1 Introduction. The patients were reviewed with an average follow-up of 4 years (minimum 3 months, maximum 10 years). footage from a surgery to repair a severed flexor pollicis longus tendon. Suggested reading regarding FPL glide: Brown & McGrouther: The excursion of the tendon of the flexor pollicis longus and its relation to dynamic splintage (J HAND SURG 9A:787-91, 1984). In 1937, Murphy identified this problem and highlighted the fact that retraction of the proximal end of the cut FPL tendon was almost always greater than that of the proximal ends of cut finger flexor tendons.1 Our clinical experience, and that of others more recently, would agree that the greater retraction of the cut FPL tendon is due to shortening of the FPL muscle as there is often considerable difficulty pulling the proximal tendon end out to length if FPL repair is attempted after even a short delay beyond 48 hours. Flexor hallucis longus (FHL) tendon injuries can range from tenosynovitis to partial tears and complete ruptures. The flexor pollicis longus is a muscle in the forearm and hand that flexes the thumb. Bivariate analyses were performed to identify factors influencing active IP-flexion and factors associated with reoperation. This product could help you, Accessing resources off campus can be a challenge. Direct end-to-end repair of flexor pollicis longus tendon lacerations. Indications for reoperation mainly included adhesion formation (n = 10, 56%) and re-rupture (n = 5, 28%). Murphy believed this problem to be due to the fact that the FPL tendon is completely separated from the other flexor tendons, making retraction easier than where a tendon is restrained by others. Extensor Pollicis Longus Tendon Repair !erapy Instructions Laith Al-Shihabi, MD 2-4 weeks Splint: -Fashion a removable short-arm thumb spica splint holding the wrist in 30 degrees of extension, thumb CMC joint in full radial abduction and extension, MCP joint in neutral, and IP joint in neutral to slight hyperextension. It lies in the same plane as the flexor digitorum profundus. Figure 16-1 The modified splint with inclusion of the fingers used for early active mobilization in St Andrew’s of FPL repairs since 1994. Three studies of primary repair of the FPL tendon34,35,37 mobilized the repairs postoperatively in variations of the Kleinert technique of active extension-passive flexion mobilization.44 The fourth compared this regimen with immobilization of the repair for 4 weeks after surgery.36 Although Percival and Sykes reported an 8% rupture rate of 50 repairs,36 we used the work of these authors as a gold standard against which we compared our results at that time because a variety of problems with data presentation in the few other reports made direct comparison with our work difficult. Extensor Pollicis Longus Tendon Repair !erapy Instructions Laith Al-Shihabi, MD 2-4 weeks Splint: -Fashion a removable short-arm thumb spica splint holding the wrist in 30 degrees of extension, thumb CMC joint in full radial abduction and extension, MCP joint in neutral, and IP joint in neutral to slight hyperextension. We retained the splint mainly because it included the fingers: power gripping with the fingers is almost automatically followed by movement of the thumb around the dorsum of the index and middle fingers, which brings the FPL into play and risks any primary FPL repair. It travels through the carpal tunnel which is the point connecting the palm and forearm, and goes into the thumb. A simplification was then made and others discussed, whereby elimination of mechanical ruptures of the repairs could be achieved using simpler suture methods that are more appropriate for use by the training surgeons who normally perform these repairs worldwide. Simply select your manager software from the list below and click on download. This tendon helps to straighten the end joint of the thumb and is essential to maintain hand span and to position the thumb in relation to the other fingers. Although there are several studies investigating spontaneous FPL tendon rupture, the exact etiology of spontaneous rupture is unclear. For more information view the SAGE Journals Sharing page. It would seem likely that this increased tension is also the cause of the higher rupture rate in the repaired FPL tendon compared to that of finger flexor tendon repairs. This muscle is located between the two muscles which facilitate flexion of the thumb, namely the Flexor Pollicis Brevis and the Abductor Pollicis. This would have required a study period of 15 years, or longer. The addition of a stronger core suture to the stronger epitendinous suture was the most obvious way of trying to further reduce the rupture rate of the FPL repair. In relation to individual structures, there is a simple flexor tendon anatomy mnemonic – the rule of 3,2,1: 3 Flexor Tendons: Flexor Digitorum Profundus (FDP), Flexor Digitorum Superficialis (FDS) and Flexor Pollicis Longus (FPL) Flexor Tendon Repair Therapy Protocol 1 of 5 Bart Eastwood D.O. Some society journals require you to create a personal profile, then activate your society account, You are adding the following journals to your email alerts, Did you struggle to get access to this article? Motion: You can be signed in via any or all of the methods shown below at the same time. The addition of a stronger core suture to the stronger epitendinous suture was the most obvious way of trying to further reduce the rupture rate of the FPL repair. A clincial and experimental study . We recommended that early active mobilization using the technique we were using at that time was not appropriate to FPL tendon primary repair. Congenital anomaly of the thumb: absent intrinsics and flexor pollicis longus. In order to restore active flexion to a finger with lacerated flexors, surgery with tendon repair is necessary. Sharing links are not available for this article. A clincial and experimental study . Good thumb function can also be obtained with th … Unfortunately, direct comparison with today is difficult, if not impossible, as the methods of assessment differ, not only between different reports but also from all of the methods of assessment in current use. 34 (3):322-8. . This tendon helps to straighten the end joint of the thumb and is essential to maintain hand span and to position the thumb in relation to the other fingers. Diagram showing the technique of stronger circumferential suturing described by Silfverskiöld and Anderson (1993) and used in St. Andrew’s for FPL repair, 1996–2004. Boyes JH, Stark HH. A strong repair using at least a 4-strand core suture and an associated epitendinous suture will allow for early rehabilitation, which can minimize the risk of adhesion formation. This presents a dilemma to clinicians reporting personal experiences in this field, even from busy units. Mobilization started at varying intervals from surgery, in one instance as early as 12 days after operation but usually after a longer delay of between 3 and 5 weeks. The FDP has one common muscle belly (often with a separate radial bundle directed toward the index finger) originating on the anterior-medial ulna and interosseous membrane, which sends individual tendons to … Click the button below for the full-text content, 24 hours online access to download content. Thumb Flexor Pollicis Longus Tendon Repair Guide . Flexor tendon injuries are some of the more common injuries, but yet complex injuries managed by hand surgeons. Peritendinous adhesions after repair of an injury to the digital flexor tendons are a major problem in hand surgery.

flexor pollicis longus tendon repair

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flexor pollicis longus tendon repair 2020