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1.
Rev. medica electron ; 43(5): 1445-1455, 2021. graf
Article in Spanish | LILACS | ID: biblio-1352124

ABSTRACT

RESUMEN La parálisis del nervio radial producida por lesiones a nivel del brazo es considerada una parálisis alta, y se caracteriza por presentar la muñeca y los dedos flexionados y el pulgar en aducción con imposibilidad para la extensión de los mismos (muñeca y dedos). Todos los autores coinciden en que, para la extensión de la muñeca, el músculo de elección a transferir es el pronador redondo para el segundo radial. Sin embargo, hay diversidad de criterios sobre la utilización del palmar mayor o del cubital anterior para el extensor común de los dedos, y del palmar menor para el extensor largo del pulgar. Se presentó el caso de un paciente de 31 años de edad, con antecedente de accidente de tránsito y diagnóstico de parálisis radial alta de 18 meses de evolución, en el que se decide tratamiento quirúrgico utilizando el músculo cubital anterior después de una rehabilitación exitosa, obteniéndose excelentes resultados (AU).


ABSTRACT The radial nerve paralysis produced by lesions at the level of the arm is considered a high paralysis, and is characterized by presenting the wrist and fingers flexed and the thumb in adduction with impossibility of extending them (wrist and fingers). All consulted authors agree that, for wrist extension, the elective muscle to transfer is the round pronator for the second radial. However, there are different criteria on the use of the palmar major or anterior ulnar for the common finger extender, and the palmar minor for the long thumb extender. We presented the case of a 31-year-old patient, with a history of traffic accident and diagnosis of 18-month high radial paralysis, in which surgical treatment using the anterior ulnar muscle after a successful rehabilitation was decided, obtaining excellent results (AU).


Subject(s)
Humans , Male , Tendon Transfer/methods , Radial Neuropathy/surgery , Quality of Life , Surgical Procedures, Operative/methods , Tendon Transfer/rehabilitation , Radial Neuropathy/diagnosis
2.
Rev. bras. ortop ; 56(3): 281-290, May-June 2021. graf
Article in English | LILACS | ID: biblio-1288662

ABSTRACT

Abstract Massive irreparable posterosuperior rotator-cuff tears are debilitating lesions that usually require surgical treatment. Even though there is no consensus regarding the best surgical technique, tendinous transfers around the shoulder are the most commonly performed procedures. The latissimus dorsi tendon remains the most commonly used, but different modifications to the original technique have been shown to minimize complications and to improve functional results and satisfaction. Other techniques, such as the transfer of the lower trapezius tendon, are promising and should be considered, especially for patients with isolated loss of external rotation. The present paper is a literary review regarding tendon transfers for irreparable posterosuperior rotator-cuff tears.


Resumo As grandes lesões posterossuperiores irreparáveis do manguito rotador são debilitantes e, de modo geral, requerem tratamento cirúrgico. Embora não haja consenso sobre a melhor técnica cirúrgica, as transferências tendíneas no ombro são os procedimentos mais realizados. O tendão do grande dorsal continua a ser o mais utilizado, mas diferentes modificações na técnica original têm minimizado as complicações e melhorado os resultados funcionais e a satisfação com o procedimento. Outras técnicas, como a transferência do tendão do trapézio inferior, são promissoras e devem ser consideradas, principalmente em pacientes com perda isolada da rotação externa. Este artigo é uma revisão da literatura a respeito da transferência de tendões para tratamento das lesões posterossuperiores irreparáveis do manguito rotador.


Subject(s)
Humans , Shoulder , Tendon Transfer , Rotator Cuff Injuries
3.
Artrosc. (B. Aires) ; 28(3): 204-209, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1348316

ABSTRACT

Introducción: El objetivo de este trabajo es evaluar resultados clínicos y funcionales de pacientes con una rotura irreparable del manguito rotador posterosuperior, sometidos a una transferencia artroscópica del trapecio inferior. Materiales y métodos: estudio de una cohorte retrospectiva de pacientes con roturas irreparables del manguito rotador, en quienes se realizó una transferencia del trapecio inferior asistida por artroscopía. Se evaluó la evolución clínica mediante la ganancia del rango de movilidad del hombro y la disminución del dolor. Del mismo modo, se evaluó la evolución funcional usando el índice de Constant-Murley y la valoración subjetiva del hombro (SSV, por sus siglas en inglés). Resultados: se incluyeron ocho pacientes, con un seguimiento promedio de veintidós meses. Obtuvimos una ganancia estadísticamente significativa de rotación externa de 32°, disminución de 5 puntos en la escala del dolor, aumento de 31 puntos en el score de Constant y un aumento de 38% del SSV. Se registró un aumento de 12° de elevación, sin embargo, este no fue estadísticamente significativo. Dos pacientes presentaron un seroma en el sitio de la cosecha del trapecio, que se resolvió con manejo conservador. Conclusión: la transferencia del trapecio inferior con asistencia artroscópica, en pacientes con rotura irreparable del manguito rotador posterosuperior, es una técnica segura que mejora significativamente la rotación externa y los índices funcionales en este grupo de pacientes. Tipo de estudio: Serie de casos IV


