bluuebunny/crossref_metadata_2025 huggingface dataset:
An Anatomical study of the mechanical Interactions of Flexor Digitorum Superficialis and profundus and the Flexor Tendon Sheath in Zone 2
Authors: WALBEEHM E. T. , McGROUTHER D. A.
Published: September 2005

The mechanical interactions of tendon loading and motion between FDS and FDP tendons and the distal edge of the A2-pulley (DEA2) were investigated in cadaveric hands.

The FDP tendon showed a two-stranded contrarotational spiral of tendon fibres, their course parallel to the FDS fibres. On loading, the FDP tendon changed cross-sectional shape and the two slips of FDS moved closer together, applying lateral force on the FDP tendon.

The formula DEA2-MCP/proximal phalanx length was calculated as 0.64 ± 0.052 mm/mm. Excursions of bifurca and chiasma were measured relative to the DEA2. In full extension the bifurca was well proximal to the DEA2, the chiasma always distal. In flexion, the chiasma approximated to DEA2 level. Therefore, an additional anteroposterior force should exist at DEA2 level between FDS and the DEA2 on the FDP-tendon. The changes in tendon shape and the lateral- and anteroposterior forces produce a “compressional” mechanism on FDP by FDS which may alter frictional resistance. This mechanism is compared with the Chiropteran tendon locking mechanism.
The Double Sheath System and Tendon Gliding in Zone 2C
Authors: TANG J. B.
Published: September 2005

Anatomical structures, the morphology of gliding tunnel, the gliding amplitude of tendons and the range of finger motion after sheath incision in zone 2C were studied in 40 fingers of ten preserved cadaver hands. The tendon of FDS in zone 2C courses around that of FDP, and FDS serves functionally as a second sheath for FDP. This “double sheath” system in zone 2C accounts for the poor results of tendon repair in zone 2C. The tendon repairs in zone 2C glide into zone 2D during finger flexion. Therefore, the condition of the gliding tunnel of zone 2D is also important to the function of tendon repairs in zone 2C. The range of motion was shown to be insignificantly influenced by partial incision of the A2 pulley, and this did not decrease the total strength of the sheath markedly. These suggest that partial incision or enlargement of the A2 pulley can be carried out for tendon repairs in zone 2C without causing mechanical problems of function.
Magnetic Resonance Imaging for Diagnosis of Digital Flexor Tendon Rupture After Primary Repair
Authors: CALANDRUCCIO J. H. , STEICHEN J. B.
Published: September 2005

Because the clinical diagnosis of rupture of a digital flexor tendon was uncertain 10 days after primary repair, magnetic resonance imaging was used for evaluation, correlating precisely with the surgical pathology. This non-invasive tool can be very helpful in the early post-operative period when active flexion is not possible to aid in the clinical diagnosis of tendon rupture.
Early Active Mobilization after Tendon Transfers Using Mesh Reinforced Suture Techniques
Authors: SILFVERSKIÖLD K. L. , MAY E. J.
Published: September 2005

23 tendon transfers in the hand and forearm were performed using a polyester mesh sleeve to reinforce conventional suture techniques. All transfers were mobilized with active flexion and extension within 3 days of operation. Excluding one rupture (due to extreme unintentional loading) and depending on the type of transfer used, a mean of between 69% and 78% of the final active range of motion was obtained 1 month post-operatively. With the exception of transfers for wrist extension, the mean final active range of motion amounted to between 91% and 100% of the available passive range of motion and between 75% and 100% of the corresponding “normal” active range of motion in the opposite hand. The mean final active range of motion after reconstructions for wrist extension amounted to 85% of the passive range of motion and to at least 80% of the maximum range of motion potentially available with the transfers used. The results indicate that early active mobilization after tendon transfers may offer significant advantages in terms of quicker and simpler rehabilitation as well as improved results.
Temporary Use of a Silicone Rod in a Case of Infection Resulting From Tendon Surgery
Authors: BLANCO R. , BLANCO F.
Published: September 2005

A patient was treated by tendon grafting following division of both flexor tendons of a digit. The graft was removed because of infection and a silicone rod was inserted in spite of the suppuration. After the replacement of the implant by a new tendon graft, the final result was satisfactory and the patient recovered good function.
The In Vivo Response of Foetal Tendons to Sutures
Authors: AL-QATTAN M. M. , POSNICK J. C. , LIN K. Y.
Published: September 2005

The in vivo response of foetal flexor digitorum profundus tendons to tendon sutures was studied macroscopically and microscopically in foetal lambs. No tendon adhesions were noted at any of the examination intervals. 4 days after injury, a mild inflammatory reaction was noted around the suture. The tendon examined at the 4-week interval showed evidence of migration of epitenon cells from the outer surface of the tendon into the suture track. The tendon examined at the 6-week interval showed normal tendon fibres surrounding the suture site. Differences between foetal skin and foetal tendon healing are discussed along with the possible role of amniotic fluid in modulating the healing process in the foetus.
Familial Congenital Pseudarthrosis of the Ulna
Authors: CRAIGEN M. A. C. , CLARKE N. M. P.
Published: September 2005

A mother and daughter, both presented with congenital pseudarthrosis of the ulna due to neurofibromatosis. The daughter is one of identical twins, the second twin not having a pseudarthrosis. The mother’s uncle also had pseudarthrosis of the tibia. This suggests a complex variable genetic inheritance pattern for pseudarthrosis in neurofibromatosis. Despite having had no treatment, the mother had minimal symptoms, minimal deformity, and no radial head dislocation.
Treatment of hyperextension injuries to the PIP Joint
Authors: THOMSEN N. O. B. , PETERSEN M. S. , HOVGAARD C.
Published: September 2005

