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At least 343 records · Page 19Linked to original sources
PubMed2005

[Therapy for static scapholunate instability -- reconstruction of the dorsal part of the scapholunate ligament with a periosteal flap of the iliac crest].

Recurrent instability is frequent following capsulodesis, tenodesis, or ligament reconstruction in static scapholunate instability. Therefore a periosteal flap of the iliac crest was designed to reconstruct the dorsal part of the SL ligament, which is known to be the biomechanically strongest portion and also the axis of rotation between the scaphoid and lunate. Biomechanical testing of ten fresh frozen dorsal SL ligaments and ten periosteal flaps of the iliac crest showed similar properties concerning failure force, failure displacement, failure stress, energy to failure and stiffness. Results of eight specimens in each group were available following successful testing. Failure force of the dorsal SL ligament was 171.8 N (SD 44.2), energy to failure amounted 269.1 N-mm (SD 98.9), failure stress was 10.3 N/mm (2) (SD 1.3), failure displacement 2.9 mm (SD 0.4), and stiffness 77.2 N/mm (SD 21.4). Testing of the periosteal flap gave the following values: failure force 144.3 N (SD 38.7), energy to failure 217.9 N-mm (SD 85.0), failure stress 9.9 N/mm (2) (SD 1.7), failure displacement 3.0 mm (SD 0.4) and stiffness 60.5 N/mm (SD 14.7). In addition to these test values, clinical and radiological data of eleven patients were available following reconstruction of the dorsal SL ligament with a periosteal flap of the iliac crest. The interval between trauma and surgery was 15 months, mean follow-up was 29 months. One patient was free of pain, whereas ten mentioned pain during or following strenuous work. Two patients were completely satisfied, nine complained about some restriction during special activities. Active range of motion amounted to 56 degrees extension, 46 degrees flexion, 17 degrees radial abduction, 30 degrees ulnar abduction. Grip strength was 38.5 kg, which was 79 % of the contralateral side. Radiological evaluation demonstrated a correction of the static instability in nine cases. In two patients recurrence of static instability was obvious. The prerequisite for success of the procedure is the easy reduction of the carpals. In cases of a fixed rotatory subluxation of the scaphoid, the technique cannot maintain the reduction.

Adult↗
PubMed1996

Application of a suture anchor technique for flap fixation to bone.

The authors have developed a technique for fixation of a flap to underlying bone. Their technique involves an anchor system which has been used for tenodesis and ligament repair in orthopedic bone and joint surgery. The anchor technique provides reliable fixation with simplicity of application. A wider use of this technique in reconstructive flap surgery is expected.

Bone and Bones↗
PubMed1996

[Biomechanics of the ligaments of the unstable ankle joint].

Ligament rupture occurs at the maximum breaking load. During ligament healing, contraction and remodeling of the scar is sufficiently advanced at 6 weeks to reach 60 to 70% of the initial strength. There is evidence of an early improvement in biomechanical properties of repaired ligaments. This advantage, however, may not be sustained as, after one year, sutured and unsutured ligaments have nearly equal length when measured at rest and comparable failure strength when subjected to exercise. Each of the ankle ligaments has a role in stabilizing the ankle and/or subtalar joint. Beside of maintaining lateral ankle stability, the lateral ankle ligaments have been shown to play a significant role in providing rotational ankle stability. This is especially true for the anterior talofibular ligament. A loss of this ligament does allow for an increase in foot inversion and external rotation of the leg to occur, without any tilting of the talus or subtalar gapping. It is this increase in foot inversion which may lead to a symptomatic instability. When treating ankle instability, it is therefore important for the clinician to take the alteration of hindfoot biomechanics into consideration. This is especially the case for any surgical repair of injured ankle ligaments. Unphysiological tenodesis procedures should be avoided.

Ankle Injuries↗
PubMed1989

[Surgical treatment of chronic upper ankle joint instability in childhood].

