Clinical characteristics and treatment analysis of three cases of congenital ulnar collateral flexor contracture of the forearm / 中国修复重建外科杂志

OBJECTIVE@#To report the clinical characteristics and treatment analysis of 3 cases of congenital ulnar collateral flexor contracture of the forearm and take a reference for clinic.@*METHODS@#A total of 3 patients with congenital ulnar collateral flexor contracture of the forearm were admitted between February 2019 and August 2021. Two patients were male and 1 was female, and their ages were 16, 20, and 16 years, respectively. The disease durations were 8, 20, and 15 years, respectively. They all presented with flexion deformity of the proximal and distal interphalangeal joints of the middle, ring, and little fingers in the neutral or extended wrist position, and the deformity worsened in the extended wrist position. The total action motion (TAM) scores of 3 patients were 1 and the gradings were poor. The Carroll's hand function evaluation scores were 48, 55, and 57, and the grip strength indexes were 72.8, 78.4, and 30.5. Preoperative CT of case 2 showed a bony protrusion of the flexor digitorum profundus tendon at the proximal end of the ulna; and MRI of case 3 showed that the ulnar flexor digitorum profundus presented as a uniform cord. After diagnosis, all patients were treated with operation to release the denatured tendon, and functional exercise was started early after operation.@*RESULTS@#The incisions of 3 patients healed by first intention. Three patients were followed up for 12, 35, and 12 months, respectively. The hand function and the movement range of the joints significantly improved, but the grip strength did not significantly improve. At last follow-up, TAM scores were 3, 4, and 4, respectively, among which 2 cases were excellent and 1 case was good. Carroll's hand function evaluation scores were 95, 90, and 94, and the grip strength indexes were 73.5, 81.3, and 34.2, respectively.@*CONCLUSION@#Congenital ulnar collateral flexor contracture is a rare clinical disease that should be distinguished from ischemic muscle contracture. The location of the contracture should be identified and appropriate surgical timing should be selected for surgical release. Active postoperative rehabilitation and functional exercise can achieve good hand function.

Incidencia, funcionalidad y reintegración laboral de pacientes con lesión de sistema flexor de la mano tratados quirúrgicamente en el Hospital Central Militar / Incidence, functionality and labor reintegration of patients with injury to the flexor system of the hand treated surgically at the Hospital Central Militar

Resumen Introducción: Las lesiones de la mano son uno de los padecimientos más frecuentemente atendidos en el Servicio de Cirugía Plástica y Reconstructiva del Hospital Central Militar, dentro de la amplia variedad de estas lesiones se encuentran las lesiones del sistema flexor. Objetivo: Estimar la incidencia, funcionalidad y tiempo de reintegración laboral en pacientes con lesiones de sistema flexor de la mano tratados en el Hospital Central Militar en el periodo del 1º de marzo del 2020 al 1º de marzo del 2022. Metodología: Estudio observacional, retrospectivo, longitudinal descriptivo en pacientes adultos con lesión de sistema flexor de la mano, en los cuales la causa de la lesión no haya condicionado un trauma complejo de la mano. Se utilizó como referencia los criterios de recuperación funcional de Strickland y Goglovac. Resultados: A pesar de que las lesiones de la zona II flexora en la literatura presentan un peor pronóstico para la recuperación de la función normal de la mano, los resultados demuestran que la mayor parte de los pacientes se encuentra en una escala funcional buena. Limitaciones del estudio: El estudio fue llevado a cabo durante el periodo comprendido por la pandemia COVID, por lo que las consultas subsecuentes con tiempos más alargados y el inicio tardío de las consultas de rehabilitación pudieron haber contribuido hacia una recuperación más deficiente de la recuperación funcional de los pacientes.

