Dynamic Profundus Splint for Flexor Profundus Repair

HAND ◽  
1977 ◽  
Vol os-9 (3) ◽  
pp. 265-267 ◽  
Author(s):  
N. D. REIS
Keyword(s):  
Flexor Tendon ◽  
Suture Line ◽  
Metacarpophalangeal Joint ◽  
Mass Action ◽  
Flexor Digitorum Profundus ◽  
Joint Mobility ◽  
Full Extension ◽  
Joint Flexion ◽  
Flexor Digitorum ◽  
Distal Joint

Flexor profundus is a mass action muscle so that when we fully extend one finger including full extension of the distal joint the entire muscle is pulled distally. By fully flexing the injured or operated finger at the metacarpophalangeal joint and fully extending the adjacent fingers, flexor digitorum profundus of the operated finger is made so redundant as to abolish all tension at the suture line. The position of the operated finger: metacarpophalangeal joint flexion with interphalangeal joint extension is ideal for the preservation of joint mobility and therefore ideal for the restoration of movement when the repaired flexor tendon is mobilized. It is permissible to splint a healthy finger in full extension for three weeks.

Feasibility of Partial A2 and A4 Pulley Excision: Residual Pulley Strength

2000 ◽  
Vol 25 (1) ◽  
pp. 90-94 ◽  
Author(s):  
G. MITSIONIS ◽  
K. J. FISCHER ◽  
J. A. BASTIDAS ◽  
R. GREWAL ◽  
H. J. PFAEFFLE ◽  
...  
Keyword(s):  
Daily Living ◽  
Flexor Tendon ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Flexor Digitorum Profundus ◽  
Full Extension ◽  
Loading Tests ◽  
Flexor Digitorum ◽  
Functional Loading ◽  
Flexor Digitorum Profundus Tendon

We investigated residual digital flexor pulley strengths after 75% excision of the A2 and A4 pulleys. For direct pull-off tests, A2 and A4 pulleys from cadaveric fingers were tested by pulling on a loop of flexor digitorum profundus tendon through the pulley. For functional loading tests, fingers were positioned with the metacarpophalangeal joint flexed to 90° for A2 testing, and with the proximal interphalangeal joint in 90° flexion for A4 testing (with all other joints in full extension). Excision of 75% of A2 and A4 pulleys reduced pulley strengths determined by both testing methods. For the functional loading tests, which are more clinically relevant, mean tendon forces at failure after partial excision of A2 and A4 pulleys were 224 and 131 N respectively, which is sufficient to withstand flexor tendon forces expected during activities of daily living.

Differential Splintage for Flexor Tendon Rehabilitation: An Experimental Study of its Effect on Finger Flexion Strength

2005 ◽  
Vol 30 (2) ◽  
pp. 168-174 ◽  
Author(s):  
R. SAVAGE ◽  
M. G. PRITCHARD ◽  
M. THOMAS ◽  
R. G. NEWCOMBE
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Metacarpophalangeal Joint ◽  
Flexor Digitorum Profundus ◽  
Active Flexion ◽  
Finger Flexion ◽  
Middle Ring ◽  
Flexor Digitorum ◽  
Flexion Force ◽  
Flexion Strength

We conducted laboratory tests to investigate the possibility of partly de-powering flexor digitorum profundus with a view of reducing flexion force during active flexor tendon rehabilitation. We constructed a splint and applied tapes to the proximal segments of fingers to test the hypothesis that holding three fingers more extended than the other finger would reduce the flexion strength of the more flexed finger. The splint allowed the metacarpophalangeal joint of the more flexed finger to be held in three positions of increasing flexion (15°, 30°, and 45°) compared to the remaining three fingers. We have called this ‘differential splintage’. Healthy volunteers were tested for maximum active flexion strength at the different flexion angles. ‘Differential splintage’ of up to 45° resulted in mean decreased flexion strength of 28% in the index finger and 35% to 38% in the middle, ring and little fingers. The results suggest that “differential splintage” of a finger after flexor tendon repair may be useful in reducing tension across the repair during a program of active tendon rehabilitation and we feel that it has potential to reduce the incidence of repair rupture before healing is complete.

