A Study to Analyse Correlation of Plate Position With Flexor Pollicis Longus Tendon Attrition In Patients Managed With Volar Plating

Background: Purpose of this study was to study association of flexor pollicis longus tendon (FPL) attrition using Ultrasonography with plate position on radiographs in patients managed with volar locked compression plate fixation (LCP) in distal radius fractures. Methods: Status of flexor pollicis longus tendon was analysed by ultrasonography in patients who underwent volar locked compression plating a minimum of one year follow up. Soong’s criteria were used to assess the plate position and then correlated with the ultrasonography findings of flexor pollicis longus. Results: There were 45 patients included in our study, of which 28 belonged to Soong’s grade zero, 10 were grades one and 7 were grade two. Flexor pollicis longus attrition was noted in 5 cases with grade two plating. Conclusion: Amongst the cases with grade 2 of Soong’s criteria, attritional changes were seen in 72 percent of patients , which warrants a proper follow up to identify any impending signs of tendon rupture and to make early intervention to prevent rupture.

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

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.

Real Color Sectioned Images and Correspondence with Ultrasound Images of the Palmar Wrist

The aim of this study was to identify sequential changes in the actual sites and shapes of wrist structures on the high-resolution sectioned images and to compare these with those on ultrasound (US) images. These images of the wrist may yield guidelines for diagnosing various pathological lesions in the wrist. In the sectioned images of a whole cadaver body, and the images including the wrist were selected, and part of the hand was cropped. A wrist of one healthy Korean subject was scanned by ultrasonography to obtain US images of the wrist. Wrist structures were identified and labeled in detail on the sectioned images and the corresponding US images. Serial changes of the sites and shapes of the wrist structures mainly occurred in the bones, median nerve, ulnar artery, ulnar nerve, and the flexor pollicis longus tendon, along with thickening of the thenar and hypothenar muscles. The present results could provide a new guide for anatomy mapping, diagnosing, and detecting various lesions of the wrist. They can also be useful and effective for educational purposes related to interpreting US images.

Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures

Aim A rare complication following volar plate fixation of a distal radius fracture is flexor pollicis longus (FPL) rupture. This study aims primarily to analyze the radiographic features and secondly to report the patient-reported outcomes of FPL reconstruction after volar plate fixation. Methods Ten patients were retrospectively identified and contacted for follow-up. Seven patients participated in the study and completed the numeric rating scale (NRS) for pain, patient-reported outcome measurement information system—upper extremity (PROMIS-UE), and quick disability of arm, shoulder, and hand (QuickDASH) questionnaires at a median of 3.4 years following FPL reconstruction. Soong grade was determined on preoperative radiographs. Results Six patients were classified as Soong grade 1 and two patients had a screw or wire protruding volarly. The median time to tendon rupture was 21.6 months. At final follow-up, the median NRS pain score was 0 (range: 0–7); the median PROMIS-UE score was 47.1 (range: 25.9–61); and the median QuickDASH-score was 12.5 (range: 4.5–75). Conclusions The outcome of FPL reconstruction after volar plate fixation is highly variable. All ruptures in our cohort occurred in patients with plate positioning classified as Soong grade 1 and occurred at up to 3 years following distal radius fixation.

Post-operative management of flexor tendon injuries at zone II and flexor Pollicis Longus – a survey of Irish practice

Purpose The post-operative management of flexor tendon injuries has been the focus of considerable exploration and there continues to be variation in approaches and methods of mobilisation. The purpose of this paper is to explore therapy management following repair to flexor tendons at zone II and flexor pollicis longus (FPL) (all zones) in Ireland. Design/methodology/approach A descriptive survey questionnaire design through an online format was used. Therapists were recruited through the Irish Association of Hand Therapists, the national bodies for occupational therapy and physiotherapy and therapy managers in acute hospitals, with 29 therapists participating in the study. Descriptive statistics were used to analyse the survey data. Findings Patients were generally seen three to five days following surgery. Early active mobilisation approaches were favoured by all but one therapist, with 62% using the Belfast protocol and 34% the Manchester Short Splint (MSS) protocol. Each early active protocol exercise session commences with passive motion followed by graded active flexion. Tenodesis is incorporated by the majority of respondents within the first four weeks. Therapy programme and splints are modified based on patient presentation. Resistance exercises are commenced from week seven. Patient compliance was identified as the most influential factor in the post-operative intervention approach taken. Originality/value This study provides the first Irish profile of current practice in the post-operative management of flexor tendon repairs at zone II and FPL which has not previously been reported. Further research should explore the reasoning behind the interventions chosen and also the implications for practice of changes to surgical techniques.

Influence of Smartphone Overuse on Grip Strength, Pinch Strength, and Cross-Sectional Area of Flexor Pollicis Longus Tendon and Median Nerve

Background and Aim The adverse effects of smartphone size and weight on the hand and hand function have not been studied extensively. This study aimed to investigate the changes to the flexor pollicis longus tendon and median nerve using diagnostic ultrasound for high and low addiction smartphone users. Methodology In this cross-sectional study, 54 healthy male university students were divided into two groups according to the Smartphone Addiction Scale: high and low users. Demographic data, hand grip strength (kg), pinch strength (kg), and smartphone weight, length and width were measured and recorded. Diagnostic ultrasound examination determined the cross-sectional area of the median nerve (mm2) and flexor pollicis longus tendon (mm2) of the dominant and non-dominant hand. Result The cross-sectional area of the median nerve was significantly higher in the high-user group (7.4±1.3 mm2) than the low-user group (6.7±1.0 mm2). The correlation of phone weight, length and width with median nerve area was respectively positive, higher and significant (0.718, 0.747, and 0.733; p<0.05). The flexor pollicis longus tendon in the mid-thenar region was moderately positively correlated with phone length (0.430; p<0.02) for high addiction smartphone users. Conclusion The findings of the current study demonstrates that change to the median nerve and flexor pollicis longus tendon, could be linked to the width, weight and length of the smartphone and high addiction.

Characteristics of Congenital Clasped Thumb: A Case Report and Literature Review

Congenital clasped thumb is a progressive flexion and adduction deformity presenting with heterogeneous congenital abnormalities and syndromes. This deformity is usually accompanied by first web space narrowing and metacarpophalangeal joint (MPJ) laxity. Understanding the various features of the clasped thumb and making an accurate diagnosis is essential for treatment. Depending on the classification, treatment can vary from conservative to surgical. We describe the case of a bilateral clasped thumb with various characteristics, which were treated differently according to the disease type. The deformity of the clasped thumb was bilateral, and the patient had MPJ flexion deformity, flexor pollicis longus shortening, first web space narrowing, and MPJ instability, which were confirmed through a stress test. The left thumb was a complex type and was surgically treated, whereas, the right thumb was a flexible type, which was treated with splinting; the treatment showed promising results at 2 years post surgery. Diagnosis of the clasped thumb through thorough history taking, physical examination and considering its characteristics, and appropriate classification of the disease is essential for treatment. Furthermore, a stress test can identify MPJ instability in the congenital clasped thumb.