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 De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidate...BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cadavers.Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally(7.03 mm and 13.36 mm).CONCLUSION An incision that measures 3 mm proximal from the radial styloid,2 cm radial from Lister’s tubercle,and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.展开更多
目的探究单腿站立姿势控制与踝跖屈肌力稳定性的相关性,为提升人体姿势控制能力提供新的理论依据。方法随机选取20名健康男性大学生作为实验对象。采用iBalance平衡测试仪与训练系统测试单腿站立的足底压力中心(center of pressure,COP...目的探究单腿站立姿势控制与踝跖屈肌力稳定性的相关性,为提升人体姿势控制能力提供新的理论依据。方法随机选取20名健康男性大学生作为实验对象。采用iBalance平衡测试仪与训练系统测试单腿站立的足底压力中心(center of pressure,COP)轨迹数据;采用CON-TREX MJ多关节等速测试与训练系统测试踝跖屈肌收缩期间的力矩振幅数据。采用单因素重复测量方差分析组间踝跖屈肌力矩振幅的标准偏差数据;采用Pearson相关系数进行相关性研究。结果踝跖屈肌执行的肌力稳定任务强度越大,力矩振幅的标准偏差越大;无干扰单腿站立下,C90面积与10%踝跖屈肌最大任意收缩(maximum voluntary contraction,MVC)力矩振幅的变异系数(coefficient of variation,CV)(r=0.761,P<0.05)呈正相关。干扰视觉单腿站立下,C90面积与30%踝跖屈肌MVC力矩振幅CV(r=0.632,P<0.05)呈正相关。干扰本体感觉单腿站立下,C90面积与20%踝跖屈肌MVC力矩振幅CV(r=0.583,P<0.05)呈正相关。结论随着踝跖屈肌执行的肌力稳定任务难度加大,肌力稳定性降低;踝跖屈肌力稳定性与单腿站立姿势控制能力存在正相关关系。相较于无干扰情况,在视觉、本体感觉干扰下,额外的信息传入减少或受到干扰,人体维持身体平衡的难度加大,踝跖屈肌需要更高发力模式下的肌力稳定性来参与人体单腿站立的姿势控制。展开更多
BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of t...BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.展开更多
This retrospective case study investigates the clinical presentation of a 53-year-old female who underwent mantle field radiotherapy roughly 26 years ago. This patient presents with diffuse muscle atrophy and weakness...This retrospective case study investigates the clinical presentation of a 53-year-old female who underwent mantle field radiotherapy roughly 26 years ago. This patient presents with diffuse muscle atrophy and weakness in the cervical musculature, as well as sensory deficits in the upper extremities. We sought to compare our patient’s symptoms with other patients who had been formally diagnosed with Dropped Head Syndrome (DHS) by reviewing the existing literature. We found that the clinical presentation under investigation was consistent with other patients who had received radiotherapy for Hodgkins’s disease and were then diagnosed with DHS. Electromyography (EMG), nerve conduction studies, and a cervical MRI were unable to identify a separate neurological cause for the symptoms, but the MRI did confirm the presence of diffuse muscle atrophy in the cervical musculature. After reviewing the existing literature and imaging results, we compared our patient’s symptoms to those that define DHS, and both the time of onset, presenting symptoms, and progressing course are consistent with a diagnosis of Dropped Head Syndrome.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 De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cadavers.Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally(7.03 mm and 13.36 mm).CONCLUSION An incision that measures 3 mm proximal from the radial styloid,2 cm radial from Lister’s tubercle,and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.
文摘目的探究单腿站立姿势控制与踝跖屈肌力稳定性的相关性,为提升人体姿势控制能力提供新的理论依据。方法随机选取20名健康男性大学生作为实验对象。采用iBalance平衡测试仪与训练系统测试单腿站立的足底压力中心(center of pressure,COP)轨迹数据;采用CON-TREX MJ多关节等速测试与训练系统测试踝跖屈肌收缩期间的力矩振幅数据。采用单因素重复测量方差分析组间踝跖屈肌力矩振幅的标准偏差数据;采用Pearson相关系数进行相关性研究。结果踝跖屈肌执行的肌力稳定任务强度越大,力矩振幅的标准偏差越大;无干扰单腿站立下,C90面积与10%踝跖屈肌最大任意收缩(maximum voluntary contraction,MVC)力矩振幅的变异系数(coefficient of variation,CV)(r=0.761,P<0.05)呈正相关。干扰视觉单腿站立下,C90面积与30%踝跖屈肌MVC力矩振幅CV(r=0.632,P<0.05)呈正相关。干扰本体感觉单腿站立下,C90面积与20%踝跖屈肌MVC力矩振幅CV(r=0.583,P<0.05)呈正相关。结论随着踝跖屈肌执行的肌力稳定任务难度加大,肌力稳定性降低;踝跖屈肌力稳定性与单腿站立姿势控制能力存在正相关关系。相较于无干扰情况,在视觉、本体感觉干扰下,额外的信息传入减少或受到干扰,人体维持身体平衡的难度加大,踝跖屈肌需要更高发力模式下的肌力稳定性来参与人体单腿站立的姿势控制。
文摘BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.
文摘This retrospective case study investigates the clinical presentation of a 53-year-old female who underwent mantle field radiotherapy roughly 26 years ago. This patient presents with diffuse muscle atrophy and weakness in the cervical musculature, as well as sensory deficits in the upper extremities. We sought to compare our patient’s symptoms with other patients who had been formally diagnosed with Dropped Head Syndrome (DHS) by reviewing the existing literature. We found that the clinical presentation under investigation was consistent with other patients who had received radiotherapy for Hodgkins’s disease and were then diagnosed with DHS. Electromyography (EMG), nerve conduction studies, and a cervical MRI were unable to identify a separate neurological cause for the symptoms, but the MRI did confirm the presence of diffuse muscle atrophy in the cervical musculature. After reviewing the existing literature and imaging results, we compared our patient’s symptoms to those that define DHS, and both the time of onset, presenting symptoms, and progressing course are consistent with a diagnosis of Dropped Head Syndrome.
