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Considering the potential action of exercise on neuroplasticity and the need to adapt protocols to enhance functional recovery after nerve injury, this study evaluated the effects of two intensities of treadmill exercise on nervous and muscular tissues and functional recovery after nerve crush injury. Wistar rats were distributed into sedentary group (SED), and 10 m/min (EG10) and 17 m/min (EG17) exercise groups. The exercise started one week after the injury. Ten daily sessions were performed with a 2-day interval after the fifth day. The flexor digitorum muscle and two segments of the median nerve were analysed histomorphometrically by light microscopy and computer analysis. Function was evaluated by grasping test, in 3 moments. Approval number: 016/2013. In the proximal segments of the median nerve, the diameter of myelinated fibres and axon, the myelin sheath thickness and the ratio of axon diameter to fibre diameter (g ratio) were significantly larger (P

OBJECTIVES: Clinical conditions such as focal dystonia often require the assessment of atrophy and weakness of the finger muscles. However, due to a lack of well-established protocols, the current investigation focused on assessing the reliability of thickness and strength assessments of the flexor digitorum (FD) muscle, including both the superficialis and profundus components. As a secondary assessment, the reliability of the strength measurement of the extensor digitorum muscle was examined as well. METHODS: Different thickness measurements of the FD were taken via ultrasonography and averaged to estimate the mean thickness of the FD. Likewise, individual finger strength measurements taken by a custom-made finger pressure device were averaged to compute the mean strength of the flexor and extensor digitorum muscles. Test-retest reliability of the above measurements performed at two different time points (about 6 months apart) were examined on the right and left hands of 10 participants. RESULTS: Findings indicated excellent test-retest reliability (ICC > 0.92) for the mean thickness assessment of the FD and mean strength of the flexor and extensor digitorum for both dominant and non-dominant hands. The standard error of measurement was ≤4.3% for all three mean assessments, indicating high sensitivity. Likewise, the smallest detectable change was also sufficiently small for the mean thickness and mean strength of the flexor digitorum (≤5.1%) and moderately small (≤12%) for the strength of the extensor digitorum. CONCLUSIONS: Results indicated an excellent relative and absolute reliability, for both hands, for the mean thickness and strength assessments of the flexor digitorum muscle and for the mean strength of the extensor digitorum (measured for both hands). These measurements can be used for future investigations and can contribute to the establishment of more precise methods for assessing the muscles in the forearms which serve the hand.

While the success or failure of carpal tunnel release ultimately depends on the interplay of a wide array of factors, a broad understanding of the normal anatomy of the carpal tunnel accompanied by awareness of the possible variations of the individual structures that make up its contents is crucial to optimizing surgical outcomes. While anatomic variants such as extension of the flexor digitorum muscle bellies have been described as a cause of primary carpal tunnel syndrome (CTS), there have been no reports depicting its association with recurrent CTS following initially successful carpal tunnel release, a finding with potentially significant prognostic implications that can aid in operative planning. In such cases where muscle extension is identified preoperatively, careful debulking of the muscle belly may be beneficial in improving long-term surgical outcomes.

In our dairy life, we often have opportunities to give others some tips of finger movements. If we can control the joints angle of each finger to the target joints angle by functional electrical stimulation, it is possible to give others some tips of finger movements. However, controlling the detail movements of fingers by functional electrical stimulation has not realized so far, because the structures of the musculoskeletal system involved in finger movement is very complicated. In this paper, we proposed a controller to control the PIP joint (the second joint of the finger) and MP joint (the third joint of the finger) in the middle finger to the arbitrary target joints angles by giving the electrical stimuli to the flexor digitorum muscle and the extensor digitorum muscle. Based on the knowledge about the relationships of the PIP/MP joints and the muscles, in our controller, the amounts to the flexor digitorum muscle and extensor digitorum muscle comparing with the current joint angles. First, we investigated we can control the PIP and MP joint to the given static target angles. As the result, it was possible to control both of PIP and MP joint to the arbitrary target. We also adopted this controller to control the joints to the target angles which change with time dynamically. Among these trials, we sometimes succeeded to track the changing target angles with time accurately but sometimes failed, in spite of performing the same tasks.

