| 1. |
- Ponten, E., et al.
(författare)
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Spastic wrist flexors are more severely affected than wrist extensors in children with cerebral palsy
- 2005
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Ingår i: Dev Med Child Neurol. - : John Wiley & Sons. - 0012-1622 .- 1469-8749. ; 47:6, s. 384-9
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Tidskriftsartikel (refereegranskat)abstract
- Morphological properties of skeletal muscle were compared between wrist flexors and extensors within the same children (n = 8, six females, two males; age range 4 to 9y, median age 7 y) with wrist muscle imbalance secondary to spastic cerebral palsy (CP). Five patients had hemiplegic CP, two diplegic CP, and one patient had tetraplegic CP. Muscle biopsies were taken during either tendon transfer or tendon lengthening procedures. Analyses included distribution of muscle fibre types, fibre sizes, and expression of developmental myosins. Extensor fibre area was significantly greater than flexor fibre area for type 2A fibres and type 2B fibres but not for type 1 fibres. Coefficient of variation (CV) of fibre size for all three fibre types was greater for flexors compared with extensors. The greatest CV was observed for the type 2A fibres in flexors (39.5 [3.6%]). A wide variation was observed for expression of developmental myosin with the magnitude of the expression being greater, but not statistically significant, in flexors compared with extensors (5.4/mm2 vs 0.53/mm2). These data demonstrate that significant secondary myopathy of wrist flexor muscles results from CP.
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| 2. |
- Reinholdt, Carina, 1968, et al.
(författare)
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Outcomes of single-stage grip-release reconstruction in tetraplegia.
- 2013
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Ingår i: The Journal of hand surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 38:6, s. 1137-44
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the outcomes of our technique for single-stage grip-release reconstruction and compare it with previous 1- and 2-stage grip reconstructions in tetraplegia.
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| 3. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Enhanced independence: experiences after regaining grip function in people with tetraplegia.
- 2013
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Ingår i: Disability and rehabilitation. - : Informa UK Limited. - 1464-5165 .- 0963-8288. ; 35:23, s. 1968-1974
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose: To explore how surgical reconstruction of grip affects everyday life for patients with tetraplegia, with special emphasis on patients perspective of their perceived changes. Design: Qualitative method. Subjects: Eleven people (aged 22-73) with tetraplegia who had undergone surgical reconstruction to restore grip function. Methods: Qualitative interviews were conducted 7-17 months after surgery and analysed using Grounded theory. Results: The core concept describing the participants experienced gains after grip reconstructive surgery was "enhanced independence". It was associated with changes in both practical and psychological aspects of independence. Practical aspects identified were: "perform more activities", "smoother everyday life", "renewed ability to participate in social activities", "less dependence on assistance" and "less restricted by physical environment". Psychological aspects of independence included "regained privacy", "increased manageability", "regained identity", "recapture a part of the body" and "share positive experiences with relatives and friends". Encompassing all categories was the concept "self-efficacy in hand control". It was seen as a result included in the enhanced independency core but also as an important factor for the development of all the other categories. Conclusion: Participants in this study experienced enhanced independence after grip reconstructive surgery and rehabilitation. The enhanced independence included both practical and physical aspects and it influenced all domains using the International Classification of Function, Disability and Health model; body function and structure, activities, participation, personal factors and environmental factors. Implications for Rehabilitation Patients with tetraplegia experience grip reconstruction as a useful intervention, an enhanced independence, related to their improved hand control. The increased hand control impacted not only physical aspects but also practical and psychological aspects. It also influenced social and community participation and the interference the environment had on the person. Self-efficacy was both a result of the intervention and a catalyst allowing the subcategories to develop. Therefore, self-efficacy in hand control seems to be an important factor to focus on during the rehabilitation process.
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| 4. |
- Abrams, G. D., et al.
(författare)
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Pronator teres is an appropriate donor muscle for restoration of wrist and thumb extension
- 2005
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Ingår i: J Hand Surg [Am]. ; 30:5, s. 1068-73
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the detailed architectural properties of the pronator teres (PT), extensor carpi radialis brevis (ECRB), and extensor pollicis longus (EPL) muscles to evaluate the suitability of PT-to-ECRB and PT-to-EPL surgical procedures. METHODS: Muscle physiologic cross-sectional areas and region-specific muscle fiber lengths were measured in cadaveric PT, ECRB, and EPL muscles (n = 10 muscles of each type). One-way repeated-analyses of variance measures and post hoc t tests with Bonferroni corrections were used for statistical comparisons. RESULTS: The ulnar head of the PT was present in 8 of 10 specimens. The average PT fiber length was similar to that of the ECRB (7.02 +/- 0.49 cm vs 6.17 +/- 0.27 cm) but was significantly longer than that of the EPL (5.44 +/- 0.25 mm). Fiber length in the humeral head of the PT was longer compared with the ulnar head (7.19 +/- 0.52 cm vs 4.14 +/- 0.25 cm). The average physiologic cross-sectional area of the PT was similar to that of the ECRB (3.5 +/- 0.4 cm2 vs 3.3 +/- 0.3 cm2) but was significantly larger than that of the EPL (3.5 +/- 0.4 cm2 vs 1.1 +/- 0.1 cm2). CONCLUSIONS: From an architectural point of view the PT is an excellent donor choice for transfer to the ECRB for restoration of wrist extension or to the EPL for restoration of thumb extension. Because there is fiber length heterogeneity within the PT, however, when the ulnar head is present it may limit the total excursion of the donor muscle. These data suggest that releasing the ulnar head of the PT before transfer may result in larger excursions of this important motor in tendon transfer surgery.
