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PubMedDate not supplied

Extensor mechanism of the fingers: MR imaging-anatomic correlation.

Extension of the fingers is a complex function carried out by simultaneous action of extrinsic and intrinsic muscles, as well as retinacular structures in the dorsum of the wrist, hand, and fingers that support and coordinate the action of the muscles. The extensor mechanism of the fingers is divided into topographic zones, which extend from the forearm to the distal phalanx. Magnetic resonance (MR) imaging shows in detail the musculotendinous and retinacular structures of the extensor apparatus. In the different extensor zones, MR imaging findings are similar to those seen macroscopically in anatomic sections. Understanding of and familiarity with the extensor anatomy of the hand and fingers by the radiologist is crucial for better assessment of pathologic conditions with MR imaging and optimization of this modality as a diagnostic tool. Extensor tendon injuries and tenosynovitis represent clinical situations in which knowledge of this anatomy is useful for the clinical radiologist.

Anatomy, Cross-Sectional↗

PubMedDate not supplied

Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features.

Diseases of the peroneal tendons and superior peroneal retinaculum (SPR) are frequently underdiagnosed causes of lateral ankle pain and instability. Common diseases include tenosynovitis, rupture, and dislocation of the peroneal tendons as well as injuries to the SPR. Many anatomic variants, such as a flat or convex retromalleolar fibular groove, hypertrophy of the peroneal tubercle, an accessory peroneus quartus muscle, a low-lying peroneus brevis muscle belly, or an os peroneum, may be associated with or predispose to lateral ankle disease. Magnetic resonance (MR) imaging is excellent for detecting soft-tissue and bone variants and abnormalities related to the lateral ankle. Knowledge of the MR imaging appearances of these entities aids radiologists in making the precise diagnosis of disorders of the peroneal tendons and SPR. Pitfalls and normal variants of the peroneal tendons, including magic angle phenomenon, pseudosubluxation of the peroneus brevis tendon, a bifurcated or mildly crescentic peroneus brevis tendon, insertion of the peroneus quartus tendon into the peroneus brevis tendon, and the presence of an os peroneum are important to recognize. It is also useful to be familiar with the MR imaging appearances of SPR injuries, which can be an overlooked but treatable cause of lateral ankle pain and instability.

Humans↗

PubMedDate not supplied

Surgical management of Achilles tendinitis.

Inflammation of the Achilles tendon and its contiguous structures is one of the most common overuse problems seen in runners. There are actually several etiologies. Involvement of the tendon itself is secondary to areas of mucinoid or fibrotic degeneration, or may be a result of a partial rupture. The sheath (or mesotenon) may also become chronically inflammed. Retrocalcaneal bursitis seems to be a separate entity with hypertrophy and fibrosis of the bursa usually occurring in conjunction with a prominent posterior superior angle of the os calcis. The vast majority of patients can be successfully treated nonoperatively; however, there is a group of patients who are refractory to nonoperative management who would like to continue running, particularly if they are competitive. A retrospective review of 45 surgical cases in 37 patients was performed. All but two of these patients were competitive long-distance runners. There were 24 cases of Achilles tendinitis and/or tenosynovitis, 14 cases with retrocalcaneal bursitis, and 7 with a combination of both. Mean followup was 3 years (range, 1 1/2 to 8 years). Overall there were 87% satisfactory results. Ninety-two percent of the patients with involvement with the tendon and/or sheath had a satisfactory outcome as compared with 71% of patients with retrocalcaneal bursitis. Passive dorsiflexion in the 29 unilateral cases improved from a mean of 17 degrees preoperatively to a mean of 25 degrees postoperatively. We feel that surgery offers a solution for highly motivated runners with chronic posterior heel pain who would like to continue running when conservative measures have failed.

Achilles Tendon↗

PubMedDate not supplied

Traumatic peroneal tendon instability.