Resume L'avulsion distale du tendon flechisseur profond de l'annulaire est tellement caracteristique du rugby qu'elle en a meme pris le nom : « rubgy finger ». Le pronostic depend d'un diagnostic precoce qui doit conduire a une reparation chirurgicale en urgence dans un centre specialise. Le niveau de retraction tendineuse et l'association d'une lesion osseuse determinent les differents types lesionnels repondant pour chacun d'entre eux a un traitement specifique. Si le diagnostic initial n'a pas ete fait, seule une chirurgie palliative pourra etre proposee laissant alors de lourdes sequelles non sans consequences pour une pratique sportive de haut niveau.

Purpose: Oblique transections in tendons tend to reduce the strength of conventional repairs. We evaluated the effectiveness of lengthening longitudinal strand passage and adding locking components to improve the strength. Methods: Seventy-six fresh pig flexor tendons were transected obliquely and repaired using either a modified Kessler (grasping) repair or a locking Kessler repair. Orientations of the strands within the tendon were varied among conventional, oblique, and lengthened. The 2-mm gap formation force and ultimate strength were tested as measures of biomechanical performance for each repair. Results: The 2-mm gap formation force and ultimate strength with either grasping or locking repair were the weakest with a conventional repair, stronger with an oblique repair, and the strongest with a lengthened repair. The strength was significantly greater in oblique and lengthened locking repairs than in corresponding types of the grasping repair but was not different between the repairs with conventional configurations. Conclusions: Lengthening the repairs effectively improves the repair strength in obliquely lacerated tendons, in which strength of the conventional repairs diminishes owing to a decrease in the distance from sutures' grasping points to the laceration. Adding locking components increases the strength to oblique and lengthened repairs but does not add to the repairs with locking points that are not sufficiently away from the level of laceration.

The goal of this experiment was to investigate the relationship between individual fingertip forces and the surface EMG of multi-digit muscles. The surface EMG of the hand extrinsic flexors (flexor digitorum profundis and superficialis) was recorded in eight subjects during multi-digit force production tasks. In one session, subjects pressed with all four fingers (IMRL, I = index, M = middle, R = ring, and L = little finger) with the total force ranging from 10% and 90% of their maximum force (MVC). Results showed a close linear relationship between an integrated EMG index and force. In another session, subjects produced constant total force of either 10% or 30% of their IMRL MVC, with different finger combinations such that the degree of involvement of each finger was manipulated (15 finger combinations were tested). The EMG level of the flexors depended greatly on the finger combination (P < 0.001). Multi-variable regression made it possible to describe the flexor EMG as a linear function of individual fingertip forces. These results suggest that: (1) hand extrinsic flexors muscles are arranged in functional compartments serving individual fingers, and (2) each compartment has a force/EMG relationship that is close to being linear.

Hand injuries are among the most common injuries arising from athletic participation. Suboptimal outcomes from poorly treated athletic hand injuries can produce functionally disabling injuries. Careful assessment and, when needed, radiographic studies are critical for the accurate and complete diagnoses of hand injuries. Carefully thought out modifications may accelerate the time for return to competition. A thorough understanding of these many variables can enable the physician to minimize time lost without compromising care.

Many suture techniques have been described for flexor tendon repair. While many of these sutures have been tested and used clinically, the interaction between repairs of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) in the same digit has not been rigorously examined. Moreover, while much data are available on the mechanical properties of various suture techniques for FDP repair, much less is known about the mechanical performance of FDS repairs during motion of tendons. To make up for this lack of information, we measured the gliding resistance of the repaired FDP tendon, as compared to different FDS tendon repairs in a human cadaver model. The FDP tendon was repaired with a modified Kessler technique, while the FDS was repaired with a modified Kessler (n = 10), Becker (n = 10), or a new double running zig-zag suture (n = 10). The modified Kessler repair had a threefold increase from normal gliding resistance, the Becker repair increased twofold, and the zig-zag repair increased twofold. The peak gliding resistance increased twofold with a modified Kessler repair, 2.5-fold with a Becker repair, and 2.5-fold with a zig-zag repair.

