Extensor Tendons Of Fingers Research Articles

Injury patterns of finger extensor tendons in population of Ivanovo region

Acute injury of finger extensor tendons constitute a significant part in overall causes for hospital admission.Purpose of the study: to evaluate injury patterns of finger extensor tendons in population of Ivanovo region.Material and methods. The authors performed the retrospective statistical analysis of 163 medical histories of patients who underwent hospital treatment in the period from January 2011 till December 2014 at department of wrist reconstructive surgery and microsurgery of Ivanovo regional clinical hospital of war veterans. The study was carried out in full compliance with medical ethics. Excel 7.0 was applied for statistical analysis.Results. Injury patterns of patients with finger extensor tendons demonstrated prevalence of males aging from 21 to 40 years old. Most frequent is the left hand trauma at home while handling devices with high-speed rotation mechanism. Most lesions occur in time interval from noon till 6 p.m. Patients with combined injuries prevailed. The authors observed hospital admittance within first 6 hours after trauma.Conclusion. A typical patient with finger extensor tendons trauma is an active age male injured in everyday life and often in a state of alcoholic intoxication.

CLASSIFICATION AND SURGICAL TREATMENT OF MUCOUS CYSTS OF DISTAL INTERPHALANGEAL JOINT

To investigate the self-made classification criterion for mucous cysts of distal interphalangeal joint and the effectiveness of the surgical treatment. Between July 2008 and August 2015, 33 patients with mucous cysts of distal interphalangeal joint were treated, and the clinical data were retrospectively analyzed. Among 33 cases, 15 were male and 18 were female, aged from 45 to 74 years (mean, 58 years). The disease duration ranged from 3 weeks to 1 year (mean, 5 months). The cyst located at thumb in 18 cases, index finger in 4 cases, middle finger in 6 cases, ring finger in 4 cases, and little finger in 1 case. According to location, mucous cysts were typed: proximity to one side of the finger extensor tendon and deviation from the midline of the finger named lateral type (22 cases); and at both sides of the finger extensor tendon named intermediate type (11 cases). The bilateral digital dorsal incision was made in the intermediate type patients, and the reverse L-shaped incision was made in the lateral type patients, then the degenerative tissue was resected, the osteophyte was removed, and the capsule was repaired; finally, mucous cysts were resected. All the patients were followed up 4 months to 2 years (mean, 14.5 months). The incision healed by first intention without infection after operation. Clinical symptoms obtained improvement and no recurrence was observed in 29 patients except 4 patients who died of other diseases during follow-up. A surgical treatment for mucous cysts of distal interphalangeal joint is feasible according to the self-made classification criterion and it has the advantage of simple operation and definite effectiveness.

Multiple Finger Extensor Tendon Dislocations in Systemic Lupus Erythematosus with Unique Trigger Phenomena

Dislocation of extensor tendons is the most frequently seen complaint for suffers of rheumatoid arthritis. Here, we present a rare clinical case of multiple finger extensor tendon dislocations in systemic lupus erythematosus (SLE). Upon physical examination, active extension of middle, ring and little fingers were impossible at the MP joint. A trigger phenomenon was generated when these extensors were reduced in passive extension. The procedure was performed under local anesthesia. A satisfactory clinical outcome was achieved with sagittal band reconstruction and reinforcement for the site using juncturae tendinum. Surgical intervention under the local anesthesia allowed for extensive gathering of information about repair site strength and dynamic stability.