A prospective randomized trial of type 1 hyperextension injuries to the PIP joint treated conservatively by an elastic double-finger bandage or an aluminium splint for 2 weeks showed no differences in the clinical outcome after 6 months.
The Carpal Boss
Authors: FUSI S. , WATSON H. K. , CUONO C. B.
Published: September 2005

Between 1969 and 1989,116 patients were evaluated and treated surgically for symptomatic carpal boss. Their mean age was 32 years and male and female patients were equally affected. 28 patients gave a history of previous injury. Surgical treatment consisted of excision of the localized bony abnormality and the associated degenerative arthritic process to the level of normal articular surfaces and normal adjacent cancellous bone. The mean follow-up period for the patients in this study was 42 months. Complete symptomatic relief was observed in 94% of the patients undergoing surgical treatment. Recurrence or persistence of symptoms developed in seven surgical patients. Six had a second operation with more extensive removal of sclerotic bone and degenerate cartilage, and all patients had relief of symptoms.
Extradigital Glomus Tumour
Authors: TAKEI T. R. , NALEBUFF E. A.
Published: September 2005

We report a case of an extradigital glomus tumour found in the forearm. A review of the literature suggests that extradigital glomus lesions in the upper limb may be more common than they are thought to be.
Flexor Tendon-Pulley Interaction afterTendon Repair
Authors: COERT J. H. , UCHIYAMA S. , AMADIO P. C. , BERGLUND L. J. , AN NK
Published: September 2005

Ten normal ring fingers from ten donors were used to determine the effect of flexor tendon repair on the gliding resistance between the tendon and the A2 pulley. Gliding resistance was measured for the intact FDP tendon and for the same tendon after it was cut transversely and repaired with a 4/0 Ticron core suture and a 6/0 running epitendinous nylon suture. After repair, the gliding pattern of the tendon through the A2 pulley changed significantly. The resistance and the friction coefficient were approximately doubled ( P<0.005).
Transposition of the Ulnar Nerve and Its Vascular Bundle for the Entrapment Syndrome at the Elbow
Authors: MESSINA A. , MESSINA J. C.
Published: September 2005

Surgical findings show important alterations of the extrinsic and intrinsic vascularity of the ulnar nerve in the epitroclear groove. Current procedures are only able to solve the mechanical aspect of nerve compression. Transposition may cause additional iatrogenic ischaemic damage of endoneural vascularity if the nerve is separated from the ulnar collateral artery to achieve anterior mobilization.

Our technique of transposition of the ulnar nerve with its vascular bundle maintains the advantages of anterior transposition currently in use, but is able to preserve the whole vascularity of the nerve, thus solving the biological aspect of nerve compression. This allows quicker recovery of axonal activity that was chronically compromised by the entrapment neuropathy.

The technique and the results in 30 patients (90% excellent and good, 10% fair) treated since 1987 are presented.
A Comparison of Immediate and Delayed Nerve Repair Using Autologous Freeze-Thawed Muscle Grafts in a Large Animal Model
Authors: LAWSON G. M. , GLASBY M. A.
Published: September 2005

Freeze-thawed muscle grafts (FTMG) have been suggested as an alternative to nerve grafts in reconstruction of peripheral nerve defects. This study compares the results of immediate and delayed nerve repair with freeze-thawed muscle graft in a large animal model.

Under general anaesthesia, ten adult sheep underwent excision of 3 cm of the right median nerve. Five had immediate nerve reconstruction with FTMGs (Group A) and five were repaired after 4 weeks (Group B). At 6 months, both the right (repaired) and left (“control”) median nerves of each sheep were assessed.

Nerve blood flow distal to the graft in both groups of repaired nerves was approximately 60% of that in their respective control nerves. Peak nerve conduction velocities were significantly slower in the repaired nerves. The mean fibre diameters of the immediate and delayed repairs were 5.06 and 3.90 μ respectively compared to a control mean of 8.58 μ. G-ratios confirmed that the repaired nerves in both groups were well myelinated.

The authors conclude that the FTMG can be used in delayed as well as immediate nerve reconstruction with minimal impairment of final results.
Tenodesis of Extensor Digitorum in Treatment of Brachial Plexus Injuries Involving C5, 6, 7 and 8 Nerve Roots
Authors: OCHIAI N. , NAGANO A. , YAMAMOTO S. , NAKAGAWA T. , SHIBATA K.
Published: September 2005

Restoration of motor function in the hand is difficult in brachial plexus injuries in which the C5, 6, 7 and 8 roots are involved, because there are insufficient motors available for transfer to restore the extensors of the fingers and wrist. We have used extensor digitorum tenodesis in 11 cases and found it effective and simple.
The Use of Bier's Block for Day Case Surgery
Authors: DUNLOP D. J. , GRAHAM C. M. , WALDRAM M. A. , MULLIGAN P. J. , WATT J. M.
Published: September 2005

With the increasing popularity of day case surgery it is important to ensure that safe and appropriate techniques are being used.

We retrospectively reviewed a large series of 732 patients who underwent planned day case hand surgery under intravenous regional anaesthesia (modified Bier's block) over a 5-year period.