To investigate the causes of, pathologic changes associated with, and treatment results after traumatic peroneal tendon subluxation or dislocation, we reviewed 11 cases in 10 patients at a mean followup of 29 months. We also describe a technique of superior peroneal retinacular repair combined with fibular rotational osteotomy. Excellent clinical and functional results were achieved in 9 of the 11 cases, enabling the patients to return to previous competitive sports by 3 months. There was one persisting subluxation that required further surgery. Another ankle, with chronic sepsis from previous surgery and documented degeneration of the ankle joint, had a recurrence of the infection and sequestration of the osteotomized fragment. The personal tendons, however, remained stabilized by the resultant scar tissue. We conclude that superior peroneal retinacular repair, with or without fibular rotational osteotomy, is a successful technique in treating both acute and recurrent instability of the peroneal tendons. It can be combined with a Bröstrom repair when there is concurrent peroneal tendon and anterolateral ankle instability. Peroneal tenosynovitis and tendon splitting were commonly found at operation, especially in cases of recurrent instability. The degree of pathologic change in the tendon did not affect the clinical result.

Acute Disease↗

PubMed2005

The peroneal tubercle: description, classification, and relevance to peroneus longus tendon pathology.

BACKGROUND: The size and configuration of the peroneal tubercle has been implicated in the pathogenesis of peroneal tendon tears and tenosynovitis. The purpose of this study was to determine the size and prevalence of the peroneal tubercle and devise a classification scheme according to the structure of the tubercle. METHODS: One hundred and seventeen calcanei were selected from 59 human skeletons in an osteological collection (one calcaneus was missing). Three were excluded because of the poor condition, leaving 114 calcanei. The peroneal tubercle was measured in length, height, and depth and its structure subjectively described as flat, prominent, concave, or tunnel for each specimen when present. RESULTS: This study revealed a peroneal tubercle prevalence of 90.4% (103) in 114 calcanei. The average length, height, and depth of the tubercle were 13.04 mm (range 3.61 mm to 26.66 mm), 9.44 mm (range 3.67 mm to 23.40 mm), and 3.13 mm (range 1 to 10), respectively. The peroneal tubercle was classified structurally as flat in 44 (42.7%), prominent in 30 (29.1%), concave in 28 (27.2%), and tunnel in one (1.0%). CONCLUSION: This data may further help to understand the size and assorted configurations of the peroneal tubercle and how they relate to peroneus longus tendon pathology.

Adult↗

PubMed1994

Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain.

Plantar lateral foot pain may be caused by various entities and the painful os peroneum syndrome (a term coined by the authors) should be included in the differential diagnosis. Painful os peroneum syndrome results from a spectrum of conditions that includes one or more of the following: (1) an acute os peroneum fracture or a diastasis of a multipartite os peroneum, either of which may result in a discontinuity of the peroneus longus tendon; (2) chronic (healing or healed) os peroneum fracture or diastasis of a multipartite os peroneum with callus formation, either of which results in a stenosing peroneus longus tenosynovitis; (3) attrition or partial rupture of the peroneus longus tendon, proximal or distal to the os peroneum; (4) frank rupture of the peroneus longus tendon with discontinuity proximal or distal to the os peroneum; and/or (5) the presence of a gigantic peroneal tubercle on the lateral aspect of the calcaneus which entraps the peroneus longus tendon and/or the os peroneum during tendon excursion. Familiarity with the various clinical and radiographic findings and the spectrum of conditions represented by the painful os peroneum syndrome can prevent prolonged undiagnosed plantar lateral foot pain. Clinical diagnosis of the painful os peroneum syndrome can be facilitated by the single stance heel rise and varus inversion stress test as well as by resisted plantarflexion of the first ray, which can localize tenderness along the distal course of the peroneus longus tendon at the cuboid tunnel.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Calcification of the tibialis posterior tendon: a case report and literature review.

The tibialis posterior muscle and tendon are subject to a number of pathological conditions and injuries that have recently received much attention in the literature. Because of its function as a main stabilizer of the subtalar complex against hindfoot valgus and forefoot pronation, the mechanical demand on the posterior tibial tendon is high. Problems with dislocation, tenosynovitis, rupture, and laceration have all been described with this tendon. In this report, we present a case of dysfunction of the posterior tibial tendon associated with chronic tendinitis and intratendinous calcifications. After removal of the calcifications, the patient became asymptomatic and returned to work. Proposed etiologies of these calcifications are discussed.

