Reconstrucción de aparato extensor en sarcoma fibromixoide de bajo grado en rodilla: reporte de caso

Introducción: El sarcoma fibromixoide de bajo grado es una tumoración maligna con alto riesgo de desarrollar recurrencia y metástasis, siendo la resección quirúrgica con márgenes amplios el tratamiento principal, la preservación de la extremidad y su reconstrucción es de alta demanda para los cirujanos. Reporte de caso: Presentamos el caso de una mujer de 67 años con recurrencia de tumoración en rodilla desde hace 12 meses, operado dos años antes. Se realizo resección oncológica de tumoración con reconstrucción de articulación de rodilla con prótesis Endo Model y reconstrucción de aparato extensor con injerto sintético de malla de polipropileno más autoinjerto de semitendinoso y gracilis. La patela se reconstruyó con autoinjerto de cóndilo femoral posterior. A los 16 meses de seguimiento la paciente se encuentra libre de enfermedad, con puntaje de 27 en la escala para miembro inferior de la MSTS (Musculoskeletal Tumour Society). Conclusión: La combinación de injerto sintético con autoinjerto de isquiotibiales puede disminuir la tasa de falla de la reconstrucción del aparato extensor por resecciones oncológicas.

Introduction: Low-grade fibromyxoid sarcoma is a malignant tumor with a high risk of developing recurrence and metastasis, surgical resection with wide margins is the main treatment, limb preservation and reconstruction is in high demand for surgeons. Case of report: We present the case of a 67-year-old woman with a recurrence of a knee tumor that had been operated on two year earlier. Oncological resection of the tumor was performed with reconstruction of the knee joint with an Endo Model prosthesis and extensor mechanism reconstruction with a synthetic polypropylene mesh graft plus a semitendinosus and gracilis autograft. The patella was reconstructed with posterior femoral condyle autograft. At 16 months of patient follow-up, she is free of disease, with a score of 27 on the lower limb scale of the MSTS (Musculoskeletal Tumor Society). Conclusion: The combination of synthetic graft with hamstring autograft can reduce the failure rate of extensor mechanism reconstruction due to oncological resections.

Application of absorbable anchor combined with Kirschner wire in reconstruction of extension function of old mallet finger / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of absorbable anchor combined with Kirschner wire fixation in the reconstruction of extension function of old mallet finger.@*METHODS@#Between January 2020 and January 2022, 23 cases of old mallet fingers were treated. There were 17 males and 6 females with an average age of 42 years (range, 18-70 years). The cause of injury included sports impact injury in 12 cases, sprain in 9 cases, and previous cut injury in 2 cases. The affected finger included index finger in 4 cases, middle finger in 5 cases, ring finger in 9 cases, and little finger in 5 cases. There were 18 patients of tendinous mallet fingers (Doyle type Ⅰ), 5 patients were only small bone fragments avulsion (Wehbe type ⅠA). The time from injury to operation was 45-120 days, with an average of 67 days. The patients were treated with Kirschner wire to fix the distal interphalangeal joint in a mild back extension position after joint release. The insertion of extensor tendon was reconstructed and fixed with absorbable anchors. After 6 weeks, the Kirschner wire was removed, and the patients started joint flexion and extension training.@*RESULTS@#The postoperative follow-up ranged from 4 to 24 months (mean, 9 months). The wounds healed by first intention without complications such as skin necrosis, wound infection, and nail deformity. The distal interphalangeal joint was not stiff, the joint space was good, and there was no complication such as pain and osteoarthritis. At last follow-up, according to Crawford function evaluation standard, 12 cases were excellent, 9 cases were good, 2 cases were fair, and the good and excellent rate was 91.3%.@*CONCLUSION@#Absorbable anchor combined with Kirschner wire fixation can be used to reconstruct the extension function of old mallet finger, which has the advantages of simple operation and less complications.

Hemiartroplastía por interposición utilizando el extensor hallucis brevis para el tratamiento de hallux rigidus con involucro unicompartimental lateral: reporte de un caso / Interposition hemiarthroplasty using extensor hallucis brevis for the treatment of hallux rigidus with lateral unicompartmental involvement: a case report

Resumen: Hallux rigidus es la patología degenerativa de la articulación metatarsofalángica del hallux. Esta patología provoca dolor y disminución en el movimiento. Existen múltiples tratamientos quirúrgicos para esta patología, todas con sus respectivas indicaciones. Presentamos el caso de un paciente de 54 años de edad con el diagnóstico de hallux rigidus quien tenía afectación únicamente del aspecto lateral de la cabeza del metatarsiano. Este paciente fue tratado con un procedimiento quirúrgico novedoso, se realizó una hemiartroplastía de interposición utilizando el extensor hallucis brevis asociado a una queilectomía y exostectomía. El paciente tuvo una favorable evolución clínica con mejoría evidenciado por escalas clínicas, con resolución de la sintomatología y sin complicaciones. La hemiartroplastía de interposición utilizando el extensor hallucis brevis es un tratamiento exitoso de preservación articular y del movimiento para el hallux rigidus en pacientes jóvenes en los que hay afectación unicompartimental lateral de la cabeza metatarsiana, en quienes es importante preservar el movimiento.