Abstract Introduction: Hand injuries are one of the conditions most frequently treated in the Plastic and Reconstructive Surgery Service of the Hospital Central Militar, within the wide variety of these injuries are injuries to the flexor system. Objective: To estimate the incidence, functionality and labor reintegration time in patients with hand flexor system injuries treated at the Hospital Central Militar in the period from March 1, 2020 to March 1, 2022. Methodology: Observational, retrospective, longitudinal, descriptive study in adult patients with injury to the flexor system of the hand, in whom the cause of the injury did not result in complex trauma to the hand. The Strickland and Goglovac functional recovery criteria were used as reference. Results: Despite the fact that flexor zone II lesions in the literature present a worse prognosis for the recovery of normal hand function, the results show that most of the patients are in a good functional scale. Limitations of the study: The study was carried out during the period covered by the COVID pandemic, so that subsequent consultations with longer times and the late start of rehabilitation consultations could have contributed to a poorer recovery of functional recovery. from the patients.

Flexor Hallucis Longus Transfer And V-Y Plasty: An Effective Treatment Modality for Chronic Achilles Rupture - A Case Series

@#Introduction: To assess outcomes of FHL transfer and V-Y plasty for chronic Achilles rupture due to insertional Achilles tendinopathy. Materials and methods: A case series of 12 patients was conducted between 1st January 2017 and 31st December 2018. The patients had short flexor hallucis longus tendon transfer with gastrocnemius lengthening by V-Y plasty for Achilles tendon rupture. Patients were allowed full weight bearing at six weeks post-operatively, and were followed up at three months and six months post-operatively, when the range of motion of the ankle was examined, and the outcome was assessed using the EFAS score. Results: Of the 12 patients in the study, the majority were males; the mean age was 50.6±8.96 years. A significant improvement in dorsiflexion and plantarflexion was noted at the six-month follow-up compared to the three-month follow-up (P=<0.001 for both). When compared to the normal side, dorsiflexion and plantarflexion of the affected ankle were significantly less at three months but were comparable at six months post-operatively. A significant improvement was noted in the mean EFAS score at the sixmonth follow-up (25.5±5.71) compared to three months (18.6±0.90) post-surgery (P=0.001). Males were also noted to have significantly higher EFAS scores at their six-month follow-up than females (P=0.022). In contrast, a negative correlation was noted between the European Foot and Ankle Society (EFAS) score at the final follow-up and age (P=0.011). Conclusion: FHL tendon transfer with V-Y plasty in chronic Achilles rupture due to insertional Achilles tendinopathy is an effective procedure resulting in the restoration of the ankle range of motion and improvement in functional scores.

THE CLINICAL AND DEVELOPMENTAL SIGNIFICANCE OF ULNAR ARTERY VARIATION DURING SURGERIES AND MEDICAL INTERVENTIONS

Background – Ulnar artery is a branch of brachial artery,it descends superficially and vertically between the FCU and FDS in lower two third of forearm. Then it passes above the fiexor retinaculum at wrist later forming superficial palmar arch. During routine dissection in S.N Medical College, Agra, an unusual finding was Case Report- identified in both the upper limb of a 60 year old male cadaver. Ulnar artery runs laterally to ulnar nerve and then passes underneath the fiexor retinaculum. Then it joins with the Superficial Branch of Radial Artery to form Superficial palmar arch. Variation of Ulnar artery is uncommon.It is important in surgical cases of Carpal tunnel release surgery, also can be confused with superficial veins during interventions

A 120-second stretch improves postural control and plantar pressure: quasi-experimental study

