Background: Extensor pollicis longus EPL tendon ruptures have been treated succesfully with the transfer of the extensor indicis proprius EIP tendon. Situations exist in which, due to intraoperative observations, another tendon transfer may be considered preferable to the standard EIP transfer method.
Objectives: To determine whether transfer of the extensor digitorum communis II EDC II tendon from the index finger to the EPL tendon, leaving the EIP tendon to the index finger intact, would serve as an equally efficient transfer and not adversely affect the function of the hand.
In each transfer type, one patient had suffered an EPL tendon rupture after a Colles' fracture, and the other had rheumatoid arthritis. The rupture occurred on the non-dominant side in one patient in each transfer type. Each patient was examined and subjected to range of motion and power testing at least one year following surgery. Results: All four patients showed a minimal extension lag with the lift off test, but there was no noticeable difference in range of motion, pinch grip and hand grip strength between the transfer types.
Three patients demonstrated a minor extension lag in the index finger and middle finger. Conclusions: These case reports suggest that either index finger tendon may be successfully transferred in EPL tendon ruptures.
Abstract in English, French.Average 3.
Tendon Transfer Principles
The clinical appearance of his hand, and radiographs are shown in Figures A through C. Surgical exploration and decompression is performed. Besides addressing thumb interphalangeal and index distal interphalangeal joint flexion, which is the most appropriate treatment to restore thumb opposition? Tested Concept. During surgery the posterior interosseous nerve was transected and primary repair was attempted.
One year following surgery the patient continues to have no posterior interosseous nerve function. Which of the following treatments will best restore function? Wrist fusion with transfer of the flexor carpi ulnaris to the finger extensors. Transfer of the flexor carpi radialis to extensor digitorum and the palmaris longus to the extensor pollicis longus. Transfer of the pronator teres to the wrist extensors and the palmaris longus to the finger extensors.
Transfer of the flexor carpi ulnaris to the wrist extensors and the palmaris longus to the extensor pollicis longus.Best anti spyware for iphone x
Tendon Transfer Principles. Deborah Allen. Key Images. Goal to regain. FROM: Donor tendon working. TO: Recipient Tendon deficient. Axillary nerve palsy. Musculocutaneous nerve palsy. Low median nerve palsy.
High median nerve palsy. Ulnar nerve palsy. Topic Rating. Please rate topic. Upgrade to PEAK.Functional deficits in the hand arise most commonly as sequelae of radial, median, or ulnar nerve injury, but can also be secondary to brachial plexus injury, spinal cord injury, specific muscle or tendon injury, or as a result of polio.
Additionally, non-displaced distal radius fractures treated non-operatively can lead to attritional rupture of the extensor pollicis longus.
Tendon transfers are used to address functional deficits created by these conditions. Much of what we know today about tendon transfers was learned in treating paralyzed limbs associated with polio and injured soldiers during World Wars I and II.
Low radial nerve injuries occur distal to the elbow and affect muscles innervated by the posterior interosseous nerve PIN. These injuries typically have no sensory deficits because they occur distal to where the superficial radial nerve branches off the radial nerve, but result in the following motor deficits:.
Low median nerve injuries occur distal to the elbow resulting in the following motor and sensory deficits:. Motor strength and sensory testing will distinguish lesions and appropriate indications for correction according to above categories. Wrist passive tenodesis test should be performed by taking the wrist passively from flexion to extension.
With a normal test, the digits transition from an extended posture in wrist flexion to a flexed posture in wrist extension with fingers maintaining symmetrical cascade.EIP to EPL Transfer for Ruptured EPL
An abnormal exam can indicate isolated tendon injuries. Wrist, hand, and finger range of motion testing is important since the full passive range of motion should be achieved before tendon transfers. Ulnar claw hand occurs because of unopposed extension forces by the EDC and EDM on the small and ring finger MP joints with no counter flexion force by the interossei and ulnar two lumbricals innervated by the ulnar nerve.
Also, the normal extensor force to the PIP and DIP joints through the extensor hood of the ring and small fingers is deficient secondary to weakness of the interossei and ulnar two lumbricals.
A low ulnar nerve palsy results in a more severe claw hand because the FDP to the ring and small fingers are intact, worsening the imbalance of flexion forces across the PIP and DIP joints. In ulnar nerve palsy, when the patient attempts to pinch an object, the thumb MP hyperextended the, and the IP flexes in an attempt by the EPL and FPL respectively to compensate for the deficiency of the adductor pollicis, 1st dorsal interosseus, and deep head of the flexor pollicis brevis FPB.
