Tendon Transfers in the Rheumatoid Hand for Reconstruction

O’Sullivan, Michael; Singh, Hardeep; Wolf, Jennifer Moriatis

doi:10.1016/j.hcl.2016.03.014

Cited by 17 publications

(15 citation statements)

References 34 publications

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“…Publications, therefore, recommend mainly the transfer or coupling of the tendons with an intact extensor tendon [ 3 , 12 ]. As a second line of defense, many authors favor free transplantation [ 14 , 22 ]. All tendon operations included in our study were secondary reconstructions with transfer or coupling.…”

Section: Discussionmentioning

confidence: 99%

Extensor tendon ruptures in rheumatoid wrists

Biehl

Rupp

Kern

et al. 2020

Eur J Orthop Surg Traumatol

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Background and aims Rheumatoid arthritis is a chronic inflammatory disease. The associated involvement of hands and tendons is over 90% and impairs overall function. In the course of the disease, the joints are often operated on. During this operation, ruptures of the extensor tendons are found by chance without the patients noticing them. The aim of this retrospective study is the prevalence of extensor tendon rupture. Which tendon is destroyed most frequently? How can the functional outcome be measured after reconstruction? Materials and methods From 1572 operations on rheumatoid wrists, 61 extensor tendon ruptures were identified in 41 patients. The average time between the first rheumatic symptoms of the hand and surgery was 6.4 years. The average duration of RA was 7.8 years. 26 patients with 27 tendon reconstructions were included in the follow-up with an average postoperative duration of 4.6 years (3 to 14.2 years). Results Extensor tendons ruptures typically occurred at mechanically stressed sites. The most frequent rupture was found in the extensor pollicis longus tendon (21 tendons), followed by the small finger extensor tendon (14 tendons). A transfer was performed on 7 tendons. Fifty-five tendon lesions were sutured at other intact tendons. Free grafts were not used. The results in Clayton and QuickDASH scores were significantly different. Functional improvement was consistent with the results of tendon reconstructions in healthy control groups. Conclusion In rheumatoid patients, a rupture of an extensor tendon must be expected at 4%. Patients tolerate and compensate this damage for a long time. The function of the hand including the tendon function is the most important factor in assessing the success of the operation. The subjective patient acceptance depends on the progress of the underlying disease, postoperative care (ergotherapy, physiotherapy, orthosis) and the patients' demands. Electronic supplementary material The online version of this article (10.1007/s00590-020-02731-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Extensor tendon ruptures in rheumatoid wrists

Biehl

Rupp

Kern

et al. 2020

Eur J Orthop Surg Traumatol

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“…La transposición tendínea es el tratamiento de elección frente a esa patología, sobre todo cuando se trata de lesiones de mayor tiempo de evolución y en pacientes con artritis reumatoide con buenos resultados, buena satisfacción del paciente y bajas complicaciones. 8,16 En nuestro paciente se realiza la transposición tendínea bajo anestesia local con vasoconstricción sin torniquete utilizando la técnica de WALANT. Esa técnica anestésica está siendo ampliamente utilizada a nivel internacional en la cirugía de la mano y sobre todo para patología tendínea con buenos resultados y escasas complicaciones.…”

Section: Discussionunclassified

“…Esa técnica anestésica está siendo ampliamente utilizada a nivel internacional en la cirugía de la mano y sobre todo para patología tendínea con buenos resultados y escasas complicaciones. [16][17][18] Con la aplicación de WALANT, se ha descrito una disminución en los tiempos de estadía hospitalaria con respecto a técnicas de anestesia tradicionales que requieren sedación, y menor necesidad de solicitud de exámenes preoperatorios, sobre todo en pacientes jóvenes sin comorbilidad. 10 Además, se ha descrito menor nivel de ansiedad preoperatoria y menor requerimiento de medicamentos analgésicos en el postoperatorio que en pacientes con anestesia tradicional.…”

Section: Discussionunclassified

Rotura espontánea del tendón extensor largo del pulgar – transferencia tendínea con técnica anestésica WALANT

