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PubMed1986

Long-term follow-up of the Moberg key grip procedure.

The long-term results of the key grip procedure (tenodesis of the flexor pollicis longus tendon to the radius, release of the A1 pulley, and percutaneous pin fixation of the interphalangeal joint of the thumb) were evaluated in 10 tetraplegic patients. Seven patients also had tenodesis of the extensor pollicis longus and brevis tendons to prevent flexion at the metacarpophalangeal (MP) joint. Patients were examined an average of 7.4 years after surgery. Progressive flexion of the MP joint gradually occurred, indicating failure of the extensor tenodesis. Excessive bowstringing of the flexor pollicis longus tendon across the MP joint occurred in nine patients. Because of failure of the extensor tenodesis and bowstringing of the flexor tendon, the patients had to progressively extend the wrist further to pinch small objects. Functional testing demonstrated improved hand use in eight patients. Lateral pinch strength was related to wrist extension torque.

Adult↗
PubMed1996

Quantitative comparison of grasp and release abilities with and without functional neuromuscular stimulation in adolescents with tetraplegia.

In this study, a functional neuromuscular stimulation (FNS) hand system designed by Case Western Reserve University (CWRU) was implemented in 5 adolescents with C5 tetraplegia and hand function with FNS was evaluated and compared to tenodesis abilities using a grasp and release test designed specifically for this purpose. The test involved the unilateral acquisition, movement and release of 6 objects of various sizes and weights. During a single test session, five 30-second trials were performed with each object with and without the FNS system where the number of completions and failures were recorded for each trial. At least 4 and as many as 8 test sessions were conducted with each subject over periods of 1.5 to 3 years. For each subject, test performance with FNS was compared statistically to tenodesis performance and session-to-session consistency was analyzed. Of 30 comparisons (5 subjects and 6 test objects), FNS was more effective in 23 cases (77%), tenodesis was better in 5 instances (17%) and in 2 cases (6%) there was no difference. Subjects were able to manipulate the 3 heaviest test objects only with FNS and in 60% of all cases involving the 3 lighter test objects there were significantly more trials in which there were more completions or fewer failures with FNS. Performance with FNS and tenodesis was generally inconsistent across sessions; possible reasons for these variations are discussed. Overall, the results of this study support those of the only previous investigation that used the grasp and release test to evaluate hand function with FNS in C5 and C6 tetraplegia.

Activities of Daily Living↗
PubMed1996

[Functional disorders of the foot after tenodeses: is the method still currently acceptable?].

On the basis of biomechanical and clinical studies, this article discusses the relevance of tenodesis in the operative treatment of chronic lateral ankle instability. Considering the experimental results, it is evident that any tenodesis leads to restriction of inversion according to the course and the tightness of the graft. It has been shown that the lateral peroneal reconstruction has a negative influence on the kinematic coupling of the ankle joint complex. The data of the clinical studies reflect the biomechanical results. Despite a high rate of satisfaction, up to 50% of the patients reveal a restriction of inversion. Some authors, particularly those who report on a 10-year follow-up, showed that the degree of arthrosis increased and that deterioration of the clinical result occurred over the time. The measurement of plantar pressure distribution during gait proved the alteration of foot biomechanics. The biomechanical and clinical data available on tenodesis and the good results of the anatomical repair suggest that tenodesis is presently only the method of last choice.

Ankle Injuries↗
PubMedDate not supplied

The effects of knee reconstruction on combined anterior cruciate ligament and anterolateral capsular deficiencies.

