Hand Trauma – Soft Tissue
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal in Plastic Surgery for Trauma, 2022
Tendon injuries are common, making up a large proportion of the on-call workload. It is important to diagnose and treat them early as primary repair becomes more difficult with time, due to the proximal end retracting and shortening. This is more the case with flexor tendons as extensor tendons have junctura tendineae which reduce retraction. Tendons should ideally be repaired within 4 days of injury, and 2 weeks is generally considered the maximum time period where primary repair may still be possible. Thereafter, the patient will likely require a 2-stage repair or a tendon transfer. Unless multiple flexors are divided (spaghetti wrist or large palm laceration), patients with tendon injuries do not need to be admitted and can be brought in as emergency day case procedures.
Skeletal Muscle
Nassir H. Sabah in Neuromuscular Fundamentals, 2020
The endomysium, perimysium, and epimysium are interconnected together and blend with tendons and aponeuroses. Tendon is a tough, fibrous, whitish, cord-like tissue that connects muscle to bone and is composed of parallel arrays of closely packed fibers that are mostly collagen. The collagen fibers aggregate to form fascicles that are surrounded by connective tissue. Bundles of fascicles, as well as the tendon as a whole, are surrounded in turn by connective tissue. Some tendons are surrounded, in addition, by a sheath that encloses synovial fluid, which acts as a lubricant that reduces friction associated with tendon movements. Tendons include blood vessels and fibroblasts for maintaining tendon tissue, as well as a type of receptor, the Golgi tendon organ (Section 9.4.1) that responds to tension in the tendon.
Muscle Physiology and Electromyography
Verna Wright, Eric L. Radin in Mechanics of Human Joints, 2020
The main bulk of the muscle is belly, which is composed of muscle fibers, the functional part of the muscle. During acontraction in vivo, the muscle belly can often be seen or palpated below the skin as a pronounced, hard bulge. The tendons anchor the muscle to the skeleton at the origin (most proximal attachment) and the insertion (more distal attachment). The tendons are composed of tough collagen fibers, which abut the ends of the muscle fibers to form a continuous structure. The size and shape of the tendon can vary enormously, in some cases being completely absent. For example in the vastus medialis, one of the quadriceps group of muscles, the fibers attach directly to the anterior surface of the femur. At the other extreme, a tendon may be 250 mm or even longer, for example in the semitendinosus of the hamstring group. Most muscles have tendons that are slim and round in cross section, but in some broad, flat muscles, the tendons are flattened accordingly. In these cases the tendon is given a specific name, the aponeurosis.
Is conservative management of partial zone II flexor tendon laceration possible? A systematic literature review and meta-analysis
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Young Woong Mo, Da Hye Ryu, Gyo-Young Cho, Jong Won Hong
In the 1990s, a large survey of 1000 members of the American Society for Surgery of the Hand was undertaken to determine the methods by which clinicians currently treat partial lacerations of flexor tendons. Results from 591 respondents showed that most surgeons use a modified Kessler technique and begin protected mobilization within the first 48 h [2]. In addition, in this study, 75% of hand surgeons answered that >50% of the flexor tendon cross-section is damaged before tendon repairs are performed [2]. Since then, there have been various studies on whether to conduct surgery according to the degree of tendon damage, and the results of these investigations are very diverse. Some reported treatment options range from repair of all partial injuries to non-surgical treatment with an early active motion therapy protocol for injuries involving ≤95% of the tendon cross-sectional area [3–6]. However, not only the indications for tendon reconstruction surgery performed according to this cross-sectional area but also the techniques used for tendon reconstruction and the protocols used for rehabilitation regimens of patients postoperatively varied [6–12]. According to Wray et al., 85% of partial flexor tendon lacerations were treated by not suturing the tendon and by early mobilization of the digit, resulting in excellent outcomes. These partial tendon lacerations varied from 25 to 95% of the cross-sectional area [6].
The utilization and effects of filiform dry needling in the management of tendinopathy: a systematic review
Published in Physiotherapy Theory and Practice, 2022
Dhinu J. Jayaseelan, Brian T. Faller, Melinda H. Avery
Tendinopathy is a common overuse condition seen in orthopedic and sports settings often characterized by degenerative processes leading to disorganized collagenous orientation and abnormal tendon structure (Maffulli, Wong, and Almekinders, 2003). Florit et al. (2019) tracked the incidence of various sports teams over eight seasons and reported a total relative frequency of tendinopathy to be 22%; while Riel et al. (2019) reported a prevalence and incidence of 16.6 and 7.9 per 1000 registered participants, respectively, for lower extremity tendinopathy. In addition to the high frequency, symptoms from tendinopathy can be functionally disabling (Bot et al., 2005; Cook et al., 1997; Kettunen, Kvist, Alanen, and Kujala, 2002; Sayana and Maffulli, 2007). While progressive tendon loading prescriptions to optimize tendon capacity are the mainstay of rehabilitation programs (Goom, Malliaras, Reiman, and Purdam, 2016; Lewis, McCreesh, Roy, and Ginn, 2015; Malliaras, Cook, Purdam, and Rio, 2015; Martin et al., 2018), less is known regarding the efficacy of adjunctive interventions in modifying mobility deficits or local pain sensitivity of tendinopathy. However, given the complexity of clinical presentations and the number of individuals not satisfied with their outcomes, it is important that additional adjunctive treatments are explored.
Effectiveness of topical glyceryl trinitrate in treatment of tendinopathy – systematic review and meta-analysis
Published in Disability and Rehabilitation, 2022
Mikhail Saltychev, Jouni Johansson, Viljami Kemppi, Juhani Juhola
The MEDLINE defines tendinopathy as a “clinical syndrome describing overuse tendon injuries characterized by a combination of pain, diffuse or localized swelling, and impaired performance.” The syndrome is very common and affects different tendons. Pain is often the first clinical symptom causing motion restriction, disability, absence from work, and increased use of healthcare services [1,2]. The most common sites are shoulder rotator cuff, Achilles tendon, humeral lateral epicondyle, and patellar area. In addition to physiotherapy and operative methods, a diverse spectrum of topical agents has been used to treat this condition such as cortisone injections, shockwave therapy, platelet-rich plasma injections, topically applied nonsteroidal anti-inflammatory drugs, and many others [1,3,4].
Related Knowledge Centers
- Bone
- Collagen
- Type I Collagen
- Connective Tissue
- Ligament
- Skeletal Muscle
- Extracellular Matrix
- Fibroblast
- Dense Regular Connective Tissue
- Tendon Cell