Adult↗

PubMed1997

Ultrasonographic examination of the posterior tibial tendon.

The posterior tibial tendons (PTTs) of 16 patients with PTT dysfunction and 10 age-matched healthy subjects were examined ultrasonographically, using a 10-MHz linear-array transducer. Normal PTTs appeared hyperechoic (more echogenic) and oval, with an average diameter of 7.8 mm x 3.7 mm at the medial malleolar level. Degenerated PTTs appeared hypoechoic (less echogenic) and swollen (9.8 mm x 5.0 mm). Peritendinitis presented as a hypoechoic rim on the longitudinal sonogram (along the long axis of the tendon) and a "target sign" (hyperechoic central structure with a hypoechoic halo) on the transverse sonogram (at the right angle to the long axis of the tendon). Complete rupture of the PTT revealed an empty tibial groove at the level of the medial malleolus on the transverse sonogram and a wavy fibril pattern over the distal end on the longitudinal sonogram. Compared with the operative findings or the results of the magnetic resonance imaging, ultrasonography was sensitive and specific in diagnosing tenosynovitis and complete rupture of the PTT.

Ankle↗

PubMedDate not supplied

Tendinopathies in the upper extremity: a paradigm shift.

Epicondylitis and de Quervain's tenosynovitis are two common diagnoses seen by hand therapists in clinical practice. Traditionally, these conditions have been viewed as being due to an inflammatory process and treated as such. New research shows that tendons exhibit areas of degeneration and a distinct lack of inflammatory cells. Tendinosis is degeneration of the collagen tissue due to aging, microtrauma, or vascular compromise. This article reviews key literature related to tendinopathies in the lower extremity and comments on the dearth of similar articles for the elbow and forearm. Hand therapists are encouraged to embrace this new terminology and to engage in research in this difficult area to improve treatment regimens and outcome measures.

Humans↗

PubMed1996

Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment.

A retrospective review was performed of the results of operative treatment of stenosing tenosynovitis of the flexor hallucis longus tendon or posterior impingement syndrome, or both, in thirty-seven dancers (forty-one operations). The average duration of follow-up was seven years (range, two to thirteen years). The results were assessed with use of a questionnaire for all patients, and a clinical evaluation was performed for twenty-one patients (twenty-two ankles). Twenty-six operations were performed for tendinitis and posterior impingement; nine, for isolated tendinitis; and six, for isolated posterior impingement syndrome. A medial incision was used in thirty-three procedures; a lateral incision, in six; an anterior and a medial incision, in one; and a lateral and a medial incision, in one. Thirty ankles had a good or excellent result; six, a fair result; and four, a poor result. (The result of the second procedure on an ankle that was operated on twice was not included.) The result was good or excellent for twenty-eight of the thirty-four ankles in professional dancers, compared with only two of the six ankles in amateur dancers.

Adolescent↗

PubMed2004

Utilization of orthopaedic services for hand and wrist conditions in a capitated population.

BACKGROUND: The utilization of orthopaedic services (office visits and surgery) to treat hand and wrist conditions is not well known. In this study, we report the utilization rates for patients referred for orthopaedic treatment of hand and wrist conditions in a large population of individuals enrolled in a capitated insurance plan. METHODS: The study population consisted of individuals enrolled, between January 1998 and December 2001, in a capitated insurance plan that had an annual average membership of 135,188 during that period. This plan was serviced by an independent physician association of sixty-two orthopaedic surgeons who were responsible for all orthopaedic care. Data were collected prospectively in a centralized database as patients with various hand or wrist conditions were referred for orthopaedic services. Odds ratios were used to compare gender-specific and age-specific utilization rates. RESULTS: Overall utilization rates were 18.06 office visits and 6.47 surgical procedures per 1000 members per year. The most frequent hand or wrist conditions were fractures, carpal tunnel syndrome, tendinitis or tenosynovitis, and ganglion or synovial cysts. These four diagnoses accounted for 70% of all office visits and 71% of all surgical cases. Across all age groups, males had a significantly higher rate of utilization of office visits (p < 0.001). Between the ages of thirty-five and fifty-five years, utilization of office visits and surgery increased approximately linearly with age. CONCLUSIONS: A comparison of these data with those of previous reports indicates that approximately one of every ten patients who are referred for orthopaedic services has a hand or wrist condition, and nearly half will require surgery.