We found a modified Bier's block to be ideally suited to day case surgery with no deaths, minimal morbidity and a success rate in excess of 98%.
Post-Operative Infection Following Hand Surgery
Authors: PLATT A. J. , PAGE R. E.
Published: September 2005

An audit was designed to analyse the risk factors for developing post-operative wound infection following hand surgery. 249 consecutive patients were prospectively entered into the study. 236 (95%) patients were available for follow-up. Infection was diagnosed by clinical criteria. There was an infection rate of 10.7% in elective operations and 9.7% in emergency operations.

There was no significant reduction in infection rate in the elective group with the use of antibiotics ( P=0.5). In the emergency group of patients peri-operative antibiotic administration was associated with an 8.5-fold reduction in infection rate ( P=0.014). The presence of a dirty wound was associated with a 13.4-fold increase in post-operative wound infection rate ( P=0.002).

A postal questionnaire of members of the British Society for Surgery of the Hand revealed a wide variation in antibiotic usage. Guidelines for antibiotic use in patients undergoing hand surgery are presented.
Quantitative Analysis of the Linkage between the interphalangeal Joints of the Index Finger
Authors: HAHN P. , KRIMMER H. , HRADETZKY A. , LANZ U.
Published: September 2005

We have established a simple method of measuring joint motion under physiological conditions. For this purpose we use an ultrasound measuring system employing marker points consisting of miniaturized ultrasound transmitters. This device was tested on a simple biomeehanical model, the linkage of the proximal and distal interphalangeal joints. The angles of these joints were recorded during opening and closing of the fist in 34 index fingers of 17 healthy persons. The results of the measurements were plotted on a rectangular coordinate system. Analysis showed an approximately linear linkage between the IP joints of the index linger. The curve for extension was the same as that for flexion. The linkage varies greatly. On average 1° of PIP joint flexion is equivalent to 0.76° of DIP joint flexion. Our study showed no significant difference between the dominant and non-dominant hand. The results showed that there is a linear linkage between the proximal and distal interphalangeal joints, which is equal for flexion and extension.
Resection Arthroplasty of the Metacarpophalangeal Joints in Rheumatoid Arthritis
Authors: RÜTHER W. , VERHESTRAETEN B. , FINK B. , TILLMANN K.
Published: September 2005

In a retrospective study of resection arthroplasty of the MP joints in rheumatoid arthritis, 23 patients (32 hands, 128 joints) have been followed for 15 to 22 years. Patient satisfaction was high, and all patients had significant pain relief. Active motion of the joints averaged 35°, ranging from full extension to 35° of flexion. Ankyloses developed in five hands (13 joints, 10%). Ulnar deviation of more than 15° occurred in six patients (ten hands, 30%). Over the course of several years a significant remodelling of the joints was to be observed. In six hands (19%) the metacarpal heads became spontaneously restored to ball-shaped geometry. Gross metacarpal resorption was observed in nine hands (30%), causing significant shortening of the metacarpals. In one-third of patients the final result was rated as good, fair and poor, respectively. Careful patient selection is mandatory. Patients with mutilating arthritis should be excluded from the procedure; rheumatoid destruction of the wrist joint definitely influences the final result.
Nerve-Muscle Sandwich Grafts: the Importance of Schwann Cells in Peripheral Nerve Regeneration through Muscle Basal Lamina Conduits
Authors: CALDER J. S. , GREEN C. J.
Published: September 2005

An interposed segment of nerve was used to enhance the distance over which freeze-thawed muscle autografts will support effective peripheral nerve regeneration. Gaps were created in the sciatic nerves of adult Lewis rats. Regeneration through 1 and 1.5 cm freeze-thawed muscle grafts was compared to regeneration through nerve-muscle sandwich grafts in which muscle grafts of equivalent length were divided and a 2 mm segment of the distal nerve sutured between the two halves of the muscle, providing an intermediate depot of Schwann cells. Electrophysiological and morphological evaluation was carried out 40 weeks after operation. Despite lengthening the graft, and having four anastomoses instead of two, this manoeuvre enhanced nerve regeneration over each gap studied and for the 1.5 cm gaps compared favourably with perfect match nerve autografts. In addition, a number of grafts were examined at 7 and 14 days by Sl00 immunohistochemistry. Schwann cell migration was seen to proceed both proximally and distally from the intermediate segment at a rate similar to that from the distal stump. It is concluded that sandwich grafts may prove to be effective alternatives to cutaneous nerve grafts for peripheral nerve reconstruction.
Orientated Mats of Fibronectin as a Conduit Material for Use in Peripheral Nerve Repair
Authors: WHITWORTH I. H. , BROWN R. A. , DORÉ C. , GREEN C. J. , TERENGHI G.
Published: September 2005

This study introduces a new nerve conduit material consisting of orientated strands of the cell adhesive fibronectin. Axonal regeneration, Schwann cell behaviour and the degree of inflammation were quantified using immunohistochemical techniques and computerized image analysis. The results when fibronectin was used to bridge a 1 cm defect in rat sciatic nerve were compared to those with autologous nerve grafts and freeze-thawed muscle grafts used as controls. The nerve grafts supported the highest rate and amount of axonal regeneration in the first 10 days; however, the fibronectin supported a significantly faster rate of growth ( P=0.0008) and amount ( P=0.0001) of axons than the freeze-thawed muscle grafts. From day 15 onwards, the fibronectin and nerve grafts had comparable amounts of regenerating axons and Schwann cells. We conclude that the orientated form of fibronectin is a suitable material for successful nerve repair and has potential clinical use.
Comparison of the Sensory Threshold in Healthy Human Volunteers with the Sensory Nerve Response of the Rat In Vitro Hindlimb Skin and Saphenous Nerve Preparation on Cutaneous Electrical Stimulation
Authors: McALLISTER R. M. R. , URBAN L. A. , DRAY A. , SMITH P. J.
Published: September 2005

