Conservative and operative treatment of mallet finger

One-hundred and thirty-five patients with mallet finger were treated and followed up at least 1 year after injury. Ninety-two patients with tendon rupture or chip fracture were treated by splinting, and 42 percent of them had a decreased range of motion, mostly of a minor degree, but only 18 percent stated complaints at the follow-up examination. The results of treatment in 43 patients with fracture were evaluated separately. In this group, 26 patients were operated on and the postoperative results were excellent in 58 percent, improved in 36 percent, and 8 percent ended with failure due to complications. Radiographic study showed bony union in 41 of 43 patients and resorption of the small fragment in 2 patients. The indications for conservative and operative treatment in the five different types of mallet finger are discussed.     

Responses of ankle plantar-flexors to various inhibitions of muscular activities in rats]

Effects of hindlimb suspension, tenotomy, denervation, and/or the combination of these models on plantar-flexors were studied in adult rats. Suspension-induced atrophy was not promoted by addition of tenotomy. But the magnitude of the atrophy was advanced if denervation or both denervation and tenotomy were combined with 5-day hindlimb suspension. Similar effects were noted in the cross-sectional area of single muscle fibers, especially of slow-twitch fibers. A shift of muscle fiber type from slow- to fast-twitch type was also induced mainly in soleus. The atrophy and fiber transformation were closely associated with a passive shortening of muscle due to the plantar-flexion of ankle and/or tenotomy and a disappeared electrical activity caused by denervation. The fiber atrophy, but not the shift of fiber type, was further advanced by the combination of tenotomy and denervation. It is suggested that muscle atrophy is caused by the decreased fiber size and protein content. The water content was also reduced proportionally.     

Muscle capillaries in tenotomized human muscles

The capillaries were studied in tenotonized human muscles after tenotomy or spontaneous rupture of the tendon. The mean capillary area was not significantly different in the patients with tenotomy, or with spontaneous rupture of the tendon, as compared to intact muscles. The mean basement membrane area as a percentage of total capillary area was significantly larger and the size capillary lumen significantly smaller in the injured than in the intact muscles. The alterations of the capillaries were time-dependent.     

Effect of glucocorticoid on protein and creatine content of inactivated muscle of rats

In denervation, there was loss of protein in gastrocnemius muscles and this loss of was more in prednisolone treated animals. There was significant change of protein loss between tenotomy and tenotomy with prednisolone treatment. The reduction of protein in denervation and denervation with prednisolone treatment were also highly significant. Significant loss of muscle creatine was observed in denervation with prednisolone treatment. It was about 50% of the normal control group and about 40% when compared to other limb. In denervation alone, the creatine loss was about 24%. In tenotomy and in tenotomy with prednisolone treatment, the loss of creatine was also significantly high. All these figures regarding the reduction of muscle creatine in different experiments were highly significant. The reduction of muscle weight, protein and creatine content of muscle in denervation were due to inactivation of the muscle and due to trophic changes caused by loss of motor supply to the muscle. But in tenotomy, the reductions were only due to inactivation.     

Anatomical variations of the extensor tendons to the fingers over the dorsum of the hand: a study of 50 hands and a review of the literature

The extensor tendons to the fingers were studied in dissections of 50 fresh cadaveric hands, and the divisions of the tendons, as well as the communications (juncturae), were analyzed. The pattern of distribution most frequently observed was as follows. The extensor digitorum communis provided one tendon to the index finger, one to the middle finger, two to the ring finger, and none to the little finger. The extensor indicis exhibited one tendon, whereas the extensor digiti minimi exhibited two tendons. The extensor indicis tendon was always observed to lack a junctura tendinum. The extensor indicis was absent in both hands of one cadaver. A tendon slip from the extensor digiti minimi to the ring finger was observed in one hand. All surgeons must bear in mind the existence of these variations when performing common tendon transfers.     

Some hormonal factors (hypophysectomy, castration and testosterone administration) modifying the course of "compensatory" muscle hypertrophy in the rat.