Adolescent↗

PubMed2006

Self-reported upper extremity health status correlates with depression.

BACKGROUND: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most widely used upper extremity-specific health-status measure. The DASH score often demonstrates greater variability than would be expected on the basis of objective pathology. This variability may be related to psychosocial factors. The purpose of the present study was to investigate the correlation between the DASH score and psychological factors for specific diagnoses with relatively limited variation in objective pathology. METHODS: Two hundred and thirty-five patients with a single, common, discrete hand problem known to have limited variations in objective pathology completed the DASH questionnaire, the Eysenck Personality Questionnaire-Revised (EPQ-R) to assess neuroticism, the Center for Epidemiologic Studies-Depression (CES-D) scale to quantify depressive symptoms, and the Pain Anxiety Symptoms Scale (PASS). Forty-five patients had carpal tunnel syndrome, forty-four had de Quervain tenosynovitis, forty-eight had lateral elbow pain, and seventy-one had a single trigger finger. In addition, twenty-seven patients were evaluated six weeks after a nonoperatively treated fracture of the distal part of the radius. Relationships between psychosocial factors and the DASH score were determined. RESULTS: A significant positive correlation between the DASH score and depression was noted for all diagnoses (r = 0.38 to 0.52; p < 0.01 for all). The DASH score also correlated with pain anxiety for four of the five diagnoses (carpal tunnel syndrome, r = 0.40; de Quervain tendinitis, r = 0.46; lateral elbow pain, r = 0.42; and trigger finger, r = 0.24) (p < 0.05 for all). The DASH score was not correlated with neuroticism for any diagnosis. There was a highly significant effect of depression (as measured with the CES-D score) on the DASH score for all diagnoses. Both the CES-D score (F = 62.68, p < 0.0001) and gender (F = 11.36, p < 0.001) were independent predictors of the DASH score. CONCLUSIONS: Self-reported upper extremity-specific health status as measured with the DASH score correlates with depression and pain anxiety but not neuroticism. These data support the contention that psychosocial factors have a strong influence on health-status measures.

Adult↗

PubMed2006

A novel approach to flexor hallucis longus tenography.

OBJECTIVE: This article presents a technically simple and more accurate approach to flexor hallucis longus (FHL) tenography than any we found reported in the literature. CONCLUSION: Tenography is used to evaluate and treat tenosynovitis. Standard FHL tenography protocol involves either direct percutaneous access of the FHL synovial sheath posterior to the medial malleolus or indirect filling of the FHL sheath from an injection of the flexor digitorum longus (FDL) tendon sheath, which often communicates with the FHL tendon sheath. However, with these methods, difficulty entering the FHL sheath may be encountered. We adapted our technique to access the FHL sheath as it courses below the sustentaculum talus. Our early experience with five cases using this technique reflects a 100% success rate with accurate needle placement within the FHL tendon sheath, thereby improving procedural efficiency.

Adult↗

PubMed1990

MR imaging of the tarsal tunnel and related spaces: normal and abnormal findings with anatomic correlation.

The tarsal tunnel syndrome may be caused by extrinsic or intrinsic pressure on the posterior tibial nerve or its terminal branches. The specific symptoms depend on the extent of nerve involvement, and compression distal or proximal to the tarsal tunnel may result in variants of the syndrome. To define better the capability of MR imaging for evaluating this entity, we performed MR imaging on three normal subjects and correlated the images with cryomicrotome sections. Six patients with symptoms suggestive of tarsal tunnel syndrome also were studied with MR. In all normal subjects, MR images showed the flexor retinaculum and the structures passing deep to the retinaculum: the tibialis posterior tendon, flexor digitorum longus tendon, flexor hallucis longus tendon, and the posterior tibial neurovascular bundle. The medial calcaneal sensory branch(es) and the medial and lateral plantar nerves also were delineated. Mechanical causes of compression were shown in all six symptomatic patients. The pathologic entities included two neurilemomas, tenosynovitis involving all three tendons, a ganglion cyst arising from the flexor hallucis longus tendon sheath, posttraumatic fibrosis, and post-traumatic fibrosis with associated posttraumatic neuroma. The MR findings were confirmed surgically in five cases. MR imaging can accurately depict the contents of the tarsal tunnel and the courses of the terminal branches of the posterior tibial nerve. In our small series, MR imaging accurately showed the lesions responsible for tarsal tunnel syndrome.

