Transthecal Digital Nerve Block

1998 ◽  
Vol 23 (4) ◽  
pp. 490-493 ◽  
Author(s):  
N. S. SARHADI ◽  
J. SHAW-DUNN
Keyword(s):  
Methylene Blue ◽  
Nerve Block ◽  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Proximal Part ◽  
Tendon Sheath ◽  
Areolar Tissue ◽  
Digital Nerve ◽  
Flexor Tendon Sheath ◽  
Digital Nerve Block

Injection studies using methylene blue and latex were used in 60 digits from 40 cadavers to study how anaesthetic fluid injected into the flexor tendon sheath might spread around the proximal part of the finger. The injected solution escaped from the flexor tendon sheath around the vincular vessels which are present near the base and head of the proximal phalanx. Outside the digital canal, the dye flowed smoothly through the perivascular loose areolar tissue and spread alongside the main digital vessels and nerves and their palmar and dorsal branches.

Comparison of four techniques for synoviocentesis of the equine digital flexor tendon sheath: A cadaveric study

2012 ◽  
Vol 25 (03) ◽  
pp. 178-183 ◽  
Author(s):  
M. Oosterlinck ◽  
F. Pille ◽  
A. Valère ◽  
A. Martens ◽  
M. Jordana
Keyword(s):  
Methylene Blue ◽  
Flexor Tendon ◽  
Tendon Sheath ◽  
Median Number ◽  
Digital Nerve ◽  
Sesamoid Bone ◽  
Injection Point ◽  
Injection Techniques ◽  
Flexor Tendon Sheath ◽  
Successful Technique

Summary Objective: To compare four different techniques for synoviocentesis of the equine digital flexor tendon sheath (DFTS). Methods: Fifteen inexperienced operators performed each of the following injection techniques on two cadaveric limbs: Proximal (at the proximal recess of the DFTS), Axial (axial to the proximal sesamoid bone), Base (at the base of the proximal sesamoid bone), and Distal (at the pastern). The number of attempts needed before the needle was assumed to be correctly positioned into the DFTS was recorded and 10 ml of methylene blue was injected. The limbs were dissected to determine the presence of methylene blue in the DFTS, the distance between the needle entrance point and the lateral palmar or plantar (digital) nerve, the degree of subcutaneous leakage and the distance between the border of the leakage zone and the lateral digital nerve. Results: The Axial (29/30) and Distal (25/30) approaches had the highest numbers of successful injections. The median number of attempts was highest for the Axial approach. The distances from the injection point and from the border of the leakage zone to the lateral digital nerve were longer for Distal and Axial approaches. Clinical relevance: In the hands of inexperienced operators, the Axial approach was the most successful technique for injection of the equine DFTS. Sparse subcutaneous leakage and larger distance to the nerve when using this technique might decrease the risk of inadvertent palmar or plantar digital nerve desensitisation when performing DFTS analgesia.

scholarly journals Flexor Tendon Sheath Ganglions: Results of Surgical Excision

Hand ◽  
2007 ◽  
Vol 2 (3) ◽  
pp. 94-100 ◽  
Author(s):  
Peter J. L. Jebson ◽  
Edwin E. Spencer
Keyword(s):  
Telephone Interview ◽  
Flexor Tendon ◽  
Surgical Excision ◽  
Tendon Sheath ◽  
Additional Patient ◽  
Dominant Hand ◽  
Digital Nerve ◽  
A2 Pulley ◽  
Flexor Tendon Sheath

The purpose of our study was to review the clinical features and determine the results following surgical excision of a flexor tendon sheath ganglion. A retrospective analysis of 24 consecutive patients (25 ganglions) who underwent excision of a painful flexor tendon sheath ganglion by the same surgeon was performed. The patient's medical and operative records were reviewed. Each patient was invited to return for an evaluation, which consisted of a clinical interview, completion of a questionnaire, and physical examination. Those patients that were unable to return underwent a detailed telephone interview. Sixteen patients returned for a clinical evaluation, while eight patients underwent a telephone interview. There were 15 women and nine men, with an average age of 43 years (range, 21–68 years). The dominant hand was involved in 15 patients. The long finger was most commonly involved (11 cases). The ganglion arose from the A1 pulley in 13 cases, between the A1 and A2 pulleys in three cases, and from the A2 pulley in nine cases. At an average follow-up of 18.5 months (range, 5–38 months), all of the patients were satisfied with their final result. No patient developed a recurrence and all returned to their previous functional level. There were two minor complications that resolved uneventfully; one patient experienced mild incisional tenderness, while an additional patient experienced transient digital nerve paresthesias. We conclude that surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath.

