Minimally invasive thread trigger digit release: a preliminary report on 34 digits of the adult hands

2018 ◽  
Vol 43 (9) ◽  
pp. 942-947 ◽  
Author(s):  
Danqing Guo ◽  
Logan McCool ◽  
Alexander Senk ◽  
Brionn Tonkin ◽  
Joseph Guo ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Functional Recovery ◽  
Preliminary Report ◽  
Flexor Tendon ◽  
Hand Function ◽  
Access Point ◽  
Level Of Evidence ◽  
Complete Extension ◽  
Pain Medications ◽  
A2 Pulley

The trigger finger release was performed in 34 digits (11 thumbs and 23 fingers) of 24 patients through the thread transecting technique with the tip-to-tip approach, in which a 22-gauge needle inserts into a 18-gauge needle when both needles are inside the hand, guiding the 22-gauge needle to exit the hand at the same access point of 18-gauge needle. We prospectively evaluated the effectiveness and functional recovery of these patients. In all 34 digits, triggering and locking were resolved, and complete extension and flexion occurred immediately following the release. There were no complications, such as incomplete release, neurovascular or flexor tendon or A2 pulley injury, infection, or tendon bow-stringing. Patients did not require prescription pain medications. Most patients used their hands to meet their basic living needs the same day of the procedure. The hand function evaluated with the Quick Disabilities of the Arm, Shoulder and Hand questionnaire, and scored 4 within 3 months. Level of evidence: II

Clinical results of releasing the entire A2 pulley after flexor tendon repair in zone 2C

2016 ◽  
Vol 41 (8) ◽  
pp. 822-828 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
K. Hara ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Clinical Results ◽  
The Other ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
A2 Pulley ◽  
Active Mobilization ◽  
Finger Motion

We report the results of complete release of the entire A2 pulley after zone 2C flexor tendon repair followed by early postoperative active mobilization in seven fingers and their comparisons with 33 fingers with partial A2 pulley release. In seven fingers, release of the entire A2 pulley was necessary to allow free gliding of the repairs in five fingers and complete release of both the A2 and C1 pulleys was necessary in two. No bowstringing was clinically evident in any finger. Two fingers required tenolysis. Using Tang’s criteria, the function of two digits was ranked as excellent, four good and one fair; there was no failure. The functional return in these seven fingers was similar with that in 33 fingers with partial A2 pulley release; in these patients only one finger required tenolysis. Our results support the suggestion that release of the entire A2 pulley together with the adjacent C1 pulley does not clinically affect finger motion or cause tendon bowstringing, provided that the other pulleys are left intact. Level of evidence: IV

Outcomes of repair of the lacerated A2 pulley with extensor retinaculum during primary flexor tendon repair

2017 ◽  
Vol 42 (9) ◽  
pp. 903-908 ◽  
Author(s):  
A. El-Shebly ◽  
M. El Fahar ◽  
H. Mohammed ◽  
A. Bahaa Eldin
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Extensor Retinaculum ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Fair Result ◽  
Active Range Of Motion ◽  
A2 Pulley ◽  
Active Mobilization ◽  
A1 Pulley

We report outcomes of repairing the lacerated A2 pulley with extensor retinaculum graft in ten patients (ten fingers) during primary flexor tendon repair in zone 2. Complete A2 pulley lacerations were found in eight fingers and partial A2 pulley laceration in two. We extended the laceration in the sheath to the middle of the A4 or A1 pulley to allow tendon repair with a four-strand core suture. The A2 pulley was reconstructed with an extensor retinaculum graft. All patients followed the early controlled active mobilization protocol and recovered active range of motion at the interphalangeal joints without major extension deficits. Using the Strickland and Glogovac criteria, there were four excellent, five good and one fair result. One finger was graded excellent, eight good, and one fair according to Tang’s criteria. No clinical bowstringing was observed. We conclude that extensive pulley lacerations reconstructed with extensor retinaculum primarily ensure functional recovery after tendon repair. Level of evidence: IV

Outcomes of grafting intrasynovial tendons of the toes to the hands in 10 patients: a preliminary report

2017 ◽  
Vol 42 (5) ◽  
pp. 469-472 ◽  
Author(s):  
H. Ohi ◽  
S. Uchiyama ◽  
T. Kanda ◽  
M. Mukoda ◽  
M. Hayashi ◽  
...  
Keyword(s):  
Complication Rate ◽  
Preliminary Report ◽  
Flexor Tendon ◽  
High Complication Rate ◽  
Level Of Evidence ◽  
Active Motion ◽  
Tendon Reconstruction ◽  
Total Active Motion ◽  
Distal Interphalangeal