We report a comparative study of stimulation thresholds of cutaneous fibres of the rat in vitro skin and saphenous nerve preparation with psychophysical measurements of sensibility to cutaneous electrical stimulation in human volunteers. The same clinical diagnostic stimulator and modified skin electrodes were used in both animal and human experiments. Axons were recruited by increasing the stimulus strength, and correlation was made between the stimulus intensity required for unit activation and their conduction velocities. The findings suggest that an initial “tingling” sensation is due to recruitment of Aβ fibres and that later sharp “pricking” occurs with recruitment of Aδ fibres.
The Functional Results of Ulnar Nerve Repair
Authors: TREVETT M. C. , TUSON C. , de JAGER L. T. , JUON J-M.
Published: September 2005

The subjective, objective and functional outcome following repair of isolated ulnar nerve injuries was assessed in 50 patients, 1 to 7 years after repair. We tried to identify those patients who may benefit from early tendon transfer. This study confirmed a satisfactory functional result in sedentary workers, but not in manual labourers.

Intrinsic muscle power, grip strength, key pinch and sensation continued to improve following repair of high injuries for at least 2 years, and of low injuries for at least 3 years. Early tendon transfers are only recommended in manual workers who complain of poor grip or key pinch.
Radial Tunnel Syndrome
Authors: LAWRENCE T. , MOBBS P. , FORTEMS Y. , STANLEY J. K.
Published: September 2005

Radial tunnel syndrome results from compression of the radial nerve by the free edge of the supinator muscle or closely related structures in the vicinity of the elbow joint. Despite numerous reports on the surgical management of this disorder, it remains largely unrecognized and often neglected. The symptoms of radial tunnel syndrome can resemble those of tennis elbow, chronic wrist pain or tenosynovitis. Reliable objective criteria are not available to differentiate between these pathologies. These difficulties are discussed in relation to 29 patients who underwent 30 primary explorations and proximal decompressions of the radial nerve. Excellent or good results were obtained in 70%, fair results in 13% and poor results in 17% of patients. The results can be satisfactory despite the prolonged duration of symptoms. We believe that a diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment. Patients with occupations requiring repetitive manual tasks seem to be particularly at risk of developing radial tunnel syndrome and it is also interesting to note that 66% of patients with on-going medico-legal claims had successful outcomes following surgery.
A New Technique for Endoscopic Carpal Tunnel Decompression
Authors: TSAI T. M. , TSURUTA T. , SYED S. A. , KIMURA H.
Published: September 2005

A new one-portal technique for endoscopic carpal tunnel release (ECTR) is introduced with its clinical results. The incision is made at the palmar aspect of file hand. A custom-made glass tube with a groove is inserted, and under endoscope observation, a meniscus knife is pushed forward along the groove to release the flexor retinaculum. This new technique has been studied in ten fresh cadaver hands and used in 123 patients' hands. Results of the cadaver study showed that the flexor retinaculum was released completely in all ten hands. No injuries to tendons, nerves, or arteries were noted. In one case the cotton tip was lost from the stick. All clinical releases were performed uneventfully except for three cases of neuropraxia of the digital nerve of the radial side of the ring finger, one laceration of the motor branch of the median nerve, one mild infection, one loss of cotton tip from the cotton swab stick, and one case of chipping of the glass tube. The case with the laceration of the motor branch of the median nerve occurred early in the series and required the conventional open incision to repair the nerve. The cases with loss of cotton from the stick and chipping of the tube also required a conventional incision to remove the cotton and glass chip. Advantages of this one-portal technique with the glass tube include less scar tenderness than with two-portal techniques, decreased risk of injury to the superficial palmar arch and ulnar nerve because of the distal approach, a view of pathology in the carpal tunnel through the glass tube, and confirmation of release of the flexor retinaculum.
Angioleiomyomas of the Hand
Authors: LAWSON G. M. , SALTER D. M. , HOOPER G.
Published: September 2005

We have reviewed a series of 14 angioleiomyomas of the hand. Unlike angioleiomyomas elsewhere, those occurring on the hand are less commonly painful, have an equal sex distribution and are not predominantly of the solid type as seen in the lower limb. We were unable to find a strong association between histological appearance and clinical presentation. We were able to demonstrate nerve fibres within angioleiomyomas, which have not been reported previously.
Vascular Leiomyoma in an Index Finger Undergoing Malignant Transformation
Authors: HERREN D. B. , ZIMMERMANN A. , BÜCHLER U.
Published: September 2005

We report a case of vascular leiomyoma of the pulp of the index finger that recurred twice and underwent malignant change. Ray resection proved to be curative. An extensive literature review is given
Hand Ischaemia Following Radial Artery Cannulation
Authors: LEE K. L. , MILLER J. G. , LAITUNG G.
Published: September 2005

Digital ischaemia following radial arterial cannulation is uncommon. It is usually the result of thrombotic occlusion of a dominant radial artery. However, factors other than arterial thrombosis per se may operate in the critically ill patient to produce digital ischaemia. The following case presentation includes a review of possible mechanisms of digital ischaemia following radial artery cannulation and discusses the therapeutic options available.
Veterinary High Pressure Injection Injuries with Inoculations for Larger Animals
Authors: COUZENS G. , BURKE F. D.
Published: September 2005