We tested the effect of intraarticular reconstructions of the anterior cruciate ligament alone and in combination with extraarticular reconstructions in 10 cadaveric knees. These knees had anterior cruciate ligament deficiency alone or in combination with anterolateral capsuloligamentous deficiencies. In the knees with combined injury, intraarticular reconstruction returned anterior stability to levels not significantly different from levels found for the knees deficient in the anterior cruciate ligament alone and treated with this procedure. After intraarticular reconstruction, rotational stability of the knee with combined injuries failed to return to the levels seen in the knee with isolated anterior cruciate ligament deficiencies that underwent the same treatment. When a tenodesis with either 0 N or 22 N of tension was added to the intraarticular reconstruction in the knee with combined injuries, we found that excessive internal rotation significantly decreased at all angles of flexion, except at full extension with 0 N of tension. In addition, the extraarticular reconstruction with 22 N of tension in the tenodesis overconstrained the knee in internal rotation between 30 degrees and 90 degrees of knee flexion. The tenodesis with 0 N of tension overconstrained the knee at only 60 degrees and 90 degrees of flexion. These results suggest extraarticular reconstruction as an adjunct to the intraarticular operation for the knee with anterior cruciate ligament and anterolateral structural injuries. The results also suggest that the surgeon can affect anterior and rotational laxity by adjusting the tension in the tenodesis.

Adult↗
PubMedDate not supplied

Rupture of the distal biceps brachii tendon: isokinetic power analysis and complications after anatomic reinsertion compared with fixation to the brachialis muscle.

Anatomic reattachment of the distal biceps tendon is well established but bears the risk of complications including loss of motion and nerve damage. We questioned whether nonanatomic repair by tenodesis to the brachialis muscle is able to accomplish similar results with less risk. We compared the results of anatomic repair with suture anchors (n = 6) with the results of nonanatomic repair (n = 8). Anatomic reattachment of the biceps tendon can restore full power of flexion in most cases as determined by isokinetic muscle tests (mean, 96.8% compared with the contralateral side). Nonanatomic repair also restores flexion strength to a mean of 96%. Supination power averaged 91% after anatomic repair. Supination strength after nonanatomic repair did not improve in 4 of 8 patients (42%-56% of the uninjured arm). The other 4 patients were able to produce 80% to 150% of the strength of the contralateral side. Major complications such as radioulnar synostosis or motor nerve damage were not encountered in either group. Heterotopic ossification was seen in 4 cases after reinsertion to the tuberosity. One of these patients was not satisfied with the procedure because of anterior elbow pain, even at rest. After tenodesis to the brachialis, one patient was unsatisfied because of considerable weakness. We concluded that major complications after anatomic repair are rare but must not be ignored. Tenodesis of the distal biceps tendon is a safe alternative procedure. We inform our patients about the benefits and risks of anatomic and nonanatomic repair as well as those of nonoperative treatment. The decision concerning the type of therapy best suited for an individual patient should be made on an informed consent basis.

Adult↗
PubMedDate not supplied

Anterior cruciate ligament reconstruction: allograft versus autograft.

PURPOSE: This study was performed to compare the minimal 2-year outcome of anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) allografts versus autografts, both augmented with an iliotibial band tenodesis. TYPE OF STUDY: Retrospective review. METHODS: Forty-six of 52 BPTB ACL reconstructions using allografts and 33 of 37 BPTB ACL reconstructions using autografts were followed up at a mean of 2.75 and 3.36 years, respectively. All patients had an iliotibial band tenodesis. Evaluations included the Lysholm II scale, a questionnaire, physical examination findings, and KT-1000 arthrometry. RESULTS: No statistically significant differences were seen between groups in Lysholm II scores or in any subjective category. Most patients (91% allograft; 97% autograft) had good to excellent Lysholm II scores. Sixty-five percent of allograft patients and 73% of autograft patients returned to their preinjury activity level. More allograft patients complained of retropatellar pain (16% v 9% for autograft patients). Fifty-three percent of allograft patients versus 23% of autograft patients had a flexion deficit of 5 degrees or more when compared with the normal contralateral side. When comparing KT-1000 side-to-side differences, we found no significant differences between groups. Ninety-one percent of both groups had maximum side-to-side differences less than 5 mm. Three allograft patients (6.5%) had traumatic ruptures at 12, 19, and 43 months postoperatively versus none in the autograft group. All three allograft patients who sustained postoperative traumatic ruptures had received fresh frozen, nonirradiated allografts. CONCLUSIONS: Results of ACL reconstruction using allografts or autografts augmented with an iliotibial band tenodesis were comparable. The BPTB autograft should remain the gold standard, although the BPTB allograft in ACL reconstruction is a reasonable alternative.