ABSTRACT BACKGROUND: There are no studies on long-term bilateral calf stretching in relation to balance and plantar pressure. OBJECTIVES: To demonstrate that there is better control of posture and pressures after continuous stretching of the posterior calf muscles. DESIGN AND SETTING: Pre and post-intervention study conducted in a private clinic. METHODS: We measured static footprints and stabilometry before and after continuous passive plantar flexor stretching of duration 120 seconds, among 24 healthy subjects. RESULTS: We found differences in Y displacement with eyes closed (P = 0.010), but not among other variables with eyes closed: X displacement (P = 0.263); surface (P = 0.940); laterolateral speed displacement (P = 0.279); and anteroposterior speed displacement (P = 0.914). There were also no differences in eyes-open variables: X displacement (P = 0.341); Y displacement (P = 0.491); surface (P = 0.167); laterolateral speed displacement (P = 0.852); and anteroposterior speed displacement (P = 0.079). The plantar pressures in the heel (maximum pressure, P = 0.048; mean pressure, P = 0.001) and in the midfoot (maximum pressure, P = 0.004; mean pressure, P = 0.004) were reduced, but not in the forefoot (maximum pressure, P = 0.391; mean pressure, P = 0.225). The surface became larger in the forefoot (P = 0.000) and midfoot (P = 0.021). CONCLUSIONS: Continuous static stretching of plantar flexors for 120 seconds improved stance balance and reduced plantar pressures (maximum and mean) in the rearfoot and midfoot. It also increased the surface in the midfoot and forefoot. TRIAL REGISTRATION: at clinicaltrials.gov, under the number NTC03743168.

Supernumerary muscles in the posterior leg compartment: a case report / Músculos supernumerarios en el compartimento posterior de la pierna: reporte de un caso

SUMMARY: The leg muscles are organized in anterior, lateral and posterior compartments. The posterior compartment is usually divided in two layers: superficial and deep. The deep muscles of the posterior compartment of the leg are known to mainly plantar flexion and toes flexion. In comparison to the other leg compartments, variations of the posterior one are rare. These variants often involve the presence or absence of one or more muscles, and they have differences among origin and insertion, which leads to confusion between anatomists. We aim to describe a case of a male cadaver that possessed three supernumerary muscles in the lateral and posterior compartments of both legs: the peroneus quartus muscle and two accessory bellies of the flexor digitorum longus. This presentation seems to be very rare and scarcely reported in the literature. These variants have the potential of causing nervous or vascular compression, thus leading to tarsal tunnel syndrome or a symptomatic peroneus quartus. The clinical and surgical implications of this abnormal presentation is discussed.

RESUMEN: Los músculos de la pierna están organizados en compartimentos anterior, lateral y posterior. El compartimento posterior por lo general es dividido en dos capas: superficial y profunda. Se sabe que los músculos profundos del compartimento posterior de la pierna se caracterizan principalmente por participar de la flexión plantar y la flexión de los dedos de los pies. En comparación con los otros compartimentos de la pierna, las variaciones musculares en el compartimiento posterior son raras. Estas variantes suelen implicar la presencia o ausencia de uno o más músculos y presentan diferencias en el origen y en la inserción, lo que conduce a confusión entre los anatomistas. Nuestro objetivo fue describir el caso de un cadáver masculino que poseía tres músculos supernumerarios en los compartimentos lateral y posterior de ambas piernas: el músculo fibular cuarto y dos vientres accesorios del músculo flexor largo de los dedos. Esta presentación parece ser muy rara y escasamente reportada en la literatura. Estas variantes musculares tienen el potencial de causar compresión nerviosa o vascular, lo que conduce al síndrome del túnel del tarso o un cuarto músculo fibular sintomático. Se discuten las implicaciones clínicas y quirúrgicas de esta presentación anormal.

Effects of Different Upper Extremity Fixing Approaches on Elbow Flexor Activities and Balance for Stroke Patients / 中国康复理论与实践

Objective:To observe the affected elbow flexor activities and balance of stroke patients in standing and walking as fixing the affected upper extremity with different methods. Methods:From September to December, 2018, 14 stroke patients from Affiliated Suzhou Science ＆ Technology Town Hospital of Nanjing Medical University were included. They were measured elbow flexor contraction ratio (integrated electromyogram of flexor/integrated electromyogram of antagonist) with wireless surface electromyography as standing and walking in normal speed, and sway index with Biodex as standing, in four conditions: the affected arm without fixing, and fixed with elbow orthosis, and with unaffected hand backwards and forwards. Results:The contraction ratio was the most as the arm fixed with elbow orthosis in both standing and walking (F > 2.687, P < 0.05). The sway index was the most as the arm fixed with unaffected hand forwards (F = 21.091, P < 0.05). Conclusion:The elbow orthosis restraint may lead to increased contraction of the affected elbow flexor, which is unsatisfactory to inhibit flexor activity of the upper extremities; while restraint of unaffected hand forwards may lead to instable balance.

