Pollicis Longus Tendon Research Articles

COMPARISON OF EFFICACY OF INJECTABLE STEROIDS VERSUS CONSERVATIVE MANAGEMENT FOR DE QUERVAINS’S TENOSYNOVITIS

BACKGROUND & OBJECTIVE: De Quervain's tenosynovitis is tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons, occurs due to chronic overuse of the wrist and hand. To compare effectiveness of steroid injection with conservative management of De Quervains’s tenosynovitis.
 METHODOLOGY: Randomized prospective study was conducted at the various private orthopedic clinic across Rawalpindi district, along with collaboration of community medicine department, Rawal Institute of health sciences, Islamabad. The study population was divided into two groups, i.e., group A and group B. Group A was given inj. corticosteroid and group B was given conservative management. The severity of pain (Visual analogue scale) and Finkelstein test were recorded on baseline and after 3 weeks follow up.
 RESULTS: Our study included 96 diagnosed cases of de Quervains tenosynovitis on a positive Finkelstein test; 48 were given corticosteroid injection and 48 were conservatively treated. The mean age in corticosteroid’s injection group was 34.76+6.95 years whereas the mean age in conservative management group was 31.7+8.91 years. Post-intervention 13, 29 patients had a positive Finkelstein test in corticosteroid and conservative groups respectively. Although the difference in pre intervention pain score between the two groups was not statistically significant but significantly lesser pain scores in the corticosteroid group; (p= 0.00).
 CONCLUSION: Steroid injection produced better results in terms of relief in pain and negative Finkelstein test as compared to conservative treatment.

Volar Approach to the First Extensor Compartment for Surgical Treatment of DeQuervain Tenosynovitis.

Many surgical techniques have been published in regards to the operative management of DeQuervain tenosynovitis. As it has been classically described, stenosing tenosynovitis of the first extensor tendon compartment is a common tendinopathy along the radial side of the wrist causing pain and swelling in the affected area. When surgery is necessary, decompression of the abductor pollicis longus and extensor pollicis brevis tendons decreases first extensor compartment friction and has been shown to successfully alleviate symptoms. A number of varying techniques have been reported in the literature to achieve adequate decompression and minimize postoperative complications such as sensory nerve injury, incomplete decompression, and tendon subluxation. We describe a novel volar approach to the first extensor compartment, which allows direct visualization of the retinaculum and a midline retinacular release. In addition, the volar approach has an associated decreased risk of iatrogenic nerve injury by passing volar and deep to the more superficial sensory nerves that overly the retinaculum. On the basis of our experience, patients do not experience an increased risk of volar tendon subluxation with this approach.

Extensor indicis transfer versus palmaris longus transplantation in reconstruction of extensor pollicis longus tendon: a protocol for a systematic review

This review will provide an overview of published data comparing transposition of the extensor indicis pollicis (EIP) tendon and palmaris longus (PL) tendon grafting in thumb extension reconstruction following loss of the extensor pollicis longus (EPL) tendon function. We will consider all studies comparing EIP and PL utilized to reconstruct thumb extension after injury/rupture of the EPL tendon. Only studies published in the English and German literature will be included. A systematic literature research will be performed across relevant health databases including the Cochrane Library, MEDLINE, and Google Scholar using the following keywords: ((extensor pollicis longus) OR EPL) AND ((extensor indicis) OR EIP OR (tendon transposition)) AND ((palmaris longus) OR (free tendon graft) OR (tendon transplantation)). Central tendencies will be reported in terms of means and standard deviations where necessary. If not reported, the standard deviation will be calculated from the standard error of the mean. Risk ratios will be calculated where possible. All calculations will be performed with a 95% confidence interval. Statistical significance will be set at P < 0.05. Adjusted effect estimates will be analyzed in preference to the unadjusted estimates, using inverse-variance weighted average. Pooled estimates will only be presented after consideration of both clinical and methodological heterogeneity of included studies. The review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.Systematic review registrationThe protocol was registered on PROSPERO CRD42019135735: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=135735

Effectiveness and Safety of Wide Awake Local Anesthesia no Tourniquet (WALANT) Technique in Hand Surgery