Adolescent↗
PubMed2003

Radioulnar convergence after distal ulnar resection: mechanical performance of two commonly used soft tissue stabilizing procedures.

Resection of the distal ulna (Darrach operation) is a common method for salvaging the arthrotic distal radioulnar joint (DRUJ). However, problems have been reported with this procedure due to residual instability and radioulnar convergence. As a result, several methods of soft tissue stabilization for the unstable distal ulna have been developed. Although their clinical efficacy has been reported, biomechanical investigations of these procedures have not been reported. The purpose of our study was to evaluate the dynamic effects on radioulnar convergence and dorsal-palmar displacement of three procedures: the Darrach procedure, a pronator quadratus interposition flap and an extensor and flexor carpi ulnaris tenodesis. We tested 7 fresh-frozen cadaver upper extremities using a dynamic computer-controlled device that generated forearm rotation with physiologic loading of relevant muscles. Displacement data concerning the ulna relative to the radius through the range of forearm rotation was collected for 4 experimental conditions: intact, distal ulna resection alone, distal ulna resection with pronator quadratus interposition and distal ulna resection with extensor and flexor carpi ulnaris tenodesis. Distal ulna resection altered the kinematics, most predictably creating a convergence of the radius towards the ulna. Anteroposterior translations in each loading condition could be detected as well. The interposition of the pronator quadratus muscle or tenodesis with the extensor and flexor carpi ulnaris tendons did not reduce the radioulnar convergence created by resection of the distal ulna.

Aged↗
PubMed2005

Repair of tears of the subscapularis.

BACKGROUND: Rotator cuff tears involving the subscapularis are less common than those involving the superior aspect of the rotator cuff. The purpose of the present study was to report the results of repair of isolated tears of the subscapularis. METHODS: The records on eighty-four shoulders that had undergone open repair of the subscapularis tendon were reviewed. The mean age of the patients at the time of surgery was 53.2 years. The mean interval from the onset of symptoms to the time of surgery was 12.5 months. Fifty-seven tears were traumatic, and twenty-seven were degenerative. Twenty-three tears involved the superior one-third of the subscapularis tendon, forty-one tears involved the superior two-thirds, and twenty tears were complete. Fifty-four shoulders had a dislocation or subluxation of the long head of the biceps tendon, and ten shoulders had a rupture of the long head of the biceps tendon. Forty-eight shoulders underwent concomitant biceps tenodesis, thirteen shoulders underwent concomitant biceps tenotomy, and four shoulders underwent concomitant recentering of the biceps. Patients were evaluated clinically and radiographically at a mean of forty-five months (range, twenty-four to 132 months) postoperatively. RESULTS: The mean Constant score increased from 55.0 points preoperatively to 79.5 points postoperatively. Seventy-five patients were satisfied or very satisfied with the result. Preoperatively, four shoulders had mild glenohumeral arthritis. Postoperatively, twenty-five shoulders had mild glenohumeral arthritis and two shoulders had moderate glenohumeral arthritis. Tenodesis or tenotomy of the biceps tendon at the time of subscapularis repair was associated with improved subjective and objective results, independent of the preoperative condition of the biceps tendon. CONCLUSIONS: Repair of isolated subscapularis tears yields acceptable improvement in shoulder function in selected patients. Additionally, the results of the present study support routine tenodesis or tenotomy of the long head of the biceps tendon at the time of subscapularis repair.

Adult↗
PubMed2006

Repair of tears of the subscapularis. Surgical technique.

