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Park CB, Hwang JS, Gong HS, Park HS. A Lightweight Dynamic Hand Orthosis With Sequential Joint Flexion Movement for Postoperative Rehabilitation of Flexor Tendon Repair Surgery. IEEE Trans Neural Syst Rehabil Eng 2024; 32:994-1004. [PMID: 38376979 DOI: 10.1109/tnsre.2024.3367990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
During the postoperative hand rehabilitation period, it is recommended that the repaired flexor tendons be continuously glided with sufficient tendon excursion and carefully managed protection to prevent adhesion with adjacent tissues. Thus, finger joints should be passively mobilized through a wide range of motion (ROM) with physiotherapy. During passive mobilization, sequential flexion of the metacarpophalangeal (MCP) joint followed by the proximal interphalangeal (PIP) joint is recommended for maximizing tendon excursion. This paper presents a lightweight device for postoperative flexor tendon rehabilitation that uses a single motor to achieve sequential joint flexion movement. The device consists of an orthosis, a cable, and a single motor. The degree of spatial stiffness and cable path of the orthosis were designed to apply a flexion moment to the MCP joint prior to the PIP joint. The device was tested on both healthy individuals and a patient who had undergone flexor tendon repair surgery, and both flexion and extension movement could be achieved with a wide ROM and sequential joint flexion movement using a single motor.
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Ando S, Loh PY. Convolutional Neural Network Approaches in Median Nerve Morphological Assessment from Ultrasound Images. J Imaging 2024; 10:13. [PMID: 38248998 PMCID: PMC10817571 DOI: 10.3390/jimaging10010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
Ultrasound imaging has been used to investigate compression of the median nerve in carpal tunnel syndrome patients. Ultrasound imaging and the extraction of median nerve parameters from ultrasound images are crucial and are usually performed manually by experts. The manual annotation of ultrasound images relies on experience, and intra- and interrater reliability may vary among studies. In this study, two types of convolutional neural networks (CNNs), U-Net and SegNet, were used to extract the median nerve morphology. To the best of our knowledge, the application of these methods to ultrasound imaging of the median nerve has not yet been investigated. Spearman's correlation and Bland-Altman analyses were performed to investigate the correlation and agreement between manual annotation and CNN estimation, namely, the cross-sectional area, circumference, and diameter of the median nerve. The results showed that the intersection over union (IoU) of U-Net (0.717) was greater than that of SegNet (0.625). A few images in SegNet had an IoU below 0.6, decreasing the average IoU. In both models, the IoU decreased when the median nerve was elongated longitudinally with a blurred outline. The Bland-Altman analysis revealed that, in general, both the U-Net- and SegNet-estimated measurements showed 95% limits of agreement with manual annotation. These results show that these CNN models are promising tools for median nerve ultrasound imaging analysis.
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Affiliation(s)
- Shion Ando
- Department of Mechanical Engineering, Faculty of Engineering, Kyushu University, Fukuoka 819-0395, Japan;
| | - Ping Yeap Loh
- Department of Human Life Design and Science, Faculty of Design, Kyushu University, Fukuoka 819-0395, Japan
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Wang Y, Qian L, Liu ZF, Chen W, Shen X, Wu JN, Yang WX, Wang XH, Wang J, Xu YW. Safety and efficacy of ultrasonography of tension after zone II flexor tendon repair: A randomized controlled trial. J Hand Ther 2023; 36:786-795. [PMID: 37598094 DOI: 10.1016/j.jht.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Primary flexor tendon repairs of lacerations in zone II of the hand are fraught with problems. Traditionally, exercise (active and passive), orthoses, and physical agents are common interventions for the rehabilitation of patients experiencing these issues. One area of focus in this field is how to safely utilize tension to lengthen gliding distance following zone II injury. Finding effective solutions in this area is a key priority for improving patient outcomes and quality of life. PURPOSE To identify the optimal immobilization position that meets safety standards for tension and is the most efficient, and consequently, to validate our clinical effectiveness. STUDY DESIGN A cross-sectional study was adopted for the first part of the research (Research 1). A prospective, parallel, 2-group, randomized trial was conducted with concealed allocation and single blinding in the second part of the research (Research 2). METHODS A total of 60 healthy adults were recruited to select the best-fit protective immobilization position in Research 1, which was confirmed by tendon tension (via Young's modulus) and excursion (via gliding distance). We then randomly assigned 45 patients after zone II flexor tendon repair into two groups in Research 2 to compare functional outcomes. The control group underwent the conventional modified Duran protocol with early passive motion, while the experimental group received the protocol (optimized by Research 1) with early active motion. Ultrasonography was used to measure the tension and excursion of the flexor tendons. The outcomes measured at 16 weeks post-repair included total active motion, strength, the Disabilities of the Arm, Shoulder and Hand, and Strickland scores. RESULTS Three participants were unable to participate in Research 2 due to medical issues and poor attendance. The investigation found that the safe tendon threshold was 345.09 ± 87.74 kPa for partial active digital motion among the 60 participants. The optimal immobilization position requires the wrist to be neutral with a flexion angle of 30° at the metacarpophalangeal joint. The grip strengths (p = 0.012), ratio of grip strength (p = 0.015), the Disabilities of the Arm, Shoulder and Hand (p = 0.036), and total active motion (p = 0.023) differed significantly between the two groups. CONCLUSIONS Protective immobilization of the wrist in a neutral flexion position and with the metacarpophalangeal joint flexed at 30° can secure the repaired flexor tendon safely and efficiently. The effects of an early active motion protocol may improve the grip strength and upper limb mobility of individuals after zone II flexor tendon repair. CLINICAL TRIAL REGISTRATION ChiCTR2000030592.
