Extensor Tendon Research Articles

Accessory extensor pollicis longus as a rare radial-sided tendon anomaly: a case report

Accessory extensor pollicis longus tendons are rare tendon anomalies. This report describes the case of a 54-year-old man who presented with pain and difficulty extending his thumb. Upon initial examination, despite a history of trauma, he could extend the interphalangeal joint, but with limited range. During the surgical exploration, an accessory extensor pollicis longus tendon was unexpectedly discovered. This tendon ran parallel to the extensor pollicis longus on the radial side and then attached to the distal phalanx of the thumb. Accessory extensor tendons are more commonly found on the ulnar side than on the radial side of the hand; therefore, this case is notable due to the unusual location of the tendon. After appropriate repair surgery, the patient successfully regained a normal range of motion. While previous classifications of extensor tendon anomalies have focused on the relationship between the extensor indicis proprius and extensor digitorum communis, this case suggests that it is also necessary to consider the relationship with the extensor pollicis brevis tendon. This case highlights the importance of recognizing tendon variations, especially in trauma situations. Detecting such variations preoperatively using imaging can significantly impact the treatment plan and surgical approach.

Transverse versus longitudinal skin incision in first extensor tendon release for radial styloid tenosynovitis: a randomized controlled trial

BackgroundDe Quervain’s tenosynovitis, characterized by the entrapment of the extensor pollicis brevis and abductor pollicis longus tendons in the first extensor compartment, leads to pain and swelling near the radial styloid. When conservative treatments including rest and antiinflammatory medications fail, surgery is often recommended. This study aimed to compare transverse and longitudinal skin incisions with respect to surgical scars, postoperative pain, and functional outcomes in the open release of the first extensor compartment in radial styloid tenosynovitis.MethodsSeventy patients were randomly assigned to either the transverse or longitudinal skin incision group using a computer-generated random number table. Postoperative scarring was assessed using the Patient and Observer Scar Assessment Scale (POSAS), pain intensity using a verbal numerical rating scale, and functional outcomes using the Thai version of the Patient-Rated Wrist Evaluation (PRWE) questionnaire at 2, 6, and 12 weeks post-surgery. Continuous data were presented as mean ± standard deviation for normally distributed data or as median (interquartile range) for skewed distributions.ResultsFollowing surgery, both groups showed marked improvements in Thai PRWE and POSAS scores, with no differences in functional outcomes. The longitudinal incision group had significant pain reduction at 2 and 6 weeks post-surgery. By 12 weeks, pain alleviation was similar in both groups. Wound infection was not observed in any case, and three patients reported temporary paresthesia, which was not statistically significant between the groups.ConclusionsBoth techniques demonstrate similar improvements in functional scores and reductions in pain scores, with no significant differences in complication rates, particularly concerning hypertrophic scars. The decision between transverse and longitudinal skin incisions should consider the surgeon’s expertise, the patient’s anatomical characteristics, and the complexity of the surgical procedure. Each approach presents distinct trade-offs, highlighting the necessity of a personalized, patient-centered strategy to optimize surgical outcomes.Trial registrationThe study was registered on 27/06/2023, at clinicaltrials.in.th (TCTR20230627001). This study was retrospectively registered.

Arthroscopic suture anchor repair and debridement for refractory lateral epicondylitis show significant clinical improvement