Equipment used in the mass vaccination of farm stock is a source of high pressure injection injury. We present four cases due to chicken vaccine, and one due to pig vaccine. Unlike injuries caused by paint or oil guns the vaccination delivers a fixed volume. Although the vaccine is in a mineral oil carrier it appears to elicit little inflammatory reaction in a small dose. The outcome is related to the volume injected. In chicken vaccine the dose is small enough to allow conservative or minimally invasive management. The large volume in pig vaccine requires treatment as for conventional high pressure injection injuries.
Biomechanics of the Human Flexor Tendon Sheath Investigated by Tenography
Authors: MESTER S. , SCHMIDT B. , DERCZY K. , NYARADY J. , BIRO V.
Published: September 2005

Tenography has been performed on eight detached lingers and two intact hands of cadavers. Bulging and overlapping of synovial pockets between the ligamentous structures during flexion, their flattening during extension and the continuous change in expansion of the proximal cul de sac suggests a possible mixing mechanism for the synovial fluid. During flexion and extension a physiological joint-type bowstringing of the flexor tendons was observed at the PIP and DIP joints. This finding supports the theory that the flexor tendon moment arm is increased at these joints.
The Zig-Zag Deformity in Pre-Axial Polydactyly
Authors: LOURIE G. M. , COSTAS B. L. , BAYNE L. G.
Published: September 2005

Most cases of zig-zag deformity following treatment of pre-axial polydactyly have resulted from inadequate reconstruction of bifid bony elements. We report its development after simple suture ligature of the radial component of a bifid thumb in the form of a soft tissue tag at the level of the MP joint. Successful reconstruction has been achieved with the use of similar principles proposed for the more characteristic zig-zag deformity. Parents, paediatricians, and obstetricians should be warned that simple suture ligature of the soft tissue tag may allow the development of a zig-zag deformity and require further reconstruction.
Hand Problems in 100 Vibration-Exposed Symptomatic Male Workers
Authors: Strömberg T. , Dahlin L. B. , Lundborg G.
Published: September 2005

Long-term use of hand-held vibrating tools may induce various types of hand problems. One hundred symptomatic men exposed to vibration from such tools were interviewed and examined with special reference to neurosensory and vasospastic problems. Three distinct symptomatic groups were identified: isolated neurosensory symptoms (48%), isolated vasospastic problems (20%), and combined neurosensory and vasospastic problems (32%). Abnormal cold intolerance (pain and coldness without blanching of the fingers on exposure to cold) occurred in 27% of the patients. Neurosensory problems were more predominant than vasospastic ones, especially during the first 20 years of vibration exposure. Of 80 patients with neurosensory symptoms, only 22 had signs of a carpal tunnel syndrome (CTS). It is concluded that vibration-induced neurosensory and vasospastic symptoms can occur separately or together, and that the neurosensory symptoms are often not due to a CTS.
Rhabdomyosarcoma of the Hand
Authors: Xarchas K. , Papavassiliou N. , Tsoutseos N. , Burke F. D.
Published: September 2005

Two cases of rhabdomyosarcoma (RMS) of the hand are reported.
Variations in the Course of the Thenar Motor Branch of the Median Nerve
Authors: Hurwitz P. J.
Published: September 2005

In a prospective study of 80 operations in 61 patients for carpal tunnel syndrome, special attention was given to the course of the thenar motor branch and its variations. An anomalous origin of the branch was found in 21%. Multiple motor branches occurred in 12.5%. Seventeen patients had operations on both hands, but anomalies were often found in one side only. Special attention is drawn to an additional anomaly where the motor branch lies superficially to the retinaculum buried in a hypertrophic preligamentous muscle. If this anomaly is not borne in mind, the nerve can easily be injured during splitting of the flexor retinaculum. We found this variation in 9% of our patients, but it is rarely mentioned in the literature and in many large series it is not described at all.
Mycobacterial Tenosynovitis of the Flexor Tendons of the Hand
Authors: Regnard P-J. , Barry P. , Isselin J.
Published: September 2005

We present five cases of mycobacterial tenosynovitis of the flexor tendons of the fingers. These cases were observed during the last 12 years and treated by the same surgeon. This pathology is uncommon now, but it is becoming more frequent, especially in patients with diminished immunity. The diagnosis was most commonly made after synovectomy in patients presenting with carpal tunnel syndrome associated with slightly painful swelling at the wrist.

Histological and bacteriological examinations are very important and revealed tuberculosis in four of our patients and mycobacterium in one, and the treatment consists of synovectomy and appropriate antibiotics.

The functional result is usually good, but recurrence is not uncommon. Long-term follow-up is necessary. Local corticosteroid therapy could have a part in the causation of this condition.
Palmar Bands in Rheumatoid Arthritis and Other Chronic Conditions of the Upper Limb
Authors: ELLIOT D. , KHAN J.
Published: September 2005

Palmar prolapse of the flexor tendons as a result of attenuation of the A1 and A2 pulleys occurs in rheumatoid arthritis and other conditions in which the joints of the fingers are chronically flexed. The flexor tendons may be palpable and sometimes visible as longitudinal bands crossing the palm. This can lead to confusion with the palmar bands of Dupuytren's disease. These bands are illustrated in a small series of patients and a serious complication of a misdiagnosis of Dupuytren's disease is presented. The pathogenesis of these palmar bands in rheumatoid arthritis is discussed.
Results of Scaphotrapeziotrapezoid Fusion for Isolated Idiopathic Arthritis
Authors: SRINIVASAN V. B. , MATTHEWS J. P.
Published: September 2005

Scaphotrapeziotrapezoid (STT) joint fusion was carried out for pain relief in eight patients with isolated arthritis. Seven patients had satisfactory relief of symptoms. The subjective results were excellent in five, good in two and bad in one patient, who had non-union of the arthrodesis and was also the only patient to develop trapeziometacarpal arthritis.