Abstract: Hallux rigidus is the degenerative pathology of the metatarsophalangeal joint of the hallux. This pathology causes pain and decreased movement. There are multiple surgical treatments for this pathology, all with their respective indications. We present the case of a 54-year-old patient diagnosed with hallux rigidus who had only the lateral aspect of the metatarsal head affected. This patient was treated with a novel surgical procedure, performing an interposition hemiarthroplasty using the hallucis brevis extender associated with a cheilectomy and exostectomy. The patient had a favorable clinical evolution with improvement evidenced by clinical scales, with resolution of the symptoms and without complications. Interposition hemiarthroplasty using the extensor hallucis brevis is a successful joint and movement preservation treatment for hallux rigidus in young patients with lateral unicompartmental involvement of the metatarsal head, in whom it is important to preserve movement.

Tendinitis cálcica atraumática de tendón extensor común del dedo medio: un caso infrecuente de dolor metacarpofalángico / Atraumatic calcium tendonitis of common extensor tendon of the middle finger: a rare case of metacarpophalangeal pain

Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.

A Cadaveric Study on the Anomalous Extensors of the Hand

Background: The hands play a pivotal role in skilled movements. Anomalous muscles of the extensors of the hand are seen usually in anatomical dissections and during surgeries. Variations of the muscles in the dorsum of hand may be asymptomatic or may cause dorsal wrist pain, particularly if a muscle belly encroaches on and obstruct the wrist’s small extensor compartments deep to extensor retinaculum. Methods: A total of 54 upper limb specimens were used for the current study from the Anatomy Department of an undergraduate & postgraduate teaching Medical College in India. Incidence of additional muscle belly and its tendon in the posterior compartment of the forearm and dorsum of the hand were noted and photographed. Results: The anomalous muscle bellies and tendons in extensor compartment of forearm and dorsum of hand were observed in 10 limbs (18.5%) of 54 limbs. Of which, the extensor medii proprius (EMP) was 9.3%, extensor digitorum brevis manus (EDBM) was 3.7%. The numbers of the tendon of the extensor digitorum (ED) were varied in 3 limbs (5.6%). Conclusion: Knowledge of anatomical data of such variant muscles and additional belly or tendon in the extensor compartment of forearm and dorsum of hand is essential for surgeons to modify treatment plan, so as to avoid reporting error and of surgical procedures while operating on hand.

Extensor indicis brevis muscle: report of a rare muscular variant and classification proposal / Músculo extensor corto del índice: reporte de una rara variante muscular y propuesta de clasificación

SUMMARY: The current report presented a rare variant of extensor indicis brevis muscle, replacing extensor indicis, in the left hand of an adult male cadaver. The origin of the muscle was reported, for the first time, to be from the distal margins of radius and ulna. The muscle is inserted into the extensor expansion of the index. A new classification for extensor indicis brevis muscle was proposed based on its origin. Awareness of rare anatomical variations would help clinicians and surgeons in accurately managing suspected cases and planning surgical procedures.

RESUMEN: Este informe presenta una variante rara del músculo extensor corto del índice, que reemplaza al extensor del índice en la mano izquierda de un cadáver masculino adulto. Se informó por primera vez, que el origen del músculo se realiza en la parte distal de los márgenes del radio y la ulna. El músculo se insertaba en la expansión extensora del índice. Se propuso una nueva clasificación para el músculo extensor corto del índice basada en su origen. El conocimiento de las variaciones anatómicas raras es útil para los médicos y cirujanos al abordar los casos sospechosos y planificar los procedimientos quirúrgicos.

Effect of Microelectronic Electromyography Bridge on Motor Function of Extensor Carpi Radialis Longus in Patients with Cervical Spinal Cord Injury / 中国康复理论与实践

Objective:To observe the effect of microelectronic EMG bridge (EMGB) training on the motor function of extensor carpi radialis longus in patients with complete cervical 5 spinal cord injury. Methods:From March, 2016 to March, 2017, 20 patients with complete cervical 5 spinal cord injury were randomly divided into control group (n = 10) and experimental group (n = 10). The control group received routine wrist extensor muscle training, and the experimental group received EMGB training in addition, for 180 days. The motor function of the affected limb was evaluated by sEMG of extensor carpi radialis longus, Manual Muscle Test (MMT), Wolf Motor Function Test (WMFT) and Spinal Cord Lesion Independence Measure (SCIM). Results:After treatment, the peak value and average value of sEMG of extensor carpi longus of both sides increased in both groups (t > 2.510, P < 0.05), the peak value and average value of the left side were higher (t > 2.759, P < 0.05), and the peak value of the right side was higher (t = 2.691, P < 0.05) in the experiment group than in the control group, however, there was no significant difference in average value of the right side between two groups (t = 2.063, P = 0.054). The scores of MMT increased in both groups (t > 2.569, P < 0.05), and were higher in the experimental group than in the control group (t > 2.278, P < 0.05). The scores of WMFT and SCIM increased in both groups (t > 3.839, P < 0.05), however, there was no significant difference between two groups (t < 1.498, P > 0.05). Conclusion:EMGB training could improve the motor function of extensor carpi radialis longus in patients with complete cervical 5 spinal cord injury.

Flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects / 中华创伤杂志

Objective:To investigate the clinical effect of flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects.Methods:A retrospective case series study was conducted to analyze the clinical date of 14 patients with hand and foot wounds associated with extensor tendon defects admitted to Ruihua Affiliated Hospital of Soochow University from January 2015 to December 2019. There were 13 males and 1 female，aged 10-57 years［（39.2±13.4）years］. The wounds were all single with the area of 10 cm×4 cm to 23 cm×12 cm，including 8 wounds on the back of the hand and 6 wounds on the back of the foot. There was 1 patient accompanied with 1 tendon defect，10 with 4 tendon defects and 3 with 5 tendon defects，with the length of tendon defects ranging from 2.0 to 6.0 cm［（3.8±1.4）cm］. The dimension of flaps ranged from 12 cm×5 cm to 23 cm×13 cm，with the fascia lata from 11 cm×5 cm to 20 cm×7 cm. The deficient extensor tendons were repaired with the fascia lata and vascular pedicles were anastomosed by flow-though. A bilobed flap was harvested in 3 patients and a single flap in 11 patients. Donor sites were sutured directly. The survival of the flap and healing of the donor area were detected after operation. The extremity revascularization and shape and sensation recovery of the flap were measured at the last follow-up. The upper extremity functional evaluation standard set up by Hand Surgery Society of the Chinese Medical Association and Maryland foot functional score were used to evaluate the hand and foot function before operation and at the cast follow-up，respectively. The donor site complications and performance of tendon release or flap thinning in the second stage were recorded.Results:All patients were followed up for 8-30 months［（15.3±6.2）months］. All flaps survived successfully，with wounds and thigh donor areas healed by first intension. No significant effect of revascularization was observed on recipient sites，and acceptable cosmetic outcomes and sensation recovery of the flap were achieved at the final follow-up. For patients with dorsal wounds of the hand，the extensor function recovered in different degrees，and the flexion activities of the fingers were not limited. The total active movement was 180°-250°［（226.3±21.7）°］at the last follow-up，compared to preoperative 110°-170°［（145.6±13.2）°］（ P<0.01）. According to the upper extremity functional evaluation standard，the function was excellent in 4 patients，good in 2 and fair in 2. For patients with wounds of the foot，the flexion and extension function was good，with no obvious deformity of toes，and the Maryland foot functional score ranged from 60 to 92 points［（76.0±12.7）points］at the last follow-up，significantly improved from preoperative 18-45 points［（27.4±7.8）points］（ P<0.01），including excellent results in 2 patients，good in 3 and fair in 1. Only linear scars were left in the thigh donor area，and there was no discomfort such as scar contracture or pain. Four patients underwent skin flap thinning at 4-8 months after operation and none underwent a tenolysis. Conclusion:Repair of dorsal wounds with extensor tendon defects of the hand and foot by flow-through anterolateral thigh perforator flap with fascia lata can reduce interference to recipient sites and repair wounds and extensor tendons simultaneously，which can obtain good flexion and extension function and minor damage to the donor area.

Biometría de las conexiones intertendinosas del dorso de la mano humana / Biometry of the intertendinous connection of the dorsum of the human hand

RESUMEN: Las conexiones intertendinosas (CIT) son bandas estrechas de tejido conectivo que unen tendones adyacentes del músculo extensor de los dedos. Dichas bandas se ubican de manera superficial en el dorso del segundo, tercer y cuarto espacios intermetacarpianos (EIMC) presentando funciones importantes como colaborar en la estabilización de la articulación metacarpofalángica y permitir la redistribución de fuerzas extensoras sobre esta articulación. El objetivo del presente estudio fue establecer la biometría de las CIT. Para ello se utilizaron 24 miembros superiores formolizados, pertenecientes al laboratorio de Anatomía, de la Universidad Andrés Bello, sede Viña del Mar, Chile. Se registraron las longitudes de inserción lateral y medial, el ancho y la longitud total de cada CIT. Siguiendo dos criterios, las CIT se clasificaron según morfología y además se localizaron según tercios del dorso de la mano. De las 69 CIT encontradas, el 39 % presentó una disposición transversa y 61 % una oblicua. En relación a la clasificación morfológica de la CIT se identificó un 29 % del tipo 1; 39 % del tipo 2. Para el caso del tipo 3, un 20 % presentó la forma "r" y en un 12 % la forma "y". Respecto a su localización se estableció que en el segundo EIMC el 18 % de las CIT se ubicaron el tercio distal del dorso y el 82 % en el tercio medio. En el tercer EIMC el 96 % de las CIT se localizó en el tercio distal y 4 % en el tercio medio. En el cuarto EIMC el 96 % se ubicó en el tercio distal y el 4 % en el tercio medio. Considerando como referencia la línea biestiloidea, las CIT en el segundo EIMC presentaron un promedio de ancho de 8,16 ± 1,94 mm y una longitud total promedio de 13,71 ± 4,70 mm. En el tercer EIMC, un promedio de 10,94 ± 4,39 mm para el ancho y 6,29 ± 3,26 mm de longitud total promedio. En el cuarto EIMC el promedio de ancho fue de 7,00 ± 3,06 mm y la longitud total promedio 7,08 ± 4,42 mm. Estos hallazgos aportan datos respecto de la biometría y localización de las CIT, lo que resulta de utilidad en procedimientos de reparación quirúrgica del dorso de la mano humana.

