Late repair of simultaneous bilateral distal biceps brachii tendon avulsion with fascia lata graft.
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A 50 year old rock climber sustained a bilateral rupture of the distal biceps brachii tendons. He retained some flexion power in both arms but minimal supination, being weaker on the non-dominant right side. As the patient presented late, with retraction and shortening of the biceps muscle bellies, reconstruction was carried out using fascia lata grafts on both sides. Because of residual weakness on the left (dominant) side, three further surgical procedures had to be carried out to correct for elongation of the graft. A functionally satisfactory outcome, comparable with that on the right side, was eventually obtained. In summary, bilateral fascia lata grafts to bridge the gap between the retracted biceps bellies and the radial tuberosities were successful in restoring function and flexion power to the elbow. Despite being the stronger side, the dominant arm did not respond as well to the initial surgery. This may be due to overuse of this arm after the operation. (+info)
Evaluation of chronic tears of the rotator cuff by ultrasound. A new index.
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The diagnosis of chronic lesions of the rotator cuff is challenging. We have developed a new index to improve the sonographic diagnosis of chronic tears of the cuff. In a pilot study, we examined 50 asymptomatic healthy volunteers by ultrasound to establish the diameter of the rotator cuff in relation to the tendon of the long head of biceps. Subsequently, the index was calculated in 64 patients who had had shoulder pain for more than three months caused by clinically diagnosed lesions of the rotator cuff. The compensatory hypertrophy of the biceps tendon was quantified sonographically in relation to the diameter of the cuff. Comparison with the contralateral shoulder revealed a significantly higher biceps rotator-cuff ratio (p < 0.05) for patients with torn rotator cuffs. A ratio greater than 0.8 was considered pathological (index positive); the mean ratio in the control group was 0.43. The sensitivity of a positive index was 97.8%, the specificity 63.2%, the positive predictive value 86.3%, and the negative predictive value 92.4% in comparison with surgical findings. Use of the index improves sensitivity in the diagnosis of chronic tears of the cuff by ultrasound. (+info)
Safety of the limited open technique of bone-transfixing threaded-pin placement for external fixation of distal radial fractures: a cadaver study.
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OBJECTIVE: To examine the safety of threaded-pin placement for fixation of distal radial fractures using a limited open approach. DESIGN: A cadaver study. METHODS: Four-millimetre Schanz threaded pins were inserted into the radius and 3-mm screw pins into the second metacarpal of 20 cadaver arms. Each threaded pin was inserted in the dorsoradial oblique plane through a limited open, 5- to 10-mm longitudinal incision. Open exploration of the threaded-pin sites was then carried out. OUTCOME MEASURES: Injury to nerves, muscles and tendons and the proximity of these structures to the threaded pins. RESULTS: There were no injuries to the extensor tendons, superficial radial or lateral antebrachial nerves of the forearm, or to the soft tissues overlying the metacarpal. The lateral antebrachial nerve was the closest nerve to the radial pins and a branch of the superficial radial nerve was closest to the metacarpal pins. The superficial radial nerve was not close to the radial pins. CONCLUSION: Limited open threaded-pin fixation of distal radial fractures in the dorsolateral plane appears to be safe. (+info)
Common extensor tendon rupture following corticosteroid injection for lateral tendinosis of the elbow.
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Corticosteroid injections are commonly administered to athletes to relieve symptoms of lateral elbow tendinosis. This report presents a case of almost total rupture of the common extensor origin in a 45 year old female squash player secondary to such a procedure. (+info)
Contribution of lumbrical muscle activity to the paradoxical extension phenomenon induced by injuries to the finger flexor tendons.
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The "Extensor habitus" phenomenon occurs in finger flexor tendon injuries and consists of a paradoxical extension of the interphalangeal joints after an attempt to flex the finger. The mechanism of extension is considered to be a contraction of the flexor digitorum profundus that is then transmitted via the lumbrical muscle structure to the extensor expansion. Using electromyography, we recorded the lumbrical muscle activity during the paradoxical extension phenomenon to determine whether the lumbrical muscle contributed to this event. Two patterns of electromyographical activity of the lumbrical muscle were observed. Group I (6 fingers) displayed electrical activities in the lumbrical muscle during flexion tasks, while group II (12 fingers) did not. In group I, the lesions were mainly located in zone V, and the response to range of motion exercises was satisfactory. In group II, nearly all of the lesion were located in zone II, and half of the cases required additional surgical interventions. Group II appeared to exhibit the "Extensor habitus" phenomenon, while group I exhibited an "Extensor habitus-like phenomenon." To distinguish between these two phenomena, an electromyographical examination of the lumbrical muscle must be performed. (+info)
Comparison of sonography and magnetic resonance imaging for the diagnosis of partial tears of finger extensor tendons in rheumatoid arthritis.
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OBJECTIVE: Finger extensor tenosynovitis in rheumatoid arthritis (RA) may lead to partial and eventually to complete tendon tears. The aim of this study was to investigate the diagnostic value of sonography (SG) and/or magnetic resonance imaging (MRI) to visualize partial tendon tears. METHODS: Twenty-one RA patients with finger extensor tenosynovitis for more than 12 months underwent SG, MRI and surgical inspection, the latter being the gold standard. RESULTS: For partial tears, sensitivity and specificity were 0.27 and 0.83 for MRI, and 0.33 and 0.89 for SG, respectively. Positive and negative predictive values were 0.35 and 0.78 for MRI, and 0.50 and 0.80 for SG, respectively. Accuracy was 0.69 for MRI and 0.75 for SG. CONCLUSION: For visualization of partial finger extensor tendon tears in RA patients, SG performs slightly better than MRI, but both techniques are at present not sensitive enough to be used in daily practice. (+info)
Brachial biceps tendon injuries in young female high-level tennis players.
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AIM: To evaluate brachial biceps tendon lesions in four young female tennis players who complained about anterior shoulder pain on their dominant side. METHODS: Medical and sport's activity history, palpation of the painful zone, Ghilchrist (palm-up) test, and brachial biceps contraction against resistance were performed. RESULTS: The two girls who suffered from mild tenderness in the bicipital groove and over the anterior aspect of the upper arm and the shoulder joint, had tendinitis of the long biceps head. The two girls who suffered from severe tenderness just under the groove, had a partial tear in the long head of the biceps. Ghilchrist test was positive in all girls. CONCLUSION: Tennis players can have shoulder pain without clear history of trauma. Pain occurred probably as a result of technical errors or use of inadequate equipment. (+info)
Intracellular biogenesis of collagen fibrils in 'activated fibroblasts' of tendo Achillis. An ultrastructural study in the New Zealand rabbit.
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We have studied the formation of collagen fibrils in 'activated fibroblasts' of tendo Achillis of rabbits. The tendon was in the process of regeneration after experimental partial tenotomy. Samples were taken from the peri-incisional region and analysed by transmission electron microscopy. Ultrastructural examination showed the presence of a 'fine dense granular substance' inside the rough endoplasmic reticulum and procollagen filaments. These come together to form collagen fibrils in the dilated vacuoles of the rough endoplasmic reticulum. The possible intra- and extracellular origin of collagen fibrils is suggested. Within the cell biosynthesis of collagen fibrils take place with the formation of collagen substance which gives rise to procollagen filaments. These make contact in parallel apposition to produce striated 'spindle-shaped bodies' which elongate by the longitudinal attachment of more procollagen filaments and form intracellular nascent collagen fibrils. (+info)