- Management of Acute Extensor Tendon Injuries. [Review]
- CPClin Plast Surg 2019; 46(3):383-391
- Thin soft tissue covering extensor tendons make them prone to injury. The extensor mechanism achieves a delicate balance with the flexor system. Inappropriate management in the acute setting can lead…
Thin soft tissue covering extensor tendons make them prone to injury. The extensor mechanism achieves a delicate balance with the flexor system. Inappropriate management in the acute setting can lead to long-term deformity and dysfunction. Acute extensor tendon injuries are usually managed with splinting and/or primary repair of the tendon. In cases of tendon length loss, tendon graft or flap may be necessary for reconstruction. This article presents a series of cases illustrating the appropriate management of traumatic extensor tendon injuries.
- Managing Swan Neck and Boutonniere Deformities. [Review]
- CPClin Plast Surg 2019; 46(3):329-337
- Acute and chronic injuries to the finger extensor mechanism can result in swan neck and boutonniere deformities. Loss of coordination between the multiple, specialized components of the extensor mech…
Acute and chronic injuries to the finger extensor mechanism can result in swan neck and boutonniere deformities. Loss of coordination between the multiple, specialized components of the extensor mechanism results in tendon imbalances leading to altered interphalangeal joint flexion and extension forces. Treatments include corrective splinting and operative interventions. Swan neck deformities are functionally limiting. Surgical correction generally results in functional benefit. Boutonniere deformities are functional but aesthetically displeasing; proximal interphalangeal (PIP) joint flexion and the ability to make a fist are maintained. Surgical improvement can be attempted with caution. Attempts to improve PIP extension can impede flexion, resulting in a poor functional outcome.
- Flexor digitorum superficialis tenodesis for treatment of flexible swan neck deformity of fingers. Comparison between two surgical techniques to fix the tendon: A pilot study. [Letter]
- JPJ Plast Reconstr Aesthet Surg 2019 Apr 19
- Arthroplasty of the proximal interphalangeal joint with the Tactys® modular prosthesis: Results in case of index finger and clinodactyly. [Journal Article]
- HSHand Surg Rehabil 2019 Mar 19
- There are various surgical solutions for arthrosis of the proximal interphalangeal (PIP) joint: arthrodesis or denervation. Clinodactyly that is major and the index fingers are traditional contraindi…
There are various surgical solutions for arthrosis of the proximal interphalangeal (PIP) joint: arthrodesis or denervation. Clinodactyly that is major and the index fingers are traditional contraindications for PIP arthroplasty prostheses. The recurrence of clinodactyly with ligament imbalance and mechanical complications are known complications. The purpose of our study was to evaluate the objective and subjective clinical results and radiological complications of Tactys® prostheses on the PIP joint of the index fingers or with clinodactyly of more than 5° in the other fingers. Two surgeons have implanted 35 total gliding modular Tactys® prostheses in 29 women and 3 men since 2010. The indications for surgery were arthrotic and painful PIP joints. Average pre-op clinodactyly was 7.03° (5-30°) with ulnar deviation (29 cases). Eleven index fingers presented with average clinodactyly of 14.2° (10-20°). The digits operated on were as follows: 13 index fingers, 14 middle fingers, 5 ring fingers and 3 little fingers. Arthrosis was primitive in 23 cases, post-traumatic in 6 cases and rheumatoid in 6 cases. The average age of patients undergoing surgery was 63.7 years (40-85). Objective (mobility, strength, index finger exclusion, scores, clinodactyly) and subjective (patient satisfaction, pain) functional results were collected by a neutral and independent observer, as were radiological complications. With an average follow-up of 2.6 years (1-6.3), the range of motion in all digits improved by 5.4° on average (55.5-60.8). The improvement in range of motion in the index fingers was 4.5° (57-61.5). Clinodactyly in all fingers was corrected by 1.36° (0-20). In the index fingers, average clinodactyly was 1.3° (0-10). The pinch strength in all PIP joints improved significantly from 2.3 kg (0.5-5) to 3.7 kg (1-8). On the PIP of the index fingers, the pinch strength had increased significantly from 2.5 kg (1-4) before surgery to 3.8 kg (1-7.5) post-op. Functional scores improved: PRWE (from 55.36 to 26.7/100), Quick DASH (from 54.6 to 30.5/100). Patient satisfaction was excellent in 15 cases, good in 8 cases, average in 10 cases, poor in 2 cases. The average VAS Pain Score improved from 5.6 to 1.45. We found 3 major complications requiring surgery: 2 stiffening and 1 mechanical loosening with secondary arthrodesis. Five patients presented with non-troublesome, reducible swan neck deformity and one algodystrophy. A gliding, fixed Tactys® prosthesis allowed us to restore ligament balance and to optimally rebalance the periarticular structures. The improvement in range of motion and the correction of clinodactyly was maintained over time. Total arthroplasty of the PIP with a Tactys® is no longer a formal contraindication for the index fingers and in cases of clinodactyly of more than 5°.
