Early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge / 中国修复重建外科杂志

OBJECTIVE@#To investigate the early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge.@*METHODS@#The clinical data of 38 patients with supraspinatus tendon tears who met the selection criteria between September 2020 and July 2022 were retrospectively analyzed, and all of them were treated with arthroscopic double-pulley suture-bridge technique. There were 15 males and 23 females, aged from 43 to 77 years, with an average of 61.5 years. There were 15 cases of left shoulder and 23 cases of right shoulder. Seven cases had a history of trauma, and the other 31 cases had no obvious inducement. The main clinical symptoms of the patient were pain in lifting the shoulder joint and hug resistance test (+). The time from onset of symptoms to admission ranged from 6 to 19 months, with an average of 10.3 months. Flexion, abduction, and external rotation of the shoulder were recorded before operation and at 3 and 12 months after operation. Pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, and American Society of Shoulder and Elbow Surgeons (ASES) score before operation and at 12 months after operation. Tendon healing, tendon continuity, and tension were evaluated by MRI at 3-6 months after operation, and patient's satisfaction was evaluated at last follow-up.@*RESULTS@#All the incisions healed by first intention, and there was no complication such as incision infection or nerve injury. All patients were followed up 12-34 months, with an average of 23.3 months. VAS score, UCLA shoulder score, and ASES score at 12 months after operation were significantly better than those before operation ( P<0.05). The external rotation range of shoulder joint significantly improved at 3 and 12 months after operation ( P<0.05), and it further improved at 12 months after operation when compared with 3 months after operation ( P<0.05). There was no significant difference in the range of flexion and abduction at 3 months after operation when compared with those before operation ( P>0.05), but the range of flexion and abduction at 12 months after operation significantly improved when compared with those before operation and at 3 months after operation ( P<0.05). MRI reexamination was performed in 28 patients at 3-6 months after operation. Among them, 25 patients had intact supraspinatus tendon structure, good tension, and tendon healing, and 3 patients had type 1 retear. The remaining 10 patients refused to undergo MRI reexamination because of the satisfactory effectiveness. At last follow-up, 29 patients (76.3%) were very satisfied with the results, 6 (15.7%) were satisfied, and 3 (7.8%) were not satisfied.@*CONCLUSION@#Arthroscopic double-pulley suture-bridge technique can achieve the effect of suture bridge operation, reduce the cost of operation and the risk of type 2 retear, and the early effectiveness is satisfactory, but the shoulder joint movement is limited within 3 months after operation.

MRI manifestations of anatomy and injuries of thumb extensor and flexor mechanism / 中华全科医师杂志

Objective:To explore the anatomy and injuries features of the thumb extensor and flexor mechanism with MRI.Methods:Ten healthy subjects without thumb injury and 20 patients with thumb extensor or flexor mechanism injuries were recruited in the study between September 2013 and September 2021. All subjects underwent MRI examination, the MRI features of thumb extensor or flexor mechanism in healthy subjects and patients were analyzed. The imaging findings were compared with the surgical results and confirmed by followed up in patients.Results:The healthy subjects showed homogeneous low-signal-intensity on T1-weighted and proton-fat saturation sequence(PD FS) images. Twenty patients with thumb extensor or flexor mechanism injures(including 8 cases of extensor pollicislongusinjury,1 case of extensor pollicisbrevis injury, 4 cases of flexor pollicislongus injury, 2 cases offlexor pollicis brevis injury and 5casesofpulley injury) demonstrated poor definition in T1WI, and heterogeneously increased signal intensity in PD-FS. Depending on the degree of injury, the fibers may be partially or completely discontinuity of the involved tendons. There was edema in the soft tissues surrounding the injured sites.Conclusion:MRI is an accurate method for evaluation of the anatomy and pathological conditions of the thumb extensor and flexor mechanism.

Tenosinovitis estenosante de tendones flexores de la mano: revisión de la literatura / Stenosing flexor tenosynovitis of the hand: literature review

Flexor tendon tenosynovitis is an entrapment of the flexor tendons at its entrance to the pulley system. Because there is a high incidence of this pathology, it should be well known by physicians, rheumathologists and orthopaedic surgeons. On this paper we present a literature review, analyzing the anatomic facts, biomechanics, diagnosis, classification, therapeutic options and we propose some general recommendations for physicians.

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.