Resume Introduction – L'indication a la suture primaire apres lesions des tendons flechisseurs de la main en zone 2 ainsi qu'une reeducation immediate apres l'intervention n'est plus contestee. En revanche, les methodes de reeducation, en particulier pendant les trois a quatre premieres semaines postoperatoires, different selon les ecoles. Les techniques de mobilisation precoce, decrites notamment par Kleinert puis par Duran, apportent un benefice fonctionnel considerable, sans pour autant permettre une sollicitation active immediate du ou des tendons sutures. Methode – Nous avons entrepris d'evaluer la methode de reeducation mobilisation en flexion active protegee (MFAP) proposee par l'ecole de Bordeaux et utilisee a Geneve depuis 1995. Cette methode est axee sur une mobilisation active en flexion dans un secteur d'amplitudes predeterminees. Elle vise a eviter la sideration des mecanismes proprioceptifs propres aux methodes passives et a limiter la formation d'adherences. Notre serie prospective comprend 22 cas consecutifs. Resultats – Ils ont ete evalues selon la classification de Strickland avec un recul moyen de 11,8 mois. Les resultats sont confrontes aux autres techniques de reeducation courante. Avec 81 % de bons et excellents resultats, les performances de nos patients tendent a confirmer celles relevees dans la litterature pour des techniques de reeducation analogues. Conclusions – Notre casuistique nous a permis de confirmer l'interet de cette methode et nous encourage a poursuivre une technique de mobilisation active protegee dans la reeducation des tendons flechisseurs en zone 2.

A case of a closed rupture of a single slip of flexor digitorum superficialis to the little finger is described. Closed rupture injuries of the flexor digitorum profundus tendon are quite common, but closed injuries to the superficialis tendon have been rarely reported. A single slip avulsion rupture of this tendon would seem to be very uncommon. The clinical presentation is reviewed.

Two-stage flexor tendon grafting is a procedure to salvage severely injured flexor tendon systems. It is a complex procedure that requires a surgeon's experience and the cooperation of the child, parents, and a therapist. The results are best in older children (10 to 15 years old) when using the Paneva Holevitch's technique with a suture in the palm of the hand. A continuing problem is always the future of the graft and the growth potential in children.

An in vivo experimental study was performed on the flexor profundus tendons of adult canines to determine tensile strength differences between locking and grasping technique repairs and to document the tensile strength using a passive mobilization protocol through the first 21 days following surgery. Forty experimental third and fourth flexor tendons of the right forepaws were lacerated and repaired with either of the 2 techniques. The experimental tendons were harvested at days 3, 7, 14, and 21 and were biomechanically tested. The third and fourth profundus tendons of the left forepaws were used as control (day 0) tendons; they were lacerated and repaired with the locking or grasping techniques at the time of harvest and also were biomechanically tested. The locking technique statistically improved tensile strength values at days 0, 3, and 21. The tensile strength decrease was minimal when using a passive mobilization protocol after surgery.

Ziele: Die Symptomatik der rheumatischen Handflexorensehnenerkrankung in Abhangigkeit vom Lasionsort und von der Art der Sehenaffektion festzustellen, um durch eine verbesserte klinische Diagnostik eine fruhzeitige operative Therapie mit Erhalt der Handfunktion zu ermoglichen.

Three anomalies of the human flexor digitorum superficial are presented. The normal development of this muscle from the amphibian to the human is discussed and the described anomalies of the muscle in humans classified.

For the restoration of thumb opposition many types of tendon transfer techniques have been described. The flexor digitorum superficialis (FDS) of the ring finger is commonly selected as a motor. On occasion, however, the quality of the flexor muscles of the fingers or wrist is not good enough for tendon transfer and another available muscle must be selected. In this situation, we have preferred to use an extensor carpi radialis longus (ECRL) or brevis (ECRB) transfer to restore opposition of the thumb. Follow-up examination, at an average 5 years and 10 months after operation, showed that the results of ten of 11 transfers were excellent and the other was good.