BACKGROUND: Rotator cuff tears involving the subscapularis are less common than those involving the superior aspect of the rotator cuff. The purpose of the present study was to report the results of repair of isolated tears of the subscapularis. METHODS: The records on eighty-four shoulders that had undergone open repair of the subscapularis tendon were reviewed. The mean age of the patients at the time of surgery was 53.2 years. The mean interval from the onset of symptoms to the time of surgery was 12.5 months. Fifty-seven tears were traumatic, and twenty-seven were degenerative. Twenty-three tears involved the superior one-third of the subscapularis tendon, forty-one tears involved the superior two-thirds, and twenty tears were complete. Fifty-four shoulders had a dislocation or subluxation of the long head of the biceps tendon, and ten shoulders had a rupture of the long head of the biceps tendon. Forty-eight shoulders underwent concomitant biceps tenodesis, thirteen shoulders underwent concomitant biceps tenotomy, and four shoulders underwent concomitant recentering of the biceps. Patients were evaluated clinically and radiographically at a mean of forty-five months (range, twenty-four to 132 months) postoperatively. RESULTS: The mean Constant score increased from 55.0 points preoperatively to 79.5 points postoperatively. Seventy-five patients were satisfied or very satisfied with the result. Preoperatively, four shoulders had mild glenohumeral arthritis. Postoperatively, twenty-five shoulders had mild glenohumeral arthritis and two shoulders had moderate glenohumeral arthritis. Tenodesis or tenotomy of the biceps tendon at the time of subscapularis repair was associated with improved subjective and objective results, independent of the preoperative condition of the biceps tendon. CONCLUSIONS: Repair of isolated subscapularis tears yields acceptable improvement in shoulder function in selected patients. Additionally, the results of the present study support routine tenodesis or tenotomy of the long head of the biceps tendon at the time of subscapularis repair.

Humans↗
PubMed1987

[Primary plastic reconstruction of a lateral ligament injury of the upper ankle joint].

The article introduces a new aspect in the treatment of ruptures of the lateral ligaments of the ankle. We used the modification of tenodesis according to Castaing and Meunier (3) in the operation of the acute lesions of the fibular ligament. The wearing of a cast for 6-7 weeks after operation is generally not necessary because stability of ankle joint ligaments is obtained. The disadvantages of complete immobilization and trophic changes as well as tenodesis effect are avoided. The patients begin with functional physiotherapy after wound healing (10th postoperative day). Careful extremity loading of the selected, active patient is possible four weeks after operation. 118 reconstructions of the ankle joint ligaments (96 with the abovementioned method) have been performed in the Department of Surgery of Witten-Herdecke University between 1970-1982. Of 43 patients checked in follow-up examination (mean postoperative period three years) 5 showed unsatisfactory balance (tenodesis effect).

Adult↗
PubMed1997

[Reconstruction of the anterior cruciate ligament by bone-patellar tendon transplant. Evaluation of 79 cases. Prognostic factors].