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Affiliation(s)
- Ying Wang
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Lei Qian
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Zhen-Feng Liu
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Wei Chen
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xia Shen
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Jia-Ni Wu
- Sports Rehabilitation, Soochow University, Suzhou, China
| | - Wei-Xiang Yang
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xin-Hao Wang
- Department of Rehabilitation and Health Care, Wuxi Vocational and Technology College: Wuxi Institute of Technology, Wuxi, China
| | - Jun Wang
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
| | - Yan-Wen Xu
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
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Duru Ç, Yaşar B, Ergani HM, Acicbe O, Utku Ö, Ünlü RE. Outcomes of Wide-Awake Flexor Tendon Repairs in 58 Fingers and 9 Thumbs. J Hand Surg Am 2022:S0363-5023(22)00054-5. [PMID: 35365356 DOI: 10.1016/j.jhsa.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/10/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to present the outcomes of wide-awake flexor tendon repairs in zones 1 and 2 in a major hand trauma referral center. METHODS Zone 1 and zone 2 wide-awake flexor tendon repairs performed between August 2018 and March 2020 were analyzed retrospectively. Outcomes were assessed by the original Strickland-Glogovac criteria for fingers and Buck-Gramcko scoring system for thumbs. Further descriptive analysis of the groups according to potential negative factors, such as injury mechanism, concomitant neurovascular injury, and the extent of injury in zone 2, were performed. RESULTS A total of 94 tendons were repaired in 67 digits (58 fingers, 9 thumbs) of the 61 patients included in the study. Satisfactory results were achieved in 89.6% of the fingers and 77.8% of the thumbs. Intraoperative gapping was corrected after active digital extension-flexion test in 1 patient. Rupture was seen in 1 patient for a rate of 1.5%. The tenolysis indication rate was 5.1% for fingers and 11.1% for thumbs. CONCLUSIONS In our series, functional outcome scores, tenolysis, and rupture rates remained similar with findings in the literature. The outcome of a flexor tendon repair is influenced by many factors that cannot be controlled intraoperatively. To assess the effect of performing the repair in a wide-awake setting on the outcome, clinical trials with large patient groups are needed. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Çağdaş Duru
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey.
| | - Burak Yaşar
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Hasan Murat Ergani
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Okan Acicbe
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Özge Utku
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ramazan Erkin Ünlü
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey; Department of Plastic Reconstructive and Aesthetic Surgery, Sağlık Bilimleri University, Istanbul, Turkey
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Stephens AR, Buterbaugh KL, Gordon JA, Steinberg DR, Bozentka DJ, Khoury V, Kazmers NH. Comparison of Magnetic Resonance Imaging and Ultrasound Evaluations of Zone II Partial Flexor Tendon Lacerations: A Cadaveric Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1651-1656. [PMID: 33174636 DOI: 10.1002/jum.15553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Surgical intervention for zone II high-grade partial flexor tendon lacerations is often required when more than half of the tendon width is torn. Reliable noninvasive tests are critical for optimizing clinical decision making. Our team previously investigated the use of ultrasound (US) for identification of high-grade zone II flexor digitorum profundus lacerations. In this study, we compared magnetic resonance imaging (MRI) to US for the evaluation of high-grade partial flexor tendon lacerations in cadaveric specimens. METHODS Dissection of 32 digits in 8 fresh-frozen upper extremity cadaveric specimens was performed. The flexor digitorum profundus tendons were randomized into 3 groups: intact, low-grade laceration, and high-grade laceration. A dynamic US examination was performed by a blinded musculoskeletal radiologist. The same specimens underwent hand coil MRI, which was read by the same blinded radiologist. Magnetic resonance imaging test performance metrics were calculated and compared to those computed for the US evaluation. RESULTS For US evaluation of high-grade lacerations, the sensitivity and specificity were 0.5 and 1.0, with positive likelihood ratio (LR+) and negative likelihood ratio (LR-) values of ∞ and 0.50, respectively. The sensitivity and specificity for MRI evaluation were 0.2 and 1.0, with LR+ and LR- values of ∞ and 0.80. CONCLUSIONS Both US and MRI are adequate at determining the presence of a high-grade laceration. Magnetic resonance imaging was more specific than US in identification of high-grade partial flexor tendon lacerations. Although less specific, US is a reasonable and less-expensive alternative to MRI when evaluating for clinically significant high-grade partial flexor tendon lacerations.
