Variations of the flexor digitorum superficialis tendon of the little finger

The use of 131I doses of several mCi for scans can stun the thyrocytes and thyroid cancer cells, whereas the usual dose (300 microCi) of 123I does not. We compared the diagnostic accuracy of the 123I (300 microCi) scans and that of 131I (3-10 mCi) scans in 155 patients. The diagnostic accuracy of a 123I scan in detecting functioning thyroid remnant/metastasis was 89.5% (77/86 scans) and that of a 131I scan was 92.9% (39/42) in 6 week-postoperative patients (p = 0.750). For radioablation therapy follow-up patients, the diagnostic accuracy of 123I in determining presence or absence of functioning remnant or metastasis was 69.4% (25/36) and that of 131I was 92.5% (49/53) with a p value of 0.079. The success rates for complete ablation of functioning tissue after radioiodine therapy administered after diagnostic 123I and after 131I were 72% (34/47) and 56% (24/43), respectively, with a p value of 0.125. Our study indicates the following: 1) for the first postoperative evaluation, the diagnostic accuracy of the 123I scan was essentially equal to that of the 131I scan, and the success rate of radioablation therapy appears to be better than 123I scan; and 2) for postablation follow-up surveys, the 131I scan appears to be better but carries the risk of stunning the functioning cells.     

Measurement of range of motion of the finger after flexor tendon repair in zone II of the hand

The purpose of this study was to compare classification systems of active range of motion of the finger after flexor tendon surgery in zone II of the hand. Active range of motion of 20 fingers (16 subjects) was classified according to five systems. Agreement between the systems was only fair. Strickland's original system and the Louisville system rated the results most strictly, followed by Strickland's adjusted system. Buck-Gramcko's systems (in centimeters and degrees) rated the results least strictly. Strickland's systems conformed most closely to measurement principles. This article concludes that at this time Strickland's original classification system is preferable for scientific and clinical purposes. However, additional research is needed to evaluate reliability of the measurement, the variability of the scaling factor of 175 degrees, the sensitivity of the measurement, and the validity of the measurement with regard to functional use of the finger and gliding of the repaired tendon.     

Closed rupture of both flexor tendons of the fifth finger due to a calcium hydroxyapatite deposit in the carpal tunnel

Retrospective analysis of clinical data from 8 State/Territory Family Planning Organizations (FPO) was conducted to determine the reproductive health services used by young women. Between July, 1996 and June, 1997, a total of 185, 879 client visits were recorded at FPO clinics, of which 72,303 (39%) were by young clients. The results showed that young women tended to use a combined oral pill, postcoital pill and spermicides more than those older than 25 years (p<0.05). Young women were also more likely to use services for management of sexually transmitted disease (STD), counselling for HIV, STD and sexual assault (p<0.05). However, there were considerable differences among the 3 groups of women: Aboriginal clients, those who did not speak English at home, and those who were born outside Australia. This study confirms that young women are using FPO services especially for emergency/postcoital contraception, STD screening and counselling. FPOs need to continue their existing role of providing reproductive and sexual health services catering to the need of this special segment of the population.     

Palmar fracture dislocation of the proximal interphalangeal joint

Palmar fracture dislocation of the proximal interphalangeal joint is uncommon. Thirteen patients treated for this injury were retrospectively reviewed. There were 9 acute injuries. Seven were treated by closed reduction and percutaneous pin fixation and 2 were treated by open reduction and internal fixation. The 4 chronic injuries (more than 1 month after injury) were treated with open reduction and soft tissue reconstruction. The length of follow-up averaged 55 months. Eight patients were free from pain. Postoperative proximal interphalangeal motion averaged 91 for the acute injuries and 70 degrees for the chronic injuries. Follow-up radiographic findings were notable for an increased height of the middle phalangeal base in 6 patients, articular irregularity in 4, and residual subluxation in 2; however, these changes did not correlate with the clinical results. Complications included loss of reduction in 1 patient, progressive swan neck deformity in 1, and development of an average 25 degrees extension lag of the distal interphalangeal joint in 5.     

Simple arthrolysis for flexor rigidity of the proximal interphalangeal joint

The authors report 19 cases of simple arthrolysis of the proximal interphalangeal joint for flexion rigidity. Their cases were limited to isolated lesions of the joint without any flexor or extensor tendon involvement. The technique is described, and the importance of postoperative physical therapy is stressed. The results in these cases, in contrast with those in complicated cases of rigidity, are very satisfactory. The etiology is primarily sprains and dislocations of the proximal interphalangeal articulation, immobilized for too long a time in flexion (in the so-called "functional position").     