The Department of Traumatology of the Hanover Medical School treated 347 patients having chronic instability or second stage rupture of the fibular ligament system, by surgery, during 1971 through 1986. Children were represented by one-seventh of the total number of patients only (13%; n = 44); however, in children the preoperative and intraoperative findings are different from normal findings and must be treated surgically in a special way. Whereas in adults old osseous/osteochondral ligament tears are apt to be rare (16% of the cases), they can be seen in children in almost every second case (18 of 44). Surgical approach requires a step-by-step procedure to achieve maximum stability and minimum functional loss. First Choice: Direct reconstruction of the ligament in case of ligaments which are present but have not healed correctly from a biomechanical point of view (e.g. pseudoarthroticosseous ligament tear) or in case of second-stage rupture (n = 20). Second Choice: Double periosteal flap plasty in case of necessary replacement of only one ligament (n = 13). Third Choice: Tenodesis of m. peroneus brevis using only half of the tendon chip while sparing the epiphysis if the condition persists for many years, or if ligaments cannot be reconstructed or replaced intraoperatively or if there is a combined instability of the ankle joint and the talo-calcaneonavicular joint (n = 11). In almost 90% of the cases very good to good results were obtained after five years, assessed according to a 100-point schema.

Adolescent↗
PubMed1985

The long-term results of the surgical management of paralytic pes cavus by soft tissue release and tendon transfer.

Twenty-six patients with paralytic pes cavus were managed by early soft tissue correction and tendon transfer. Eighteen had spina bifida, 6 had peroneal muscular atrophy and two had cerebral palsy. The most frequent operations were flexor hallucis longus tenodesis, Girdlestone's flexor to extensor tendon transfer and plantar release. The indications for these procedures are discussed and the results presented, with particular reference to static and dynamic foot pressure studies performed at review. Follow-up averaged 5.2 years. Toe correction was found to be successful in most cases but plantar release failed in 55% of feet, with many progressing to fusion. Many failed feet had presented at an earlier age and it was felt that the initial procedures had delayed the need for bony correction thus minimising growth disturbance.

Adolescent↗
PubMedDate not supplied

The incidence of pathologic changes of the long head of the biceps tendon.

The incidence of primary and secondary bicipital tendinitis remains unknown. In our prospective study, 200 consecutive shoulders underwent arthroscopic subacromial decompression for impingement syndrome. A biceps tenodesis was performed in 80 shoulders (40%) featuring macroscopic degeneration of the long head of the biceps; rotator cuff tears were apparent in 91% of these shoulders, the mean patient age being 55 years. In each of 120 shoulders (60%), an extraarticular tenosynovectomy was performed, and histopathologic studies revealed chronic inflammation in 63% and fibrotic degeneration in 13% of the specimens; rotator cuff tears were evident in 70% (23% full thickness) of these cases, the mean patient age being 47 years. In addition, when glenohumeral arthritis was present, it was uniformly associated with pathologic biceps tenosynovium. In summary, the high incidence of chronic inflammation of the long head of the biceps in shoulders with benign-appearing intraarticular portions viewed arthroscopically is significant, and long head of the biceps disease should also be considered in patients with painful rotator cuff disease and arthritic shoulder conditions.

Adult↗
PubMedDate not supplied

Diagnosis and treatment of anterosuperior rotator cuff tears.

Nineteen of 407 patients who underwent rotator cuff repair surgery over a 6-year period were found to have a tear of the subscapularis in combination with the supraspinatus and infraspinatus tendons. Nine of these patients had an unsuccessful prior surgery, which failed to recognize the extent of the subscapularis component. Surgical repair of the subscapularis tendon required a deltopectoral approach, and repair of the supraspinatus and infraspinatus components of the tear could only be accomplished through this approach in 4 patients. In the remaining 15, an extended superior approach was required to mobilize and repair the supraspinatus and infraspinatus tendons. In all cases, the biceps tendon was either torn or severely degenerated, requiring tenodesis. At a mean follow-up of 40 months (range 24 to 75 months), subjective results were excellent in 5 patients, good in 3, fair in 4, and poor in 7. The modified Constant score improved to a mean of 69% (range 23% to 130%), compared with a preoperative mean of 38% (range 23% to 100%). Physical findings positive for subscapularis insufficiency persisted in 14 of 19 patients. A significant correlation (P <.05) was found between a lower Constant score and duration of symptoms longer than 6 months as well as an appearance of severe fatty degeneration and atrophy of the subscapularis muscle on magnetic resonance imaging. We conclude that anterosuperior rotator cuff tears are an infrequent configuration that may require surgical repair through an extended approach combining deltopectoral mobilization of the subscapularis with transdeltoid mobilization of the supraspinatus and infraspinatus. Repair before 6 months of symptoms is associated with a better functional outcome and is the result of less involution of muscle and tendon tissue.