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Affiliation(s)
- Andrew R Stephens
- University of Utah, School of Medicine, Salt Lake City, Utah, USA
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, USA
| | - Kristin L Buterbaugh
- Departments of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua A Gordon
- Departments of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David R Steinberg
- Departments of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Bozentka
- Departments of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Viviane Khoury
- Departments of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nikolas H Kazmers
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, USA
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Murphy SL, Krause D, Roll SC, Gandikota G, Barber M, Khanna D. Development of a Musculoskeletal Ultrasound Protocol to Examine Upper Extremity Rehabilitation Outcomes in Systemic Sclerosis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021; 37:13-23. [PMID: 33521795 PMCID: PMC7842414 DOI: 10.1177/8756479320965210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study developed a musculoskeletal ultrasound (MSUS) protocol to evaluate rehabilitation outcomes in systemic sclerosis. MATERIALS & METHODS Three MSUS methods (grey scale, Doppler, strain elastography) and two acquisition techniques (long versus short axis; transducer on skin versus floating on gel) were examined in the forearm before and after rehabilitation treatment. For grey-scale, tissue thickness measures, intra- and inter-rater reliability were calculated (ICCs), and paired t-tests examined differences among techniques. RESULTS Five people with diffuse cutaneous systemic sclerosis participated. The most valid and reliable grey-scale technique was with the transducer in long-axis, floating on gel. Doppler and strain elastography did not detect changes. Both dermal and subcutaneous thickness measurement error was small; intra- and inter-rater reliability was good to excellent. Preliminary data indicate that treatment may lead to dermal thinning. CONCLUSION A replicable protocol was established and may be an adjunct to rehabilitation outcome measurement in systemic sclerosis.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Health Care System, Ann Arbor, MI, Geriatric Research Education and Clinical Center (GRECC)
| | - Donnamarie Krause
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Mary Barber
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Dinesh Khanna
- Rheumatology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Wang MY, Yang TH, Huang H, Hsu HY, Kuo LC, Su FC, Huang CC. Evaluation of Hand Tendon Movement by Using High-Frequency Ultrasound Vector Doppler Imaging. IEEE Trans Biomed Eng 2020; 67:2945-2952. [PMID: 32078528 DOI: 10.1109/tbme.2020.2974244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Injuries to the hands, wrists, and fingers often involve damage to the tendons. The ability to measure tendon movements during the rehabilitation process can provide clinicians with important information in the quantification of tendon injuries. Conventionally, the tendon is considered a single spring-like structure during force transmission, and its twisted structure is neglected. Recently, clinicians believed that the twisted fiber structure (which enables tendon rotation during movement) of the tendon can provide it with a degree of elasticity and improve the efficiency of force transmission. However, observation of the hand tendon rotation in vivo by using the current imaging modalities is difficult. METHODS In this study, a 40-MHz high-frequency vector Doppler imaging (HFVDI) was used to visualize the movement of the hand tendon during muscle contraction. The performance of HFVDI was verified using a rotation phantom experiment. Two human experiments were designed in the present study: 1) participants were allowed to bend their distal and proximal interphalangeal (DIP and PIP) joints of fingers freely and 2) the PIP joint of the finger was fixed such that only the DIP could be moved. The HFVDIs of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons were obtained in the transverse and longitudinal views to observe the movements of the hand tendon during finger movements. RESULTS The average longitudinal displacements of the FDS and FDP were approximately 3-4 mm for free bending of the finger; however, it was reduced when only the DIP was moved. The rotational phenomenon of the FDS and FDP tendons was observed in the transverse view, which demonstrated the different rotational behaviors of the FDS and FDP fibers during muscle contraction. CONCLUSION All the results validated the potential of HFVDI as a novel tool for visualizing tendon rotation and would be useful in providing quantitative information regarding tendon function to determine the rehabilitation process following injuries.
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Misirlioglu TO, Ozben H. Dynamic ultrasound imaging for the assessment of extensor tendon adhesion after fifth metacarpal intraarticular head fracture: A case report. J Hand Ther 2020; 32:121-123. [PMID: 29089198 DOI: 10.1016/j.jht.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 06/16/2017] [Accepted: 07/03/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case report. INTRODUCTION Development of extensor tendon adhesions is a common complication after intra-articular metacarpal head fracture. Whenever these adhesions cannot be mobilized by rehabilitation, tenolysis should be considered. However, the decision for tenolysis is often delayed. When the rehabilitation program comes to a plateau and clinical examination may not be sufficient to find out the cause, dynamic ultrasound (US) can show where the gliding mechanism is disrupted and help clinicians to give an accurate decision for determining the next steps. PURPOSE OF THE STUDY To determine the role of dynamic US during hand rehabilitation. METHODS A 22-year-old woman presented with a fifth metacarpal intra-articular head fracture. Ten days after the surgery (open reduction and internal fixation) the hand rehabilitation program was commenced. After the third week, the metacarpophalangeal (MP) joint range of motion (ROM) gradually diminished. Dynamic US near the level of fifth MP joint revealed diminished extensor tendon excursion and capsular thickening. RESULTS Considering physical and sonographic findings, surgical tenolysis and capsular release was planned. After surgery, the DIP, PIP and MP joints reached full passive ROM. CONCLUSION(S) Ultrasound is a quick and practical way to diagnose tendon adhesions. With this report, the authors suggest that clinicians may use dynamic US, especially in times when the patient comes to plateau during hand rehabilitation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tugce Ozekli Misirlioglu
- Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Istanbul, Turkey.
