Biomechanical Study of Extensor Tendon Lacerations Over the Finger Metacarpophalangeal Joints

Over a 20-year period, six patients (19 tendons) underwent two-staged extensor tendon reconstruction using silicone rods followed by palmaris longus tendon grafts sutured proximally to the divided flexor carpi radialis tendon. All patients were young men (mean age, 22 years) who sustained the injury in car accidents. The soft tissue loss from the dorsum of the hand was associated with extensor tendon loss over the entire zone 6 with or without loss in zone 7. Primary soft tissue coverage was done elsewhere, and patients presented for secondary tendon reconstruction. All patients had supple metacarpophalangeal joints before reconstruction. After the two-staged tendon reconstruction, full or near-full active flexion at the metacarpophalangeal joints was obtained in all patients. However, minor extension lags (10°–15°) at the metacarpophalangeal joints were seen in 15 out of 19 reconstructed fingers.

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Traumatic index extensor tendon attenuation mimicking closed tendon rupture: two case reports

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03692-6 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Yusuke Miyashima ◽

Takuya Uemura ◽

Takuya Yokoi ◽

Shunpei Hama ◽

Mitsuhiro Okada ◽

...

Keyword(s):

High Speed ◽

Tendon Rupture ◽

Case Reports ◽

English Literature ◽

Extensor Tendon ◽

Sports Injury ◽

Tendon Graft ◽

Metacarpophalangeal Joints ◽

Extensor Indicis Proprius ◽

Tendon Ruptures

Abstract Background While some traumatic closed index extensor tendon ruptures at the musclotendinous junction have been previously reported, closed index extensor tendon pseudorupture due to intertendinous attenuation is exceedingly rare with only one case report of a gymnastics-related sports injury in the English literature. Herein, we report two non-sports injury related cases of traumatic index extensor tendon attenuation mimicking closed tendon rupture, including the pathological findings and intraoperative video of the attenuated extensor indicis proprius tendon. Case presentation A 28-year-old man and a 30-year-old man caught their hands in a high-speed drill and lathe, respectively, which caused a sudden forced flexion of their wrists. They could not actively extend the metacarpophalangeal joints of their index fingers. Intraoperatively, although the extensor indicis proprius and index extensor digitorum communes tendons were in continuity without ruptures, both tendons were attenuated and stretched. The attenuated index extensor tendons were reconstructed either with shortening by plication or step-cut when the tendon damage was less severe or, in severely attenuated tendons, with tendon grafting (ipsilateral palmaris longus) or tendon transfer. Six months after the operation, the active extension of the index metacarpophalangeal joints had recovered well. Conclusions Two cases of traumatic index extensor tendon attenuation were treated successfully by shortening the attenuated tendon in combination with tendon graft or transfer. We recommend WALANT (wide-awake local anesthesia and no tourniquet) in the reconstruction surgery of index extensor tendon attenuation to determine the appropriate amount of tendon shortening or optimal tension for tendon grafting or transfer. Intraoperative voluntary finger movement is essential, as it is otherwise difficult to judge the stretch length of intratendinous elongation and extent of traumatic intramuscular damage affecting tendon excursion.

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Peritenon Extensor Tendon Inflammation in Psoriatic Arthritis Is an Enthesitis-related Lesion

The Journal of Rheumatology ◽

10.3899/jrheum.180856 ◽

2019 ◽

Vol 46 (10) ◽

pp. 1295-1298 ◽

Cited By ~ 2

Author(s):

Cristina Macía-Villa ◽

Sandra Falcao ◽

Marwin Gutierrez ◽

Julio Medina ◽

Hilde Berner Hammer ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Outcome Measures ◽

Power Doppler ◽

Extensor Tendon ◽

Positive Correlation ◽

Metacarpophalangeal Joints

Objective.To analyze the association between enthesitis, synovitis, and peritenon extensor tendon inflammation (PTI) in psoriatic arthritis (PsA).Methods.PsA patients with swelling of metacarpophalangeal joints were included. Greyscale and power Doppler (PD) were used for synovitis and PTI ultrasound identification. Madrid Sonographic Enthesis Index (MASEI) was used for enthesitis assessment. PD activity was evaluated using PD item of MASEI and PD Outcome Measures in Rheumatology (OMERACT) definition.Results.Synovitis had no association with enthesitis. PTI was associated with PD MASEI and PD OMERACT. Only PD OMERACT showed a positive correlation with PTI.Conclusion.In PsA, PTI is associated to enthesitis, as opposed to synovitis.

