Finger Tendon Research Articles

Kinematic analysis of the role of the finger tendons

In an earlier paper (Storace and Wolf, 1979), the functional anatomy of the finger was studied by considering the equilibrium of tendon forces and externally applied forces. The current work presents an alternative approach which studies the finger's functional anatomy from a kinematic viewpoint. This approach, based on measured tendon displacement, can be used to graphically display the criteria for which normal finger function will exist. Examples of the application of this procedure to normal and non-normal finger conditions are presented to demonstrate its utility.

Nerve compression following opponensplasty as a result of wrist anomalies: Report of a case

A l3-year-old boy lacerated the palm on broken glass, but only the wound was sutured in the emergency room and no attempt was made to repair the nerve . Five months later there was severe pain in the median nerve distribution, marked thenar weakness with atrophy of the abductor pollicis brevis muscle, and a posit.ive Tinel 's sign. At operation the median nerve was found to divide into three branches in the carpal tunnel, and a median artery was present. A great deal of scar tissue was present, and it appeared that only the one branch to the thenar muscles had been severed. This was repaired under the microscope by direct neurorrhaphy without tension. In 7 months there was no return of opposition and because the patient was unable to use the thumb well, an opponensplasty was done using the flexor superficial is tendon of the ring finger. The Palazzi technique was used for the pulley, and the Brandl type of insertion into the thumb was used. A Brand tendon passer was used to pass the tendon blindly through the palm. Immediately after the operation, he had minimal pain, and some numbness and tingling was noted in the fingertips, which was relieved by splitting the plaster dressing. Three weeks later therapy was begun, and by the fifth week he was using the thumb well. However , numbness and tingling occurred in the areas of distribution of the ulnar and median nerves . Soon there was almost complete sensory loss of the hand , with clawing of all of the fingers . The hand became much more anesthetic as the function improved in the opponensplasty. An electromyogram (EMG) study at this time showed that there was complete conduction loss of both the ulnar and median nerves at the wrist. Because of these findings a reexploration was done. At operation it was found that two branches of the median

An epidermoid cyst of the tendon

An epidermoid cyst in the flexor superficialis tendon of the right middle finger of a child limited extension of the finger by preventing the distal gliding of the tendon at the inlet of the flexor tendon sheath. Full extension was regained by excising the tendon.

Functional analysis of the role of the finger tendons

An approach to deriving the force equilibrium equations for a finger, based on the principle of virtual work, is presented. Ligament tension forces and bone contact forces do not appear in the equilibrium equations because they are workless constraints. Examples including normal and non-normal anatomy are given to illustrate the way in which useful information may be inferred from these equations, even though they are indeterminate and cannot be used to calculate the actual values of the tendon forces.

Hand injuries in children

The differences in management, of hand injuries in children and adults are highlighted. Topics covered include skin and subcutaneous tissues, finger nail and finger nail matrix injuries, amputations, tendon injuries, and nerve injuries.

Determination of Internal Forces in Human Hand

Three-dimensional force analysis of finger tendons and joints in isometric hand functions was formulated as a statically indeterminate problem. This problem was solved adjunctly by the permutation-combination technique and the method of linear programming. Optimal solutions were compared with those produced by the permutation-combination technique and justified based on clinical and physiologic assessments. The results obtained are within the expected range and the muscle force distribution coincides with the data established in previous EMG studies and muscle volume analyses. The validity of the technique used and its potential applications to force analysis of the entire human hand in various functional configurations were considered.

Spontaneous Tendon Ruptures in Patients Treated by Chronic Hemodialysis

Patients with renal failure treated by chronic hemodialysis tend to spontaneous tendon ruptures. In five out of 35 patients, 8 ruptured tendons have been found--four quadriceps and four finger tendon ruptures. Finger tendon ruptures are usually ignored by the patients because of the low disabling factor in the presence of more vital problems. Secondary hyperparathyroidism was found in all patients who had tendon ruptures and may possibly be the major disposing factor. The patients with tendon ruptures in our series were significantly younger than those without ruptures and had been treated for a longer period of time by hemodialysis, indicating that, whatever the reason for the ruptures, it seems to be a time-related phenomenon.

