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Graham DJ, Clitherow HDS, Singh HP, Clarke EC, Smith BJ, Tonkin MA. The Effect of Extensor Tendon Adhesions on Finger Motion. J Hand Surg Am 2019; 44:903.e1-903.e5. [PMID: 30733099 DOI: 10.1016/j.jhsa.2018.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/24/2018] [Accepted: 12/19/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the amount and pattern of finger range of motion loss at the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints with a simulated extensor tendon adhesion at the level of the proximal phalanx or metacarpal. METHODS In 10 cadaveric specimens, traction sutures were placed in the forearm extensor digitorum communis and flexor digitorum profundus tendons of the middle and ring fingers. Active motion was simulated by suspending weights from the traction sutures via pulleys. The angles of the MCP, PIP, and DIP joints were measured at the position of maximum flexion and extension. Extensor tendon adhesions were simulated alternately at the proximal phalanx and metacarpal levels of the middle and ring fingers, using suture anchors. Repeat measurements were taken using the same amount of force. RESULTS There was an average total loss of flexion of 38° and of extension of 6° with a proximal phalanx adhesion, with a greater contribution of flexion loss at the PIP joint. The loss of flexion was 17° and of extension was 50° with a metacarpal adhesion, with a loss of extension mostly at the MCP joint. CONCLUSIONS The results of this study identified clear patterns of motion loss that are associated with isolated simulated adhesions in different locations along the extensor mechanism. The greatest motion loss occurred at the joint immediately distal to the simulated adhesion. CLINICAL RELEVANCE Although extrapolation of these findings to clinical relevance remains unclear, the ability to predict the level of adhesion by the pattern of motion restriction may allow for a targeted tenolysis procedure. This would reduce the amount of soft tissue dissection required, which in turn, could be expected to reduce the degree of repeat adhesion formation.
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Affiliation(s)
- David J Graham
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Harry D S Clitherow
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Harvinder P Singh
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Elizabeth C Clarke
- Murray Maxwell Biomechanics Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Belinda J Smith
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Michael A Tonkin
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia.
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Bain GI, Clitherow HDS, Millar S, Fraysse F, Costi JJ, Eng K, McGuire DT, Thewlis D. The effect of lunate morphology on the 3-dimensional kinematics of the carpus. J Hand Surg Am 2015; 40:81-9.e1. [PMID: 25447001 DOI: 10.1016/j.jhsa.2014.09.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/30/2014] [Accepted: 09/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess carpal kinematics in various ranges of motion in 3 dimensions with respect to lunate morphology. METHODS Eight cadaveric wrists (4 type I lunates, 4 type II lunates) were mounted into a customized platform that allowed controlled motion with 6 degrees of freedom. The wrists were moved through flexion-extension (15°-15°) and radioulnar deviation (RUD; 20°-20°). The relative motion of the radius, carpus, and third metacarpal were recorded using optical motion capture methods. RESULTS Clear patterns of carpal motion were identified. Significantly greater motion occurred at the radiocarpal joint during flexion-extension of type I wrist than a type II wrist. The relative contributions of the midcarpal and radiocarpal articulations to movement of the wrist differed between the radial, the central, and the ulnar columns. During wrist flexion and extension, these contributions were determined by the lunate morphology, whereas during RUD, they were determined by the direction of wrist motion. The midcarpal articulations were relatively restricted during flexion and extension of a type II wrist. However, during RUD, the midcarpal joint of the central column became the dominant articulation. CONCLUSIONS This study describes the effect of lunate morphology on 3-dimensional carpal kinematics during wrist flexion and extension. Despite the limited size of the motion arcs tested, the results represent an advance on the current understanding of this topic. CLINICAL RELEVANCE Differences in carpal kinematics may explain the effect of lunate morphology on pathological changes within the carpus. Differences in carpal kinematics due to lunate morphology may have implications for the management of certain wrist conditions.