SUMMARY: Intertendinous connections (IC) are narrow connective tissue bands extending between the extensor digitorum (ED) tendons. These bands are located superficially on the dorsum of the second, third and fourth intermetacarpal (IMC) space, presenting important functions such as collaborating in the stabilization of the metacarpophalangeal joint (MCP) and allowing the redistribution of extensor forces on this joint. The objective of the present study was to establish the biometric characteristics of IC. To do this, 24 formalized upper limbs are used, belonging to the Anatomy laboratory of the Universidad Andrés Bello, Viña del Mar, Chile. Lateral and medial insertion lengths, width and total length of each IC were recorded. Following two criteria, IC were classified according to morphology and were also located according to thirds of the back of the hand. 69 IC were found, 39% presented a transverse arrangement and 61 % an oblique arrangement. In relation to the morphological classification of IC, 29 % of type 1 were identified, 39 % of type 2. In the case of type 3, 20 % presented the form "r" and 12 % the form "y". Regarding its location, it was established that in the second IMC space, 18 % of the IC were located in the distal third of the back and 82 % in the middle third. In the third IMC space, 96 % of the IC was located in the distal third and 4 % in the middle third. In the fourth IMC space, 96 % were located in the distal third and 4 % in the middle third. Considering the biestiloid line as a reference, the IC in the second IMC space considers an average width of 8.16 + 1.94 mm and an average total length of 13.71 + 4.70 mm. In the third IMC space, an average of 10.94 + 4.39 mm for the width and 6.29 + 3.26 mm of average total length. In the fourth IMC space the average total width of 7.00 + 3.06 mm and the average total length of 7.08 + 4.42 mm. These findings provide data regarding the biometrics and location of IC, which is useful in surgical repair procedures on the back of the human hand.

Biometría de los músculos extensor corto de los dedos y extensor corto del hallux en individuos brasileños: análisis anatómico para su uso como colgajo muscular en cirugías reconstructivas / Biometry of the extensor digitorum brevis and extensor hallucis brevis muscles in Brazilian individuals: anatomical analysis for use as a muscle flap in reconstructive surgeries

RESUMEN: El músculo extensor corto de los dedos (ECD) se sitúa junto con el músculo extensor corto del hallux (ECH) en la región dorsal del pie y están encargados de colaborar con la acción agonista de los músculos extensor largo de los dedos (ELD) y extensor largo del hallux (ELH), en la extensión de los cuatro dedos mediales en las articulaciones metatarsofalángicas. Esta condición complementaria permite su transferencia quirúrgica hacia otras regiones receptoras sin afectar la funcionalidad extensora de los dedos del pie motivo por el cual durante las últimas décadas se ha convertido en un tejido importante para la reconstrucción de lesiones tisulares, sin embargo, son escasos los estudios biométricos que lo describan en detalle. El objetivo de esta investigación fue establecer la longitud, ancho y área de extensión de estos músculos acompañada de la determinación de las distancias de éstos respecto a la cuña medial y la base del quinto metatarsiano para su uso quirúrgico. Sumado a lo anterior y posterior a la descripción de las variantes musculares encontradas se determinó los puntos motores de inervación de estos dos músculos. Para ello se estudiaron 36 miembros inferiores formolizados de individuos adultos brasileños pertenecientes a la Universidad Federal de Alagoas (UFAL), Maceió, Brasil. Las mediciones se realizaron con un cáliper marca Mitutoyo de 0,01 mm de precisión obteniendo una longitud, ancho y área de 6,89 ± 1,64 cm, 3,81 ± 0,42 cm y 31,98 ± 7,60 cm2 en el lado derecho de 6,91 ± 1,64 cm, 3,68 ± 0,46 cm y 30,75 ± 7,61 cm2 en el izquierdo respectivamente. En el 17 % de los casos hay presencia de tendones accesorios para el músculo ECD. La distancia desde el margen medial del músculo ECH respecto a la cuña medial y del margen lateral del músculo ECD a la base del quinto metatarsiano fue de 1,97 ± 0,43 y 1,72 ± 0,41 al lado derecho y de 2,01 ± 0,62 y 1,87 ± 0,36 al lado izquierdo respectivamente. Los puntos motores (Pm) predominaron en un 64 % en el tercio medio del músculo ECH y en un 64 % en el tercio proximal del músculo ECD. Estos resultados son un aporte significativo, tanto para quienes realizan cirugía ortopédica como para el conocimiento detallado de la anatomía dorsal del pie.

