Functional Outcome of Surgical Management of Congenital Trigger Thumb – A Prospective Study

Introduction: Congenital trigger thumb is an uncommon anomaly of children. Its management is controversial, ranging fromobservation to extensive release.Aim: The aim of the study was to study the functional outcome of surgical management of the congenital trigger thumb in children.Materials and Methods: In this prospective study, 26 thumbs (21 pediatrics) underwent surgical release of the trigger thumb.Surgery was performed under general anesthesia with a tourniquet.Results: The prospective study demonstrated that pre-operative range of motion (ROM) averaged 36° loss of extension (range,0°–90°; standard deviation [SD], 22°); and post-operative ROM averaged 1° loss of extension (range, 0°–30°; SD, 7°) at 3 yearsfollow-up. There were no secondary surgeries. The children were being followed up for 3 years. All of them are found to havea good functional outcome and free of any complications until follow-up for 3 years.Conclusion: Congenital trigger thumb is a rare anomaly which is noticed by the parents around the age of 1½ years. Asconservative treatment invariably failed to give good results, all children are managed surgically with better cosmetic andfunctional results.

Morphometric study of pulleys of the thumb / 대한해부학회지

Pulleys are thickened regions in flexor tendons sheaths of the digits. They are essential and act as fulcrum for the flexion and extension of the digits. The arrangement and number of pulley system differs greatly between the thumb and other digits. There is paucity of literature regarding the pulley system of thumb. We aimed to study the morphometry of the pulley system of the thumb in Indian cadavers. Dissection was carried out in 55 adult human cadaveric thumbs. The most common morphologic pattern of pulley observed in the thumb is type III (30 thumbs). The least observed is type I (4 thumbs). The mean width and standard deviation of A1, Av, oblique, and A2 pulleys are 5.06±0.87, 5.38±1.22, 4.68±1.13, and 6.04±1.41 mm, respectively. The gap distances between the pulleys were also measured. The results obtained from the present study may be helpful in surgical treatment of trigger thumb with less complication and also in reconstruction of the closed rupture of the pulley of the thumb.

Double Gantzer's Muscles by Four Muscle Bellies and Its Clinical Significance: A Case Report / 체질인류학회지

The Gantzer's muscle (GM) is an additional muscle in the forearm as the accessory head of the flexor pollicis longus (FPL) and accessory head of the flexor digitorum profundus (FDP). We reported a rare case of double GM formed by four muscle bellies. From the dorsal part of flexor digitorum superficialis, small four bellies formed two muscles merging to FDP and FPL, as GMs. These accessory heads of FDP and FPL crossed the ulnar artery and the median nerve, respectively. These additional muscles in the forearm flexor compartment are rare and its clinical and embryological significances should be considered.

Flexor Pollicis Longus Reconstruction in Patient with the Linburg-Comstock Syndrome

Linburg-Comstock phenomenon is defined simultaneous flexion of thumb and other fingers. The coupling of the flexor pollicis longus and flexor digitorum profundus tendons is the main pathognomonic feature of this lesion. Typically, pain is noted at the distal level of the forearm at the site of the abnormal connection. We describe a case of flexor pollicis longus tendon rupture who undergoes a carpal tunnel release, and report the Linburg-Comstock syndrome after the flexor tendon reconstruction.

Estudio anatómico del fascículo accesorio del músculo flexor largo del pulgar y su relación con el nervio interóseo anterior en individuos brasileños / Anatomical study of the accessory head of the flexor pollicis longus muscle and its relationship to the anterior interosseous nerve in Brazilian individuals

