Dorsal Approach to Transfer of the Flexor Digitorum Brevis Tendon

2011 ◽  
Vol 101 (4) ◽  
pp. 297-306 ◽  
Author(s):  
Ricardo Becerro de Bengoa Vallejo ◽  
Marta Elena Losa Iglesias ◽  
Juan Carlos Prados Frutos ◽  
Miguel Fuentes Rodriguez ◽  
Kevin T. Jules
Keyword(s):  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Tendon Sheath ◽  
Cadaveric Study ◽  
Flexor Digitorum Longus ◽  
Dorsal Approach ◽  
Hammer Toe ◽  
Flexor Digitorum Brevis ◽  
Flexor Tendon Sheath ◽  
Flexor Digitorum

Background: Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammer toe deformities. Only transposition of the flexor digitorum brevis tendon has been reported in the literature in a cadaveric study that used the dorsal and plantar approach. A search of the literature revealed no reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions through a unique dorsal cutaneous incision. We performed a cadaveric study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique dorsal cutaneous incision. Methods: Transposition of the flexor digitorum brevis tendon was attempted in 156 toes of cadaveric feet (52 each second, third, and fourth toes) through a unique dorsal incision. Results: The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes by the dorsal incision approach. Conclusions: Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammer toe deformities, especially in the second, third, and fourth toes. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon is essential to the success of the procedure. (J Am Podiatr Med Assoc 101(4): 297–306, 2011)

Transfer of the Flexor Digitorum Brevis Tendon

2008 ◽  
Vol 98 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Ricardo Becerro de Bengoa Vallejo ◽  
Fermín Viejo Tirado ◽  
Juan Carlos Prados Frutos ◽  
Marta Elena Losa Iglesias ◽  
Kevin T. Jules
Keyword(s):  
Extensor Digitorum Longus ◽  
Anatomical Variation ◽  
Proximal Phalanx ◽  
Cadaver Study ◽  
Medial Aspect ◽  
Flexor Digitorum Longus ◽  
Longus Tendon ◽  
Hammer Toe ◽  
Flexor Digitorum Brevis ◽  
Flexor Digitorum

Background: Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw or hammer toe deformities. In contrast, a search of the literature revealed no previous reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions. We performed a cadaver study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect. Methods: Transposition of the flexor digitorum brevis tendon was attempted in 180 toes of cadaver feet: 45 second toes, 45 third toes, 45 fourth toes, and 45 fifth toes. Results: The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes and in 42 (93.3%) of the fifth toes. In the three remaining fifth toes (6.7%), the flexor digitorum brevis tendon was absent, a known anatomical variation. Conclusions: Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for correction of claw or hammer toe deformities, especially in the second, third, and fourth toes. The transverse aponeurotic fibers originating from the extensor digitorum longus impede the transfer of the flexor digitorum brevis tendon, and meticulous excision of these fibers is essential to the success of the procedure. (J Am Podiatr Med Assoc 98(1): 27–35, 2008)

Single Longitudinal Dorsal Incision Approach to Transfer the Flexor Digitorum Longus Tendon Between the Flexor Digitorum Brevis Hemitendons

2013 ◽  
Vol 103 (5) ◽  
pp. 430-437 ◽  
Author(s):  
Ricardo Becerro de Bengoa Vallejo ◽  
Marta Elena Losa Iglesias ◽  
Miguel Fuentes Rodriguez ◽  
Fermín Viejo Tirado
Keyword(s):  
Proximal Phalanx ◽  
Tendon Sheath ◽  
Proximal Interphalangeal Joint ◽  
Flexor Digitorum Longus ◽  
Longus Tendon ◽  
Longitudinal Incision ◽  
Novel Approach ◽  
Vascular Compromise ◽  
Flexor Digitorum Brevis ◽  
Flexor Digitorum

Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammertoe deformities. The most common technique uses two cutaneous incisions, one plantar and another dorsal. We performed a cadaveric study to determine whether the flexor digitorum longus tendon could be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique single longitudinal central dorsal incision. The rationale for this novel approach was to minimize the risk of vascular compromise to the digit associated with the two-incision approach. Transposition of the flexor digitorum longus tendon was attempted in 120 toes of cadaveric feet (60 each second and third digits) through a central longitudinal dorsal incision. The flexor digitorum longus tendon segment was long enough to be successfully transposed between the flexor digitorum brevis hemitendons of the second and third toes in 100% of the cases using the central longitudinal dorsal incision approach, with a resection arthroplasty at the proximal interphalangeal joint. Transfer of the flexor digitorum longus tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammertoe deformities in the second and third digits. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon and its longitudinal incision are essential to the successful transfer of the flexor digitorum longus tendon between the flexor digitorum brevis hemitendons. (J Am Podiatr Med Assoc 103(5): 430–437, 2013)