SUMMARY: The extensor digitorum brevis muscle (EDB) is located along with the extensor hallucis brevis (EHD) in the dorsal region of the foot and are responsible for collaborating with the agonist action of the extensor digitorum longus muscles (EDL) and extensor hallucis longus (EHL) in the extension of the four medial fingers in the metatarsophalangeal joints. This complementary condition allows its surgical transfer to other receptor regions without affecting the extensor functionality of the toes, which is why during the last decades it has become an important tissue for the reconstruction of tissue injuries, however, there are few studies biometrics that describe it in detail. The objective of this investigation was to establish the length, width and area of extension of these muscles accompanied by the determination of their distances from the medial wedge and the base of the fifth metatarsal for surgical use. In addition to the above and after the description of the muscle variants found, the innervation motor points of these two muscles were determined. To do this, 36 formalized lower limbs of Brazilian adult individuals belonging to the Federal University of Alagoas (UFAL), Maceió, Brazil, were studied. Measurements were made with a 0.01 mm precision Mitutoyo caliper obtaining a length, width and area of 6.89 ± 1.64 cm, 3.81 ± 0.42 cm and 31.98 ± 7.60 cm2 on the right side of 6.91 ± 1.64 cm, 3.68 ± 0.46 cm and 30.75 ± 7.61 cm2 on the left, respectively. In 17 % of cases there is presence of accessory tendons for the EDB muscle. The distance from the medial margin of the EHB muscle with respect to the medial wedge and the lateral margin of the EDB muscle to the base of the fifth metatarsal was 1.97 ± 0.43 and 1.72 ± 0.41 on the right side and 2,01 ± 0.62 and 1.87 ± 0.36 on the left side respectively. Motor points (Pm) predominated in 64 % in the middle third of the EHB muscle and in 64 % in the proximal third of the EDB muscle. These results are a significant contribution both for those who perform orthopedic surgery and for detailed knowledge of the dorsal foot anatomy.

Realineamiento Proximal del Mecanismo Extensor en la Luxación Congénita de la Rótula en Niños y Adolescentes / Proximal Realignment of the Extensor Mechanism in Congenital Dislocation of the Knee in Children And Adolescents

Introducción La luxación congénita de la rótula (LCR) es una entidad poco frecuente. El diagnóstico precoz suele ser difícil porque la rótula en el recién nacido es pequeña y de difícil palpación. El tratamiento no quirúrgico ha demostrado ser ineficaz. El enfoque terapéutico de esta patología requiere de la liberación externa y extensa del cuádriceps, el avance del vasto interno oblicuo y de la transferencia o hemitransferencia del aparato extensor. Materiales y métodos se busca evaluar la funcionalidad de los pacientes tratados quirúrgicamente mediante realineamiento proximal del mecanismo extensor por la técnica descrita por Green y modificada por los autores. Desde el año 2000 hasta el año 2015 se recolectaron 15 pacientes (20 rodillas) con diagnóstico de LCR tratados quirúrgicamente mediante la técnica descrita. Resultados Los resultados postoperatorios fueron evaluados mediante el cuestionario Kujala: 93.8/100 en promedio. Discusión El tratamiento de la LCR es un desafío y más aún si se encuentra asociada a retracción idiopática del recto anterior. Los resultados clínicos y funcionales obtenidos sugieren que la recolocación anatómica y estable de la rótula dentro de la tróclea femoral permite una satisfactoria alineación extensora del cuádriceps, desapareciendo su acción flexora inicial, lo que permite la elongación progresiva del mecanismo extensor durante las fases postoperatorias de rehabilitación. La técnica quirúrgica descrita ofrece una buena alternativa para el tratamiento de esta infrecuente patología congénita de la rodilla.

Background Congenital dislocation of the patella (CDP) is a rare condition. The early diagnosis is difficult, as the patella in the newborns is small and also difficult to recognise. The therapeutic approach of this disorder requires the extended and external release of the quadriceps, the forward movement of the internal oblique vastus, and the transfer or hemi-transfer of the extensor compartment. Methods To review the functionality of those patients who have received surgical treatment with proximal realignment of the extensor mechanism using Green's surgical technique and the one modified by the author. Between the years 2000 and 2015, a total of 15 patients with 20 knees found to have had congenital dislocation of the patella, and had received the abovementioned surgical treatment. Results The post-operative results were evaluated using the Kujala questionnaire, which gave a mean result of 93.8 / 100. Discussion The CDP treatment is a challenge, and even more so if it is associated with an idiopathic retraction of the anterior rectus. The clinical and functional results obtained suggest that an anatomic and stable realignment of the patella in the femoral trochlea allows a satisfactory extensor alignment of the quadriceps. This leads to the disappearance its initial flexor action, which allows the gradual elongation of the extensor mechanism during the postoperative phases of rehabilitation. The surgical technique described offers a good alternative for the treatment of this rare congenital disorder of the knee.

