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At least 55 records · Page 3Linked to original sources
PubMed2001

Orthopedic pitfalls in the emergency department: closed tendon injuries of the hand.

Closed tendon injuries of the hand are frequently seen in the emergency department. Unlike open tendon injuries, however, these injuries are often missed on initial presentation. Early recognition and treatment can decrease the pain, dysfunction, and long-term sequelae associated with these injuries. This review article examines the clinical presentation, historical factors, diagnostic techniques, and management options applicable to the emergency practitioner. Injuries discussed include rupture of the flexor digitorum profundus, mallet finger, central slip rupture, extensor hood rupture, and ulnar collateral ligament injury.

Emergency Service, Hospital↗
PubMed1993

Extensor tendon injuries of the hand.

Extensor tendon injuries are often initially evaluated and diagnosed in the Emergency Department. These injuries may be painfully obvious or frightfully subtle, but if the emergency physician has a firm understanding of the anatomy involved and he or she embarks on a careful and complete history and physical examination, the diagnosis should be made. There are various considerations in the ultimate treatment and outcome for the patient, and the patient's best interests are served when the emergency physician provides the initial appropriate treatment and proper disposition.

Emergencies↗
PubMed1988

Tendon injuries about the ankle in athletes.

Tendinous injuries about the foot and ankle are often the result of overloading and repetitive microtrauma stemming from training errors, poor technique, and the use of inappropriate surfaces or equipment. Other factors that must be considered include anatomic malalignment and muscle imbalance. Injuries involving tendons include inflammation, subluxation, and rupture. A correct and timely diagnosis should assist athletes, trainers, coaches, and physicians in preventing and treating these disorders.

Achilles Tendon↗
PubMed1992

Cell-matrix response in tendon injury.

The healing response after tendon injury is defined by cell matrix adaptive capability. There are distinct macrotraumatic and microtraumatic injury patterns and a spectrum of pathologic responses from inflammation to tissue degeneration, as characterized by the tendinosis phenomenon. Epigenetic and genetic factors govern recovery from tendon injury. The potential for future modulation of injury repair by protein mediators or growth factors appears promising.

Achilles Tendon↗
PubMed2006

Complications after treatment of flexor tendon injuries.

The goals of flexor tendon repair are to promote intrinsic tendon healing and minimize extrinsic scarring in order to optimize tendon gliding and range of motion. Despite advances in the materials and methods used in surgical repair and postoperative rehabilitation, complications following flexor tendon injuries continue to occur, even in patients treated by experienced surgeons and therapists. The most common complication is adhesion formation, which limits active range of motion. Other complications include joint contracture, tendon rupture, triggering, and pulley failure with tendon bowstringing. Less common problems include quadriga, swan-neck deformity, and lumbrical plus deformity. Meticulous surgical technique and early postoperative tendon mobilization in a well-supervised therapy program can minimize the frequency and severity of these complications. Prompt recognition of problems and treatment with hand therapy, splinting, and/or surgery may help minimize recovery time and improve function. In the future, the use of novel biologic modulators of healing may nearly eliminate complications associated with flexor tendon injuries.

Connective Tissue Diseases↗
PubMed1994

Achilles tendon injuries in athletes.

