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Total hand degloving injuries present a significant challenge in treatment, with no consensus yet on the optimal choice of flap for coverage. Functional reconstruction necessitates careful consideration of syndactyly release, particularly after flap coverage. A 64-year-old woman sustained a total hand degloving injury and underwent extensive reconstructive surgery. Initially, a free superficial circumflex iliac perforator flap was applied to the thumb, whereas pedicled groin and superficial inferior epigastric artery flaps were used for the remaining fingers. However, partial necrosis at the edges of the pedicled flaps necessitated the adduction of the fingers, followed by suturing the skin flaps closed. This led to the formation of adduction contractures, requiring careful release and skin flap extension for effective syndactyly release. Subsequently, the innovative use of an Ilizarov minifixator was used for the dual purpose of interdigital widening and elongation of the flap. At the 27-month follow-up, the patient demonstrated significant functional recovery of the hand and fingers, showing the effectiveness of this multifaceted surgical approach. Despite some residual flexion contractures, the patient regained the ability to write and perform pinching motions with the thumb and middle finger, expressing satisfaction with the surgical outcome. In conclusion, for a functional reconstruction of the thumb and fingers, the thumb and other fingers should be covered separately. When the fingers are in adduction and there is insufficient skin stock for syndactyly release, using an external fixator to expand the interdigital spaces before the syndactyly release proved to be effective.
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Background: Acute flaccid myelitis (AFM) is a disabling, poliomyelitis-like illness that mainly affects children. Although various surgical interventions are performed for intractable paralysis due to AFM, the timing of surgery and its long-term outcomes have yet to be established, especially for shoulder reconstruction. This study aimed to analyze the midterm outcomes of nonsurgically and surgically treated upper-extremity AFM and the factors influencing shoulder functional outcomes after surgical reconstruction. Methods: We retrospectively examined 39 patients with AFM in 50 upper extremities between 2011 and 2019. The degree of spontaneous recovery of completely paralyzed muscles was evaluated at a median of 3, 6, and 37 months after the onset of paralysis. Twenty-seven patients with 29 extremities underwent surgery involving nerve transfer, muscle-tendon transfer, or free muscle transfer for shoulder, elbow, and hand reconstruction. Results: Patients with complete paralysis of shoulder abduction at 6 months did not show later recovery. Twenty-two patients with 24 extremities underwent shoulder surgery, and all but 1 were followed for at least 24 months after surgery. Although postoperative shoulder abduction recovery was similar between transfer of the spinal accessory nerve and of the contralateral C7 nerve root to the suprascapular nerve, the outcomes obtained with spinal accessory nerve transfer had more variability, likely related to latent spinal accessory nerve paralysis, shoulder instability related to pectoralis major paralysis, and the type of paralysis. Shoulder abduction recovery was also greatly affected by scapulothoracic joint movement. In contrast, the outcomes of the elbow flexion and hand reconstructions were more consistent and acceptable. Conclusions: All patients had loss of shoulder abduction, and restoration of shoulder function was less predictable and depended on the quality of the donor nerves and recovery of the synergistic muscles. Strict donor nerve selection and additional nerve transfer for shoulder reconstruction are imperative for satisfactory outcomes. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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BACKGROUND: Acute flaccid myelitis (AFM) is a rare debilitating poliomyelitis-like illness characterized by the sudden onset of flaccid palsy in the extremities. The purpose of this study was to report the mid-term clinical course of knee extension in AFM and the effect of contralateral obturator nerve-to-femoral nerve transfer (CONFNT) for restoration of knee extension in AFM. METHODS: Twenty-six patients with lower extremity palsy due to AFM were referred to our clinic for possible surgical reconstruction. Their median age was 4.0 years, and the first evaluation of the palsy was done at a mean of 6 months after paralysis onset. The paralysis ranged from lower limb monoplegia to quadriplegia. The clinical course of knee extension was assessed using the British Medical Research Council (MRC) grading scale and surface electromyography (EMG). Five patients with unilateral paralysis of knee extension underwent CONFNT. RESULTS: The mean follow-up period for 19 limbs with complete