Factors affecting extension lag after tendon reconstruction for finger extensor tendon rupture due to distal radioulnar lesion

BackgroundAlthough extensor tendon rupture associated with distal radioulnar joint disorder is often encountered, its treatment has not yet been established. We report the postoperative results for reconstruction of finger extensor tendon rupture due to distal radioulnar lesion and analyse the factors affecting postoperative extension lag. MethodsWe examined 74 index, middle, ring, or little fingers with extensor tendon rupture of 34 hands. Primary diseases were rheumatoid arthritis in 24 hands and osteoarthritis in 10. Reconstruction methods included tendon graft in 45 fingers, extensor indicis proprius tendon transfer in 15, and end-to-side adjacent tendon suture in 14. At final postoperative follow-up ranging from 12 to 40 (mean: 18) months, we measured metacarpophalangeal (MCP) joint range of motion and extension lag and statistically evaluated the relationship between postoperative extension lag and several clinical factors. ResultsWe encountered no cases of re-rupture or worsening of finger flexion range after reconstruction. Mean postoperative active flexion of the MCP joint was 78.1 (range: 45–95) degrees. Mean postoperative extension lag was 10.3 (range: 0–50) degrees. We observed that postoperative extension lag was significantly larger in fingers associated with extensor tendon rupture in two or three additional fingers in the affected hand or in fingers of patients aged 80 years or over. The interval from rupture to reconstruction, reconstruction method, or arthritis type did not remarkably affect outcome. ConclusionsThis study uncovered that surgical intervention for extensor tendon rupture should be performed before three fingers become affected.

Number of Ruptured Tendons and Surgical Delay as Prognostic Factors for the Surgical Repair of Extensor Tendon Ruptures in the Rheumatoid Wrist

Extensor tendon ruptures in the rheumatoid wrist are usually restored by extensor tendon reconstruction surgery. However, the factors significantly correlated with the outcomes of extensor tendon reconstruction have not been defined. We examined factors showing a statistically significant correlation with postoperative active motion after tendon reconstruction. Spontaneous extensor tendon ruptures of 66 wrists in patients (mean age, 52.6 yrs) with rheumatoid arthritis (RA) were evaluated. All patients underwent tendon reconstruction surgery with wrist arthroplasty or arthrodesis. Active ranges of motion of the affected fingers were evaluated at 12 weeks postsurgery. Statistical significance was determined using multiple and single regression analyses. Forty-six (69.6%) wrists had "good" results, while 13 (19.7%) and 7 (10.6%) wrists had "fair" and "poor" results, respectively. In multiple regression analysis, an increased number of ruptured tendons and the age at operation were independent variables significantly correlated with the postoperative active motion of reconstructed tendons (p = 0.009). Single regression analysis also showed a significant association between the number of ruptured tendons and surgical delay (p = 0.02). The number of ruptured extensor tendons was significantly correlated with the results of tendon reconstruction, and the number of ruptured tendons was significantly correlated with preoperative surgical delay. Our results indicate that, in patients presenting with possible finger extensor tendon rupture, rheumatologists should consult with hand surgeons promptly to preserve hand function.

Marked multiple tendinitis at the onset of rheumatoid arthritis in a patient with heterozygous familial hypercholesterolemia: ultrasonographic observation.

A 59-year-old woman who had been diagnosed with heterozygous familial hypercholesterolemia developed rheumatoid arthritis (RA). She presented with marked tendinitis of the Achilles tendons, patellar tendons, and finger extensor tendons at the onset of RA. Ultrasonographic examination revealed that tendon lesions were predominantly tendinitis rather than paratenonitis, and that the tendinitis was of the noninsertional variety, rather than the insertional variety. Preexisting tendon xanthomas might have contributed to the unusually dominant noninsertional tendinitis of multiple tendons.

Variantes Anatómicas dos Músculos Extensores dos Dedos da Mão

The extensor tendons of fingers are subject of many variations, some of them quite frequent. The dissection of the posterior region of forearm and hand was carried out, and the anatomical variations were documented. In Case 1 the extensor digitorum divided into 5 tendons: one for the index finger, one for the middle finger, two for the ring finger and one for the little finger; the extensor indicis proprius divided into two tendons: one for the index and one for the middle finger. In Case 2 the extensor digitorum divided into 4 tendons: one tendon joined the extensor pollicis longus, one tendon for the index, one for the middle finger and one for the ring finger with one slip to the little finger; the extensor indicis proprius divided into two tendons, one for the index and one for the middle finger; the extensor digiti minimi divided into two slips for the little finger. The existence of a double tendon from extensor digitorum for the ring finger is described in several studies. The tendinous slip from extensor digitorum to extensor pollicis longus is not a frequent finding. The double tendon from extensor digiti minimi may occur in 60 to 90% of cases. The knowledge of the most common variations of the tendons of extensor muscles is very important in surgical practice.