| | - Hakan Ozben
- Department of Orthopaedics and Traumatology, Hand and Microsurgery Unit, Koc University School of Medicine, Istanbul, Turkey
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Hauraix H, Goislard DE Monsabert B, Herbaut A, Berton E, Vigouroux L. Force-Length Relationship Modeling of Wrist and Finger Flexor Muscles. Med Sci Sports Exerc 2018; 50:2311-2321. [PMID: 29933345 DOI: 10.1249/mss.0000000000001690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Because the hand joints possess a broad range of motion, the muscle length can vary importantly which might result in significant variations of the muscle force-generating capacities. However, facing the complexity of this musculoskeletal system, no study has examined the effect of hand muscle length change on muscle force. This study aimed to characterize the force-length relationship of muscles involved in wrist and metacarpophalangeal flexion. METHODS Eleven participants performed two sessions: (i) one for the wrist flexor muscles and (ii) one for the finger flexor muscles. For each session, the participants performed two maximal voluntary contractions and then two progressive isometric ramps from 0% to 100% of their maximal force capacity at five different wrist/metacarpophalangeal angles. Torque, kinematic, and electromyographic data were recorded. An ultrasound scanner was used to measure the myotendinous junction displacement of flexor carpi radialis (FCR) and flexor digitorum superficialis (FDS) during isometric contractions. A three-dimensional relationship between muscle length, force, and activation level was modeled using optimization procedure. RESULTS Globally, the FCR was stronger and shorter compared with FDS. The results showed that the three-dimensional relationships fitted well the experimental data (mean R = 0.92 ± 0.07 and 0.87 ± 0.11 for FCR and FDS, respectively). Using joint angle and EMG data, this approach allows to estimate the muscle force with low estimation errors (<9% of Fmax). CONCLUSIONS This study proposes a new method to investigate the force-length relationship by combining ultrasound measurement, musculoskeletal modeling and optimization procedures. The data and relationships provide a new insight into hand biomechanics and muscle function that could be useful for designing hand tools or surgical operations.
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Affiliation(s)
- Hugo Hauraix
- Institute of Movement Sciences, Aix-Marseille University, CNRS, ISM, Marseille, FRANCE
| | | | - Alexis Herbaut
- Department of Movement, Sciences, Decathlon Sports Lab, Villeneuve d'Ascq, FRANCE
| | - Eric Berton
- Institute of Movement Sciences, Aix-Marseille University, CNRS, ISM, Marseille, FRANCE
| | - Laurent Vigouroux
- Institute of Movement Sciences, Aix-Marseille University, CNRS, ISM, Marseille, FRANCE
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Abstract
The principles of hand therapy for proximal interphalangeal joint disorders include protecting injured structures, minimizing patient discomfort, and optimizing patient recovery. Comprehension of hand anatomy, the nature of the injury being treated, and the phases of healing are critical when designing a safe and effective hand therapy program. Hand therapists use a combination of orthoses, guided exercises, and modalities to improve edema, sensitivity, range of motion, and function.
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Affiliation(s)
- Nathan P Douglass
- Department of Orthopedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion C, Redwood City, CA 94063, USA
| | - Amy L Ladd
- Department of Orthopedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion C, Redwood City, CA 94063, USA.
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11
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Tendon displacements during voluntary and involuntary finger movements. J Biomech 2018; 67:62-68. [DOI: 10.1016/j.jbiomech.2017.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 11/24/2022]
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Busato A, Balconi G, Vismara V, Bertelè L, Garo G, DE Gregorio D. Management and control of isotonic contraction generated stress: evaluation of masseter muscle deformation pattern by means of ecography. ACTA ACUST UNITED AC 2017; 9:45-53. [PMID: 28280532 DOI: 10.11138/orl/2016.9.1s.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The objective of the following study is to observe the behavior of the six layers of the masseter during an isometric contraction at maximum exertion with the deformation pattern analysis method. MATERIALS AND METHODS This study has been conducted by use of an ultrasound machine (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm) which allowed us to record a video (DCM) comprised of 45 frames per second. The probe was fixed to a brace and the patient was asked to clench their teeth as hard as possible, obtain the muscle's maximum exertion, for 5 seconds three times, with 30 seconds intervals in between. Both right and left masseter muscles were analyzed. Then we applied to the resulting video a software (Mudy 1.7.7.2 AMID Sulmona Italy) for the analysis of muscle deformation patterns (contraction, dilatation, cross-plane, vertical strain, horizontal strain, vertical shear, horizontal shear, horizontal displacement, vertical displacement). The number of videos of masseter muscles in contraction at maximum exertion due to dental clenching made during this research is around 12,000. Out of these we chose 1,200 videos which examine 200 patients (100 females, 100 males). RESULTS The analysis of the deformation patterns of the masseter allows us to observe how the six layers of the muscle have different and specific functions each, which vary depending on the applied force (application point, magnitude and direction) so that we find it impossible to assign to one of the three sections of the muscle a mechanical predominance. Therefore it appears that the three parts of the muscle have specific and synergistic tasks.