Neuromodulation for Flexion of Fingers under Initiative Inadequate of Flexor Digitorum / 中国康复理论与实践

Objective:To observe the characteristics of neuromuscular modulation for fingers flexion under the condition of initiative inadequate of flexor digitorum. Methods:In March, 2019, twelve healthy girls in college were recruited. They were measured strength of grip of right hands with the wrist on neutral position and maximum flexion, and finished 15 times of fingers flexion under 50% maximal voluntary isometric contraction (MVC). The surface electromyography (sEMG) and electroencephalography (EEG) were recorded synchronously, and corticomuscular coherence (CMC) was measured. Results:The strength of grip decreased as wrist maximum flexion compared with that on neutral position (t = 5.757, P < 0.001), as well as mean power frequency of sEMG (t = -2.152, P = 0.043). For dynamic contraction, sEMG amplitude of flexor digitorum was higher than that of extensor (t > 2.964, P < 0.01); while sEMG amplitude of flexor digitorum was more as wrist maximum flexion (t = 4.135, P < 0.001), as well as the CMC (t > 2.203, P < 0.05). Conclusion:Wrist maximum flexion may induce initiative inadequate of flexor digitorum. Cerebral related areas are activated as finger flexion under the condition of initiative inadequate, maybe a kind of compensation.

A Modified Flexor Tendon Suture Technique Combining Kessler and Loop Lock Flexor Tendon Sutures

OBJECTIVES: In the present study, a novel single knot tenorrhaphy was developed by combining the modified Kessler flexor tendon suture (MK) with the loop lock technique. METHODS: A total of 48 porcine flexor digitorum profundus tendons were collected and randomly divided into six groups. The tendons were transversely cut and then repaired using six different techniques, the MK method, double knot Kessler-loop lock flexor tendon suture (DK), and single knot Kessler-loop lock flexor tendon suture (SK), each in combination with the epitendinous suture (P), and the same three techniques without P. Furthermore, by performing the load-to-failure tests, the biomechanical properties and the time taken to complete a repair, for each tenorrhaphy, were assessed. RESULTS: Compared to the MK+P method, DK+P was more improved, thereby enhancing the ultimate tensile strength. The SK+P method, which required fewer knots than DK+P, was easier to perform. Moreover, the SK+P repair increased the force at a 2-mm gap formation, while requiring lesser knots than DK+P. CONCLUSION: As opposed to the traditional MK+P method, the SK+P method was improved and exhibited better biomechanical properties, which may facilitate early mobilization after the repair.

Effectiveness of a modified posterior approach for arthroscopic resection on painful talocalcaneal coalition in adults / 中国修复重建外科杂志

Objective: To investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach. Methods: Between January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness. Results: The operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved ( t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved ( t=-27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up. Conclusion: It is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.

Effects of tenectomy of the medial head of the deep digital flexor on the hindlimbs of healthy horses / Efeitos da tenectomia da cabeça medial do tendão flexor digital profundo nos membros posterior de cavalos saudáveis

The tenectomy of the medial head of the deep digital flexor (TMHDDF) is a minimally studied surgery used in cases of dorsal subluxation of the proximal interphalangeal joint of the hindlimb in horses. The TMHDDF was evaluated in six healthy horses by the degree of lameness, perimeter of the surgical site, the angle of the distal articular joints, and the linear and angular measures of the hoof. Thus, TMHDDF of the right hindlimb was performed and the contralateral limb was used as a control. Both, right and left limbs were evaluated before surgery, as well as at 15, 30, and 60 days after surgery aiming to evaluate the effects of the surgical procedure in healthy limbs. Data were compared by analysis of variance regarding days and limbs. Values below the significant level (P< 0.05) were analyzed using the Tukey's test. TMHDDF caused a mild increase of the toe length and the height of lateral heel (0.2cm in both), as well as a decrease of the angle of the proximal interphalangeal joint (2°) when comparing the left hindlimb to the right hindlimb, 30 and 60 days after surgery. Overall, TMHDDF did not cause significant changes in the evaluated variables up to the 60 days of surgery.(AU)