1. Maximum compensatory hypertrophy of the soleus and plantaris muscle in male rats is attained seven days after tenotomy of the gastrocnemius muscle (39% and 9% respectively). When tenotomy of the gastrocnemius was performed seven days ater hypophysectomy, hypertrophy in these two muscles was aproximately half that found in control animals. 2. After 81-day castration of young male rats the weight of the saleus and plantaris was reduced and hypertrophy following tenotomy of the gastrocneumius muscle did not develop. 3. Chronically castrated rats received testosterone two weeks prior to tenotomy of the gastrocnemius and a week during the muscle hypertrophy phase. Hypertrophy of the soleus in castrated rats which had received testosterone seven days after tenotomy of the gastrocnemius was 25% as compared with muscles of castrated animals. The corresponding value in the plantaris muscle was 10%. 4. These results indicate that even calf muscles of the rat, namely the soleus and plantaris muscles, are significantly affected by testosterone under these conditions, although it is not, as yet, clear whether its action is direct or indirect.     

Biceps tenotomy in the presence of a supraspinatus tear alters the adjacent intact tendons and glenoid cartilage

A rotator cuff tear is a common injury in athletes and workers who repeatedly perform overhead movements, and it is not uncommon for this demographic to return to activity shortly after treatment. A biceps tenotomy is often performed in the presence of a rotator cuff tear to help reduce pain and improve joint function. However, the effect of this procedure on the surrounding tissues in the glenohumeral joint is unknown. Therefore, the purpose of this study was to investigate the effect of a biceps tenotomy in the presence of a supraspinatus rotator cuff tear followed by overuse activity on ambulatory function and mechanical and histologic properties of the remaining rotator cuff tendons and glenoid cartilage. 46 rats underwent 4 weeks of overuse activity to create a tendinopathic condition, then were randomized into two groups: unilateral detachment of the supraspinatus tendon or detachment of the supraspinatus and long head of the biceps tendons. Ambulatory measurements were performed throughout the 8 weeks prior to euthanasia, followed by analysis of the properties of the remaining intact tendons and glenoid cartilage. Results demonstrate that shoulder function was not effected in the biceps tenotomy group. However, the intact tendons and glenoid cartilage showed altered mechanical and histologic properties. This study provides evidence from an animal model that does not support the use of tenotomy in the presence of a supraspinatus tendon rotator cuff tear, and provides a framework for physicians to better prescribe long-term treatment strategies for patients.     

Lipoprotein lipase activity in skeletal muscles of the rat: effects of denervation and tenotomy.

The effects of denervation, tenotomy, or tenotomy with simultaneous denervation on the activity of heparin-releasable and intracellular, residual lipoprotein lipase (LPL) and triacylglycerol (TG) content were examined in rat skeletal muscles. An influence of muscle electrostimulation on denervated and tenotomized muscles was also evaluated. Activity of both LPL fractions was decreased in denervated and/or tenotomized soleus and red portion of gastrocnemius muscles. It was accompanied by a slight elevation of the intracellular TG content. Electrostimulation increased activities of both fractions of LPL in red muscles from intact hindlimbs. In stimulated denervated muscles without or with simultaneous tenotomy, activity of two LPL fractions was also enhanced, but control values were reached only in denervated soleus muscle. Electrical stimulation had no pronounced effect on LPL activity in tenotomized muscles. In conclusion, denervation and/or tenotomy decreases LPL activity in red muscles, indicating reduction of the muscle potential to utilize circulating TG. Electrostimulation only partly restores the diminished LPL activity in denervated muscles, without any effect in tenotomized ones. Thus, to maintain LPL activity in resting muscle, intact innervation and tension are needed.     

Torticollis

Torticollis can be an isolated deformity or a sign of other neuromuscular disease. Underlying central nervous system or infectious disorders need to be considered and treated. In most patients, an improvement in the aesthetic disability is the primary objective. In general, an operation is indicated for the classical "congenital" muscular torticollis that does not respond to physiotherapy and forceful stretching of the restricting neck band. The mass or "tumor" of "congenital" torticollis requires no specific treatment. Operation may be delayed until age 1, but should probably be completed prior to school age. Reversal of craniofacial asymmetry is best achieved at an early age when there is maximum growth potential. Principles of surgery are (1) identification and release of all restricting bands involving the sternocleidomastoid muscle and other neck structures, (2) moving of the head and neck through a full range of motion prior to the completion of the procedure, and (3) resumption of physical therapy within 2 weeks of operation to prevent recurrent scar contracture. Various operations have been recommended, the most popular and reliable being inferior open tenotomy of the sternal and clavicular heads of the sternocleidomastoid muscle. Incisions should be placed low in the neck along skin lines and not over the clavicle in order to avoid hypertrophic scarring. Other procedures discussed are superior open sternocleidomastoid tenotomy (mastoid release), muscle lengthening procedures, and sternocleidomastoid excision. Only modest results should be anticipated in older children or adults with long-standing disease or advanced craniofacial asymmetry.     