Comparison Of Low Back Extensors, Abdominal Core And Abdominal Muscle Endurance In Normal And Overweight Young Females

Background: High Body Mass Index(BMI) has been linked with increased risk of low back pain(LBP) in females. High BMI has been linked with an increased risk of low back pain. Increased body fat could increase the mechanical load on the spine by causing a higher compressive force or increased shear on the lumbar spine structures during various activities. In LBP, the muscular endurance of the back muscles mainly, the abdominal core, back extensors and abdominals is reduced. Hence, there is a need to assess muscular endurance of the trunk muscles in overweight females so as to determine a cause for LBP. The objective of this study is to compare back extensors, the abdominal core and abdominal muscle endurance in overweight and normal females in the age group of 20-30years. Method: A group of 120 healthy females were included in this study. Out of these, 60 females were with normal BMI and 60 were overweight. Back extensor endurance was evaluated by Beiring-Sorenson’s test. The core muscle endurance was assessed by Sphygmomanometer method in prone lying. In both the tests, holding time was measured by stopwatch. The abdominal muscle endurance was assessed by Partial curl-up test. Curl-ups were done according to the metronome beats. The number of repetitions performed was measured. A comparison was done between normal and overweight females. Results: In normal females the mean age was 21.18 with mean BMI of 21.96 whereas in overweight females the mean age was 21.27 with mean BMI of 27.44. The mean back extensor, core and abdominal endurance in normal females were 59.053,10.81 and 18.97 respectively was high as compared to overweight which was 30.33,6.13 and 11.27 respectively. Data analysis was done using unpaired t-test. The muscular endurance was significantly reduced (p<0.00) in overweight females as compared to the normal females. Conclusion: This study concluded that back extensor, core and abdominal endurance are significantly reduced in overweight females as compared to normal.

Paratricepital Approach for Fixation of Distal Humerus Fractures in Adult – A Review of Thirty Cases

Background: Distal humerus fractures are most commonly managed by surgical approaches that disrupt the extensor mechanismof the elbow. Paratricepital approach for distal humerus fracture fixation has been done by orthogonal or parallel plate constructthat allows excellent healing of fracture, motion arc of elbow more than 100°, and maintains of extensor mechanism strength.Materials and Methods: Atotal of 30 cases of distal humerus fractures are fixed by paratricepital posterior approach. Bicolumnerfixation done by elevating and retracting the triceps of the distal humerus keeping triceps insertion undisturbed by orthogonalor parallel plate construct. Early active-assisted range of motion initiated within limits of pain. The age group was 15–60 years.Among them 21% was Type A fracture, 17% Type B fracture, 33% Type C1 fracture, and 29% Type C2 fracture. More than60% of cases have 1 year of follow-up. Radiograph and functional evaluation were done by mayo elbow performance score(MEPS), disability of arm, shoulder, and hand questionnaire.Results: All 30 fractures healed primarily. The median arc of elbow motion was 105° (range 70°–140°). Average MEPS was91 points (range 65–100) indicating excellent scores.Conclusion: Treatment of distal humerus fracture in adults by paratricepital posterior approach results in excellent healing, amean flexion extensor arc more than 100°, maintains of almost normal elbow extensor strength compared with the contralateralnormal elbow.

Physical Activity Level And Physical Fitness Parameters In Physiotherapy Students

Background: Regular physical activity (PA) and health-related physical fitness are key indicators of health outcomes. Physiotherapy professional bodies are recognizing that physical activity and exercise are integral to professional practice and are core contributors to health along with reducing the risk of developing diabetes, hypertension, and cardiovascular diseases. PA also improves emotion and stress control. Objective: The objectives of the study are to find the level of physical activity and compare physical fitness parameters in physiotherapy students by evaluating aerobic capacity, endurance and body composition in different levels of physical activity. Methods: An observational study was conducted on 100 male and female physiotherapy students aged 18-24 years using random sampling. Subjects having severe back pain, recent fractures were excluded. Students were divided into three groups low PA, moderate PA, high PA based on their Physical activity score evaluated using international physical activity questionnaire-short form (IPAQ). Aerobic capacity was measured by Queens college step test, endurance of trunk extensor muscles (TE) was found by Sorenson’s test and endurance of trunk flexor muscles (TF) by holding time of prone forearm plank position and body composition was calculated by Body mass index (BMI). Level of significance was kept at 5%. Results: Data of 100 students was analysed. Forty one students were in low activity group, Thirty four students were in moderate activity group and twenty five students were in high activity group. Mean Aerobic capacity was 42.94±8.31ml/min/kg, Trunk Flexor endurance was 63.62±25.65s, Trunk extensor endurance was 71.50±30.41s and BMI was 23.33±4.02kg/m2. Comparing means of 3 groups by Kruskal Wallis test, Aerobic capacity ᵪ2=51.019, p<0.001, TE endurance ᵪ2=23.644, p<0.001.TF endurance ᵪ2=15.832, p<0.001, BMI ᵪ2=2.869, p>0.05. Conclusion: Low to moderate level of physical activity was found among physiotherapy students. Physiotherapy students who were physically active in their routine life have better aerobic capacity, Trunk flexor endurance and Trunk extensor endurance and thus better physical fitness, compared to those with low levels of physical activity. The body mass Index was not significantly different in three groups.