Ankle↗

PubMed1995

Abnormalities of the biceps tendon of the shoulder: sonographic findings.

The purpose of this essay is to illustrate sonographic findings for patients with abnormalities of the tendon of the long head of the biceps muscle of the arm. The tendon is vulnerable to a variety of injuries caused by abnormalities of its osseous and soft-tissue supports, including impingement of the tendon against the acromion and arthritis of the glenohumeral joint. These abnormalities include acute and chronic tenosynovitis, rupture, subluxation, and dislocation.

Adult↗

PubMed2004

"Baby wrist": MRI of an overuse syndrome in mothers.

OBJECTIVE: The purpose of our study was to describe the MRI findings and interesting clinical aspects of a postpartum overuse syndrome of the wrist and thumb, de Quervain's tenosynovitis, or "baby wrist." CONCLUSION: Mothers may experience a wrist and thumb overuse syndrome, which can be diagnosed by MRI with an increase in size and low signal intensity on both T1- and T2-weighting, in and around the first dorsal tendon sheath compartment of the wrist.

Adult↗

PubMed1984

Rheumatic disorders of the upper limbs associated with repetitive occupational tasks in Finland in 1975-1979.

This study, which dealt with occupational rheumatic disorders associated with repetitive monotonous working movements, is based on the reports received by the National Board of Labour Protection during the 5-year period 1975-79. Altogether 3 090 cases were analysed. Of these, 2 139 (69.2%) were females and 951 (30.8%) males. The mean age of the patients was 40.7 years; the majority (82.2%) were 30-59 years old. The upper limb was involved in 93% and especially the forearm in 63% of cases. Tenosynovitis and peritendinitis of the hand was present in 58% and epicondylitis in 24%. Other disorders, such as shoulder disorders, neck and low back pain, and disorders of the lower extremities were much less frequent. The incidence of occupational musculoskeletal disorders was highest among female workers in the textile, leather and food industries. On comparing different occupations, butchers and meat cutters had the highest incidences. The patients were treated mostly at occupational health centres (66.2%) and local health centres (27.1%). The data on exposure time was rather meagre. This factor was estimated in only 77% of cases. In these the average exposure time was 2.4 years.

Adult↗

PubMed1997

[A case of polymyalgia rheumatica with swelling and pitting edema of the distal lower extremities].

We report a case of an 82-year-old woman with polymyalgia rheumatica (PMR) associated with swelling and pitting edema of the lower extremities. The patient had been previously admitted because of PMR in 1990, but there was no history of swollen extremities. In July 1996, at another hospital, she was again diagnosed as having PMR on the basis of pain in the neck, shoulders and lower back. Administration of prednisolone was followed by improvement of the symptoms. Four months later, similar pain recurred and swelling of the lower extremities was noted. On admission, the erythrocyte sedimentation rate was 86 mm/h, and C-reactive protein was 15.5 mg/dl. Reviewing the previous treatment, it was ascertained that her clinical deterioration was due to premature reduction of the steroid dosage. The cause of the swelling of the lower extremities was unlikely to be heart, liver, kidney or endocrine disease. Prednisolone was increased from 2.5 mg to 10 mg daily with marked improvement in all the symptoms including the swelling and pitting edema. In 1996, a study reported distal extremity swelling with pitting edema as a manifestation of PMR, which mostly developed concurrently with proximal symptoms or during relapses of PMR. The swelling responded poorly to non-steroidal antiinflammatory drugs but promptly to corticosteroids. The distal swelling was reported to be tenosynovitis and synovitis of the surrounding structures. The present case appears similar to that report. More studies of PMR need to be done.

Aged↗