Average grip strength was 0.8 and lateral pinch strength was 0.7 of that in the other hand. There was a very small relative difference in dexterity. There was an average difference of 9° of flexion–extension and 13° of radio-ulnar deviation.

It is concluded that for isolated idiopathic STT arthritis, fusion gives very satisfactory results with minimal complications.
Acute Radiocarpal Collapse of Unknown Aetiology
Authors: ten BROEKE R. H. M. , VERHAAR J. A. N.
Published: September 2005

A 23-year-old man presented with spontaneous carpal collapse of his dominant wrist, with radiographic destruction of the lunate, scaphoid and distal radius, for which no cause could be found.
Maintaining the Safe Position in a Palmar Splint
Authors: TAAMS K. O. , ASH G. J. , JOHANNES S.
Published: September 2005

The injured and operated hand is routinely immobilized for a variable period of time in a palmar plaster splint. To minimize subsequent joint stiffness, the preferred position of immobilization of the hand is the “safe position”.

The true position of the hand in a splint was assessed on a lateral X-ray directly after application and just before removal 3 weeks later. It appears that in time the hand in a conventional palmar plaster splint loses its initial position because the bandage stretches. The “double-T” plaster splint maintains the safe position of the hand significantly better than the conventional palmar splint.
Various Manifestations of Hyperphalangism
Authors: GUNAL I. , DURAK T. , OZTUNA V. , SEBER S.
Published: September 2005

Hyperphalangism is a rare congenital anomaly, with an extra phalanx between the phalanges in a finger. About 100 cases have been recorded in the literature. We report 42 cases in six generations of a family with various manifestations.
Subungual Dermatofibroma of the Thumb
Authors: KINOSHITA Y. , KOJIMA T. , FURUSATO Y.
Published: September 2005

We report a rare case of subungual dermatofibroma in a 38-year-old man who was noted to have bulging and thinning of the thumb nail plate. Growth of the nail plate to normal thickness and shape was achieved after surgical removal of the tumour and careful repair of the nail matrix.
Complex Carpal Dislocation
Authors: IRWIN L. R. , PAUL R. , KUMAREN R. , BAGGA T. K.
Published: September 2005

We present an unusual case of carpal dislocation which to our knowledge has not previously been described in any of the current classifications of such injuries. Despite the extensive damage sustained, the case was managed without difficulty and outcome has been very satisfactory.
Rupture of the Extensor Mechanism Associated with a Closed Phalangeal Fracture
Authors: DUBERT T.
Published: September 2005

A case of closed rupture of the extensor mechanism associated with a fracture of the proximal phalanx of the little finger is presented. Diagnosis was made only after surgical exposure for internal bone fixation.
The Effects of Ultrasound Treatment on Flexor Tendon Healing in the Chicken Limb
Authors: GAN B. S. , HUYS S. , SHEREBRIN M. H. , SCILLEY C. G.
Published: September 2005

We report the effects of early and late ultrasound treatment protocols on healing of surgically lacerated zone 2 flexor tendons in a chicken model. Ultrasound was administered directly using a coupling gel. Treatment was shown to increase range of movement, to advance scar maturation and to decrease the amount of inflammatory infiltrate around the repair site. No adverse effects on tensile strength were noted in either group. Early (starting 7 days post-operatively) administration was more effective than late (starting 42 days post-operatively) administration in achieving these effects. These results suggest that ultrasound therapy may be of benefit in the early healing process of flexor tendon lacerations.
Radio-Lunate Arthrodesis for Distal Radial Intraarticular Malunion
Authors: SAFFAR P.
Published: September 2005

Eleven cases of symptomatic distal radial intraarticular malunion were treated by radio-lunate arthrodesis from 1983 to 1991. The mean age was 35.3 years. There were 11 men, all manual workers. The mechanism was usually a high velocity injury. The time elapsed since injury was a mean 23 months (2–109 months).

The range of motion was, on average, flexion 39°, extension 27°, radial deviation 10° and ulnar deviation 20°. Pain was present on light work and grip strength was 45% of the opposite side. The average step-off was 4.4 mm. The scapho-lunate gap was greater than 3 mm in three cases and 5 mm in one case. An ulnar translation of the carpus greater than 4 mm was present in four cases. Posterior subluxation was significant in three cases. The distal radio-ulnar joint (DRUJ) was totally destroyed in three cases, and incongruent in five.

Radio-lunate arthrodesis is performed by a posterior approach. Other procedures were combined, mainly on the DRUJ.