- Fowler Central Slip Tenotomy or Spiral Oblique Retinacular Ligament Reconstruction? A Cadaveric Biomechanical Study in Swan-Neck Deformity. [Journal Article]
- HHand (N Y) 2019 Mar 08; :1558944719834643
- CONCLUSIONS: This study supports the SORL reconstruction in correcting a chronic mallet deformity, especially when there is a concomitant PIP hyperextension deformity, which lowers the risk of reversing the deformity after a Fowler procedure.
- Swan neck deformity. [Journal Article]
- JMJ Med Imaging Radiat Oncol 2018; 62 Suppl 1:159-160
- StatPearls: Swan-Neck Deformity [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Swan neck deformity is characterized by proximal interphalangeal (PIP) joint hyperextension and flexion of the distal interphalangeal (DIP) joint. There is also reciprocal flexion noted of the metaca…
Swan neck deformity is characterized by proximal interphalangeal (PIP) joint hyperextension and flexion of the distal interphalangeal (DIP) joint. There is also reciprocal flexion noted of the metacarpophalangeal (MCP) joint. This is a result of an imbalance of the extensor mechanism of the digit. The imbalance could be due to a significant laceration or stretching of the extrinsic tendon forces on the distal phalanx or from tightness and pulling of the extensor mechanism, both intrinsic and extrinsic, at the PIP joint.
- Rheumatoid Arthritis: A Brief Overview of the Treatment. [Review]
- MPMed Princ Pract 2018; 27(6):501-507
- Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease, affecting the joints with varying severity among patients. The risk factors include age, gender, genetics, and envir…
Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease, affecting the joints with varying severity among patients. The risk factors include age, gender, genetics, and environmental exposure (cigarette smoking, air pollutants, and occupational). Many complications can follow, such as permanent joint damage requiring arthroplasty, rheumatoid vasculitis, and Felty syndrome requiring splenectomy if it remains unaddressed. As there is no cure for RA, the treatment goals are to reduce the pain and stop/slow further damage. Here, we present a brief summary of various past and present treatment modalities to address the complications associated with RA.
- Osteogenesis imperfecta and the teeth, eyes, and ears-a study of non-skeletal phenotypes in adults. [Journal Article]
- OIOsteoporos Int 2018; 29(12):2781-2789
- CONCLUSIONS: Although significant health problems outside the skeleton are frequent in adult patients with OI, the patients are not consistently monitored and treated for their symptoms. Clinicians treating adult patients with OI should be aware of non-skeletal health issues and consider including regular interdisciplinary check-ups in the management plan for adult OI patients.
New Search Next
- A novel surgical correction and innovative splint for swan neck deformity in hypermobility syndrome. [Case Reports]
- JFJ Family Med Prim Care 2018 Jan-Feb; 7(1):242-245
- Splinting is a great domain of occupational therapy profession. Making a splint for the patient would depend on the need or requirement of the problems and deformities. Swan neck deformity is an unco…
Splinting is a great domain of occupational therapy profession. Making a splint for the patient would depend on the need or requirement of the problems and deformities. Swan neck deformity is an uncommon condition, and it can be seen in rheumatoid arthritis, cerebral palsy, and after trauma. Conservative treatment of the swan neck deformity is available by different static splints only. There are very few reports of surgical correction of swan-neck deformity in benign hypermobility syndrome. This case report describes the result of novel surgical intervention and an innovative hand splint in a 20-year-old female with a history of cardiovascular stroke with no residual neurological deficit. She presented with correctable swan neck deformity and failed to improve with static ring splints to correct the deformity. She underwent volar plate plication of the proximal interphalangeal joint of the left ring finger along with hemitenodesis of ulnar slip of flexor digitorum superficialis (FDS) tendon whereby, the ulnar slip of FDS was passed through a small surgically created rent in A2 pulley and sutured back to itself. Postoperatively, the patient was referred to occupational therapy for splinting with the instruction that the splint would work sometimes for as static and some time as dynamic for positional and correction of the finger. After occupational therapy intervention and splinting, the patient had a full correction of the swan-neck deformity with near full flexion of the operated finger and can work independently.