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.

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.

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.

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).

Accessory Roles of the Vinculum Breve of the Flexor Digitorum Profundus and Check-Rein Ligaments at the Distal Interphalangeal Joint

1991 ◽  
Vol 16 (3) ◽  
pp. 305-310 ◽  
Author(s):  
EMMA FLINDALL ◽  
D. A. McGROUTHER
Keyword(s):  
Interphalangeal Joint ◽  
Volar Plate ◽  
Flexor Digitorum Profundus ◽  
Distal Interphalangeal Joint ◽  
Distal Interphalangeal ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

The vinculum breve of the flexor digitorum profundus tendon was found to apply traction to the volar plate on flexion of the distal interphanageal joint. It was also observed that the check-rein ligaments of the joint only became taut in the hyperextended position. This may account for the greater amount of passive hyperextension that can be achieved at the distal than the proximal interphanageal joint.

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.

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.

Sign in / Sign up

Export Citation Format

Share Document