Superficial Tendon Research Articles

Chronic Granulomatous Tenosynovitis Treated With Ulnar Superficialis Slip Resection

Ulnar superficialis slip resection is a procedure initially performed to treat flexor tenosynovitis in the rheumatoid finger. It was first described for treating trigger digits of children with mucopolysaccharide storage disorders and for more complex trigger digits in children. The procedure for adults with trigger finger was described for triggering with flexion contracture at the proximal interphalangeal joint level persisting after release of the A1 pulley and for trigger finger in diabetic patients.This article describes a case of chronic flexor tenosynovitis treated with ulnar superficialis slip resection. The patient was injured by the needle of a water pressure gauge. He developed chronic flexor tenosynovitis, and 1 year after the initial injury, surgery was performed due to a severe limitation of passive and active proximal interphalangeal joint flexion. Synovectomy was performed first, then the A1 pulley was divided. Passive finger flexion and extension was simulated and failed to reproduce full range of motion (ROM). The A3 pulley was then divided and still failed to reproduce full ROM. The ulnar slip of the flexor digitorum superficialis tendon was then resected from the distal margin of the carpal tunnel to the distal edge of the A3 pulley. The tendons could now move smoothly, and full passive ROM was achieved.Surgery consisting of synovectomy alone with or without resection of the A1 pulley without achieving full intraoperative ROM will likely lead to a poor result. We believe that cases like ours should be addressed with an "à la carte" procedure, starting with synovectomy and followed by A1 resection, A3 resection, and finally ulnar superficialis slip resection for achieving full intraoperative ROM.

Mechanical Strength of the Side-to-Side Versus Pulvertaft Weave Tendon Repair

The side-to-side (SS) tendon suture technique was designed to function as a repair that permits immediate postoperative activation and mobilization of a transferred muscle. This study was designed to test the strength and stiffness of the SS technique against a variation of the Pulvertaft (PT) repair technique. Flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons were harvested from 4 fresh cadavers and used as a model system. Seven SS and 6 PT repairs were performed, using the FDS as the donor and the FDP as the recipient tendon. For SS repairs, the FDS was woven through one incision in the FDP and was joined with 4 cross-stitch running sutures down both sides and one double-loop suture at each tendon free end. For PT repairs, the FDS was woven through 3 incisions in the FDP and joined with a double-loop suture at both ends of the overlap and 4 evenly spaced mattress sutures between the ends. Tendon repairs were placed in a tensile testing machine, preconditioned, and tested to failure. There were no statistically significant differences in cross-sectional area (p = .99) or initial length (p = .93) between SS and PT repairs. Therefore, all comparisons between methods were made using measures of loads and deformations, rather than stresses and strains. All failures occurred in the repair region, rather than at the clamps. However, failure mechanisms were different between the 2 techniques-PT repairs failed by the suture knots either slipping or pulling through the tendon material, followed by the FDS tendon pulling through the FDP tendon; SS repairs failed by shearing of fibers within the FDS. Load at first failure, ultimate load, and repair stiffness were all significantly different between SS and PT techniques; in all cases, the mean value for SS was higher than for PT. The SS repair using a cross-stitch suture technique was significantly stronger and stiffer than the PT repair using a mattress suture technique. This suggests that using SS repairs could enable patients to load the repair soon after surgery. Ultimately, this should reduce the risk of developing adhesions and result in improved functional outcome and fewer complications in the acute postoperative period. Future work will address the specific mechanisms (eg, suture-throw technique and tendon-weave technique) that underlie the improved strength and stiffness of the SS repair.

Hind limb myology of the common hippopotamus, Hippopotamus amphibius (Artiodactyla: Hippopotamidae)

Based on morphological traits, hippos have traditionally been classified with pigs and peccaries in the suborder Suiformes. However, molecular data indicate that hippos and cetaceans are sister taxa. This study analyses muscle characters of the common hippo hind limb in order to clarify the phylogenetic relationships and functional anatomy of hippos. Several muscles responsible for propelling the body through water are robust and display extensive fusions, including mm. semimembranosus, semitendinosus, biceps femoris and gluteus superficialis. In addition, common hippos retain long flexor and extensor tendons for each digit, reflecting the fact that all four toes are weight-bearing. These flexor tendons, together with the well-developed intrinsic muscles of the pes, serve to adduct the digits, preventing splaying of the toes when walking on soft terrain. Lastly, common hippos retain a number of primitive features, including the presence of m. articularis coxae, a well-developed m. obturator internus, superficialis and profundus tendons to all digits, mm. flexor digitorum brevis, abductor digiti V, lumbricalis IV, adductores digitorum II and V, and two mm. interossei per digit. Pygmy hippos share these features. Thus, hippopotamids retain muscles that have been lost in the majority of artiodactyls, including other suiforms. These and previously reported findings for the forelimb support the molecular data in indicating an early divergence of the Hippopotamidae from the rest of the Artiodactyla. © 2010 The Linnean Society of London, Zoological Journal of the Linnean Society, 2010, 158, 661–682.

