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At least 307 records · Page 17Linked to original sources
PubMed1990

Phasic relationships of the extrinsic muscles of the normal hand.

The objective of this investigation was to improve the interpretation of dynamic electromyogram studies of upper extremity musculature by providing normal reference data. Fine wire electrodes recorded electromyogram data from the extrinsic forearm and hand muscles of 10 normal adults. Simultaneous wrist and finger motions were recorded by goniometers with the electromyogram data. Subjects performed hand opening and closing while actively maintaining selected elbow, forearm, and wrist positions. Phasic muscle activity was identified in each position for individual subjects. Normal adult subjects use gravity and tenodesis effects in addition to active muscle contraction to achieve motor goals. Individual subjects used different muscles to accomplish the same motor task, but each subject was remarkably consistent in muscle assignment. These findings suggest that individuals employ "motor planning strategies" in hand function.

Adult↗
PubMed1991

Digital ranges of motion: normal values in young adults.

Analysis of the range of motion of fingers was done in young (eighteen to thirty-five year old) adult volunteers with no history of previous injury to their hands. The data show that there are slight differences between the individual digits. Notably, metacarpophalangeal flexion and total active motion increase linearly in proceeding from the index to the small finger. There were also minor differences in comparing sexes. Women have greater extension at the metacarpophalangeal joint in both active and passive motion and have a greater total active motion at all digits as a result. A significant tenodesis effect was found at the distal interphalangeal joint in normal subjects. No differences were found that could be attributable to handedness.

Adult↗
PubMed1977

Avulsion of the profundus tendon insertion in athletes.

A review of 36 avulsions of the flexor profundus tendon insertion in athletes seen during the past 5 years showed the injury to be most common in the ring finger. The injury was classified into three types depending upon (1) the presence or absence of a bony fragment on roentgenograms, (2) the level to which the tendon retracted, and (3) the status of the blood supply of the avulsed tendon. If the tendon retracts into the palm at the time of injury, it should be repaired within 7 days. If the tendon retracts only to the proximal interphalangeal joint, it often can be repaired a few months after the injury. Late untreated patients who were relatively asymptomatic were left alone. Those with unstable distal interphalangeal joints were treated by fusion or tenodesis of the distal joint. A flexor tendon graft through an intact functioning superficialis tendon in the ring finger seldom was indicated. Prompt diagnosis and surgical repair within the first week gave the best results.

Athletic Injuries↗
PubMed1978

Tendon transfers for radial nerve palsy: use of superficialis tendons for digital extension.

Since 1959, 22 patients have had wrist extension restored by transfer of the pronator teres to the extensor carpi radialis longus and brevis, common finger extension by transfer of the superficialis of the long finger, independent thumb and index finger extension by transfer of the superficialis of the ring finger, and abduction of the thumb by transfer of the flexor carpi radialis at the wrist joint level. Twenty-one of 22 patients have been evaluated from 8 months to 15 years after operation, with an average follow-up of 4.5 years. By our new system of evaluation, there were 10 excellent results, six good results, five fair results, and all patients improved. Sixteen patients obtained full, independent thumb-index finger extension, three had fair function, and two obtained thumb-index extension by tenodesis of the transfer. This procedure allows full metacarpophalangeal extension independent of wrist position, provides thumb-index finger extension independent of the ulnar three digits, and maintains the dorsal-radial-to-volar-ulnar plane of functional motion of the wrist by retaining the flexor carpi ulnaris.

Adolescent↗
PubMed1978

The spiral oblique retinacular ligament (SORL).

A procedure is described for reconstruction of the oblique retinacular ligament using a small tendon graft in a spiral fashion to act as a dynamic tenodesis to restore distal interphalangeal extension and to restrain proximal interphalangeal hyperextension. The method has been uniformly successful in the treatment of post-traumatic "swan-neck" or "mallet" deformity. Although the concept is simple, the procedure demands thorough understanding of digital anatomy for successful completion.

Adolescent↗
PubMed1982

Flexor pollicis longus abductor-plasty for spastic thumb-in-palm deformity.

Seven patients with thumb-in-palm deformity due to spasticity of the flexor pollicis longus (FPL) were treated by transferring the tendon of the FPL to the radical side of the proximal phalanx of the thumb and stabilizing the interphalangeal (IP) joint in 15 degrees of flexion by tenodesis or arthrodesis. Surgery was not performed unless: (1) the affected limb was used spontaneously for bimanual activities, (2) there was functional disability due to the thumb-in-palm deformity, (3) the thumb could be passively extended and abducted with the wrist palmar flexed, or (4) the thumb could be actively adducted and the metacarpophalangeal joint flexed with the wrist palmar flexed. Neither low intelligence nor sensory deficit was considered an absolute contraindication to treatment. After the operation, there was improved appearance in the hands of all seven patients. The thumb was no longer held clenched in the palm. Each patient was able to use the operated hand for assistive grasp; however, ability to use the hand for manipulation of small objects and for pinch was not improved. In fact, one patient had decreased small object manipulative ability postoperatively and required subsequent tendon transfer to restore thumb adduction. Release of the FPL from its insertion, stabilization of the IP joint of the thumb, and transfer of the FPL to the radical side of the thumb can achieve improved thumb balance and function in patients with spastic FPL thumb-in-palm deformity who have functioning adductor pollicis and thumb extensors. The operation lessens thumb flexion and adduction and improves thumb extension and abduction.