PURPOSE OF THE STUDY: The purpose of this study was to evaluate the results of the anterior cruciate ligament (A.C.L.) reconstruction according to two scoring systems (Arpege and IKDC), to analyse the influence of different factors on the results, to study the effect of a lateral extra-articular tenodesis, the morbidity of patellar tendon graft harvesting, and the advantage of arthroscopically assisted reconstruction. MATERIAL: Seventy nine patients, 17 to 39 years old (average 27 years), underwent an anterior cruciate ligament reconstruction for chronic instability, using a free bone-patellar tendon-bone graft. In 43 cases, a lateral extra-articular plasty was added (Lemaire's procedure). The reconstruction was arthroscopically assisted in 17 cases. Interval between initial injury and surgery was 24 months (2 months to 9 years and 7 months). The average follow-up was 2.5 years (range 1 to 18). METHOD: All patients were reviewed for evaluation with two scoring systems (Arpege and IKDC). Roentgenograms of both knees, including antero-posterior weight-bearing and lateral view, patellar view, dynamic radiographs, allowed evaluation of post-operative arthrosis and residual anterior laxity in extension. Fischer's test and chi square test were used for statistical evaluation. RESULTS: Using the Arpege CLAS system, functional results were excellent or good in 75.9 per cent of cases (excellent in 44.3 per cent, good in 31.6 per cent), fair in 15.2 per cent, poor in 8.9 per cent; according to the IKDC system, 65.8 per cent were excellent or good. 84.8 per cent of the patients were satisfied in Arpege system and 91.2 per cent in IKDC system. The pivot-shift test was negative in 86 per cent, equivocal in 7.6 per cent and positive in 6.4 per cent. The radiological Lachman's test (difference between control and affected knee) was 0-2 mm in 53.2 per cent, 3-5 mm in 39.2 per cent, 6-10 mm in 7.6 per cent, never greater than 10 mm. Antero-posterior weight-bearing radiographs were normal in 83.5 per cent, showed joint remodeling in 10.1 per cent pre-arthrosis in 6.3 per cent but no arthrosis. Functional results were not correlated with age at time of surgery, interval between initial injury and surgery, nor clinical Lachman's test. Competitive sportsmen had a better result (p = 0.001). Residual laxity in extension was correlated with lesions of medial meniscus (p = 0.035). Degenerative changes in femoro-tibial joint were correlated with residual laxity in extension (p = 0.019). There was no significative difference between A.C.L. reconstruction isolated or associated with lateral extra-articular tenodesis. Time to return to work was shorter for patients with arthroscopically assisted procedure (p = 0.067). DISCUSSION AND CONCLUSION: Functional results after A.C.L. reconstruction using a free bone-patellar tendon-bone graft are satisfactory and confirm the reliability of this procedure. Arpege CLAS and IKDC systems give comparable functional results, but IKDC evaluate anatomical results, residual laxity and degenerative changes of the joint, that constitute essential long-term pronostic factors. Morbidity of patellar tendon harvesting appears to be of short duration and largely reversible. Added lateral extra-articular tenodesis doesn't improve the results. Arthroscopically assisted procedure seems to allow a faster rehabilitation.

Adolescent↗
PubMed1977

[Chronic fibular instability of the ankle-joint -- x-ray diagnostic and ligamentous graft (author's transl)].

It was tried to find out how many radiographs are necessary to show instabilities of the ankle-joint with ruptures of the ligamentum talofibulare anterius alone (which is the most common ligamentous lesion) and in combination with other fibular ligaments. Therefore stress views of anatomical speciems of ankle-joints with previous artifically coused lesions were done. It was found that one lateral view with the talus stressed in subluxation and one a.p. view with stressed pes equinus and supination with slight internal rotation of the foot are enough in comparison with the other side. The mostly used plastic reconstructions of old fibular ligament teares by Watson-Jones and Evans act as a tenodesis for the subtalar joint, because the natural anatomical position of the ligamentum calcaneofibulare, which should be replaced, is not respected. We looked for the best positioning of a graft as a replacement of the ligamentum calcaneofibulare by help of a string model in anatomical speciems. Only the straight graft of this ligament gives the best chance of free mobility in the subtalar joint. Other directions of this ligamentous graft lead either to a tenodesis or to an outwear of the graft without a stabilizing effect. Postoperative examinations of nine patients with ligamentous grafts stress this point.

Ankle Joint↗
PubMed1997

[Ligamentization as an explanation for the stability of periosteal flap repair in the replacement of the fibular ligament system].

The gold standard in the operative treatment of chronic insufficiency of the lateral ligaments of the ankle joint is replacement with a tendon (tenodesis). The disadvantage of this method is limitation of movement. The results of the replacement of ligaments with a periosteal flap are similar to the results after tenodesis, but the rate of complications is significant lower. We investigated the histological changes in periosteal flaps in patients. We saw an alignment of the collagenous fibers in the periosteal flap 8-12 weeks after the operation. The results are statistically significant. The conclusion is that the periosteal flap in the replacement of ligaments changes into a ligament-like structure.