A tenectomia da cabeça medial do flexor digital profundo (TCMFDP) é uma técnica cirúrgica pouco estudada, indicada para equinos com subluxação dorsal da articulação interfalângica proximal do membro pélvico. A TCMFDP foi avaliada em seis equinos hígidos no grau de claudicação; na perimetria da área operada; nos ângulos articulares distais; e nas medidas lineares e angulares de parâmetros dos cascos. Nesse sentido, foi realizada a TCMFDP do membro pélvico direito, permanecendo o esquerdo como controle. Ambos os membros foram avaliados nos momentos pré-operatório (0) e 15, 30 e 60 dias após a cirurgia, sendo objetivo avaliar os efeitos do procedimento cirúrgico em membros hígidos. Para comparação dos dados entre momentos e membros, foi realizada análise de variância. Os valores inferiores ao de significância (P<0,050) foram submetidos ao teste de Tukey. A TCMFDP provocou discreto aumento (0,2cm, em ambos) do comprimento de pinça e da altura do talão lateral e redução no ângulo da articulação interfalângica proximal (2°) na comparação com o membro pélvico esquerdo aos 30 e 60 dias após a cirurgia no contralateral. Em geral, a TCMFDP não causou alterações influentes nos aspectos avaliados até 60 dias do experimento.(AU)

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.

Protocolo de Durán modificado en rehabilitación precoz de lesiones tendinosas flexoras de la mano / Modified Duran protocol in early rehabilitation of flexor tendon injuries of the hand

OBJETIVOS: conocer la efectividad del Protocolo de Durán Modificado en las Lesiones Tendinosas Flexoras de la Mano determinando el grado de discapacidad funcional en pacientes atendidos por el Servicio de Medicina Física y Rehabilitación del Hospital de Clínicas en el periodo agosto ­ diciembre de 2016. MATERIAL Y MÉTODOS: se incluyeron dos grupos paralelos: al primer grupo (9 pacientes) se aplicó el protocolo de Durán Modificado y al segundo (9 pacientes) el tratamiento rehabilitador convencional. La valoración de la funcionalidad fue a través de la fórmula de Strickland, el sistema de Bruck Gramcko y la Distancia Pulpejo-Palma. Se realizó en 36 sesiones de 30 minutos aproximadamente para cada modalidad terapéutica con la correspondiente evaluación al finalizar los 3 meses de terapia. RESULTADOS: los que realizaron el protocolo de Durán Modificado finalizaron el tratamiento con una funcionalidad excelente en 4 casos, bueno en 3 y regular en 2 según la fórmula de Strickland. Según el sistema de Buck Gramcko la funcionalidad fue excelente para 5 pacientes y regular para 4. Y finalmente con la evaluación de la distancia pulpejo - palma se determinó que 4 pacientes obtuvieron un rango excelente, 4 bueno y 1 regular. CONCLUSIONES: la aplicación del protocolo de Durán modificado como rehabilitación precoz en pacientes con lesiones tendinosas flexoras de la mano es de mayor efectividad que el tratamiento rehabilitador convencional siendo una herramienta que puede ser aplicada de manera temprana en pacientes postoperados por esta afección