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SPONTANEOUS ULNAR DISLOCATION OF THE INDEX, LONG, RING AND SMALL FINGER EXTENSOR TENDONS AT THE METACARPOPHALANGEAL JOINTS: A CASE REPORT

Hand Surgery ◽

10.1142/s0218810411005345 ◽

2011 ◽

Vol 16 (02) ◽

pp. 193-196 ◽

Cited By ~ 1

Author(s):

Katsuhisa Tanabe ◽

Takaya Nakajima ◽

Eiji Sogo

Keyword(s):

Rheumatoid Arthritis ◽

Congenital Anomaly ◽

Case Report ◽

Extensor Tendon ◽

Metacarpophalangeal Joint ◽

Extensor Digitorum ◽

Extensor Digitorum Communis ◽

Metacarpophalangeal Joints ◽

Extensor Tendons

Finger extensor tendon dislocation at the metacarpophalangeal joint is caused by various etiologies, such as trauma, congenital anomaly, or rheumatoid arthritis. When the dislocation occurs with no etiology, this is called spontaneous dislocation. Although spontaneous extensor tendon dislocation in one, two or three fingers has been described, to our knowledge, simultaneous dislocation in four fingers has not been reported. In this paper, we report a spontaneous ulnar dislocation of all the extensor tendons in the index, long, ring, and small fingers. Repair of the radial sagittal bands of the extensor digitorum communis of the middle and ring fingers reduced dislocation of all the extensor tendons in four fingers.

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Spontaneous Dislocation of the Extensor Tendons with Flexion and Ulnar Deviation Contracture of the Metacarpophalangeal Joint: A Case Report

Hand Surgery ◽

10.1142/s0218810403001376 ◽

2003 ◽

Vol 08 (01) ◽

pp. 97-101

Author(s):

Masaharu Makino

Keyword(s):

Case Report ◽

Extensor Tendon ◽

Metacarpophalangeal Joint ◽

Ulnar Deviation ◽

Metacarpophalangeal Joints ◽

Extensor Tendons ◽

Right Hand ◽

Intrinsic Muscles

A case with spontaneous extensor tendon dislocation was treated operatively. Right hand was more severely affected with contracture of the metacarpophalangeal joints. Centralisation of the extensor tendons and sectioning of ulnar intrinsic muscles sufficed correction of the pathology. No recurrence occurred in the last 24 months.

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The Role of Supinator in the Pathogenesis of Chronic Lateral Elbow Pain: A Biomechanical Study

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.06.001 ◽

2004 ◽

Vol 29 (5) ◽

pp. 461-464 ◽

Cited By ~ 31

Author(s):

S. ERAK ◽

R. DAY ◽

A. WANG

Keyword(s):

Tensile Force ◽

Balloon Catheter ◽

Extensor Tendon ◽

Biomechanical Study ◽

Extensor Digitorum ◽

Moderate Increase ◽

Extensor Digitorum Communis ◽

Lateral Epicondyle ◽

The Common ◽

Extensor Carpi Radialis

The relative contributions of the forearm extensors to the tensile force at the lateral epicondyle were examined by implanting a force transducer in the common extensor tendon of four soft fixed cadaver elbows and sequentially stretching each muscle arising from the lateral epicondye. Extensor carpi radialis brevis and extensor digitorum communis produced the largest increases while the superficial head of supinator produced a moderate increase in tensile force in the common extensor tendon. Extensor carpi radialis longus and extensor carpi ulnaris had no significant effect. Radial tunnel pressure was measured using a balloon catheter in a separate study of five cadaver elbows. Radial tunnel pressure increased on moving the wrist from neutral to a flexion–pronation position. This positional rise in pressure was reduced by supinator musculotendinous lengthening (77%) while lengthening of the extensor carpi radialis brevis and extensor digitorum communis had no effect. This study demonstrates a biomechanical basis for the superficial head of supinator in the aetiology of both lateral epicondylitis and radial tunnel syndrome.