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Affiliation(s)
| | - G Balconi
- Department of Radiology, Hospital San Raffaele Turro, Milano, Italy
| | | | | | - G Garo
- President and Founder of Siach - The International Society of Surgical Anatomy
| | - D DE Gregorio
- Director of Siach, Aesthetic Surgeon, Perugia, Italy
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13
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Busato A, Balconi G, Vismara V, Bertelè L, Garo G, DE Gregorio D. Ultrasound and analysis of the deformation patterns of the masseter muscle: comparing surgical anatomy, ultrasound and functional anatomy. ORAL & IMPLANTOLOGY 2017; 9:28-37. [PMID: 28280530 DOI: 10.11138/orl/2016.9.1s.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE We have tried to demonstrate whether the analysis of the muscle strain allows us to identify the three distinct functional areas of the architecture of the masseter, as one would see them by performing or viewing an anatomical dissection of said muscle, and whether these sections have behave differently in terms of origin and coping of the strain they face (quantitative analysis). MATERIALS AND METHODS This work has been elaborated by the use of an ultrasound machine (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm) which allowed us to record a 45 frame per second video (DCM). Videos has been elaborated by use of an ultrasound machine (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm) which allowed us to record a 45 frame per second video (DCM). We applied to the resulting video a software (Mudy 1.7.7.2 AMID Sulmona Italy) for the analysis of muscle deformation patters (contraction, dilatation, cross-plane, vertical strain, horizontal strain, vertical shear, horizontal shear, horizontal displacement, vertical displacement). The number of videos of masseter muscles in contraction at maximum exertion due to dental clenching made during this research is around 12,000. Out of these we chose 1,200 videos which examine 200 patients (100 females, 100 males). RESULTS The deformation pattern analysis of the skeletal muscle on ultrasound basis seems to be an adequate instrument to use during the investigation of the functional structure of the masseter muscle given its ability to highlight the distinct activity of each separate part of the muscle. CONCLUSIONS Moreover the strain does not apply to the muscle uniformly; instead it varies according to the observed area.
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Affiliation(s)
| | - G Balconi
- Department of Radiology, Hospital San Raffaele Turro, Milano, Italy
| | | | | | - G Garo
- President and Founder of Siach - The International Society of Surgical Anatomy
| | - D DE Gregorio
- Director of Siach, Aesthetic Surgeon, Perugia, Italy
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14
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Chinchalkar SJ, Larocerie-Salgado J, Suh N. Pathomechanics and Management of Secondary Complications Associated with Tendon Adhesions Following Flexor Tendon Repair in Zone II. J Hand Microsurg 2016; 8:70-9. [PMID: 27625534 PMCID: PMC5018978 DOI: 10.1055/s-0036-1586173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022] Open
Abstract
Despite the number of rehabilitation strategies and guidelines developed to maximize the gliding amplitude of repaired tendons, secondary complications, such as decreased range of motion and stiffness associated with tendon adhesions, commonly arise. If left untreated, these early complications may lead to secondary pathomechanical changes resulting in fixed deformities and decreased function. Therefore, an appropriate treatment regimen must not only include strategies to maintain the integrity of the repaired tendon, but must also avoid secondary complications due to reduced gliding amplitude. This review presents a biomechanical analysis of the dynamics of tendon gliding following repair in zone II and rehabilitation strategies to minimize secondary complications related with tendon adhesions.
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Affiliation(s)
- Shrikant J. Chinchalkar
- Department of Hand Therapy, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Juliana Larocerie-Salgado
- Department of Hand Therapy, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
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15
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Kociolek AM, Keir PJ. Relative motion between the flexor digitorum superficialis tendon and paratenon in zone V increases with wrist flexion angle. J Orthop Res 2016; 34:1248-55. [PMID: 26686976 DOI: 10.1002/jor.23133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 12/08/2015] [Indexed: 02/04/2023]
Abstract
Carpal tunnel syndrome is characterized by non-inflammatory fibrosis of the subsynovial connective tissue (SSCT), a paratenon-like structure inside the carpal tunnel. This pathology suggests repetitive and/or excessive shear forces are involved in injury development. We assessed relative motion between the flexor digitorum superficialis (FDS) tendon and adjacent paratenon in Zone V using colour Doppler imaging as 16 healthy participants completed three long finger movements (metacarpophalangeal joint flexion, proximal and distal interphalangeal joint flexion, full finger flexion) in three wrist postures (30° extension, 0°, 30° flexion). While the type of finger movement did not affect tendon-paratenon relative motion, we found a significant main effect of wrist posture (p < 0.001). Relative displacement between the FDS tendon and paratenon (as a percentage of tendon displacement) increased from 27.2% (95%CI = 24.8-29.5%) in 30° wrist extension to 39.9% (95%CI = 37.3-42.4%) in 30° wrist flexion. Optical motion capture confirmed that wrist posture did not affect metacarpophalangeal joint range of motion (p = 0.265) or proximal interphalangeal joint range of motion (p = 0.582). These results indicate that relative motion increased due to paratenon strain when the wrist was flexed. While our findings agree with previous cadaveric research in wrist flexion, we found that relative displacement decreased in 30° wrist extension (compared to 0°). These results differ from cadaveric research, possibly due to challenges maintaining anatomic fidelity of the viscoelastic paratenon tissue in vitro. Overall, our study suggests a greater susceptibility to shear injury during repetitive finger movements, particularly when the wrist is flexed. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1248-1255, 2016.