OBJECTIVES: to determine the effectiveness of the Modified Duran Protocol on flexor tendon injuries of the hand determining the degree of functional disability in patients treated by the Department of Physical Medicine and Rehabilitation at the Hospital de Clinicas during term August - December 2016.MATERIAL AND METHODS: we included two parallel groups: The Duran Modified protocol was applied on the first group (9 patients) and the Conventional Rehabilitation (9 patients) Treatment on the second. The assessment of the functionality was carried out with the formula Stricklan, Bruck Gramcko System and Pulpejo-Palma Distance. It was conducted in 36 sessions of approximately 30 minutes for each treatment modality with the corresponding evaluation at the end of 3 months of therapy. RESULTS: those who carried out the Modified Duran protocol completed treatment with excellent functionality in 4 cases, good in 3 and fair in 2 according to the formula Strickland. According Gramcko Buck system functionality was excellent for 5 patients and Fair for 4. Finally the evaluation of the pulpejo - palm distance showed that four patients had an excellent range, 4 good and 1 fair. CONCLUSIONS: the application the Modified Duran protocol as immediate rehabilitation in patients with flexor tendon injuries of the hand is more effective than conventional rehabilitation treatment being a tool that can be applied early in patients after surgery for this injury

Efficacy Of Endurance Training On Deep Cervical Flexor Muscles Using Pressure Feedback In Mechanical Neck Pain

Background: Mechanical neck pain is most prevalent in middle age and a common condition affecting 22 % to 70% of the general population. While the exact aetiology of the pain is unknown, most of the mechanical pain is due to mechanical factors such as sprains and strains of the neck muscles or ligaments. Methods: 60 subjects (male 33, female 27) with mechanical neck pain who fulfilled the inclusion criteria were chosen. After baseline evaluation of history, NPRS, cervical range of motion and Deep Cervical Flexor Endurance (DCF), the subjects were allocated into three groups which received DCF training by modifying the use of pressure biofeedback. Group 1 received DCF Training with Visual Pressure Biofeedback 10 repetition for three sets. Group 2 received DCF training without Visual Pressure Biofeedback 10 repetition three sets. And Group 3 received DCF training with Pressure Biofeedback (without visual input) 3 set of 10 repetitions. After 15 days of intervention, post-intervention measures of the variables were obtained. Results: Data were analyzed using SPSS 1 version. Between-group analyses showed that subjects in Group 1 have a statistically and clinically significant improvement (p-value< .005), pain (NPRS), cervical ROM, DCF endurance and Neck Disability Index when compared to the Group 2 and 3. The pre and post values for all the three groups within the group analysis showed a statistical and clinically significant difference. Conclusion: Deep Cervical Flexor Training with Visual Pressure Biofeedback provides better clinical improvement in terms of pain reduction, cervical flexion and extension ROM, DCF endurance, and Neck Disability Index score.

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.

Morphological And Morphometric Study Of Dry Scaphoid Bone In The North Indian Population

Background: A review of the relevant literature showed that previous descriptions of scaphoid were not detailedenough to match our present clinical knowledge or the requirements of modern imaging especially in the NorthIndian population. With this in mind a study was conducted on 50 dry cadaveric scaphoids of North Indianorigin.Material and Methods: The study was performed on 50 dry human scaphoid bones of the North Indian population.Various morphological and morphometric parameters were observed and measured using vernier callipers, anon-stretchable thread, centimetre scales and a protractor.Results: All the morphological parameters studied were present in all the 50 bones except the sulcus for flexorcarpi radialis that was absent in 12 and the ridge for the scapho-capitate interosseous ligament that was absentin 13 bones. The tubercle was conical in 36, pyramidal in 13 and round in the remaining 1 bone. The maximallength of scaphoid and the thickness of waist were significantly higher on the right side. 30 bones had equallydeveloped, 10 bones had under developed proximal while the remaining 10 bones had under developed distalpole. The average value of anteroposterior intra scaphoid angle of 50 scaphoid was found to be 39.20+6.420.Clinical significance: The data obtained in the present study will be helpful for the hand surgeons, radiologists,morphologists and clinical anatomists

Study On Tendinous Connections Between Flexor Hallucis Longus And Flexor Digitorum Longus