PurposeTo retrospectively compare the clinical outcomes of arthroscopic suture anchor repair of the common extensor tendon (CET) and arthroscopic debridement of CET for the treatment of refractory lateral epicondylitis. MethodsPatients with refractory lateral epicondylitis who underwent arthroscopic surgery between August 2018 and September 2022 with a minimum of 1-year follow-up were included. All patients were divided into two groups based on whether they underwent suture anchor repair. The modified Nirschl technique was used to debride the CET lesions in all patients, and modified anchor repair was used for CET insertion reconstruction in patients after January 2021. In short, suture anchor fixation (single-row) was used in patients with tear areas less than 50% of the CET insertion, and suture-bridge fixation (double-row) was used in patients with tear areas greater than 50%. The outcomes, including the visual analog scale (VAS) score for pain, the Mayo Elbow Performance Score (MEPS), the quick Disabilities of the Arm, Shoulder and Hand (DASH) score, and surgical satisfaction, were measured one day preoperatively and at the latest follow-up. The proportion of patients achieving the minimal clinically important difference (MCID) was compared between the groups. ResultsA total of 62 patients (60% female) were included in the final analysis (30 in the debridement group and 32 in the repair group). The mean age of the cohort was 47.6 ± 7.3 years, with 77% of patients affecting the dominant arm. The follow-up time was 29.3 ± 3.2 (range: 19 - 35) months for the debridement group and 27.2 ± 5.4 (range: 20 - 37) months for the repair group (P = 0.073). Preoperative patient-reported outcomes were comparable between the groups and were significantly improved after surgery. Postoperatively, patients in the repair group had better MEPS score (95.8 ± 6.9 vs 91.2 ± 8.0; P = 0.017) and quick DASH scores (2.2 ± 3.9 vs 4.2 ± 3.9; P = 0.043), while there were no differences between the two groups in terms of VAS scores for pain during rest (0.1 ± 0.4 vs 0.1 ± 0.3; P = 0.933) or during activity (0.3 ± 0.8 vs 0.4 ± 0.6; P = 0.639). MCID achievement of VAS score during rest was similar between the repair group (97%) and the debridement group (93%, P = 0.607), while MCID achievement in the VAS score during activity, MEPS score, and quick-DASH score was 100% in both groups. ( All patients resumed their daily life and work after surgery, for a surgical satisfaction rate of 98.4%. ConclusionArthroscopic suture anchor repair and debridement of the CET insertion resulted in significant clinical improvement in patients with refractory lateral epicondylitis. Level of evidenceRetrospective comparative case series; level 3.

Finger Sprains, Ultrasound Anatomy, and Pathology of Finger Ligaments.

The joints of the fingers play an important role in prehension. They must accomplish both great mobility in the sagittal plane to allow the fingers to roll up and great stability to ensure the grip is both precise and firm. The collateral ligaments and palmar plates are the main passive stabilizing structures between the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Sprains with or without dislocation of the proximal IP joints of the fingers are common injuries in sports pathology and may involve not only the ligaments but also their bony insertion on the phalanges or extensor tendons. Certain entities are specific to the MCP joints: ligament ruptures with Stener-like effect under the sagittal bands and MCP flexion locking (locked finger). Radiographs and ultrasound usually enable a precise diagnosis, so appropriate treatment can be provided.

Complications of Volar Versus Low-Profile Dorsal Plating of Distal Radius Fractures.

Distal radius fractures are one of the most common injuries of the upper extremity. Although nonsurgical management is common, surgical intervention, particularly using volar and dorsal plate fixation, is essential in a subset of injuries. Historically, dorsal plates were avoided due to a high rate of extensor tendon irritation and rupture. Volar locking plates were developed in the early 1990s and first published in 2000 to avoid the complications associated with dorsal plating and have since become widely considered the workhorse for most distal radius fractures. Despite advancements, both fixation methods are still associated with complications, warranting careful selection based on fracture patterns. The purpose of this review is to summarize the most recent literature on the complications associated with the use of volar and low-profile dorsal distal radius plates.

Associations Between Partial Common Extensor Tendon Tears and Clinical-Ultrasonographic Findings in Patients with Lateral Epicondylitis

Abstract Objective This study investigates the effect of partial common extensor tendon(CET) tears on demographic, clinical and ultrasound(US) parameters in patients with lateral epicondylitis(LE). The research aimed to provide a comprehensive understanding of how these US-detected partial tears, influence the clinical presentation and imaging findings associated with LE. Design Retrospective cross-sectional study. Records of 227 patients with LE met the inclusion-exclusion criteria were reviewed. The patient-rated tennis elbow evaluation(PRTEE) questionnaire was used as the primary outcome measure. Secondary outcome measures were visual analogue scale for pain, algometric measurements, hand grip strength, and US parameters(maximum tendon thickness measurements from the capitellar-radiocapitellar sides and presence of bone abnormalities). Results Partial CET tears detected using US were present in 22.7%(n = 54) of the patients. Patients with partial CET tears were older(50,31±9,22), had higher PRTEE scores(65,48±12,76), capitellar-radiocapitellar maximum tendon thickness measurements(0,60±0,80/0,60±0,72), and incidence of bone abnormalities(%40.7,n = 32)(p < .05). Logistic regression analysis identified age and PRTEE pain score as associative factors with partial CET tears. Capitellar-radiocapitellar maximum tendon thickness measurements greater than 0.55 cm were associated with an increased probability of partial CET tears. Conclusion US-detected partial CET tears may worsen the clinical and US parameters in patients with LE. Older age, higher PRTEE scores and higher maximum tendon thickness measurements were associated with partial CET tears.