Introduction: The purpose of this study is to compare clinical and functional outcomes of patients with irreparable posterosuperior rotator cuff tears treated by arthroscopic assisted lower trapezius transfer. Materials and methods: retrospective cohort design of patients with irreparable rotator cuff tear, treated by arthroscopy-assisted lower trapezius transfer. The clinical evolution was evaluated according to the gain in the range of shoulder movement and the decrease of pain. Functional outcomes were evaluated using the Constant-Murley score and the subjective shoulder value (SSV). Results: eight patients were included, with average follow-up of twenty-two months. We obtained a statistically significant gain in active external rotation of 32°, 5-point decrease in the pain scale (VAS), a 31-point increase in the Constant score, and a 38% increase in SSV. There was a 12° increase in active forward elevation, however this was not statistically significant. Two patients had a seroma at the trapezius harvest site, which resolved with conservative treatment. Conclusion: arthroscopically assisted lower trapezius transfer in patients with irreparable posterosuperior rotator cuff tears were a safe technique that significantly improves external rotation and functional scores in patients. Type of study: Case series IV


Subject(s)
Adult , Arthroscopy/methods , Shoulder Joint/surgery , Shoulder Joint/injuries , Tendon Transfer , Rotator Cuff Injuries/surgery
4.
Artrosc. (B. Aires) ; 28(3): 227-231, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1348321

ABSTRACT

El objetivo de este artículo es describir un procedimiento que puede ser aplicado en pacientes esqueléticamente inmaduros con el objetivo de realinear el aparato extensor a nivel distal. Se describe en detalle la técnica y se analizan otras alternativas terapéuticas para este escenario. Diseño del estudio: Técnica quirúrgica. Nivel de Evidencia: V


The aim of this article is to describe a procedure that can be applied in skeletally immature patients for distal realignment of the extensor mechanism. The author makes a detailed description of the technique and analyzes therapeutic alternatives for this scenario. Study design: Surgical technique. Level of Evidence: V


Subject(s)
Child , Tendon Transfer , Patellofemoral Joint/injuries , Joint Instability
5.
Artrosc. (B. Aires) ; 28(1): 87-91, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1252456

ABSTRACT

Las transferencias tendinosas son consideradas para mejorar la función de la escápula y restablecer la biomecánica de la cintura escapular en aquellos pacientes con escápula alada que tienen alteración en la funcionalidad y que no han progresado con tratamiento conservador. Existen diferentes técnicas de transferencias tendinosas como parte del tratamiento. En este artículo realizamos una revisión narrativa, además, ilustramos con videos las siguientes técnicas: la triple transferencia tendinosa en parálisis del trapecio y la transferencia del pectoral mayor hacia la escápula en disfunción del serrato anterior


Tendon transfers are used in management of winged scapula refractory to conservative treatment to improve scapula function and reestablish adequate shoulder biomechanics. There are different techniques described for these tendon transfers. In this article we reviewed these techniques, in addition, we illustrate with videos on cadavers the following techniques: triple tendon transfer for trapezius paralysis and pectoralis mayor tendon transfer to scapula for serratus anterior disfunction


Subject(s)
Scapula , Shoulder Joint/pathology , Tendon Transfer , Cadaver
7.
Rev. cuba. ortop. traumatol ; 34(1): e219, ene.-jun. 2020. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1139113

ABSTRACT

RESUMEN Introducción: La ruptura espontánea del tendón de Aquiles es una afección frecuente en los pacientes jóvenes que practican deportes. Cuando no se realiza el diagnóstico inicial, pasa a ser una lesión crónica, donde su diagnóstico y tratamiento es aún más complejo. En la mayoría de estos casos son necesarios los injertos tendinosos. Objetivo: Demostrar la eficacia y resultados clínicos funcionales de la reparación quirúrgica de la ruptura crónica del tendón de Aquiles mediante transferencia del tendón peroneo lateral corto. Presentación del caso: Paciente masculino de 38 años de edad con antecedentes de una caída mientras practicaba deportes. Se constató ruptura crónica del tendón de Aquiles. Se realizó una cirugía a cielo abierto, con transferencia tendinosa del tendón peroneo lateral corto hacia el cabo distal del tendón de Aquiles. Se reforzó la plastia con el tendón del plantar delgado. Se colocó una inmovilización tipo bota para el tobillo con 30o de flexión plantar por seis semanas. Pasado este tiempo, se colocó una bota de marcha y comenzó la deambulación, así como la rehabilitación con apoyo parcial hasta cumplir tres meses. A los seis meses se incorporó a su vida normal con adecuada función del pie y el tobillo. Conclusiones: La reparación quirúrgica de la ruptura crónica del tendón de Aquiles mediante transferencia del tendón peroneo lateral corto constituye un método eficaz y ofrece buenos resultados clínicos y funcionales(AU)


