scholarly journals Management of Flexor Pollicis Longus Injury - Experience in BSMMU

2021 ◽  
Vol 12 (1) ◽  
pp. 20-26
Author(s):  
Md Ashraful Islam ◽  
Ismat Ara Begum ◽  
Monisha Datta ◽  
Suvendu Kumar Banik ◽  
Shahidullah ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Transfer ◽  
Subjective Assessment ◽  
Pinch Strength ◽  
Flexor Pollicis Longus ◽  
Mean Power ◽  
Active Motion ◽  
Power Grip ◽  
Rupture Rate ◽  
Pinch Grip

Anatomic consideration: Flexor pollicis longus (FPL) tendon arises from volar aspect of middle third of radial shaft and from the lateral aspect of interosseous membrane. The anterior interosseous branch of median nerve innervates the muscle in the proximal/mid forearm. Blood supply is predominantly from radial artery. Abstract Purpose: The purpose of this study was to evaluate the results of repair and one stage reconstruction of FPL injury and to find out complications and rupture rate and effectiveness of repair and reconstruction. Method: This retrospective review was carried out in Bangabandhu Sheikh Mujib Medical University from January 2015 to December 2018. 30 consecutive patients were enrolled in the study. 4 strands core suture with simple circumferential suture were used for repair and reconstruction. Tendon transfer was done in few cases. Power grip, active and passive range of motion, American Society for Surgery of the Hand criteria and Buck-Gramcko criteria were used for outcome assessment. Results: Out of 30 patients, 20 (67%) were male and 10 (33%) were female. Mean age was 30 years. Mean follow up period was 1.5 years. All cases were due to various type of cut injuries. In subjective assessment 40% patients achieved excellent, 50% good, 10% fair results. Our rupture rate was 0%. Mean power grip, pinch grip strength of index and key pinch strength were 87.5%, 68.18% and 86.66% respectively from contralateral normal hand. Active range of motion of IP joint was 64.28% of normal side. Conclusions: Use of 4 strands core sutures and early active motion give good to excellent results in 90% cases of repair, reconstruction and tendon transfer in FPL injuries with 0% rupture rate J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 20-26

scholarly journals Simultaneous powering of forearm pronation and key pinch in tetraplegia using a single muscle-tendon unit

2011 ◽  
Vol 37 (4) ◽  
pp. 323-328 ◽  
Author(s):  
J. Fridén ◽  
C. Reinholdt ◽  
A. Gohritz ◽  
W. J. Peace ◽  
S. R. Ward ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Transfer ◽  
Interosseous Membrane ◽  
Pinch Strength ◽  
Single Muscle ◽  
Flexor Pollicis Longus ◽  
Transfer Group

This study clinically assessed the concept that both thumb flexion and forearm pronation can be restored by brachioradialis (BR)-to-flexor pollicis longus (FPL) tendon transfer if the BR is passed dorsal to the radius. Six patients [two women and four men, mean age 32.3 years (SD 4.9, range 23–56)] underwent BR-to-FPL transfer dorsal to the radius and through the interosseous membrane (IOM). Lateral key pinch strength and pronation range of motion (ROM) were measured 1 year after surgery. A group of six patients [two women and four men, mean age 31.2 years (SD 5.0, range 19–52)] who underwent traditional palmar BR-to-FPL was included for comparison. Postoperative active pronation was significantly greater in the dorsal transfer group compared to the palmar group [149 (SD 6) and 75 (SD 3), respectively] and pinch strength was similar in the two groups [1.28 (SD 0.16) kg and 1.20 (SD0.21) kg, respectively]. We conclude that it is feasible to reconstruct lateral key pinch and forearm pronation simultaneously using only the BR motor.

Brachioradialis Transfer for Digital Palsy

1990 ◽  
Vol 15 (3) ◽  
pp. 312-316
Author(s):  
J. M. FAILLA ◽  
C. A. PEIMER ◽  
F. S. SHERWIN
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Tendon Transfer ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Pinch Grip ◽  
The Common ◽  
Finger Motion ◽  
Flexor Digitorum ◽  
Tendon Excursion

Although brachioradialis tendon transfer is thought to offer limited tendon excursion and finger motion, we have used it to restore active thumb and digital function in eight patients. Three had Volkmann’s contracture, one avulsion of forearm muscles and four had tetraplegia resulting in inability to perform activities of daily living and loss of pinch or grasp and extrinsic extension. The brachioradialis was transferred to the flexor pollicis longus, to the flexor digitorum profundus or to the common digital extensors. Except for one patient who had unremitting pain, all were pleased with their improved motion, pinch, grip, and independence. Function, however, remained abnormal in all but one.