Hand function in systemic sclerosis: A clinical and ultrasonographic study

Aim of the workTo evaluate hand impairment and functional disability in scleroderma patients using clinical and ultrasonographic (US) measures. Patients and methodsFifteen scleroderma patients and 10 age and sex-matched healthy controls were studied. Patients underwent clinical examination including modified Rodnan skin score. Hand function assessment included pinch and grip strength measurement, finger range of motion (ROM) assessment, Hand Mobility in Scleroderma (HAMIS) test and Hand Functional Index (HFI). Hand disability was assessed by Health Assessment Questionnaire (HAQ), Scleroderma HAQ Visual Analogue Scale (SHAQ VAS) and Cochin scale. US hand examination included measuring hand skin thickness, screening of the finger flexor and extensor tendons, measuring cartilage thickness of the 2nd MCP joint, anteroposterior thickness of the flexor retinaculum, and surface area of the median nerve. ResultsNine patients had healed digital ulcers while only one patient had active ulcers. Seven patients had arthralgia in the hand joints. The patients had a significant decrease in grip strength and finger ROM. By US, patients showed significant increase in hand skin thickness and flexor retinaculum thickness and a significant decrease in median nerve surface area. Hand disability measures showed variable significant correlations with pinch and grip strength and hand mobility measures which were significantly correlated with US skin thickness of the 2nd inter-metacarpal web space. ConclusionsHand disability in scleroderma was mainly related to impaired hand mobility and also diminished strength. The use of US in adjunct to clinical examination refines the evaluation of hand impairment in scleroderma.

Dynamic Splinting With Early Motion Following Zone IV/V and TI to TIII Extensor Tendon Repairs

To investigate the influence of a dynamic splinting protocol on outcomes of extensor tendon repairs. All patients in a prospectively collected database underwent extensor tendon repair by a single surgeon between 2004 and 2008. The inclusion criterion was simple extensor tendon repairs in zone IV and V in the fingers and zones TI to TIII in the thumb. The tendon repairs used a 4-strand core technique and running epitendinous suture. Within 7 days, each subject began using a dynamic extension splint during the day and a static extension splint at night. The extension splint allowed the patient to passively extend and actively flex the digits. After 3 weeks, the dynamic splint was discontinued and the patients were started on active digital motion. Static night splinting was continued for the next 3 weeks, after which time splinting was discontinued and strengthening was instituted. A total of 17 patients with 19 tendon lacerations met the inclusion criterion. There were 5 patients with lacerations of the thumb extensors and 12 patients with zone IV/V finger extensor tendon lacerations. The average time from injury to surgery was 11 days (range, 2-39 d). The follow-up was 43 to 215 days, with an average of 96 days. A total of 16 patients achieved good or excellent results by 6 weeks according to our grading system. One patient had a fair result. There were no ruptures and no tenolysis surgeries performed. Dynamic splinting resulted in generally good functional outcomes for extensor tendon laceration repairs in zone IV/V and TI to TIII, without complications. Therapeutic IV.

