A Case of Destructive Gout in the Hand

1993 ◽  
Vol 1 (2) ◽  
pp. 91-94
Author(s):  
Robert Backstein ◽  
Arnis Freiberg ◽  
Tim Haswell
Keyword(s):  
Flexor Tendon ◽  
Gouty Arthritis ◽  
Tendon Sheath ◽  
Metacarpophalangeal Joint ◽  
Flexor Digitorum Profundus ◽  
Prior History ◽  
Tophaceous Gout ◽  
Radiologic Findings ◽  
Microscopic Evaluation ◽  
One Year

R Backstein, a Freiberg, T Haswell. A case of destructive gout in the hand. Can J Plast Surg 1993;1(2):91-94. A 49-year-old male presented with bilateral finger masses of one year duration. Radiologic findings were consistent with chronic tophaceous gout and this diagnosis was confirmed by microscopic evaluation of pathologic specimens. The patient had no prior history of acute gouty arthritis. Surgical exploration revealed tophaceous masses involving the metacarpophalangeal joint and the contents of the flexor tendon sheath of the left long finger with complete destruction of the flexor digitorum profundus tendon distal to the sublimus insertion. Gout presenting as tophaceous deposits of the finger with flexor tendon destruction has not previously been described in the literature.

Palmar Dislocation of the Metacarpophalangeal Joint of the Finger

2004 ◽  
Vol 29 (1) ◽  
pp. 90-93 ◽  
Author(s):  
TSUYOSHI MURASE ◽  
HISAO MORITOMO ◽  
HIDEKI YOSHIKAWA
Keyword(s):  
Open Reduction ◽  
Flexor Tendon ◽  
Tendon Sheath ◽  
Metacarpophalangeal Joint ◽  
Collateral Ligaments ◽  
Flexor Tendon Sheath ◽  
Joint Disruption ◽  
Supporting Structures

We report a case of palmar dislocation of a finger metacarpophalangeal joint. Disruption of all the supporting structures of this joint and rupture of the flexor tendon sheath caused marked instability. Treatment was by open reduction and repair of the collateral ligaments.

Trigger Wrist Caused by a Giant Cell Tumour of Tendon Sheath

1985 ◽  
Vol 10 (1) ◽  
pp. 121-123 ◽  
Author(s):  
N. SUEMATSU ◽  
T. HIRAYAMA ◽  
Y. TAKEMITSU
Keyword(s):  
Giant Cell ◽  
Medical Literature ◽  
Giant Cell Tumour ◽  
Flexor Tendon ◽  
Rare Condition ◽  
Tendon Sheath ◽  
Metacarpophalangeal Joint ◽  
Cell Tumour ◽  
Flexor Tendon Sheath ◽  
Trigger Wrist

Trigger wrist is a rare condition unlike the trigger finger of the metacarpophalangeal joint. This report describes a case of trigger wrist secondary to a giant cell tumour of the flexor tendon sheath. No previous reports are available in the medical literature.

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.

Differential Splintage for Flexor Tendon Rehabilitation: An Experimental Study of its Effect on Finger Flexion Strength

2005 ◽  
Vol 30 (2) ◽  
pp. 168-174 ◽  
Author(s):  
R. SAVAGE ◽  
M. G. PRITCHARD ◽  
M. THOMAS ◽  
R. G. NEWCOMBE
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Metacarpophalangeal Joint ◽  
Flexor Digitorum Profundus ◽  
Active Flexion ◽  
Finger Flexion ◽  
Middle Ring ◽  
Flexor Digitorum ◽  
Flexion Force ◽  
Flexion Strength

We conducted laboratory tests to investigate the possibility of partly de-powering flexor digitorum profundus with a view of reducing flexion force during active flexor tendon rehabilitation. We constructed a splint and applied tapes to the proximal segments of fingers to test the hypothesis that holding three fingers more extended than the other finger would reduce the flexion strength of the more flexed finger. The splint allowed the metacarpophalangeal joint of the more flexed finger to be held in three positions of increasing flexion (15°, 30°, and 45°) compared to the remaining three fingers. We have called this ‘differential splintage’. Healthy volunteers were tested for maximum active flexion strength at the different flexion angles. ‘Differential splintage’ of up to 45° resulted in mean decreased flexion strength of 28% in the index finger and 35% to 38% in the middle, ring and little fingers. The results suggest that “differential splintage” of a finger after flexor tendon repair may be useful in reducing tension across the repair during a program of active tendon rehabilitation and we feel that it has potential to reduce the incidence of repair rupture before healing is complete.

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.

