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.

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.

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.

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).

The Morbidity of the Button-over-Nail Technique for Zone 1 Flexor Tendon Repairs. Should we still be using this Technique?

2008 ◽  
Vol 33 (5) ◽  
pp. 566-570 ◽  
Author(s):  
N. KANG ◽  
D. MARSH ◽  
D. DEWAR
Keyword(s):  
Flexor Tendon ◽  
Interphalangeal Joint ◽  
Flexor Digitorum Profundus ◽  
Distal Interphalangeal Joint ◽  
Close Attention ◽  
The Core ◽  
Joint Infections ◽  
Distal Interphalangeal ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

The button-over-nail technique is commonly used to fix the core suture to the distal phalanx for flexor digitorum profundus repairs in zone 1. We report a retrospective study of 23 consecutive patients who had a repair of the flexor digitorum profundus tendon in zone 1 using the button-over-nail technique. Fifteen patients experienced a complication, of which ten were directly related to the button-over-nail technique. Complications included nail deformities, fixed flexion deformities of the distal interphalangeal joint, infections and prolonged hypersensitivity. Two patients required amputation of the fingertip. We recommend that the button-over-nail technique should be avoided or used only with caution and with close attention to the details of the technique.

A New Technique of Attachment of Flexor Tendons to The Distal Phalanx without A Button Tie-Over

1996 ◽  
Vol 21 (5) ◽  
pp. 629-632 ◽  
Author(s):  
M. K. SOOD ◽  
D. ELLIOT
Keyword(s):  
Flexor Tendon ◽  
Distal Phalanx ◽  
New Technique ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendons ◽  
Tendon Grafts ◽  
A New Technique ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

A new technique of attachment of the flexor digitorum profundus tendon and flexor tendon grafts to the distal phalanx, without using a button on the nail, is described and its use reported in 14 cases.

Primary Flexor Tendon Repair in Zone 1

2000 ◽  
Vol 25 (1) ◽  
pp. 78-84 ◽  
Author(s):  
N. S. MOIEMEN ◽  
D. ELLIOT
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Range Of Movement ◽  
Realistic Assessment ◽  
Distal Interphalangeal ◽  
Active Mobilization ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon ◽  
Distal Tendon

This paper presents an analysis of the results of repair of 102 complete flexor tendon disruptions in zone 1 which were rehabilitated by an early active mobilization technique during a 7 year period from 1992 to 1998. These injuries were subdivided into: distal tendon divisions requiring reinsertion; more proximal tendon divisions but still distal to the A4 pulley; tendon divisions under or just proximal to the A4 pulley; and closed avulsions of the flexor digitorum profundus tendon from the distal phalanx. Assessment by Strickland’s original criteria showed good and excellent results of 64%, 60%, 55% and 67% respectively in the four groups. However, examination of the results measuring the range of movement of the distal interphalangeal (DIP) joint alone provided a more realistic assessment of the affect of this injury on DIP joint function, with good and excellent results of only 50%, 46%, 50% and 22% respectively in the four groups.

RUPTURE OF THE FLEXOR DIGITORUM PROFUNDUS TENDON TO THE SMALL FINGER WITHIN THE CARPAL TUNNEL

Hand Surgery ◽  
2005 ◽  
Vol 10 (01) ◽  
pp. 109-114 ◽  
Author(s):  
I. Grant ◽  
A. C. Berger ◽  
D. C. R. Ireland
Keyword(s):  
Carpal Tunnel ◽  
Metacarpophalangeal Joint ◽  
Flexor Digitorum Profundus ◽  
Common Mechanism ◽  
Mechanism Of Injury ◽  
Radiological Evidence ◽  
Hook Of Hamate ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

We report three patients who sustained a rupture of the flexor digitorum profundus tendon to the small finger within the carpal tunnel. There was a common mechanism of injury, each rupture occurred during resisted flexion of the digit with the metacarpophalangeal joint in extension. All the patients were male, one patient had an asymptomatic undiagnosed fracture of the hook of hamate, one patient had radiological evidence of piso-triquetral osteoarthritis. In each case, an attrition rupture was confirmed at surgery.

Comparison of modified Kessler tendon suture at different levels in the human flexor digitorum profundus tendon and porcine flexors and porcine extensors: an experimental biomechanical study

2011 ◽  
Vol 36 (8) ◽  
pp. 670-676 ◽  
Author(s):  
J. Havulinna ◽  
O. V. Leppänen ◽  
T. L. N. Järvinen ◽  
H. Göransson
Keyword(s):  
Tensile Testing ◽  
Flexor Tendon ◽  
Biomechanical Study ◽  
Flexor Digitorum Profundus ◽  
Uniaxial Tensile ◽  
Uniaxial Tensile Testing ◽  
Polyester Suture ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon ◽  
Different Levels

This study compared the biomechanical behaviour of repairs in the human flexor digitorum profundus tendon in zones I, II and III with repairs of different segments of the porcine flexor tendon of the second digit and the extensor digiti quarti proprius tendon, in order to assess the validity of porcine tendons as models for human flexor tendon repairs. These porcine tendons were selected after comparing their size with the human flexor digitorum profundus tendon. The tendon repairs were done in three segments of each porcine tendon and repairs in the human tendons were done in zones I,II and III. Ten tendons in each group yielded a total of 90 specimens. A modified Kessler repair was done with 3-0 coated braided polyester suture and subjected to uniaxial tensile testing. In human flexor tendons, the ultimate force was higher in zones I and II than in zone III. The porcine flexor digitorum profundus tendon from the second digit and the proximal segment of the extensor digiti quarti proprius tendon behaved similarly to the human flexor tendon in zone III and can be considered as surrogates for the human flexor tendon.

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