Ten patients had intrasynovial tendon grafting harvested from the toes for secondary flexor tendon reconstruction in nine fingers and one thumb in our institutes from 2009 to 2014. These patients were followed for a mean of 15 (range: 8–36) months. The ranges of total active motion of the proximal and distal interphalangeal joints of these nine fingers were 143° (range: 108–175°) and of the metacarpophalangeal and interphalangeal joints of one thumb were 110°. In conclusion, this technique is feasible and gives a good result when successful but with a high complication rate. Level of Evidence IV

Outcomes of flexor tendon repairs in zone 2 subzones with early active mobilization

2017 ◽  
Vol 42 (9) ◽  
pp. 896-902 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
S. Matsuzawa ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Level Of Evidence ◽  
Active Motion ◽  
Risk Of Rupture ◽  
Total Active Motion ◽  
A2 Pulley ◽  
Active Mobilization ◽  
The Mean ◽  
Difficult Area

We report on the outcomes of flexor tendon repair in zone 2 subzones with early active mobilization in 102 fingers in 88 consecutive patients. There were 28, 53, 15, and six fingers with repairs in zones 2A to 2D, respectively. Rupture of the repair occurred in four fingers, all in zone 2B. Excluding those with repair ruptures, the mean total active motion was 230° (range 143°–286°). Evaluated with Tang’s criteria, the outcomes were ranked excellent in 39 fingers, good in 46, fair in ten, poor in three, and failure in four. The outcomes in zone 2C were significantly inferior to those in zones 2B and 2D ( p = 0.02). Our results suggest that the tendon laceration in the area covered by the A2 pulley (zone 2C) is the most difficult area to obtain satisfactory active digital motion and tendon repair in zone 2B is the area where the risk of rupture is highest. Level of evidence: IV

Robust thumb flexor tendon repairs with a six-strand M-Tang method, pulley venting, and early active motion

2017 ◽  
Vol 42 (9) ◽  
pp. 909-914 ◽  
Author(s):  
Z. J. Pan ◽  
J. Qin ◽  
X. Zhou ◽  
J. Chen
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Level Of Evidence ◽  
Active Motion ◽  
Post Surgery ◽  
A2 Pulley ◽  
Tendon Ruptures ◽  
Flexor Pollicis Longus Tendon ◽  
Thumb Motion ◽  
Tendon Laceration

We present the outcomes of flexor pollicis longus tendon repairs in 34 thumbs using a six-strand M-Tang repair with venting of one or two pulleys according to site of tendon laceration. The A2 pulley was vented in all three thumbs with zone 1 injury. In 31 thumbs with zone 2 injuries, the oblique pulley was vented partially or entirely. Twenty-two thumbs had both the A1 and oblique pulleys vented. Six to 46 months post-surgery, 14 thumbs with zone 2 injuries were rated excellent, 13 good, three fair and one failure according to Tang criteria. No tendon ruptures or bowstringing occurred. Fourteen of 34 thumbs had deficits in interphalangeal joint extension averaging 13°. We conclude that venting of one or two pulleys may ensure recovery of thumb function without risking tendon bowstringing and that early active thumb motion is safe with a robust tendon repair. Level of evidence: IV

Flexor tendon repair in the hand with the M-Tang technique (without peripheral sutures), pulley division, and early active motion

2018 ◽  
Vol 43 (5) ◽  
pp. 474-479 ◽  
Author(s):  
Thomas Giesen ◽  
Lisa Reissner ◽  
Inga Besmens ◽  
Olga Politikou ◽  
Maurizio Calcagni
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Level Of Evidence ◽  
Active Motion ◽  
Post Surgery ◽  
A2 Pulley ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

We report outcomes in 29 patients with flexor tendon repairs in 32 digits (five thumbs and 27 fingers) with our modified protocols. We repaired the lacerated flexor digitorum profundus tendons with core suture repairs using the 6-strand M-Tang method and without circumferential sutures. We divided the pulleys as much as needed to allow excursion of the repaired tendons, including complete division of the A4 or A2 pulleys when necessary. In nine fingers, we repaired one slip of the flexor digitorum superficialis tendon and resected the other half. When the flexor digitorum profundus tendon would not glide under the A2 pulley, we excised the remaining slip of the flexor digitorum superficialis tendon. The wrist was splinted in mild extension post-surgery with early commencement of tenodesis exercises. No tendon repair ruptured. By the Strickland criteria, out of 27 fingers, 18 had excellent, six had good, two had fair, and one had poor results. We conclude that a strong core suture (such as the M-Tang repair) without peripheral sutures, and with division of pulleys as necessary is safe for early active motion and yields good outcomes. Level of evidence: IV