Flexor Tendon Blood Vessels

2000 ◽  
Vol 25 (6) ◽  
pp. 552-559 ◽  
Author(s):  
M. E. JONES ◽  
K. LADHANI ◽  
V. MUDERA ◽  
A. O. GROBBELAAR ◽  
D. A. MCGROUTHER ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Metacarpophalangeal Joint ◽  
Cross Reactivity ◽  
Flexor Digitorum Profundus ◽  
Human Antibody ◽  
Cross Sectional ◽  
Endothelial Cell Surface ◽  
Avascular Zone ◽  
Quantitative Manner ◽  
Flexor Digitorum

The aim of this study was to assess rabbit long flexor tendon vascularity in a qualitative and quantitative manner using immunohistochemistry. The endothelial cell surface marker CD31 was targeted with a specific monoclonal mouse-anti-human antibody with good species cross-reactivity. Subsequent signal amplification and chromogen labelling allowed vessel visualization. Computer image analysis was performed. Values for vessel number and total vessel area per section, as well as the sections’ cross-sectional tendon areas, were obtained. There was a consistent deep tendon avascular zone between the A2 and A4 pulley in the rabbit forepaw. This was not the case in the hindpaw, with dorsally orientated longitudinal vessels coursing the length of the intrasynovial tendon. The area of least vascularity in the hindpaw was around the metacarpophalangeal joint. We therefore recommend the use of hindpaw tendons when using the rabbit as a flexor tendon experimental model. This is because its vascular pattern is similar to that of the human flexor digitorum profundus.

The suture loop holding capacity of flexor digitorum profundus tendon within and outside the digital tendon sheath

2013 ◽  
Vol 38 (7) ◽  
pp. 801-804 ◽  
Author(s):  
J. Havulinna ◽  
O. V. Leppänen ◽  
H. Göransson
Keyword(s):  
Flexor Tendon ◽  
Tendon Sheath ◽  
Flexor Digitorum Profundus ◽  
Simple Loop ◽  
Pull Out ◽  
Polyester Suture ◽  
The Mean ◽  
The Difference ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

In a previous study we found that the strength of a Kessler core suture in the flexor tendon was greater in flexor zone 2 than in zone 3. To further investigate the material properties of the flexor tendon without the influence of a locking suture configuration, we measured the ultimate strength of a simple loop suture in the flexor digitorum profundus tendon in zones 1, 2, and 3. Eight cadaver flexor digitorum profundus tendons were tested in 10 mm increments with a 3-0 polyester suture loop pull-out test in the mid-substance of the tendon. The mean strength in zones 1 and 2 (26.7 N, SD 5.6) was significantly higher than the mean strength in zone 3 (17.7 N, SD 5.4). We conclude that the difference is owing to variations of the structure of the flexor tendon in different sections of the tendon, as the suture configuration was a simple loop without a locking or grasping component.

scholarly journals Digital flexion contracture caused by tophaceous gout in flexor tendon

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984470 ◽  
Author(s):  
Tsuyoshi Tajika ◽  
Takuro Kuboi ◽  
Tokue Mieda ◽  
Noboru Oya ◽  
Fumitaka Endo ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Full Range ◽  
Rare Condition ◽  
Metacarpophalangeal Joint ◽  
Flexion Contracture ◽  
Proper Treatment ◽  
Histological Findings ◽  
Tophaceous Gout ◽  
Gouty Tophus ◽  
White Substance

Gouty tophus is an unusual cause of digital flexion contracture. Awareness of this pathophysiology will lead to more confidence in proper treatment and surgical management of this rare condition. This report describes a case of digital flexion contracture by tophaceous gout distinguished between trigger finger and locking of the metacarpophalangeal joint. We found the flexor tendon with a deposited chalky white substance suggestive of gouty tophus intraoperatively. We performed tenosynovectomy and removed the chalky white substance to the greatest degree possible. Histological findings confirmed the diagnosis of gout. Postoperatively, the patient recovered nearly to a full range of motion of the affected digits. When meeting with the patient who has had hyperuricemia and who is unable to extend the affected digits suddenly, one must keep in mind digital flexion contracture caused by tophaceous gout.

High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

2019 ◽  
Vol 16 (3) ◽  
pp. 250-257 ◽  
Author(s):  
Jiann-Der Lee ◽  
Ya-Han Hu ◽  
Meng Lee ◽  
Yen-Chu Huang ◽  
Ya-Wen Kuo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Prior History ◽  
Multivariate Logistic Regression ◽  
Cart Analysis ◽  
Younger Age ◽  
History Of ◽  
One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

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