Resume Les ruptures de tendon flechisseur des doigts a la paume de la main sont rares. Un facteur etiologique, congenital ou acquis, est presque toujours retrouve. Nous rapportons ici le premier cas, a notre connaissance, de rupture d'un tendon de la main chez un patient atteint d'osteogenese imparfaite (maladie de Lobstein). Cette lesion est attribuee a une deterioration qualitative du collagene, source de fragilite tendineuse. Cette rupture tendineuse, vue a distance de l'accident (un mois), a ete traitee par une greffe tendineuse, a l'aide du long palmaire. Malgre un protocole de reeducation classique, a 6 mois de l'intervention une tenolyse etait necessaire. A un an, il persiste un deficit d'enroulement de l'articulation interphalangienne distale. Les series de la litterature rapportent des desinsertions a la jonction tendon os avec des resultats satisfaisants. Nous evoquons la possibilite d'une alteration du resultat en relation avec l'anomalie du collagene.

The purpose of this study was to compare the effect of unrestricted active versus passive mobilization on the gliding function and structural properties (ultimate load and stiffness) of repaired and nonrepaired canine flexor digitorum profundus tendons following partial laceration at 1 week. Using a radiographic method, normalized tendon gliding of the flexor digitorum profundus tendon adjacent to the metacarpal bone and total joint rotation were shown to be significantly greater in passive than in active tendons. Each group differed from their control group, however, by an average of only 5%. Both rehabilitation (active vs. passive) and treatment (repair vs. nonrepaired) of the partial tendon laceration significantly affected gap formation. Both active rehabilitation and repair of the laceration significantly increased gap formation compared with passive rehabilitation and nonrepair of the partial laceration. Rehabilitation did not significantly affect the normalized ultimate loads and stiffness in the passive and active groups but the nonrepair groups displayed significantly higher ultimate loads and stiffness than the repair groups.

Injection studies using methylene blue and latex were used in 60 digits from 40 cadavers to study how anaesthetic fluid injected into the flexor tendon sheath might spread around the proximal part of the finger. The injected solution escaped from the flexor tendon sheath around the vincular vessels which are present near the base and head of the proximal phalanx. Outside the digital canal, the dye flowed smoothly through the perivascular loose areolar tissue and spread alongside the main digital vessels and nerves and their palmar and dorsal branches.

The tensile strengths of various suture techniques were studied in vitro using rabbit Achilles’ and flexor digitorum longus tendons. Two new suture methods, a Double and Triple (modified) Kessler, were compared with the Savage, Indiana and modified Kessler techniques. All were core sutures without epitendinous sutures. All suture techniques were found to be significantly different for 2 mm of gap formation. The study found the Savage technique strongest, followed by the Triple Kessler, the Double Kessler, and finally the Indiana. The Double Kessler was almost twice as strong as the modified Kessler. This study also compared two four-stranded techniques (the Indiana and Double Kessler) and found the Double Kessler stronger. The Double Kessler is a simple yet strong suture and may be useful for flexor tendon repairs.

The repair of interrupted flexor tendons of the hand and their return to satisfactory function has been one of the most difficult and challenging tasks and problems even for the hand surgeon. Accordingly, nearly all publications have dealt with suture techniques, suture material and even the number of knots with regard to vascularization, course of sheaths and biology of healing. The aim of all surgical intentions is intrinsic healing, with as few adhesions as possible. On the one hand, this requires non-traumatic treatment of the tendon, respecting the dorsally located blood support and, on the other, early motion, jeopardizing the continuity of sutures. These diametrical requirements are the crux of flexor tendon surgery. Many authors-including-prefer a combination of Kleinerts intratendinously knotted suture with Ikuta's technique with the knot sunk below the tendon surface. Closure of the severed sheath is recommended, as is reconstruction of both tendons, provided that both are injured. The repair of partial lacerations is different, however. Kleinert's early motion treatment in the rubber-hand-protected flexion position is the postoperative management that has the most acceptance. In two consecutive follow-up studies (1974-1987 and 1988-1994) of 253 patients with 348 injured fingers, we achieved excellent and good results in 84.8% in the earlier group and in only 80.3% in the later one, which involved more surgeons with varying amounts of experience in hand surgery.