Tenotomy or Tenodesis for the Long Head of Biceps Lesions in Shoulders: A Systematic Review and Meta-Analysis

Background

Both tenotomy and tenodesis have been widely used for the treatment of long head of biceps tendon (LHBT) lesions, but the optimal strategy remains considerably controversial. In this meta-analysis of published studies, we compared the results of the two procedures.

Methods

A literature search that compared tenotomy with tenodesis was performed using MEDLINE, and Embase until August 2014. A total of 7 studies reporting data on 622 subjects were included. Study quality was evaluated using the PEDro critical appraisal tool and the NO quality assessment tool.

Results

Data synthesis showed higher functional outcomes, a lower complication rate, and longer surgical time in patients managed with tenodesis compared to tenotomy (Constant score, P = 0.02; Popeye sign, P < 0.001; cramp pain, P = 0.04; surgical time, P < 0.001, respectively).

Conclusion

This meta-analysis indicates that tenodesis results in better arm function and lower incidences of cramp pain and Popeye sign in LHBT lesions, while the procedure required longer surgical time compared to tenotomy. More sufficiently powered studies would be required to further determine the optimal strategy.     

Soft tissue strain energy minimization: a candidate control scheme for intra-finger normal-tangential force coordination

The safety margin (SM) measure has been used to quantify the phenomenon that humans grasp objects more firmly than is necessary to prevent slip. The biomechanical basis for the SM phenomenon is addressed herein. A hypothesis is proposed regarding intra-finger normal-tangential force coordination. The idea is that the central nervous system (CNS) minimizes the strain energy of the soft finger pad tissue by varying normal force when presented with a certain tangential force. This control scheme requires no knowledge of the frictional conditions at the finger-object interface; the CNS needs only to detect the strain energy in the contact region, an area abundant with strain-sensitive mechanoreceptors. The scheme is not independent, but is rather a possible component of a more complicated system. The strain energy minimization problem was solved using the finite element model (FEM) of Wu et al. (Med. Eng. Phys. 24(4)(2002) 253). Optimization results revealed that the suggested control scheme produced SM values of 30-50%, corresponding closely to those reported experimentally. Slip prevention naturally emerges from the control scheme provided that the friction coefficient exceeds 0.7, a value lower than typically encountered.     

Tension- and afferent input-associated responses of neuromuscular system of rats to hindlimb unloading and/or tenotomy

Responses of electromyogram (EMG) in soleus muscle and both afferent and efferent neurograms at the fifth lumbar (L(5)) segmental level of spinal cord were investigated during acute and chronic unloading induced by hindlimb suspension and/or tenotomy in adult rats. The soleus EMG and afferent neurogram decreased 88 and 37%, respectively, relative to those at quadrupedal posture on the floor after acute hindlimb suspension that causes passive shortening of soleus due to ankle plantarflexion. However, the afferent neurogram (P < 0.05) and soleus EMG (P > 0.05) recorded on the floor increased after tenotomy of synergists. Furthermore, the afferent input was inhibited when the soleus EMG disappeared after tenotomy of soleus. The afferent neurogram and EMG of the soleus showed correlated responses to a variety of treatments, suggesting that the afferent neurogram recorded at the L(5) segmental level reflects the neural input associated with the activity level of the soleus predominantly. The level of efferent neurogram decreased after acute hindlimb suspension but was not influenced significantly by tenotomy of synergists and/or soleus itself. The EMG and afferent neurograms remained low up to the 4th day but recovered to the preexperimental levels within 14 days, due to reorganization of sarcomere number and length, as well as the shortening of muscle fiber length and recovery of tension development. It is suggested that the levels of EMG and afferent neurogram associated with antigravity muscle are closely related to the tension development of the muscle.     

Cell proliferation in skeletal muscle following denervation or tenotomy

Summary Autoradiographic experiments using ³H-thymidine were designed to analyse cell proliferation which occurs in skeletal muscle after denervation and after tenotomy. In mouse tibialis anterior and tongue muscles during the first 24 h after denervation or tenotomy labelling levels were low and did not differ significantly from sham operated control muscles. By 48 h after denervation and tenotomy of tibialis anterior muscles, increased levels of labelling occurred in both muscle and connective tissue nuclei. Daily pulse labelling for 7 days after denervation produced a labelling level which was 8 times that of sham operated controls, 25–30% of the total nuclear population being labelled. Denervated muscles had twice the level of labelling compared to tenotomised muscles. These results provide conclusive evidence that both denervation and tenotomy stimulate cell proliferation in skeletal muscle and it is suggested that the increased numbers of labelled muscle nuclei are likely to be the result of mitotic activity in muscle satellite cells.     

