young female martial art athlete after minor trauma history, and discuss with a review of the literature.
文摘Despite early cautions against the primary repair of zone II flexor tendon injuries, recent advances in surgical technique and suture materials have allowed such repairs to become commonplace. The 6-strand repair technique is rarely applied to the young pediatric population, however, to our knowledge, no English-language articles have described this method of primary repair in zone II of children less than 2 years old. A 13-month-old male presented flexor digitorum profundus repair after lacerating it in zone II on a sharp aluminum can. The tendon was repaired with a 6-strand technique, using a 4.0 Fiberloop for the core suture and 6.0 Prolene for the epitendinous suture. Approximately four months after surgery, the patient developed a palmar collection at the level of his middle phalanx and a serosanguinous sinus tract at the distal interphalangeal crease. During the revision surgery, the inspection of the repaired tendon revealed a small gap filled with scar tissue. There was no evidence of new fistula formation at his final visit one month after the second procedure. After the revision, the patient could move his digit with minimal loss of range of motion at the distal interphalangeal joints. Unfortunately, he was subsequently lost to follow up. This surgical technique was selected to provide a strong repair that would allow the early postoperative movement. In retrospect, a 6-strand repair with braided suture is not ideal in young children as the bulky suture can cause a foreign-body reaction and possibly extrude through the skin. Additionally, the immobilization with a long-arm cast remains a valuable tool after tendon repair in infants who cannot voluntarily restrict their movements.
文摘Flexor tendon repair has conventionally been done by suturing techniques. However, in recent times, there have been attempts of using fibrous braided structures for the repair of ruptured tendons. In this regard, the numerical analysis of the flexural stiffness of a braided structure under bending moments is vital for understanding its capabilities in the repair of flexor tendons. In this paper, the bending deflection, curvature, contact stresses and flexural bending stiffness in the braided structure due to bending moments are simulated using Finite Element (FE) techniques. Three dimensional geometry and FE models of five sets of biaxial braided structures were developed using a python programming script. The FE models of the hybrid biaxial braids were imported into ABAQUS (v17) for post-processing and analysis. It was established that the braided fabric with largest braid angle, <em>θ</em> = 52.5<span style="white-space:nowrap;">°</span> had the highest flexural deflection while the lowest deflection was seen in the results of the braided structure with the least braid angle, <em>θ</em> = 38.5<span style="white-space:nowrap;">°</span>. The results in this study also portrayed that the curvature in biaxial braids will increase with a decrease in the angle between the braided yarns. This was also consistent with the change of bending angle of the biaxial structures under a bending moment. The deformation of the structures increased with increase in the braid angles. This implies that the flexural bending stiffness decreased with increase in braid angle. The stress limits during bending of the braided structures were established to be within the range that could be handled by flexor tendons during finger bending.
文摘We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis(EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus(EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension.
文摘BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anatomic variants including split tendons and variations in tendon arrangement.AIM To characterize the anatomy of the EIP at the level of the extensor retinaculum,where tendon harvest is often performed,and share our preferred technique for EIP to EPL transfer.METHODS Twenty-nine fresh-frozen cadaveric forearms without history of forearm or hand injury or surgery were dissected.Tendon circumference and relationship of the EIP and extensor digitorum communis to the index(EDCI)at the metacarpophalangeal(MCP)joint and the distal extensor retinaculum were recorded.Distance from the distal extensor retinaculum to the EIP myotendinous junction was measured.RESULTS EIP was ulnar to the EDCI in 96.5%of specimens(28/29)at the distal edge of the extensor retinaculum.In the remaining specimen,EIP was volar to EDCI.Tendon circumference at the distal extensor retinaculum averaged(9.3 mm±1.7 mm)for EDCI and 11.1 mm(±2.7 mm)for EIP(P=0.0010).The tendon circumference at the index MCP joint averaged 11.0 mm(±1.7 mm)for EDCI and 10.6 mm(±2.1 mm)for EIP(P=0.33).EIP had a greater circumference in 76%(22/29)of specimens at the distal extensor retinaculum whereas EIP had a greater circumference in only 31%(9/29)of specimens at the MCP joint.CONCLUSION The EIP tendon is frequently ulnar to and greater in circumference than the EDCI at the distal extensor retinaculum,which can be taken into consideration for tendon transfers involving EIP.
文摘<div style="text-align:justify;"> <strong>Background: </strong><span "="">To determine whether muscle contraction-induced leg blood flow (LBF) during exercise may be altered in a patient with an ischemic limb due to peripheral arterial disease (PAD) compared with the non-PAD limb. <b>Case Presentation: </b>A 66-year-old male patient with intermittent claudication due to PAD in the right leg (ankle brachial pressure index, 0.69) showed complete obstruction in both common iliac arteries including internal/external segments with collaterals above the femoral artery and popliteal artery with collaterals, and in the healthy left non-PAD-leg (1.06). He attempted unilateral repeat isometric knee extensions at a target contraction rhythm with each leg at incremental contraction intensities (5%, 10%, and 30% of maximum voluntary contraction [MVC] for 3 min at each intensity). Blood velocity/flow (Doppler ultrasound) in the femoral artery, blood pressure, and leg vascular conductance (LVC) were measured. Isometric thigh MVC strength pre-exercise was similar between the PAD-leg (48.0 kg) and non-PAD-leg (48.7 kg). Pre-exercise LBF (ml/min) was also similar between the PAD-leg (316) and non-PAD-leg (327). Blood pressure increases were similar during exercise. Average exercising LBF in ml/min in the last 1 min at each intensity was higher in the PAD-leg than the non-PAD-leg: 1087 vs. 471 at 5%, 2097 vs. 712 at 10%, and 2656 vs. 1517 at 30% MVC with a close positive linear relationship between LBF and %MVC in the non-PAD-leg (r = 0.999, P</span> <span "="">< 0.01), in agreement with previous findings, but less significant in the PAD-leg (r = 0.879, P = NS), indicating intense vasodilation (increasing LVC) in the PAD-leg compared with the non-PAD-leg. <b>Conclusion: </b>Knee extensor exercising LBF in the femoral artery was dissimilar between the PAD-leg and non-PAD-leg at the same exercise intensity, even though pre-exercising LBF was the same. Further research on the time-course in hemodynamics during leg exercise in PAD might potentially provide insight for the cardiovascular adjustment in severity of arteriosclerosis, stenosis and/or collaterals reserve.</span> </div>
文摘BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported.Here,we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review.CASE SUMMARY A 48-year-old man who had been a rice-field farmer for 7–8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints.The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma.Exploratory surgery was performed,and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed,which was pathologically diagnosed as an osteochondroma.CONCLUSION One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.
