Flexor tendon excursion and load during passive and active simulated motion: a cadaver study

Sapienza, Anthony; Yoon, Hye Kyoung; Karia, Raj; Lee, S. K.

doi:10.1177/1753193412469128

Cited by 17 publications

(14 citation statements)

References 35 publications

(42 reference statements)

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“…Future studies may require the use of noninvasive techniques of measuring tendon elongation to fully investigate the use of relative motion in zone 2 or 1. 8 However, there is evidence to demonstrate that flexor tendons glide longer distances in zones 4 and 3 than in zone 2, which should result in even smaller elongation values in zone 2 than the ones reported in this study of tendons in zone 3. 5,8 We theorize that a relative motion protocol for flexor tendon repair will have the following additional benefits:…”

Section: Discussioncontrasting

confidence: 60%

Relative Motion Flexion Splinting for Flexor Tendon Lacerations: Proof of Concept

Chung

Chiu

Thanik

2017

Hand (New York, N,Y.)

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Section: Discussioncontrasting

confidence: 60%

Relative Motion Flexion Splinting for Flexor Tendon Lacerations: Proof of Concept

Chung

Chiu

Thanik

2017

Hand (New York, N,Y.)

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“…Additionally, in vivo studies have revealed that active movements generate 1.0 to 2.0 mm per 10-degree of arc of motion, whereas passive exercises generated only 0.4 to 0.9 mm per 10-degree, likely associated with tendon buckling. [60][61][62] Sapienza and colleagues 63 validated these results in a recent cadaveric study analyzing tendon excursion and load during passive and active simulated motion. They demonstrated that active motion generated greater tendon excursions than passive motion, while hook flexion generated the greatest total tendon excursion and differential gliding without placing excessive loads on tendons.…”

Section: Discussionmentioning

confidence: 69%

“…They demonstrated that active motion generated greater tendon excursions than passive motion, while hook flexion generated the greatest total tendon excursion and differential gliding without placing excessive loads on tendons. 63 Based on these studies, it is obvious that to move the digits maximally, in relation to the position of the wrist, a significant amount of excursion of the flexor tendons must be available. If there is a progressive loss of tendon excursion then there will be a substantial loss of joint motion.…”

Section: Discussionmentioning

confidence: 99%

Pathomechanics and Management of Secondary Complications Associated with Tendon Adhesions Following Flexor Tendon Repair in Zone II

2016

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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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“…If such gliding is absent, DIP joint motion is theoretically impossible. In the cadaveric study of Sapienza et al, the highest mean inter‐tendinous excursion was 5.6 mm during simulated hook positioning and the lowest 0.8 mm during PIP joint block. In another cadaveric study by Nimbarte et al, the FDP generated average flexion of 19.7°, 41.8°, and 29.4° at the MCP, PIP, and DIP joints, respectively, and the FDS generated average flexion of 24.8° and 47.9° at the MCP and PIP joints, respectively.…”

Section: Discussionmentioning

confidence: 90%

Biomechanical analyses of the human flexor tendon adhesion models in the hand: A cadaveric study

Kim

Rhee

Gong

et al. 2015

Journal Orthopaedic Research

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Patients with longstanding trigger finger may develop flexion contracture at the proximal interphalangeal (PIP) joint that persists even after division of the A1 pulley. The purpose of this study was to explore the hypothesis that flexion deformity of the PIP joint in advanced trigger finger is caused by severe adhesion between the flexor digitorum superficialis (FDS) and the flexor digitorum profundus (FDP) tendons. Ten freshly frozen cadaveric hands were used in the experiments. After preparation of the extrinsic flexor, extrinsic extensor, and intrinsic muscle tendons, we applied weights to the flexor tendons and minimal tension to the extrinsic extensor and intrinsic muscle tendons. We then measured the initial flexion angles of the metacarpophalangeal (MCP) and PIP joints. Next, we measured the flexion angles of the MCP and PIP joints as increasing tension was applied to the extrinsic extensor and intrinsic muscle tendons, respectively. We repeated these experiments after constructing flexor tendon adhesion model. The initial flexion angles of the MCP and PIP joints were greater in the adhesion model, as were the average tensions required for full extension of these joints. Our results suggest that adhesion between two flexor tendons contributes to progression of flexion deformity in the PIP joint. Keywords: adhesion; flexion deformity; flexor digitorum profundus; flexor digitorum superficialis; trigger finger Stenosing tenosynovitis of the fingers and thumb is one of the most common conditions managed by hand surgeons. Strom reported that the lifetime prevalence of trigger finger among a group of nondiabetics above the age of 30 years was 2.2%.1 Patients with longstanding trigger finger may develop flexion contracture at the proximal interphalangeal (PIP) joint.2 Sato et al. 3 suggested that enlargement of the flexor tendons contributed to the pathogenesis of PIP joint contracture. Several authors have reported that contracture may not be restored by only release of the A1 pulley. 4-6Favre and Kinnen 7 considered that the contracture might be attributable to degenerative enlargement and/ or shortness of the flexor digitorum superficialis (FDS) and suggested resection of the FDS to treat the contracture. Le Viet et al.2 were of the view that ulnar superficialis slip resection was indicated for patients with loss of passive extension in the PIP joint, and a long history of triggering. Will and Lubahn 6 described PIP joint arthrofibrosis as one of the major complications arising after open trigger finger release and recommended serial casting and active range-of-motion exercise to treat PIP joint arthrofibrosis.However, we have observed dense tenosynovial tissues encircling both the flexor digitorum profundus (FDP) and the FDS tendons intraoperatively in most of our triggerfinger patients with flexion contracture of the PIP joint. The two tendons exhibited severe adherence, and moved as a monotendon. Because we used longitudinal skin incisions, we were able to observe the conditions of flexor t...

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Flexor tendon excursion and load during passive and active simulated motion: a cadaver study

Cited by 17 publications

References 35 publications

Relative Motion Flexion Splinting for Flexor Tendon Lacerations: Proof of Concept

Relative Motion Flexion Splinting for Flexor Tendon Lacerations: Proof of Concept

Pathomechanics and Management of Secondary Complications Associated with Tendon Adhesions Following Flexor Tendon Repair in Zone II

Biomechanical analyses of the human flexor tendon adhesion models in the hand: A cadaveric study

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