ABSTRACT Introduction: Spontaneous rupture of the Achilles tendon is a frequent condition in young patients who practice sports. When the initial diagnosis is not made, it becomes a chronic injury, consequently, diagnosis and treatment is even more complex. In most of these cases, tendon grafts are necessary. Objective: To demonstrate the efficacy and functional clinical results of the surgical repair of the chronic rupture of the Achilles tendon by transferring the short lateral peroneal tendon. Case report: We report the case of a 38-year-old male patient with a history of a fall while playing sports. A chronic rupture of the Achilles tendon was found. Open surgery was performed, the short lateral peroneal tendon was transferred to the distal end of the Achilles tendon. The plasty was reinforced with the thin plantar tendon. Ankle boot-type immobilization was placed with 30° plantar flexion for six weeks. After this time, the patient received a walker boot, ambulation and rehabilitation began. The latter started with partial support during three months. At six months this patient returned to his normal life with adequate foot and ankle function. Conclusions: Surgical repair of chronic Achilles tendon rupture by transferring the short lateral peroneal tendon is an effective method and offers good clinical and functional results(AU)


Subject(s)
Humans , Male , Adult , Rupture/surgery , Achilles Tendon/injuries , Tendon Transfer/methods , Lateral Ligament, Ankle/transplantation
8.
Acta ortop. mex ; 34(1): 58-64, ene.-feb. 2020. graf
Article in Spanish | LILACS | ID: biblio-1345087

ABSTRACT

Resumen: Las lesiones de plexo braquial pueden afectar de forma muy significativa la función de los pacientes. El tipo de manejo va a depender de la severidad de la lesión como también de la localización anatómica de ésta. Las transferencias tendíneas alrededor del hombro han surgido como una alternativa efectiva de tratamiento y por lo tanto, debemos considerarlas cuando nos vemos enfrentados a pacientes que la podrían requerir. Existen diversas técnicas de transferencia, las que se utilizan con más frecuencia son las transferencias de trapecio superior, de dorsal ancho y de trapecio inferior, cada una con sus indicaciones y objetivos específicos según el tipo de paciente. Estas cirugías tienen como propósito disminuir el dolor producto de la hipotonía y subluxación glenohumeral como también mejorar el rango de movimiento del hombro, logrando que el paciente lleve su mano al plano que requiera para realizar sus actividades de la vida diaria. Presentaremos algunas de las técnicas de transferencia tendínea de hombro más utilizadas asociadas a una revisión bibliográfica y una descripción de nuestra experiencia con estas cirugías.


Abstract: Brachial plexus lesions can significantly affect patient function. The type of management will depend on the severity of the injury as well as the anatomical location. Tendon transfers around the shoulder have emerged as an effective treatment alternative, and therefore we should consider them when faced with patients who might require it. There are various transfer techniques, within which the most frequently used are upper trapezium, latissimus dorsi and lower trapezium transfers, each with its specific indications and objectives depending on the type of patient. These surgeries aim to decrease the pain resulting from the hypotonia and glenohumeral subluxation as well as improve the range of movement of the shoulder, getting the patient to take his hand to the plane that requires to perform his daily life activities. We will provide a description of some of the most commonly used shoulder tendon transfer techniques associated with a bibliographic review and a description of our experience with these surgeries.