Flexor Tendon Blood Vessels

2000 ◽  
Vol 25 (6) ◽  
pp. 552-559 ◽  
Author(s):  
M. E. JONES ◽  
K. LADHANI ◽  
V. MUDERA ◽  
A. O. GROBBELAAR ◽  
D. A. MCGROUTHER ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Metacarpophalangeal Joint ◽  
Cross Reactivity ◽  
Flexor Digitorum Profundus ◽  
Human Antibody ◽  
Cross Sectional ◽  
Endothelial Cell Surface ◽  
Avascular Zone ◽  
Quantitative Manner ◽  
Flexor Digitorum

The aim of this study was to assess rabbit long flexor tendon vascularity in a qualitative and quantitative manner using immunohistochemistry. The endothelial cell surface marker CD31 was targeted with a specific monoclonal mouse-anti-human antibody with good species cross-reactivity. Subsequent signal amplification and chromogen labelling allowed vessel visualization. Computer image analysis was performed. Values for vessel number and total vessel area per section, as well as the sections’ cross-sectional tendon areas, were obtained. There was a consistent deep tendon avascular zone between the A2 and A4 pulley in the rabbit forepaw. This was not the case in the hindpaw, with dorsally orientated longitudinal vessels coursing the length of the intrasynovial tendon. The area of least vascularity in the hindpaw was around the metacarpophalangeal joint. We therefore recommend the use of hindpaw tendons when using the rabbit as a flexor tendon experimental model. This is because its vascular pattern is similar to that of the human flexor digitorum profundus.

Comparison of a multifilament stainless steel suture with FiberWire for flexor tendon repairs — an in vitro biomechanical study

2012 ◽  
Vol 38 (4) ◽  
pp. 418-423 ◽  
Author(s):  
E. McDonald ◽  
J. A. Gordon ◽  
J. M. Buckley ◽  
L. Gordon
Keyword(s):  
Mechanical Properties ◽  
Stainless Steel ◽  
Ultimate Load ◽  
Flexor Tendon ◽  
Biomechanical Study ◽  
Flexor Digitorum Profundus ◽  
Human Cadaver ◽  
Mode Of Failure ◽  
Flexor Digitorum

Our goal was to investigate and compare the mechanical properties of multifilament stainless steel suture (MFSS) and polyethylene multi-filament core FiberWire in flexor tendon repairs. Flexor digitorum profundus tendons were repaired in human cadaver hands with either a 4-strand cruciate cross-lock repair or 6-strand modified Savage repair using 4-0 and 3-0 multifilament stainless steel or FiberWire. The multifilament stainless steel repairs were as strong as those performed with FiberWire in terms of ultimate load and load at 2 mm gap. This study suggests that MFSS provides as strong a repair as FiberWire. The mode of failure of the MFSS occurred by the suture pulling through the tendon, which suggests an advantage in terms of suture strength.

OUTCOME OF TRACTION TENOLYSIS IN OPEN TRIGGER FINGER RELEASE — A RETROSPECTIVE REVIEW

Hand Surgery ◽  
2013 ◽  
Vol 18 (03) ◽  
pp. 375-379 ◽  
Author(s):  
Muntasir Mannan Choudhury ◽  
Shian Chao Tay
Keyword(s):  
Flexor Tendon ◽  
Group Versus ◽  
Trigger Finger ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Active Motion ◽  
Total Active Motion ◽  
The Mean ◽  
Flexor Digitorum ◽  
A1 Pulley

Surgical treatment for trigger finger involves division of the A1 pulley. Some surgeons perform an additional step of traction tenolysis by sequentially bringing the flexor digitorum superficialis and flexor digitorum profundus tendons out of the wound gently with a Ragnell retractor. There is currently no study which states whether flexor tendon traction tenolysis should be routinely performed or not. The objective of this study is to compare the outcome in patients who have traction tenolysis performed (A group) versus those who did not have traction tenolysis (B group) performed. It was noted that even though the mean total active motion (TAM) for the B group in our study was lower preoperatively, it was consistently higher than the A group in all the 3 post-operative visits demonstrating a better outcome in the B group. Even though it was not statistically significant, our data also showed that patients with traction tenolysis appeared to have more postoperative pain compared to those without.