Biopsy↗
PubMed1999

[Chronic instability after posterior cruciate ligament injury. Tactics, techniques, and results].

This article reviews the surgical treatment of chronic posterior knee instability. The treatment rationale includes exact definition of the instability pattern ("envelope-of-motion" of the tibia) by clinical examination, arthrometry and stress radiography. Exact evaluation of the osseous anatomy is mandatory to identify an eventual varus morphotype. This osseous variant in combination with posterior/posterolateral instability should be treated by an osteotomy in every case. The technique of additive osteotomy to correct varus and increase the sagittal tilt of the proximal tibia is described. Ligament reconstruction in chronic posterior knee instability must address the posterior cruciate ligament and the lateral/posterolateral structures in many cases. Patellar tendon grafts, quadriceps tendon grafts or hamstrings can be used for posterior cruciate ligament replacement. Arthroscopic or mini-open techniques may be used for graft placement, direct posterior fixation of the graft via a posterior incision is an option for patellar tendon grafts. Bousquet's biceps plasty or Clancy's biceps tenodesis may be used for posterolateral stabilization; a biceps tendon strip can also be used for lateral collateral ligament reconstruction. Results of surgery are still moderate. In the author's series of chronic posterior/posterolateral instability, 26 cases were treated with posterior cruciate ligament reconstruction and biceps tenodesis. Follow-up at 18 months demonstrated increased stability (mean residual posterior drawer 8 mm at 70 degrees and 20 lb force) and improved knee function (33 % IKDC B, 67 % IKDC C). Presently, surgical treatment of chronic posterior knee instability should be restricted to centers devoted to this problem.

Arthroscopes↗
PubMed1999

[Chronic recurrent ligament instability on the lateral ankle].

According to the literature, chronic ankle instability occurs after acute rupture of the lateral ankle ligaments in 10-20% of the cases. The etiology of the instability are ligamentous damage and functional neuromuscular disorder of the peroneal muscles. The standards of diagnostics are the history with the frequency of inversion trauma per period and the interval from the primary trauma, the clinical examination and radiological stress tests. Newer diagnostic methods, up to now not well established in clinical routine, include stabilometry, cybex-measurements of the pronator muscles, the evaluation of peroneal reaction time on a tilting platform and dynamic pedography. Conservative management of chronic ankle instability consists of wearing ankle braces and rehabilitation programs concerned with peroneal muscle strengthening and coordination training. The indication for surgical reconstruction of the ankle ligaments are a well-documented mechanical instability with the neuromuscular reflexes intact and a failed physiotherapeutic training program. The surgical procedure should be selected according to a priority list: 1. anatomical repair, eventually augmented with periosteum from the fibula, 2. Watson-Jones tenodesis, and 3. Chrisman-Snook tenodesis to treat a concomittant subtalar instability.

Ankle Injuries↗
PubMed1992

Biceps tendon and superior labral injuries.

Twenty-two patients sustained injury to the biceps tendon, rotator cuff interval, or superior labrum. Seven patients with "interval lesions" underwent biceps tenodesis, one biceps repair, and three subscapularis repairs. All were satisfied, although one tenodesis failed with distal biceps retraction. Key arthroscopic findings included biceps or subscapularis fraying. Thirteen patients with "S.L.A.P. (superior labrum anterior to posterior) lesions" underwent labral debridement. All but one obtained pain relief. Eight cadaveric shoulders exhibited extreme anatomic variability of the bicipital origin/superior labral attachment. Biomechanical study showed anterior-superior and posterior-superior labral strain with simulated biceps contraction to be greatest in shoulder abduction (p < 0.01). Biceps tendon strain was greatest in shoulder adduction (p < 0.05). A continuum of injuries to the biceps tendon exist, from the rotator cuff interval to the labral attachment. Key arthroscopic findings may assist in the difficult diagnosis of interval lesions. Individual anatomy and mechanism of injury may determine the site of the lesion.