Effectiveness and Complications of Percutaneous Needle Tenotomy with a Large Needle for Muscle Contractures: A Cadaver Study

Background

Twenty-two percent of institutionalised elderly persons have muscle contractures. Contractures have important functional consequences, rendering hygiene and positioning in bed or in a chair difficult. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not very effective and surgery may be required. Surgery is carried out in the operating theatre, under local or general anaesthesia but is often not possible in fragile patients. Mini-invasive tenotomy could be a useful alternative as it can be carried out in ambulatory care, under local anaesthesia.

Objective

To evaluate the effectiveness of percutaneous needle tenotomy and the risks of damage to adjacent structures in cadavers.

Method

Thirty two doctors who had never practiced the technique (physical medicine and rehabilitation specialists, geriatricians and orthopaedic surgeons) carried out 401 tenotomies on the upper and lower limbs of 8 fresh cadavers. A 16G needle was used percutaneous following location of the tendons. After each tenotomy, a neuro-orthopaedic surgeon and an anatomist dissected the area in order to evaluate the success of the tenotomy and any adjacent lesions which had occurred.

Results

Of the 401 tenotomies, 72% were complete, 24.9% partial and 2.7% failed. Eight adjacent lesions occurred (2%): 4 (1%) in tendons or muscles, 3 (0.7%) in nerves and 1 (0.2%) in a vessel.

Conclusion

This percutaneous needle technique effectively ruptured the desired tendons, with few injuries to adjacent structures. Although this study was carried out on cadavers, the results suggest it is safe to carry out on patients.     

Dissection of a Single Rat Muscle-Tendon Complex Changes Joint Moments Exerted by Neighboring Muscles: Implications for Invasive Surgical Interventions

The aim of this paper is to investigate mechanical functioning of a single skeletal muscle, active within a group of (previously) synergistic muscles. For this purpose, we assessed wrist angle-active moment characteristics exerted by a group of wrist flexion muscles in the rat for three conditions: (i) after resection of the upper arm skin; (ii) after subsequent distal tenotomy of flexor carpi ulnaris muscle (FCU); and (iii) after subsequent freeing of FCU distal tendon and muscle belly from surrounding tissues (MT dissection). Measurements were performed for a control group and for an experimental group after recovery (5 weeks) from tendon transfer of FCU to extensor carpi radialis (ECR) insertion. To assess if FCU tenotomy and MT dissection affects FCU contributions to wrist moments exclusively or also those of neighboring wrist flexion muscles, these data were compared to wrist angle-moment characteristics of selectively activated FCU. FCU tenotomy and MT dissection decreased wrist moments of the control group at all wrist angles tested, including also angles for which no or minimal wrist moments were measured when activating FCU exclusively. For the tendon transfer group, wrist flexion moment increased after FCU tenotomy, but to a greater extent than can be expected based on wrist extension moments exerted by selectively excited transferred FCU. We conclude that dissection of a single muscle in any surgical treatment does not only affect mechanical characteristics of the target muscle, but also those of other muscles within the same compartment. Our results demonstrate also that even after agonistic-to-antagonistic tendon transfer, mechanical interactions with previously synergistic muscles do remain present.     

Fetuin A is down-regulated in rats during heterotopic ossification after Achilles tenotomy

We investigated the role of fetuin A during heterotopic ossification (HO) in rats following Achilles tenotomy. We performed a right midpoint Achilles tenotomy on 24 rats. At 5 and 10 h after surgery, we investigated the formation of ectopic bone using X-ray and histological examination. We evaluated the mRNA level of fetuin A using real-time PCR. Presence of fetuin A in the Achilles tendon was assessed by immunohistochemical staining. We also measured the serum concentration of fetuin A using enzyme linked immunosorbent assay (ELISA). The expression of fetuin A was significantly decreased in both the liver and Achilles tendon during HO. ELISA showed a small amount of fetuin A in blood throughout the development of HO. Immunohistochemical staining showed that fetuin A was abundant in the ectopic bone. Fetuin A appears to be involved in the formation of ectopic bone induced by Achilles tenotomy, and a deficiency of fetuin A plays a role in the development of HO.