The average follow-up was 28.5 months (8–79 months). Healing was achieved in ten out of 11 cases in 45 to 90 days. Pain was absent or moderate after 4 months. The range of motion was 33° in flexion, 39° in extension, 17° in radial deviation and 29° in ulnar deviation. The average post-operative strength was 57% of the opposite side (19 kg/33). Eight patients returned to their previous work and two to lighter work.
Triradiate Skin Incision for Dorsal Approach to the Wrist
Authors: BARBIERI C. H. , MAZZER N.
Published: September 2005

A new triaradiate skin incision is presented as an approach to the wrist. Centred over Lister’s tubercle, it consists of one longitudinal proximal and two oblique distal rays, making three 120° skin flaps. These provide an excellent triangular operating field to the distal radius, the radio-carpal joint and the carpus itself, allowing for most procedures in this region. There have been no complications in 32 patients, and the cosmetic appearance has been excellent in most of them.
Synovial Osteochondromatosis of the Distal Radio-Ulnar Joint
Authors: von SCHROEDER H. P. , AXELROD T. S.
Published: September 2005

Synovial osteochondromatosis is an uncommon lesion characterized by cartilagenous and osseous metaplasia of joint synovium. It is typically monarticular, affecting large joints such as the knee and hip, although it has also been described in the ankle, elbow and shoulder. It is exceptionally rare in the hand, but has been reported involving the tenosynovium of the digits and the wrist. We report a rare case of synovial osteochondromatosis involving the distal radio-ulnar joint in a 16-year-old man.
Rotation-Angulation Osteotomy in the Hand
Authors: EVANS D. M. , GATELEY D. R. , TELFER J. R. C.
Published: September 2005

The use of a single osteotomy combining both rotation and angulation is described, with a means of achieving the correct angle and direction of the osteotomy. Patients who have been treated by this method are presented.
Sciatic Nerve Regeneration in the Rat after Frozen Muscle Grafting
Authors: DELAERE O. , GUERIT J. M. , VAN WIJCK R.
Published: September 2005

In an experimental study, somatosensory evoked potentials were used to evaluate sciatic nerve regeneration in the rat after 12 mm-long conventional nerve grafting, vascularized nerve grafting and frozen muscle grafting. This experimental method was found to be technically easy and highly reproducible. No statistical difference was found between the three groups concerning amplitude of the negative electrical wave recorded at the cortex level after distal stimulation. Conduction velocities were found to be significantly higher in both the vascularized nerve group and the frozen muscle group, compared with the conventional nerve grafting group. The frozen muscle grafting technique is valuable as it gives good experimental results, is easy to carry out and causes minimal damage to the donor site.
Innervation of the Lumbrical Muscles
Authors: LAURITZEN R. S. , SZABO R. M. , LAURITZEN D. B.
Published: September 2005

It has long been recognized that the first and second lumbricals are normally innervated by the median nerve, whereas the third and fourth lumbricals are innervated by the ulnar nerve (Sunderland and Ray, 1946). However, the courses of the motor nerves, particularly to the first two lumbricals and their loci of insertion, have not been clearly described. Because this information may be useful to a surgeon operating in the palm, we undertook a cadaver study to define more precisely the pathways of innervation of the lumbrical muscles.
Upper Arm Fasciotomy
Authors: MAGINN P. , ELLIOT D.
Published: September 2005

The incisions used for fasciotomy of the upper arm are re-appraised in the light of recent advances in the understanding of the vascular anatomy of the integument of the upper arm, and a new approach is described.
The Effects of a Shortened Postoperative Mobilization Programme after Flexor Tendon Repair in Zone 2
Authors: ADOLFSSON L. , SÖDERBERG G. , LARSSON M. , KARLANDER L-E.
Published: September 2005

The effects of a shortened post-operative mobilization programme following flexor tendon repair in zone 2 in the hand were examined in a prospective, randomized study. 91 digits in 82 patients were included in the study. All injured tendons were repaired within 24 hours and all patients were subjected to the same mobilization programme during the first 6 weeks using a passive flexionactive extension régime. After 6 weeks the patients were randomized into two groups; in group A full activity was allowed after 8 weeks while in group B unrestricted use of the injured hand was not allowed until 10 weeks after the tendon repair. Functional results were compared using the Louisville, Tsuge and Buck-Gramcko assessment systems. Grip-strength was measured 16 weeks after repair, subjective assessment of hand function was recorded on a visual analogue scale, and absence from work was registered. No significant differences were observed between the groups regarding functional results, rupture rates, grip strength or subjective assessment, but absence from work was reduced by 2.1 weeks with the shorter mobilization programme.

Using the described régime, full activity can be encouraged 8 weeks after flexor tendon repair in zone 2 of the hand without adverse effects on functional results or increased risk of rupture of the repair.
Mechanical Strength of Scaphoid Fixation
Authors: NEWPORT M. L. , WILLIAMS C. D. , BRADLEY W. D.
Published: September 2005

We have investigated five devices suitable for scaphoid fixation (ASIF 2.7 mm and 3.5 mm cannulated screws, Herbert, Herbert-Whipple, and Howmedica Universal Compression Screw). The biomechanical properties tested were compression and resistance to cantilever bending. There was no statistically significant difference in compression between devices. There were significant differences in resistance to cantilever bending, with the Howmedica screw being strongest in both failure mode and in ultimate failure strength.
Pre-Operative Distraction Lengthening for Radial Longitudinal Deficiency
Authors: NANCHAHAL J. , TONKIN M. A.
Published: September 2005

Patients treated for total radial aplasia have been reviewed. It was possible to re-align the carpus by radialization in five out of six limbs treated with pre-operative distraction, but in only one out of six treated without distraction.

The average improvement in radial angulation in the non-distraction group was 19° and in the distraction group 38°. The average improvement in radial translation was 16 mm and 17 mm in the two groups respectively.