Management Options and Clinical Outcomes After Flexor Tendon Ruptures Following Volar Plating of Distal Radius Fractures.

The transition to volar locking plates for the treatment of distal radius fractures has improved patients' range of motion, reduced extensor tendon issues, and hastened return to activity compared to older fixation methods or nonoperative treatment. One drawback to volar plating is the potential for flexor tendon ruptures due to aberrant plate or screw placement. This study aims to describe the reconstruction options and patient outcomes after flexor tendon rupture due to volar plating. This is a single-institution, retrospective review of patients who presented with flexor tendon rupture from 2014 to 2023 after a distal radius fracture previously managed with a volar plate. Patient demographics, operative details, range of motion, complications, and patient-reported outcomes were collected. Ten patients presented with flexor tendon ruptures after volar plating for distal radius fractures from 2014 to 2023. The most common rupture was flexor pollicis longus (FPL) in 7 patients, followed by index finger flexor digitorum profundus (FDP) in 2 patients, and small and ring finger FDP rupture in 1 patient. Flexor pollicis longus (FPL) was reconstructed with a palmaris longus (PL) graft in 4 patients, ring finger flexor digitorum superficialis transfer in 2 patients, and repaired primarily in 1 patient. All patients with FPL ruptures regained functional thumb interphalangeal flexion except for 1 patient who reruptured 4 weeks after surgery. Flexor tendon ruptures can occur following volar plating of distal radius fractures, even years after fixation of the fracture. These are attritional ruptures and generally reconstructed with tendon grafting of transfer, providing functional flexion of the affected digit.

Management of partial extensor tendon lacerations of the hand and forearm: A national survey of practice in the United Kingdom

Management of partial extensor tendon lacerations of the hand and forearm: A national survey of practice in the United Kingdom

Chronic Injury of Sagittal Band by Metacarpal Head Osteoma: A Case Report

Injury of the sagittal band, a crucial component of the extensor hood, can occur in various situations, including spontaneous events, trauma, and rheumatic diseases. This case presents a rupture of the sagittal band resulting from chronic irritation caused by a metacarpal head osteoma. A 22-year-old female presented with ulnar subluxation of the extensor tendon at the left third metacarpophalangeal joint, without any history of trauma or pain. Ultrasonography and computed tomography revealed a 1.7 mm-sized bony lesion on the radial side of the metacarpal head, accompanied by a partial tear of the radial sagittal band. Our hypothesis that chronic irritation of the sagittal band by the adjacent bony lesion led to the partial tear was confirmed by intraoperative findings. The lesion was excised, and the radial sagittal band was reconstructed. Histopathological examination confirmed a diagnosis of osteoma. To our knowledge, this is the first reported case of sagittal band rupture caused by an osteoma of the metacarpal head. This case underscores the importance of considering an underlying metacarpal head osteoma in patients with non-rheumatoid joints presenting, in the absence of a traumatic history, with a sagittal band rupture due to chronic irritation.

Treatment of proximal phalangeal fracture with miniature combined external fixator

