IFSSH Flexor Tendon Committee report.
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Biomechanical Phenomena↗
Biomedical subjects
A Ejeskär
Publications and source records attributed to A Ejeskär.
Protection of the deltoid to triceps tendon transfer repair sites.
The posterior deltoid muscle was used to replace lost elbow extension in 11 patients with C5 or C6 level tetraplegia. During surgery stainless steel sutures were inserted into the donor muscle, graft, and tendon insertion sites. Over the succeeding time periods (1 month to 2 years) the distances between the various markers were measured. Significant tendon elongation of 23.1 +/- 4.8 mm (mean +/- SEM; n = 6) was observed in patients receiving traditional postoperative care. To reduce the tendon elongation observed, a specially designed armrest was developed and applied the first postoperative day. The armrest was designed to maintain the elbow in 20 degrees flexion and to prevent shoulder adduction. The addition of this armrest to the traditional postoperative protocol resulted in a dramatic decrease of tendon elongation to only 8.4 +/- 3.0 mm (n = 5). Elongation occurred within the first 6 postoperative weeks in the armrest group; in the nonprotected group, elongation continued for several additional months. The majority of the elongation in both groups occurred in the proximal portion of the tendon-graft-tendon unit. Although this study did not explicitly measure strength, we conclude that preventing excessive muscle length change is required to protect repair sites in posterior deltoid to triceps transfer. (J Hand Surg 2000; 25A:144-149.
Adult↗
Sollerman hand function test. A standardised method and its use in tetraplegic patients.
A standardised hand function test based on seven of the eight most common hand grips is reported. The test consists of 20 activities of daily living. The test procedure and the method of scoring are described as is our evaluation of the validity and reliability of the test. Fifty-nine tetraplegic patients were evaluated using the test before reconstructive surgery to their hands. The test score correlated well with the accepted international functional classification of the patient's arm (r = 0.76, p < 0.001). The mean test score in the arms of patients lacking sensation was significantly lower than in those with tactile gnosis (O:1-3 compared with OCu:1-3, p < 0.001).
Activities of Daily Living↗
Zone II flexor tendon repair in children. A retrospective long term study.
Forty-three children with 46 lacerations of the flexor digitorum profundus tendon were evaluated at a mean of five and a half years (range three to 10) after tendon repair. Postoperatively, 27 digits were treated with early controlled mobilisation as described by Kleinert and 19 digits were immobilised in plaster. Thirty-one digits were primarily repaired within 24 hours, and in 15 digits repair was delayed. The return of total active motion (TAM) in the interphalangeal joints was evaluated with the Strickland formula, and the mean was 77%. TAM correlated with the age of the child at the time of injury. Variables such as postoperative regimen, concurrent injury to the superficial tendon or digital nerve, delayed tendon repair, localisation of injury in the fibro-osseous canal, and type of trauma, had no significant effect on the final result.
Adolescent↗
[Perilunar luxation--an unusual injury demanding immediate and correct treatment].
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Adult↗
Results of reconstructive surgery in the upper limb of tetraplegic patients.
Forty three out of 62 tetraplegic patients operated on in Sweden during 1970 to 1984 with various reconstructive procedures in the arm and hand have been reexamined. The results show that reconstruction of elbow extensor, key grip and finger flexor are all very valuable procedures if performed on correct indications. All but 4 patients improved by surgery and in many instances the surgical treatment facilitated return to work.
Adult↗
Hand function after replantation or revascularization of upper extremity injuries. A follow-up study of 21 cases operated on 1979-1985 in Göteborg.
Twenty-one patients with revascularized/replanted amputated parts of the upper limb were studied for an evaluation of hand function. Two patients had been injured at the lower arm to wrist level, four between the wrist and MCP joint, three distal to the MCP joints in thumbs and/or fingers, and twelve in the thumb only. Hand function was measured as grip and pinch strength, range of movement (ROM), sensibility (two point discrimination), and Sollerman test score. Cold sensitivity as related to circulatory changes in the replanted limb was evaluated in six patients using the critical opening test (COP). Twelve of 17 initiated replantations (71%), and 11 of 12 revascularizations (92%), were successful. Hand function was restricted in patients with amputations at the lower arm to wrist level, fair in replanted midhands, good, but with wide variations after replantations at the MCP or distal II-V fingers, and best of all in replanted thumbs. Sensibility was poor in a majority of the patients. Three out of six of the patients who were COP-tested had significantly reduced blood pressure in the replanted part. The test results (grip, ROM, Sollerman score) in three patients with amputated thumbs were not found to differ greatly from those with replanted thumbs. These results raise the question of whether the Sollerman test underestimates the importance of the thumb or whether the thumb is overestimated in hand function.
Adult↗
Upper limb surgical rehabilitation in high-level tetraplegia.
The author describes the preoperative examination and classification of the tetraplegic patient. General principles of treatment are presented, along with methods for the reconstruction of the elbow extensor and one-hand grip in different groups of classification. Results of the techniques are also briefly described.
Arm↗
Flexor tendon repair in no-man's-land: results of primary repair with controlled mobilization.
Fifty-three patients with 60 injuries within the digital sheath, which were treated with primary tendon repair by the Kleinert technique, had follow-up of 6 to 36 months after operation. Seventeen digits had isolated lesions of the profundus tendon and regained an average 38 degrees range of motion (ROM) in the distal interphalangeal (DIP) joint. Forty-three digits had injuries to both the profundus and superficialis tendons, 35 of which flexed within 2 cm from the distal palmar crease (81%), and 21 had a total active motion of at least 200 degrees (49%). The average active ROM in the DIP joint was 30 degrees. The results were superior to our own results with primary repair by the Verdan technique. Comparison with our own results after secondary tendon repair by the Kleinert technique showed that repair of isolated profundus lesions could be done primarily or secondarily within 1 month of injury with equally good results. Primary repair of double tendon lesions gave better results than secondary repair.