Longitudinal tendon tear concurrent with bilateral medial luxation of the superficial digital flexor muscle tendon in a dog

Luxation of the superficial digital flexor muscle tendon (SDFMT) is a rarely reported condition in dogs, and tendon tear concurrent with SDFMT luxation had never been reported. Abnormal conformation of both calcanei and strenuous activity were suspected as contributing factors in this case. Bilateral medial SDFMT luxation was surgically treated with bursa medial incision release, redundant lateral bursa excision and apposition to the edge of the SDFMT with nonabsorbable sutures. The unilateral longitudinal tendon tear of the SDFMT associated with medial SDFMT luxation was successfully treated with horizontal mattress sutures, and a good outcome was reported for both hindlimbs.

Ultrasound Assessment of the Displacement and Deformation of the Median Nerve in the Human Carpal Tunnel with Active Finger Motion

Peripheral nerves are mobile structures, stretching and translating in response to changes in the position of adjuvant anatomic structures. The objective of this study was to develop a novel method to characterize the relative motion and deformation of the median nerve on cross-sectional ultrasound images of the carpal tunnel during active finger motion. Fifteen volunteers without a history of carpal tunnel syndrome or wrist trauma were recruited. An ultrasound scanner and a linear array transducer were used to evaluate the motion of the median nerve and the flexor tendons within the carpal tunnel during motion from full extension to full flexion by the four fingers (fist motion) and by the long finger alone. The displacement of the median nerve relative to the long-finger flexor digitorum superficialis tendon as well as the perimeter, cross-sectional area, circularity, and aspect ratio of a minimum enclosing rectangle of the median nerve were measured. The data were compared between single-digit motion and fist motion and between extension and flexion positions. The distance between the long-finger flexor digitorum superficialis tendon and the median nerve with isolated long-finger flexion was decreased in the ulnar-radial direction and increased in the palmar-dorsal direction as compared with the distance with four-finger flexion (p < 0.01). Compared with the values with fist motion, the aspect ratio was decreased and the circularity was increased with long-finger motion (p < 0.01). This report presents a method with which to assess displacement and deformation of the median nerve on a cross-sectional ultrasound image during different finger motions. This method may be useful to assess pathological changes within the carpal tunnel, and we plan to perform a similar study of patients with carpal tunnel syndrome on the basis of these preliminary data.

Understanding the Kinematics and Dynamics of the Digit

The flexor tendon system of the hand and the relationship between the flexor digitorum superficialis and flexor digitorum profundus is complicated and has been the subject of much research1-3. Treatment recommendations for diseases and injuries involving the flexor tendon system have evolved substantially over the past thirty years as a better understanding of its anatomy, function, healing capacity, and rehabilitation protocols has emerged. Both muscles originate in the forearm, and distally they form the flexor tendons of the digits. The flexor tendons are oval-shaped spiral bands composed of tenocytes and type-I collagen. Distally, beginning at the level of the metacarpal neck, the flexor tendons are enclosed in the flexor sheath, a fibro-osseous sheath with multiple functions. As has been well described, the sheath has thickened regions that form the pulley system. The pulley system is composed of the anular and cruciform pulleys. The A1, A3, and A5 pulleys arise from the volar plate of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints, respectively. The A2 and A4 pulleys arise from the proximal and middle phalanges. The cruciform pulleys are located between the anular pulleys and are less rigid. The flexor digitorum superficialis tendon of each digit is located volar to the flexor digitorum profundus tendon until the level of the flexor sheath, at which point the flexor digitorum superficialis tendon divides into two slips. One slip passes radial and the other passes ulnar to the flexor digitorum profundus tendon before rejoining dorsal to the flexor digitorum profundus tendon and inserting into the middle phalanx (Fig. 1). At this location, the flexor digitorum superficialis appears, anatomically, to have the capacity to act as an additional pulley for the flexor digitorum profundus. This anatomic layout prompted our investigation. Fig. 1 Diagram of the flexor tendon system of the digit. (Reprinted, …

Subkutaner Sehnenabriss des M. flexor digitorum profundus

The diagnostic and treatment of a closed avulsion of the flexor digitorum profundus muscle at its insertion of the little finger is presented. This happened as a 41-year-old woman wanted to hold a dog lead in her left hand and suddenly the dog started to run. In the literature the flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons were found to be more frequently ruptured than the flexor digitorum superficialis tendon. Closed ruptures of the FDP have been rarely reported. In the case described here there was no torn fragment at the distal end of the FDP tendon and the bone structure of the phalanx distales was intact. The operative treatment, postoperative care and clinical course are presented.