Double-Pulley technique combined with 8-shaped tension band for fixation of comminuted fractures of distal patellar pole / 第二军医大学学报

Objective: To explore the feasibility and clinical effects of Double-Pulley technique combined with 8-shaped tension band in teatment of comminuted fractures of distal patellar pole. Methods: From Jan. 2017 to Apr. 2018, 10 patients (6 males and 4 females) were treated with Double-Pulley technique combined with 8-shaped tension band in our hospital. The ages of patients ranged from 28 to 58 years old, with an average of (36.4± 11.4) years old. The average time from injury to surgery was (2.8 ± 1.1) d, ranging from 1 to 5 d. The injury cause was traffic accident in 6 cases, falling iniury in 3 cases, and sport injury in 1 case. Bostman's patellar fracture function evaluation system was used to evaluate the postoperative knee joint function. The clinical evaluation indexes included the excellent and good rate of Bostman's patellar fracture function score, and X-ray examination results and knee mobility during follow-up. Results: All patients were followed up for 16 to 24 months. The incision of all patients healed well, and no anterior knee pain or complications were found. Six months after surgery, X-ray examination showed that the patellar fracture healing of 10 patients were all osteonal union. Six months after surgery, the flexion range of knee joint was 132.0°±12.3°, and Bostman's patellar fracture function score was 28.5±1.8, with the excellent and good rate being 100% (excellent in 9 cases and good in 1 case). Conclusion: Double-Pulley technique combined with 8-shaped tension band is effective and reliable in the treatment of comminuted fractures of distal patellar pole, and the patients can start functional exercise early after surgery.

Research progress of flexor tendon injury of the fingers / 中华全科医师杂志

The flexor tendon and pulley system injuries of fingers are relatively common.Injuries to those structures may lead to different degrees of dysfunction,and some injuries may be missed or misdiagnosed in its early stage,resulting in delayed functional recovery,and reduced quality of life.The article is to describe the normal anatomic structure,mechanisms of injury and its imaging features,and the related research progress of the finger flexor tendon system.

Comparison of thin sectional anatomy based on the Chinese Visible Human with MRI of biceps reflection pulley / 局解手术学杂志

Objective To explore the morphologic features of the biceps reflection pulley through the comparative study of the thin sec -tional anatomy based on the Chinese Visible Human ( CVH) and MRI sectional anatomy of the biceps reflection pulley ,and to provide ima-ging anatomic data for the diagnosis of lesions .Methods The thin slices of sagittal oblique plane and coronal oblique plane by visualization -al reconstruction based on 5 data set of the Chinese visible human ( CVH) were compared with the corresponding MR images from 20 shoulder joints of the normal volunteer individuals with routine MRI ,5 shoulders without abnormalities with MR arthrography .The detailed sectional a-natomy structure of the the biceps reflection pulley was marked from the CVH ,routine MRI and MR arthrography one by one with Photoshop CS2 software.Results The main three components of the biceps reflection pulley including the coracohumeral ligament (CHL),the superior glenohumeral ligament ( SGHL) ,and the long head of the biceps tendon ( LBT) were markedly displayed on the CVH and MRI .The CHL was markedly displayed on the sagittal oblique , using plain MRI .The SGHL was markedly displayed on the CVH , especially in the transverse plane.The LBT was markedly displayed on the CVH ,especially in the coronal oblique plane parallel to the LBT .The biceps reflection pulley was markedly displayed on the sagittal oblique plane with CVH and MR arthrography .The SGHL was perpendicular to the CHL , with T-shaped link anterior to the LBT on the sagittal oblique plane .Conclusion It is complementary for MRI and CVH displaying the components of the biceps reflection pulley .The sagittal oblique plane is the best position for displaying the components and adjacent structures of the bi -ceps reflection pulley ,which provide helpful position mark for the diagnosis of the lesions in the rotator interval .