Finger Injuries↗
Surgery versus chemonucleolysis for herniated lumbar discs. A prospective study with random assignment.
The results of removal of a disc hernia at the L4/L5 level were compared with those obtained by the injection of 4000 IU (2 ml) of chymopapain (Discase) in 29 consecutive patients randomly selected for either treatment. All exhibited severe incapacitating sciatica, and all had a myelogram demonstrating a definite disc hernia. The two groups of patients did not differ significantly with regard to age, sex, or length of history. The total time of general anesthesia was significantly shorter for the injected patients by 20 minutes (p less than 0.01), as was the length of hospitalization, by three days (p less than 0.05). Within five months, eight of the patients receiving chymopapain injections had to be operated on because of unrelieved symptoms. All had definite disc herniae, and in four, a free fragment was found. All patients were seen at the time of dismissal from the hospital and at six and 12 months after operation by an independent observer. Comparisons made at these intervals, following either surgery or chymopapain injection with or without subsequent surgery, did not reveal any significant differences, but the short-term results following either treatment alone significantly (p less than 0.01) favored the surgical approach.
Adult↗
Finger flexion force and hand grip strength after tendon repair.
Isolated finger flexion force and hand grip strength were measured in a group of patients with flexor tendon lacerations treated by primary tendon repair. The results show that reduced isolated finger flexion force is much more common than reduced hand grip strength (66% and 26% respectively). Reduced finger flexion force is strongly correlated to elongation in tendon repair, to the range of motion in the distal interphalangeal joint, and to reduced hand grip strength in patients with lesions of both flexor tendons in one finger. Range of motion in the distal interphalangeal joint and hand grip strength in the individual patient are of little value for prediction of isolated finger flexion force, however. Hand grip strength is sufficient for evaluation of strength in many cases, but knowledge of finger flexion force is a valuable adjunct in analyzing patients with subjective and/or objective weakness in their hands after flexor tendon surgery.
Adolescent↗
Isolated finger flexion force--a methodological study.
A method is presented for measuring isolated finger flexion force in a transverse volar grip in a standardized manner. Normal values for forty healthy subjects are given. The mean force of the digits varied from 5.9 to 10.6kp, the middle finger being the strongest, followed by the index, ring and little finger. Large individual variations were observed, especially among men. Men were significantly stronger than woman in corresponding digits. The symmetry between the hands, judged by the order of strength of the fingers, was good in both sexes but especially in women. It is suggested that the strength ratio between dominant and non-dominant might be used to assess the recovery of finger flexion force after, for instance, tendon surgery. Although a correlation exists between isolated finger flexion force and vigorimetric values of the hand grip strength, it is of little value in evaluation of an individual patient.
Adult↗
Elongation in profundus tendon repair. A clinical and radiological study.
A radiographical study of 63 digits with tendon lacerations within the digital sheath is presented. 60 of these digits were evaluated clinically 6-36 months (mean 15 months) after surgery. At primary tendon repair one wire marker was placed on each side of the repair site in the profundus tendon. The distance between the markers was measured at operation and postoperatively on 3 different occasions on radiograms. The results showed that increase of the distance between the markers by more than 5 mm, considered to indicate elongation in the suture, occurred in 25 out of 59 repaired profundus tendons (42%) and in most instances this happened during the period of immobilization. The cause of elongation could be identified in 9 digits. In 5 it was due to rupture of the suture material, the tendons being repaired with 5-0 Flexon steel wire. In the other 4 digits, sutured with 4-0 Silky Polydec, slipping of the knot was revealed at reoperation. There was a strong correlation between increased distance between the markers and a poor outcome, elongation being the most frequent cause.
Adolescent↗
Flexor tendon repair in no man's land. II. Early versus late secondary tendon repair ad modum Kleinert.
A follow-up study of patients who had undergone secondary tendon repair within the digital sheath showed results comparable to those reported after both primary tendon repair and free tendon grafts. However, the results were best when the operation was performed within one month of injury. With a delay of more than one month the results deteriorated markedly, mostly because of extension deficits.
Adolescent↗
Arthrography in dislocation of the acromioclavicular joint.
Arthrography was performed in 10 patients with dislocation of the acromioclavicular joint. The examination was unsuccessful in one case. In the remaining 9 patients, leakage of the contrast medium was observed around the joint and in the direction of the coracoid process. The arthrographic abnormalities were compared with the findings at operation. The distribution of the medium that had leaked out provided information on the severity of the injury to the ligaments.
Acromioclavicular Joint↗
Oxygen tension measurements in the intervertebral disc. A methodological and experimental study.
A polarographic membrane-covered electrode has been used for measurements of oxygen tension in the intervertebral disc. In vitro studies showed that the method measured partial pressures of oxygen with good reproducibility. However, in long continuous experiments, disc matrix adhering to the membrane influenced the readings negatively. The results of in vivo measurements in canine nucleus pulposus showed tensions of the order of 0.53 - 1.06 KPa (4 - 8 mm Hg). No significant variations between different disc levels were found.
Animals↗
Coracoclavicular wiring for acromioclavicular joint dislocation. A ten year follow-up study.
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Acromioclavicular Joint↗