Anatomical Demonstration of the Nerve-Supply to the Flexor Tendon

1991 ◽  
Vol 16 (1) ◽  
pp. 92-93 ◽  
Author(s):  
C. M. PESSON ◽  
T. P. FINNEY ◽  
C. J. DEPAOLO ◽  
E. J. DABEZIES ◽  
M. L. ZIMNY
Keyword(s):  
Flexor Tendon ◽  
Tendon Sheath ◽  
Nerve Supply ◽  
Digital Artery ◽  
Digital Nerve ◽  
Nerve Fibres ◽  
Flexor Tendon Sheath ◽  
Transverse Branch

A dissection of four unembalmed human fingers demonstrated a branch from the digital nerve which enters the flexor tendon sheath at the same place as the transverse branch of the digital artery. We conclude that this branch supplies the nerve fibres found within the vinculum.

scholarly journals Response of three digital anesthetic technics in horses with forelimb hoof lameness

2017 ◽  
Vol 69 (4) ◽  
pp. 793-801
Author(s):  
S.L. Dau ◽  
M.S. Azevedo ◽  
F.D. De La Corte ◽  
K.E. Brass ◽  
M. Gallio ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Sheath ◽  
Interphalangeal Joint ◽  
Navicular Bone ◽  
Digital Nerve ◽  
Distal Interphalangeal Joint ◽  
Time Points ◽  
Flexor Tendon Sheath ◽  
Distal Interphalangeal ◽  
Over Time

ABSTRACT The presented study aimed to assess objectively the response of distal interphalangeal joint (DIJ), navicular bursa (NB) and deep digital flexor tendon sheath (DDFTS) anesthesia in horses with forelimb hoof lameness; and evaluate if the presence of radiographic abnormalities on navicular bone could interfere on blocks’ results. Fifteen horses with lameness improvement above 70% after palmar digital nerve (PDN) block were selected for this study. Blocks were assessed separately on five consecutive trials at seven different time-points. The fifth trial was performed to evaluate the influence of exercise on preexisting lameness. Most of horses (73.33%) presented pain related to the podotrochlear apparatus based on clinical and lameness exam and blocks’ responses. NB and DIJ anesthesia differed on the frequency of horses with lameness improvement above 70% only at 10min (p=0.03), and both differed from DDFTS block until 30’(p<0.05). The blocks’ response was variable along the time and the highest means for NB, DIJ and DDFTS were observed at 5-10 minutes (’), 15-20’ and 10-15’ respectively.Exercise had low interference on lameness intensity since no improvement above 50% was observed and an increase on lameness intensity over time was identified in seven horses. Variable grades of navicular bone radiographic lesions were observed in 14 horses, although these lesions had no interference on blocks’ response (p>0.05). The NB and DIJ blocks had similar responses and both were superior to DDFTS anesthesia, coincident with a major prevalence of podotroclear apparatus abnormalities in this equine population.

scholarly journals Surgery for ganglia of the flexor tendon sheath

2013 ◽  
Vol 5 (1) ◽  
pp. 6
Author(s):  
Vilhjalmur Finsen ◽  
Øyvind Håberg ◽  
Grethe Elisabeth Borchgrevink
Keyword(s):  
Nerve Injury ◽  
Flexor Tendon ◽  
Tendon Sheath ◽  
Digital Nerve ◽  
General Satisfaction ◽  
Flexor Tendon Sheath ◽  
Results Of Surgery

There are very few reports in the literature on the results of surgery for ganglia of the flexor tendon sheaths of the digits. We reviewed 24 patients operated for flexor tendon sheath ganglia 8 (3-11) years previously. Two operations were for recurrences and one of these recurred again. There was one permanent digital nerve injury and one patient complained of cold sensibility. VAS (0=best; 100=worst) for mean general complaints from the hand was remembered as 51 before surgery and was 5 at review. Mean pain at review was reported as VAS 4 and general satisfaction with the operation as VAS 3. All stated that they would have consented to surgery if they had known the outcome in advance. We conclude that the results of surgery are good, although complications do occur.