Two-thirds of Achilles tendon injuries in competitive athletes are paratenonitis and one-fifth are insertional complaints (bursitis and insertion tendinitis). The remaining afflictions consist of pain syndromes of the myotendineal junction and tendinopathies. The majority of Achilles tendon injuries from sport occur in males, mainly because of their higher rates of participation in sport, but also with tendinopathies a gender difference is probably indicated. Athletes in running sports have a high incidence of Achilles tendon overuse injuries. About 75% of total and the majority of partial tendon ruptures are related to sports activities usually involving abrupt repetitive jumping and sprinting movements. Mechanical factors and a sedentary lifestyle play a role in the pathology of these injuries. Achilles tendon overuse injuries occur at a higher rate in older athletes than most other typical overuse injuries. Recreational athletes with a complete Achilles tendon rupture are about 15 years younger than those with other spontaneous tendon ruptures. Following surgery, about 70 to 90% of athletes have a successful comeback after Achilles tendon injury. Surgery is required in about 25% of athletes with Achilles tendon overuse injuries and the frequency of surgery increases with patient age and duration of symptoms as well as occurrence of tendinopathic changes. However, about 20% of injured athletes require a re-operation for Achilles tendon overuse injuries, and about 3 to 5% are compelled to abandon their sports career because of these injuries. Myotendineal junction pain should be treated conservatively. Partial Achilles tendon ruptures are primarily treated conservatively, although the best treatment method of chronic partial rupture seems to be surgery. Complete Achilles tendon ruptures of athletes are treated surgically, because this increases the likelihood of athletes reaching preinjury activity levels and minimises the risk of re-ruptures. Marked forefoot varus is found in athletes with Achilles tendon overuse injuries, reflecting the predisposing role of ankle joint overpronation. Athletes with the major stress in lower extremities have often a limited range of motion in the passive dorsiflexion of the ankle joint and total subtalar joint mobility, which seems to be predisposing factor for these injuries. Various predisposing transient factors are found in about one-third of athletes with Achilles tendon overuse injuries; of these, traumatic factors (mostly minor injuries) predominate. The typical histological features of chronically inflamed paratendineal tissue of the Achilles tendon are profound proliferation of loose, immature connective tissue and marked obliterative and degenerative alterations in the blood vessels. These changes cause continuing leakage of plasma proteins, which may have an important role in the pathophysiology of these injuries. The chronically inflamed paratendineal tissues of the Achilles tendon do not seem to have enough capacity to form mature connective tissue.

Achilles Tendon↗
PubMed1991

[Tendon injuries in sports].

Epidemiologic data on the incidence of tendon injuries in these actively engaged in sports are missing. The significance of the tendon injury lies in the prognosis for any further sporting activities, the risk of chronicity, and thus the impairment of functional capacity (fitness). Pathogenesis, clinical features and treatment of the most essential tendon injuries are presented, based upon a literature search. The choice between conservative and operative treatment of tendon injuries is great of practical significance.

Achilles Tendon↗
PubMed2006

[Extensor tendon injuries of the hand].

The treatment of extensor tendon injuries of the hand is based on Verdan's division of the different sections into eight zones. Taking the anatomic characteristics of those zones into consideration, good functional results can be achieved in most cases by differentiating between indications for operative or conservative treatment. The most frequent extensor tendon injury of the hand is the closed tendon rupture over the DIP joint. In almost all cases it can be completely cured by immobilization for at least 8 weeks. Open extensor tendon injuries on the other hand require surgical therapy. This paper gives a clearly arranged overview of the different therapeutic options.

Adult↗
PubMed1981

[The treatment of the extensor tendon injuries of the hand (author's transl)].

The authors treated 101 extensor tendon injuries from 1973 to 1978 in the traumatological ward of the Ist Department of Surgery at the Medical University of Pécs. During the period the number of flexor tendon injuries were only the half of the extensor tendon injuries. The methods of the employed treatments were evaluated in details by the 73 extensor tendon injuries of the 62 reexamined patients. This was almost the 2/3 part (61%) of the total extensor tendon injuries. The period between the operation and the reexamination was at least one year. Discussing the different kinds of injuries the importance of the primary repair and of the reconstructions of the anatomical connections was emphasized, moreover it was underlined that the treatment of the major extensor tendon lesions are the duty of those hand surgeons who are working in special departments.

Hand Injuries↗
PubMed2005

Bone morphogenetic proteins for tendon injuries: an orthopedic primer.

Throughout the world, tendon injuries are a significant source of pain and disability. Most research on treating tendon injuries has been focused on developing new surgical techniques and perfecting existing ones. Recently, attention has turned to the biology of tendon healing as a means to improve the outcome of such injuries. If the biological milieu of the healing tendon can be altered to produce a stronger tendon, then clinical outcome can be improved. Use of bone morphogenetic proteins (BMPs) is one proposed method for improving the biology of tendon healing. BMPs 12, 13, and 14 have each been shown to improve tendon healing in animal models. In this article, I review BMP history, current research and future directions, and potential application in treating tendon injuries.

Animals↗
PubMed1993

Flexor tendon injuries of the hand.

Flexor tendon injuries can be problematic injuries from the time of occurrence until the patient returns to full and complete recovery. There are many misadventures that can occur along the way. The emergency physician must be keenly aware of the anatomy involved, and a careful history and physical examination must be performed. The diagnosis may be obvious or subtle, and the emergency physician must methodically search for the unsuspected injury. An appropriate referral should be initiated soon after an injury is determined. The hand surgeon has many considerations and obstacles in flexor tendon repairs, but good to excellent results can be expected in up to 80% of patients if the emergency physician and the hand surgeon work together to ensure an optimal patient outcome.