This is called Froment sign. In the setting a non-displaced distal radius fracture, integrity of the EPL can be tested by having the patient place their hand flat on a table, inability to lift their thumb off of the table is consistent with an EPL rupture. An EMG can help determine nerve injury severity and likelihood of recovery.
Unlike procedures to reinnervate muscles, tendon transfers do not depend on the viability of the motor endplate of the dysfunctional muscle and so can be performed at any time. Principles of Tendon Transfer to Avoid Complications   . The procedure is typically performed in the operating room under general anesthesia. A tourniquet is placed high in the axilla, and the arm rests on a hand table. The operative equipment required includes a tendon passer and basic hand tray.
Donor tendons are attached to recipient tendons most commonly using the Pulvertaft weave. A minimum of three passes should be used for appropriate strength. Complications are related mainly to an improper initial graft tensioning and repair site rupture or loosening as a result of slit propagation or knot failure. Alternative repair techniques spiral linking and loop-tendon suture can be used based on surgeon preference to help improve the biomechanical strength of the repair site with the tradeoff of increased bulk of the repair.Published in Hand clinics Skip to search form Skip to main content You are currently offline.
Some features of the site may not work correctly. DOI: Wolf Published Medicine Hand clinics. Long-standing rheumatoid arthritis can result in spontaneous tendon rupture caused by attrition of the tendons.
Ruptures of the ulnar-sided extensor tendons, flexor pollicis longus, and the flexor digitorum profundus can be seen. Primary repair of these tendon ruptures is frequently not possible because of delayed presentation and tendon damage by the disease process. Tendon transfers are the preferred method of treatment in patients with rheumatoid arthritis.
View on PubMed. Save to Library. Create Alert. Launch Research Feed. Share This Paper. Figures, Tables, and Topics from this paper. Figures and Tables. Citation Type. Has PDF. Publication Type. More Filters. Reconstruction and repair of atraumatic extensor tendon ruptures in rheumatoid wrists: less extension lag after direct repair than interposition tendon grafting. Research Feed. Extensor tendon ruptures in rheumatoid wrists.Merkez turkey postal code
View 1 excerpt, cites background. Tendon ruptures in the rheumatoid hand: analysis of treatment and functional results in 60 patients. View 2 excerpts, references background and methods.
Tendon reconstruction for the rheumatoid hand. Highly Influential. View 10 excerpts, references background. View 3 excerpts, references background.
Tendon transfer or tendon graft for ruptured finger extensor tendons in rheumatoid hands. View 4 excerpts, references background and results. The treatment of ruptures of multiple extensor tendons at wrist level by a free tendon graft in the rheumatoid patient. View 1 excerpt, references results.
Attrition ruptures of flexor tendons in rheumatoid arthritis caused by bony spurs in the carpal tunnel. A clinical and radiological study. View 1 excerpt, references background. The intercalated tendon graft for treatment of extensor pollicis longus tendon rupture.Metz Jr. Rey N. Ramirez John D.
When tendon rupture occurs on the dorsum of the hand or wrist, patients cannot extend their fingers and have difficulty grasping objects. The most common tendon ruptures on the dorsum of the hand begin on the ulnar side and usually are a result of subluxation of the distal radioulnar joint DRUJthe so-called Vaughan-Jackson or caput ulnae syndrome.Repicking the 2014 nba draft
This is referred to as Mannerfelt syndrome. The retinaculum is divided into six separate compartments lined by tenosynovium, which can become involved in the pathology of rheumatoid arthritis. The first compartment contains the tendons of the abductor pollicis longus and the extensor pollicis brevis.
The former tendon often contains multiple slips, which can contribute to limited space in its respective compartment and secondary de Quervain tenosynovitis. The second compartment consists of the extensor carpi radialis longus ECRL and extensor carpi radialis brevis ECRBthe former tendon inserting at the base of the index metacarpal and the latter at the base of the long finger.
The third compartment contains only the tendon of the extensor pollicis longus EPLwhich passes around the tubercle of Lister at a fairly sharp angle. Although frequently involved in tendon ruptures in rheumatoid arthritis, the EPL may also present as an isolated tendon rupture after nondisplaced fractures of the distal radius. The fourth compartment contains the extensor indicis proprius EIP and the extensor digitorum communis EDCsending tendons from the common extensor muscle in the forearm to each of the fingers.