SPONTANEOUS ULNAR DISLOCATION OF THE INDEX, LONG, RING AND SMALL FINGER EXTENSOR TENDONS AT THE METACARPOPHALANGEAL JOINTS: A CASE REPORT

Finger extensor tendon dislocation at the metacarpophalangeal joint is caused by various etiologies, such as trauma, congenital anomaly, or rheumatoid arthritis. When the dislocation occurs with no etiology, this is called spontaneous dislocation. Although spontaneous extensor tendon dislocation in one, two or three fingers has been described, to our knowledge, simultaneous dislocation in four fingers has not been reported. In this paper, we report a spontaneous ulnar dislocation of all the extensor tendons in the index, long, ring, and small fingers. Repair of the radial sagittal bands of the extensor digitorum communis of the middle and ring fingers reduced dislocation of all the extensor tendons in four fingers.

Thickening of finger extensor tendons in affected hands among patients with stroke: prevalence and sonographic features

To evaluate the prevalence and sonographic characteristics of thickened finger extensor tendons in affected hands of patients with stroke. Observational survey. Thirty-six patients (12 women, 24 men) admitted for rehabilitation because of stroke. 30 right-handed healthy volunteers. We used an 8-16 or a 6-12 MHz sonographic transducer to measure tendon thickness of the extensor digitorum communis of the middle (EDCiii) and ring (EDCiv) fingers at the wrist level. The thickness of EDCiii (1.79 mm, standard deviation (SD) 0.56) and EDCiv (2.31 mm, SD 0.63) tendons of affected hands were significantly greater than those of the contralateral hands (EDCiii: 1.31 mm (SD 0.23), EDCiv: 1.59 mm (SD 0.46), p < 0.0001). When the upper limits of side-to-side tendon thickness differences were set at mean value plus 3 times SD among healthy volunteers (EDCiii: 0.60 mm, EDCiv: 0.74 mm), 18 (50%) patients and no volunteers had tendon thickening. No clinical features other than hand weakness correlated with tendon thickening. Thickening of finger extensor tendons of the affected hands is common among stroke patients. It should be considered in the differential diagnosis of swelling of the dorsal wrists and hands in stroke-affected upper limbs.

Tendon transfer or tendon graft for ruptured finger extensor tendons in rheumatoid hands

We evaluated the clinical outcome of tendon reconstruction using tendon graft or tendon transfer and the parameters related to clinical outcome in 51 wrists of 46 patients with rheumatoid arthritis with finger extensor tendon ruptures. At a mean follow-up of 5.6 years, the mean metacarpophalangeal (MP) joint extension lag was 8 degrees (range, 0-45) and the mean visual analogue satisfaction scale was 74 (range, 10-100). Clinical outcome did not differ significantly between tendon grafting and tendon transfer. The MP joint extension lag correlated with the patient's satisfaction score, but the pulp-to-palm distance did not correlate with patient satisfaction. We conclude that both tendon grafting and tendon transfer are reliable reconstruction methods for ruptured finger extensor tendons in rheumatoid hands.

Return to Work in the Setting of Upper Extremity Illness

HE PATIENT ary is a 44-year-old woman who sustained a simple ong finger extensor tendon laceration at the midetacarpal level at work 5 months ago. Surgical repair as straightforward. She had difficulty getting to hand herapy due to family issues, but she did participate in a -month program and regained full motion. Her theraist noted disproportionate complaints of pain, particuarly when discussing return to work (RTW). Three years before the injury she was disabled for 1 ear due to upper extremity pain that she describes as eing due to repetitive trauma. She states that she did ot feel normal even when she returned to work. Mary has confided that she has a stressful relaionship with her supervisor at work. Presently, here are no findings on examination or diagnostic tudies that explain Mary’s pain complaints. She oes not feel that she can return to her job, and she eports that her employer does not want her back nless she can return without restrictions. She decribes her job as fast paced and requiring frequent eavy lifting. Mary has not been in contact with ny of her co-workers since the accident. She xpressed hope that you will not make her return to ork. Her attorney is pursuing litigation against er employer and is requesting a letter from you egarding permanent disability. Her worker’s comensation carrier wants to know whether she is leared for duty and indicates that they can accomodate any restrictions.