This study employed a tendon injury model in chickens to determine the effect of immobilization, immediate mobilization, and delayed mobilization on the energy required to fully flex the digit following surgical trauma to the tendon, as determined by measurement of the work of flexion (WOF). The immobilized group showed no increased WOF at 3 days compared to the zero time control values, followed by significant increased WOF at 1 week (36%), 2 weeks (41%), and 3 weeks (63%). The immediate mobilization tendons showed an initial 36% rise in the work of flexion at 3 days, which increased to 40% at 1 week, and then decreased to baseline control values by 3 weeks. Delaying the period of mobilization until 5 days was not shown to significantly lower the peak WOF value at 1 week, but delaying the period of mobilization until 3 days lowered the peak WOF value at 1 week dramatically to 13%; both the 3- and 5-day delayed-mobilization groups returned to baseline WOF values by 3 weeks. From these data, it can be assumed that there is an early increase in the work necessary for flexion of the injured operated digit and tendon that is present in the immediately mobilized tendons at 3 days and persists to 1 week and that does not appear until 1 week in the immobilized tendons; this rise in WOF can be blunted by delaying the institution of mobilization.

We report two cases in whom human composite flexor tendon allografts were used, and followed-up for more than 5 years. The results show a real improvement in function, without any complications.

Resume La section isolee du tendon flechisseur profond au niveau du canal digital des doigts longs est consideree classiquement de bon pronostic. Les auteurs evaluent a propos d'une serie de 51 sections (44 patients), les repercussions sur la mobilite des articulations interphalangiennes proximales et interphalangiennes distales. Le recul moyen a la revision est de 7,7 ans. Dans cette serie homogene de lesions simples, ils observent 84% de bons ou tres bons resultats. Les mauvais resultats comprennent deux ruptures secondaires et deux infections. Ils sont surtout dus a la retraction en «coup de fouet du bout proximal dans la paume pour les lesions en zone I, a la section contuse des tendons chez des patients non motives. Les resultats des sections en zone I sont comparables aux resultats des sections en zone II. Les raideurs, meme moderees de l'articulation IPP sont frequentes, ceci que la lesion soit en zone I ou II. La mobilite de l'articulation metacarpophalangienne reste dans tous les cas normale. Les auteurs n'ont pas retrouve de meilleurs resultats dans les cas mobilises selon Kleinert par rapport aux cas immobilises par plâtre, et n'ont pas d'explication satisfaisante a donner a ce resultat.

Tenography has been performed on eight detached lingers and two intact hands of cadavers. Bulging and overlapping of synovial pockets between the ligamentous structures during flexion, their flattening during extension and the continuous change in expansion of the proximal cul de sac suggests a possible mixing mechanism for the synovial fluid. During flexion and extension a physiological joint-type bowstringing of the flexor tendons was observed at the PIP and DIP joints. This finding supports the theory that the flexor tendon moment arm is increased at these joints.

The in vivo response of foetal flexor digitorum profundus tendons to tendon sutures was studied macroscopically and microscopically in foetal lambs. No tendon adhesions were noted at any of the examination intervals. 4 days after injury, a mild inflammatory reaction was noted around the suture. The tendon examined at the 4-week interval showed evidence of migration of epitenon cells from the outer surface of the tendon into the suture track. The tendon examined at the 6-week interval showed normal tendon fibres surrounding the suture site. Differences between foetal skin and foetal tendon healing are discussed along with the possible role of amniotic fluid in modulating the healing process in the foetus.