Transthecal Digital Nerve Block

1998 ◽  
Vol 23 (4) ◽  
pp. 490-493 ◽  
Author(s):  
N. S. SARHADI ◽  
J. SHAW-DUNN
Keyword(s):  
Methylene Blue ◽  
Nerve Block ◽  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Proximal Part ◽  
Tendon Sheath ◽  
Areolar Tissue ◽  
Digital Nerve ◽  
Flexor Tendon Sheath ◽  
Digital Nerve Block

Injection studies using methylene blue and latex were used in 60 digits from 40 cadavers to study how anaesthetic fluid injected into the flexor tendon sheath might spread around the proximal part of the finger. The injected solution escaped from the flexor tendon sheath around the vincular vessels which are present near the base and head of the proximal phalanx. Outside the digital canal, the dye flowed smoothly through the perivascular loose areolar tissue and spread alongside the main digital vessels and nerves and their palmar and dorsal branches.

Rupture of the Flexor Pollicis Longus Tendon after 30 Years due to Migration of a Retained Foreign Body

1995 ◽  
Vol 20 (6) ◽  
pp. 803-805 ◽  
Author(s):  
S. S. YANG ◽  
B. J. BEAR ◽  
A. J. WEILAND
Keyword(s):  
Foreign Body ◽  
Flexor Tendon ◽  
Ring Finger ◽  
Tendon Sheath ◽  
Glass Fragment ◽  
Flexor Pollicis Longus ◽  
Retained Foreign Body ◽  
Flexor Tendon Sheath ◽  
Flexor Pollicis Longus Tendon ◽  
Flexor Digitorum

Delayed rupture of a flexor tendon in the hand due to the presence of a retained foreign body is rare. We present the case of a late flexor pollicis longus rupture 30 years after traumatic implantation of a glass fragment. The foreign body had migrated distally a distance of 4.5 cm from the site of the original injury and eroded into the flexor tendon sheath. Thumb function was restored with a flexor digitorum superficialis tendon transfer from the ring finger with excellent results.

scholarly journals Comparison of the Thickness of Pulley and Flexor Tendon Between in Neutral and in Flexed Positions of Trigger Finger

2016 ◽  
Vol 10 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Junko Sato ◽  
Yoshinori Ishii ◽  
Hideo Noguchi
Keyword(s):  
Flexor Tendon ◽  
Tendon Sheath ◽  
Trigger Finger ◽  
Neutral Position ◽  
Flexor Tendons ◽  
Flexor Tendon Sheath ◽  
Posterior Direction ◽  
Flexor Digitorum ◽  
A1 Pulley ◽  
Anterior Posterior

Objective: This study aims to compare the morphology of the A1 pulley and flexor tendons in idiopathic trigger finger of digits other than the thumb between in neutral position and in the position with the interphalangeal joints full flexed and with the metacarpophalangeal (MP) joint 0° extended (hook grip position). Method: A total of 48 affected digits and 48 contralateral normal digits from 48 patients who initially diagnosed with idiopathic trigger finger were studied sonographically. Sonographic analysis was focused on the A1 pulley and flexor tendons at the level of the MP joint in the transverse plane. We measured the anterior-posterior thickness of A1 pulley and the sum of the flexor digitorum superficialis and profundus tendons, and also measured the maximum radialulnar width of the flexor tendon in neutral and hook grip positions, respectively. Each measurement was compared between in neutral and in hook grip positions, and also between the affected and contralateral normal digits in each position. Results: In all the digits, the anterior-posterior thickness of flexor tendons significantly increased in hook grip position as compared with in neutral position, whereas radial-ulnar width significantly decreased. Both the A1 pulley and flexor tendons were thicker in the affected digits as compared with contralateral normal digits. Conclusion: The thickness of flexor tendons was significantly increased anteroposteriorly in hook grip position as compared with in neutral position. In trigger finger, A1 pulley and flexor tendon were thickened, and mismatch between the volume of the flexor tendon sheath and the tendons, especially in anterior-posterior direction, might be a cause of repetitive triggering.

scholarly journals Deep Digital Flexor Tendon Injury at the Level of the Proximal Phalanx in Frontlimbs With Tendon Sheath Distension Characterized by Standing Low-Field Magnetic Resonance Imaging in Horses: 13 Cases (2015–2021)

2021 ◽  
Vol 8 ◽  
Author(s):  
Elisabeth Cornelia Susanna van Veggel ◽  
Kurt T. Selberg ◽  
Brenda van der Velde-Hoogelander ◽  
Katrien Vanderperren ◽  
Stefan Marc Cokelaere ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Case Series ◽  
Tendon Sheath ◽  
Tendon Injury ◽  
Mri Findings ◽  
Retrospective Case ◽  
Low Field ◽  
Previous Level ◽  
Flexor Tendon Sheath