paralysis of knee extension (MRC grade M0) in 13 patients who were evaluated for spontaneous recovery was 43 months. No patient who had complete paralysis of knee extension at >6 months and paralysis of the hip adductor muscle had improvement of knee extension to better than M2. Five of the original 26 patients were treated with CONFNT and followed for a mean of 61 months. Two of 5 patients had the CONFNT ≤8 months after paralysis onset and obtained M4 knee extension. Only 1 of the 3 patients with CONFNT performed approximately 12 months after paralysis onset obtained M3 knee extension; the other 2 obtained only M1 or M2 knee extension. CONCLUSIONS: The paralysis of the lower extremity in our patients with AFM was similar to that in poliomyelitis. However, in AFM, spontaneous recovery of knee extension was possible if there were signs of recovery from hip adductor paralysis up to 6 months after paralysis onset. CONFNT may enhance the recovery of knee extension and seems to be a reliable reconstruction for restoring knee extension if performed no more than 8 months after paralysis onset. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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PURPOSE: Trapeziometacarpal (TM) arthrodesis may increase adduction motion of the thumb metacarpophalangeal (MCP) joint, causing radial collateral ligament laxity. Stability of the MCP joint is important to the long-term functional outcome after TM arthrodesis. This study assessed preoperative and postoperative radial collateral ligament laxity using dynamic radiographs to confirm whether laxity was exacerbated after surgery and examined whether there is a relationship between the fixation angle of arthrodesis and the degree of laxity. METHODS: Forty-four thumbs in 33 patients who underwent TM arthrodesis and were followed for at least 5 years were studied. Dynamic radiographs in radial adduction-abduction and palmar adduction-abduction were obtained. We defined the midpoint of arc of motion as the fixation angle of arthrodesis in the radial and palmar planes. We measured the intersection angle between longitudinal axis of the first metacarpal (M1) and that of thumb proximal phalanx (P1). P1M1 angle in a palmar adduction view of dynamic radiographs reflected radial collateral ligament laxity in palmar adduction (adduction P1M1 angle). We subtracted a preoperative adduction P1M1 angle from a postoperative adduction P1M1 angle and defined its value as an exacerbated adduction P1M1 angle. RESULTS: Adduction P1M1 angle increased from 9° ± 5° to 18° ± 10°. The median exacerbated adduction P1M1 angle was 7°. Ten thumbs (23%) developed ulnar subluxation of MCP joint in the palmar adduction view of dynamic radiographs. Among them, two thumbs developed osteoarthritis of MCP joint (5%). Fixation angle of the arthrodesis was a mean of 35° ± 7° and 32° ± 9° in the radial arc and palmar arc planes, respectively. There was a positive correlation between increasing adduction P1M1 angle and TM arthrodesis in an increasingly palmarly abducted position. CONCLUSIONS: Radial collateral ligament laxity of thumb MCP joint was exacerbated after TM arthrodesis. Greater fixation angle in palmar abduction resulted in more laxity of the joint. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
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BACKGROUND: The carpal tunnel syndrome instrument (CTSI) is the most widely used patient-reported outcome measure (PROM) in carpal tunnel syndrome (CTS). However, CTSI is an ordinal-type questionnaire and might have caused misinterpretations of the PROM between surgical outcomes of CTS (Camitz and extra/open carpal tunnel release). PURPOSE: This study aims to convert the CTSI to an interval scale using Rasch analysis (RA) and evaluate the outcome differences between the original and transformed scales. STUDY DESIGN: Prospective control study. METHODS: Four hundred twenty-four patients with 567 CTSs had been interviewed for CTSI perioperatively and treated with either endoscopic/open carpal tunnel release or Camitz tendon transfer. Each CTSI was analyzed for dimensionality, fit statistics, and a transformation of the ordinal-to-interval scale by RA. We compared the two groups perioperative scores of three CTSI versions (original 11-item, modified 8-item, and transformed 8-item). RESULTS: Based on the RA, the original CTSI was not unidimensional. We identified two dimensions. After removing misfit items, the perioperative course of each score by three versions of each dimension was compared (Repeated 2-factor analysis of variance). The transformed interval scales of CTSI provided different assessments of score changes from the ordinal scale of CTSI analyses. CONCLUSIONS: Original CTSI consisted of ordinal scale items that yielded different conclusions than scores converted to interval scale by Rasch analysis. CTSI should convert into an interval scale after reclassifying dimensionality by Latent Factor Analysis and removing misfit items.