Adult↗
PubMedDate not supplied

Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii.

Historically, the surgical treatment of bicipital pathology has been a variety of tenodesis techniques. The purpose of this study is to report the results of simple biceps tenotomy for the treatment of bicipital pathology. Thirty shoulders in 30 consecutive patients who had a simple arthroscopic biceps tendon release were reviewed. Data was collected according to the method of the American Shoulder and Elbow Surgeons (ASES) shoulder evaluation form. Outcome was assessed with the rating system of the ASES. The mean ASES shoulder score was 81.8. There was a significant reduction in pain and improvement in function after the procedure. The complication rate was 13.3%. Bicipital pathology is a significant cause of morbidity around the shoulder. The results of this study demonstrate that functional outcome as measured by the ASES scoring system can be very good with an arthroscopic biceps tendon release for the treatment of biceps tendon pathology.

Adolescent↗
PubMedDate not supplied

Prosthetic replacement in the treatment of osteoarthritis of the shoulder: early results of 268 cases.

Two hundred sixty-eight anatomically designed shoulder arthroplasties for primary osteoarthritis were reviewed at a mean follow-up of 30 months. The Constant score adjusted for age and sex was 38% preoperatively and 97% at follow-up. Good or excellent results were observed in 77% of patients, and 94% were satisfied or very satisfied. Mean active forward elevation was 145 degree postoperatively, and all clinical parameters improved. Glenoid radiolucent lines were present in 58% of cases and were associated with a less satisfactory objective result. Postoperative active forward elevation, strength, and Constant score were inversely related to a tear of the supraspinatus or fatty degeneration of the infraspinatus. Patients who underwent biceps tenodesis had better pain relief. Complications occurred in 8.6% of cases, and 4.9% of shoulders required reoperation. Good early results can be obtained with nonconstrained shoulder arthroplasty in primary osteoarthritis.

Adult↗
PubMed1992

Heterotopic ossification of the extensor tendons in the hand associated with traumatic spinal cord injury.

Heterotopic ossification (HO) occurs in spinal cord injury (SCI), most frequently in the large joints such as hips, shoulders, knees, and elbows. It always occurs below the level of neurologic lesion. In the upper extremities, HO associated with SCI usually involves the flexor side of the involved joint. HO has only been reported once to involve the hands and rarely develops parallel to the long bones. We present a 44-year-old male with C5 traumatic SCI who developed HO involving the extensor tendons of one hand. The HO was discovered four months after the SCI and involved the extensor sheaths of the second, third, and fourth digits, from the metacarpal-phalangeal joint to the proximal inter-phalangeal joint. The patient had been improving neurologically with poor to fair extension of the right wrist allowing for tenodesis finger flexion, but with the onset of HO he lost some functional grasp. Diagnosis, possible etiology, and treatment (including options of radiation therapy and surgery) are discussed.

Adult↗
PubMed2003

Dorsal wrist joint pain in tetraplegic patients during and after rehabilitation.