The aim of the study was to confirm the effectiveness and safety of wide awake local anesthesia no tourniquet (WALANT) technique in hand surgery, to present our results and to encourage its use on Romania and all over the world. The study group consisted of 120 patients in which local anesthesia with 1% lidocaine and 1: 100,000 epinephrine solution was used. The conditions requiring surgery were Dupuytren disease (DD) stages II and III affecting one or two digital rays, carpal tunnel syndrome (CTS), trigger finger (TF), rupture of the flexor pollicis longus (FPL) tendon. The amount of anesthetic used, onset time, intraoperative bleeding, surgeon’s comfort during surgery, patient’s comfort, operative time, the immediate postoperative complications and length of hospital stay were evaluated, correlations between these parameters being made with the help of SPSS 20.0 software using regressions (ANOVA), and taking into account Pearson correlation coefficients with statistical significance, alpha at most .05 and CI 95%. In the group of 120 operated patients (58 men - M and 62 female -F) (M/F ratio = 0.93), no cases of digital necrosis or other vascular complications were recorded. Also, the absence of tourniquets did not result in intraoperative bleeding causing discomfort to the surgeon. The amount of anesthetic varied, being less than that recommended in the literature in approximately 40% of the cases. In all cases, patient comfort and satisfaction were highest, and length of hospital stay was several hours. Phentolamine, an antidote used to reverse the effects of epinephrine, was not used in any case. The correlation coefficient between the amount of anesthetic and waiting time = 0.3372 (p = 0.0001) - positive, direct, moderate, and statistically significant correlation. The correlation coefficient between the amount of anesthetic and length of hospital stay = 0.2700 (p = 0.002) - positive, direct, weak and statistically significant correlation. Correlation coefficient between age and length of hospital stay = 0.1361 (p = 0.1380) - positive, direct, weak correlation, but statistically insignificant. WALANT technique is safe and has many advantages: no need it is not necessary to use the tourniquet and intravenous sedation, surgeon and patient comfort is maximum, there is no risk of finger necrosis, intraoperative collaboration and last but not the least, hospital stay is short and costs are minimal. Keywords: local anesthesia, epinephrine, Dupuytren disease (DD), carpal tunnel syndrome (CTS), trigger finger (TF)

Anatomy of the extensor mechanism of the thumb in relation to the clinical presentation of extensor pollicis longus rupture

Extensor pollicis longus (EPL) tendon rupture is a debilitating condition that presents with impaired interphalangeal joint (IPJ) extension. Standard descriptions of EPL function state that it is the sole thumb IPJ extensor. It has been suggested that the intrinsic muscles of the thumb, acting through a dorsal extensor expansion (DEE), are also capable of producing IPJ extension which can result in a missed diagnosis of EPL rupture. It remains controversial whether the thumb possesses a DEE analogous to the DEE of the fingers. The aim of this study was to determine if a DEE of the thumb exists and to establish if intrinsic hand muscles insert into it to produce IPJ movement. Nine cadaveric hands were dissected, and muscle function was assessed. A DEE was observed in all thumbs and its structure closely resembled the DEE of the fingers. The DEEs had clear margins that received contributions from intrinsic muscles of the thumb and EPB. Applying traction to the intrinsic muscle attachment consistently resulted in IPJ extension. A DEE is present in the thumb that structurally and functionally resembles that of the fingers. Traction on the EPL tendon produced a compound movement including IPJ and metacarpophalangeal joint extension and supination of the entire first ray around the carpometacarpal joint. This compound movement is, in effect, the antagonistic movement to thumb opposition. This explains the profound loss of function associated with EPL rupture and suggests a more accurate test for EPL function than simply assessing for active IPJ extension. Level of evidence: Level IV, diagnostic study.

Autogenous palmaris longus tendon grafting for rupture of extensor pollicis longus tendon after distal radius fractures

Background: Secondary rupture of the extensor pollicis longus (EPL) tendon is a known complication following distal radius fracture. While surgical options for EPL tendon tear have been extensively investigated, the surgical results of free tendon graft reconstruction for patients with EPL tendon rupture after distal radius fracture are relatively unexplored. Purpose: We aimed to investigate the outcomes of autogenous palmaris longus (PL) tendon grafting for treating EPL tendon rupture after distal radius fracture. Methods: The study included 9 adult patients (2 male, 7 female; age range, 30-78 years; mean age, 56.7 years) with delayed EPL tendon rupture after distal radius fracture treated at the Taoyuan Armed Forces General Hospital between September 2000 and September 2011. In our hospital, we adopted a protocol for EPL tendon reconstruction that uses the ipsilateral PL tendon. A dynamic splint was applied, and a rehabilitation program including wrist motion and occupational therapy was started within 3 days postoperatively. Extension lag at the interphalangeal joint of the injured thumbs, as well as Geldmacher scores were recorded. Results: At the final follow-up (15-34 months), the extension lag at the interphalangeal joint of the involved thumb had improved significantly (p ＜ 0.05), from a preoperative mean value of 41.7° (range, 35°-60°) to a postoperative mean value of 3.8° (range, 0°-6°). Regarding the Geldmacher scores, 5 patients (55%) achieved ＂excellent＂ results, and 4 (45%) achieved ＂good＂ results. No patients experienced tendon re-rupture, wound infections, nerve injury, or other complications. Conclusions: In this short-term follow-up study, using free PL grafts for treating EPL tendon rupture was found to provide good outcomes, suggesting that tendon grafting using the PL tendon is an effective method to treat delayed EPL tendon rupture after distal radius fracture.