Subject(s)
Carpal Tunnel Syndrome , Orthopedic Procedures , Humans , Carpal Tunnel Syndrome/diagnosis , Carpal Tunnel Syndrome/surgery , Prospective Studies , Orthopedic Procedures/methods , Surveys and Questionnaires , Endoscopy/methodsABSTRACT
SUMMARY: Replantation of fingertip amputations restores the original tissue and is the ideal treatment to provide the best aesthetic and functional outcome. However, successful fingertip replantation is considered challenging because it requires supermicrosurgery techniques. This article provides a detailed surgical technique for fingertip replantation and the authors' preferences and recommendations. In the authors' experience, the most important factors for successful fingertip replantation are meticulous vascular dissection, reliable arterial repair, and venous anastomosis to avoid postoperative venous congestion. Proximal arterial dissection until pulsatile bleeding is encountered avoids the zone of vascular injury, and is particularly important in crush or avulsion amputations. Distal arterial dissection is performed until undamaged intima is identified. The authors believe anastomosis to the central artery is reliable even in a Tamai zone II amputation. When an arterial defect is present, the authors recommend using a vein graft to anastomose to the central artery. In addition, the authors highly recommend at least one venous anastomosis to avoid postoperative venous congestion. In Tamai zone I, available veins can be found on the palmar side of the pulp. It is important to search directly below the dermis and remove adipose tissue around the vessels to secure space for anastomosis. The authors consider nerve suture in Tamai zone I and II replantations inessential, because spontaneous sensory recovery can be expected. Postoperative management of venous congestion, spasm in artery, and arterial thrombosis are as important as surgery.
Subject(s)
Amputation, Traumatic , Dissection, Blood Vessel , Finger Injuries , Hyperemia , Humans , Amputation, Traumatic/surgery , Finger Injuries/surgery , Replantation/methods , Fingers/surgery , Fingers/blood supply , Anastomosis, Surgical/methodsABSTRACT
Plexiform schwannoma is an uncommon benign tumour that grows in a plexiform pattern. We report a 47-year-old man with a mass on the palmar aspect of the metacarpophalangeal joint of the right index finger that had been growing gradually for more than 10 years. The mass was palpated from the distal carpal tunnel to the ulnar aspect of the proximal interphalangeal joint of the index finger, with tingling and numbness sensation. The tumour was a multinodular tumour involving the first common palmar digital nerve to the ulnar proper palmar digital nerve. It was resected and reconstructed with a sural nerve graft. Plexiform schwannoma is rare in the digital nerve, with only six cases reported. Generally, classic schwannomas can be enucleated without causing neurologic deficits; however, plexiform schwannoma may require nerve resection. There have been reports of recurrence of plexiform schwannoma; definitive resection and long-term follow-up are necessary. Level of Evidence: Level V (Therapeutic).
Subject(s)
Neurilemmoma , Male , Humans , Middle Aged , Neurilemmoma/surgery , Paresthesia/surgery , Fingers/pathology , Neurosurgical Procedures , WristABSTRACT
The current articles recommended the interfascicular neurolysis for anterior interosseous nerve (AIN) palsy with hourglass-like fascicular constrictions (FCs) detected by ultrasonography or surgical exploration to realign to the fascicular torsion for those who failed to recover spontaneously. We present the case report of spontaneous AIN palsy recovered after conservative treatment; however, ultrasonographic findings showed persistent FCs of AIN in the arm at the beginning, at 6 weeks, and subsequent 3-year follow-ups, even after complete clinical recovery of palsy. This finding calls into question the current notion that AIN paralysis is due to FCs and that neurolysis is the best surgical treatment when spontaneous recovery does not occur for a considerable observation period. Level of Evidence: Level V (Therapeutic).