Entre los síndromes de compresión nerviosa en el antebrazo, debido a la presencia de arcos tendinosos de músculos relacionados al trayecto de los nervios que transcurren entre sus capas musculares, se encuentra el del nervio interóseo anterior (NIA). La presencia de variaciones musculares puede generar arcos que ocasionan compresión nerviosa. El objetivo fue establecer la incidencia y morfología del músculo accesorio del flexor largo del pulgar (AFLP) y la relación de éste con el NIA o sus ramos motores. Se utilizaron 30 antebrazos, de cadáveres formolizados de individuos adultos brasileños. El punto de referencia seleccionado para las mediciones fue el epicóndilo medial del humero (EMH). Se observó que tres miembros superiores presentaron el AFLP (10%), en todos ellos se originó en el EMH para terminar insertándose en el tendón del músculo flexor largo del pulgar (FLP). El vientre muscular presentó aspecto fusiforme, el cual tenía un tendón que formó un arco con el FLP. En uno de los casos, este arco se relacionó con el paso del NIA; en los otros dos, lo hizo con los ramos motores que se originan del NIA. Al diagnosticar los síndromes generados por compresión nerviosa se debe considerar la presencia del AFLP, el cual, potencialmente se puede relacionar con el trayecto del NIA o de sus ramos.

Between the syndromes of nerve compression in the forearm, due to the presence of the tendinous arches related to the nerves that pass between its muscle layers, is the anterior interosseous nerve (AIN). The presence of muscular variations can generate arches that cause nerve compression. The aim of our study was to establish the incidence and morphology of the accessory head of flexor pollicis longus muscle (AFPLm) and its relationship with AIN or its branches. Thirty forearms of formalized corpses of adult Brazilians were used. The selected landmark for measurements was the medial epicondyle of the humerus (MEH). It was noted that three upper limbs presented the AFPLm (10%), originated from the MEH to end inserted into the tendon of the flexor pollicis longus muscle. The AFPLm showed fusiform appearance, which had a tendon that formed an arch with the flexor pollicis longus muscle. In one case, this arch was associated with the passage of AIN. In the other two, this arch was related to motor branches originating from the AIN. The diagnosis of nerve compression syndromes should consider the presence of AFLPm, which potentially can be related to the course of the AIN or its branches.

Flexor Pollicis Longus Tendon Rupture due to Scaphoid Nonunion

Flexor pollicis longus rupture due to scaphoid nonunion is very rare complication. It has never been reported in the Korean literatures. We reported a case of flexor pollicis longus rupture due to scaphoid non union that was treated by tendon graft with palmaris longus and osteosynthesis with bone graft.

Múltiples Variaciones Musculares y Neurovasculares en los Miembros Superiores: Presentación de Caso / Multiple Muscle and Neurovascular Variations in the Upper Limbs: Case Report

Se presenta un raro caso de múltiples variaciones en los miembros superiores de un espécimen cadavérico de 45 años de género masculino, del laboratorio de morfología de la Universidad Industrial de Santander (Bucaramanga-Colombia). Se observó variaciones musculares (presencia bilateral de cabezas adicionales del bíceps braquial y del musculo flexor largo del pulgar, agenesia del palmar largo derecho), nerviosas (anastomosis entre mediano y nervio musculocutáneo, y entre ulnar y mediano al nivel palmar superficial). Adicionalmente, presentó el origen de la arteria radial izquierda desde el segmento superior de la braquial. Estas diversas expresiones morfológicas determinan relevantes implicaciones clínicas y deben tenerse en cuenta en los diferentes abordajes quirúrgicos de los miembros superiores.

It is presented a rare case of multiple variations in the upper limbs of a 45 years old male cadaver specimen, ownership of the morphology laboratory of the Universidad Industrial de Santander (Bucaramanga, Colombia). Muscle variations were observed (presence of both additional heads of the biceps brachii and the flexor pollicis longus, agenesis of right palmaris longus), nervous variations (anastomosis between median and musculocutaneous nerve and between ulnar and median at superficial palmar level). Additionally it presented the radial artery origin from upper left segment of the brachial artery. These various morphological expressions determine relevant clinical implications and should be taken into account in the various surgical approaches to the upper limbs.