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Affiliation(s)
- Aaron M Kociolek
- Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
| | - Peter J Keir
- Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
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16
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Lai TY, Chen HI, Shih CC, Kuo LC, Hsu HY, Huang CC. Application of a novel Kalman filter based block matching method to ultrasound images for hand tendon displacement estimation. Med Phys 2016; 43:148. [PMID: 26745907 DOI: 10.1118/1.4937932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Information about tendon displacement is important for allowing clinicians to not only quantify preoperative tendon injuries but also to identify any adhesive scaring between tendon and adjacent tissue. The Fisher-Tippett (FT) similarity measure has recently been shown to be more accurate than the Laplacian sum of absolute differences (SAD) and Gaussian sum of squared differences (SSD) similarity measures for tracking tendon displacement in ultrasound B-mode images. However, all of these similarity measures can easily be influenced by the quality of the ultrasound image, particularly its signal-to-noise ratio. Ultrasound images of injured hands are unfortunately often of poor quality due to the presence of adhesive scars. The present study investigated a novel Kalman-filter scheme for overcoming this problem. METHODS Three state-of-the-art tracking methods (FT, SAD, and SSD) were used to track the displacements of phantom and cadaver tendons, while FT was used to track human tendons. These three tracking methods were combined individually with the proposed Kalman-filter (K1) scheme and another Kalman-filter scheme used in a previous study to optimize the displacement trajectories of the phantom and cadaver tendons. The motion of the human extensor digitorum communis tendon was measured in the present study using the FT-K1 scheme. RESULTS The experimental results indicated that SSD exhibited better accuracy in the phantom experiments, whereas FT exhibited better performance for tracking real tendon motion in the cadaver experiments. All three tracking methods were influenced by the signal-to-noise ratio of the images. On the other hand, the K1 scheme was able to optimize the tracking trajectory of displacement in all experiments, even from a location with a poor image quality. The human experimental data indicated that the normal tendons were displaced more than the injured tendons, and that the motion ability of the injured tendon was restored after appropriate rehabilitation sessions. CONCLUSIONS The obtained results show the potential for applying the proposed FT-K1 method in clinical applications for evaluating the tendon injury level after metacarpal fractures and assessing the recovery of an injured tendon during rehabilitation.
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Affiliation(s)
- Ting-Yu Lai
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan
| | - Hsiao-I Chen
- Department of Occupational Therapy, National Cheng Kung University, Tainan 701, Taiwan
| | - Cho-Chiang Shih
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan and Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, National Cheng Kung University, Tainan 701, Taiwan
| | - Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan
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17
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Abstract
There have been immense technical innovations and broadened clinical applications of ultrasound in the musculoskeletal system over the past 20 years. Specifically with regard to the hand and wrist, the advent of higher resolution transducers and postprocessing software applications have resulted in overall enhanced visualization of soft tissue structures (tendons/ligaments) as well as surface osseous lesions such as subclinical erosions in rheumatoid arthritis. Quantitative ultrasound, using either power Doppler or contrast-enhanced imaging, has become a central outcomes measure used to evaluate and document patient response to treatment in inflammatory arthropathies such as rheumatoid arthritis. This review will summarize the current state of clinical applications of ultrasound in the evaluation of the hand and wrist, with a summary of technical advances and specific applications in rheumatologic conditions.This review was exempt from institutional review board approval.
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18
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Pearson SJ, Hussain SR. Region-specific tendon properties and patellar tendinopathy: a wider understanding. Sports Med 2015; 44:1101-12. [PMID: 24838651 DOI: 10.1007/s40279-014-0201-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patellar tendinopathy is a common painful musculoskeletal disorder with a very high prevalence in the athletic population that can severely limit or even end an athletic career. To date, the underlying pathophysiology leading to the condition remains poorly understood, although reports suggesting that patellar tendinopathy most frequently concerns the proximal posterior region of the tendon has prompted some researchers to examine region-specific tendon properties for a better understanding of the etiology and potential risk factors associated with the condition. However, to date, research concerning the in vivo region-specific tendon properties in relation to patellar tendinopathy is very scarce, perhaps due to the lack of validated techniques that can determine such properties in vivo. In recent years, a technique has been developed involving an automated tendon-tracking program that appears to be very useful in the determination of region-specific tendon properties in vivo. In terms of regional variations in tendon properties, previous research has demonstrated differences in structural, mechanical, and biochemical properties between the discrete regions of the patellar tendon, but the extent to which these regional variations contribute to patellar tendinopathy remains elusive. In addition, with respect to treatment strategies for patellar tendinopathy, previous research has utilized a wide range of interventions, but the use of eccentric exercise (EE) and/or heavy-slow resistance (HSR) training appear to be most promising. However, the optimal program design variables of EE and HSR training that induce the most favorable effects are yet to be determined. This review article provides a detailed discussion of all of the above to allow a better understanding of the etiology and potential risk factors associated with the condition as well as the most effective treatment strategies. First, a comprehensive literature review is provided with respect to region-specific structural, mechanical, and biochemical properties, in association with patellar tendinopathy. Second, the automated tendon-tracking methodology is outlined to assist future researchers in the determination of region-specific tendon properties. Finally, potential treatment strategies are discussed, particularly with regards to the use of EE and HSR training for the management of patellar tendinopathy.