Evaluation criteria in follow-up studies of flexor tendon therapy

Oxphenisatin is known to induce liver damage and is suspected to cause or perpetuate chronic liver disease. In order to evaluate the hepatotoxic effect of long-term therapy with oxyphenisatin 26 consecutive patients with rheumatoid arthritis were investigated for the presence of liver disease. In all cases, liver biopsy, biochemical liver function tests and determination of Hepatitis-B antigen were performed. Ten patients showed no pathological changes in the liver biopsy and a further 2 had only non-specific changes. Seven patients had fatty liver, 5 passive congestion, one haemosiderosis and only one had cirrhosis of the liver. No correlation was found between the activity of rheumatoid arthritis, and duration of the disease, the drug therapy given, and the liver damage.     

Functional distal interphalangeal joint splinting for trigger finger in laborers: a review and cadaver investigation

This two-part study evaluates the efficacy of functional distal interphalangeal joint (DIP) splinting for the treatment of trigger finger. Thirty-one fingers from 21 meat packing plant workers were treated with DIP splinting. A single corticosteroid injection was offered if triggering was stage 4 or greater. All workers returned to work immediately. Eighty-one percent of the digits were treated successfully (mean follow-up: 1 year). Treatment failure correlated with duration of symptoms and stage of triggering but did not correlate with age, race, sex, disease in multiple digits, or prior treatment. For the second part of the study, the effect of DIP splinting on flexor digitorum profundus (FDP) tendon excursion was studied in 16 fingers from 4 fresh cadavers. Excursion decreased 4.8 mm for the Stax splint and 4.2 mm for the dorsal Alumafoam splint. We conclude that DIP splinting provides a reliable and functional means of treating work-related trigger finger without lost time from work. Our cadaver investigation supports our theory that DIP splinting significantly decreases FDP excursion.     

In vivo tendon forces correlate with activity level and remain bounded: evidence in a rabbit flexor tendon model

The purpose of this study is to assess the feasibility, clinical tolerance, local control, and survival rates using a combined-modality treatment program of intraoperative radiation, chemotherapy, and external beam radiation for the management of patients with pancreatic cancer. One hundred eighty patients with biopsy-proven adenocarcinoma of the pancreas have been treated by a single surgical practice between 1979 and 1992. Of these, 105 had locally advanced but unresectable primary tumors (stages 2 and 3). All patients were treated with a program of multimodality therapy, including surgery, chemotherapy, and radiation therapy. Three groups were identified. Group I (33 patients) received intraoperative radiation therapy (IORT) as part of their treatment. Group II (43 patients) received intraoperative radiation in the form of iodine-125 (I-125) implantation. Group III (29 patients) received no intraoperative radiation. All three groups were comparably similar with respect to age at presentation, amount of preoperative weight loss, preoperative symptoms, and tumor location. Overall perioperative mortality was 4.8 per cent (five patients), with no difference between groups noted. Perioperative complications occurred in 32 (30.4%) of the 105 patients. Complications occurred in only 18.1 per cent of patients in Group I (IORT), compared with 39.5 per cent of Group II (I-125) patients (P < 0.01). Group III patients (no intraoperative radiation) experienced complications in 31.0 per cent of cases (P = 0.09 vs Group I). Actuarial survival was 18 months for Group I (IORT) versus 15 months for Group II (I-125). One- and 2-year actuarial survival rates were 60 and 17 per cent for patients in Group I (IORT) and 56 and 19 per cent for Group II (I-125). Actuarial local control rates for patients receiving IORT (Group I) was 70 per cent at 2 years. Patients with pancreatic cancer historically have poor survival and local control rates despite aggressive chemotherapy and radiation. The addition of intraoperative radiation to the combined modality management of pancreatic cancer offers markedly improved survival rates and local control with minimal morbidity for patients with unresectable disease. Intraoperative radiation in the form of IORT can be delivered with a significantly fewer complications than I-125 seed implantation.     

Treatment routines of flexor tendon injuries. Results of a questionnaire study

A questionnaire was distributed to the surgical departments of all Norwegian hospitals, asking about the routines for treating flexor tendon injuries in 1990. The response rate was 95.5%. Some of the smaller hospitals did their own flexor tendon surgery, but referred patients with a complex injury to a hospital with better trained hand surgeons. In 1990, a total of 573 flexor tendon repairs were carried out in Norwegian hospitals. After surgery, all patients had a cast or a brace for a period ranging from three to six weeks. Most of the hospitals used dynamic traction and had a programme for training the patient, which was supervised by a hand therapist. Active flexion was allowed from two to eight weeks after the operation. We recommend referral of all flexor tendon injuries in zone II to a surgical unit with trained hand surgeons. After surgery, a programme including dynamic traction and training supervised by the surgeon and a hand therapist should be compulsory.     

Atraumatic retrieval of the proximal end of a severed digital flexor tendon

A suction catheter technique is suggested as the next procedure of choice when proximal digital "milking" with wrist flexion fails to deliver the proximal end of the flexor tendon severed within the digital sheath.     

