Flexor Digitorum Superficialis Tendon Research Articles

Sliding Position of the Flexor Tendons Relative to the Hook of Hamate in CT Scans.

The aim of this study was to assess the height of nonunion formation injuring the ulnar-side finger flexor tendon, the positional relationship between the hook of the hamate and little finger flexor tendon was evaluated on CT scans. The subjects were 20 healthy patients (40 hands) (14 males and 6 females, mean age: 28 years old). Their hands were imaged in extension and flexion of the fingers on CT. The position of the little finger flexor tendon was determined regarding the height of the hook of the hamate as 100%. The heights of the flexor digitorum profundus tendons were 46 ± 6% in extension and 44 ± 9% in flexion, and those of the flexor digitorum superficialis tendons were 87 ± 8% in extension and 91 ± 9% in flexion. Our study suggested that 40% of the base of the hook of the hamate does not contact with the flexor tendon, suggesting that flexor tendon injury is unlikely to occur in that region.

Closed disruption of a single flexor digitorum superficialis tendon slip: 3 cases

Two men and one woman (age 31, 36 and 45 years) felt a painful pop in the left middle, right middle and right index finger during sport-related activities (2 sport climbing and 1 judo). Clinical examination found a painful flexor tendon in zone 2 but no function deficit specific to the flexor digitorum superficialis (FDS) tendon. MRI and ultrasonography revealed a complete disruption of the radial FDS tendon slip only, which was found retracted between the A2 and A3 pulleys. All flexor tendon pulleys remained intact. Conservative and functional treatment resulted in unrestricted normal function and return to sport. Disruption of one FDS tendon slip is a differential diagnosis for a popping incident in the finger, which is typically associated with a closed flexor tendon pulley injury.

Biomechanical evaluation of tendon regeneration with adipose-derived stem cell.

The use of Adipose-Derived Stem Cells (ADSC) has been presented as a new alternative for tendon reconstruction. Have been admitted that ADSCs are related to better outcomes when used in tendon healing. This research was designed to apply the potential of ADSCs in tendon healing. Flexor digitorum superficialis tendon lesion was performed on both legs of eleven New Zealand rabbits and them, at the same time, treated as follows: Suture alone (Group III - Suture, n:10), suture associated with ADSC (Group IV - Suture + ADSC, n:10) or without suture (Group II - SHAN, n:2). At four weeks after the tendon surgery, the animal was euthanized, and the tendon evaluated (biomechanically and macroscopically). We used 5 additional New Zealand rabbits in the control group "Group I - Control, n:10". In the macroscopic evaluation, the group with ADSC presented a more homogeneous gross morphology compared with the group III. Biomechanical testing showed a lower ultimate tensile load, stiffness and a higher cross-sectional area in the group III and IV compared with the control group. The group with ADSC showed a greater ultimate tensile load, a larger cross-sectional area and bigger deformation at the ultimate tensile load when compared to the group without ADSC. In general terms, the use of ADSCs in tendon healing have biomechanical advantages compared to the non-use of ADSCs at 4 weeks after surgery. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1281-1286, 2019.

Reconstruction of Traumatic Central Slip Injuries: Technique Using a Slip of Flexor Digitorum Superficialis.

Multiple reconstruction techniques have been described for correction of boutonniere deformities including direct repair, central slip reconstruction, lateral band reconstruction, transverse retinacular ligament reconstruction, staged reconstruction, and extensor tenotomy. Each technique has been reported to have variable results with complications including capsular contracture, loss of proximal interphalangeal flexion, and residual deformity. We describe a surgical technique for central slip reconstruction using a slip of the flexor digitorum superficialis tendon through a bone tunnel.

Flexor Tendon Injuries and Repairs: A Single Centre Experience.

Although flexor tendon injuries cause significant morbidities and socio-economic implications, there have been limited data on patient demographics, injury characteristics and surgical details. The aim of this study is to describe our experience in flexor tendon injuries and repairs. We performed a retrospective study of all digital flexor tendon injuries that were repaired from January 2011 to December 2014. The collected data included patient demographics, injury characteristics and surgical details. A total of 214 patients, 308 digits with 446 flexor tendon repairs were identified. We found that males, non-residents, and 20-29 age group were most prone to flexor tendon injuries. Cleaners, labourers and related occupations were the most vulnerable. The mechanism of injury was usually work-related and mostly caused by glass. Most injuries involve both flexor digitorum profundus and flexor digitorum superficialis tendons. Concomitant digital nerve and vessel injuries were common. Most patients suffered zone 2 laceration of a single digit of the non-dominant hand. Most patients underwent procedures that lasted 1 to 2 hours, including multiple flexor tendon repairs, microsurgical repairs and other interventions. This study is the largest study on patient demographics, injury characteristics and surgical details on flexor tendon injuries and repairs. It could be used to plan resources and policies for the management and prevention of flexor tendon injuries.