Ultrasound-Guided Percutaneous Release of the Trigger Thumb

PURPOSE: Trigger thumb is a common condition with a prevalence rate up to 3% among the adults. The main pathophysiology is locking of the flexor tendon at the A1 pulley. Treatments include nonsteroidal anti-inflammatory drug, steroid injection, and surgical A1 pulley release. The purpose of this study was to evaluate the safety and effectiveness of ultrasound-guided percutaneous release of trigger thumb. METHODS: The author prospectively reviewed 37 patients who had undergone ultrasound-guided percutaneous release by the same surgeon from January 2012 to June 2014. The effect of ultrasound-guided A1 pulley release was evaluated by using visual analogue scale (VAS) score, disabilities of arm, shoulder, and hand (DASH) score, and grip and pinch strengths preoperatively and at 12weeks after the surgery. In addition, complications related with the procedure were evaluated. RESULTS: Triggering and locking were resolved in all patients after surgery. VAS and DASH improved from 5.0±1.8 and 45.8±16.9 preoperatively to 0.3±0.6 and 16.2±6.3 at 12 weeks, respectively (p=0.019 and p=0.021). Grip and pinch strengths statistically improved from33.5±8.6 kg and 36.7±8.1 kg, preoperatively 46.2±6.1 kg and 47.1±7.4 kg, respectively (p=0.026 and p=0.041). Complications such as incomplete resection, neurologic symptoms or wound infection were not found throughout the period of the study. CONCLUSION: Ultrasound-guided percutaneous A1 pulley release provides complete relief of symptoms with no major complication in trigger thumb.

Trigger Finger of a Distal A2 Pulley

Trigger finger commonly occurs in A1 pulley. However, there have been occasional reports of proximal or distal A2 pulley and A3 pulley at other sites. Especially, trigger finger that occurs in A2 pulley is usually due to thickening of flexor tendon. Flexor tendon plasty surgery or A2 pulley partial release are well known treatments of A2 pulley trigger finger. We conducted pulley lengthening of the A2 pulley to a 62-year-old man who has trigger finger occurring in distal portion of the A2 pulley, and we report about this with good results obtained.

Pulley tissues maintain the mechanical advantage of extraocular muscles under eye adduction: A simulation study / 医用生物力学

Objective To study the biomechanical effect from pulley tissues of extraocular muscles on super adduction of the eye. Methods By the coordinate parameters of extraocular muscles reported in the literature and based on the mechanical equilibrium of eye movement, two mechanical models, active pulley model and non pulley model (as control), were established to simulate eye adduction in the range of 30°-45°. Results For the contribution of medial rectus muscle, the non pulley model produced more force than the active pulley model to control eye adduction, and its corresponding force value increasingly exceeded the physiologically safe threshold (0.5 N). At the maximum simulative adduction of 45°, the force of medial rectus obtained by active pulley model and non pulley model was 0.508 N and 0.782 N, respectively, and the latter was 56% greater than the safe threshold. For controlling eye adduction, the active pulley model consumed much less energy than the non pulley model. Conclusions Due to the existence of pulley tissues, extraocular muscles could control eye adduction by consuming less biological energy and reinforce the ocular derivation. In addition, with the active pulley, the medial rectus muscle could maintain its mechanical advantage under super adduction of the eye.

Analysis of the structure and function of the extraocular muscle connective tissue in rabbit / 中华实验眼科杂志

Background The extraocular muscles (EOMs) Pulley in primate is related to the function of EOMs,but there are arguments about that.The location of rabbit's eyes is different from the primate.Study on the structure of the extraocular muscle connective tissue in rabbit may play a role to analyze the function of the EOMs Pulley.Objective The structure of the connective tissue around EOMs in rabbit was studied,the difference between this structure in rabbit and homan' s EOMs Pulley in past reports was analyzed,and then,the role of EOMs Pulley to ocular movement was investigated.Methods Five adult rabbits were involved.The gross anatomy of an orbit in each rabbit was observed.The other orbit was processed with paraffin imbedding and coronal serial sections.A murine monocolonal antibody to α-smooth muscle actin(α-SMA) was used to show the smooth muscle,while Weigert stain was used to show muscle and collagen,and Masson trichrome stain to show the elastin.Results An encircling ring of collagen circled every EOM.The collagen ring was thin and connected to the orbital layer muscle fiber loosely.Collagen tissues coupled to adjacent EOMs.Less elastin fibers and scanty the smooth muscle cells were embedded in the collagen.Conclusions The connective tissue around rectus in rabbit is different from that in human with developed binocular ocular movements.It shows that connective tissue around EOMs may be related to the function of ocular movements.