A Comparative Study On The Effects Of Pelvic Pnf Exercises And Hip Extensor Strengthening Exercises On Gait Parameters Of Chronic Hemiplegic Patients

Background: Most hemiplegic patients who suffer from stroke experience restrictions on mobility at home and in the community, and they especially have difficulty with independent walking. Proprioceptive Neuromuscular Facilitation (PNF) is one approach commonly used to improve the gait of patients with hemiplegia. Various PNF procedures have been used, depending on the affected site. Among these PNF techniques is facilitation of pelvic motion to improve control of the pelvis.Hence the study was done to compare the effects of pelvic PNF exercises and Hip extensor strengthening exercises on gait parameters of chronic hemiplegic patients. Materials and Methods: 30 subjects were conveniently divided into either of the two groups namely Pelvic PNF Group (Group A) and Hip extensor strengthening Group (Group B). Subjects in Group A received a protocol of 3 PNF techniques for 3 days a week for a total duration of 4 weeks (12 sessions). These procedures were done to facilitate anterior elevation and posterior depression of pelvis in a side lying position. Subjects in Group B received a protocol for hip extensor strengthening exercise (HESE) program. Each session consisted of 3 sets of 15 performances of the 3-step program lasting about 30 min, with 30 seconds of relaxation time between the sets. The measurements of the variables i.e. Gait speed, Cadence, Stride Length, Step Length was taken twice, one at the beginning of the study (Pre) and one at the conclusion of the 4 week duration (Post).The pre post measurements of outcome measures were analysed. Results: Following 4 weeks of Pelvic PNF exercises and Hip extensor strengthening exercises, there was a statistically significant increase in Gait parameters in all domains. However the increase was statistically more significant in the experimental group (Pelvic PNF) as compared to the control group (HESE). Conclusion: Pelvic Proprioceptive Neuromuscular Facilitation technique is more effective than Hip extensor strengthening exercises in improving gait parameters such as stride length, gait velocity and cadence in chronic hemiplegic patients.

Rare Variations Of Extensor Tendons In The Dorsum Of Hand

Extensor digitorum muscle originates from the front of lateral epicondyle of humerus as common extensororigin, the adjacent intermuscular septa and the antebrachial fascia. It divides into four tendons in the distalthird of forearm for the medial four fingers. During routine dissection of back of forearm and dorsum of hand forundergraduate students, we discovered that extensor digitorum muscle was unusually giving a common slip tothe ring and little finger. Also, extensor digiti minimi(EDM) was found to be bifurcating into two separate slips forthe little digit.

Inervación del músculo extensor radial largo del carpo en individuos brasileños: biometría de su origen y distribución / Innervation of the extensor carpi radialis longus muscle in Brazilian individuals: biometry of its origin and distribution

El músculo extensor radial largo del carpo (MERLC) es un músculo localizado en el compartimiento posterior (extensor-supinador) del antebrazo y tiene gran importancia en el cierre del puño. Hay pocos estudios biométricos con respecto al punto de origen de sus ramos de inervación, así como sobre la distribución de los mismos. Basado en lo anterior, se estudiaron 30 miembros superiores, formolizados, de individuos adultos Brasileños, de la Facultad de Medicina de la Universidad Estadual de Ciencias da Saúde de Alagoas, Maceió, Brasil. Luego de localizar el nervio, se midió la distancia entre el origen del ramo primario y el de los puntos motores respecto a la línea biepicondílea (LBE), los cuales fueron visualizados y disecados utilizando una lupa. El nervio en cuestión, se observó a nivel del brazo o proximal a LBE en 28 casos (93 %) y los 2 restantes a nivel de esta línea (7 %). Los ramos para el ERLC se originaron a partir del nervio radial, observando un ramo primario en 20 miembros (80 %), y en los restantes 10 (20 %) se observaron 2 ramos primarios, promediando 1,3 ramos (DS 0,5). El origen más proximal del primer ramo primario (RP) independiente de que si existían 1 o 2 fue en promedio 3 cm (DS 1,0) proximal a LBE. El PM más distal, se ubicó distal a LBE en 24 casos con un promedio de 1,9 cm (DS 1,0); localización a nivel de LBE en 3 casos. Sólo en 3 casos el PM más distal se encontró proximal a LBE, en un promedio de 0,8 cm (DS 0,5). La distribución de puntos motores fue variable, ya que muchas veces los RP se bifurcaban en ramos secundarios y éstos, a su vez se dividían hasta 6 veces en ramos terciarios que penetraban en el músculo. El conocimiento biométrico del origen del nervio del MERLC, así como su distribución, es un aporte importante al área anátomo-quirúrgica, así como, su utilización en bloqueos nerviosos, transferencias nerviosas y zonas de ubicación de electrodos con propósitos de estimulación eléctrica en pacientes que necesiten rehabilitar la acción de musculatura extensora radial lesionada.