The EIP is a separate muscle tendon unit located within the fourth compartment. It can be differentiated by its distal muscle belly. The fifth extensor compartment contains the extensor digiti quinti EDQoften consisting of two slips and passing almost directly over the DRUJ. The sixth compartment contains only the extensor carpi ulnaris ECU. On the palmar side of the wrist, the flexor pollicis longus is located most radially and passes over the radiocarpal joint adjacent to the trapeziometacarpal joint of the thumb.
The flexor pollicis, along with the median nerve and the profundus and sublimis tendons to each digit, passes beneath the deep transverse carpal ligament and represents the contents of the carpal canal.
Tenosynovial proliferation can exist within the carpal tunnel, arising from the undersurface of the ligament but more commonly proliferating along the tendons themselves. The tendon initially affected is the EDQ. As the carpus supinates and subluxates volarly, causing the distal ulna to be more dorsal, tendons typically rupture sequentially in an ulnar to radial direction.
Pre and post operative management in tendon transfer. Upcoming SlideShare. Like this presentation? Why not share! Embed Size px. Start on. Show related SlideShares at end. WordPress Shortcode. Rajal Sukhiyaji Follow.Rete quattro programmi domani
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Are you sure you want to Yes No. Nancy Patel. Nadirah Muneer. Suma Tomsy. Show More. No Downloads. Views Total views. Actions Shares. No notes for slide. Pre and post operative management in tendon transfer 1. Rajal Sukhiyaji M.Key Words tendon transfers, median nerve palsy, radial nerve palsy, ulnar nerve palsy, claw hand. Tendon transfers can be used to restore hand and wrist function after a nerve injury, both in the acute setting and in delayed presentations. Injuries of the brachial plexus and peripheral motor nerves are common indications for tendon transfers.
Alternatively, patients may have loss of a muscle-tendon unit MTU from trauma or after an oncologic resection; reconstruction with a tendon transfer can replace the function of the lost MTU. Tendon transfers can also restore function after attritional tendon ruptures, which are most commonly seen in rheumatoid arthritis.
They can be used in the upper and lower extremity. In the upper extremity, they are most commonly used to restore flexion and extension of the wrist and fingers and less frequently used for the shoulder and elbow. Tendon transfers in the upper extremity can restore function after the loss of an MTU function caused by injury of the central or peripheral nervous system, closed rupture or open injury to the MTU, and various diseases.
Infectious diseases, such as poliomyelitis, can cause damage to motor neuron ganglia and subsequent muscle paralysis. Inflammatory arthropathies, most commonly rheumatoid arthritis, can be complicated by attritional tendon ruptures. Some patients with hand spasticity, for example due to cerebral palsy, can benefit from carefully selected tendon transfers.
Patient presentation varies based on the etiology of the MTU loss. Mixed peripheral nerve injuries present with sensory and motor losses in the affected nerve distribution. Lacerations or fractures can result in discontinuity of an MTU. Primary MTU repair is preferred; however, if not possible or if unsuccessful, tendon transfers can be used for reconstruction. Nerve lacerations can be repaired acutely or can be reconstructed with nerve transfers up to approximately 12 months after injury; better outcomes are seen with earlier nerve surgery.
In the case of a delayed nerve injury presentation or failed nerve repair, tendon transfers are options to restore function.
In rheumatoid arthritis, the ulnar dorsal tendons extensor digiti minimum [EDM], extensor digitorum communis [EDC] are most commonly ruptured, due to attrition over a dorsally prominent ulnar head. The flexor pollicis longus FPL can rupture due to chronic attrition over a volar osteophyte on the scaphoid known as a Mannerfelt lesion.
Transfer of either index finger extensor tendon to the extensor pollicis longus tendon
Rheumatoid arthritis patients typically have systemic disease symptoms, and multiple joints are involved. Traumatic nerve and MTU injuries affect the balance between the flexor and extensor muscle groups of the upper extremity.
This can lead to asynchronous and weak function. Tendon grafts, tendon transfers, nerve transfers, and free muscle transfers can be used for upper-extremity reconstruction.
The risks and benefits of each technique must be considered and each patient treated with an individualized plan.
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