Complex Regional Pain Syndrome Following Percutaneous Trigger Thumb Release / 대한정형외과학회잡지

Trigger finger is one of the most common causes of hand pain and disability. Persistent trigger finger after conservative treatment has been managed with surgical release of the A1 pulley. Percutaneous A1 pulley release is being increasingly performed and many authors have reported comparable outcomes with open surgical release. However, complications have been reported, including incomplete release, flexor tendon injury, and neurovascular injury due to the blind nature of the procedure. We report on a case of a 49-year-old female who presented with features of a type I complex regional pain syndrome (CRPS) following percutaneous A1 pulley release. CRPS is a relatively common complication occurring after trauma and surgical procedures of the upper extremities. We experienced a case of CRPS following percutaneous A1 pulley release which was treated effectively following early diagnosis and through a multidisciplinary approach including physical therapy and medication.

Study on the connective tissue around extraocular muscle in cat / 中华实验眼科杂志

Background The extraocular muscles (EOMs) Pulley is considered as the functional origins of the recti EOMs,it is determinants of ocular motility.Objective The structure of the connective tissue around EOMs in cat was studied,and the role of EOMs Pulley to ocular movement was investigated.Methods Five adult cats were involved.The gross anatomy of an orbit in each cat was observed.The other orbit was processed with paraffin imbedding and coronal serial sections.A murine monocolonal antibody to α-smooth muscle actin (α-SMA) was used to show smooth muscle,while Masson trichrome stain was used to show muscle and collagen,and Weigert stain to show elastin.Results An encircling ring of collagen circled EOM was thin and connected to the orbital layer of muscle fiber loosely.Less elastin fibers and little smooth muscle cells were embedded in the collagen ring and connective band.Collagen ring around medial rectus and the connective band between medial rectus and inferior rectus was not more significantly developed than other bands.Conclusions The connective tissue around EOMs in cat may be related to its function of ocular movement,which is not developed.

Open Reduction Through the Modified Volar Approach in Complex Dorsal Dislocations of the Metacarpophalangeal Joint

PURPOSE: To describe the surgical treatment of the complex dorsal metacarpophalangeal dislocations and its results, emphasizing on the modified volar approach with A1 pulley release. MATERIALS AND METHODS: We experienced 6 cases of dorsal dislocation of the metacarpophalangeal joint. We performed open reduction with the modified volar approach described by Eaton and Dray. Postoperatively posteroanterior and lateral radiographs of the index finger metacarpophalangeal joint and metacarpophalangeal joint range of motion was followed. RESULTS: One case with a large osteochondral fracture was operated with volar and doral approach both. Overall end results were good without any significant restriction of motion and stability of the fingers. CONCLUSION: Modified volar approach with A1 pulley release is an excellent method for complex dorsal metacarpophalangeal dislocations without osteochondral fracture.

A2 Pulley Reconstruction after Revascularization for Crushing or Amputation Injury of the Hand

PURPOSE: We report the results of A2 pulley reconstruction following revascularization for crushing or amputation injury of the hand. MATERIALS AND METHODS: The A2 pulley reconstruction was performed in 5 patients(5 digits) in whom the flexion of finger is restricted due to loss of the A2 pulley. All the patients underwent replantation or revascularization for the treatment of crushing or amputation injury of hand. Methods for reconstructing pulley were a tendon graft using palmaris longus(3 cases) and extensor retinaculum(2 cases). For assessments, the total active range of motion was measured. RESULTS: Total active range of motion increased by a mean of 39degrees(range, 15~100degrees) after pulley reconstruction. The mean improvement was 44%(range, 12~69%) of the maximum expected motion. CONCLUSION: In patients who underwent replantation or revascularization, the A2 pulley reconstruction after multiple-stage of flexor tendon reconstruction is a way to improve the active range of motion when the finger flexes.

Application of MRI in several special forms of strabismus / 眼科研究

Magnetic resonance imaging(MRI) is a non-invasive imaging technique of biological spin.MRI shows more advantages in imaging of orbital and ocular muscle than B-type sonography and X ray.MRI plays important roles in the study on anatomy of eye muscle,eye movements,survey of strabismus cause,also identification and diagnosis of strabismus.The imaging features,analysis of MRI,application of MRI in several special forms of strabismus were reviewed.

Solitary Synovial Chondromatosis as a Cause of Trigger Finger at the A3 Pulley: A Case Report / 대한정형외과학회잡지

A trigger finger is commonly secondary to stenosing tenosynovitis at the A1 pulley. However, there have been occasional reports of triggering at other sites as well as from other etiologies. We describe a patient who suffered a triggering of the left middle finger at the A3 pulley due to the solitary synovial chondromatosis obstructing the flexor tendon from gliding.

