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The wrist and hand
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
This condition is a tenosynovitis affecting any of the flexor tendons (superficial and deep) in the palm. These tendons are enveloped by synovial sheaths as they traverse the carpal tunnel. They extend for about 1 inch (2.5 cm) above the flexor retinaculum to about halfway along each metacarpal, except for the little finger, in which the sheath is continuous and extends to the terminal phalanx, and the thumb (flexor pollicis longus), where the sheath is continuous to the tip of the finger. The fibrous synovial sheaths of the terminal parts of the tendons are thinner over the joints.
Ligaments and Tendons
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Cheh Chin Tai, James Hui, Andy Williams
Tendons and ligaments are surrounded by loose areolar connective tissues, known as the paratenon in tendons (no specific name in ligaments). These form a sheath, which can either run the entire length of the tendon or exist only at the point where the tendon bends in concert with a joint. The paratenon protects the tendon and facilitates gliding. It is also the major source for remodelling and healing responses, as it contains abundant cells and blood vessels (vascular tendons). In some tendons, a true synovial sheath replaces the paratenon (avascular tendons).
Upper limb symptoms and signs
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
Distension of the flexor tendon synovial sheath produces a soft, fluctuant swelling that can be felt on the anterior aspect of the wrist and lower forearm, and in the palm of the hand. Because the swelling passes beneath the flexor retinaculum, compression of the lump on one side of the retinaculum makes it distend on the other side.
Effect of electromyographic biofeedback training on functional status in zone I-III flexor tendon injuries: a randomized controlled trial
Published in Physiotherapy Theory and Practice, 2023
Umut Eraslan, Ali Kitis, Ahmet Fahir Demirkan, Ramazan Hakan Ozcan
The Modified Duran Protocol developed by Strickland and Glogovac is a controlled passive motion protocol for flexor tendon rehabilitation wherein, between exercises or nocturnally, the interphalangeal (IP) joints are maintained in extension by wrapping a band around them (Pettengill and Van Strien, 2011). The controlled passive motion protocol is used safely after flexor tendon injuries without conferring significant tendon strain. Despite the lower risk of rupture, the Modified Duran Protocol is associated with a higher risk of joint motion limitation (Kannas, Jeardeau, and Bishop, 2015; Lutsky, Giang, and Matzon, 2015; Starr, Snoddy, Hammond, and Seiler, 2013). Furthermore, despite modifications, passive motion protocols are inadequate for improving the differential glide of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons. In addition, the presence of a synovial sheath around the digital flexor tendons and predominant extrinsic healing, which facilitates adhesion formation in sheath involvement impede the gliding of tendons (Klifto, Bookman, and Paksima, 2019; Pearce, Brown, Fraser, and Lancerotto, 2021). Thus, treatment modalities that can be adjunctively applied with a controlled passive motion protocol are needed to improve functional outcomes following flexor tendon repairs.
Musculoskeletal complications of hand–arm vibration syndrome among tyre shop workers in Kelantan, Malaysia
Published in International Journal of Occupational Safety and Ergonomics, 2022
Asraf Ahmad Qamruddin, Nik Rosmawati Nik Husain, Mohd Yusof Sidek, Muhd Hafiz Hanafi, Zaidi Mohd Ripin, Nizam Ali
HAV exposure is believed to contribute to musculoskeletal complications of the upper limbs at the digits, wrists, elbows, shoulders and, sometimes, neck [6]. High-frequency vibrations produced by tools such as drills, saws and impact wrenches are absorbed mostly by the fingers. However, some vibrations – especially those with lower frequencies – are believed to be transmitted into the shoulders, arms and even the neck as well; as such, they are associated with musculoskeletal disorders in these parts of the body [11]. Exposure to HAV is believed to cause pain, swelling and stiffness, which may result in reduced grip strength and a loss of motion of the musculoskeletal system among affected workers [12]. Cysts, osteoarthritis and inflammation of tendons or synovial sheath might also be caused by exposure to HAV [13].
Lateral ankle anatomical variants predisposing to peroneal tendon impingement
Published in Alexandria Journal of Medicine, 2018
Mahmoud Agha, Mohamed Saied Abdelgawad, Nasser Gamal Aldeen
Two lateral calcaneal bony protuberances are also considered to play some role in lateral ankle stability. The posterior one, which is the RCE, is located posterior to the peroneal tendons. The anterior one, which is called the PT, is situated immediately inferior to the lateral malleolus. The common synovial sheath that covers the two peroneal tendons proximal to the tubercle splits to enclose each tendon separately at the tubercle and distally. The peroneus brevis lies anterior to the tubercle, and the peroneus longus lies posterior to the tubercle.11,12 A maximum width of 5 mm can be used as a cut off level to diagnose an enlarged PT or RCE, which was seen in 21.6% and 18.3% of group A patients; respectively. These enlarged tubercles, can impinge the peroneus tendons and may facilitate chronic inflammatory process like stenosing tenosynovitis or different grades of tendons tears. In candidates with enlarged PT or RCE variants, we recorded PTT incidences of 35.9% and 36.4%; respectively. These results match what was published by Celikyay et al. at their published study named: Tenosynovitis of the peroneal tendons associated with a hypertrophic PT: radiography and MRI findings13 (Fig. 5).