Subject(s)
Brachial Plexus Neuritis , Humans , Brachial Plexus Neuritis/complications , Brachial Plexus Neuritis/surgery , Constriction , Paralysis/etiology , Paralysis/surgery , Forearm/innervation , Neurosurgical Procedures , Constriction, Pathologic/complications , Constriction, Pathologic/surgeryABSTRACT
We report a case of a missed wooden foreign body in the metacarpophalangeal (MP) joint of the right little finger following a workplace injury. The patient presented to our institution with a persisted pain and limited range of motion of the MP joint 1 week following the injury. Plain radiographs detected no foreign body or fractures. However, detailed examination as ultrasonography (USG) and computed tomography revealed the presence of a foreign body of 10 × 1.5 mm size in the MP joint capsule. The excision of the radiolucent foreign body was performed arthroscopically and was confirmed successful removal using intraoperative USG. The foreign body was recognized as a wooden piece. The patient was immediately pain free postoperatively and regained full range of motion. Arthroscopy can be a practical, reliable method to remove a radiolucent foreign body located in a small joint in a minimally invasive manner, and USG can help surgeons confirm no remnants left.
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PURPOSE: The modified Camitz procedure has been used to improve thumb opposition in patients with severe carpal tunnel syndrome (CTS), although its indications remain controversial. This study compared the functional recovery of thumb opposition following carpal tunnel release with and without a concomitant Camitz procedure. We used the Carpal Tunnel Syndrome Instrument questionnaire (CTSI) and the compound muscle action potential of the abductor pollicis brevis (APB-CMAP) to assess the recovery. METHODS: Five hundred sixty-seven hands underwent surgical treatment for CTS following electrophysiologic studies and the CTSI. The procedures included carpal tunnel release (either endoscopic carpal tunnel release [ECTR] or open carpal tunnel release [OCTR]) and OCTR with a Camitz procedure. One hundred thirty-six patients with absent preoperative APB-CMAP constituted the material of our study. The CTSI and APB-CMAP recoveries between the "ECTR/OCTR group" and the "Camitz group" were compared before surgery and at three, six, and 12 months after surgery. RESULTS: There were no statistically significant differences in recovery between the "ECTR/OCTR group" and the "Camitz group" according to the three scales of CTSI (symptom severity scale, functional state scale, and FS-2 item, buttoning clothes: an alternative test of thumb opposition) and the APB-CMAP. CONCLUSION: Carpal tunnel release procedures resulted in the useful recovery of thumb opposition without the need for Camitz, even if APB-CMAP did not fully recover. The action of the other synergistic muscles acting on the thumb and the sensory recovery may have contributed to the recovery of thumb opposition. The Camitz procedure also may be only rarely indicated for hands affected by severe CTS. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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Objective: This report presents a case of supracondylar femur fracture with finite element analysis and discusses its causes and prevention. Patient and Methods: A 53-year-old man presented with right talar osteonecrosis after osteosynthesis for a talus fracture. A medial femoral condyle-free vascularized bone graft (size, 20 × 12 × 17 mm) from the contralateral femur was performed, including the posteromedial cortical corner. The patient suffered a donor-site supracondylar femoral fracture while standing up from a cross-legged sitting position on the bed on postoperative day 6. The fracture was treated with intramedullary nailing. We analyzed the effects of the location of the bone graft harvest in an intact model using the three-dimensional finite element method (FEM). Results: The talar necrosis and the femur fracture healed. The FEM result revealed that the longitudinal axial pressure had minimal effect on the femur; however, the stress around the bone defect increased with rotation, especially in the posteromedial bone defect model. Conclusion: Harvesting the bone graft should not include the posteromedial corner of the supracondylar femur. The patient should strictly limit the motion of torsional stress, such as standing from a cross-legged sitting position or pivoting turn.