The extensor carpi radialis longus muscle (ECRLm) is located in the posterior compartment (extensorsupinator) of the forearm and has great importance in the closure of the hand. There are few biometric studies with respect to the point of origin of their branches of innervation, as well as on the distribution of them. For this study, 30 upper limbs, formalized, of Brazilian adult individuals were used, from the Faculty of Medicine of the Universidad Estadual de Ciencias da Saúde de Alagoas, Maceió, Brazil. After locating the nerve, we measured the distance between the origin of the primary branch and that of the motor points with respect to biepicondilar line (BEl), which were visualized and dissected using a magnifying glass. The nerve in question was observed at the level of the arm or proximal to BEl in 28 cases (93 %) and the remaining 2 at the level of this line (7 %). The branches for the ECRLm originated from the radial nerve, observing a primary branch in 20 limbs (80 %), and in the remaining 10 (20 %) two primary branches were observed, averaging 1.3 branches (SD 0.5). The most proximal origin of the first primary branch (PB) independent of whether there was 1 or 2 was on average 3 cm (SD 1.0) proximal to BEl. The most distal MP was distal to BEl in 24 cases with an average of 1.9 cm (SD 1.0); location at the BEl level in 3 cases. Only in 3 cases was the most distal MP found proximal to BEl, an average of 0.8 cm (SD 0.5). The distribution of motor points was variable, since many times the PB bifurcated into secondary branches and these, in turn, could divide up to 6 times in tertiary branches that penetrated in the muscle. The biometric knowledge of the origin of the nerve of the ECRLm, as well as its distribution, is an important contribution to the anatomo-surgical area, as well as its use in nerve blocks, nerve transfers and electrode placement areas for purposes of electrical stimulation in patients they need to rehabilitate the action of injured radial extensor musculature.

A case of extensor pollicis longus (EPL) tendon rupture in an automotive assembly line worker: an ergonomic evaluation through job strain index (JSI) and musculoskeletal risk factor survey

BACKGROUND: We report a case of extensor pollicis longus (EPL) tendon rupture caused by repetitive motions and awkward posture on hand and wrist joints. CASE PRESENTATION: A 47-year-old right-handed man who worked for 15 years in an assembly line at an automotive manufacturing company has been diagnosed with a complete tear of right EPL tendon. We investigated the patient's occupational history in detail and evaluated the tasks ergonomically through musculoskeletal risk factors survey and job strain index (JSI) using the 22 task-related videos recorded by the patient. Three out of the 12 tasks (25%) were identified as high-risk work on the hand and wrist in the musculoskeletal risk factors survey in 2016. Among the 22 tasks analyzed by JSI, 11 tasks (50%) were evaluated as probably hazardous. In addition, he used localized vibration tools in 19 (86.4%) out of 22 tasks. CONCLUSION: We concluded the patient's disease was probably caused by repetitive motion and improper posture of the hand and wrist, and the hand-arm vibration is a possible cause as well.

Effect of Laminoplasty with Reconstructing of Cervical Extensor Attachment on Cervical Spondylotic Myelopathy Involving C2 Segment / 中国康复理论与实践

Objective:To observe the efficacy of laminoplasty with reconstructing of cervical extensor attachment on cervical spondylotic myelopathy (CSM) involving C2 segment. Methods:From March, 2014 to January, 2017, 46 cases with CSM involving C2 accepted surgery in our hospital. They were divided into two groups according to the surgical methods. Control group (n = 21) accepted traditional laminoplasty, while observation group (n = 25) accepted laminoplasty with extensor muscle attachment point reconstruction. They were assessed with Japanese Orthopaedic Association (JOA) spinal scores, cervical range of motion (ROM), cervical curvature, areas of posterior cervical muscles and axial symptoms. Results:There was no significant difference at operative time and intraoperative blood loss (t < 0.863, P > 0.05) between groups. After surgery, the JOA score increased in both groups (F > 24.961, P < 0.001), but there was no significant difference between two groups (t < 0.282, P > 0.05). ROM varied little in both groups (F < 0.931, P > 0.05). The cervical neutral position curvature decreased in the control group (F = 8.241, P < 0.01), but not in the observation group (F = 2.705, P > 0.05). The areas of posterior muscle decreased in control group (t = 2.678, P < 0.05), but not in the observation group (t = 0.854, P > 0.05). The incidence of axial symptoms was less in the observation group than in the control group (Z = -2.192, P < 0.05). Conclusion:Laminoplasty could relieve the spinal compression at C2 segment and promote the recovery of neurological function, and it can do better in cervical curvature and posterior cervical muscle atrophy as combination with reconstruction of extensor muscle attachment, to reduce the axial symptoms.

A single simple position for ultrasound assessment of both common extensor and common flexor origin at the elbow

Abstract Objective: Is to evaluate the simplicity of 90° flexion/neutral position for ultrasonography assessment of both common extensor and common flexor origins in comparison with the standard position. Material and methods: A standard questionnaire was distributed on 50 trainees, rheumatologists with No previous experience or training in ultrasonography. (They) were attending musculoskeletal training workshops at AL-Azhar rheumatology department musculoskeletal ultrasonography unit in 2016. Each participant then (was) asked to practice US examination of both common extensor and common flexor origins in both positions and then fill four questionnaires, two (of which are) for common flexor and (the other) two (are) for the common extensor origins, in the standard and the other proposed single position. Each questionnaire (whose) answer was graded on scale from 0 to 10, includes the following points: Time needed to examine the tendon in minutes, Difficulty in maintaining the probe contact to the skin, Difficulty in getting good image of the tendon, The overall impression of simplicity. Results: Descriptive analysis of the questionnaire results shows that the participants favors the single position in all questionnaire parameters. Comparing means of the four questionnaire parameters in both positions shows highly significant difference in the four parameters at the level of both common flexor and extensor origins in favor of the single position as p > 0.005. Conclusion: The 90 degree flexion/neutral position appears to be simpler than the standard position for ultrasonography assessment of common extensor and common flexor tendons at the elbow.