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| 5. |
- Anderson, K. D., et al.
(författare)
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Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury
- 2009
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Ingår i: Spinal Cord. - 1362-4393. ; 47:4, s. 334-8
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Secure, web-based survey. OBJECTIVES: To determine how quadriplegics in the US view tendon transfer surgeries (TTS) and what activities of daily living (ADL) involving arm/hand function are important in improving quality of life (QoL). SETTING: World wide web. METHODS: Individuals >or=18 years of age living with a cervical spinal cord injury (SCI). Participants obtained a pass code to enter a secure website and answered survey questions. A total of 137 participants completed the survey. RESULTS: Two-thirds of participants had injury levels between C4/5 and C5/6. Over 90% felt that improving their arm/hand function would improve their QoL. ADL that were ranked most important to regain were dressing, feeding, transferring in/out of bed, and handwriting. Less than half of the participants had never been told about TTS and only 9% had ever had TTS. Nearly 80% reported that they would be willing to spend 2-3 months being less independent, while recovering from surgery, to ultimately become more independent. Over 75% reported that the ideal time preferred to have TTS, if chosen, would be within 5 years post-injury. CONCLUSION: Regaining arm and hand function is of primary importance to individuals with cervical SCI, in particular, to increase independence in multiple ADL. There is a critical need in the US to improve awareness of TTS as a viable option for improving arm/hand function in some people. This information needs to be provided early after injury so that informed choices can be made within the first 5 years.
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| 6. |
- Andersson, Jonny K, 1972, et al.
(författare)
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Distal radio-ulnar joint instability in children and adolescents after wrist trauma.
- 2014
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 39:6, s. 653-661
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Tidskriftsartikel (refereegranskat)abstract
- This study retrospectively evaluated the medical records and radiographs of patients younger than aged 25 that were referred for a second opinion due to ulnar-sided wrist pain and persistent distal radio-ulnar (DRU) joint instability. We identified 85 patients with a major wrist trauma before the age of 18. Median age at trauma was 14 years. Median time between trauma and diagnosis of DRUJ instability was 3 years. Sixty-seven patients (79%) had sustained a fracture at the initial trauma. The two most common skeletal injuries related to the DRUJ instability were Salter-Harris type II fractures (24%) and distal radius fractures (19%). In 19 patients (22%), the secondary DRUJ instability was caused by malunion or growth arrest. Eighteen patients (21%) had no fracture; in spite of this, they presented with subsequent symptomatic DRUJ instability. Fourteen of these 18 patients had a triangular fibrocartilage complex (TFCC) tear, confirmed by arthroscopy, open surgery, or magnetic resonance imaging. In conclusion, late DRUJ instability due to wrist fractures or isolated TFCC tears was found to be common in children and adolescents.Level of evidence: IV.
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| 10. |
- Brown, Stephen H. M., et al.
(författare)
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Mechanical strength of the side-to-side versus Pulvertaft weave tendon repair
- 2010
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 35:4, s. 540-545
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The side-to-side (SS) tendon suture technique was designed to function as a repair that permits immediate postoperative activation and mobilization of a transferred muscle. This study was designed to test the strength and stiffness of the SS technique against a variation of the Pulvertaft (PT) repair technique. METHODS: Flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons were harvested from 4 fresh cadavers and used as a model system. Seven SS and 6 PT repairs were performed, using the FDS as the donor and the FDP as the recipient tendon. For SS repairs, the FDS was woven through one incision in the FDP and was joined with 4 cross-stitch running sutures down both sides and one double-loop suture at each tendon free end. For PT repairs, the FDS was woven through 3 incisions in the FDP and joined with a double-loop suture at both ends of the overlap and 4 evenly spaced mattress sutures between the ends. Tendon repairs were placed in a tensile testing machine, preconditioned, and tested to failure. RESULTS: There were no statistically significant differences in cross-sectional area (p = .99) or initial length (p = .93) between SS and PT repairs. Therefore, all comparisons between methods were made using measures of loads and deformations, rather than stresses and strains. All failures occurred in the repair region, rather than at the clamps. However, failure mechanisms were different between the 2 techniques-PT repairs failed by the suture knots either slipping or pulling through the tendon material, followed by the FDS tendon pulling through the FDP tendon; SS repairs failed by shearing of fibers within the FDS. Load at first failure, ultimate load, and repair stiffness were all significantly different between SS and PT techniques; in all cases, the mean value for SS was higher than for PT. CONCLUSIONS: The SS repair using a cross-stitch suture technique was significantly stronger and stiffer than the PT repair using a mattress suture technique. This suggests that using SS repairs could enable patients to load the repair soon after surgery. Ultimately, this should reduce the risk of developing adhesions and result in improved functional outcome and fewer complications in the acute postoperative period. Future work will address the specific mechanisms (eg, suture-throw technique and tendon-weave technique) that underlie the improved strength and stiffness of the SS repair.
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