Tendon transfer or tendon graft for ruptured finger extensor tendons in rheumatoid hands

2009 ◽  
Vol 35 (4) ◽  
pp. 279-282 ◽  
Author(s):  
U. S. Chung ◽  
J. H. Kim ◽  
W. S. Seo ◽  
K. H. Lee
Keyword(s):  
Clinical Outcome ◽  
Tendon Transfer ◽  
Extensor Tendon ◽  
Tendon Graft ◽  
Satisfaction Scale ◽  
Patient’S Satisfaction ◽  
Extensor Tendons ◽  
Reconstruction Methods ◽  
Tendon Ruptures ◽  
The Mean

We evaluated the clinical outcome of tendon reconstruction using tendon graft or tendon transfer and the parameters related to clinical outcome in 51 wrists of 46 patients with rheumatoid arthritis with finger extensor tendon ruptures. At a mean follow-up of 5.6 years, the mean metacarpophalangeal (MP) joint extension lag was 8° (range, 0–45) and the mean visual analogue satisfaction scale was 74 (range, 10–100). Clinical outcome did not differ significantly between tendon grafting and tendon transfer. The MP joint extension lag correlated with the patient’s satisfaction score, but the pulp-to-palm distance did not correlate with patient satisfaction. We conclude that both tendon grafting and tendon transfer are reliable reconstruction methods for ruptured finger extensor tendons in rheumatoid hands.

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

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.

A Comparison of Results of Extensor Tendon Repair Followed by Early Controlled Mobilisation Versus Static Immobilisation

1989 ◽  
Vol 14 (1) ◽  
pp. 18-20 ◽  
Author(s):  
J. A. Chow ◽  
S. Dovelle ◽  
L. J. Thomes ◽  
P. K. Ho ◽  
J. Saldana
Keyword(s):  
Tendon Repair ◽  
Extensor Tendon ◽  
Functional Results ◽  
Consecutive Series ◽  
Extensor Tendons ◽  
Dynamic Splinting ◽  
Tendon Surgery ◽  
Tendon Ruptures ◽  
Controlled Motion ◽  
Extensor Lag

To compare the functional results of early controlled mobilisation and static immobilisation following repair of extensor tendons, we conducted a comparative study between two centres. In one, a consecutive series of tenorrhaphy patients was treated post-operatively by the dynamic splinting technique. In the other, a consecutive group was treated by static splinting. All patients treated by dynamic splinting were graded excellent within six weeks following surgery; no tendon ruptures occurred and no secondary corrective tendon surgery was required. After static splinting, 40% were graded excellent, 31% good, 29% fair, and none poor; six fingers treated by static splintage subsequently required tenolysis. Following surgical repair of extensor tendons of the hand, patients treated by early controlled motion regain better flexion function in terms of grip strength and pulp-to-palm distance. Dynamic splinting is a more effective technique than static splinting in the prevention of extensor lag.

The Excursions of the Long Extensor Tendons of the Hand

1986 ◽  
Vol 11 (1) ◽  
pp. 77-80
Author(s):  
D. ELLIOT ◽  
D. A. McGROUTHER
Keyword(s):  
Extensor Tendon ◽  
Cadaveric Study ◽  
Joint Motion ◽  
Mathematical Relationship ◽  
Extensor Tendons ◽  
The Mean ◽  
Clinical Problems ◽  
Tendon Excursion

In a cadaveric study in seven hands, the mathematical relationship between extensor tendon excursion and joint motion (wrist, m.p., p.i.p. and d.i.p.) has been investigated. This has been found to be linear at all joints, allowing the mean tendon excursions corresponding to ten degrees of joint motion to be calculated for each of the above joints for all five rays of the hand. A table of these excursion values is presented as a reference for calculation of clinical problems.

scholarly journals Extensor tendon ruptures in rheumatoid wrists

2020 ◽  
Vol 30 (8) ◽  
pp. 1499-1504
Author(s):  
C. Biehl ◽  
M. Rupp ◽  
S. Kern ◽  
C. Heiss ◽  
T. ElKhassawna ◽  
...  
Keyword(s):  
Extensor Tendon ◽  
Underlying Disease ◽  
Chronic Inflammatory Disease ◽  
Functional Improvement ◽  
Patient Acceptance ◽  
Extensor Pollicis Longus ◽  
Extensor Tendons ◽  
Long Time ◽  
Healthy Control ◽  
Tendon Ruptures