The Influence of Injected Volume on Discomfort During Administration of Digital Block

2016 ◽  
Vol 21 (03) ◽  
pp. 369-373
Author(s):  
Solveig Ballo ◽  
Tonje Hjelseng ◽  
Lena Flatlandsmo Tangen ◽  
Janne Svindal Lundbom ◽  
Trine Skarsvåg ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Nerve Block ◽  
Proximal Phalanx ◽  
Rapid Onset ◽  
Digital Nerve ◽  
Dorsal Aspect ◽  
Verbal Assessment ◽  
Time To Onset ◽  
Digital Nerve Block ◽  
Digital Block

Background: Digital nerve block is associated with pain. In a search for methods to reduce the discomfort, we investigated how the volume of anaesthetic fluid influences pain during subcutaneous digital nerve block, and how it affects the success of the anaesthesia. Methods: A randomized blinded prospective study was performed on 36 healthy volunteers. The single injection subcutaneous digital block technique was used to anaesthetize the participants´ 4th digit on both hands. The same amount of lidocaine was used, but in two different volumes; 1 ml 2% lidocaine and 2ml 1% lidocaine. After each injection the participant was asked to estimate pain intensity on a visual analogue scale (VAS). The distribution of anaesthesia was then measured by using a Semmes-Weinstein 4.56 monofilament. Finally, participants gave a verbal assessment of which injection was least painful. Results: In total, 72 blocks were performed. There were no statistically significant differences in pain intensity or preference between the two groups. Furthermore, the 1 ml injection gave poorer anaesthesia and had longer time to onset. Neither injection anaesthetized the dorsal aspect of the proximal phalanx. Conclusions: The two volumes cause the same degree of discomfort. Greater volume gives a greater area of distribution and more rapid onset of anaesthesia. It seems unreasonable to use a smaller volume of more concentrated anaesthetic when performing the subcutaneous technique.

scholarly journals Deep Digital Flexor Tendon Injury at the Level of the Proximal Phalanx in Frontlimbs With Tendon Sheath Distension Characterized by Standing Low-Field Magnetic Resonance Imaging in Horses: 13 Cases (2015–2021)

2021 ◽  
Vol 8 ◽  
Author(s):  
Elisabeth Cornelia Susanna van Veggel ◽  
Kurt T. Selberg ◽  
Brenda van der Velde-Hoogelander ◽  
Katrien Vanderperren ◽  
Stefan Marc Cokelaere ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Case Series ◽  
Tendon Sheath ◽  
Tendon Injury ◽  
Mri Findings ◽  
Retrospective Case ◽  
Low Field ◽  
Previous Level ◽  
Flexor Tendon Sheath

Objective: To describe the MRI findings for 13 horses with deep digital flexor tendon (DDFT) injury at the proximal phalanx where the tendon goes from ovoid to bilobed in frontlimbs with tendon sheath distension. In addition, the prognosis of this lesion was assessed.Design: Retrospective case series.Animals: Thirteen client-owned horses.Procedures: Medical records were reviewed, and data were collected regarding signalment, history, MRI findings, and outcomes of horses. Findings of MRI were recorded and whether the case was confirmed with tenoscopy.Results: A diagnosis of DDFT injury at the junction between ovoid and bilobed portions at the level of the proximal phalanx was established in 13/20 (65%) horses that underwent MRI examination of the frontlimb digital flexor tendon sheath. Return to previous level of work was poor in this subset of horses with only three of 13 (23%) horses returning to previous level of work and one horse still in rehabilitation.Conclusions and Clinical Relevance: Standing low-field MRI represents a potentially useful diagnostic tool to evaluate digital flexor tendon sheath distension especially when evaluating the DDFT at the proximal phalanx where the tendon progresses from ovoid to bilobed. Prognosis of lesions of the DDFT at the proximal phalanx appears less favorable than previously reported causes of tendon sheath distension.

Dorsal Approach to Transfer of the Flexor Digitorum Brevis Tendon

2011 ◽  
Vol 101 (4) ◽  
pp. 297-306 ◽  
Author(s):  
Ricardo Becerro de Bengoa Vallejo ◽  
Marta Elena Losa Iglesias ◽  
Juan Carlos Prados Frutos ◽  
Miguel Fuentes Rodriguez ◽  
Kevin T. Jules
Keyword(s):  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Tendon Sheath ◽  
Cadaveric Study ◽  
Flexor Digitorum Longus ◽  
Dorsal Approach ◽  
Hammer Toe ◽  
Flexor Digitorum Brevis ◽  
Flexor Tendon Sheath ◽  
Flexor Digitorum

Background: Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammer toe deformities. Only transposition of the flexor digitorum brevis tendon has been reported in the literature in a cadaveric study that used the dorsal and plantar approach. A search of the literature revealed no reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions through a unique dorsal cutaneous incision. We performed a cadaveric study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique dorsal cutaneous incision. Methods: Transposition of the flexor digitorum brevis tendon was attempted in 156 toes of cadaveric feet (52 each second, third, and fourth toes) through a unique dorsal incision. Results: The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes by the dorsal incision approach. Conclusions: Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammer toe deformities, especially in the second, third, and fourth toes. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon is essential to the success of the procedure. (J Am Podiatr Med Assoc 101(4): 297–306, 2011)

Sign in / Sign up

Export Citation Format

Share Document