Subject(s)
Humans , Shoulder Joint , Birth Injuries , Brachial Plexus/surgery , Brachial Plexus/injuries , Brachial Plexus Neuropathies/surgery , Brachial Plexus Neuropathies/etiology , Shoulder , Tendon Transfer , Range of Motion, Articular , Treatment Outcome
9.
Acta ortop. mex ; 33(5): 333-336, sep.-oct. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1284967

ABSTRACT

Resumen: Introducción: Las luxaciones posteriores de hombro son raras (2%) y se asocian a convulsiones, electrocuciones y traumatismos de alta energía. Pueden presentarse asociadas a una lesión de Hill Sachs reversa. Uno de los principios del tratamiento consiste en la transferencia del tendón subescapular hacia el área de lesión o procedimiento de McLaughlin. Caso clínico: Se expone el caso de un masculino con un defecto de Hill-Sachs reverso tratado con una modificación de la técnica original de McLaughlin. Se reportan los resultados funcionales tras 13 meses de la cirugía. Resultados: Actualmente con un Constant Score de 98 puntos. Discusión: La modificación técnica empleada para el tratamiento quirúrgico de la lesión de Hill Sachs reversa presentada en este paciente demostró bueos resultados funcionales con material de bajo costo.


Abstract: Introduction: Posterior shoulder dislocations are rare (2%) and are associated with seizures, electrocutions and high-energy trauma. They may be associated with a reverse Hill-Sachs lesion. One of the treatment principles consists of the subscapular tendon transfer to the injury area or McLaughlin procedure. Clinical case: A case of a man with a reverse Hill-Sachs defect treated with a modification of McLaughlin's original technique is presented. The functional results after 13 months of surgery are reported. Results: Currently with a Constant Score of 98 points. Conclusion: The technical modification used for the surgical treatment of the reverse Hill-Sachs lesion presented in this patient demonstrated good functional results with low cost material.


Subject(s)
Humans , Male , Shoulder , Shoulder Dislocation/surgery , Tendon Transfer
10.
Rev. bras. ortop ; 54(1): 99-103, Jan.-Feb. 2019. graf
Article in English | LILACS | ID: biblio-1003605

ABSTRACT

Abstract Latissimus dorsi transfer around the shoulder is the most frequently used surgical technique to treat young patients with irreparable posterosuperior rotator cuff lesions. This technique, as initially described and popularized by Gerber et al., has two main drawbacks thatmay predispose to complications and unsatisfactory functional results: 1) postoperative rupture of the origin of the deltoid, as its detachment from the acromion is necessary during the superior approach to the shoulder; and 2) postoperative rupture of the transferred tendon. In an attempt to avoid these problems, the authors have developed the following modifications to the original technique. Through a deltopectoral approach, the latissimus dorsi tendon is identified and detached from the humerus shaft. After being reinforced and elongated with a tendinous allograft, it is transferred around the humerus and fixed to the superolateral aspect of the greater tubercle. No rigid thoraco-brachial immobilization is used postoperatively.


Resumo No contexto do tratamento cirúrgico dos pacientes jovens com lesões irreparáveis da porção posterossuperior do manguito rotador, a técnica mais usada é a transferência do tendão do grande dorsal para a porção superolateral do tubérculo maior, conforme descrita e preconizada por Gerber et al. Entretanto, duas características dessa técnica podemlevar a resultados ruins e complicações: (i) a deiscência da origem do deltoide, que ocorre devido à sua violação durante a criação da via em golpe de sabre e (ii) a ruptura pós-operatória da inserção da transferência. Na tentativa de solucionar esses dois problemas, as seguintes modificações foram feitas à técnica cirúrgica original. Por meio de uma única via deltopeitoral, o tendão do grande dorsal é isolado e desinserido do úmero. Ele é então alongado e reforçado com um enxerto tendíneohomólogo, transferido ao redor do úmero e fixado à porção superolateral do tubérculomaior. Não foi usada imobilização pós-operatória comórtese toracobraquial rígida.


Subject(s)
Orthopedics , Shoulder , Tendon Transfer , Rotator Cuff Injuries , Shoulder Injuries
11.
Article in Spanish | LILACS, BINACIS | ID: biblio-1003009

ABSTRACT

Se presenta un paciente con una extremidad superior gravemente lesionada por arma de fuego. Inicialmente fue tratado con múltiples limpiezas quirúrgicas y colocación de tutor externo AO. El tratamiento definitivo consistió en tutor externo monolateral, además de injerto estructural de cresta ilíaca. Durante el manejo inicial, se detecta lesión del nervio radial, con nervio en continuidad. Dado el proceso cicatricial y la infección de partes blandas, no se logra manejar en la etapa aguda. Posteriormente se realizan transferencias tendinosas para nervio radial. La evolución fue favorable y la función de la extremidad superior resultó satisfactoria. Se comunica este caso debido a su complejo manejo a causa de las lesiones óseas, neurovasculares, cutáneas y de partes blandas. Nivel de Evidencia: IV