Abstract Background and aims Rheumatoid arthritis is a chronic inflammatory disease. The associated involvement of hands and tendons is over 90% and impairs overall function. In the course of the disease, the joints are often operated on. During this operation, ruptures of the extensor tendons are found by chance without the patients noticing them. The aim of this retrospective study is the prevalence of extensor tendon rupture. Which tendon is destroyed most frequently? How can the functional outcome be measured after reconstruction? Materials and methods From 1572 operations on rheumatoid wrists, 61 extensor tendon ruptures were identified in 41 patients. The average time between the first rheumatic symptoms of the hand and surgery was 6.4 years. The average duration of RA was 7.8 years. 26 patients with 27 tendon reconstructions were included in the follow-up with an average postoperative duration of 4.6 years (3 to 14.2 years). Results Extensor tendons ruptures typically occurred at mechanically stressed sites. The most frequent rupture was found in the extensor pollicis longus tendon (21 tendons), followed by the small finger extensor tendon (14 tendons). A transfer was performed on 7 tendons. Fifty-five tendon lesions were sutured at other intact tendons. Free grafts were not used. The results in Clayton and QuickDASH scores were significantly different. Functional improvement was consistent with the results of tendon reconstructions in healthy control groups. Conclusion In rheumatoid patients, a rupture of an extensor tendon must be expected at 4%. Patients tolerate and compensate this damage for a long time. The function of the hand including the tendon function is the most important factor in assessing the success of the operation. The subjective patient acceptance depends on the progress of the underlying disease, postoperative care (ergotherapy, physiotherapy, orthosis) and the patients' demands.

Extensor Tendon Rupture Due to Osteoarthritis of the Distal Radio-Ulnar Joint

1991 ◽  
Vol 16 (4) ◽  
pp. 450-453 ◽  
Author(s):  
I. OHSHIO ◽  
T. OGINO ◽  
A. MINAMI ◽  
H. KATO ◽  
A. MIYAKE
Keyword(s):  
Tendon Transfer ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Tendon Graft ◽  
Distal Ulna ◽  
Radioulnar Joint ◽  
Dorsal Aspect ◽  
Closed Rupture ◽  
Little Finger

Five cases of closed rupture of the finger extensor tendon due to osteoarthritis of the distal radioulnar joint were studied. Difficulty in extension began at the little finger and extended to the ring and long fingers. Pain and swelling in the dorsal aspect of the wrist preceded the tendon rupture. Osteoarthritic changes at the distal radio-ulnar joint were more severe than those at the radio-carpal and intercarpal joints. The distal end of the ulna showed the plus variant, as well as dorsal dislocation or subluxation. All patients underwent a tendon graft or tendon transfer, with excision of the distal ulna. The tendon rupture was thought to be caused mainly by friction between the displaced distal end of the ulna and osteophytes of the distal radio-ulnar joint.

Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures in Professional Soccer Players

2021 ◽  
pp. 107110072110364
Author(s):  
Nasef Mohamed N. Abdelatif ◽  
Jorge Pablo Batista
Keyword(s):  
Achilles Tendon ◽  
Tendon Transfer ◽  
Case Series ◽  
Return To Play ◽  
Soccer Players ◽  
Flexor Hallucis Longus ◽  
Professional Soccer ◽  
Case Series Study ◽  
Tendon Ruptures ◽  
The Mean

Background: Acute Achilles tendon ruptures (AATRs) that occur in athletes can be a career-ending injury. The aim of this study was to describe return to play and clinical outcomes of isolated endoscopic flexor hallucis longus (FHL) transfer in active soccer players with AATR. Methods: Twenty-seven active male soccer players who underwent endoscopically assisted FHL tendon transfer for acute Achilles tendon ruptures were included in this study. Follow up was 46.2 (±10.9) months after surgery. Return to play criteria and clinical outcome measures were evaluated. Results: All players returned to playing professional competitive soccer games. Return to active team training was at a mean of 5.8 (±1.1) months postoperatively. However, return to active competitive match play occurred at a mean of 8.3 (±1.4) months. Twenty-two players (82%) were able to return to their preinjury levels and performances and resumed their professional careers at the same soccer club as their preinjury state. One player (3.7%) shifted his career to professional indoor soccer. At 26 months postoperatively, the mean Tegner activity scale score was 9.7 (±0.4), the mean Achilles tendon total rupture score was 99 (±2), and the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot score was 99 (±3). No patients reported any great toe complaints or symptomatic deficits of flexion strength. Conclusion: The current study demonstrated satisfactory and comparable return to play criteria and clinical results with minimal complications when using an advanced endoscopically assisted technique involving FHL tendon transfer to treat acute Achilles tendon ruptures in this specific subset of patient cohort. Level of Evidence: Level II, prospective cohort case series study.