Hand Injuries in Children

The differences in management, of hand injuries in children and adults are highlighted. Topics covered include skin and subcutaneous tissues, finger nail and finger nail matrix injuries, amputations, tendon injuries, and nerve injuries.

Three-dimensional force analysis of finger joints in selected isometric hand functions

Three-dimensional constraint forces of the finger tendons and joints in isometric hand functions were determined. The joint and tendon orientations were defined from biplanar X-ray films. Coordinate systems at each joint were used to define the constraint forces and moments. Four index fingers, one long finger, and one little finger were analyzed. Through free-body analysis, a statically indeterminate problem was derived. The method of systematic elimination of redundant unknown tendon forces was applied. Constraint conditions based on EMG and physiologic assessments were used to obtain admissible solutions. The findings are important in understanding the functional anatomy and pathologic deformities involving the hand and the basic requirements on prosthetic design of finger joints.

New developed dynamic finger splint (K. U. Finger Splint)

In order to improve conventional hand-finger splints, we doveloped a new type of finger splint. The splint consists of a wrist cuff with two wire holders and piano spring wire which attached to the plastic coated trough.With this splint, you can assist the finger movement in any direction and any extent you want. Therefore you may apply the splint to several kind of finger disabilities, for example, radial nerve palsy, median nerve palsy, ulnar nerve palsy, and finger ulnar deviation. It may be also used to pre-and post-surgery of finger tendon troubles.This K. U. Finger Splint has following features; 1) simple to make 2) light weight 3) excellent adjustability 4) cosmstically acceptable 5) inexpensive 6) may apply to lots of finger disabilities.

Transfer of the long flexor tendon of the index finger to the proximal phalanx of the long finger during index-ray amputation

During the past three years the authors have used, in conjunction with indexray amputation, a tendon transfer of a flexor tendon of the index finger to the proximal phalanx of the long finger. A total of ten patients have undergone index-ray amputations combined with this transfer. In all but one patient the hand with the ray amputation maintained or increased strength in pulp-to-pulp or pulp-to-side pinch postoperatively. We continue to use this procedure and feel that it is a worth-while reconstructive procedure.

Transfer of the Long Flexor Tendon of the Index Finger to the Proximal Phalanx of the Long Finger During Index-Ray Amputation

During the past three years the authors have used, in conjunction with indexray amputation, a tendon transfer of a flexor tendon of the index finger to the proximal phalanx of the long finger. A total of ten patients have undergone index-ray amputations combined with this transfer. In all but one patient the hand with the ray amputation maintained or increased strength in pulp-to-pulp or pulp-to-side pinch postoperatively. We continue to use this procedure and feel that it is a worth-while reconstructive procedure.

Traumatic Dislocation of the Long-Finger Extensor Tendon

Five cases of traumatic dislocation of the extensor tendon of the long finger are presented. The anatomical defect consists of loss of continuity between the radial intrinsic muscles and the extensor tendon. The extensor tendon of the long finger sits on top of the proximal portion of the transverse fibers where it is maintained by a relatively poor fibrous attachment. The force tending to displace the normally situated extensor ulnarward is greatest in full extension, decreases during the first 60 degrees of flexion, and subsequently increases as flexion increases from 60 to 90 degrees. The force required to prevent further ulnar dislocation is large once the tendon is displaced. Simple primary repair is usually satisfactory for traumatic dislocation of the extensor tendon.

Innervation of Human Finger Tendons as Determined by Histochemical Techniques

Innervation of the extensor and flexor tendons in human fingers has been studied by a whole-mount histochemical enzyme technique, and the findings have been compared with those from sections stained with silver. The flexor tendons in the fingers are well innervated in the region of the vineula, but the remainder of each tendon is sparsely innervated. A free type of nerve ending is more abundant than are organized encapsulated nerve endings. The extensor hood is innervated by a plexus of nerves more abundant over joints and least abundant over the phalanx. The function of these nerve fibers and endings has not been established. The need for study of pathological states by this technique is apparent.