Incidence of tenolysis and features of adhesions in the digital flexor tendons after multi-strand repair and early active motion.

We report seven patients requiring tenolysis after primary or delayed primary flexor tendon repair and early active mobilization out of 148 fingers of 132 consecutive patients with Zone 1 or 2 injuries from 1993 to 2017. Three fingers had Zone 2A, two Zone 2B, and two Zone 2C injuries. Two fingers underwent tenolysis at Week 4 or 6 after repair because of suspected repair rupture. The other five fingers had tenolysis 12 weeks after repair. Adhesions were moderately dense between the flexor digitorum superficialis and profundus tendons or with the pulleys. According to the Strickland and Tang criteria, the outcomes were excellent in one finger, good in four, fair in one, and poor in one. Fingers requiring tenolysis after early active motion were 5% of the 148 fingers so treated. Indications for tenolysis were to achieve a full range of active motion in the patients rated good or improvement of range of active motion of the patients rated poor or fair. Not all of our patients with poor or fair outcomes wanted to have tenolysis. Level of evidence: IV.

Prognostic factors for digital range of motion after intrasynovial flexor tendon injury and repair: Long-term follow-up on 273 patients treated with active extension-passive flexion with rubber bands

Study DesignObservational cohort study. IntroductionInvestigating prognostic factors using population-based data may be used to improve functional outcome after flexor tendon injury and repair. Purpose of the StudyThe aim of this study is to investigate the effect of concomitant nerve transection, combined flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendon transection and the age of the patient, on digital range of motion (ROM) more than 1 year after FDP tendon transection and repair in zone I and II. MethodsTwo hundred seventy-three patients with a total of 311 fingers admitted for FDP injury in zone I and II were treated with active extension-passive flexion with rubber bands and followed for at least 1 year. We compared outcome by evaluating digital mobility using Strickland's evaluation system. ResultsAt 12 months 72% of patients aged > 50 had fair or poor ROM compared to 17% of patients aged 0-25 years. At 24 months the results for patients aged > 50 had improved to 33% with fair or poor ROM, whereas no improvement had occurred for patients aged 0-25 (17% with fair or poor ROM). Concomitant nerve transection and FDS tendon transection had no negative effects on digital mobility. DiscussionAge above 50 was significantly associated with impaired digital ROM during the first year after flexor tendon injury and repair but not at 2 years follow-up. Concomitant nerve transection and combined transection of FDP and FDS do not affect digital mobility. ConclusionsOlder patients are likely to have a slower healing process and impaired digital ROM during the first year after surgery.

Quantitative stiffness measurement of structures in carpal tunnel according to motion of wrist and fingers using acoustic radiation force impulse (ARFI) elastography

Repetitive use of wrist and finger is well known cause of damage of the median nerve and the soft tissue around it and contributes to development of the carpal tunnel syndrome. The aim of this study is to unveil the stiffness variation of the structures in the carpal tunnel according to the hand and the wrist motions. This study was designed as a prospective, cross-sectional study and 26 healthy volunteers were enrolled ( Fig. 1 ). Target structures for stiffness measurement in the carpal tunnel were median nerve (MN), transverse carpal ligament (TCL), and tendon of flexor digitorum superficialis (FDS) and profundus (FDP). Stiffness measurement were done transversely at the carpal tunnel inlet (pisiform bone to scaphoid tubercle) of non-dominant hand in combination of the 2 wrist joint motions; wrist neutral and wrist 30 degrees extension, and the 3 finger motions; finger neutral, full finger grasp, and full finger extension. Stiffness (m/s) of mean and range of the target structures in wrist neutral-finger neutral position were 2.3(1.6–3.4), 3.4(2.7–3.9), 2.9(2.7–3.4), and 3.2(2.8–3.8) each. Those in wrist extension-finger full extension position were 3.0(2.3–4.0), 4.0(3.3–5.1), 3.5(2.8–5.1), and 3.9(2.9–5.0) ( Table 1 ). Stiffness was significantly higher compared to wrist neutral-finger neutral position in other all five wrist-finger motions ( Fig. 2 ). Generalized estimating equation (GEE) analysis among the all six wrist-finger joint motions shows that wrist and finger joint movement increases stiffness of the structures in carpal tunnel compared to the wrist neutral-finger neutral position. Further study with large sample size and with carpal tunnel syndrome patients should be required to clarify these tendencies.