A Comparison of Post-Operative Mobilization of Flexor Tendon Repairs with “Passive Flexion–Active Extension” and “Controlled Active Motion” Techniques

1994 ◽  
Vol 19 (4) ◽  
pp. 517-521 ◽  
Author(s):  
L. C. BAINBRIDGE ◽  
C. ROBERTSON ◽  
D. GILLIES ◽  
D. ELLIOT
Keyword(s):  
Comparative Study ◽  
Range Of Motion ◽  
Flexor Tendon ◽  
Active Motion ◽  
Rupture Rate ◽  
Passive Flexion ◽  
Extensor Lag

We report a comparative study of the outcome of flexor tendon repairs mobilized by either a “passive flexion-active extension” or a “controlled active motion” regimen. We show that the controlled active motion regimen conferred significant benefits on the final range of motion and extensor lag. The rupture rate was raised with “controlled active motion” but this was not greater than levels reported by other authors using “passive flexion-active extension” regimens.

Retrospective Outcome Analysis of Staged Flexor Tendon Reconstruction

2000 ◽  
Vol 25 (2) ◽  
pp. 168-174 ◽  
Author(s):  
T. G. FRAKKING ◽  
K. P. DEPUYDT ◽  
M. KON ◽  
P. M. N. WERKER
Keyword(s):  
Flexor Tendon ◽  
Outcome Analysis ◽  
Mean Power ◽  
Active Motion ◽  
Pinch Grip ◽  
Significant Difference ◽  
Contralateral Hand ◽  
Total Active Motion ◽  
Better Than

Forty staged flexor tendon reconstructions were done in 38 patients between 1991 and 1997. Results were assessed by clinical examination and questionnaire. At follow-up (mean, 35 months) a tenolysis had already been done in 12 cases. In the long fingers there was a significant difference between total active motion (187°) and total passive motion (237°). There was also a significant difference between active (24°) and passive (58°) IP motion in the thumbs. The mean power grip was 82%, pinch grip 74% and key grip 63% of the contralateral hand. None of the ten FPL reconstructions could be graded as excellent; four were good, using the criteria of Buck-Gramcko et al. (1976) . Twenty-eight of the FDP reconstructions had excellent or good results. These results were better than the subjective scores given by the patients, 24 of whom complained of functional problems in daily life at follow-up.

Assessment

2011 ◽  
Author(s):  
David Warwick ◽  
Roderick Dunn ◽  
Erman Melikyan ◽  
Jane Vadher
Keyword(s):  
Range Of Motion ◽  
Sensory Testing ◽  
Power Grip ◽  
Pinch Grip ◽  
Muscle Testing

Assessment 2Range of motion 4How to measure individual joints 6Oedema 12Muscle testing 14Power grip 16Pinch grip 18Sensory testing 20Pain 29Scar 30Function 32Outcomes 36• Identifying the underlying cause of their problems• Prioritizing their problems...

Early Active Mobilization of Primary Repairs of the Flexor Pollicis Longus Tendon

1999 ◽  
Vol 24 (6) ◽  
pp. 647-653 ◽  
Author(s):  
M. SIROTAKOVA ◽  
D. ELLIOT
Keyword(s):  
Primary Repair ◽  
Flexor Pollicis Longus ◽  
Active Motion ◽  
Longus Tendon ◽  
Rupture Rate ◽  
Active Mobilization ◽  
Group 2 ◽  
Flexor Pollicis Longus Tendon ◽  
Methods Of Treatment

This study reports the treatment of divided flexor pollicis longus (FPL) tendons from 1989 to 1998. The first 30 patients, in whom the tendon was repaired with a Kessler suture and simple epitendinous suture and mobilized using early active motion with only the thumb splinted, achieved 70/73% (White/Buck-Gramcko assessments respectively), excellent or good results and a rupture rate of 17%. The next 39 patients underwent the same treatment but in a splint with the thumb position altered and the fingers also splinted, with 67/72% excellent or good results and a rupture rate of 15%. The next 49 patients underwent repair with a Kessler suture and a reinforced epitendinous suture and the same mobilization as group 2, with 76/80% excellent or good results and a rupture rate of 8%. The final combination of repair and early active mobilization for primary repair of FPL tendons compares favourably with previous methods of treatment.

Outcome of flexor digitorum superficialis opponensplasty for Type II and IIIA thumb hypoplasia

2015 ◽  
Vol 41 (3) ◽  
pp. 258-264 ◽  
Author(s):  
M. de Kraker ◽  
R. W. Selles ◽  
J. M. Zuidam ◽  
H. M. Molenaar ◽  
H. J. Stam ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Transfer ◽  
Ring Finger ◽  
Metacarpophalangeal Joint ◽  
Pinch Strength ◽  
Type Ii ◽  
Flexor Digitorum Superficialis ◽  
Joint Stability ◽  
Type Iiia ◽  
Flexor Digitorum