Sliding Position of the Flexor Tendons Relative to the Hook of Hamate in CT Scans

2019 ◽  
Vol 24 (01) ◽  
pp. 72-75
Author(s):  
Kenji Goto ◽  
Kiyohito Naito ◽  
Yoichi Sugiyama ◽  
Nana Nagura ◽  
Ayaka Kaneko ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Injury ◽  
Ct Scans ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Ulnar Side ◽  
Flexor Tendon Injury ◽  
Hook Of Hamate ◽  
Flexor Digitorum ◽  
Little Finger

Background: The aim of this study was to assess the height of nonunion formation injuring the ulnar-side finger flexor tendon, the positional relationship between the hook of the hamate and little finger flexor tendon was evaluated on CT scans. Methods: The subjects were 20 healthy patients (40 hands) (14 males and 6 females, mean age: 28 years old). Their hands were imaged in extension and flexion of the fingers on CT. The position of the little finger flexor tendon was determined regarding the height of the hook of the hamate as 100%. Results: The heights of the flexor digitorum profundus tendons were 46 ± 6% in extension and 44 ± 9% in flexion, and those of the flexor digitorum superficialis tendons were 87 ± 8% in extension and 91 ± 9% in flexion. Conclusions: Our study suggested that 40% of the base of the hook of the hamate does not contact with the flexor tendon, suggesting that flexor tendon injury is unlikely to occur in that region.

Flexor Tendon Repair Using a Stainless Steel Internal Anchor

1998 ◽  
Vol 23 (1) ◽  
pp. 37-40 ◽  
Author(s):  
L. GORDON ◽  
M. TOLAR ◽  
K. T. VENKATESWARA RAO ◽  
R. O. RITCHIE ◽  
S. RABINOWITZ ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Stainless Steel ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Active Flexion ◽  
Active Range Of Motion ◽  
Flexor Digitorum

We have developed a stainless steel internal tendon anchor that is used to strengthen a tendon repair. This study tested its use in vitro to produce a repair that can withstand the tensile strength demands of early active flexion. Fresh human cadaver flexor digitorum profundus tendons were harvested, divided, and then repaired using four different techniques: Kessler, Becker or Savage stitches, or the internal tendon anchor. The internal splint repairs demonstrated a 99–270% increase in mean maximal linear tensile strength and a 49–240% increase in mean ultimate tensile strength over the other repairs. It is hoped that this newly developed internal anchor will provide a repair that will be strong enough to allow immediate active range of motion.

Patterns of Cellular Activation after Tendon Injury

1996 ◽  
Vol 21 (6) ◽  
pp. 813-820 ◽  
Author(s):  
U. KHAN ◽  
J. C. W. EDWARDS ◽  
D. A. McGROUTHER
Keyword(s):  
Flexor Tendon ◽  
Rabbit Model ◽  
Early Period ◽  
Tendon Injury ◽  
Flexor Digitorum Profundus ◽  
Cellular Activation ◽  
Relative Response ◽  
Tendon Surgery ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

Mechanisms which lead to disabling adhesions following flexor tendon surgery of the hand were investigated in a rabbit model which was used to assess the relative response of the cells of the synovial sheath, epitenon and the endotenon to injury. A transverse laceration, cutting through 50% of the tendon, was made just outside the synovial sheath on the flexor aspect of the flexor digitorum profundus tendon. The synovial sheath was preserved intact. Using monoclonal antibodies for localizing specific inflammatory markers, we were able to follow the response and activity of the synovial sheath, epitenon and endotenon with respect to these markers at various times after surgery. Our findings suggest that the synovial sheath and the epitenon are relatively more reactive in the early period after injury, as judged by a range of inflammatory indices with the notable exception of the expression of the potent neovascularizing agent, basic fibroblast growth factor (bFGF).