Introduction: Flexor Hallucis Longus (FHL) and Flexor Digitorum Longus (FDL) are long flexors of the toes, oftenwith the interconnecting tendinous slips at various points. These interconnecting slips hold great significance inreconstruction surgeries of ankle and foot such as chronic Achilles tendon rupture, posterior tibial tendondysfunction (PTTD) and peroneal tendon rupture. In view of the above this study was aimed to find out varioustypes of connections between tendons of FHL & FDL.Materials and methods: This cross sectional study was carried out in the Department of Anatomy ACSR GovernmentMedical College, Nellore, conducted in a total of 34 lower limbs. Flexor digitorum brevis and abductor hallucismuscles were reflected distally after the removal of the skin, superficial fascia and plantar aponeurosis toexpose FHL and FDL tendons which were examined for the interconnections. Specimens with interconnectionswere photographed and documented.Result: Out of 34 samples, 17 were right sided and 17 were of left sided. Mean foot length was 22.4 ± 1.9 cm. Threetypes of connections i.e. type 1, 4 & 5 were documented at 17 (50%), 16 (47.1%) and 1 (2.9%) type 5 respectively.Type 1 tendinous connections were further classified into 3 sub types i.e. type 1A were 10 (58.8%), type 1B were5(29.4%) and type C were of 2(11.8%).Conclusion: This study finds maximum distribution of type1 interconnections followed by type 4 and sub type 1Aamong type 1. This study also reports for the first time a common origin of 1st lumbrical from distal part oftendinous slip as well as from 1st digital slip of FDL. These interconnections provide stable base and enhancedpropulsion by toes and also act as natural tenodesis

Hamstring Tendon Autograft Contamination in Anterior Cruciate Ligament Reconstruction: Comparison between two Harvesting Techniques / Contaminação de enxertos de tendões flexores na reconstrução do ligamento cruzado anterior: comparação de duas técnicas de retirada

Abstract Objective: To evaluate the contamination rate of hamstring tendon autografts by comparing two different techniques, and to verify whether intraoperative contamination is associated with the development of clinical infection in patients submitted to reconstruction of the anterior cruciate ligament (ACL). Methods: A total of 110 hamstring tendon autograft ACL reconstructions were performed and divided into two groups: 1-hamstring tendon retraction technique; and 2 - technique maintaining the tibial insertion of the hamstring tendon. During the preparation, two graft fragments were sent for culturing; the harvesting time, the preparation time, and the total surgery time were measured. Twenty-four hours after the surgery, the C-reactive protein was assayed. The clinical outpatient follow-up was performed up to 180 days postoperatively. Results: Although there were two postoperative infections, there was no graft contamination or difference between the groups in relation to the graft preparation time and to the 24-hour postoperative C-reactive protein assessment. The classic technique presented a longer graft harvesting time (p = 0.038), and there was no statistical difference between the 2 groups regarding the degree of contamination and consequent clinical infection, although 2 patients in group 2 presented with infection, with negative perioperative cultures. Conclusion: Based on the results obtained, there was no association between graft contamination and the time or technique of its preparation. In addition, there was also no association between intraoperative contamination and the development of clinical infection, nor was there any sign of an association between the early alteration of Creactive protein and the onset of infection.

Resumo Objetivo: Avaliar a taxa de contaminação de autoenxerto de tendões flexores comparando duas técnicas e verificar se a contaminação intraoperatória está associada ao desenvolvimento de infecção clínica em pacientes submetidos a reconstrução do ligamento cruzado anterior. Métodos: Foram feitas 110 reconstruções do ligamento cruzado anterior com tendão dos flexores e divididas em dois grupos: 1) técnica com retirada total dos tendões flexores e 2) técnica que manteve a inserção tibial desses tendões. Durante o preparo, dois fragmentos de cada um desses foram enviados para cultura, sendo mensurado o tempo de retirada dos tendões, do preparo dos tendões e total da cirurgia. Com 24 horas de pós-operatório, foi dosada a proteína C reativa. Seguimento clínico ambulatorial foi realizado de forma protocolada até 180 dias de pós-operatório. Resultados: Apesar de terem sido observadas duas infecções pós-operatórias, não houve contaminação dos enxertos nem diferença entre os grupos emrelação ao tempo de preparo dos enxertos e a proteína C reativa com 24 horas de pós-operatório. A técnica clássica apresentou maior tempo de retirada do enxerto (p = 0,038) e não houve diferença estatística entre os dois grupos no que tange ao grau de contaminação e consequente infecção clínica, embora dois pacientes do grupo 2 tenham tido infecção com culturas perioperatórias negativas. Conclusão: Com base nos resultados obtidos, não houve associação entre contaminação do enxerto com o tempo ou a técnica de sua preparação, tampouco entre a contaminação intraoperatória e o desenvolvimento de infecção clínica ou entre alteração precoce da proteína C reativa e o surgimento de infecção.