Burned hands in children

Summary Children's hands are extremely vulnerable to injury by burning. Among the more difficult problems facing surgeons as they deal with the burned hand are (1) constricting circumferential burns; (2) exposed tendons and joints, especially with burns on the back of the hand; and (3) scar contractures resulting in later deformity. Circumferential constricting burns must be incised throughout their length if they are causing any significant degree of circulatory impairment. Incision of the tissues deep to the eschar is unnecessary if they are comparatively normal and adjust to mobility. Problems associated with exposed tendons and joints are especially common in the fingers because the tissues covering the extensor tendon mechanism and joints are so thin. Regardless of the circumstances, when fatty tissues, tendons, and nerves are exposed, they do not respond well to such alterations in their environment. The use of a skin graft for either a temporary or permanent biologic dressing for these areas minimizes their exposure and significantly enhances their chances of survival. Denudation or damage of tendons in fingers may be compounded by an exposed or injured joint. Such injuries can be treated more effectively by immobilizing them with internal fixation and applying the biologic dressing of a skin graft.

Carpal boss.

Carpal bossing, involving the articulation between the third metacarpal and the capitate bones, was apparently first described by Fiolle and Ailland in the French literature in 1932. Several subsequent reports have appeared in France and South America, but only one in the United States. In the American radiological literature, we were unable to find any mention of the condition. Etiology The exact etiology of carpal bossing is unknown. The evidence would seem to indicate that it is acquired rather than congenital. Repeated slight trauma causing pressure at the involved joint has been suggested as one factor. Another hypothesis is that trauma causes a slight rupture of the dorsal ligament of the involved joint with subsequent spur formation. Many of the cases reported have occurred in persons in occupations requiring frequent movement of the fingers, such as typists, seamstresses, surgeons, knitters, and woodcarvers. Symptoms No characteristic symptoms have been reported. The usual complaint, if any, is mild aching and easy fatigability of the wrist. No functional disturbance has been recorded other than a clicking sensation due to slipping of the extensor tendon over the boss. Clinical and Radiographic Findings The essential feature is a small bony tumor on the dorsal aspect of the wrist over the third metacarpal-carpal joint (Fig. 1). Radiographically (Figs. 2–4), this is best demonstrated in the lateral projection in palmar flexion. There is a bony overgrowth of the dorsal aspect of both the capitate and the third metacarpal bones at the joint margins, producing a characteristic double beak or bossing. No erosion, sclerosis of the joint margin, or narrowing of the joint space is evident. Treatment In most instances of carpal bossing, conservative management is adequate for relief of the minor symptoms. In cases treated by surgical intervention, recurrence of the deformity has been frequent. Relief of the symptoms, however, has usually been obtained. Case Report A colored male kitchen-helper, aged 38, had a tumor over the dorsal aspect of the right wrist. This had been present for several years but had caused no symptoms until four months before admission, when the patient struck his hand while at work. After this, he complained of pain on motion of the extensor tendon of the middle finger. Physical examination revealed a bony hard mass at the junction of the third metacarpal and capitate bones. On motion of the middle finger, the dorsal extensor tendon would apparently slide over the mass, causing pain. The pain persisted despite conservative treatment, and operation was undertaken. A bony exostosis with overlying thickened bursa, arising from the capitate bone and impinging upon the metacarpal, was removed. The pathologist stated that there was no evidence of osteochondroma, reactive bone sclerosis, or osteoarthritis (Fig. 5). Summary The entity of carpal bossing with characteristic clinical and radiologic findings is described.

Cellophane in bone and joint surgery

Three cases are reported in which cellophane was used as an interposition membrane with excellent results in each case. 1. 2. In the first case there was an adherent extensor tendon of the index finger which was dissected free and prevented from re-adhering by means of the cellophane. 2. 3. In the second case an adherent triceps muscle at the elbow was kept free postoperatively with a piece of cellophane. 3. 4. In the third case cellophane was placed between the radius and ulna to prevent a recurrence after removing a radio-ulnar synotosis.

Contribution to the physiological method of repair of damaged finger tendons: Preliminary report on reconstruction of the destroyed tendon sheath

1. 1. The historical development of tendon transplantation is briefly sketched. 2. 2. Traumatic and paralytic cases differ in that in the former the tendon sheath is destroyed. 3. 3. A method is described for creating a new tendon sheath by the use of celloidin. 4. 4. At a second operation the tendon may be transplanted into the newly formed sheath. Our thanks are due to the Dupont Company for furnishing us with the supply of chemically pure celloidin and for the cooperation of their staff, also to Miss Geraldine Kahn, whose aid in making the celloidin tubes was invaluable.