To investigate the clinical effect of limited open reduction treatment of proximal phalangeal fracture with miniature external fixator combined with small incision. Between January 2020 and December 2022, 29 patients with proximal phalangeal fracture were treated with micro external fixator combined with small incision in fracture plane, including 23 males and 6 females, aged from 19 to 62 years old with an average of (36.2±21.0) years old. Five patients with open phalangeal fracture were treated with stageⅠsurgery, 24 cases of closed phalangeal fracture were treated with elective surgery. At the 6 month follow-up, the curative effect was evaluated according to the total active flexion scale (TAFS) of the American Hand Surgery Association. The fracture healing, nail path, local soft tissue healing, and complications were observed. All the 29 patients were followed up for 6 to 10 months with an average of(8.3±2.1) months, 3 patients had delayed fracture healing, 1 patient had distal skin numbness, symptoms were relieved after nutritional nerve treatment, no external fixator broken nails, no infection, the nail path and small incision healing was good, bone healing was achieved at the end of follow-up. Fracture healing time ranged from 10 to 24 with an average of (13.7±3.1) weeks. Six months after operation, according to the TAFS standard, 19 cases (227.68±4.23) were excellent, 7 cases (203.86±14.32) were good, and 3 cases (170.33±7.32) were poor. The micro-combined external fixator combined with limited incision with small incision can be used in the treatment of proximal phalangeal fracture. The operation is simple and beneficial to early functional exercise, small extensor tendon irritation, convenient second-stage removal, and high rate of excellent and good functional score in recovery period.

Surgical Management of Early Metacarpophalangeal Joint Silicone Implant Fracture in Patient With Rheumatoid Arthritis

Introduction: Metacarpophalangeal (MCP) joint arthroplasty is a common treatment modality to correct ulnar drift, pain, and functional deficits in patients with rheumatoid arthritis, an autoimmune condition targeting the synovium of joints. While silicone MCP joint implants are susceptible to revision in the long term, there is a lack of literature discussing their early breakage. The present case illustrates silicone implant fracture only 10 weeks after MCP arthroplasty—the first instance in the literature to the authors’ knowledge. Materials and Methods: The patient is a 64-year-old female with stage 4 rheumatoid arthritis who underwent right index and middle finger MCP joint arthroplasties using 0-degree silicone implants, radial sagittal band imbrication on these digits, and right ring and small finger extensor tendon centralization at the MCP joint. Results: During the 10th postoperative week, the patient presented with atraumatic middle finger pain and ulnar deviation. Imaging revealed a right middle finger MCP implant fracture at the distal stem, which underwent successful revision using a 30-degree flexed implant and index and middle extensor tendon centralization. Discussion: Nineteen months after revision surgery, the patient continues to have no pain and an improved range of motion. Ultimately, we are hopeful that the flexed silicone implant will last the patient's lifetime.

Focal Versus Combined Focal Plus Radial Extracorporeal Shockwave Therapy in Lateral Elbow Tendinopathy: A Retrospective Study.

Background: Lateral epicondylitis of the elbow, commonly known as tennis elbow, is a musculoskeletal disorder characterized by pain and degeneration of the common extensor tendon. Despite various treatments, optimal management remains debated. Objective: This study aimed to compare the effectiveness of focal extracorporeal shockwave therapy (F-ESWT) alone versus a combination of focal and radial pressure waves (F-ESWT+R-PW) in treating chronic lateral epicondylitis. Methods: This retrospective observational study included 45 patients diagnosed with chronic lateral epicondylitis divided into two groups based on the treatment received: group A (F-ESWT, n = 23) and group B (F-ESWT+R-PW, n = 22). Both groups underwent three weekly sessions of their respective treatments. Patients were also given a home exercise protocol. Primary outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Patient-Rated Tennis Elbow Evaluation (PRTEE) for pain and functional impairment at baseline (T0), 4 weeks (T1), 12 weeks (T2), and 24 weeks (T3) post-treatment. Secondary outcomes included grip strength and ultrasonographic measurements of common extensor tendon (CET) thickness and vascularization. Results: Significant improvements in VAS and PRTEE scores were observed in both groups at all follow-up points. Group B showed greater pain reduction at T1 (VAS: 3.0 ± 1.6 vs. 4.43 ± 1.47; p < 0.005) and T2 (VAS: p < 0.030) compared to group A. Functional outcomes (PRTEE) also favored group B at T1 (p < 0.030) and in the pain section at T2 (p < 0.020). Grip strength improved similarly in both groups. CET thickness showed no significant differences at T3. Vascularization decreased significantly in both groups, with a non-significant trend favoring group B. Conclusions: The combined F-ESWT+R-PW therapy proved more effective than F-ESWT alone in the short- to mid-term management of chronic lateral epicondylitis, significantly enhancing pain reduction and functional outcomes. The combination of focal and radial pressure waves offers a superior therapeutic approach, leveraging the distinct mechanisms of each modality for better clinical results. Further research is needed to confirm these findings and establish long-term efficacy.