We present a patient with a severely injured upper extremity due to a shotgun. Patient was initially managed with multiple surgical debridements and an external AO fixator. Final treatment was performed with a monolateral external fixator in addition to a iliac crest structural graft. During initial management, a radial nerve injury was observed; the nerve was intact, though devitalized. Given the scarring process and soft tissue infection, treatment was performed in the acute phase. Subsequently, tendon transfers were made to treat a radial nerve injury. Patient evolved favorably and regained adequate function of the upper extremity. This case is presented due to its complex management due to bone, neurovascular, skin, and soft tissue involvement. Level of Evidence: IV


Subject(s)
Adult , Arm Injuries , Tendon Transfer , Wounds, Gunshot , External Fixators , Fractures, Open , Humeral Fractures
12.
Article in English | WPRIM | ID: wpr-739754

ABSTRACT

BACKGROUND: Latissimus dorsi (LD) tendon transfer is used as a treatment option for massive irreparable posterosuperior rotator cuff tears, and recently, an arthroscopic-assisted technique was introduced. This study was undertaken to evaluate the clinical and radiological outcomes of arthroscopic-assisted LD tendon transfer for the management of irreparable rotator cuff tears in active middle-aged patients. METHODS: The records of five patients (two males) with irreparable tears involving the supraspinatus and infraspinatus tendons managed by arthroscopic-assisted LD tendon transfer were retrospectively reviewed. Clinical outcomes were assessed using the visual analogue scale (VAS) pain scale, American Shoulder and Elbow Surgeon's (ASES) scores, the University of California Los Angeles (UCLA) scale, and ranges of motion. Postoperative integrities of transferred tendon were evaluated by magnetic resonance imaging in 4 patients and by ultrasound in one. RESULTS: Mean patient age was 55 years (range, 48–61 years), and mean follow-up period was 20 months (range, 12.0–27.2 months). Mean VAS score significantly improved from 6.6 ± 2.6 preoperatively to 1.8 ± 2.5 postoperatively (p=0.009), mean ASES score increased from 67.6 ± 9.2 to 84.6 ± 15.1, and mean UCLA score from 18.0 ± 1.4 to 28.8 ± 8.5 (all p<0.001). Postoperative imaging of the transferred LD tendon showed intact repair in 4 patients. The remaining patient experienced LD transfer rupture and a poor outcome. CONCLUSIONS: Arthroscopic-assisted LD tendon transfer improved shoulder pain and function in patients with massive, irreparable rotator cuff tears, and may be an option for this condition, especially in physically active patients.


Subject(s)
California , Elbow , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Retrospective Studies , Rotator Cuff , Rupture , Shoulder , Shoulder Pain , Superficial Back Muscles , Tears , Tendon Transfer , Tendons , Ultrasonography
13.
Rev. Col. Bras. Cir ; 46(2): e2151, 2019. graf
Article in Portuguese | LILACS | ID: biblio-1003092

ABSTRACT

RESUMO O objetivo deste trabalho é descrever, em cadáver, a técnica de transferência do tendão longo do bíceps para o tratamento da instabilidade anterior do ombro. Nesta técnica, o tendão longo do bíceps braquial é desinserido do tubérculo supraglenoidal e transferido para a borda anterior da cavidade glenoidal, através da tenotomia do subescapular, reproduzindo o efeito tirante e aumentando o batente anterior. A técnica é de fácil execução, minimizando os riscos da transferência do processo coracoide e pode ser uma opção para o tratamento da instabilidade glenoumeral.


ABSTRACT Our objective is to describe the long biceps tendon transfer technique for the treatment of shoulder anterior instability. In this procedure, the long tendon of the biceps brachii is detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity through a subscapularis tenotomy, reproducing the sling effect and increasing the anterior block. The technique is easy to perform and minimizes the risks of the coracoid process transfer. In conclusion, the transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.


Subject(s)
Humans , Shoulder Joint/surgery , Tendon Transfer/methods , Tendons/surgery , Rotator Cuff/surgery , Tenotomy/methods , Joint Instability/surgery , Reproducibility of Results , Treatment Outcome , Medical Illustration
14.
Article in English | WPRIM | ID: wpr-741556

ABSTRACT

Temporalis tendon transfer is a technique for dynamic facial reanimation. Since its inception, nearly 80 years ago, it has undergone a wealth of innovation to produce the modern operation. Temporalis tendon transfer is a relatively minimally invasive technique for the dynamic reanimation of the paralyzed face. This technique can produce significant and appropriate movement of the lateral oral commissure, more closely mimicking the normal side. The aim of this article is to review the technique of temporalis tendon transfer involving transferring of the coronoid process of the mandible with the insertion of the temporalis tendon via intra-oral and transcutaneous approach.