The Distribution of the Extraocular Pulley Smooth Muscle in the Rabbit

PURPOSE: We evaluated the structure, innervation of the extraocular pulley smooth muscle in the rabbit. METHODS: A rabbit was transcardially perfused with physiological saline followed by 4% formalin. The rabbit orbit was dissected en bloc, paraffin processed, and serially sectioned for Hematoxylin-Eosin and Masson's trichrome stain. The distribution of the extraocular pulley smooth muscle was confirmed by immunohistochemistry with human smooth muscle(SM) alpha-actin. RESULTS: We found that the pulley structure consisted of focal condensations of eleastin and collagenous connective tissue in relationship to the rectus muscle in the equatorial Tenon's fascia. The pulley smooth muscle in relation to medial rectus muscle was immunostained with TH and nNOS. CONCLUSIONS: The data support the presence of the extraocular pulley smooth muscle in the rabbit orbit having both parasympathetic and sympathetic innervation.

The Distribution and Innervation of the Extraocular Pulley Smooth Muscle in the Rat

PURPOSE: We evaluated the structure, distribution and innervation of the extraocular pulley smooth muscle in the rat, a species with a less complex visuomotor repertoire than primates. METHODS: The adult Sprague-Dawley rat was perfused transcardially with physiological saline followed by 4% formalin. The rat orbit was dissected en bloc, then paraffin processed and serially sectioned for hematoxylin-eosin and Masson's trichrome stain. The distribution and innervation of the extraocular pulley smooth muscle was confirmed by immunohistochemistry with human smooth muscle (SM) alpha-actin, tyrosine hydroxylase (TH) and neuronal nitric oxide synthase (nNOS). RESULTS: We found the pulley structure consist of focal condensations of eleastin and collagenous connective tissue in relationship to the rectus muscle in the equatorial Tenon's fascia. Especially, the pulley smooth muscle connected to medial rectus muscle was immunostained to TH and NOS. CONCLUSIONS: The data supports the presence of the extraocular pulley smooth muscle in the rat orbit supposing to have dopaminergic and nitroxidergic innervation.

A study about the change of locations of the center of resistance according to the decrease of alveolar bone heights and root lengths during anterior teeth retraction using the laser reflection technique / 대한치과교정학회지

Treatment mechanics should be individualized to be suitable for each patient`s personal teeth and anatomic environment to get a best treatment result with the least harmful effects to teeth and surrounding tissues. Especially, the change of biomechanical reaction associated with that of the centers of resistance of teeth should be considered when crown-to-root ratio changed due to problematic root resorption and/or periodontal disease during adult orthodontic treatment. At the present study in order to investigate patterns of initial displacements of anterior teeth under certain orthodontic force when crown-to-root ratio changed in not only normal periodontal condition but also abnormal periodontal and/or teeth condition, the changes of the centers of resistance for maxillary and mandibular 6 anterior teeth as a segment were studied using the laser reflection technique, the lever&pulley force applicator and the photodetector with these quantified variables reducing alveolar bone 2mm by 2mm for each of maxillary 6 anterior teeth until the total amount of 8mm and root 2mm for each of mandibular 6 anterior ones until the total amount of 6mm. The results were as follows: 1. Under unreduced condition, the center of resistance during initial displacement of maxillary 6 anterior teeth was located at the point of about 42.4% apically from cemento-enamel junction(CEJ) of the averaged tooth of them and kept shifting to about 76.7% with alveolar bone reduction. 2. The distance from the averaged alveolar crest level of maxillary 6 anterior teeth to the center of resistance for the averaged tooth of them kept decreasing with alveolar bone reduction, but the ratio to length of the averaged root embedded in the alveolar bone was stable at around 33% regardless of that. 3. Under unreduced condition, the center of resistance during initial displacement of mandibular 6 anterior teeth was located at the point of about 43% apically from CEJ of the averaged tooth of them and this ratio kept increasing tc about 54% with root reduction. Bur the distance from CEJ to the center of resistance decreased from around 5.3mm to around 3.3mm, that is to say, the center of resistance kept shifting toward CEJ with the shortening of root length. 4. A unit reduction of alveolar bone had greater effects on the change of the centers of resistance than that of root did during initial phase of each reduction. But both of them had similar effects at the middle region of whole length of the averaged root.