The effect of tension on tendon healing was evaluated in vitro using cyclic tension and no tension groups of chicken flexor digitorum profundus tendons and histologic and immunohistologic techniques. A Vitrodyne force-loading machine was used for application of cyclic tension on partially lacerated chicken flexor tendons in culture media. Laceration sites under cyclic tension after 14 days were covered by newly proliferated fibroblasts, aligned in the direction of tension. This new growth was much thicker than that seen in the no tension group at the same time interval. Procollagen synthetic activity began at 3 days of culture in both groups. At 21 days, newly formed fibroblasts in the cyclic tension group were stained positive more strongly at the surface layer than in the deeper layers. In the no tension group, the staining was primarily in the surface layer. Cyclic tension stimulated the intrinsic response of lacerated flexor tendons significantly more than no tension did by enhancing proliferation and migration of fibroblasts, as well as stimulating collagen synthesis.

Resume A partir d'une serie de treize arthrodeses partielles du carpe dans le traitement du poignet rhumatoide, l'auteur rapporte deux complications a type de rupture et prerupture de tendons flechisseurs des doigts. Celles-ci se sont produites par frottement sur l'epiphyse radiale apres reduction de la subluxation anterieure du carpe.

Nine patients are described with closed traumatic rupture of the digital flexor pulley system. All presented with significant flexion contractures of the proximal interphalangeal joint and bow-stringing of the flexor tendons. In seven patients, the pathology was verified at surgery and pulley reconstruction provided a good result. The diagnoses in the other patients, treated conservatively, were verified by tenogram and magnetic resonance imaging.

This paper describes a new and simple approach to the flexor tendon via strategically placed transverse incisions in the flexor tendon sheath.

Despite the many advances in the surgical and rehabilitative management of flexor tendon injuries, problems of adhesion, contracture, and rupture continue to limit the restoration of function in a significant number of cases. This article reviews the most frequent complications after flexor tendon injuries. The treatment options for these problems, including the authors' methods of choice, are discussed.

We have reviewed 22 flexor tendon repairs in zone 1 undertaken in Hobart, Tasmania, during the period 1986 to 1991. The repairs were assessed using both ultrasound and Strickland’s clinical criteria. The results are presented, and the two methods of assessment compared. A new method of grading results is proposed based on the ultrasound findings.We have demonstrated that ultrasound has an important role to play in assessing tendon repairs, both in the on-going management and as an objective method of measuring the results of repair.

Resume En matiere de chirurgie tendineuse au niveau de la main, la preoccupation des chirurgiens tout le long des vingt dernieres annees a ete de trouver un moven efficace et reproductible pour eviter les adherences post-operatoires. Ces adherences ont ete, pour la plupart des auteurs, la cause principale des mauvais resultats dans cette chirurgie difficile. Depuis 1960, une amelioration nette et constante a ete apportee avec l'evolution des techniques operatoires et la meilleure comprehension de la physiopathologie de la cicatrisation tendineuse. Avec la technique de reeducation passive controlee selon Kleinert, ou selon Duran, la prise en charge post-operatoire a completement modifie le pronostic des lesions des tendons flechisseurs. Malgre tous les progres, les lesions tendineuses en zone II posent toujours un probleme difficile. Dans ce travail, nous avons voulu apporter deux nouvelles orientations, l'utilisation de la colle biologique dans la reparation des plaies recentes d'une part pour remplacer le surjet epitendineux, d'autre part pour son action benefique directe sur la cicatrisation tendineuse et une amelioration de la technique de reeducation de Duran, apportee par l'equipe de reeducation de l'Hopital Bichat et realisee depuis 1987. La serie est constituee de 77 lesions tendineuses (55 doigts longs et 22 pouces). Elle s'etale sur 4 ans de 1987 a 1991 date a laquelle nous avons commence l'utilisation de la colle biologique dans la reparation des tendons flechisseurs. Toutes les lesions etudiees au niveau des doigts longs sont en zone II, et en zone TII pour le pouce, toutes les autres zones sont ecartees de l'etude. Le recyl moyen est de 14,4 mois. L'evaluation est basee sur la cotation de la Federation Internationale des Societes de Chirurgie de la Main pour les doigts longs et la cotation de Tubiana pour le pouce. 74 % des doigts longs et 86 % des pouces sont cotes excellents ou bons.