In a study of 42 tetraplegic patients, physiological, neurological, electrophysiological and radiological examinations were made in 11 patients with complete tetraplegia who had wrist pain after rehabilitation. Pain relief produced by a selective, posterior interosseous nerve lidocaine block indicated distal posterior interosseous nerve syndrome. This syndrome can sometimes be treated conservatively, but surgical excision was required after nerve scarification. Repetitive dorsiflexion, as in wheelchair handling, transfer and tenodesis-like movement, compresses the distal posterior interosseous nerve in some tetraplegic patients. Moreover, weakness of the wrist joint stabilizing muscles is likely to contribute to an increased weight load on the wrist joints. The aetiology of wrist pain in tetraplegia should be considered when there is carpal tunnel syndrome, Wartenberg syndrome, Kienböck syndrome or distal posterior interosseous nerve syndrome. The causes need to be adequately treated to reduce the negative impact of the resultant pain on carrying out the activities of daily life.

Activities of Daily Living↗
PubMed1978

Combined motor and peripheral sensory insufficiency. III. Management of spinal cord injury.

For clarity in presenting the concepts of care, the patients have been divided into discrete neurological levels according to their dominant patterns of muscle strength. Individuals can vary considerably, however, and these differences must be accommodated by corresponding modification in the orthotic functional plan. The C6 level patient, with his effective wrist extensor as well as arm musculature, can recover a single mode of grasp and release through a wrist-driven, flexor-hinge-hand orthosis, or a natural tenodesis. Available arm function, despite the loss of all wrist and hand musculature, enables the C5 quadriplegic patient to regain prehension with a passive ratchet flexor-hinge or an electric flexor-hinge-hand orthosis. Both groups of patients also require various aids to accomplish wheelchair propulsion, ischial pressure relief, bed transfers, and, for the C6 level, driving.

Adult↗
PubMed2001

Optimum tensioning position for extensor indicis to extensor pollicis longus transfer.

This study evaluates various wrist and thumb positions for tensioning the extensor indicis proprius when transferred to the extensor pollicis longus tendon to determine which positions provide optimum passive range of flexion and extension of the thumb. In five adult cadaver upper limbs, transfer of the extensor indicis proprius to the extensor pollicis longus was simulated. The limbs were fixed with the elbow in 90 degrees flexion and the forearm and wrist in neutral. Surface bone markers were digitized to determine the thumb and wrist positions in three-dimensional space and their intersegmental joint angles. Twelve combinations of thumb (the interphalangeal and metacarpophalangeal joints) and wrist positions for tensioning were tested. A fixed tension of 80 N was applied to the tendon ends for each of the tensioning positions and during the transfer to ensure that the tendon remained taut. A wrist tenodesis effect was used subsequently to assess the passive range of thumb motion as an indicator of the outcome of the transfer. The results showed that the better tensioning position was with the thumb fully extended and the wrist in neutral. In six patients in whom an extensor indicis proprius to extensor pollicis longus transfer was done, the tendons were tensioned with the thumb in full extension and the wrist in neutral. A prospective review and functional assessment at an average of 18.6 months' followup was done. No significant differences between the surgically treated and normal thumbs were seen for the Jebsen Taylor, 9-peg, and grip and pinch strength tests. The study suggests that in an extensor indicis proprius to extensor pollicis longus transfer, tensioning of the tendons with the thumb in full extension and the wrist in neutral gives good thumb flexion and extension range.

Aged↗
PubMed2001

Complications of lateral ankle ligament reconstruction.

Complications after ankle ligament reconstruction are infrequent, but present significant challenges to the treating orthopaedist. Local wound problems and nerve injuries may cause difficulty in the early postoperative period. Recurrent instability may be attributable to failure of the operation, poor rehabilitation, reinjury, or unrecognized predisposing factors. Postoperative stiffness of the subtalar and ankle joints frequently is reported after anatomic and nonanatomic tenodesis procedures and may cause significant morbidity. The current author reviews reported complications and treatment options in failed lateral ankle ligament surgery.

Ankle Joint↗
PubMed2002

Ulnar-styloid nonunion and partial rupture of extensor carpi ulnaris tendon: two case reports and review of the literature.