Effectiveness of virtual reality treatment after flexor tendon surgery: Preliminary results

Biofeedback can improve the effectiveness of an intervention as a helpful tool in the physiological process of rehabilitation. In our study, we aimed to investigate the efficacy of Virtual Reality (VR) in the rehabilitation of patients with flexor tendon repair. Twenty patients with flexor digitorum superficialis (FDS) and/or flexor digitorum profundus (FDP) tendon repair were included in the study and randomized into two groups: VR and traditional treatment. VR was administered with the HandTutor™ device from postoperative 8th week for 3 weeks, 3 sessions per week. Both groups were given splinting and progressively increased exercise as a home program. Before and after treatment, patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and hand grip strength was measured using a Jamar dynamometer. The Wilcoxon signed rank test was used to compare dependent variables and the Mann-Whitney U test was used to compare independent groups. The mean age of the patients was 35.4 ± 13.8 years. 10% of the patients had FDS, 40% had FDP, 50% had FDS and FDP tendon injuries. There was a significant decrease in DASH scores and a significant increase in hand grip strength in both VR ( P = 0.008) and traditional treatment groups ( P = 0.003). In between-group comparisons, no significant difference was found in DASH scores ( P = 0.110). However, the increase in hand grip strength was significantly greater in the VR treatment than that in the traditional treatment group ( P = 0.030). The results of this pilot study support the use of HandTutor™ with traditional therapy in hand rehabilitation after flexor tendon repair and warrant further studies with larger samples.

Evaluation of Results after Flexor Digitorum Superficialis Tendon Transfer to Provide Fingers and Thumb Extension in Radial Nerve Lesions

Purpose: Objective and subjective evaluation of the resultsof flexor digitorum superficialis tendon transfer for the restorationof finger extension in irreparable radial nerve lesions.Methods: Restoration of finger extension, thumb extension,was done in 10 patients (seven with radial nerve and threewith posterior interossius nerve injury; age range: 5-60 years).We used tendon transfer technique using the flexor digitorumsuperficialis (FDS) 3 [to extensor pollicis longus (EPL)]and FDS 4 [to extensor digitorum communis (EDC)] as donorsfor the reconstruction of fingers and thumb extension (allpatients) and pronator teres (PT) for wrist extension.Results: Eight patients (out of 10) yielded 'Excellent togood' results: These patients showed marked improvement tothe motor power scoring M4-M5 on the MRC grading systemwhile 2 patients (out of 10) yielded 'Fair' results: Moderateimprovement to the motor power scoring M3 on the MRCgrading system.Conclusions: The FDS transfer provides thumb extensionindependent from the fingers and wrist extension, becausethe FDS control for each finger is independent from the otherfingers

Flexor tendon repair in the hand with the M-Tang technique (without peripheral sutures), pulley division, and early active motion.

IV.

Technique of Dynamic Flexor Digitorum Superficialis Transfer to Lateral Bands for Proximal Interphalangeal Joint Deformity Correction in Severe Dupuytren Disease.

Pseudo-boutonniere deformity is an uncommon complication from long-standing proximal interphalangeal (PIP) joint contracture in Dupuytren disease. Prolonged flexion contracture of the PIP joint can lead to central slip attenuation and resultant imbalances in the extensor mechanism. We present a technique of flexor digitorum superficialis (FDS) tendon transfer to the lateral bands to correct pseudo-boutonniere deformity at the time of palmar fasciectomy for the treatment of Dupuytren disease. The FDS tendon is transferred from volar to dorsal through the lumbrical canal and sutured into the dorsally mobilized lateral bands. This technique presents an approach to the repair of pseudo-boutonniere deformity in Dupuytren disease.

透析手根管症候群の術後複数回再発に対する浅指屈筋腱切除術の術後成績

透析手根管症候群は透析アミロイドーシスにより初回手術後も複数回再発をきたし得るため長期的視野に立った治療計画が必要である. 症状が再発または複数回再発し通常の手根管開放術では対処できない症例に対し著者らが行っている浅指屈筋腱切除術の術後成績を調査し治療選択の一助とする. 本手術を行った50手の臨床症状回復状況と再発の有無を調査した. しびれは92% (平均19週), 痛覚障害は100% (17週), 触覚障害は100% (19週), APB筋力は56% (197週) で改善, 運動神経遠位潜時の15% (2年), 知覚神経遠位潜時の19% (3年) で正常化した. 臨床症状再燃または再手術をエンドポイントとした場合の50%生存率はそれぞれ6.1年と9.0年であった. 本法は手根管掌側の切離可能な組織がない場合に適応となり, 再発例, 再再発例のいずれにおいても術後良好な臨床症状改善が得られた.

