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
Objective:To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair.Methods:In this study,72 patients were selected fr...Objective:To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair.Methods:In this study,72 patients were selected from among patients who underwent flexor tendon rupture repair of the hand in Yancheng Third People’s Hospital from May 2018 to May 2020;the patients were randomly divided into the control group(routine hand rehabilitation training)and the experimental group(musculoskeletal ultrasound and targeted hand rehabilitation training based on examination results)by die roll,with 34 cases in each group;the hand rehabilitation of the two groups were compared.Results:The excellent and good rate of the total active motion(TAM)of the experimental group(94.44%)was significantly higher than that of the control group(69.44%)(P<0.05);before treatment,there was no significant difference in the diameter and degree of stenosis of the artery in the finger between the two groups(P>0.05);after treatment,the degree of stenosis and the diameter of the artery of the experimental group were significantly better than those of the control group(P<0.05).Conclusion:For patients treated with flexor tendon rupture repair of the hand,the use of musculoskeletal ultrasound in the rehabilitation process can significantly improve the functional recovery of the hand;therefore,it is worthy of in-depth research,promotion,and application in clinical rehabilitation.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
Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the t...Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.展开更多
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
Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients.Most injuries are open injuries to the flexor or extensor tendons,but less frequent in...Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients.Most injuries are open injuries to the flexor or extensor tendons,but less frequent injuries,e.g.,damage to the functional system tendon sheath and pulley or dull avulsions,also need to be considered.After clinical examination,ultrasound and magnetic resonance imaging have proved to be important diagnostic tools.Tendon injuries mostly require surgical repair,dull avulsions of the distal phalanges extensor tendon can receive conservative therapy.Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair.In the postoperative course offlexor tendon injuries,the principle of early passive movement is important to trigger an"intrinsic"tendon healing to guarantee a good outcome.Many substances were evaluated to see if they improved tendon healing;however,little evidence was found.Nevertheless,hyaluronic acid may improve intrinsic tendon healing.展开更多
Giant cell tumor of the tendon sheath is the second most common tumor of the hand often referred to as xanthoma. Histologically these tumors are composed of multinucleated giant cells, polyhedral histiocytes, fibrosis...Giant cell tumor of the tendon sheath is the second most common tumor of the hand often referred to as xanthoma. Histologically these tumors are composed of multinucleated giant cells, polyhedral histiocytes, fibrosis and hemosiderin deposits. Marginal excision of giant cell tumor of the tendon sheath is the treatment of choice. We present a case of xanthoma of flexor pollicis longus tendon presented as a single enlarging mass in volar aspect of left thumb. After clinical diagnosis, work-up is done with ultrasound, FNAC and excision biopsy.展开更多
The non-synovial part of the tendon of the profound digital flexor of rabbits was put into the knee joint cavity aseptically and the non-synovial tendon of the digital flexor of a human fetus was cultured with synovia...The non-synovial part of the tendon of the profound digital flexor of rabbits was put into the knee joint cavity aseptically and the non-synovial tendon of the digital flexor of a human fetus was cultured with synovial cells in vitro.It was found the non-synovial tendon of rabbits was covered with a sheet of membrane-like tissue exhibiting the morphological features of the synovial membrane and the implanted tendon was kept free in the joint cavity without adhesion to the surrounding tissues.The surface of the human non-synovial tendon was covered with a layer of synovial cells.It is concluded that synovialization of a nonsynovial tendon can be achieved either in an environment full of synovial fluid in vivo or through tissue culture in vitro.展开更多
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.
文摘Objective:To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair.Methods:In this study,72 patients were selected from among patients who underwent flexor tendon rupture repair of the hand in Yancheng Third People’s Hospital from May 2018 to May 2020;the patients were randomly divided into the control group(routine hand rehabilitation training)and the experimental group(musculoskeletal ultrasound and targeted hand rehabilitation training based on examination results)by die roll,with 34 cases in each group;the hand rehabilitation of the two groups were compared.Results:The excellent and good rate of the total active motion(TAM)of the experimental group(94.44%)was significantly higher than that of the control group(69.44%)(P<0.05);before treatment,there was no significant difference in the diameter and degree of stenosis of the artery in the finger between the two groups(P>0.05);after treatment,the degree of stenosis and the diameter of the artery of the experimental group were significantly better than those of the control group(P<0.05).Conclusion:For patients treated with flexor tendon rupture repair of the hand,the use of musculoskeletal ultrasound in the rehabilitation process can significantly improve the functional recovery of the hand;therefore,it is worthy of in-depth research,promotion,and application in clinical rehabilitation.
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Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.
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Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients.Most injuries are open injuries to the flexor or extensor tendons,but less frequent injuries,e.g.,damage to the functional system tendon sheath and pulley or dull avulsions,also need to be considered.After clinical examination,ultrasound and magnetic resonance imaging have proved to be important diagnostic tools.Tendon injuries mostly require surgical repair,dull avulsions of the distal phalanges extensor tendon can receive conservative therapy.Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair.In the postoperative course offlexor tendon injuries,the principle of early passive movement is important to trigger an"intrinsic"tendon healing to guarantee a good outcome.Many substances were evaluated to see if they improved tendon healing;however,little evidence was found.Nevertheless,hyaluronic acid may improve intrinsic tendon healing.
文摘Giant cell tumor of the tendon sheath is the second most common tumor of the hand often referred to as xanthoma. Histologically these tumors are composed of multinucleated giant cells, polyhedral histiocytes, fibrosis and hemosiderin deposits. Marginal excision of giant cell tumor of the tendon sheath is the treatment of choice. We present a case of xanthoma of flexor pollicis longus tendon presented as a single enlarging mass in volar aspect of left thumb. After clinical diagnosis, work-up is done with ultrasound, FNAC and excision biopsy.
文摘The non-synovial part of the tendon of the profound digital flexor of rabbits was put into the knee joint cavity aseptically and the non-synovial tendon of the digital flexor of a human fetus was cultured with synovial cells in vitro.It was found the non-synovial tendon of rabbits was covered with a sheet of membrane-like tissue exhibiting the morphological features of the synovial membrane and the implanted tendon was kept free in the joint cavity without adhesion to the surrounding tissues.The surface of the human non-synovial tendon was covered with a layer of synovial cells.It is concluded that synovialization of a nonsynovial tendon can be achieved either in an environment full of synovial fluid in vivo or through tissue culture in vitro.