A prospective study of flexor tendon repair in zone 5

A prospective study of postoperative mobilization of flexor tendon repairs in zone 5 was conducted over a 2-year period between 1994 and 1996 using a controlled active motion (active extension-active flexion) regimen of mobilization. Fifty-two patients, who had a total of 151 flexor digitorum superficialis (FDS) and 103 flexor digitorum profundus (FDP) divisions, were available for review at a mean follow-up of 10 months. Of the 161 fingers with division of one or both flexor tendons, 66% exhibited independent FDS function and 90% achieved good or excellent results of digital range of motion. No rupture of an FDP tendon repair occurred during the study period. The data allowed us to define a new method of classifying the results of treatment of these injuries in terms of the injured wrists as a whole and not simply as a series of isolated observations for each individual finger with divided flexor tendons. The results of recovery of independent FDS action and range of finger movement achieved for injuries in which the flexors of all four fingers had been divided indicate a statistically significant interdependence of injuries of finger flexors of adjacent fingers at the wrist. Multivariate analysis showed the presence of a "spaghetti wrist" injury to have a significant adverse effect on the recovery of the independent FDS action but not on the recovery of the digital range of motion.     

Rupture of the flexor pollicis longus tendon at the musculotendinous junction in a bowler

Traumatic rupture of the flexor tendons at the musculotendinous junction is rare. A case of flexor pollicis longus tendon rupture at the musculotendinous junction is described. The mechanism of the tendon injury appears to be longitudinal traction on the contracted muscle during delivery of a bowling ball.     

Surgical treatment of freshly closed articular fractures of proximal interphalangeal joints

Eleven fractures of the base of P2 and 8 fractures of the head of P1 were treated surgically. We review the results after a mean follow-up of 4 years 5 months. Due to their complexity is no real consensus on the treatment of P2 and various treatments were used. This series demonstrated two points: first the was no correlation between the degree of patient satisfaction and the section of digital immobilization; second, residual subluxation and/or arthrosic remodeling was frequent but was not incompatible with a good objective and subjective outcome.     

Open complex metacarpophalangeal joint dislocation. Two cases: index finger and long finger

Two patients with open complex dislocation of a metacarpophalangeal joint were treated by cleansing of the wound, open reduction, primary wound closure, and early motion. One dislocation occurred in the index finger, the other in the long finger which is only the second such case to be described. Antibiotics were given before and continued for 5 days after operation. There were no infections, and both patients regained an excellent range of motion without pain.     

Anatomical factors in displacement of the superficial digital flexor tendon in dogs

The superficial digital flexor muscles of 12 adult dogs were investigated to get informations on the possible anatomical factors which could play a role in the displacement of the superficial digital flexor tendon in dogs. It was seen that the lateral displacement of the superficial digital flexor tendon, tearing its medial attachment, was a result of the weaker medial attachment on the tuber calcanei and the change of the angulation between the calcaneus, insertion and origin points of the muscle in flexed hind limb.     

Division of flexor tendons causes progressive degradation of tendon matrix in rabbits

Deep flexor tendons of 30 rabbits were divided at the ankle level. The effects of unloading on the synthesis and content of matrix components, the synthesis of DNA, and dry weight were investigated. The ability of the tendons to synthesize collagen during short-term culture and the contents of matrix components decreased inversely to the time of unloading. 12 weeks following division, the fibrocartilagnious segments had lost 2/5 of their dry weight, 2/3 of proteoglycan and 1/3 of collagen and non-collagen protein content. Less pronounced losses were observed in the non-fibrocartilaginous segments. A transient increase in cell proliferation in both types of segments was found. These findings indicate that divided flexor tendons undergo a progressive degradation, degradation, which may have implications for delayed suture of deep flexor tendon injuries.     

Double dislocation of a finger (personal cases and contributions from the literature)]

This is the author's third report on this extremely rare injury. New cases are discussed, and a review of observations is given on the basis of the author's experience and that of others.     

The motion analysis system and goniometry of the finger joints

A case is reported of idiopathic CD4+T lymphocytopenia with progressive multifocal leukoencephalopathy and cervical lymph node tuberculosis. A 57 year old Japanese man presented with cervical lymphadenopathy and progressive neurological deficits, and six months later he developed akinetic mutism. He had a persistent severely depressed number of circulating CD4+T lymphocytes in the absence of human immunodeficiency virus infection. T1 weighted MRI showed a diffuse decreased signal intensity limited to the white matter without mass effect. A brain biopsy specimen had a morphology similar to that of progressive multifocal leukoencephalopathy. Polyomavirus antigen was detected in the brain lesion, and viral DNA was identified in nucleated blood cells and urine. Unusually this serious medical condition has lasted for more than three years without remission. To our knowledge this is the first patient with CD4+T lymphocytopenia with progressive multifocal leukoencephalopathy, suggesting that similar opportunistic infections should be considered even in previously normal people.