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PURPOSE: An accurate diagnosis of the site and severity of a brachial plexus injury is imperative for selecting the appropriate management. Conventional magnetic resonance imaging (MRI) does not allow for the precise interpretation of preganglionic injuries (pre-GIs), especially intravertebral canal injuries. We developed 4 MRI sequences of conventional 1.5-tesla 3-dimensional T2-weighted turbo spin echo sampling perfection with the application of optimized contrasts using different flip angles evolution (T2-SPACE) images to clearly visualize each component of the brachial plexus. The purpose of this study was to introduce basic normal and pathologic findings of our current MRI approach, focusing on its diagnostic accuracy for pre-GIs. METHODS: We initially examined 119 patients with brachial plexus injuries who underwent surgical exploration by MRI using 4 sequences of the 1.5-tesla 3-dimensional T2-SPACE technique. We obtained coronal, transverse, coronal oblique, and coronal cuts of T2 short time inversion recovery. The images of 595 roots were interpreted by multiple-image synchronizing techniques of the 4 views to precisely interpret the presence of spinal cord edema, numbers of anterior and posterior rootlets, sites of ganglions, meningeal cysts, and the "black line sign" (displaced ruptured dura or bundles of ruptured rootlets). We assessed the accuracy, sensitivity, and specificity of these abnormal findings with regard to diagnosing pre-GIs by comparing surgical exploration. RESULTS: The absence or decreased numbers of anterior and posterior rootlets and displacement of ganglions were definitive evidence of pre-GIs and the other findings, like spinal cord edema, meningeal cysts, and black line signs, were predictive signs. CONCLUSIONS: The synchronizing techniques of the four 1.5-tesla 3-dimensional T2-SPACE images provided high diagnostic accuracy of pre-GIs. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.
Subject(s)
Brachial Plexus , Cysts , Brachial Plexus/diagnostic imaging , Brachial Plexus/injuries , Contrast Media , Humans , Imaging, Three-Dimensional/methods , Magnetic Resonance Imaging/methods , Sensitivity and SpecificityABSTRACT
Background: The purpose of this study was to evaluate the results of arthrodesis with multiple Kirschner (K)-wires and tension band wire for primary osteoarthritis of trapeziometacarpal (TM) joint in female patients aged 40 years or older. Methods: We retrospectively obtained data regarding all female patients 40 years or older who underwent TM joint arthrodesis for TM joint osteoarthritis with K-wires and tension band wire over a 10-year period from 2009 till 2019. Thumb length, active range of motion (ROM) at the metacarpophalangeal (MCP) joint, active ROM of radial and volar adduction and abduction and key pinch strength was measured. Patient-reported outcomes were assessed using a pain and satisfaction questionnaire and the DASH score. We also recorded postoperative complications. Results: The study included 60 thumbs in 49 patients with an average age 60 years and a mean follow-up of 40 ± 21 months. All but one thumb had radiographic evidence of fusion within 6 months and the union rate was 98%. Key pinch strength increased from 2.3 to 4.9 kg after surgery. Total arc of motion in radial adduction-abduction decreased from 16° to 10°. Total arc of motion in volar adduction-abduction decreased from 25° to 9°. One patient experienced attritional rupture of the flexor pollicis longus tendon attributed to a K-wire penetration into the carpal tunnel. Although 46 thumbs (77%) had no or mild hardware-related symptoms, they underwent hardware removal after solid bone union. In 23 thumbs with follow-up period longer than 48 months, two thumbs developed scaphotrapeziotrapezoid joint arthritis and two thumbs developed metacarpophalangeal joint arthritis. Conclusions: We found that arthrodesis with multiple K-wires and tension band wire is a valuable option in the management of trapeziometacarpal joint osteoarthritis in female patients aged 40 years or older. Level of Evidence: Level IV (Therapeutic).