Subject(s)
Mandible , Tendon Transfer , Tendons
15.
Article in English | WPRIM | ID: wpr-716771

ABSTRACT

Malignant peripheral nerve sheath tumor (MPNST) is a very rare type of sarcoma, with an incidence of 0.001%. MPNST has a 5-year survival rate near 80%, so successful reconstruction techniques are important to ensure the patient's quality of life. Sarcoma of the forearm is known for its poor prognosis, which leads to wider excision, making reconstruction even more challenging due to the unique anatomical structure and delicate function of the forearm. A 44-year-old male presented with a large mass that had two aspects, measuring 9×6 cm and 7×5 cm, on the dorsal aspect of the right forearm. The extensor compartment muscles (EDM, EDC, EIP, EPB, EPL, ECRB, ECRL, APL) and invaded radius were resected with the mass. Tendon transfer of the entire extensor compartment with skin defect coverage using a 24×8 cm anterolateral thigh (ALT) perforator free flap was performed. The patient was discharged after 18 days without wound complications, and has not complained of discomfort during supination, pronation, or wrist extension/flexion through 3 years of follow-up. To our knowledge, this is the first report of successful reconstruction of the entire forearm extensor compartment with ALT free flap coverage after resection of MPNST.


Subject(s)
Adult , Follow-Up Studies , Forearm , Free Tissue Flaps , Humans , Incidence , Male , Muscles , Neurilemmoma , Peripheral Nerves , Prognosis , Pronation , Quality of Life , Radius , Sarcoma , Skin , Supination , Surgical Flaps , Survival Rate , Tendon Transfer , Tendons , Thigh , Wounds and Injuries , Wrist
16.
Rev. chil. ortop. traumatol ; 58(2)ago. 2017. ilus
Article in Spanish | LILACS | ID: biblio-909916

ABSTRACT

La rotura espontanea del tendón extensor largo del pulgar (ELP), es una patología infrecuente existiendo casos reportados en la literatura donde no se logra encontrar factores predisponentes. El manejo quirúrgico suele realizarse utilizando una técnica de transposición tendínea del tendón del extensor propio del índice. En la actualidad, la técnica anestésica de WALANT "Wide Awake Local Anesthesia with No-Torniquet" ha sido de amplio desarrollo en la cirugía de la mano, sobre todo para la resolución quirúrgica de patología de tendones, con buenos y excelentes resultados. Se presenta un caso de un paciente con rotura espontánea del tendón ELP, que fue manejado con una transferencia tendínea utilizando la técnica anestésica WALANT.


The spontaneous rupture of thumb extensor pollicis longus (EPL) is a rare disease with just a few case reports known where no trigger factor has been found. The surgical management is done by the proper index extensor tendon transposition. Nowadays, the WALANT anesthetic technique ("Wide Awake Local Anesthesia with No-Torniquet") has had a broad development in hand surgery, especially in surgery for tendon injuries, with good and excellent results. A clinical case is shown with a patient who had a spontaneous EPL rupture which was managed with a tendon transfer under the WALANT anesthetics technique.


Subject(s)
Humans , Male , Adult , Anesthesia, Local/methods , Tendon Injuries/surgery , Tendon Transfer/methods , Thumb , Rupture, Spontaneous
17.
Acta ortop. mex ; 31(2): 61-66, mar.-abr. 2017. graf
Article in Spanish | LILACS | ID: biblio-886537

ABSTRACT

Resumen: La transferencia del tibial posterior al centro del dorso del pie es un método que se utiliza para lograr la dorsiflexión en parálisis flácida de la musculatura anteroexterna de la pierna o para contrarrestar el desequilibrio muscular del pie equino varo. Objetivo: Describir los resultados funcionales después del procedimiento quirúrgico de transposición del tibial posterior al centro del pie. Material y métodos: Estudio observacional, descriptivo, transversal y ambispectivo con una descripción del universo de trabajo en pacientes con deficiencia de la musculatura dorsiflexora del pie y afectación de la marcha en el período de Enero de 2008 a Diciembre de 2014. Resultados: Se obtuvo un total de 18 pacientes. Discusión: Creemos que este estudio podría considerarse como generador de hipótesis sobre si representa una alternativa superior a la artrodesis. Para ello proponemos continuar estudios en esta rama con mayor cantidad de evaluaciones en el preoperatorio y postoperatorio para obtener resultados más objetivos y con un grupo más amplio de individuos.