Surgical reconstruction for thumb opposition in severe carpal tunnel syndrome by transfer of the flexor digitorum superficialis tendon of the ring finger and simultaneous decompression of the carpal tunnel: a case report

Surgical reconstruction for thumb opposition in severe carpal tunnel syndrome by transfer of the flexor digitorum superficialis tendon of the ring finger and simultaneous decompression of the carpal tunnel: a case report

Treatment of Trigger Fingers with Flexion Contracture of the Proximal Interphalangeal Joint by Resection of the Ulnar Slip of the Flexor Digitorum Superficialis Tendon

Treatment of Trigger Fingers with Flexion Contracture of the Proximal Interphalangeal Joint by Resection of the Ulnar Slip of the Flexor Digitorum Superficialis Tendon

Qualitative and Quantitative Analyses of the Dynamic and Static Stabilizers of the Medial Elbow: An Anatomic Study

Background: The anterior bundle of the medial ulnar collateral ligament (UCL) and the forearm flexors provide primary static and dynamic stability to valgus stress of the elbow in overhead-throwing athletes. Quantitative anatomic relationships between the dynamic and static stabilizers have not been described. Purpose: To perform qualitative and quantitative anatomic evaluations of the medial elbow-UCL complex with specific attention to pertinent osseous and soft tissue landmarks. Study Design: Descriptive laboratory study. Methods: Ten nonpaired, fresh-frozen human cadaveric elbows (mean age, 54.1 years [range, 42-64 years]; all male) were utilized for this study. Quantitative analysis was performed with a 3-dimensional coordinate measuring device to quantify the location of pertinent bony landmarks and tendon and ligament footprints on the humerus, ulna, and radius. Results: The anterior bundle of the UCL attached 8.5 mm (95% CI, 6.9-10.0) distal and 7.8 mm (95% CI, 6.6-9.1) lateral to the medial epicondyle, 1.5 mm (95% CI, 0.5-2.5) distal to the sublime tubercle, and 7.3 mm (95% CI, 6.1-8.5) distal to the joint line on the ulna along the ulnar ridge. The flexor digitorum superficialis (FDS) ulnar tendinous insertion was closely related and interposed within the anterior bundle of the UCL, overlapping with 45.6% (95% CI, 38.1-53.6) of the length of the anterior bundle of the UCL. The flexor carpi ulnaris (FCU) attached 1.9 mm (95% CI, 0.8-2.9) posterior and 1.3 mm (95% CI, 0.6-3.2) proximal to the sublime tubercle and overlapped with 20.9% (95% CI, 7.2-34.5) of the area of the distal footprint of the anterior bundle of the UCL. Conclusion: The anterior bundle of the UCL had consistent attachment points relative to the medial epicondyle and sublime tubercle. The ulnar limb of the FDS and FCU tendons demonstrated consistent insertions onto the ulnar attachment of the anterior bundle of the UCL. These anatomic relationships are important to consider when evaluating distal UCL tears both operatively and nonoperatively. Excessive stripping of the sublime tubercle should be avoided during UCL reconstruction to prevent violation of these tendinous attachments. Clinical Relevance: The findings of this study enhance the understanding of valgus restraint in throwing athletes and provide insight into the difference in nonoperative outcomes between proximal and distal tears of the UCL.

Prevalence of Absence of Palmaris Longus and Its Association with Gender, Hand Dominance and Absence of FDS Tendon to Little Finger Among Malay Population.

Palmaris Longus is being widely used in reconstructive, plastic and cosmetic surgeries due to its long tendon. It is the most readily available source for tendon grafting. The objective of this study was to determine the prevalence of absence of Palmaris Longus and its association with gender, hand dominance and absence of FDS (flexor digitorum superficialis) tendon to little finger among Malay population. An analytical cross sectional study design was used and a self-administered proforma was distributed for data collection. 1239 Malay secondary school children in Putrajaya were tested for absence of Palmaris Longus using Schaffer's test. 4 additional tests namely Thompson's test, Mishra's test I, Mishra's test II and Pushpakumar's 'two-finger sign' method were used to confirm its absence in respondents with negative Schaffer's test. Function of Flexor Digitorum Superficialis tendon to little finger was determined by flexing PIP of little finger while hyperextend the other fingers. The prevalence of absence of Palmaris Longus was 11.7%. Left side absence of Palmaris Longus was much common. There was a significant association between absence of Palmaris Longus with gender in which female had higher prevalence of absence of Palmaris Longus than male. In conclusion, the prevalence of absence of Palmaris Longus in Malay population was lower than Indian but higher than Chinese population. Females had higher prevalence of absence of Palmaris Longus and no association can be found with hand dominance and absence of Flexor Digitorum Superficialis tendon to little finger.