Objective: To describe the MRI findings for 13 horses with deep digital flexor tendon (DDFT) injury at the proximal phalanx where the tendon goes from ovoid to bilobed in frontlimbs with tendon sheath distension. In addition, the prognosis of this lesion was assessed.Design: Retrospective case series.Animals: Thirteen client-owned horses.Procedures: Medical records were reviewed, and data were collected regarding signalment, history, MRI findings, and outcomes of horses. Findings of MRI were recorded and whether the case was confirmed with tenoscopy.Results: A diagnosis of DDFT injury at the junction between ovoid and bilobed portions at the level of the proximal phalanx was established in 13/20 (65%) horses that underwent MRI examination of the frontlimb digital flexor tendon sheath. Return to previous level of work was poor in this subset of horses with only three of 13 (23%) horses returning to previous level of work and one horse still in rehabilitation.Conclusions and Clinical Relevance: Standing low-field MRI represents a potentially useful diagnostic tool to evaluate digital flexor tendon sheath distension especially when evaluating the DDFT at the proximal phalanx where the tendon progresses from ovoid to bilobed. Prognosis of lesions of the DDFT at the proximal phalanx appears less favorable than previously reported causes of tendon sheath distension.

Operative Findings in Camptodactyly of the Little Finger

1992 ◽  
Vol 17 (6) ◽  
pp. 661-664 ◽  
Author(s):  
T. OGINO ◽  
H. KATO
Keyword(s):  
Flexor Tendon ◽  
Ring Finger ◽  
Tendon Sheath ◽  
Flexor Digitorum Superficialis ◽  
Muscle Belly ◽  
Normal Tendon ◽  
Flexor Tendon Sheath ◽  
Palmar Aponeurosis ◽  
Operative Findings ◽  
Flexor Digitorum

In five of six cases of camptodactyly in which an abnormality of the flexor tendon was examined at operation, the flexor digitorum superficialis tendon was hypoplastic and there was no continuity of the normal tendon between the muscle belly and bony insertion. The proximal end of the flexor digitorum superficialis tendon was attached to the palmar aponeurosis and the flexor tendon sheath of the ring finger in two patients, to the palmar aponeurosis in one, to the undersurface of the transverse carpal ligament in one and to the flexor tendon sheath of the ring finger in one. The tenodesis effect of the abnormal tendon of the flexor digitorum superficialis is considered to play an important role in the cause and rapid increase of the deformity of camptodactyly.

A Case of Trigger Finger by Flexor Tendon Sheath Ganglion

2015 ◽  
Vol 16 (2) ◽  
pp. 81-83
Author(s):  
Seok-Kyun Park ◽  
Soo Uk Chae
Keyword(s):  
Flexor Tendon ◽  
Tendon Sheath ◽  
Trigger Finger ◽  
Flexor Tendon Sheath

Epithelial inclusion cyst of the equine digital flexor tendon sheath: diagnosis by ultrasonography and magnetic resonance and successful treatment by tenoscopy

2019 ◽  
Vol 88 (6) ◽  
pp. 320-326 ◽  
Author(s):  
Z. Joostens ◽  
L. Vanslambrouck ◽  
H. De Cock ◽  
T. Mariën
Keyword(s):  
Magnetic Resonance ◽  
Flexor Tendon ◽  
Surgical Excision ◽  
Tendon Sheath ◽  
Good Prognosis ◽  
Inclusion Cyst ◽  
Flexor Tendon Sheath ◽  
Dense Mass ◽  
Epithelial Inclusion Cyst ◽  
Distal Aspect

A six-year-old warmblood horse was presented with a longstanding frontlimb lameness with mild digital flexor tenosynovitis and swelling of the distomedial pastern. Ultrasonography and magnetic resonance revealed a dense mass lesion in the distal aspect of the digital flexor tendon sheath, with a partial lamellar architecture, absence of internal vascularization and adjacent smooth pressure osteolysis of the middle phalanx. After surgical excision, histopathology confirmed an epithelial inclusion cyst. Epithelial inclusion cysts, also known as keratinizing or follicular cysts, are expansile benign mass-like lesions of aberrant epidermal tissue. In the horse, they are known to occur in cutaneous and several non-cutaneous tissues. In the digital flexor tendon sheath, they have rarely been described. Given their often chronic presentation in this location, they may appear as an atypical dense mass on imaging, uncommon for cystic lesions. Complete tenoscopic removal, even for larger masses, is achievable and considered curative with good prognosis for return.

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