Emergencies↗
PubMed2006

How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks? Interplay between early regeneration and mechanical stimulation.

BACKGROUND: Mechanical stimulation improves the repair of ruptured tendons. Injection of a platelet concentrate (platelet-rich plasma, PRP) can also improve repair in several animal models. In a rat Achilles tendon transection model, 1 postoperative injection resulted in increased strength after 4 weeks. Considering the short half-lives of factors released by platelets, this very late effect calls for an explanation. METHODS: We studied the effects of platelets on Achilles tendon regenerates in rats 3, 5 and 14 days after transection. The tendons were either unloaded by Botulinum toxin A (Botox) injections into the calf muscles, or mechanically stimulated in activity cages. No Botox injections and ordinary cages, respectively, served as controls. Repair was evaluated by tensile testing. RESULTS: At 14 days, unloading (with Botox) abolished any effect of the platelets and reduced the mechanical properties of the repair tissue to less than half of normal. Thus, some mechanical stimulation is a prerequisite for the effect of platelets at 14 days. Without Botox, both activity and platelets increased repair independently of each other. However, at 3 and 5 days, platelets improved the mechanical properties in Botox-treated rats. INTERPRETATION: Platelets influence only the early phases of regeneration, but this allows mechanical stimulation to start driving neo-tendon development at an earlier time point, which kept it constantly ahead of the controls.

Achilles Tendon↗
PubMed1989

[Scanning electron microscopy studies following two-stage tendon and tendon sheath reconstruction in experimental flexor tendon injuries].

This study involves the initial injury of a flexor tendon in chickens toes, followed by a two-step reconstruction of the tendon and its sheath. At first the damaged scarred tendon sheath region was replaced by a transplanted vein or fascia. Tendon restoration was done in the second step with a free tendon transplantation. The restored tendon sheath was then studied in sections under EM. It was observed that the surface of the reconstructed sheath was very similar to that of an intact sheath; the inner surface of the fascia being smoother than the vein. Likewise, the surface and inner structure of the transplanted tendon was proved to resemble an intact tendon. On the basis of the results of this investigation, it is believed that this procedure may be successfully applied to the reconstruction of human flexor tendon injuries in the future.

Animals↗
PubMed2003

[Advances in treatment of Achilles tendon injury].

OBJECTIVE: To review the anatomy, etiology, therapy strategy of Achilles tendon injury and its related advances in recent years. METHODS: The related articles in recent years were extensively reviewed. RESULTS: There still were many arguments about the effect of corticosteroid on the treatment of tendon disease. Fluoqmnolone was found to be related with Achilles tendon injury. Acute rupture of Achilles tendon could be treated with open operation, percutaneous repair, or conservative therapy. For old rupture, many kinds of operations could be selected. CONCLUSION: The growth factors found in recent years provide us with new prospect for future treatment of Achilles tendon injury.

Achilles Tendon↗
PubMed1975

cis-hydroxyproline limits work necessary to flex a digit after tendon injury.

Present surgical procedures for the repair of tendon injury are complicated by formation of peritendinous collagenous adhesions which restrict tendon gliding. Several sensitive biomechanical tests have been developed to quantitate peritendinous restriction of gliding. Using these tests it was found that cis-hydroxyproline significantly limits net collagen accumulation following tendon injury in a rat model and decreases the adhesive restraints to tendon gliding. cis-Hydroxyproline and other proline analoques offer a method for specifically preventing excessive collagen formation.

Animals↗
PubMed2005

[Flexor tendon injuries of the hand].

At last, flexor tendon injuries of the hand and digit are no longer nearly impossible to treat. Many recent studies have reported a more than 75% success with excellent results, in particular in zone 2, in some cases reaching 98% satisfactory outcomes. The challenge inherent in treating and rehabilitating the zone 2 flexor tendon injury remains, however, even for the skilled hand surgeon. We must remain diligent, obeying principles outlined earlier by the first surgeons willing to attempt these repairs, while carefully gleaning the helpful and critical recommendations of the now sophisticated researchers in the subject of flexor tendon repair and rehabilitation.

Hand Injuries↗