Adult↗
PubMed1983

Palmar arthroplasty for the treatment of the stiff swan-neck deformity.

Palmar arthroplasty for the treatment of the stiff swan-neck deformity in rheumatoid arthritis is designed to correct the mechanical block to flexion that is caused by palmar plate adhesions (which obliterate the retrocondylar recess) and by collateral ligament contracture and adhesions. This procedure can be performed at the same time as correction of the primary cause of proximal interphalangeal joint (PIP) hyperextension (e.g., intrinsic tightness or flexor tenosynovitis) and can also be supplemented with superficialis tenodesis to minimize recurrent hyperextension. Postoperative flexor dynamic traction, which is started at 24 to 48 hours and continued for a minimum of 3 to 4 weeks, is critical to the maintenance of motion. Arthroplasty in 47 PIP joints in 14 hands of 9 patients demonstrate an increase in motion from +20 degrees hyperextension and 9.5 degrees flexion to -7 degrees extension and 72 degrees flexion postoperatively.

Adult↗
PubMed1985

Brachioradialis to flexor pollicis longus tendon transfer for active lateral pinch in the tetraplegic.

Seventeen hands in 15 patients with posttraumatic tetraplegia had transfers of the brachioradialis tendon to the flexor pollicis longus in an attempt to create an active lateral pinch. In addition, interphalangeal joint fixation with a Moberg screw was performed in 16 thumbs and tenodesis of the extensor pollicis longus and brevis tendons to the metacarpal was performed in 11 patients. Average patient age was 32 years, time from onset of tetraplegia to operation was 5.3 years, and postoperative follow-up was 2.3 years. Functional improvement was noted in 15 hands and 80% of the patients could name at least four activities of daily living that were now possible or made more efficient as a result of surgery. With the elbow flexed to 90 degrees, the average lateral pinch was 3.9 pounds with the wrist extended 30 degrees, 4 pounds with the wrist in the neutral position, and 2.3 pounds with the wrist flexed 30 degrees. There was a direct correlation between pinch strength and the amount of residual triceps and wrist extensor strength.

Activities of Daily Living↗
PubMed1987

Extensor tendon involvement in Smith's and Galeazzi's fractures.

Extensor tendon involvement in three Smith's and two Galeazzi's fractures are reported. In two cases of previous Smith's fracture, the extensor indicis proprius tendon had been entrapped and ruptured in one case, and in the other the extensor digitorum communis tendon of the index was pierced by the fragment. Both showed a severe tenodesis effect on the index finger and thumb. In a new case of Smith's fracture, long extensor tendons of the fingers and thumb had been trapped beneath a dorsally displaced third fragment making closed reduction impossible. In the two cases of Galeazzi's fracture; in one the extensor carpi ulnaris tendon was trapped between the dorsally displaced ulnar head and the avulsed styloid process and in the other, the extensor digiti minimi tendon was caught beneath the radial border of the dorsally dislocated ulnar head.

Adolescent↗
PubMed2002

Cervical epidural anesthesia in tetraplegia.

The primary result of this series is that each patient participated actively during his or her procedures. The concept of selective sensory block, therefore, which was the authors' overriding reason for using CEA in secondary tendon surgery, also may be beneficial to tetraplegic patients. Nystrom and Nystrom [2] also came to this conclusion. The use of CEA in tetraplegia is and must be used only in exceptional cases. If the usual surgical techniques seem to be inadequate for a given patient, and if the surgeon wishes to assess muscle tonicity and the effect of tenodesis in vivo, CEA may be used. The patients in the authors' series have been so satisfied with the technique that this dynamic approach to the tetraplegic upper leg may be as advantageous for the patient as it is for the surgeon.

Adult↗
PubMed2002

Tendon transfers as applied to tetraplegia.

The techniques of the tendon transfers that are used primarily for the functional rehabilitation of upper limbs in tetraplegia are described in this article. The restoration of active elbow extension can be obtained either by biceps-to-triceps or by deltoid-to-triceps transfers. Grasp and key grip can be restored either by active or by passive tendon transfers. The usual motors of active transfer are the BR and ECRL. The usual tenodesis involve the FDS (via lassos), EDC, EPL, FPL, and APL.

Arm↗
PubMed2002

The unoperated hand: the role of passive forces in hand function after tetraplegia.