Recent evolutions in flexor tendon repairs and rehabilitation

2018 ◽  
Vol 43 (5) ◽  
pp. 469-473 ◽  
Author(s):  
Jin Bo Tang
Keyword(s):  
Flexor Tendon ◽  
Hand Function ◽  
Active Motion ◽  
Repair Site ◽  
Flexor Tendons ◽  
The Core ◽  
A2 Pulley

This article reviews some recent advancements in repair and rehabilitation of the flexor tendons. These include placing sparse or no peripheral suture when the core suture is strong and sufficiently tensioned, allowing the repair site to be slightly bulky, aggressively releasing the pulleys (including the entire A2 pulley or both the A3 and A4 pulleys when necessary), placing a shorter splint with less restricted wrist positioning, and allowing out-of-splint active motion. The reported outcomes have been favourable with few or no repair ruptures and no function-disturbing tendon bowstringing. These changes favour easier surgeries. The recent reports have cause to re-evaluate long-held guidelines of a non-bulky repair site and the necessity of a standard peripheral suture. Emerging understanding posits that minor clinically noticeable tendon bowstringing does not affect hand function, and that free wrist positioning and out-of-splint motion are safe when strong surgical repairs are used and the pulleys are properly released.

Up to five-week delay in primary repair of Zone 2 flexor tendon injuries: outcomes and complications

2021 ◽  
pp. 175319342110244
Author(s):  
Giovanni Munz ◽  
Andrea Poggetti ◽  
Luca Cenci ◽  
Anna Rosa Rizzo ◽  
Marco Biondi ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Primary Repair ◽  
Early Mobilization ◽  
Exercise Programme ◽  
Tendon Injuries ◽  
Level Of Evidence ◽  
Active Motion ◽  
Active Flexion ◽  
Surgical Methods ◽  
Flexor Tendon Injuries

We report the outcomes of delayed primary repair of flexor tendons in Zone 2 in 31 fingers and thumb (28 patients) averaging 15 days (range 4–37) after injury in 2020. The delay was longer than usual due to the COVID-19 pandemic. The tendons were repaired with a 6-strand core suture (M-Tang method) or a double Tsuge suture and a peripheral suture. This was followed by an early, partial-range, active flexion exercise programme. Adhesions in four digits required tenolysis. These patients were not with longest delay. Outcomes of two improved after tenolysis. The other two patients declined further surgery. One finger flexor tendon ruptured in early active motion. This was re-repaired, and final outcome was good. Overall excellent and good results using the Tang criteria were in 27 out of 31 fingers and thumbs (87%). The time elapsed between the injury and surgery is not an important risk factor for a good outcome, rather it depends on proper surgical methods, the surgeon's experience and early mobilization, properly applied. Adhesions may occur, but they can be managed with tenolysis. Level of evidence: IV

scholarly journals Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review

2021 ◽  
Author(s):  
Joanna Nowaczyk ◽  
Michał Zawistowski ◽  
Piotr Fiedor
Keyword(s):  
Systematic Review ◽  
Complete Remission ◽  
Minimally Invasive ◽  
Subcutaneous Tissue ◽  
Sodium Thiosulfate ◽  
Common Adverse Event ◽  
Chronic Infections ◽  
Level Of Evidence ◽  
Calcinosis Cutis ◽  
Extracorporeal Shock Wave

AbstractCalcinosis cutis is a deposition of calcium in the skin and subcutaneous tissue, often accompanied by pain, reduced mobility, and chronic infections. Limited evidence is available about the feasibility and efficacy of therapies alternative to systemic treatment and surgical excision, both of which often lead to unsatisfactory results or complications. We conducted a systematic review to evaluate the efficacy and safety of topical and intralesional sodium thiosulfate, extracorporeal shock-wave lithotripsy (ESWL), and laser for calcinosis cutis. PubMed, Embase, and Web of Science were searched. Reports of calciphylaxis and treatment combined with systemic medications were excluded. A total of 40 studies including 136 patients were analysed. Partial or complete remission after monotherapy was observed in 64% to 81% of cases. Self-applied topical sodium thiosulfate required patient’s adherence (mean treatment duration, 4.9 months; range 2–24). Laser therapy enabled complete remission of microcalcifications after a single procedure (57%; 12/21). ESWL and intralesional sodium thiosulfate injections decreased calcinosis-associated pain (median reduction in VAS score, 3; range 0–9 and 1; range 0–5, respectively). The most common adverse event was scarring and hyperkeratosis, observed after CO2 laser (56%; 10/18). Intralesional sodium thiosulfate injections caused transient pain in over 11% of patients. Recurrences within the follow-up were rare (2%; 3/136). This study provides an overview of minimally invasive and local therapies that in selected cases might transcend conventional treatment. The limitation of this study is the poor level of evidence, which emerges mainly from non-randomized studies at high risk of bias.

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