Faúndez

Sanhueza

Penna

2017

Rev Chil Ortop Traumatol

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IntroducciónLa rotura espontanea del tendón extensor largo del pulgar (ELP), es una patología infrecuente dentro de la patología de la mano. En la literatura han sido reportados distintos factores asociados dentro de los cuales los más frecuentes son la fractura de radio distal con una incidencia de hasta un 5% de las fracturas, la artritis reumatoide y la inyección sistémica o local de corticoides.1-4 Las actividades repetitivas con la extremidad, como son algunos tipos de danza y oficios, también han sido consideradas factores de riesgo para el desarrollo de esta patología. 5-7 Otro factor asociado es la tendinosis en la zona del tubérculo de Lister debido a un efecto compresivo, donde incluso se ha planteado la descompresión profiláctica. 8Palabras Clave ResumenLa rotura espontanea del tendón extensor largo del pulgar (ELP), es una patología infrecuente existiendo casos reportados en la literatura donde no se logra encontrar factores predisponentes. El manejo quirúrgico suele realizarse utilizando una técnica de transposición tendínea del tendón del extensor propio del índice. En la actualidad, la técnica anestésica de WALANT "Wide Awake Local Anesthesia with No-Torniquet" ha sido de amplio desarrollo en la cirugía de la mano, sobre todo para la resolución quirúrgica de patología de tendones, con buenos y excelentes resultados. Se presenta un caso de un paciente con rotura espontánea del tendón ELP, que fue manejado con una transferencia tendínea utilizando la técnica anestésica WALANT. Keywords► hand surgery ► EPL ► extensor pollicis longus ruptura ► tendon transfer ► WALANT AbstractThe spontaneous rupture of thumb extensor pollicis longus (EPL) is a rare disease with just a few case reports known where no trigger factor has been found. The surgical management is done by the proper index extensor tendon transposition. Nowadays, the WALANT anesthetic technique ("Wide Awake Local Anesthesia with NoTorniquet") has had a broad development in hand surgery, especially in surgery for tendon injuries, with good and excellent results. A clinical case is shown with a patient who had a spontaneous EPL rupture which was managed with a tendon transfer under the WALANT anesthetics technique.

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“…48 This ruptured FPL can be reconstructed by transferring the FDS of the middle or the long finger. 49 Attritional rupture of extensor tendons, including EPL and finger extensors, also occurs. 50 Finger extensor rupture in RA usually starts at the small finger, and may progress radially to affect the ring, long, and index fingers as well.…”

Section: Rheumatoid Arthritis and Traumatic Rupturementioning

confidence: 99%

“…The most common tendon to rupture in RA is FPL, which is usually caused by bony spurs in the carpal tunnel, a condition commonly referred to as “Mannerfelt syndrome.” 48 This ruptured FPL can be reconstructed by transferring the FDS of the middle or the long finger. 49 Attritional rupture of extensor tendons, including EPL and finger extensors, also occurs. 50 Finger extensor rupture in RA usually starts at the small finger, and may progress radially to affect the ring, long, and index fingers as well.…”

Section: Rheumatoid Arthritis and Traumatic Rupturementioning

confidence: 99%

Upper Extremity Tendon Transfers: A Brief Review of History, Common Applications, and Technical Tips

Gardenier

Garg

Mudgal

2020

Indian J Plast Surg

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Background Tendon transfer in the upper extremity represents a powerful tool in the armamentarium of a reconstructive surgeon in the setting of irreparable nerve injury or the anatomic loss of key portions of the muscle-tendon unit. The concept uses the redundancy/expendability of tendons by utilizing a nonessential tendon to restore the function of a lost or nonfunctional muscle-tendon unit of the upper extremity. This article does not aim to perform a comprehensive review of tendon transfers. Instead it is meant to familiarize the reader with salient historical features, common applications in the upper limb, and provide the reader with some technical tips, which may facilitate a successful tendon transfer. Learning Objectives (1) Familiarize the reader with some aspects of tendon transfer history. (2) Identify principles of tendon transfers. (3) Identify important preoperative considerations. (4) Understand the physiology of the muscle-tendon unit and the Blix curve. (5) Identify strategies for setting tension during a tendon transfer and rehabilitation strategies. Design This study was designed to review the relevant current literature and provide an expert opinion. Conclusions Tendon transfers have evolved from polio to tetraplegia to war and represent an extremely powerful technique to correct neurologic and musculotendinous deficits in a variety of patients affected by trauma, peripheral nerve palsies, cerebral palsy, stroke, and inflammatory arthritis. In the contemporary setting, these very same principles have also been very successfully applied to vascularized composite allotransplantation in the upper limb.

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Tendon Transfers in the Rheumatoid Hand for Reconstruction

Cited by 17 publications

References 34 publications

Extensor tendon ruptures in rheumatoid wrists

Extensor tendon ruptures in rheumatoid wrists

Rotura espontánea del tendón extensor largo del pulgar – transferencia tendínea con técnica anestésica WALANT

Upper Extremity Tendon Transfers: A Brief Review of History, Common Applications, and Technical Tips

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