Subject(s)
Bone Wires , Osteoarthritis , Arthrodesis/methods , Female , Follow-Up Studies , Humans , Middle Aged , Osteoarthritis/diagnostic imaging , Osteoarthritis/etiology , Osteoarthritis/surgery , Retrospective StudiesABSTRACT
Purpose: The upper limb single-joint hybrid assistive limb (HAL), a wearable robot that can support elbow flexion and extension motions, was originally used to rehabilitate patients with stroke. We report the preliminary outcomes of serial HAL use for rehabilitation following nerve transfer (NT) for elbow flexion reconstruction in brachial plexus injuries. Methods: Hybrid assistive limb training consisted of virtual and power training courses. Virtual training was started before HAL picked up motor unit potentials (MUPs) from the target muscle through electrodes attached to the skin overlying the original donor muscles. Power training was started after the maturation of MUPs, the stage where the MUPs were strong to be recognized to arise from the target muscles. Hybrid assistive limb assist at this stage was carried out by decreasing the settings in an inversely proportionate manner to the increase in target muscle strength. Fourteen patients underwent HAL training following NT. Eight patients had the intercostal nerve to musculocutaneous nerve (ICN-MCN) transfer, and their postoperative functional outcomes and rehabilitation performance were compared to 50 patients with ICN-MCN transfer who underwent conventional postoperative rehabilitation with electromyographic biofeedback (EMG-BF) techniques. Results: Comparison of the long-term results following ICN-MCN transfer between EMG-BF and HAL groups showed similar follow-up times, elbow flexion range of motion, or power of elbow flexion assessed using the British Medical Council grade, and quantitative measurement using Kin-Com dynamometer. However, the number of rehabilitation sessions was significantly fewer in the HAL than EMG-BF group. Conclusion: HAL training accelerated patients' learning to convert the original muscle function into elbow flexion following NT by replicating elbow flexion during the pre-MUP detection stage and shortening the rehabilitation time. Type of study/level of evidence: Therapeutic IV.
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Background: Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most widely used patient-reported outcome measure (PROM) for assessment of upper extremity disability assessment. However, DASH is a multidimensional measurement with different difficulty levels and ratio apportionment of the items categorised by ordinal scale. This has caused a misinterpretation of the total disability scores. We created a modified DASH adapted to the Rasch model. The aim of this study is to compare the functional recovery and quality of life (QOL) improvement and to assess the validity of the original DASH and modified DASH between C56/C567, C5-8 and total types of brachial plexus injury (BPI) following surgical reconstruction. Methods: A total of 183 BPI patients who underwent reconstructive surgery were evaluated for functional recovery using the range of motion and power of the affected limb, and improvement in QOL with DASH. The collected data were analysed using Rasch measurement theory to detect the misfit items. The original and modified DASH were compared under the three different types of BPI after item reduction by removing the misfit items. Results: There were significant differences in functional recovery between three types of palsy. However, PROM using DASH score with or without misfit items (12 items) did not show any significant differences. Conclusions: DASH is not suitable for comparison of upper extremity disabilities even after being corrected mathematically due to the inclusion of items from many different domains unequally. Therefore, each item of the function (with or without compensation of the uninjured hand), pain and impact to the patients should be evaluated separately. Level of Evidence: Level IV (Prognostic).
Subject(s)
Brachial Plexus , Shoulder , Arm , Brachial Plexus/injuries , Brachial Plexus/surgery , Humans , Psychometrics , Quality of Life , Reproducibility of Results , Shoulder/surgery , Surveys and Questionnaires , Upper ExtremityABSTRACT
Stabilization for displaced dorsoulnar fragments in distal radius fractures is challenging to treat with conventional volar locking plates alone. The integrated compression screw combined with a volar locking plate has been introduced as an additional tool to stabilize the dorsoulnar fragment and has been reported to work effectively. However, the compression screw is unable to stabilize a comminuted dorsal ulnar fragment; therefore, it is necessary to consider using an additional dorsal plate. We have developed a modified surgical technique to stabilize a comminuted dorsal intra-articular fragment by combining the integrated compression screw with a mini-plate as a washer or a buttress.