Multiple Flexor Tendon Injuries after Volar Plate Fixation for Distal Radius Fracture: Two Cases Report

As the, injury of flexor tendons has been rarely reported rarely after volar plate fixation in the distal radius fractures. Author experienced one case with delayed rupture of flexor pollicis longus and flexor digitorum profundus of index finger caused by anterior protrusion of volar plate. We also experienced another case with delayed rupture of flexor pollicis longus and wear on flexor digitorum profundus of index finger caused by volar plate placed distally to watershed line. Proper placement of volar plate and distal shape of the plate are important to prevent multiple tendon injury.

Delayed Rupture of Flexor Pollicis Longus after Volar Plating for a Distal Radius Fracture

Although extensor tendon rupture often occurs after volar plating for a distal radius fracture, a flexor tendon rupture is extremely rare. Most reported instances of flexor tendon ruptures after volar plating have involved improper placement of the plate, increased prominence of the distal edge of the plate because of collapse of the fracture site, use of custom-made plates, current steroid use by the patient, or a history of tendon injury. We report a case of delayed rupture of the flexor pollicis longus tendon 40 months after volar plating with a 3.5-mm T-locking compression plate for which the distal edge was located at the transverse ridge level of the distal radius. If symptoms such as tendon irritation occur in this situation, surgeons should consider removing the plate as soon as possible after bony union is achieved.

Flexor Pollicis Longus Tendon Rupture as a Complication of a Closed Distal Radius Fracture: A Case Report

There are few reported cases of flexor pollicis longus tendon (FPL) rupture complicating a closed distal radius fracture. We report a case of FPL tendon rupture complicating a closed distal radius fracture. A 24-year-old male presented with a severe right wrist pain. He had a closed distal radius fracture that was treated by closed manual reduction. Three days later, he complained forearm pain and limitation of thumb motion. The physical examination revealed loss of active interphalangeal joint flexion of thumb. He was taken to the operating room. Intraoperatively, the FPL was found to be discontinuous at the level of the radius fracture site. The FPL was repaired by a modified Kessler technique, and the fracture was repaired with a volar plate. Clinicians must be cautious in possibility of tendon injury complicating a closed distal radius fracture and assessing patients with distal radius fracture following closed reduction.

The Anterior Interosseous Nerve Syndrome: Clinical Investigation of Surgically Treated 7 Cases

PURPOSE: The etiology and treatment strategy of the anterior interosseous nerve (AIN) syndrome are still controversial. Seven patients with the AIN syndrome who were treated by surgical exploration and neurolysis were reviewed at a mean of 35.9 months follow up period. MATERIALS & METHODS: There were six men and one woman. The mean age was 37.3 years, ranging from 26 to 59. No patient was related to trauma and associated neurological lesion. Surgical exploration was performed at 7.7 months after onset of paralysis. RESULTS: All except one patients experienced pain around the elbow region before the onset of the palsy. On 7 patients, only the flexor pollicis longus was paralysed in 1, only the index flexor digitorum profundus in 2, and none had paralysis of the middle. The most common compression structures were fibrous bands within flexor digitorum sublimis arcade. However there was no demonstrable abnormality in three. Recovery was complete in all cases within 12 months after surgery. CONCLUSION: We recommended surgical exploration and neurolysis in patients who have shown no improvement after 6 months of conservative treatment. And careful preoperative examination is essential to avoid misdiagnosis and inappropriate surgery, especially in incomplete AIN syndrome.

Delayed Rupture of Flexor Pollicis Longus by Plate for Fracture of the Distal Radius

PURPOSE: Delayed rupture of flexor pollicis longus as a sequelae of the plate inserted for distal radius fracture is a very rare. This is the first case reported and published in Korea. METHODS: A 48 years old female patient visited hospital, complaining flexor disturbance of interphalangeal joint of left thumb, which suddenly occurred without any external wound. We found that she had received operation of fixing plate for fracture of left distal radius 10 years ago. As operational opinion, we have checked that flexor pollicis longus tendon has been ruptured with oblique ways being stimulated by extended plate to palmar side over long period. RESULTS: Authors performed tenorrhaphy of flexor pollicis longus without tendon graft and presented a successful active flexion of the left thumb interphalangeal joint 1 year after the operation. CONCLUSION: If the extruded part of the end plate is observed during the operation or follow-up, it is considered to be necessary to get rid of the plate as early as possible after the fracture healing.