Pre-operative distraction with the Kessler device permits re-alignment of the hand without skeletal resection or excessive tension on the radial neurovascular structures.
Carpal Tunnel Syndrome in Children and Adolescents with no History of Trauma
Authors: AL-QATTAN M. M. , THOMSON H. G. , CLARKE H. M.
Published: September 2005

Four cases of carpal tunnel syndrome in children and adolescents with no history of trauma are discussed. The pertinent literature and a classification of the different causes of carpal tunnel syndrome in this age group is presented.
Dupuytren’s Disease in Children
Authors: URBAN M. , FELDBERG L. , JANSSEN A. , ELLIOT D.
Published: September 2005

Although Dupuytren’s disease of the hand has been reported in teenagers, it is generally considered to be a disease of adults. A series of nine children who developed Dupuytren’s disease of the hand before the age of 13 years is presented. Eight had surgical removal of the diseased tissue and histological confirmation of the diagnosis before the age of 13 years and one at 14 years of age. The presence of the condition in young children and teenagers is discussed and the literature summarized.
Infantile Haemangiopericytoma of the Hand
Authors: TEMPLETON P. A. , GORDON D. J. , O’HARA M. D.
Published: September 2005

Infantile haemangiopericytomas (IHP) are rare subcutaneous tumours arising from pericytes. Clinically they are difficult to diagnose and pathologically they appear to be locally invasive, but they have a better prognosis than adult haemangiopericytomas. We report a case of IHP affecting the hand of a 7-week-old child that required urgent treatment.
Ulnar Nerve Compression at the Elbow Caused by a Prominent Medial Head of the Triceps and an Anconeus Epitrochlearis Muscle
Authors: O’HARA J. J. , STONE J. H.
Published: September 2005

A number of musculo-tendinous variations around the medial epicondyle have been alleged to cause ulnar nerve compression. Subluxation of the ulnar nerve, a “snapping” separate medial head of triceps, a prominent medial head of triceps covering the ulnar nerve, anconeus epitrochlearis, Osborne’s band, and the ligament of Struthers have been implicated. We present a case of clear-cut compression of the ulnar nerve at two levels just at and posterior to the epicondyle by a tightly applied prominent head of the triceps, and at a more distal level beneath an anconeus epitroch-learis muscle.
A Modified Dorsal Approach to the Wrist for Arthrodesis of the Non-Rheumatoid Wrist
Authors: BIYANI A. , EBRAHEIM N. A. , LU J. , YEASTING R.A.
Published: September 2005

Fourteen cadaveric wrists were dissected to investigate a modified dorsal approach that involved osteotomy of the small and dorsal tubercles without opening the third compartment. This approach could be safely made with good exposure of the dorsum of the wrist. The mean normal angle formed by the extensor pollicis longus tendon at the level of the dorsal tubercle was 144°. An approach that involves division of the third compartment may lead to effective lengthening of the extensor pollicis longus musculotendinous unit by 8 to 17 mm with corresponding decrease in the tension generated by its contraction. The modified approach permits restoration of the normal alignment of the extensor pollicis longus tendon, and may be useful for performing arthrodesis of the non-rheumatoid wrist in young manual workers.
Wrist Arthrodesis Using a Dynamic Compression Plate
Authors: SAGERMAN S. D. , PALMER A. K.
Published: September 2005

In order to determine the effectiveness of wrist arthrodesis using dynamic compression plating and bone grafting, we reviewed 18 consecutive procedures in 17 patients performed using a standardized technique over a 6-year period. Fourteen patients had previously undergone an average of 2.1 operations prior to arthrodesis. Mean follow-up was 48 months. All but one patient reported considerable pain relief and were satisfied with their results. Grip strength remained limited compared to the contralateral wrist. Complications were limited to one case of reflex sympathetic dystrophy and metacarpophalangeal joint contracture, and minor problems related to the bone graft donor site.
Combined Fracture of the Hook of the Hamate and Palmar Dislocation of the Fifth Carpometacarpal Joint
Authors: GARCIA-ELIAS M. , ROSSIGNANI P. , COTS M.
Published: September 2005

A case of fracture of the hook of the hamate associated with a palmar dislocation of the fifth carpometacarpal joint is described. Surgical exploration revealed that the different elements of the flexor carpi ulnaris musculotendinous unit, which includes the pisiform, the pisohamate and pisometacarpal ligaments, were displaced proximally together with the avulsed fragment of the hook of the hamate and the fifth metacarpal. These findings suggest that such an injury results from a sudden, violent contraction of the flexor carpi ulnaris against the fixed wrist. It was successfully treated by open reduction and fixation of the hook of the hamate fracture and stabilization of the carpometacarpal joint.
Colour Doppler Ultrasound Examination of Hand Tendon Pathologies
Authors: BUYRUK H. M. , STAM H. J. , LAMÉRIS J. S. , SCHUT H. A. , SNIJDERS C. J.
Published: September 2005

Apart from real-time sonography, in most of the imaging techniques used to examine the musculoskeletal system, such as X-ray, computerized tomography scan and magnetic resonance imaging produce mainly static images. Although colour Doppler imaging (CDI) is generally used in the examination of blood flow, it may offer the opportunity to study the dynamic characteristics of tendons and muscles. The purpose of this study was to examine the unilateral flexor and extensor tendon pathologies of the hand and compare these images with the healthy side. A Philips Quantum Doppler was used to study patients with tendon adhesions and trigger finger. The normal and pathological tendons were scanned at three anatomical levels: wrist, metacarpal and proximal phalanx. The results obtained from the comparison of pathological images with normal ones indicate that CDI offers a promising approach to image dynamically and, in the future, to quantify the function of the tendons and muscles in the musculoskeletal system and to define their pathologies.