Outcomes of Single Corticosteroid Injection in De Quervain's Tenosynovitis.

The aim is to demonstrate the effectiveness of steroid injection in treating De Quervain disease. This study took place in the Orthopedic and Spine unit of Hayatabad Medical Complex. This study started in June 2022 and ended in February 2023. Seventy-five patients and 76 hands with De Quervain's Tenosynovitis were recruited for the study. Of these 75 patients, 54 (72%) were female and 21 (28%) were male. The diagnosis of De Quervain's Tenosynovitis was established from the patients' histories, physical examinations, and special tests. One ml of local anesthetic (2% of xylocaine) mixed with 1 ml of Corticosteroid (Depo-Medrol®, containing methylprednisolone acetate 40 mg/ml) were injected between abductor pollicis longus (APL) and extensor pollicis brevis (EPB), 3-4 cm proximal to radial styloid on the effected side. Patients were reviewed at two- and three-weeks period after injection. Results: Sixty-three (84%) patients were completely pain-free, 9 (12%) patients had mild pain, while 2 (2.2%) patients had no improvement in pain status at all. 1 (1.3%) patient didn't show up on the second follow-up. Injecting corticosteroids into the first compartment of the dorsal extensor tendon is a good treatment for De Quervain's tenosynovitis. The incidence of De Quervain's disease is higher in females and in the right hand. Only a limited subset of individuals who have not responded to non-invasive and minimally invasive treatments can be considered for surgical intervention. The study's limitations include a small sample size and fewer follow-ups. Further studies, especially randomized controlled trials with large sample sizes and long follow-ups, are needed to determine the long-term efficacy of steroid injection in De Quervain's tenosynovitis and whether the documented effect is likely to have occurred due to the treatment.

Effectiveness of Ultrasound In Tennis Elbow Patients: Literature Review

Lateral Epicondylitis, commonly known as Tennis Elbow, is caused by tension in the common extensor tendon, particularly at the origin of the extensor carpi radialis brevis tendon. This condition leads to pain and reduced hand grip strength, as well as impaired elbow function. This study aims to evaluate the effectiveness of Ultrasound therapy in managing pain, improving grip strength, and enhancing elbow functionality in patients diagnosed with Tennis Elbow. The method employed is a systematic literature review, analyzing relevant studies from various scientific databases. The results show that ultrasound therapy, applied consistently over several weeks, significantly reduces pain levels, improves hand grip strength, and enhances the functional movement of the elbow. The effectiveness of ultrasound treatment is supported by the statistical significance of p&lt;0.01, indicating a strong reduction in pain and improvements in physical function. The findings suggest that Ultrasound therapy is an effective, non-invasive modality for treating Tennis Elbow, offering substantial improvements in patient recovery.

Regeneration of full thickness common extensor tendon tear after percutaneous microfragmented adipose graft.

Tennis elbow, also commonly known as lateral epicondylitis or common extensor tendinosis, is a common musculoskeletal injury in the adult population. Currently, the standard treatment regimen prescribed for this injury involves a combination of rest, physical therapy, bracing and anti-inflammatory medications. If refractory to these conservative measures, platelet-rich plasma has been shown effective. However, in the case of full thickness tears, surgery has remained the only treatment option until now. We present a case report of a 56-year-old man with a diagnosis of a left large full thickness tear and rupture with retraction of his common extensor tendon (CET) following a corticosteroid injection. The patient was treated with microfragmented adipose transfer. He was re-evaluated around 7weeks and again at 15weeks post-treatment and demonstrated ultrasound evidence of complete bridging and remodeling of his prior full thickness CET tear and resolution of retraction. This case presents a promising option for patients with full thickness CET tears who would like to refrain from or are unable to have surgery. Further research and possible randomized controlled trials are needed to further assess the full efficacy of microfragmented adipose transfer in the treatment of full thickness CET tears.