Accessory Head of Flexor Pollicis Longus Muscle and its Significance in Anterior Interosseous Nerve Syndrome: Case Report and Review / Cabeza Accesoria del Músculo Flexor Largo del Pulgar y su Significancia en el Síndrome del Nervio Interóseo Anterior: Reporte de Caso y Revisión

During the laboratory dissection of the fore arm, an accessory head of flexor pollicis longus muscle has been observed unilaterally in the right upper limb of a male cadaver. It took its origin from the under surface of flexor digitorum superficialis muscle just distal to the origin of this muscle from medial epicondyle. On further dissection we have noticed that, the accessory belly was running downwards to the medial aspect of the tendon of flexor pollicis longus muscle for its insertion. Its possible role in anterior interosseous syndrome is discussed in detail with a brief review.

Durante una disección en el laboratorio se encontró en el antebrazo derecho de un cadáver de sexo masculino una cabeza accesoria del músculo flexor largo del pulgar. Ésta se originaba de la superficie profunda del músculo flexor superficial de los dedos, inmediatamente distal al origen de este músculo en el epicónddilo medial. El vientre accesorio se dirigía hacia abajo medial al tendón del músculo flexor largo del pulgar hasta su inserción. Se discute detalladamente su posible rol en el síndrome interóseo anterior.

Pathologic Rupture of Flexor Pollicis Longus Tendon Secondaryto Kienbock's Disease: A Case Report / 대한정형외과학회잡지

A pathologic rupture of the flexor pollicis longus tendon secondary to Kienbock disease is extremely rare with only three cases being reported in the literature. We encountered a case of a pathological rupture of the flexor pollicis longus tendon secondary to longstanding Kienbock disease. The treatment included tendon ball insertion after excising the collapsed lunate and a flexor pollicis longus tendon reconstruction with autogenous palmaris longus tendons. Satisfactory results with a restoration of the active motion of the interphalangeal joint of the thumb, maintenance of the preoperative active range of motion of the wrist and markedly reduced pain was achieved after a one year follow up. We describe this case with a review of the relevant literature.

Repair of Flexor Pollicis Longus Tendon Injury / 대한정형외과학회잡지

Anatomically flexor pollicis longus is different from deep finger flexors. Flexor pollicis longus tendon is unique in that it may be advanced without disturbing its blood supply, since it has no vinculum. From January 1990 to December 1992, 17 cases of patients with laceration of the flexor pollicis longus tendon were treated at Kyungpook National University Hospital. The follow up period ranged from 3 to 36 months. The results were as follows; 1. agents causing the laceration were broken bottles in 10 cases(58.8%), knives in 3 cases(17.6%) and machinary like saw in 2 cases(11.8%). 2. Totally 17 cases, 9 cases of them were located at distal to metacarpophalageal joint. 3. As associated injuries, digital nerve injuries were 4 cases(23.5%) and the recurrent branch of median nerve injuries was 1 case. 4. The surgical treatment was direct suture with or without proximal lengthening in 13 cases(76%) as primary or secondary repair and distal advancement with or without proximal lengthening in 4 cases(24%) as secondary repair. 5. Distal to metacarpophalangeal joint, the surgical treatment was direct suture with or without proximal lengthening in 3 cases as primary or secondary repair and distal advancement with or without proximal lengthening in 4 cases as secondary repair. 6. The result by Urbaniak method was excellent in 8 cases(47.0%), good in 7 cases(41.2%) and fair in 2 cases(11.8%). 7. Based on the results in these patients, it was recommended that secondary treatment for lacerations distal to the metacarpophalangeal at the wrist, as needed is bettewr than free tendon graft.