The purpose of this study was to investigate the effects of temperature, velocity and load on the gliding resistance (GR) of flexor digitorum profundus (FDP) tendons in a human cadaver model. A total of 40 FDP tendons from the index through small digits of ten human cadavers were tested to assess the effect of temperature (4, 23 or 36 °C), velocity (2, 4, 6, 8, 10 or 12 mm/s) and load (250, 500, 750, 1000, 1250 and 1500 g) on GR. The mean GR at 4 °C was significantly higher than the mean GR at 36 °C (p

From 1986 to 1990, twelve patients were treated for avulsions of the flexor digitorum profundus in either the ring or the long finger. Six patients had misleading x-ray films because the tendon had retracted farther than the fracture pattern had suggested. All of these patients had avulsion fractures from the palmar aspect of the distal phalanx. Although the classification of Leddy and Packer is very helpful in determining the prognosis for these injuries, the fracture patterns are not reliable in predicting the location of the retracted tendon end preoperatively. Therefore all flexor digitorum profundus tendon avulsions should be surgically repaired as soon as possible.

Digital pulley reconstruction with a synthetic material, PTFE membrane, was compared with suture repair of the native A3 pulley at the time of tenorrhaphy in the chicken model. The surgically treated foot was immobilized in flexion for either 28 or 35 days and then allowed full ambulation for periods of up to 42 days postoperatively. At sacrifice digits underwent range-of-motion testing, and the pulley and tenorrhaphy sites were explored. No disruptions were noted in the reconstructed PTFE pulleys. The number of tenorrhaphy disruptions was similar between the PTFE pulley group (11%) and the suture repair of the native pulley group (14%). No decrease in range of motion was demonstrated in the PTFE pulley digits, and no deleterious effect of increasing immobilization time (35 days versus 28 days) was noted. The results indicate that this synthetic pulley did not interfere with normal tendon healing processes. PTFE membrane may prove to be a promising reconstructive alternative when the native pulley is irreparably damaged.

A pseudotumor of the palm was due to an anomalous flexor digitorum superficialis muscle belly. Magnetic resonance imaging is an excellent diagnostic tool to define the three dimensional extension of such an anomaly. Surgical resection of the anomalous muscle belly resulted in a complete relief of all symptoms.

The anatomic two-tendon, three-joint finger cannot always be restored to normal after a severe flexor tendon injury. An effective alternative to consider is reconstruction of superficialis finger function or one-tendon to two-joint function. This principle has been applied to two-stage flexor tendon reconstruction in severe salvage situations to provide a good working arc of digital flexion. The surgical procedure, postoperative considerations, and biomechanical principles are discussed.

Resume Les auteurs analysent une serie homogene de 77 cas de reinsertion en rappel par barb-wire de Jennings des flechisseurs profonds des doigts longs en zone I (57 cas) et du flechisseur du pouce en zone TI (20 cas). Tous les patients ont ete revus avec un recul moyen de 4 ans (minimum 3 mois - maximum 10 ans). Cette technique nous a permis une mobilisation active immediate dans 70 cas sur 77. La mobilite de la metacarpo-phalangienne et de l'interphalangienne proximale a ete conservee dans tous les cas sauf un. Au niveau de l'inter-phalangienne distale, la flexion active recuperee a ete en moyenne de 42,8° avec un deficit d'extension moyen de 5,5°, correspondant a un deficit de 1,3 % pour le pouce et de 2 % pour les doigts longs selon la cotation de Swanson adoptee par la Federation Internationale des Societes de Chirurgie de la Main. Des complications sont survenues dans 12 cas sur 77. Deux cas ont necessite une tenolyse secondaire. L'analyse des facteurs influencant le resultat fait ressortir la frequence des lesions associees qui grevent le pronostic traditionnellement bon de ces lesions. L'arret du travail moyen a ete de 6,9 semaines (minimum 0 jour - maximum 6 mois). Cette technique simple et rapide realise une reinsertion solide permettant une mobilisation active immediate. Ceci au prix d'une rigueur de technique chirurgicale et de suveillance post-operatoire propres a l'utilisation du barb-wire. C'est egalement la raison pour laquelle elle est peu adaptee aux jeunes enfants.