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Extensor Tendon Transfers for Treatment of Foot Drop in Charcot-Marie-Tooth Disease: A Biomechanical Evaluation

Foot & Ankle International ◽

10.1177/1071100719901119 ◽

2020 ◽

Vol 41 (4) ◽

pp. 449-456

Author(s):

Glenn B. Pfeffer ◽

Max Michalski ◽

Trevor Nelson ◽

Tonya W. An ◽

Melodie Metzger

Keyword(s):

Tibialis Anterior Muscle ◽

Extensor Tendon ◽

Biomechanical Study ◽

Ankle Dorsiflexion ◽

Foot Drop ◽

Optical Data ◽

Primary Role ◽

Tendon Transfers ◽

Charcot Marie Tooth ◽

Intact State

Background: In Charcot-Marie-Tooth (CMT) disease, selective weakness of the tibialis anterior muscle often leads to recruitment of the long toe extensors as secondary dorsiflexors, with subsequent clawing of the toes. Extensor hallucis longus (EHL) and extensor digitorum longus (EDL) tendon transfers offer the ability to augment ankle dorsiflexion and minimize claw toe deformity. The preferred site for tendon transfer remains unknown. Our goal was to quantify ankle dorsiflexion in the “intact” native tendon state, compared with tendon transfers to the metatarsal necks or the cuneiforms. We hypothesized that EHL and EDL transfers would improve ankle dorsiflexion as compared with the intact state and would produce similar motion when anchored at the metatarsal necks or cuneiforms. Methods: Eight fresh-frozen cadaveric specimens transected at the midtibia were mounted into a specialized jig with the ankle held in 20 degrees of plantarflexion. The EHL and EDL tendons were isolated and connected to linear actuators with suture. Diodes secured on the first metatarsal, fifth metatarsal, and tibia provided optical data for tibiopedal position in 3 dimensions. After preloading, the tendons were tested at 25%, 50%, 75%, and 100% of maximal physiologic force for the EHL and EDL muscles, individually and combined. Results: Transfers to metatarsal and cuneiform locations significantly improved ankle dorsiflexion compared with the intact state. No difference was observed between these transfer sites. Following transfer, only 25% of maximal force by combined EHL and EDL was required to achieve a neutral foot position. Conclusion: Transfer of the long toe extensors, into either the metatarsals or cuneiforms, significantly increased dorsiflexion of the ankle. Clinical Relevance: The transferred extensors can serve a primary role in treating foot drop in CMT disease, irrespective of the presence of clawed toes. This biomechanical study supports tendon transfers into the cuneiforms, which involves less time, fewer steps, and easier tendon balancing without compromising dorsiflexion power.

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A Biomechanical Study of Extensor Tendon Repair Methods: Introduction to the Running-Interlocking Horizontal Mattress Extensor Tendon Repair Technique

Yearbook of Orthopedics ◽

10.1016/s0276-1092(10)79777-7 ◽

2010 ◽

Vol 2010 ◽

pp. 194-196

Author(s):

S.D. Trigg

Keyword(s):

Tendon Repair ◽

Extensor Tendon ◽

Biomechanical Study ◽

Repair Technique

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A Biomechanical Study of Extensor Tendon Repair Methods: Introduction to the Running-Interlocking Horizontal Mattress Extensor Tendon Repair Technique

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2009.09.011 ◽

2010 ◽

Vol 35 (1) ◽

pp. 19-23 ◽

Cited By ~ 31

Author(s):

Steve K. Lee ◽

Ashok Dubey ◽

Byung H. Kim ◽

Alissa Zingman ◽

Josh Landa ◽

...

Keyword(s):

Tendon Repair ◽

Extensor Tendon ◽

Biomechanical Study ◽

Repair Technique

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Locking of the Proximal Interphalangeal Joint of the Little Finger

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2001.0573 ◽

2001 ◽

Vol 26 (4) ◽

pp. 389-390 ◽

Cited By ~ 1

Author(s):

C. H. COSTELLO ◽

D. G. K. LAM ◽

H. P. GIELE

Keyword(s):

Extensor Tendon ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Metacarpophalangeal Joints ◽

Little Finger

Locking of the metacarpophalangeal joints is well documented, but locking of other joints in the finger has not been described. We present a case of locking of the little finger proximal interphalangeal joint due to an osteophyte impinging on the extensor tendon.

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