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.

Rice Bodies In The Wrist

Rice bodies are a rare finding in medicine and remain to be a challenge to provide adequate treatment. As occurrence varies over multiple rheumatic as well as infectious diseases, multiple hypotheses have been made about their origin. While rice bodies are most frequently reported in the shoulder and knee joints, flexor tendon synovitis with accompanying rice bodies is more rare. We report a case of extensive flexor tenosynovitis with rice bodies in the wrist in a 90-year old patient with seronegative rheumatoid arthritis. The patient reported a 5 month history of painful swelling of the right wrist. Ultrasound showed pronounced swelling of the synovial tissue of the flexor digitorum tendons as well as the flexor pollicis longus tendon. Laboratory test were negative for rheumatology tests with normal CRP and sedimentation rates. T2 weighted MRI demonstrated an extensive synovitis reaching from the distal forearm into the hand with inclusions, better known as rice bodies. Synovectomy including carpal tunnel release was performed with dissection of the mass revealing an extensive synovitis with a multitude of rice bodies. Histopathology showed lymphohistiocytic infiltrates consistent with rheumatoid nodules, no atypical cells were discovered. After surgery the patient regained full function of the wrist within two weeks without any remaining pain or mass in the affected limb.

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.

Unusual case of locked trigger thumb due to tophaceous infiltration of the flexor tendon over the wrist: a lesson learned

We report a rare case in which intratendinous gouty tophi were found within the flexor pollicis longus tendon at the wrist, causing locked thumb, which was misdiagnosed as trigger thumb.

Correlation of Flexor Pollicis Longus Tendon Status by Ultrasonography with Plate Position on Radiographs Following Volar Plate Fixation of Distal Radius Fractures with Pronator Quadratus Repair

Background Purpose was to correlate flexor pollicis longus tendon (FPL) attrition using Ultrasonography with plate position on radiographs following volar locked compression plate fixation (LCP) in patients who have undergone pronator quadratus (PQ) repair for distal radius fractures. Methods Status of flexor pollicis longus tendon was analyzed by ultrasonography in patients who underwent volar locked compression plating with pronator quadratus repair at a minimum of one year follow up. Soong’s criteria was used to assess the plate position and then correlated the ultrasonography findings of flexor pollicis longus. Results There were 33 patients included in our study, of which 15 belonged to Soong’s grade zero, 10 were grade one and eight were grade two. Flexor pollicis longus attrition was noted in all cases with grade two plating. Conclusion Pronator quadratus repair may not prevent attritional changes in higher grades of Soong’s, hence follow up may be required in these patients to identify attritional changes and early implant removal to prevent complications.