extensor tendons
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PURPOSE OF THE STUDY Two tendons, i.e., the extensor indicis proprius (EIP) and the extensor carpi radialis longus (ECRL), are commonly used to reconstruct the function of a ruptured extensor pollicis longus (EPL) tendon. We reviewed a group of patients with EPL ruptures treated by ECRL tendon transfer to the EPL tendon, which was the method of choice. The aim was to evaluate the results and to assess the effect of ECRL detachment on hand function. MATERIAL AND METHODS Twenty patients were treated surgically for a subcutaneous rupture of the EPL tendon between 2003 and 2007. Each patient was examined at 2 years after surgery. The range of motion (ROM) of both the injured and the contralateral hand was recorded and evaluated with a modified Geldmacher scoring system; a response to the DASH questionnaire was obtained. The mean follow-up was 24 months (19-31 months). RESULTS For the ROM of the operated hand, the mean Total Active Motion (TAM) of 98.75 degrees (60-140, SD 22.74) was calculated. The mean extension lag at the interphalangeal (IP) joint was 5.42 degrees (0-25, SD 8.77) and the mean IP flexion was 65.8 degrees (40-80, SD 13.2). In order to evaluate body side differences, the ROM of the contralateral thumb was recorded. The values were as follows: mean TAM, 141.3 degrees (115-190, SD 20.43); mean IP extension lag, 0 degrees (0-0, SD 0); mean IP flexion, 68.8 degrees (50-80, SD 9.6). DISCUSSION The extension lag at the IP joint was detected in both the operated and the contralateral hands. The patients examined at a longer interval after surgery showed an increase in extension lag. This may have been caused by undesired adaptation of the donor muscle, the presence of adhesions or suture loosening. CONCLUSIONS The results showed increased adaptation of thumb motion to the extension lag at the IP joint, which had a mild effect on the patient's hand function. The difference in wrist extension between the operated and the contralateral hand corresponded to the pre-operative condition.
- MeSH
- dospělí MeSH
- hodnocení výsledků zdravotní péče statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- obnova funkce MeSH
- ortopedické výkony využití MeSH
- palec ruky fyziologie chirurgie zranění MeSH
- poranění šlachy chirurgie MeSH
- přenos šlachy metody statistika a číselné údaje využití MeSH
- průzkumy a dotazníky MeSH
- rozsah kloubních pohybů MeSH
- senioři MeSH
- spontánní ruptura chirurgie MeSH
- svalová síla MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie metody využití MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
Innumerable descriptions about variations in the pattern of extensor tendons are recorded in the literature. The dorsum of the hand in an adult male cadaver revealed an unusual pattern of extensor arrangement during a gross anatomical practical session. The extensor digitorum, extensor indicis and extensor digiti minimi tendons displayed a variant pattern. Extensor digitorum contributed tendons only to the middle and ring fingers, with junctura tendinum present between the extensor digitorum for the ring finger and extensor digiti minimi. Interestingly, an accessory muscle was observed arising from the common extensor origin passing to the index finger, in addition to the usual extensor indicis. The origin and insertion of extensor digiti minimi was as usual with an accessory slip contributed from the extensor carpi ulnaris to the proximal phalanx of the fifth finger. The plethora of variations in this region is of paramount importance for the reconstructive surgeon, who may utilize the accessory tendons to restore functional capacity of the fingers.
- MeSH
- lidé MeSH
- ruka anatomie a histologie MeSH
- šlachy abnormality anatomie a histologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
Úvod: Ruptura šlachy dlouhého natahovače palce je relativně častá komplikace po zlomeninách distálního radia. Materiál a metoda: V našem souboru pacientů v rozmezí let 2001–2009 jsme tuto lézi diagnostikovali u 21 pacientů. V 5 případech se jednalo o stav po nedislokované fraktuře, v 7 případech se jednalo o pacienty ošetřené repozicí a následnou sádrovou fixací a v 9 případech se jednalo o pacienty, kteří podstoupili operační léčbu zlomeniny distálního radia. Pacienti byli ošetřeni transferem šlachy m. extensor carpi radialis longus s následným dynamickým dlahováním. Výsledky: Pozorovali jsme 1 rerupturu. Zbylých 20 pacientů se zahojilo. I přes mírné omezení rozsahu hybnosti pacienti nepociťovali žádné subjektivní potíže a ani funkční omezení ruky. Diskuze: V diskuzi jsou rozebrány etiologické faktory, diagnostika a jiné možnosti léčby a prevence této léze. Závěr: Transpozice šlachy m. extensor pollicis longus představuje nenáročnou, ale účinnou vyhovující metodu léčby této léze.