This study reports on outcomes of the flexor digitorum superficialis tendon transfer from the ring finger in Type II and IIIA hypoplastic thumbs. We included 22 patients with 27 involved hands: 16 Type II thumbs and five Type IIIA treated by transfer and six non-operated Type II thumbs. The outcomes were assessed by range of motion, strength, sensibility, joint stability and patient/parent satisfaction. Compared with normative data, the range of motion was diminished in all patient groups. Opposition strength in operated Type II thumbs was significantly better than in non-operated thumbs. Grip strength, pinch strength, tripod strength and key pinch strength were approximately 50% of normal in Type II thumbs and 35% in Type IIIA thumbs. Metacarpophalangeal joint stability was restored in all operated Type II thumbs and in 40% of Type IIIA thumbs. We conclude that the flexor digitorum superficialis tendon transfer of the ring finger is a good functioning opponensplasty in both Type II and IIIA thumbs. The transfer provides excellent stability of the metacarpophalangeal joint in Type II thumbs. Level of Evidence: Level IV

scholarly journals Six-Strand Flexor Pollicis Longus Tendon Repairs With and Without Circumferential Sutures: A Multicenter Study

Hand ◽  
2022 ◽  
pp. 155894472110572
Author(s):  
Géraldine Lautenbach ◽  
Marco Guidi ◽  
Bernadette Tobler-Ammann ◽  
Vera Beckmann-Fries ◽  
Elisabeth Oberfeld ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Repair ◽  
Suture Technique ◽  
Flexor Pollicis Longus ◽  
Postoperative Rehabilitation ◽  
Active Motion ◽  
Treatment Groups ◽  
Longus Tendon ◽  
Outcome Measurements ◽  
Flexor Pollicis Longus Tendon

Background: The purpose of this study is to assess outcomes in flexor pollicis longus tendon repairs with 6-strand core sutures with and without circumferential sutures. Methods: A 6-strand core suture technique with and without circumferential sutures was used. Thirty-three patients were summarized in the C group (circumferential group) and 16 patients in the NC group (non-circumferential group). After the surgery, the wrist was stabilized with a dorsal blocking splint and a controlled early active motion protocol was applied. At weeks 6, 13, and 26 data on demographics, type of injury, surgery, postoperative rehabilitation, complications such as re-rupture and the following outcome measurements were collected: range of motion and its recovery according to the Tang criteria, Kapandji score, thumb and hand strengths, Disabilities of the Arm, Shoulder and Hand score, and satisfaction. Results: There were no significant differences in range of motion and strength between the 2 treatment groups. In both groups, the outcome measurements increased over time and they expressed similar satisfaction with the surgical treatment. In 4 patients of the C group tendon repair ruptured and in 1 patient of the NC group. Conclusions: Six-strand repair technique is an effective procedure to assure early active motion after flexor pollicis longus tendon injuries and good results can also be achieved by omitting the circumferential suture.

Radial Nerve Palsy: Nerve Transfer Versus Tendon Transfer to Restore Function

Hand ◽  
2021 ◽  
pp. 155894472098812
Author(s):  
J. Megan M. Patterson ◽  
Stephanie A. Russo ◽  
Madi El-Haj ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Radial Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Nerve Transfer ◽  
Pinch Strength ◽  
Radial Nerve Palsy ◽  
Nerve Injuries ◽  
Tendon Transfers ◽  
Nerve Transfers ◽  
Transfer Group

Background: Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries. Methods: A retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups. Results: For the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups. Conclusions: The nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy.

Clinical Outcomes After Aggressive Active Early Motion and Modified Kleinert Regimens: Comparison of 2 Consecutive Cohorts

Hand ◽  
2021 ◽  
pp. 155894472110172
Author(s):  
Kaisa Jokinen ◽  
Arja Häkkinen ◽  
Toni Luokkala ◽  
Teemu Karjalainen
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Hand Grip Strength ◽  
Active Motion ◽  
Hand Grip ◽  
Active Range Of Motion

Background Modern multistrand repairs can withstand forces present in active flexion exercises, and this may improve the outcomes of flexor tendon repairs. We developed a simple home-based exercise regimen with free wrist and intrinsic minus splint aimed at facilitating the gliding of the flexor tendons and compared the outcomes with the modified Kleinert regimen used previously in the same institution. Methods We searched the hospital database to identify flexor tendon repair performed before and after the new regimen was implemented and invited all patients to participate. The primary outcome was total active range of motion, and secondary outcomes were Disabilities of Arm, Shoulder, and Hand; grip strength; globally perceived function; and the quality of life. Results The active range of motion was comparable between the groups (mean difference = 14; 95% confidence interval [CI], −8 to 36; P = .22). Disabilities of Arm, Shoulder, and Hand; grip strength; global perceived function; and health-related quality of life were also comparable between the groups. There was 1 (5.3%) rupture in the modified Kleinert group and 4 (15.4%) in the early active motion group (relative risk = 0.3; 95% CI, 0.04-2.5; P = .3). Conclusions Increasing active gliding with a free wrist and intrinsic minus splint did not improve the clinical outcomes after flexor tendon injury at a mean of 38-month follow-up.

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