Two unusual cases of symptomatic partial rupture of the extensor carpi ulnaris tendon associated with ulnar-styloid nonunion are described. Intraoperative findings suggested that the jagged surface of the distal ulna was the cause of flaying. In one case, debridement of the frayed extensor carpi ulnaris tendon and fixation of the ulnar styloid were effective for the relief of symptoms. But after the same procedure in another case, osteosynthesis of the ulnar-styloid could not be attained and tenodesis of the extensor carpi ulnaris tendon to the ulnar head was needed. Partial rupture of the ECU tendon should be taken into account in the differential diagnosis of a patient with ulnar wrist pain after ulnar-styloid fracture.

Adult↗
PubMed1997

Flexor tendon graft for late management of isolated rupture of the profundus tendon.

BACKGROUND: Late management options for the neglected flexor tendon injury include arthrodesis, tenodesis, tendon advancement, or tendon grafting. Although the clinical outcomes of single-stage and second-stage flexor tendon grafting are satisfactory, many controversies exist. The present study retrospectively reviewed the clinical outcomes of flexor tendon grafting for 15 patients with isolated profundus rupture. METHODS: Fifteen cases of isolated rupture of the flexor profundus tendon were treated by free tendon graft. The age of the patients ranged from 13 to 21 years (mean, 17.3 years). The time from injury to operation ranged from 4 to 14 weeks (mean, 8.3 weeks). All tendon grafts were passed through the intact superficialis tendon to repair the injured profundus tendon. These patient were followed up from 14 to 62 months after treatment mean, 31.3 months). RESULTS: All but one patient had less than 3.2 cm of flexion from fingertip to mid-palmar crease. Fourteen patients achieved active distal interphalangeal (DIP) joint flexion of more than 20 degrees. Four patients developed extension loss of the proximal interphalangeal (PIP) joint of more than 30 degrees after surgery. The mean active flexion after surgery was 33 degrees (range, 15-55 degrees) for DIP joints and 91.3 degrees (range, 80-100 degrees) for PIP joints. Three patients had combined extension loss of PIP and DIP joints of more than 40 degrees for the index and middle fingers. Twelve patients (80%) had satisfactory results, whereas treatment of the other 3 patients was considered unsuccessful. CONCLUSION: Flexor tendon graft can be used to reconstruct the isolated rupture of the profundus tendon and achieve satisfactory results for properly selected patients.

Adolescent↗
PubMed1988

Roping injuries in the hand: mechanism of injury and functional results.

Twenty-two patients with roping injuries to 38 digits, including 19 patients injured while team roping, are discussed. Ten digits in nine patients were successfully revascularized or replanted. Seven digits in three patients failed after initial success. One patient is included in both categories. The failure rate is 41 percent for all 17 digits. Average follow-up is 18 months. The dominant hand was injured in 83 percent of team roping injuries; the thumb is the most commonly injured digit. Average interphalangeal motion for thumb replants is zero; for revascularizations, it is 47 degrees. There was 43 percent return of pinch strength for thumb replants compared to 83 percent return for a single thumb revascularization. The most common mechanism of injury was catching the roping thumb in the "thumb up" position during dallying. There are good motion and pinch strength with thumb revascularizations provided tendons and the interphalangeal joint are intact. Reconstruction of the flexor pollicis longus in the replanted thumb gave poor results. Primary tenodesis or arthrodesis is recommended.

Adolescent↗
PubMed2006

Treatment of the supination deformity in the pediatric brachial plexus patient.

A supination deformity of the forearm can occur after brachial plexus palsy. The initial deformity is correctable; however, a fixed deformity often develops over time. Fixed supination creates difficulties with activities of daily living, impairs tenodesis grasp and gravity release, and limits the ability to perform bimanual activities. In the supple or passively correctable forearm, restoring active supination via tendon transfer frequently leads to better function. The fixed supination deformity, however, is not amenable to tendon transfer. An osteotomy of the radius and/or ulna is necessary to reposition the limb into pronation. A biceps transfer may be performed at the same time to further balance the forearm and prevent recurrence. This article describes our preferred surgical technique for both supple and fixed supination deformities of the forearm.

Adolescent↗