0313: Knee Tendons and Ligaments. Anatomy and Pathology

In the knee, particular strengths of US include the ability to assess traumatic disease affecting tendons and some ligaments. In the quadriceps tendon, US is able to distinguish partial from complete tears thus helping clinical examination that is often misleading. In partial-thickness tears, the superficial tendon layer (from the rectus femoris) is the first involved, followed by the intermediate one (from the vastus medialis and lateralis). In complete tears, the tendon can be retracted at variable distance: the medial and lateral patellar retinacula should also be carefully evaluated because they are often involved. In patellar tendinosis (jumper's knee), chronic microtrauma between the undersurface of the patellar insertion and a prominent patellar tip has been assumed to be a causative factor for chronic impingement and secondary degenerative changes of the patellar tendon. Complete patellar tendon tears may follow a direct local injury or represent the end stage chronic tendinopathy. On the medial knee, MCL injuries can be readily diagnosed with US. Partial tears most often affect the meniscofemoral ligament and can be difficult to differentiate from complete ruptures. Pes anserinus tendinopathy is rare and presents with thickened, hypoechoic tendons and bony cortex irregularities resulting from traction injury. On the lateral knee, chronic local impingement of the iliotibial band against the lateral condyle may lead to friction, local inflammation and pain, the so called “runner's knee”. When inflamed, the bursa between the iliotibial band and the lateral condyle is distended by fluid and can be associated with iliotibial band thickening. In the intercondylar fossa, the middle and distal thirds of the PCL can be demonstrated with US as a deep thick hypoechoic band. Ganglion cysts arising in close proximity to the cruciate ligaments can be occasionally identified with US as incidental findings. A rare tendon-related pathology of the posterior knee is the popliteal artery entrapment syndrome. This syndrome is related to compression of the popliteal artery secondary to the anatomic relationships between the vessel and an abnormal medial head of the gastrocnemius or popliteus. When examining the distal biceps femoris, US scanning should be extended cranially to include the musculotendinous junction as it is a common site of sport-related injuries.

Comparison of Loop-Tendon Versus End-Weave Methods for Tendon Transfer or Grafting in Rabbits

The loop-tendon method for the stabilization of tendon transfers or grafts has been demonstrated previously to have greater initial tensile strength than that of the end-weave method. To our knowledge, a comparison of the mechanical strengths of these methods over the early postoperative period has not been made. The purpose of this study was to compare the mechanical strengths of loop-tendon and end-weave methods of repair during the early postoperative period in rabbit hind limb tendons. In bilateral hind limbs of 30 New Zealand white rabbits of an average weight of 3.5 kg, a distally cut gastrocnemius Achilles' tendon and a proximally cut flexor digitorum superficialis tendon were connected to each other by using the loop-tendon method with 5 stitches in one limb and a 1-pass end-weave method in the contralateral limb. Postoperatively, all rabbits were immobilized by a short-leg cylinder cast. Six rabbits were killed at each of the following time points: immediately after surgery (baseline) and at 1, 2, 3, and 4 weeks postoperatively. Repaired tendons were harvested and were loaded to failure in a tensile load-testing machine to record the ultimate strength and to calculate the absorbed energy. Ultimate tensile loads were significantly higher in the loop-tendon method group than in the end-weave group from baseline to 3 weeks postoperatively, but there was no difference at 4 weeks postoperatively. During the postoperative period, the ultimate tensile load and absorbed energy decreased over the first 2 weeks postoperatively and then increased to reach baseline strengths at 3 weeks postoperatively in both groups. The loop-tendon method provided greater strength than that of the end-weave method during the early postoperative period in rabbit tendons. The loop-tendon method may provide greater surgical repair strength during the early postoperative rehabilitation period than the end-weave method.