Extensor carpi radialis brevis transfer to extensor pollicis longus: an anatomical study

Objective To investigate the anatomical basic of extensor carpi radialis brevis (ECRB) tendon trans-ferring to extensor pollicis longus (EPL) tendon. Methods Twelve sides of ECRB and EPL in fresh adult cadaver’s forearms were collected, and the anatomical model of ECRB transferring to EPL was set up in all the forearms. The ana-tomical parameters of EPL were measured before and after anatomical model established. Results The effective trans-ferring length of ECRB was (3.5±0.8) cm; the maximum circumferential of ECRB and EPL were (8.5±0.8) cm and (3.6±0.3) cm (P >0.05) , the ratio of muscle cross-sectional area was 5.57; After the anatomical model setting up, anatomic an-gles of EPL was (30±7) °, which was a decrease of (20±5) ° comparing with the preoperative angel of (50±9) ° (P >0.05) ; Thumb extension angle was (50±12) °, which was a decrease of (8±3) ° comparing with the preoperative angel of (58 ±16) ° (P 0.05) ; Thumb tip lifting height was (2.3±0.9) cm, which was a decrease of (1.2±0.6) cm comparing with the preoperative height (3.5±1.2) cm (P >0.05). Conclusion Based on the measurement of the anatomic parameters of ECRB and EPL, the ECRB has enough length and muscle force to reconstruct the function of EPL. The thumb had a good extension appearance and accorded with the rule of biomechanics after setting up the anatom-ical model of ECRB transferring to EPL. This study will provide the anatomical evidence for further clinical application Key words: Extensor carpi radialis brevis; Extensor pollicis longus; Tendon transfer; Applied anatomy

Mão reumatoide: um caso de sinovite crônica associado às rupturas tendinosas

Rheumatoid arthritis is a chronic progressive disease characterized by symmetric poliarticular synovitis and joint destruction. It is the most common inflammatory arthritis. Synovitis is usually located in dorsal aspect of the wrist. There is a synovial expansion and erosion, soft tissues and ligamentous laxity, and cartilage and bone degradation, which produce pain, deformity, and functional impairment. Despite medical management, many patients have progressive disease. Surgical intervention can improve hand and wrist function for many patients. The aim of this study is to report a clinical case of dorsal synovitis of the wrist, associated with dorsal dislocation of the ulnar head causing extensor pollicis longus, fourth and fifth extensor tendons rupture.

Free Functioning Gracilis Muscle Transfer With and Without Simultaneous Intercostal Nerve Transfer to Musculocutaneous Nerve for Restoration of Elbow Flexion After Traumatic Adult Brachial Pan-Plexus Injury

After complete 5-level root avulsion brachial plexus injury, the free-functioning muscle transfer (FFMT) and the intercostal nerve (ICN) to musculocutaneous nerve (MCN) transfer are 2 potential reconstructive options for restoration of elbow flexion. The aim of this study was to determine if the combination of the gracilis FFMT and the ICN to MCN transfer provides stronger elbow flexion compared with the gracilis FFMT alone. Sixty-five patients who underwent the gracilis FFMT only (32 patients) or the gracilis FFMT in addition to the ICN to MCN transfer (33 patients) for elbow flexion after a pan-plexus injury were included. The 2 groups were compared with respect to postoperative elbow flexion strength according to the modified British Medical Research Council grading system as well as preoperative and postoperative Disability of the Arm, Shoulder, and Hand scores. Two subgroup analyses were performed for the British Medical Research Council elbow flexion strength grade: FFMT neurotization (spinal accessory nerve vs ICN) and the attachment of the distal gracilis tendon (biceps tendon vs flexor digitorum profundus/flexor pollicis longus tendon). The proportion of patients reaching the M3/M4 elbow flexion muscle grade were similar in both groups (FFMT vs FFMT+ ICN to MCN transfer). Statistically significant improvement in postoperative Disability of the Arm, Shoulder, and Hand score was found in the FFMT+ ICN to MCN transfer group but not in the FFMT group. There was a significant difference between gracilis to biceps (M3/M4= 52.6%) and gracilis to FDP/flexor pollicis longus (M3/M4= 85.2%) tendon attachment. The use of the ICN to MCN transfer associated with the FFMT does not improve the elbow flexion modified British Medical Research Council grade, although better postoperative Disability of the Arm, Shoulder, and Hand scores were found in this group. The more distal attachment of the gracilis FFMT tendon may play an important role in elbow flexion strength. Therapeutic IV.