Adult↗
PubMedDate not supplied

Entrapment of the long head of the biceps tendon: the hourglass biceps--a cause of pain and locking of the shoulder.

We describe an unrecognized mechanical condition affecting the long head of the biceps (LHB) tendon with entrapment of the tendon within the joint and subsequent pain and locking of the shoulder on elevation of the arm. We identified 21 patients with a hypertrophic intraarticular portion of the LHB tendon during open surgery (14 patients) or arthroscopic surgery (7 patients). All cases but one were associated with a rotator cuff rupture. Patients were treated by biceps tenotomy (2 patients) or tenodesis (19 patients) after removal of the hypertrophic intraarticular portion of the tendon and appropriate treatment of concomitant lesions. Minimum follow-up was 1 year. All patients presented with anterior shoulder pain and loss of active and passive elevation averaging 10 degrees to 20 degrees. A dynamic intraoperative test, involving forward elevation with the elbow extended, demonstrated entrapment of the tendon within the joint in each case. This test creates a characteristic buckling of the tendon and squeezing of it between the humeral head and the glenoid (hourglass test). The mean Constant score improved from 38 to 76 points at the final follow-up (P <.05). Complete and symmetric elevation was restored in all cases after resection of the intraarticular portion of the LHB tendon. The hourglass biceps is caused by a hypertrophic intraarticular portion of the tendon that is unable to slide into the bicipital groove during elevation of the arm; it can be compared with the condition of trigger finger in the hand. A loss of 10 degrees to 20 degrees of passive elevation, bicipital groove tenderness, and radiographic findings of a hypertrophied tendon can aid in the diagnosis. A definitive diagnosis is made at surgery with the hourglass test: incarceration and squeezing of the tendon within the joint during forward elevation of the arm with the elbow extended. The hourglass biceps is responsible for a mechanical block, which is similar to a locked knee with a bucket-handle meniscal tear. Simple tenotomy cannot resolve this mechanical block. Excision of the intraarticular portion of the LHB tendon, during bipolar biceps tenotomy or tenodesis, must be performed. The hourglass biceps is an addition to the familiar pathologies of the LHB (tenosynovitis, prerupture, rupture, and instability) and should be considered in cases of shoulder pain associated with a loss of elevation.

Aged↗
PubMed1983

Upper limb reconstruction in quadriplegia: functional assessment and proposed treatment modifications.

The functional results following reconstruction of key grip (40 limbs in 30 patients) and active elbow extension (14 limbs in 9 patients) in higher spinal level quadriplegic patients were reviewed and results were classified as follows: Good result (55% of operated limbs)--Patients were very pleased with the greater ease and capabilities in performing functional activities. Fair result (30%)--Patients were moderately satisfied; thumb instability and poor finger position during pinch were the two greatest sources of dissatisfaction. Poor result (15%)--Patients were disappointed, usually because of progressive contracture, spasticity, or pain. On preoperative assessment, these were the weakest patients or those who had the longest interval between injury and surgery. In 10 of 14 limbs functionally active elbow extension was obtained, although the long convalescent time was a deterrent. Based on these results, the modifications in the following areas of treatment protocol were made: (1) Patient selection--Of those patients with only minimum levels of functional resources, only the most highly motivated should have elective reconstructive surgery. (2) Surgical technique--Procedures to better stabilize the thumb metacarpophalangeal joint and to assist in positioning the other digits during pinch include a stronger tenodesis of the thumb extensor tendons to the metacarpal and tenodesis of the superficialis tendons of the index and long fingers to the proximal phalanx. Other procedures include modification of the methods of attachment of tendon transfers to shorten convalescence following reconstruction of active elbow extension. (3) Postoperative care--postoperative problems develop insidiously. Frequent reassessment is mandatory.

Elbow Joint↗