Spontaneous rupture of the flexor digitorum superficialis tendon of the index and middle fingers: “The pen sign”

We report this case of a flexor digitorum superficialis (FDS) tendon rupture of the second and third fingers of the right hand in a 46-year-old patient. This rupture seems to occur under moderate stress. In this precise situation, the diagnosis was confirmed from the MRI data. Treatment was entirely conservative. However, the clinical presentation of the patient appeared quite original and so misleading to us that we reported this case here and developed the term "pen sign" to describe it. Considering this case, in order to reanimate thumb flexion transferring the fourth finger, FDS would appear to be entirely justified because of the lack of consequent difficulties on fine thumb index finger grasping used when holding pens or fine tweezers. It should also lead us in our everyday surgical practice to attempt to systematically repair the two index flexor tendons when they are damaged.

Ultrasound-Guided First Annular Pulley Injection for Trigger Finger

The purpose of this study was to develop an ultrasound-guided first annular (A1) pulley injection technique for trigger finger with documentation of outcomes at 1 year. We performed a short-axis injection into a triangle bordered by the A1 pulley, the flexor digitorum superficialis and profundus tendons and volar plate, and the distal metacarpal bone with a 10-mg median dose of triamcinolone acetonide and 2% lidocaine. This was a prospective study of 50 of 52 consecutive trigger fingers from 24 patients recruited from a physical medicine and rehabilitation private practice. All patients were available for follow-up, with 94% (47 of 50) of fingers having complete resolution of symptoms at 6 months, 90% (37 of 41) at 1 year, 65% (17 of 26) at 18 months, and 71% (12 of 17) at 3 years after a single injection. Our ultrasound-guided A1 pulley injection technique is a highly effective and minimally invasive treatment option for trigger finger with a 90% success rate at 1 year for complete resolution of symptoms after a single injection. Assuming similar patient populations, our results were statistically significant (P < .01) compared with the 56% to 57% success rates recently reported for blind injections.

Reconstruction of the Extensor Central Slip Using a Distally Based Flexor Digitorum Superficialis Slip

Several methods have been reported for reconstruction of the extensor central slip. We describe the successful use of a distally based slip of the flexor digitorum superficialis tendon for the reconstruction of an incompetent central slip of the extensor mechanism. The flexor digitorum superficialis tendon was transferred from volar to dorsal through the base of the middle phalanx and then woven through the extensor tendon over the proximal phalanx. The technique is straightforward and appears to be robust.

Mesenchymal stem cells and insulin‐like growth factor‐I gene‐enhanced mesenchymal stem cells improve structural aspects of healing in equine flexor digitorum superficialis tendons

Tendinitis remains a catastrophic injury among athletes. Mesenchymal stem cells (MSCs) have recently been investigated for use in the treatment of tendinitis. Previous work has demonstrated the value of insulin-like growth factor-I (IGF-I) to stimulate cellular proliferation and tendon fiber deposition in the core lesion of tendinitis. This study examined the effects of MSCs, as well as IGF-I gene-enhanced MSCs (AdIGF-MSCs) on tendon healing in vivo. Collagenase-induced bilateral tendinitis lesions were created in equine flexor digitorum superficialis tendons (SDFT). Tendons were treated with 10 x 10(6) MSCs or 10 x 10(6) AdIGF-MSCs. Control limbs were injected with 1 mL of phosphate-buffered saline (PBS). Ultrasound examinations were performed at t = 0, 2, 4, 6, and 8 weeks. Horses were euthanized at 8 weeks and SDFTs were mechanically tested to failure and evaluated for biochemical composition and histologic characteristics. Expression of collagen types I and III, IGF-I, cartilage oligomeric matrix protein (COMP), matrix metalloproteinase-3 (MMP-3), matrix metalloproteinase-13 (MMP-13), and aggrecanase-1 (ADAMTS-4) were similar in MSC and control tendons. Both MSC and AdIGF-MSC injection resulted in significantly improved tendon histological scores. These findings indicate a benefit to the use of MSCs and AdIGF-MSCs for the treatment of tendinitis.