ECRL Suspension as a Revision Procedure in Failed Resection Arthroplasty of the First Carpometacarpal (CMC-I) Joint

Objective: Resection arthroplasty (RSA) is the standard procedure for first carpometacarpal (CMC-I) joint arthritis and gives excellent results in 95% of patients. There are several reasons explaining the 5% unsatisfying results. To the best of our knowledge, there is no report in the literature concerning revision procedures in failed RSA. The purpose of this retrospective study was to investigate the outcome after extensor carpi radialis longus (ECRL) suspension as a revision procedure in patients with persistent pain due to proximalization and bony impingement of the base of the first metacarpal and the base of the second metacarpal bone and/or the distal scaphoid. Methods: Between 2002 and 2013, 3429 patients with CMC-I arthritis underwent an RSA using the abductor pollicis longus (APL) tendon in our clinic. In the same period of time, we performed 128 revision procedures due to persistent pain following an RSA. Twenty-one of these patients with a mean age of 59 years (range, 51-70 years) demonstrated a proximalization and bony impingement. In these cases, we performed a revision suspension using half of the ECRL tendon. After an average follow-up of 4 years, 15 patients (13 female, 2 male) were available for a clinical and radiological follow-up examination, including range of motion (Kapandji-Score), grip and pinch strength, as well as several clinical tests (eg, grind test). Mayo Wrist Score (MWS) as well as DASH score and patient’s pain (visual analogue scale [VAS], 0-10) were evaluated. Standard radiographs of the wrist and the thumb in two planes were obtained. One of the 6 patients who could not be included in the follow up died, another refused follow-up due to total well-being and 4 patients moved and could not be located. Results: The time between RSA and revision averaged 2 years (range, 1-7 years). Clinical examination showed a positive grind test in 4 patients, and 11 patients remained free of pain. Eleven patients showed full opposition, and 4 patients showed mild restriction of opposition. The Kapandji score averaged 9.4 (range, 8-10), pinch strength averaged 76% of the opposite side. Postoperative MWS was 67, and DASH score was 39 points, whereas MWS was 37 preoperatively. Postoperative pain on VAS was 3 at rest and 5 with activity, whereas it was 8 at rest and 9 with activity previous to revision. Thirteen patients reported major improvement and 2 reported unchanged pain postoperatively. Fourteen patients were satisfied with the final result and would have the same procedure. Radiological evaluation showed a significant improvement in proximalization postoperatively. Twelve patients resumed the original employment, 10 of them performing heavy manual labor. Conclusion: These findings show that ECRL tendon suspension after previous RSA leads to a significant clinical improvement. The operation appears to be an effective revision procedure for patients with persistent pain due to proximalization of the first metacarpal bone and bony impingement following RSA.

Treatment of type II congenital clasped thumb with skin and soft tissue release and full thickness skin graft: a clinical analysis