Introduction: The rupture of the pollicis longus extensor tendon is a relatively frequent complication following distal radius fractures. Material and method: In the authors' group of patients monitored from 2001-2009, this kind of lesion was diagnosed in 21 cases. In 5 cases the lesion was related to a non-dislocated distal radius fracture, in 7 cases the patients were treated with a subsequent reduction and a plaster fixation, in 9 cases patients underwent a surgical treatment of the distal radius fracture. The patients were treated by the transfer of the m. extenzor carpi radialis longus tendon with subsequent dynamic splinting. Results: One recurring rupture was detected. The remaining 20 patients healed. Despite the mild range of motor limitations, patients did not exhibit any subjective discomfort and functional limitations of the hand. Discussion: The etiological factors, diagnostics, other therapeutic options and prevention of this injury are analysed in the discussion. Conclusion: The transposition of the m. extensor pollicis longus tendon is not a demanding, but an effective and a satisfactory method of treatment of this lesion.
- Klíčová slova
- extensor pollicis longus, transpozice, extensor carpi radialis brevis, zlomenina distálního radia,
- MeSH
- fraktury vřetenní kosti komplikace MeSH
- lidé MeSH
- obnova funkce MeSH
- ortopedické výkony metody MeSH
- palec ruky fyziologie chirurgie patofyziologie MeSH
- poranění šlachy etiologie chirurgie rehabilitace MeSH
- přenos šlachy metody MeSH
- rozsah kloubních pohybů MeSH
- ruptura komplikace MeSH
- Check Tag
- lidé MeSH
The hand is a unique structure in human body performing complex activities of daily life making it prone to injuries. While operating on zone VI extensor tendon injury, a surprising entity was observed. The extensor digitorum to the right index finger was absent. This is an extremely rare entity in the literature. Also, all previous studies on the extensor digitorum are cadaveric. Our findings are first of its kind intraoperative, incidental, and confirmed on MRI. Thus, it becomes a case report of special worth mentioning in literature.
- Klíčová slova
- extensor digitorum communis,
- MeSH
- anatomická variace MeSH
- dospělí MeSH
- lidé MeSH
- poranění prstů ruky * chirurgie diagnóza MeSH
- poranění šlachy chirurgie diagnóza MeSH
- prsty ruky abnormality chirurgie diagnostické zobrazování MeSH
- šlachy * abnormality chirurgie diagnostické zobrazování MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: There is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet. Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score. METHODS: RA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. dorsal regions (chi-square test). The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. Analyses were also performed separately for early and established RA. RESULTS: A total of 435 patients (N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). The dorsal vs. palmar side of the wrist by GS/PD (p < 0.001) and the palmar side of the finger joints by PD (p < 0.001) were more frequently pathologic. The reduced US7 score (GS/PD: palmar MCP2, dorsal wrist, EDC and ECU, only PD: dorsal MCP2) showed therapy response (SRM 0.433) after 6 months and retained 76% of the full US7 score's information. No major differences between the groups of early and established RA could be detected. CONCLUSIONS: The wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level.
- MeSH
- lidé MeSH
- mladiství MeSH
- revmatoidní artritida * diagnostické zobrazování farmakoterapie patologie MeSH
- šlachy diagnostické zobrazování MeSH
- stupeň závažnosti nemoci MeSH
- synovitida * patologie MeSH
- ultrasonografie MeSH
- zápěstí MeSH
- zápěstní kloub diagnostické zobrazování patologie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
PURPOSE OF THE STUDY: The aim of this study to evaluate the subjective and objective results of Extensor indicis proprius (EIP) to extensor pollicis longus (EPL) transfer with an emphasis on donor site morbidity. MATERIAL AND METHODS: 17 patients (59% men, 41% women) who underwent EIP-EPL transfer were retrospectively analyzed. The mean age was 43 (9-64) years, and the mean follow-up was 72 (19-124) months. The extensor strengths were measured according to the Medical Research Council (MRC) scoring system. Nail tip-table surface distance (NTD) was measured to evaluate extension loss, and pulp-palm distance (PPD) to evaluate thumb flexion-adduction limitation. Grip and key pinch strengths were measured and corrected regarding the dominance and compared with those of the non-operated side. Quick Disability of Arm, Shoulder, and Hand (QDASH) and satisfaction scores of the patients were evaluated. RESULTS: Donor site morbidity was detected in 6 patients (35%). The extension strength of the index finger was found to be significantly lower than the non-operative side (p<0.05). Thumb mean NTD and PPD values were 6.8 (0-50) and 2.9 (0-20) mm, respectively. The index finger mean NTD was 0.6 (0-10) mm. The grip strength was 86% (43%-100%) and the pinch strength was 82% (31-100%) of the expected strengths. Compared to the preoperative period, there was a significant decrease in the QDASH score (p <0.05). Postoperative QDASH scores of patients with donor site morbidity were significantly higher than those without (p <0.05). CONCLUSIONS: Although patients are generally satisfied with the EIP-EPL transfer results, the permanent morbidity rate in the index finger is high. Therefore, alternatives other than EIP should be considered for transfer to EPL in individuals whose occupation requires complete and strong index finger extension. KEY WORDS: extensor pollicis longus, neglected tendon laceration, extensor indicis proprius, tendon transfer, donor site morbidity.
- MeSH
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- palec ruky chirurgie fyziologie MeSH
- přenos šlachy * metody MeSH
- retrospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- síla ruky fyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