Comparative Efficacy of Hip Flexor Muscle Strengthening with Femoral Nerve Stretching and Facet Joint Mobilization for Lumbar Spondylitis

Background: Lumbar Spondylitis (LS) is a common term that denotes degenerative changes that develop in trauma-center patients, specific age groups, and head injury patients. A study done on Indian population reported 60% to 90% of radiological changes of L4 at L5-S1 levels in asymptomatic individuals. These degenerative changes in the lumbar spine may remain asymptomatic or can present as pure axial lumbar pain, lumbar radiculopathy, lumbar myelopathy, or lumbar myeloradiculopathy. So, the aim of the study was to check the effectiveness of hip flexor muscle strengthening, femoral nerve muscle stretching with facet joint mobilization for lumbar spondylitis. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group. Pre-test measurements of the patient were done with the help of two measures - RolandMorris Low Back Pain and Disability Questionnaire for disability and Visual Analog Scale (VAS). Goniometer was used for range motion of lumbar spine movements done in each group. The Subjects in Group-A were given hip flexor muscles strengthening with femoral nerve stretching for lumbar region for 45 minutes for 4 days in a week for four weeks where the subject were sitting. The Subjects in Group-B were given femoral nerve stretching with facet joint mobilization for 45 minutes for 4 days in a week for four weeks where the subjects were in supine and prone position and remain Sreenivasu Kotagiri, Neeti Mathur, Ashwin Kumar. Comparative Efficacy of Hip Flexor Muscle Strengthening with Femoral Nerve Stretching and Facet Joint Mobilization for Lumbar Spondylitis. IAIM, 2019; 6(9): 49-57. Page 50 relaxed with the feet uncrossed. Result analysis was done by Wilcoxon Sum Rank Test (Mann Whitney U Test). Results: On comparing Group A and Group B for post-treatment VAS score and RMQ score, results showed a significant difference (p=0.001) in improvement in terms of VAS and RMQ. The overall study proved that hip flexor muscle strengthening, femoral nerve stretching with facet joint mobilization for lumbar spondylitis in improving Pain and decreasing the disability level in lumbar radiculopathy and reduce tightness subjects. Conclusion: The analysis obtained indicated that Group B (femoral nerve stretching with facet joint mobilization) showed more significant improvement when compared to Group A ( hip flexor muscles strengthening with femoral nerve stretching).

Flexor Carpi Radialis Tendon Rupture due to Repetitive Golf Swing

Flexor carpi radialis (FCR) muscle is located in the forearm anteriorly that runs through a synovial fibro-osseous tunnel in the forearm. We described a case of FCR tendon rupture due to repetitive overuse injury. A 55-year-old man, right-hand dominant, presented with right forearm pain and swelling which started 3 days ago while playing amateur golf. Focal tenderness and bruising over volo-ulnar region of the right forearm were examined. Plain radiographs showed soft tissue edema around lesion area and no detectable fracture. Ultrasonography showed multiple hypoechoic lesions suspected as hematoma of the flexor muscle group. After done magnetic resonance imaging, he was diagnosed with rupture of FCR tendon at proximal origin and strain of flexor digitorum superficialis and palmaris longus muscle. He received compressive dressing and restriction of wrist range of motion for three weeks. Two months later, remaining traces of lesions were observed at the follow-up ultrasonography and the pain disappeared.