Stability of Reconstructed Paralyzed Shoulders Using a Reflected Long Head Biceps Technique

1999 ◽  
Vol 123 (3) ◽  
pp. 227-233 ◽  
Author(s):  
C. Y. Tang ◽  
A. F. T. Mak ◽  
L. K. Hung ◽  
H. S. Wong ◽  
T. Pacaldo
Keyword(s):  
Rotator Cuff ◽  
Tendon Transfer ◽  
Tendon Graft ◽  
Operation Conditions ◽  
Post Operation ◽  
The Mean ◽  
Long Head ◽  
Transfer Procedures ◽  
Long Head Biceps ◽  
Anterior Posterior

A new tendon transfer technique is proposed for the reconstruction of the paralyzed shoulders secondary to Brachial Plexus Injury (BPI). In this tendon transfer, the long head of the biceps tendons is utilized as a bridging tendon graft. It is reflected at the exit of the bicipital groove, passed through the deltoid and directed to the trapezius. The technique is referred to here as the Reflected Long Head Bicepts (RLHB) technique. This study evaluated the effect of this tendon transfer on the anterior, posterior, and inferior stability of the reconstructed should using cadaveric specimens. It was shown that loading of the RLHB contributed significantly to anterior stability of the reconstructed shoulder for 90 deg elevation in the scapula plane. The mean displacement was reduced by 56 percent with RLHB loaded (p<0.01), by 56 percent with the rotator cuff loaded (p<0.005), and by 67 percent with both the RLHB and the rotator cuff loaded (p<0.004). For the post-operation conditions, variation of the directions of RLHB had no significant effect on joint displacement in response to anterior loading. The RLHB tendon also contributed to the posterior and inferior stability for the low and middle elevations in the plane of scapula. Two variations of the RLHB tendon transfer procedures, namely the “Sub-Deltoid” and the “Through-Deltoid” techniques, were introduced and studied. These two techniques did not seem to have significantly different effects on the displacement of the humeral head in response to both posterior and inferior loading. The results of this study seemed to support the clinical feasibility of this tendon transfer approach as far as the biomedical stability of the reconstruction is concerned.

The By-Pass Extensor Tendon Transfer

1995 ◽  
Vol 20 (3) ◽  
pp. 392-397 ◽  
Author(s):  
C. OBERLIN ◽  
A. ATCHABAYAN ◽  
A. SALON ◽  
A. BHATIA ◽  
J. M. OVIEVE
Keyword(s):  
Tendon Transfer ◽  
Extensor Tendon ◽  
Tendon Graft ◽  
Middle Phalanx ◽  
Extensor Apparatus ◽  
Pip Joint ◽  
Substance Loss ◽  
Active Mobilization

A salvage technique for the treatment of substance loss of the extensor apparatus with some special features is presented. It uses the extensor indicis muscle prolonged with a tendon graft. The tendon is directly attached to the middle phalanx. After surgery, the wrist is immobilized in extension, allowing immediate active mobilization of the PIP joint. The results in five patients are satisfactory.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Gamma knife radiosurgery for craniopharyngiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 47-56 ◽  
Author(s):  
Wen-Yuh Chung ◽  
David Hung-Chi Pan ◽  
Cheng-Ying Shiau ◽  
Wan-Yuo Guo ◽  
Ling-Wei Wang
Keyword(s):  
Clinical Outcome ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Content Type ◽  
Stereotactic Aspiration ◽  
Cystic Component ◽  
The Mean ◽  
Fine Print

Object. The goal of this study was to elucidate the role of gamma knife radiosurgery (GKS) and adjuvant stereotactic procedures by assessing the outcome of 31 consecutive patients harboring craniopharyngiomas treated between March 1993 and December 1999. Methods. There were 31 consecutive patients with craniopharyngiomas: 18 were men and 13 were women. The mean age was 32 years (range 3–69 years). The mean tumor volume was 9 cm3 (range 0.3–28 cm3). The prescription dose to the tumor margin varied from 9.5 to 16 Gy. The visual pathways received 8 Gy or less. Three patients underwent stereotactic aspiration to decompress the cystic component before GKS. The tumor response was classified by percentage reduction of tumor volume as calculated based on magnetic resonance imaging studies. Clinical outcome was evaluated according to improvement and dependence on replacement therapy. An initial postoperative volume increase with enlargement of a cystic component was found in three patients. They were treated by adjuvant stereotactic aspiration and/or Ommaya reservoir implantation. Tumor control was achieved in 87% of patients and 84% had fair to excellent clinical outcome in an average follow-up period of 36 months. Treatment failure due to uncontrolled tumor progression was seen in four patients at 26, 33, 49, and 55 months, respectively, after GKS. Only one patient was found to have a mildly restricted visual field; no additional endocrinological impairment or neurological deterioration could be attributed to the treatment. There was no treatment-related mortality. Conclusions. Multimodality management of patients with craniopharyngiomas seemed to provide a better quality of patient survival and greater long-term tumor control. It is suggested that GKS accompanied by adjuvant stereotactic procedures should be used as an alternative in treating recurrent or residual craniopharyngiomas if further microsurgical excision cannot promise a cure.

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