Treatment of mallet finger deformity by single Kirschner wire fixation and open repair of the tendon

Objective To explore the clinical outcome of treating mallet finger by fixing the proximal and distal interphalangeal joints with a single Kirschner wire. Methods From February 2005 to August 2007, 18 cases of mallet fingers were treated using a single lmm diameter Kirschner wire fixation. The distal interphahngeal (DIP) joint was fixed in hyperextension, and the proximal interphalangeal (PIP) joint was fixed in 45° to 60° flexion. The finger extensor tendon was repaired with nylon suture. When tendon rupture was at the tendon insertion or was accompanied by avulsed fracture, it was fixed by bone anchor or pull-out stainless steel wire. The K.irschner wire was withdrawn to the base of the middle phalanx at 3 weeks postoperatively to free the PIP joint. It was completely removed at 6 weeks postoperatively. Results The follow-up period ranged from 2 to 6 months. The range of motion of the DIP joints was 0° to 70° in 11 cases, 0° to 60° in 4 eases, 0° to 55° in 2 cases and 0° to 35° in 1 case. Range of motion of DIP joint of the injured fingers was compared with that of the normal one. TAM system was adopted to grade the results. Excellent results were achieved in 11 cases, good in 6 cases and poor in 1 case. The excellent and good rate was 94.4%. Conclusion Single Kirschner wire fixation and open repair of the tendon is an effective surgical technique to treat mallet finger. Advantages include easy operation and reliable fixation. Key words: Tendon injuries; Surgical prooedures,operative; Mallet finger

Anatomic variations in a cleft hand of an elder cadaveric specimen

Cleft hand is a rare and complex malformation in which the central part of the hand is missing. Since the nineteenth century, a very small number of dissections in cleft hand have been reported and very few reports describe the soft-tissue abnormalities. We report a case of an elderly cadaveric specimen with bilateral cleft hand. X-ray, CT-scan with 3D reconstruction and dissection were performed on the right hand and forearm. On both the sides, we noted the absence of the index, middle and ring finger. Malformation and degenerative arthrosis at the carpal bones level have been identified. The flexor and extensor tendons of the absent fingers fuse with one another over the end of the remaining carpal bones, forming a radial and an ulnar tendinous plexus and two tendon loops. Data concerning intrinsic muscles, vessels and nerves are entirely recorded. Soft-tissue abnormal distribution is due to the abnormal bony configuration. Correction of the bone abnormalities does not resume the surgical treatment of a cleft hand. Hand surgeons need to be aware of the soft-tissue disorders and their surgical implications.

Estimation of the effective static moment arms of the tendons in the index finger extensor mechanism

A novel technique to estimate the contribution of finger extensor tendons to joint moment generation was proposed. Effective static moment arms (ESMAs), which represent the net effects of the tendon force on joint moments in static finger postures, were estimated for the 4 degrees of freedom (DOFs) in the index finger. Specifically, the ESMAs for the five tendons contributing to the finger extensor apparatus were estimated by directly correlating the applied tendon force to the measured resultant joint moments in cadaveric hand specimens. Repeated measures analysis of variance revealed that the finger posture, specifically interphalangeal joint angles, had significant effects on the measured ESMA values in 7 out of 20 conditions (four DOFs for each of the five muscles). Extensor digitorum communis and extensor indicis proprius tendons were found to have greater MCP ESMA values when IP joints are flexed, whereas abduction ESMAs of all muscles except extensor digitorum profundus were mainly affected by MCP flexion. The ESMAs were generally smaller than the moment arms estimated in previous studies that employed kinematic measurement techniques. Tendon force distribution within the extensor hood and dissipation into adjacent structures are believed to contribute to the joint moment reductions, which result in smaller ESMA values.