Work of Flexion Related to Different Suture Materials After Flexor Digitorum Profundus and Flexor Digitorum Superficialis Tendon Repair in Zone II: A Biomechanical Study

Repair of both flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons is commonly performed in zone II flexor tendon injuries; however, the bulk of the repair may impair tendon gliding. We evaluated whether repairing 1 slip of FDS tendon and resecting the other would significantly decrease work of flexion and whether suture material affected this interaction in an in vitro study. The index, middle, and ring fingers from 10 fresh-frozen human cadaveric hands were disarticulated and their tendon sheaths opened. Baseline work of flexion was tested. Lacerations were made in zone II, and then the FDP tendon was repaired with 3 different suture materials: FiberWire, Ticron, and prolene. Work of flexion was again measured and the percentage increase calculated. Further iterations were performed with both slips of FDS tendon repaired and with one slip of FDS tendon repaired and the other resected. There was no significant difference in the work of flexion after repairs done with FiberWire, Ticron, or Prolene. Work of flexion after repair of both FDP and FDS tendons increased 51% compared with an increase of 21% after FDP-only repair and an increase of 9% after repair of one and resection of the other slip of FDS. Repair of both FDP and FDS tendons significantly increased work of flexion. Resection of 1 slip of FDS tendon significantly reduces work of flexion in zone II flexor tendon repair. Suture material had no effect on this interaction.

Distally Based Anteromedial Thigh Fasciocutaneous Island Flap for Patellar Soft Tissue Reconstruction

Muscles used for patellar and peripatellar soft tissue construction, which include the vastus medialis, vastus lateralis, gastrocnemius, and sartorius muscle, are often clinically inadequate for reconstruction of the patellar and peripatellar regions. Split-thickness skin grafts are also inadequate in supporting superficial patellar tendons and resisting perpetual shear stress. We report our experience with distally based anteromedial thigh fasciocutaneous island flaps for patellar soft tissue reconstruction in seven patients. Fasciocutaneous island flaps based on the cutaneous feeder vessels and perforator vessels in the muscle septum and deep fascia of the saphenous artery above the medial condylar of the femur were designed for seven patients. Transposition and rotation island flap designs were used. Flap sizes ranged from 5 cm x 5 cm to 10 cm x 9 cm, and the mean size of the vascular pedicle was approximately 10 cm (range, 8-15 cm). All flaps survived completely, whereas only one patient had venous congestion. A distally based anteromedial fasciocutaneous flap is useful and viable option for patellar soft tissue reconstruction due to its versatile vascular pedicle, pliable deep fascia, adequate retrograde perfusion, and the possibility of direct closure of the donor site when no losses of the medial thigh are expected.

The Effects of Hypertonic Dextrose Injection on Connective Tissue and Nerve Conduction Through the Rabbit Carpal Tunnel

Yoshii Y, Zhao C, Schmelzer JD, Low PA, An K-N, Amadio PC. The effects of hypertonic dextrose injection on connective tissue and nerve conduction through the rabbit carpal tunnel. Objective To investigate the effects of hypertonic dextrose injection on the subsynovial connective tissue (SSCT) in a rabbit model. We hypothesized that dextrose injection would induce proliferation of the SSCT, hinder median nerve conduction, and alter SSCT mechanical properties, similar to what is observed in patients with carpal tunnel syndrome (CTS). Design Randomized, controlled prospective study. Setting Not applicable. Participants New Zealand white rabbits (N=28) weighing 4.0 to 4.5kg. Intervention One forepaw was randomly injected with 0.1mL 10% dextrose solution. The contralateral paw was injected with a similar amount of 0.9% saline solution as a control. Animals were killed at 12 weeks after injection. Main Outcome Measures Animals were evaluated by electrophysiology (EP), mechanical testing, and histology. EP was evaluated by distal motor latency and amplitude. Shear force was evaluated when the middle digit flexor digitorum superficialis tendon was pulled out from the carpal tunnel. The ultimate tensile load and the energy absorption were also measured. Tissue for histology was evaluated qualitatively. Results EP demonstrated significant prolongation of distal motor latency. The energy absorption and stiffness were also significantly increased in the dextrose group. Histologically, the dextrose group showed thickening of the collagen bundles and vascular proliferation within the SSCT compared with the saline group. Conclusions These results are consistent with the findings in patients with CTS and suggest that hypertonic dextrose injection has the potential to create a novel animal model in which to study the evolution of CTS.

Temporal growth factor release from platelet‐rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression

Platelet-rich plasma (PRP) has generated substantial interest for tendon and ligament regeneration because of the high concentrations of growth factors in platelet alpha-granules. This study compared the temporal release of growth factors from bone marrow aspirate (BMA), PRP, and lyophilized platelet product (PP), and measured their effects on tendon and ligament gene expression. Blood and BMA were collected and processed to yield PRP and plasma. Flexor digitorum superficialis tendon (FDS) and suspensory ligament (SL) explants were cultured in 10% plasma in DMEM (control), BMA, PRP, or PP. TGF-beta1 and PDGF-BB concentrations were determined at 0, 24, and 96 h of culture using ELISA. Quantitative RT-PCR for collagen types I and III (COL1A1, COL3A1), cartilage oligomeric matrix protein (COMP), decorin, and matrix metalloproteinases-3 and 13 (MMP-3, MMP-13) was performed. TGF-beta1 and PDGF-BB concentrations were highest in PRP and PP. Growth factor quantity was unchanged in BMA, increased in PRP, and decreased in PP over 4 days. TGF-beta1 and platelet concentrations were positively correlated. Lyophilized PP and PRP resulted in increased COL1A1:COL3A1 ratio, increased COMP, and decreased MMP-13 expression. BMA resulted in decreased COMP and increased MMP-3 and MMP-13 gene expression. Platelet concentration was positively correlated with COL1A1, ratio of COL1A1:COL3A1, and COMP, and negatively correlated with COL3A1, MMP-13, and MMP-3. White blood cell concentration was positively correlated with COL3A1, MMP3, and MMP13, and negatively correlated with a ratio of COL1A1:COL3A1, COMP, and decorin. These findings support further in vivo investigation of PRP and PP for treatment of tendonitis and desmitis.

Diagnostic value of ultrasonography to assess stifle lesions in dogs after cranial cruciate ligament rupture : 13 cases

The objective of this study was to evaluate the accuracy of ultrasonographic diagnosis of lesions in the canine stifle associated with cranial cruciate ligament rupture. Thirteen dogs that had a diagnosis of cranial cruciate ligament rupture were included in this prospective clinical study. Two ultrasonographers who were unaware of specific historical and clinical data performed the sonography with a high frequency (8-16 MHz) linear transducer. Surgical treatment of the affected stifle was performed within two days of ultrasonography by a surgeon who was unaware of the ultrasonographic findings. The lesions observed during ultrasonography and arthrotomy were compared at the completion of the study. Visualisation of the superficial tendons (quadriceps and long digital extensor) and ligaments (patellar ligament, collateral ligaments) of the stifle using ultrasonography was excellent. However, the detection of deep stifle ligaments (cranial cruciate ligament and caudal cruciate ligament) was extremely difficult to perform using ultrasonography. For cranial cruciate ligament rupture, the sensitivity for ultrasonographic diagnosis was 15.4%. For meniscal lesions, the sensitivity, specificity, positive and negative predictive values for ultrasonographic diagnosis were 82%, 93%, 90% and 88% respectively. High frequency ultrasonography is a non-invasive method for accurately and efficiently detecting superficial ligaments, tendons and meniscal lesions associated with cranial cruciate ligament rupture in the stifle of non-sedated dogs.

Shear Strain and Motion of the Subsynovial Connective Tissue and Median Nerve During Single-Digit Motion

The objective of this study was to measure the relative motion of the middle finger flexor digitorum superficialis (FDS) tendon, its adjacent subsynovial connective tissue (SSCT), and the median nerve during single-digit motion within the carpal tunnel in human cadaver specimens and to estimate the relative motions of these structures in different wrist positions. Using fluoroscopy during simulated single-digit flexion, we measured the relative motion of the middle finger FDS tendon, SSCT, and median nerve within the carpal tunnel in 12 human cadavers. Measurements were obtained for 3 wrist positions: neutral, 60 degrees flexion, and 60 degrees extension. After testing with an intact carpal tunnel was completed, the flexor retinaculum was cut with a scalpel, and the same testing procedure was repeated for each wrist position. The relative motions of the tendon, SSCT, and median nerve were compared using a shear index, defined as the ratio of the difference in motion along the direction of tendon excursion between 2 tissues divided by tendon excursion, expressed as a percentage. Both tendon-SSCT and tendon-nerve shear index were significantly higher in the 60 degrees of wrist flexion and extension positions than in the neutral position. After division of the flexor retinaculum, the shear index in the 60 degrees wrist extension position remained significantly different from that of the neutral position. We have found that the relative motion between a tendon and SSCT in the carpal tunnel is maximal at extremes of wrist motion. These positions may predispose the SSCT to shear injury.

黒毛和種子牛における浅趾および深趾屈腱全断裂の１例

突然の跛行、右後肢切創からの出血、同肢球節の著しい沈下を示し、浅趾および深趾屈腱全断裂と診断した6ヵ月齢の黒毛和種子牛において外科的整復手術を行った。腱縫合はDouble-locking loop変法とBunnell変法を併用し、プラスティックギプスによる外固定を実施した。術後の経過は良好で、40日目には患肢への負重および歩様も改善して治癒と判断した。