Effectiveness of a novel finger range-of-motion brace for extensor tendon injury: a report of 10 patients

BackgroundExtensor tendon injuries require surgical repair, followed by rehabilitation to ensure optimal outcomes. Immobilization has been the cornerstone of postoperative management. However, immobilization after surgery frequently makes the finger stiffness, often resulting in reduced functionality and quality of life for patients. Recent studies indicate that early controlled motion can significantly improve outcomes, but safe early range of motion (ROM) exercise is a significant clinical challenge. This article aims to check the efficacy of the novel designed finger ROM brace for preventing finger stiffness for extensor tendon injuries with case series.MethodsA finger ROM brace was designed based on the natural finger movement. Like a real finger, there are two tiny hinge joints and three round-shape body components. The design aimed to be ergonomic dynamic splint assisting controlled motion to promote early motion, thus reducing tendon tension and preventing stiffness. Elastic resistant ROM exercise could be by inserting a silicone band into the groove on the components and free movement could be achieved by removing a silicone band.ResultBetween December 2022 and July 2023, 10 patients who underwent tenorrhaphy because of extensor tendon laceration were involved. Complete extensor tendon laceration was 3 patients, other seven patients had partial laceration of extensor tendons. Surgery was performed within 2 days of injury, and no infection was observed in all patients. After the extensor tendon was confirmed as healed state by ultrasound, the patients were permit the active exercise wearing finger ROM brace with a silicone band. Within 1–2 weeks after elastic resistant exercise, the patients could achieve free full ROM movement without any complication.ConclusionThe novel finger ROM brace combines the advantages of dynamic splinting and under-actuated mechanisms to offer a comprehensive solution for preventing stiffness after extensor tendon suture. Future studies should focus on clinical trials to validate the efficacy and safety of this brace in a larger population.

Extensor Tendon Repair.

Extensor tendon injuries are a common condition that hand surgeons must be prepared to treat. The area of extensor tendon injury can traditionally be broken down into 9 zones. Physical examination is the best way to diagnose extensor tendon injury with a loss of active extension in the injured digit. The tenodesis effect may be utilized to aid in diagnosis: wrist flexion should cause passive extension at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints if the extensor tendon is in continuity. Repair of extensor tendon injuries depends on the zone of injury and the thickness of the tendon, which determines its ability to hold core sutures. For zone-I and II injuries, several "figure of 8" buried sutures can be utilized or a running type of suture may be employed. For zone-III to VII injuries, 1 or 2 core sutures and a supplementary running suture can be utilized. Several alternative techniques have been previously described. These include variations in the number of core strands, repair configuration, and suture caliber, as well as the use of epitendinous repair. Alternative treatments also include nonoperative treatment, which is typically reserved for partial tendon injuries and for patients who are unable to tolerate a surgical procedure. The techniques that we describe are tailored to the thickness of the tendon. Running sutures are applicable to any zone, whereas core sutures are best utilized in zones III through VII. The running interlocking horizontal mattress technique has been found to be stiffer and faster to accomplish compared with the other techniques, and was found to have good to excellent clinical results in a study of lacerations in zones IV and V1,2. Repair of extensor tendon lacerations has demonstrated good long-term outcomes if performed in a timely manner after injury. A previous study showed good to excellent function in up to 64% of acute extensor tendon repairs, more fingers lost the ability to flex fully than lost the ability to extend3. Systematic reviews have suggested that dynamic rehabilitation may not provide superior long-term benefit compared with static splinting4. The Elson test should be performed under a digital nerve block in order to properly assess the integrity of the central slip.In distal zone I and III injuries, suture anchors or bone tunnels may be utilized when there is no remaining tendon on the distal end of the laceration.When preparing the tendon ends for repair, it is important to handle the tendon delicately-preferably through the cut end of the tendon rather than the tendon itself.In zone-VII injuries, the injured tendon may lie beneath the extensor retinaculum. In such cases, windowing of the extensor retinaculum may decrease adhesion formation and facilitate repair. MCP = metacarpophalangealPIP = proximal interphalangealDIP = distal interphalangealIP = interphalangealROM = range of motionRMS = relative motion splintRIHM = running interlocking horizontal mattress.

Spontaneous Resolution of Congenital Insufficiency of the Extensor Tendon Central Slip.