Early Active Motion Rehabilitation Versus Immobilisation For Thumb Extensor Tendon Repairs: A Review Of Two Case Studies

Following positive outcomes reported in recent literature, early active motion within a static splint is now a recognised rehabilitation regime for finger extensor tendons. This paper discusses the available literature on thumb extensor tendon rehabilitation, and the justification for introducing early motion for this injury.The early active motion regime for the thumb extensor tendon used at our unit is described and compared against the traditional static splint regime. Two case studies are presented to illustrate the problems associated with these regimes and the patient outcomes achieved. Outcomes were analysed utilising Total Active Motion (Kleinert and Verdan 1983), Kapandji's opposition (1992) and White's assessment of tendon repair (1956).Both patients made a full, uncomplicated recovery after their thumb extensor tendon repair, but the patient who followed the Early Active Motion regime regained motion and light function sooner than the patient who underwent four weeks of immobilisation. This enabled an earlier discharge (eight rather that 12 weeks) and less therapy intervention overall. These are all factors that need to be considered when deciding upon which rehabilitation regime to use.

Analysis of Relative Motion Splint in the Treatment of Zone VI Extensor Tendon Injuries

Early protected motion after extensor tendon repair is desirable. The low-profile relative motion splint, described previously by Merritt et al, holds the affected digit in 15 degrees of extension relative to the uninjured digits to allow less-cumbersome early protected motion versus dynamic splinting. Although early clinical results have been favorable, formal biomechanic testing of this approach is lacking. We used an in vitro model to assess the effect of the low-profile relative motion splint on the biomechanics of zone VI extensor tendons by measuring tendon elongation with and without the splint. Tendon elongation also was measured after transection and repair of extensor tendons in zone VI with and without splint protection. Ten fresh-frozen cadeveric upper extremities were prepared and mounted on a testing apparatus with the wrist in 25 degrees of extension. Alternating applications of extension and flexion loads to the tendons induced a full range of motion for 25 cycles. Differential variable reluctance transducers were applied to zone VI of the index, middle, and ring extensor tendons. Measurements of intact tendon microelongation (or strain) were obtained with and without the relative motion splint. The middle finger extensor tendon then was transected (in zone VI) and was repaired immediately. Measurements were repeated with and without splint protection. Elongation ratios were calculated and analyzed statistically. For the intact tendon of the middle finger splinting reduced the elongation by 1% in extension, by 2% in flexion, and by 3% in neutral position. After the transection and repair of this same tendon, the splint reduced the elongation by 5% in extension, by 7% in flexion, and by 6% in neutral position. Cycling without splint protection caused permanent stretching at the repair site. Reapplication of the splint decreased elongation at the repair site by 2% in extension, by 3% in flexion, and by 3% in neutral position. The relative motion splint reduces the effective strain on intact and repaired zone VI middle finger extensor tendons and supports its clinical use.

Normal MR imaging findings of the midhand and fingers with anatomic correlation

In the present article, we correlate MR imaging studies of cadavers, volunteers and patients with cadaveric dissection and sectioning. First anatomy at wrist level is discussed. In a next section, we address the midhand with the flexor and extensor tendons, and interosseous and lumbricalis muscles. The dorsal hood at the level of the metacarpophalangeal joint is also addressed. An overview of the anatomy of the thenar is provided. Finally, the flexor system of the fingers with pulleys and volar plates, as well as the central and distal insertion of the finger extensor tendons is discussed.

Extensor Mechanism Laxity at the Metacarpophalangeal Joint as Identified by a New Provocative Test: Predisposition to Dislocation

A tendon subluxation test was performed on the unaffected side in 13 patients with traumatic extensor tendon dislocation of the middle finger and on both middle fingers in 800 healthy controls to identify extensor mechanism laxity at the metacarpophalangeal joint. Ten of the 13 patients with dislocation had laxity of middle finger extensor tendon, compared with 174 of the 800 (22%) controls. The difference in these rates of extensor tendon laxity is significant (P<0.0001), and suggests that extensor mechanism laxity at the metacarpophalangeal joint may predispose to traumatic extensor tendon dislocation.