Subject(s)
Fractures, Comminuted , Radius Fractures , Bone Plates , Bone Screws , Fracture Fixation, Internal/methods , Fractures, Comminuted/diagnostic imaging , Fractures, Comminuted/surgery , Humans , Radius Fractures/diagnostic imaging , Radius Fractures/surgeryABSTRACT
Background: Flexor tendon rehabilitation protocols minimize repair tension by limiting range of movement to prevent tendon rupture. The resultant muscle contracture inhibits finger extension, increases resistance in tendon gliding distally, and progress to proximal interphalangeal (PIP) joint flexion contracture. This study describes our new rehabilitation protocol, the Tension Reducing Muscle Stretch (TRMS), designed to prevent flexor muscle contracture and obtain full distal tendon excursion. Methods: We reviewed retrospectively 14 fingers in 13 consecutive patients with primary repair of complete zone I or II flexor digitorum profundus (FDP) tendon rupture were treated with our protocol between 2007 and 2019. Our rehabilitation following FDP 4-strand repairs consisted of three steps. The first step comprised of exercises from traditional protocols such as Duran, Kleinert, Synergistic-wrist-motion, and Place-and-hold. The second step comprised the TRMS exercise to prevent the onset of muscle contracture. Anatomically, FDP tendons arise from the same FDP muscle belly. TRMS involved placing the affected finger in full passive flexion while unaffected fingers were passively extended to full extension. This made the affected FDP muscle stretched. The final step incorporated the early active flexion motion exercise, in which simple fisting was performed, from a fully extended position. Results: The mean total active motion at the final follow up was 235° (range 170-265). Using the Strickland criteria, eight achieved excellent, four had good, two had fair results. The mean angle of passive extension deficit at the PIP joint at four weeks after surgery was -7° (-30-0), and at the final follow up was -3° (-20-0). No tendon repair was ruptured. Conclusions: This protocol reduced tension in the affected tendon muscle and encouraged tendon excursion distal to the repair site without complications. It allows full tendon excursion and prevents PIP joint contractures.
Subject(s)
Tendon Injuries , Tendons , Humans , Muscle, Skeletal , Range of Motion, Articular , Retrospective Studies , Tendon Injuries/surgery , Tendons/surgeryABSTRACT
Objectives The purpose of this study was to report the functional outcomes of phrenic nerve transfer (PNT) to suprascapular nerve (SSN) for shoulder reconstruction in brachial plexus injury (BPI) patients with total and C5-8 palsies, and its pulmonary complications. Methods Forty-four out of 127 BPI patients with total and C5-8 palsies who underwent PNT to SSN for shoulder reconstruction were evaluated for functional outcomes in comparison with other types of nerve transfers. Their pulmonary function was analyzed using vital capacity in the percentage of predicted value and Hugh-Jones (HJ) breathless classification. The predisposing factors to develop pulmonary complications in those patients were examined as well. Results PNT to SSN provided a better shoulder range of motion significantly as compared with nerve transfer from C5 root and contralateral C7. The results between PNT and spinal accessory nerve transfer to SSN were comparable in all directions of shoulder motions. There were no significant respiratory symptoms in majority of the patients including six patients who were classified into grade 2 HJ breathlessness grading. Two predisposing factors for poorer pulmonary performance were identified, which were age and body mass index, with cut-off values of younger than 32 years old and less than 23, respectively. Conclusions PNT to SSN can be a reliable reconstructive procedure in restoration of shoulder function in BPI patients with total or C5-8 palsy. The postoperative pulmonary complications can be prevented with vigilant patient selection.
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BACKGROUND: Measurement of extremity volume is the most commonly used method for evaluation of lymphedema. However, volumetry would be inappropriate for comparing patients with different physiques, because body-type significantly affects extremity volume. Thus, we cannot evaluate using absolute values. To overcome this problem, we developed a simple index of proportion of the upper-extremity volume to total body volume (upper-extremity volume/total body volume ratio [UVR]) for body type-corrected volume evaluation of upper-extremity lymphedema. The purpose of this study was to compare upper-extremity volume and UVR in nonedematous upper extremities and to establish normative values of UVR in adult women. METHODS: Eighty-five normal female subjects were included in this study. The average age was 38 ± 12 years, and the average body mass index (BMI) was 21.4 ± 2.9. Volumetry of both upper extremities using water displacement method was tested in all subjects. Upper-extremity volume/total body volume ratio was calculated by dividing upper-extremity volume by total body volume. Total body volume was calculated by dividing body weight (g) by body density (g/mL). We used linear regression equation (body density = 1.0560 - 0.0005 × age) to calculate body density. RESULTS: UVR of 170 upper extremities averaged 2.580 ± 0.202%. Although there was significant relationship between upper-extremity volume and BMI, there was no relationship between UVR and BMI. CONCLUSIONS: Although further studies are necessary to establish usefulness of UVR, UVR has a potential to allow better body type-corrected volume evaluation for upper-extremity lymphedema.