Objective To evaluate the results of skin and soft tissue release and full-thickness skin graft in the treatment of type Ⅱ congenital clasped thumb. Methods Ten patients with 12 affected hands were treated from January to September 2014 for type Ⅱ congenital clasped thumb. There were 6 males and 4 females, with an average age of 3.5 years (range, 2 to 7 years). Seven cases were on the left side and 5 on the right side. Preoperative passive motion of the thumb was (24.830±4.218)° for radial abduction, (20.580±2.503)° for palmar abduction and (-24.420±30.705)° for dorsiflexion. Surgical management consisted of skin and soft tissue release of the first wed space, release of the volar contracture of the first metacarpophalangeal joint, K-wire fixation of the widened first web space or straightened MP joint (if necessary), and full-thickness skin graft. Two hands had the flexor pollicis longus (FPL) tendon lengthened. All the hands were immobilized in a splint. The K-wires were removed 4 weeks after the surgery. Functional exercise included active and passive thumb abduction and extension. The splint was continued only during the night until 12 weeks. Results All the patients were follow-up for a mean of 4 months. The clasped thumb deformity was corrected in all cases. Grip and pinch function was significantly improved. Postoperative passive motion of the thumb was (44.830±4.218)° for radial abduction, (44.250±3.251)° for palmar abduction and (-2.000±7.793)° for dorsal extension, all significantly better than preoperative values (P<0.05). Conclusion Release of the skin and soft tissue at the first web space and the volar aspect of the metacarpophalangeal joint followed by full-thickness skin graft is an easy, safe and reliable method for treating type Ⅱ congenital clasped thumb. Key words: Hand deformities, congenital; Treatment outcome; Clasped thumb

Surgical and anatomical studies on De Quervain's tenosynovitis syndrome: Variations in the first extensor compartment

Purpose: Anomalies of the first extensor compartment are widely present in patients presenting with De Quervain’s tenosynovitis (DQT) and require surgical release of the wrist tendons. The aim of this study was to test the hypothesis that such patients exhibit significantly more anatomical alterations in the first extensor compartment, the abductor pollicis longus (APL) tendons and the extensor pollicis brevis (EPB) tendons in comparison with the general population using cadavers. Methods: A cross-sectional study was conducted during the period January 2013 to May 2014 in which anatomical variations identified in the first extensor compartments of the wrists of 101 DQT patients who had undergone tenolysis were compared with those detected in the wrists of 65 cadavers without DQT determination. Results: The occurrence of septation in the first extensor compartment was observed in 62.4% of the DQT group (64/101). Supernumerary APL tendons were present in 86.1% of DQT patients (87/101), whereas double EPB tendons occurred in seven patients. In one patient, the EPB tendon was absent. In the cadaveric group, 21.5% (14/65) of the anatomical specimens exhibited double tunnel in the first extensor compartment, while supernumerary APL tendons occurred in 52.3% (34/65) of the wrists. No anatomical variations in the EPB tendon were observed in the cadaveric group. Conclusion: The predominance of the septated first extensor compartment and the presence of supernumerary APL tendons observed in the DQT group indicated that these anatomical variations may be associated with the syndrome. Such anomalies tend to be less common in the general population and are, presumably, asymptomatic. Clinical relevance: As septation of the first extensor compartment and multiple APL tendons appears to represent risk factors for the development of DQT, prior knowledge of the frequency of such anomalies may assist surgeons in pre-operative evaluation and perioperative procedures.

Tension setting for extensor indicis proprius to extensor pollicis longus transfer using the wide-awake approach

Objectives: The tendon transfer operation is the most preferred surgical method for chronic extensor pollicis longus (EPL) tendon rupture repair. The key factor in these operations is tension setting of the tendon transfer. In this article, we retrospectively reviewed our extensor indicis proprius (EIP) to EPL transfer cases for chronic EPL ruptures. Methods: Five patients were operated on for chronic rupture of the EPL tendon between December of 2011 and April of 2014. The EIP tendon was transferred to the EPL tendon using the wide-awake approach in order to optimally set the tension. Results: All five patients were able to extend their thumbs. No second operation was needed for tension adjusting. No complications were encountered postoperatively and during the follow-up period. Conclusion: Tendon transfers using the wide-awake approach provides the benefit of improved tendon tension setting with active movement and minimal risks of complication.

CLOSED TRAUMATIC RUPTURE OF THE FLEXOR POLLICIS LONGUS TENDON IN ZONE T I: A CASE REPORT

A healthy 41-year-old male suffered a direct blow on the palmar side of his right thumb when folding a table, which slipped along his thumb until it was stopped at the inter-phalangeal (IP) joint, resulting in a complete rupture of the flexor pollicis longus (FPL) tendon in zone T I. The proximal tendon stump was passed through the oblique pulley, fixed to the base of the distal phalanx with a pull-out wire technique and augmented on it using a part of the distal tendon remnant. After removal of the cast and the pull-out wire three weeks postoperatively, range of motion exercise was initiated and good functional recovery was obtained.

Late extensor pollicis longus rupture following plate fixation in Galeazzi fracture dislocation.