Resume Les synovites isolees de la main d'origine sarcoidosique, sans atteinte osseuse, ne rentrant pas dans le cadre de la dactylite sarcoidosique sont exceptionnelles. Le cas rapporte a debute par des arthralgies chroniques touchant essentiellement les genoux et les chevilles. Le diagnostic initial et errone a ete celui de polyarthrite rhumatoide sero-negative. Une synovite des tendons flechisseurs des doigts, responsable d'un syndrome irritatif du nerf median, a necessite une synovectomie chirurgicale. L'examen anatomo-pathologique a oriente le diagnostic en mettant en evidence des lesions folliculaires sans necrose caseeuse. Le diagnostic a ete confirme par l'association d'une anergie tuberculinique et d'une augmentation de l'enzyme de conversion de l'angiotensine. La synovite n'a pas recidive apres synovectomie et traitement par la colchicine mais les polyarthralgies ont persiste.

Maximal voluntary static muscle force production was assessed both in strength trials and during 2-min contractions by three muscle groups (right-hand finger flexors [RHF], right-leg extensors [RLE], and both leg extensors [BLE]) in young males (n = 13) and females (n = 14). There was a significant difference (p less than .01) between males and females for RHF strength and BLE strength but no significant difference between sexes for RLE strength. During the 2-min task, impulse (force x time) declined significantly (p less than .001) and there was a significant difference (p less than .001) between muscle groups, but there was no difference between sexes. There was a significant (p less than .05) sex x time interaction for the impulse values indicating that the fatigability was greater in males than females.

The development of an internationally accepted system of assessment of results after flexor tendon repair is important. In a prospective study of ninety-five digits, gross discrepancies were demonstrated between five popular methods of assessment: Buck-Gramcko, linear measurement, Grossman, American Society for Surgery of the Hand, and Strickland. The relative merits of each systems were studied and modifications for the Buck-Gramcko system are suggested.

Summary. Pressures in the flexor digitorum muscle, posterior tibial and anterior tibial muscles and subcutaneous pressure in the lower leg were recorded in 18 volunteers with a non-infusion technique. The venous plexus of the sole of the foot was compressed by a pneumatic foot pump. Activation of this device creates oscillations of intramuscular and subcutaneous interstitial fluid hydrostatic pressure in the lower leg. The mechanism for this is explained by intermittent passive muscle stretch. The interstitial fluid pressure decreased following active muscle contractions during venous stasis of the limb, but not following activation of the pneumatic pump. Although the pneumatic foot pump may on theoretical grounds be useful in early treatment of postoperative and post-traumatic oedema of the leg, complementary studies are necessary to establish its effectiveness.

Two unusual cases of flexor digitorum profundus avulsion with an associated fracture of the distal phalanx are reported. In one case the injury consisted of avulsion of a large bone fragment from the distal phalanx and an associated profundus avulsion from the fragment. The other case showed simultaneous shaft fracture of the distal phalanx with avulsion of the profundus tendon, which could not be included in the existing classification of profundus injuries. The latter injury was misdiagnosed initially.

Twenty-two Flexor Digitorum Superficialis (FDS) muscles from 18 cadavers were dissected to find the Optimal Injection Site (OIS) for botulinum toxin injections to individual bellies of FDS. Coordinates are given as a percentage of the distance along a landmarking line from the medial epicondyle to the pisiform and in millimetres (mm) lateral to it. The OIS were: FDS2: 72%, 14 mm; FDS3: 54%, 17mm; FDS4: 49%, 7mm; FDS5: 76%, 6mm. OIS measurements guide the electromyographer to localize the targeted muscle belly.