The congenital insufficiency of the extensor tendon central slip of the fingers is a relatively rare condition, with only a few reported cases in pediatric patients, as described in 2 clinical series. In this study, we aimed to present the natural history of a significant number of untreated patients with this deformity. This study has received institutional review board approval, and parents provided informed consent following the Declaration of Helsinki guidelines for biomedical research involving humans. A retrospective analysis of children with this deformity, ranging from June 2008 to July 2021, was collected by 1 surgeon. The inclusion criteria included children with a supple PIP flexion deformity, characterized by MP hyperextension and PIP extension lag, which had been present since birth. Complete passive PIP extension and the absence of volar skin webbing differentiated this condition from camptodactyly. The mean age of 24 children with 57 involved digits at diagnosis was 7 months (range, 1 to 17) and the mean follow-up was 6 years to 9 months (2yr to 1mo to 13yr). Six patients had an incorrect previous diagnosis of camptodactyly.Active PIP extension recovered progressively. At the final follow-up, complete PIP extension occurred in all except 4 cases in which a residual 10° extension lag. The mean time for a complete active PIP extension was 2 years to 7 months (20mo to 3yr to 9mo). Nineteen cases (79%) showed a mild FDS contracture of the involved digits at the final follow-up.The deformity was bilateral in 15 children (62.5%) and involved only 1 finger (unilaterally or bilaterally) in 15 cases (62.5%), and 2 fingers in 6 (25%). Little and ring fingers were most commonly involved. In 7 cases, there was a family history of finger deformity. Congenital insufficiency of the extensor tendon central slip typically resolves spontaneously within the first 4 years of life. Literature suggests that splinting can expedite the correction of the deformity and thus, if possible, it can be used. In most cases, a residual, clinically insignificant FDS contracture may be present. This condition is often misdiagnosed as camptodactyly. IV.

Evaluation and Surveillance of Lateral Elbow Tendinopathy in Manual Workers: Identifying Elbows at Risk

Abstract Background: Manual workers are at risk of developing lateral elbow tendinopathy (LET). We aimed to validate the hypothesis that asymptomatic elbows of manual workers with LET are more likely to have positive physical examination results and morpho-mechanical changes on elbow ultrasonography compared to healthy individuals. Methods: This cross-sectional case–control study included 30 manual workers with unilateral LET (LET group) and 30 age- and sex-matched healthy volunteers (control group). Demographic data collection and functional evaluation were performed using the Disabilities of the Arm, Shoulder, and Hand; Patient-Rated Tennis Elbow Evaluation; and European Quality of Life Five-Dimensions questionnaires. Physical examination of the elbows and evaluation of the common extensor tendon (CET) with B-mode morphology ultrasonography and Young’s modulus elastography were performed. The LET-unaffected and LET-affected elbows in the LET group were compared with the elbows in the control group. Results: The LET-unaffected elbows in the LET group had a higher prevalence of positive chair test results and focal hypoechoic change and microcalcification on ultrasonography than those in the control group (P &lt; 0.05, 0.005, and 0.05, respectively). In addition, LET-affected elbows showed higher focal hypoechoic change, microcalcification, erosive cortex, and neovascularity than elbows in the control group (P &lt; 0.001, 0.001, 0.005, and 0.001, respectively). The unaffected and affected elbows showed greater CET thickness than those in the control group (P &lt; 0.05 and 0.005). Conclusion: The unaffected elbows of manual workers with unilateral LET should be considered at risk of LET. We proposed a risk assessment and surveillance protocol based on chair test results and abnormal ultrasonographic findings.

An extensive infiltrative diffuse tenosynovial giant cell tumor in both compartment of the forearm: A case report

Diffuse tenosynovial giant cell tumors are relatively rare but second most common tumor effecting the synovial containing tissues. The study aim was to present a case involving a 40-year-old male patient with a complaint of a progressively enlarging swelling on the radial side of right wrist. On local examination, there was a bi-lobed swelling 7×9 and 6×5 cm on the dorsolateral and anterolateral aspect of right wrist respectively. Through Hennery’s modified approach tumor was exposed. It was extending from dorsolateral to anteromedial wrist encasing the flexors, extensor and abductor tendons of thumb and radial neurovascular bundle and adjacent wrist and finger flexors. The tumor surrounding the tendons was carefully removed, and carpal tunnel release was performed to address the tingling sensation. The patient managed was having lobulated diffuse type tumor involving the both flexor and extensor compartment. Better outcome, less morbidity and least chance of recurrence can be expected if the tumor had been operated earlier.