Late rupture of extensor pollicis longus (EPL) tendon after Galeazzi fracture dislocation fixation is an unknown entity though it is a well-established complication following distal radius fractures. We report the case of a 55-year old male who presented with late EPL tendon rupture 4 months following internal fixation of Galeazzi fracture dislocation with a Locking Compression Plate (LCP). He was managed with extensor indicis proprius (EIP) transfer to restore thumb extension. At 4 years followup, functional result of the transfer was good. We identify possible pitfalls with this particular patient and discuss how to avoid them in future.

A Loop Suture for Dynamic Tendon Transfer in the Repair of Chronic or Acute Extensor Pollicis Longus Ruptures

Ruptures of extensor pollicis longus (EPL) tendon may need a tendon transfer for repair, especially in chronic ruptures. We describe a novel transfer technique using a loop-tendon suture for dynamic transfer of extensor pollicis brevis to EPL. We performed an end-to-side transfixing-loop self-locking suture preserving the extensor pollicis brevis, which acts as a motor unit for the distal end of the repaired tendon. Contraindications would mainly be simultaneous rupture of EPL and brevis tendons. No complications were observed, except for mild metacarpal-phalangeal stiffness in chronic ruptures. An early rehabilitation program may be started when no other associated injuries exist.

Spontaneous rupture of EPL and ECRB tendons in a washerwoman: an unusual phenomenon.

Spontaneous rupture of the extensor pollicis longus (EPL) tendon is rare, and spontaneous non-traumatic rupture of both extensor pollicis longus (EPL) and extensor carpi radialis brevis (ECRB) tendons is not reported in literature. Rupture of EPL is usually associated with rheumatoid arthritis, systemic or local steroid injections, fractures of the wrist and repetitive and excessive abnormal motion of the wrist joint. We describe a case of spontaneous rupture of the EPL and ECRB tendons in a female patient, washerwoman by occupation, with no predisposing factor. Exploration of the tendons along with end to end tendon repair was done with excellent results. We describe the possible mechanism of the injury and result after one year follow up.

BIOMECHANICAL CONSEQUENCE OF EXTENSOR POLLICIS LONGUS TENDON RELOCATION

The extensor pollicis longus (EPL) tendon is responsible for thumb extension and normally passes over Lister's tubercle which acts as a pulley. During procedures in which access to the radiocarpal joint is required through a dorsal approach, the EPL tendon must be relocated toward the radial side of the wrist. However, in the clinical setting, we have observed that some patients have limited thumb extension following relocation surgery. In order to better understand this effect, a rigid body mathematical model was developed to evaluate the effect of EPL tendon relocation on thumb extension. Simulated thumb extensions were performed for both the natural and relocated positions and the model was calibrated and verified with cadaveric experimental data. Relocating the EPL tendon increased the moment arm resulting in an improved mechanical advantage. However, it also shortened the path causing tendon slack and reduced muscle force generation. When these two effects were combined, thumb extension decreased with tendon relocation and the thumb extension force was reduced. These results support clinical studies and observations that suggest displacement of the EPL tendon would result in loss of function or deformity. These results are a first step toward developing a quantitative understanding of the effect of EPL relocation. Further studies including more advanced models and clinical trials are needed before definite conclusions can be made regarding the implications of this research.

Emergent Tendon Transfer in Hand Trauma: A Case Report

In this report we describe our encounter of a case of hand trauma referred to our center presenting with incomplete left thumb amputation at metacarpal level with extensor pollicis longus (EPL) and flexor pollicis longus (FPL) tendon avulsion from the tenomuscular junction. After metacarpal bone fixation the ulnar digital artery was anastomosed and the digital nerves were coapted. Transfer of extensor indicis proprius (EIP) to EPL and side-to-side suturing of the FPL to the deep flexor tendon of the index finger were performed.

The Usefulness of Ultrasonography as a Guide for the Treatment of Delayed Diagnosed Tendon Injury in a 2-Year-Old Child

In children, flexor pollicis longus (FPL) tendon injuries are uncommon. In delayed diagnosed cases, CT and MRI are hard to perform, even though to confirm the location of the lacerated proximal tendon end is preferable for the planning of operation procedure. In such condition, ultrasonography is suitable because of its characteristic feature of easy-to-perform procedure even in children. In this report, preoperative ultrasonography was practical in the delayed diagnosis of FPL tendon in a 2-year-old child to schedule the primary repair because the precise location of both FPL proximal and distal ends was identified. In addition, routine postoperative ultrasonography was also useful to track its healing process without concern about mutual communication due to the patient's age, which helped to promote active motion.