Abstract: The transfer of the posterior tibial tendon to the center of the dorsum of the foot is a method used to achieve dorsiflexion in flaccid paralysis of the anterolateral leg muscles or muscular imbalance of clubfoot. Objective: To describe functional results back to the surgical procedure for transposition of posterior tibial the center of the foot. Material and methods: The study design was observational, descriptive, transversal, ambispective with a description of the world of work patients with impaired dorsiflexora foot muscles and impaired gait in the period January 2008 to December 2014. Results: A total of 18 patients who were candidates for what this type of treatment was obtained. Discussion: We believe that this study can be estimated as generating hypotheses about whether it is a superior alternative to arthrodesis. For this plan to continue studies in this field, with an increased number of assessments both before and after surgery to have more objective results and a greater number of individuals.


Subject(s)
Humans , Adult , Arthrodesis , Clubfoot/surgery , Neuromuscular Diseases/surgery , Tendon Transfer , Foot
18.
Rev. Asoc. Argent. Ortop. Traumatol ; 82(3): 182-188, 2017. []
Article in Spanish | LILACS, BINACIS | ID: biblio-869366

ABSTRACT

Introducción: el objetivo del trabajo fue realizar una valoración clínico-radiológica de pacientes con rupturas masivas e irreparables posterosuperiores del manguito rotador tratadas con transferencia del dorsal ancho. Materiales y Métodos: Estudio retrospectivo, descriptivo, de observación. Se incluyeron pacientes <70 años con lesión masiva e irreparable posterosuperior del manguito rotador tratados con transferencia del dorsal ancho y un seguimiento mínimo de 2 años. Se valoró la movilidad y la fuerza en abducción. Se emplearon la escala analógica visual y la de Constant-Murley modificada. En las radiografías, se analizaron la distancia acromiohumeral y el grado de artropatía. Resultados: Se incluyeron 17 pacientes (12 hombres, 5 mujeres; edad promedio: 54 años [rango 34-65]). El seguimiento promedio fue 46 meses (rango 24-71). En el grupo de cirugía primaria, la ganancia de movilidad promedio en flexión anterior fue de 53º, en abducción de 50º y en rotación externa de 19º. La fuerza en abducción registró una ganancia promedio de 1,4 kg. La escala de Constant-Murley modificada fue de 75,6 (rango 63-80) al final del seguimiento. En las cirugías de revisión, la ganancia de movilidad activa en flexión anterior fue de 48º, en abducción de 30º y en rotación externa de 10º. La fuerza en abducción tuvo una ganancia promedio de 1,1 kg. La escala analógica visual posoperatoria mejoró 5,1 puntos en el grupo con cirugía primaria y 3,4 en el otro grupo. Conclusión: La transferencia del dorsal ancho para lesiones posterosuperiores del manguito rotador mejoró el rango de movilidad, la fuerza, la función del hombro y alivió el dolor.


Introduction: the aim of the study was to analyze the clinical and radiological outcomes of a series of patients with massive ruptures of the rotator cuff treated with latissimus dorsi tendon transfer. Methods: A retrospective, descriptive and observational study was performed. Patients <70 years with massive and irreparable posterosuperior lesions of the rotator cuff were treated with latissimus dorsi transfer and with a minimum follow-up of 2 years. Range of motion and strength in abduction were assessed. In addition, the visual analogue scale and modified Constant-Murley scale were recorded. Acromio-humeral distance and arthropathy stage were radiographically analyzed. Results: Seventeen patients were included (12 males, 5 females), mean age 54 years (range 34-65), with a mean followup of 46 months (range 24-71). In the primary surgery group, the average motion gain was 53º in anterior flexion, 50º in abduction and 19º in external rotation. The abduction strength recorded an average gain of 1.4 kg. Modified Constant-Murley scale of 75.6 (range 63-80) at the end of follow-up. In the revision surgery group, the gain of active motion was 48º in anterior flexion, 30º in abduction and 10º in external rotation. Abduction strength had an average gain of 1.1 kg. Postoperative visual analogue scale improved 5.1 points in the primary surgery group and 3.4 in the other group. Conclusion: Latissimus dorsi tendon transfer for the treatment of massive posterosuperior rupture of the rotator cuff showed improvements in range of motion, strength, pain relief and shoulder function.