Passive forces play a large role in hand function after tetraplegia. Most individuals with tetraplegia choose not to undergo surgical reconstruction of hand function and, therefore, depend on the passive properties of their musculoskeletal system to perform functional tasks. Knowledge of the levels of force needed to perform many of these tasks is lacking. Understanding the mechanics of producing passive force is important for designing adaptive tools and other devices for tetraplegic individuals. Knowledge of the passive properties of the upper extremity is important in forming treatment strategies. The passive forces produced for change to the tenodesis grasp are small but useful to the individual. Since these forces arise from basic anatomy and muscle function, they are important even after surgical restoration of hand function. Compensatory strategies for the unoperated hand probably play a role in the operated hand. The approach to surgical restoration of grasp must consider how passive forces contribute to functional outcome.

Adaptation, Physiological↗
PubMed2002

Evolution of surgery for tetraplegic hands in Japan.

In Japan, reconstructive surgery for the tetraplegic hand has developed mainly with Tsuge, Yabe, and their students for a little more than 30 years. They mostly used Zancolli's classification and, consequently, followed his treatment guidelines. Some unique procedures and techniques, however, have been devised based on their own experiences, including a static opponens tenodesis using FCR tendon, a modified lasso procedure to anchor a paralyzed flexor superficialis tendon through A2 pulley rather than A1 pulley, one-stage reconstruction of both extensor and flexor tendons, and the percutaneous functional electrical stimulation (FES) system.

Elbow Joint↗
PubMed2002

Surgical rehabilitation for the weaker patients (groups 1 and 2 of the International Classification).

We have benefited from having had an initial large experience with the straightforward and predictable FPL tenodesis procedure and, after gaining experience, have continually modified it with the goal of customizing procedures to particular patients. We have moved toward reconstructing a dynamic pinch by tendon transfer when the brachioradialis is not needed to augment wrist extension. In any case, any patient and any hand are different. There is no such thing as a "standard procedure" when dealing with tetraplegic patients, and available procedures must be discussed in view of each patient's needs, desires, and specific circumstances.

Hand↗
PubMed2002

Strategy for improving hand opening in the tetraplegic upper limb.

In the tetraplegic patient, restoring an adequate grip requires primary restoration of proper hand opening. This opening (or "extensor") surgical stage is performed 3 or 4 months before the closing (or "flexor") stage. Surgical strategy is based on group 5 of the IC, which represents a turning point. Above this group (i.e., in IC groups 2-4), opening is essentially based on passive procedures (such as tenodesis and arthrodesis). Starting at group 5, restoration of active digital extension is [table: see text] feasible, as well as active stabilization of the thumb ray in lower groups. In those lower groups, all efforts should aim at re-establishing an intrinsic balance, keeping in mind the difference between supple and rigid claw deformities, which require different corrective procedures (Table 1).

Fingers↗
PubMed1996

Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction.

This article presents the minimum 2-year results (range, 24 to 54 months) of 21 arthroscopically assisted posterior cruciate ligament/posterior lateral complex (PCL/PLC) reconstructions, evaluated preoperatively and postoperatively using the Tegner, Lysholm, and Hospital for Special Surgery knee ligament rating scales, and the KT 1000 knee ligament arthrometer (Medmetric Corp., San Diego, CA, U.S.A.). There were 15 male and 6 female patients; 6 right and 15 left; and 10 acute and 11 chronic knee injuries. All injuries were PCL/PLC knee ligament injuries. PCLs were reconstructed using allograft Achilles tendon, or autograft patellar tendon. Posterior lateral instability was successfully treated with long head of biceps femoris tendon tenodesis. Tegner, Lysholm, and Hospital for Special Surgery knee ligament rating scales significantly improved preoperatively to postoperatively (P = .0001). PCL screen and corrected posterior KT 1,000 measurements improved from preoperative to postoperative status (P = .0009, and P = .0096, respectively).

Arthroplasty↗
PubMed1996

Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction.

This article presents the minimum 2-year results (range, 24 to 48 months) of 20 arthroscopically assisted combined anterior cruciate ligament/posterior cruciate ligament (ACL/PCL) reconstructions, evaluated preoperatively and postoperatively using the Tegner, Lysholm, and Hospital for Special Surgery knee ligament rating scales, and the KT 1000 knee ligament arthrometer (Medmetric Corp, San Diego, CA). There were 16 men or boys, 4 women or girls; 9 right, 11 left; 10 acute, and 10 chronic knee injuries. Ligament injuries included 1 ACL/PCL tear, 2 ACL/PCL/medial collateral ligament (MCL)/posterior lateral corner tears. 7 ACL/PCL/MCL tears, and 10 ACL/PCL/posterior lateral corner tears. ACLs were reconstructed using autograft or allograft patellar tendons. PCLs were reconstructed using allograft Achilles tendon, or autograft patellar tendon. MCL tears were successfully treated with bracing. Posterior lateral instability was successfully treated with long head of the biceps femoris tendon tenodesis. Tegner, Lysholm, and Hospital for Special Surgery knee ligament rating scales significantly improved preoperatively to postoperatively (P = .0001). Corrected anterior KT 1000 measurements improved from preoperative to postoperative status (P = .0078).

Adolescent↗