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Affiliation(s)
- Stephen John Pearson
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Manchester, M6 6PU, UK,
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Kociolek AM, Keir PJ. Development of a kinematic model to predict finger flexor tendon and subsynovial connective tissue displacement in the carpal tunnel. ERGONOMICS 2015; 58:1398-1409. [PMID: 25679821 DOI: 10.1080/00140139.2015.1013575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Finger flexor tendinopathies and carpal tunnel syndrome are histologically characterised by non-inflammatory fibrosis of the subsynovial connective tissue (SSCT) in the carpal tunnel, which is indicative of excessive and repetitive shear forces between the finger flexor tendons and SSCT. We assessed flexor digitorum superficialis (FDS) tendon and adjacent SSCT displacements with colour Doppler ultrasound as 16 healthy participants completed long finger flexion/extension movements captured by a motion capture system. FDS tendon displacements fit a second-order regression model based on metacarpophalangeal and proximal interphalangeal joint flexion angles (R(2) = 0.92 ± 0.01). SSCT displacements were 33.6 ± 1.7% smaller than FDS tendon displacements and also fit a second-order regression model (R(2) = 0.89 ± 0.01). FDS tendon and SSCT displacement both correlated with finger joint thickness, enabling participant-specific anthropometric scaling. We propose the current regression models as an ergonomic method to determine relative displacements between the finger flexor tendons and SSCT. PRACTITIONER SUMMARY Relative displacements between the finger flexor tendons and SSCT provide insight into gliding and friction in the carpal tunnel. Our regression models represent a move towards mechanistic-based ergonomic risk assessment of the wrist/hand. This is a natural evolution of ergonomic methods based on tendon-joint interaction.
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Affiliation(s)
- Aaron M Kociolek
- a Department of Kinesiology , McMaster University , 1280 Main Street West, Hamilton, Ontario L8S 4K1 , Canada
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20
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Ghasemi-rad M, Nosair E, Vegh A, Mohammadi A, Akkad A, Lesha E, Mohammadi MH, Sayed D, Davarian A, Maleki-Miyandoab T, Hasan A. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World J Radiol 2014; 6:284-300. [PMID: 24976931 PMCID: PMC4072815 DOI: 10.4329/wjr.v6.i6.284] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/28/2014] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anatomy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation.
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21
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Buschmann J, Puippe G, Bürgisser GM, Bonavoglia E, Giovanoli P, Calcagni M. Correspondence of high-frequency ultrasound and histomorphometry of healing rabbit Achilles tendon tissue. Connect Tissue Res 2014; 55:123-31. [PMID: 24283274 DOI: 10.3109/03008207.2013.870162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Static and dynamic high-frequency ultrasound of healing rabbit Achilles tendons were set in relationship to histomorphometric analyses at three and six weeks post-surgery. MATERIALS AND METHODS Twelve New Zealand White rabbits received a clean-cut Achilles tendon laceration (the medial and lateral Musculus gastrocnemius) and were repaired with a four-strand Becker suture. Six rabbits got additionally a tight polyester urethane tube at the repair site in order to vary the adhesion extent. Tendons were analysed by static and dynamic ultrasound (control: healthy contralateral legs). The ultrasound outcome was corresponded to the tendon shape, tenocyte and tenoblast density, tenocyte and tenoblast nuclei width, collagen fibre orientation and adhesion extent. RESULTS The spindle-like morphology of healing tendons (ultrasound) was confirmed by the swollen epitenon (histology). Prediction of adhesion formation by dynamic ultrasound assessment was confirmed by histology (contact region to surrounding tissue). Hyperechogenic areas corresponded to acellular zones with aligned fibres and hypoechogenic zones to not yet oriented fibres and to cell-rich areas. CONCLUSIONS These findings add new in-depth structural knowledge to the established non-invasive analytical tool, ultrasound.
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Affiliation(s)
- Johanna Buschmann
- Department for Plastic Surgery and Hand Surgery, University Hospital Zurich , Zurich , Switzerland
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22
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Sapienza A, Yoon HK, Karia R, Lee SK. Flexor tendon excursion and load during passive and active simulated motion: a cadaver study. J Hand Surg Eur Vol 2013; 38:964-71. [PMID: 23221181 DOI: 10.1177/1753193412469128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to quantify the amount of tendon excursion and load experienced during simulated active and passive rehabilitation exercises. Six cadaver specimens were utilized to examine tendon excursion and load. Lateral fluoroscopic images were used to measure the excursions of metal markers placed in the flexor digitorum superficialis and profundus tendons of the index, middle, and ring fingers. Measurements were performed during ten different passive and active simulated motions. Mean tendon forces were higher in all active versus passive movements. Blocking movements placed the highest loads on the flexor tendons. Active motion resulted in higher tendon excursion than did passive motion. Simulated hook position resulted in the highest total tendon excursion and the highest inter-tendinous excursion. This knowledge may help optimize the management of the post-operative exercise therapy regimen.