Subject(s)
Humans , Adult , Shoulder Joint/surgery , Shoulder Joint/injuries , Rotator Cuff Injuries/surgery , Rotator Cuff/surgery , Tendon Transfer/methods , Retrospective Studies , Range of Motion, Articular , Recovery of Function
19.
Hansen. int ; 42(1/2): 19-27, 2017. tab
Article in Portuguese | SES-SP, LILACS, SES-SP, CONASS, HANSEN, HANSENIASE, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: biblio-1150307

ABSTRACT

Esse estudo tem por objetivo avaliar a capacidade funcional da mão das pessoas atingidas pela hanseníase na realização das atividades básicas e instrumentais da vida diária. A amostra foi constituída por 50 pacientes, maiores de 18 anos, que estavam sendo acompanhados no ambulatório do Instituto Lauro de Souza Lima. Para avaliação das características sociodemográficas e clínicas foi elaborado um questionário próprio. As dificuldades manuais para realizar atividades nas áreas de vestuário, alimentação, higiene pessoal, cuidados com a casa, escrita e outros foram avaliados por meio da Avaliação Funcional das Mãos em Hanseníase. Os resultados demonstram que em todas as atividades houve algum grau de dificuldade, porém, a maioria dos pacientes as realiza com independência. As atividades consideradas mais difíceis de serem executadas pelos pacientes com garra ulnar foram: pegar objetos pequenos em superfície plana, abrir/fechar fecho de corrente e cortar unhas. Na população de pacientes com garra ulnar/mediano foram: pegar objetos pequenos em superfície plana, abotoar/desabotoar, dar laço/ amarrar cadarço e abrir/fechar fecho de corrente. As atividades são realizadas com algum grau de dificuldade, porém, com independência pela maioria dos indivíduos que tem ou tiveram hanseníase e apresentam deformidades visíveis. Muitas dessas dificuldades podem ser minimizadas por meio de transferências tendinosas ou pela indicação, confecção e uso de tecnologia assistiva(AU).


This study aims to assess the functional capacity of the hand of people affected by leprosy in carrying out basic and instrumental activities of daily living. The sample consisted of 50 patients, aged over 18, who were being followed up at the outpatient clinic of the Instituto Lauro de Souza Lima. A questionnaire was developed to assess sociodemographic and clinical characteristics. Manual difficulties in carrying out activities in the areas of clothing, food, personal hygiene, home care, writing and others were assessed through the Functional Hand Assessment in Leprosy. The results show that in all activities there was some degree of difficulty, however, most patients perform them independently. The activities considered most difficult to be performed by patients with an ulnar claw were: picking up small objects on a flat surface, opening / closing the chain clasp and cutting nails. In the population of patients with an ulnar / median claw were: picking up small objects on a flat surface, buttoning / unbuttoning, looping / tying shoelaces and opening / closing chain fastening. The activities are performed with some degree of difficulty, however, independently by the majority of individuals who have or have had leprosy and have visible deformities. Many of these difficulties can be minimized by means of tendon transfers or by the indication, preparation and use of assistive technology(AU).


Subject(s)
Humans , Male , Female , Activities of Daily Living , Disabled Persons/rehabilitation , Leprosy/rehabilitation , Self-Help Devices , Tendon Transfer , Ulnar Nerve/injuries , Hand Injuries/rehabilitation , Median Nerve/injuries
20.
Article in Korean | WPRIM | ID: wpr-180217

ABSTRACT

PURPOSE: The spontaneous extensor pollicis longus (EPL) tendon rupture is a well-documented complication of non-displaced or minimally displaced distal radius fracture. Authors analyzed the radiographs of patients treated for closed EPL rupture after distal radius fracture. MATERIALS AND METHODS: Twenty-eight patients (21 females, 7 males; average age of 58 years) with tendon transfer for spontaneous rupture of EPL after distal radius fracture were included. Wrist radiographs were taken at the first visit with EPL rupture. On the lateral view, posterior cortical displacement, distance from highest point in Lister's tubercle to fracture line, and height of the Lister's tubercle were measured. The distance from the lunate facet to the fracture line was measured on anteroposterior view. Radiologic change at the time of EPL rupture around the Lister's tubercle was evaluated by comparing it with the contra lateral wrist radiograph. Radial beak fracture pattern was also identified. RESULTS: The interval between the injury and the spontaneous EPL rupture varied from 2 to 20 weeks, with an average of 6.7 weeks. There were 25 cases of non-displacement, 3 cases of mean 2.0 mm cortical displacement. The average distance from the lunate facet to the fracture line was 9.1 mm (3-12.1 mm), from the highest point in Lister's tubercle to the fracture line was 3.0 mm toward proximal radius (1.7-4.9 mm). The average height of the Lister's tubercle was 3.4 mm in the injured wrist and 3.1 mm in the opposite wrist. Radial beak fracture pattern was shown at 11 cases. CONCLUSION: All cases presented no or minimal displaced fracture, and the fracture line was in the vicinity of the Lister's tubercle. Those kinds of fractures can highlight the possibility of spontaneous EPL rupture, depites its rarity.


Subject(s)
Animals , Beak , Female , Humans , Male , Radius Fractures , Radius , Rupture , Rupture, Spontaneous , Tendon Transfer , Tendons , Wrist
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