The quantitative evaluation of the relationship between the forces applied to the palm and carpal tunnel pressure

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy occurring in upper limbs. The etiology, however, has not been fully understood yet. Median nerve could be compressed by either increase of carpal tunnel pressure (CTP) or direct impingement when it is forced toward to carpal ligament especially in wrist flexion leading to CTS development. Thus, the increase of carpal tunnel pressure is considered an important role in CTS development. It has been identified that forces applied to the palm would affect the CTP. However, the quantitative relationship between palmar contact force and CTP is not known. The purpose of this study was to quantitatively evaluate the relationship between palmar contact force and CTP. Eight human cadaveric hands were used. The CTP was measured with a diagnostic catheter-based pressure transducer inserted into the carpal tunnel. A custom made device was used to apply forces to the palm for the desired CTP. Palmar contact forces corresponding to the determined CTP level were recorded respectively. The testing was repeated with different ranges of tension applied to the flexor digitorum superficialis tendon of the third finger. The tensions were constant at 50 g for the other flexor tendons and median nerve. The results showed that CTP increased linearly with the force applied to the palm. When CTP was 30 mmHg, mean values of the contact force to the palm was 293 g (SD: 15.2) including all tensions. These results would help to understand the effect of daily activities with hands on CTP.

Redefining Zone II: Anatomy of the Flexor Digitorum Superficialis Insertion.

Flexor zone II is defined as the region spanning the proximal aspect of the A1 pulley to the insertion of the flexor digitorum superficialis (FDS) tendon. Descriptions of the FDS insertion are inconsistent in the literature, but zones of injury are frequently determined with reference to superficial landmarks. The purpose of this study was to describe the footprint of the FDS insertion and define its relationship to the proximal interphalangeal (PIP) skin crease. The FDS insertion on the index, middle, ring, and small fingers was dissected in 6 matched pairs of fresh-frozen cadaveric hands. A Kirschner wire was used to mark the level of the PIP skin crease on bone before measurements of the FDS footprint and its position relative to the PIP skin crease were made using digital calipers. The radial and ulnar FDS slips inserted a mean distance of 3.22 mm from the distal aspect of the PIP skin crease and varied by digit. The mean distal extent of the FDS insertion was 8.29 mm. The mean length of the insertion of each FDS slip was 5.15 mm and the mean width was 1.9 mm. The radial and ulnar FDS slips insert on average 3.22 mm distal to the PIP skin crease and vary by digit. Knowledge of the FDS insertion is clinically relevant when differentiating between flexor zone I and zone II injuries, planning surgical approaches to the finger, and in guiding patient expectations for surgery given the variability in outcome based on zone of injury.

Wrist ultrasound examination - scanning technique and ultrasound anatomy. Part 2: Ventral wrist.

Ultrasound imaging of the musculoskeletal system is an important element of the diagnostic and therapeutic protocol. Clinical decisions, including those regarding surgical procedures, are often based solely on ultrasound imaging. However, detailed knowledge on the anatomy and a correct scanning technique are crucial for an accurate diagnosis. Modern ultrasonographic equipment allows obtaining detailed anatomical images of muscle tendons, ligaments, nerves and vessels of the carpal area. Ventral wrist ultrasound is one of the most common diagnostic procedures in patients with suspected carpal tunnel syndrome. Ventral wrist evaluation is also often performed in patients with wrist pain of unclear etiology, rheumatic diseases, wrist injuries or symptoms of ulnar neuropathy. The aim of this paper is to present ultrasound images with corresponding anatomical schemes. The technique of ultrasound examination of the ventral wrist along with practical guidance to help obtain highly diagnostic images is also discussed. The present paper is the second part of an article devoted to ultrasound anatomy and wrist ultrasound technique – the part discussing the dorsal side of the wrist was published in the Journal of Ultrasonography, Vol. 15, No 61. The following anatomical structures should be visualized during an ultrasound examination of the ventral wrist, both in the carpal tunnel as well as proximally and distally to it: four flexor digitorum superficialis tendons, four flexor digitorum profundus tendons, flexor pollicis longus, flexor carpi radialis tendon, median nerve and flexor retinaculum; in the carpal tunnel as well as proximally and distally to it: the ulnar nerve, ulnar artery and veins; the tendon of the flexor carpi ulnaris muscle; carpal joints.