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Affiliation(s)
- A Sapienza
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
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23
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Korstanje JWH, Soeters JN, Schreuders TA, Amadio PC, Hovius SE, Stam HJ, Selles RW. Ultrasonographic assessment of flexor tendon mobilization: effect of different protocols on tendon excursion. J Bone Joint Surg Am 2012; 94:394-402. [PMID: 22398732 PMCID: PMC6882526 DOI: 10.2106/jbjs.j.01521] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Different mobilization protocols have been proposed for rehabilitation after hand flexor tendon repair to provide tendon excursion sufficient to prevent adhesions. Several cadaver studies have shown that the position of the neighboring fingers influences tendon excursions of the injured finger. We hypothesized that the positions of adjacent fingers influence the long finger flexor digitorum profundus tendon excursion, measured both absolutely and relative to the surrounding tissue of the tendon. METHODS Long finger flexor digitorum profundus tendon excursions and surrounding tissue movement were measured in zone V in eleven healthy subjects during three different rehabilitation protocols and two experimental models: (1) an active four-finger mobilization protocol, (2) a passive four-finger mobilization protocol, (3) a modified Kleinert mobilization protocol, (4) an experimental modified Kleinert flexion mobilization model, and (5) an experimental modified Kleinert extension mobilization model. Tendon excursions were measured with use of a frame-to-frame analysis of high-resolution ultrasound images. RESULTS The median absolute long finger flexor digitorum profundus tendon excursions were 23.4, 17.8, 10.0, 13.9, and 7.6 mm for the active four-finger mobilization protocol, the passive four-finger mobilization protocol, the modified Kleinert mobilization protocol, the experimental modified Kleinert flexion mobilization model, and the experimental modified Kleinert extension mobilization model, respectively, and these differences were all significant (p ≤ 0.041). The corresponding relative flexor digitorum profundus tendon excursions were 11.2, 8.5, 7.2, 10.4, and 5.6 mm. Active four-finger mobilization protocol excursions were significantly (p = 0.013) greater than passive four-finger mobilization protocol excursions but were not significantly greater than experimental modified Kleinert flexion mobilization model excursions (p =0.213). CONCLUSIONS The present study demonstrated large and significant differences among the different rehabilitation protocols and experimental models in terms of absolute and relative tendon displacement. More importantly, the present study clearly demonstrated the influence of the position of the adjacent fingers on the flexor tendon displacement of the finger that is mobilized.
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Affiliation(s)
- Jan-Wiebe H. Korstanje
- Department of Rehabilitation Medicine and Physical Therapy, Rooms Ee16.22 (J.-W.H.K.), Ca 001k (J.N.M.S.), H 014 (T.A.R.S. and R.W.S.), H 028 (H.J.S.), and HS 501 (S.E.R.H.), Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for J.-W.H. Korstanje:
| | - Johannes N.M. Soeters
- Department of Rehabilitation Medicine and Physical Therapy, Rooms Ee16.22 (J.-W.H.K.), Ca 001k (J.N.M.S.), H 014 (T.A.R.S. and R.W.S.), H 028 (H.J.S.), and HS 501 (S.E.R.H.), Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for J.-W.H. Korstanje:
| | - Ton A.R. Schreuders
- Department of Rehabilitation Medicine and Physical Therapy, Rooms Ee16.22 (J.-W.H.K.), Ca 001k (J.N.M.S.), H 014 (T.A.R.S. and R.W.S.), H 028 (H.J.S.), and HS 501 (S.E.R.H.), Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for J.-W.H. Korstanje:
| | - Peter C. Amadio
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Steven E.R. Hovius
- Department of Rehabilitation Medicine and Physical Therapy, Rooms Ee16.22 (J.-W.H.K.), Ca 001k (J.N.M.S.), H 014 (T.A.R.S. and R.W.S.), H 028 (H.J.S.), and HS 501 (S.E.R.H.), Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for J.-W.H. Korstanje:
| | - Henk J. Stam
- Department of Rehabilitation Medicine and Physical Therapy, Rooms Ee16.22 (J.-W.H.K.), Ca 001k (J.N.M.S.), H 014 (T.A.R.S. and R.W.S.), H 028 (H.J.S.), and HS 501 (S.E.R.H.), Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for J.-W.H. Korstanje:
| | - Ruud W. Selles
- Department of Rehabilitation Medicine and Physical Therapy, Rooms Ee16.22 (J.-W.H.K.), Ca 001k (J.N.M.S.), H 014 (T.A.R.S. and R.W.S.), H 028 (H.J.S.), and HS 501 (S.E.R.H.), Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for J.-W.H. Korstanje:
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Yoshii Y, Henderson J, Villarraga HR, Zhao C, An KN, Amadio PC. Ultrasound assessment of the motion patterns of human flexor digitorum superficialis and profundus tendons with speckle tracking. J Orthop Res 2011; 29:1465-9. [PMID: 21469183 PMCID: PMC3134554 DOI: 10.1002/jor.21428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 03/14/2011] [Indexed: 02/04/2023]
Abstract
The purposes of our study were to correlate ultrasonographically measured and joint angle estimated excursions of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons of the hand and to estimate the relative motion of FDS and FDP while gripping cylinders of standard diameter in normal human subjects. Thirty wrists from 15 human subjects were imaged with an ultrasound scanner. Speckle tracking was used to measure the excursion of the FDS and FDP tendons. The tendon excursions necessary to grip three differently sized acrylic tubes were measured and correlated with the corresponding finger joint angles. The FDP/FDS excursion ratio was calculated. The Pearson's correlation coefficient between the FDS excursion and MP + PIP joint angle was 0.61. The Pearson's correlation coefficient between the FDP + FDS excursion and the DIP + PIP + MP joint angle was 0.67. The FDP/FDS excursion ratio was smaller for larger excursions (gripping a smaller diameter tube) and larger for small excursions (gripping a larger diameter tube, P < 0.01). These data suggest that speckle tracking may be a useful method to discriminate the relative motion of flexor tendons, which in turn may be relevant in evaluating tendon function, for example after tendon injury.
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