scholarly journals Infiltration of synovitis into the flexor tendon: a case report

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093618
Author(s):  
Qianjun Jin ◽  
Haiying Zhou ◽  
Hui Lu
Keyword(s):  
Flexor Tendon ◽  
Surgical Excision ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexion Angle ◽  
Flexor Digitorum Profundus ◽  
Normal Tendon ◽  
Active Flexion ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

Synovitis is a type of aseptic inflammation that occurs within joints or surrounding tendons. No previous reports have described a hypertrophic synovium eroding the tendon sheath and manifesting as synovitis within the flexor tendon. We herein report a case involving a 10-year-old girl who presented to our hospital with a 1-month history of a swollen mass and progressive inability to completely flex her left index finger. The active flexion angle of the proximal interphalangeal joint was limited to 85°. A longitudinal incision of the flexor digitorum profundus tendon was surgically performed. The synovium inside and outside the flexor digitorum profundus tendon was completely removed. After the surgical excision, normal tendon gliding returned without recurrence by the 1-year follow-up. The active flexion angle of the proximal interphalangeal joint improved to 100°. To the best of our knowledge, this is the first case of synovitis affecting the flexor tendon and leading to limited flexion of a finger. The manifestation of a double ring sign on magnetic resonance imaging is quite characteristic. Early diagnosis and monitoring of the hyperproliferation and invasiveness of the synovial tissue are required. Surgical excision can be a simple and effective tool when necessary.

Are Flexor Tendon Ruptures Ever Spontaneous? - A Literature Review on Closed Flexor Tendon Ruptures of the Little Finger

2019 ◽  
Vol 24 (02) ◽  
pp. 180-188
Author(s):  
Jasmin Shimin Lee ◽  
Duncan Angus McGrouther
Keyword(s):  
Spontaneous Rupture ◽  
Tendon Rupture ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Pubmed Database ◽  
Tendon Ruptures ◽  
Flexor Digitorum ◽  
Surgical Setting ◽  
Little Finger

Background: When closed ruptures of flexor tendons of fingers occur, there is often an identifiable pathology, which should be addressed in the same surgical setting as the tendon repair. The concept of “spontaneous” tendon rupture, occurring in the absence of identified pathology, however, has also been reported in a significant number of papers. This controversy has prompted us to do a review of the existing literature.Methods: We did a review of cases of closed ruptures of the flexor digitorum profundus (FDP) of the little finger in existing literature. Fifty-three publications were retrieved by searching “FDP tendon rupture” and “little finger” using PubMed database. We analyzed data such as the zone of rupture noted intra-operatively; and any precipitating factors, pathology or trauma. We also conducted a review on papers which discussed the concept of “spontaneous rupture”.Results: Fifty-three publications were retrieved. There were 8 cases of ruptures in Zone I; 2 in Zone II; 30 in Zone III; 59 in Zone IV and 5 in Zone V. Majority of cases were associated with an element of trauma of varying severity, or pathology. A precipitating cause was not documented in 12 cases. Amongst all 36 cases of ruptures labelled as “spontaneous”, only 1 case was truly “spontaneous” without any associated trauma or pathology.Conclusions: Most reports labeled as spontaneous rupture occurred in Zone III, where tendon ruptures are rare. There are documented pathological causes or evidence of trauma to most of these cases. We conclude these ruptures may have been mislabeled as spontaneous ruptures. Bearing in mind the propensity for tendon excursion, we suspect the lack of documentation of exploration in proximal zones contributed to this mislabeling. Understanding this concept of non-spontaneity to most tendon ruptures and the common sites of rupture or pathology is crucial for a surgeon to make strategic incisions and minimize future recurrence.

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