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Affiliation(s)
- Gregory I Bain
- Department of Orthopaedic Surgery, Flinders Hospital, Adelaide, SA; Department of Orthopaedic Surgery, and the Biomechanics & Implants Research Group, The Medical Device Research Institute, School of Computer Science, Engineering & Mathematics, Flinders University, Adelaide, SA; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, Modbury Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA; Sansom Institute for Health Research & School of Health Sciences, University of South Australia, South Australia; Department of Orthopaedics and Trauma, Geelong Hospital, Geelong, Victoria, Australia; Martin Singer Hand Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and UCT Private Academic Hospital, Cape Town, South Africa
| | - Harry D S Clitherow
- Department of Orthopaedic Surgery, Flinders Hospital, Adelaide, SA; Department of Orthopaedic Surgery, and the Biomechanics & Implants Research Group, The Medical Device Research Institute, School of Computer Science, Engineering & Mathematics, Flinders University, Adelaide, SA; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, Modbury Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA; Sansom Institute for Health Research & School of Health Sciences, University of South Australia, South Australia; Department of Orthopaedics and Trauma, Geelong Hospital, Geelong, Victoria, Australia; Martin Singer Hand Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and UCT Private Academic Hospital, Cape Town, South Africa.
| | - Stuart Millar
- Department of Orthopaedic Surgery, Flinders Hospital, Adelaide, SA; Department of Orthopaedic Surgery, and the Biomechanics & Implants Research Group, The Medical Device Research Institute, School of Computer Science, Engineering & Mathematics, Flinders University, Adelaide, SA; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, Modbury Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA; Sansom Institute for Health Research & School of Health Sciences, University of South Australia, South Australia; Department of Orthopaedics and Trauma, Geelong Hospital, Geelong, Victoria, Australia; Martin Singer Hand Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and UCT Private Academic Hospital, Cape Town, South Africa
| | - François Fraysse
- Department of Orthopaedic Surgery, Flinders Hospital, Adelaide, SA; Department of Orthopaedic Surgery, and the Biomechanics & Implants Research Group, The Medical Device Research Institute, School of Computer Science, Engineering & Mathematics, Flinders University, Adelaide, SA; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, Modbury Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA; Sansom Institute for Health Research & School of Health Sciences, University of South Australia, South Australia; Department of Orthopaedics and Trauma, Geelong Hospital, Geelong, Victoria, Australia; Martin Singer Hand Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and UCT Private Academic Hospital, Cape Town, South Africa
| | - John J Costi
- Department of Orthopaedic Surgery, Flinders Hospital, Adelaide, SA; Department of Orthopaedic Surgery, and the Biomechanics & Implants Research Group, The Medical Device Research Institute, School of Computer Science, Engineering & Mathematics, Flinders University, Adelaide, SA; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, Modbury Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA; Sansom Institute for Health Research & School of Health Sciences, University of South Australia, South Australia; Department of Orthopaedics and Trauma, Geelong Hospital, Geelong, Victoria, Australia; Martin Singer Hand Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and UCT Private Academic Hospital, Cape Town, South Africa
| | - Kevin Eng
- Department of Orthopaedic Surgery, Flinders Hospital, Adelaide, SA; Department of Orthopaedic Surgery, and the Biomechanics & Implants Research Group, The Medical Device Research Institute, School of Computer Science, Engineering & Mathematics, Flinders University, Adelaide, SA; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, Modbury Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA; Sansom Institute for Health Research & School of Health Sciences, University of South Australia, South Australia; Department of Orthopaedics and Trauma, Geelong Hospital, Geelong, Victoria, Australia; Martin Singer Hand Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and UCT Private Academic Hospital, Cape Town, South Africa
| | - Duncan T McGuire
- Department of Orthopaedic Surgery, Flinders Hospital, Adelaide, SA; Department of Orthopaedic Surgery, and the Biomechanics & Implants Research Group, The Medical Device Research Institute, School of Computer Science, Engineering & Mathematics, Flinders University, Adelaide, SA; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, Modbury Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA; Sansom Institute for Health Research & School of Health Sciences, University of South Australia, South Australia; Department of Orthopaedics and Trauma, Geelong Hospital, Geelong, Victoria, Australia; Martin Singer Hand Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and UCT Private Academic Hospital, Cape Town, South Africa
| | - Dominic Thewlis
- Department of Orthopaedic Surgery, Flinders Hospital, Adelaide, SA; Department of Orthopaedic Surgery, and the Biomechanics & Implants Research Group, The Medical Device Research Institute, School of Computer Science, Engineering & Mathematics, Flinders University, Adelaide, SA; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, Modbury Hospital, Adelaide, SA; Department of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA; Sansom Institute for Health Research & School of Health Sciences, University of South Australia, South Australia; Department of Orthopaedics and Trauma, Geelong Hospital, Geelong, Victoria, Australia; Martin Singer Hand Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and UCT Private Academic Hospital, Cape Town, South Africa
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