| 1. |
- Abrahamsson, Sven Olof, et al.
(författare)
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Variations in cellular proliferation and matrix synthesis in intrasynovial and extrasynovial tendons : An in vitro study in dogs
- 1994
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 0363-5023. ; 19:2, s. 259-265
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Tidskriftsartikel (refereegranskat)abstract
- Intrasynovial and extrasynovial flexor tendon grafts recently have been shown to have dissimilar patterns of cellular survival and host integration within the digital sheath. In an effort to determine if fundamental differences exist between these two types of tendons, we investigated the biochemical composition and cellular activity of intrasynovial and extrasynovial tendon segments of 12 adult mongrel dogs in short-term explant culture in MCDB 105 and in DMEM media. Proteoglycan, collagen and noncollagen protein synthesis and content and DNA synthesis were determined following culture in both media. Intrasynovial tendon segments cultured in MCDB 105 medium synthesized significantly less collagen, noncollagen protein, and DNA and had similar amounts of proteoglycans compared to extrasynovial tendons. Comparison of intrasynovial and extrasynovial tendon segment responses in DMEM medium showed that intrasynovial tendons synthesized more proteoglycan, protein, and DNA than they did in MCDB 105. Extrasynovial tendons had similar rates of matrix component and DNA synthesis in both media. Findings that the synthesis of matrix components and DNA between intrasynovial flexor and extrasynovial peroneal tendon segments differ significantly indicate that intrasynovial flexor tendons may be specially adapted to the nutritional milieu provided by an intrasynovial environment. These data are supported by the selective successful stimulation of fibrocartilaginous segments within intrasynovial flexor tendons in media favored for the culture of cartilaginous tissue.
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| 2. |
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| 3. |
- Lundborg, G, et al.
(författare)
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Tubular versus conventional repair of median and ulnar nerves in the human forearm : early results from a prospective, randomized, clinical study
- 1997
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Ingår i: The Journal of Hand Surgery. - 0363-5023. ; 22:1, s. 99-106
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Tidskriftsartikel (refereegranskat)abstract
- Injury to a peripheral nerve is followed by local synthesis and release of neurotrophic factors of importance for the regeneration process. This concept was adopted for repair of transected human median and ulnar nerves in the forearm. As an alternative to conventional microsurgical repair of the nerve trunk, silicone tubes of appropriate size were used to enclose the injury zone, intentionally leaving a gap measuring 3-4 mm between the nerve ends inside the tube. The early results from a prospective, randomized, clinical study comparing this principle with conventional microsurgical technique for repair of human median and ulnar nerves, is presented. Eighteen patients (14 men and 4 women), aged 12-72 (mean, 29.5) years, were randomized to either tubulization (11 cases) or conventional microsurgical repair (7 cases). A battery of tests for sensory and motor functions of the hand were carried out at regular intervals for up to 1 year after surgery. The results show no difference between the both techniques, with the exception of perception of touch, which showed a significant difference (p < .05) at the 3-month checkup in favor of the tubulization technique. At re-exploration 11 months after the initial procedure (1 case), the former gap was replaced by regenerated nerve tissue in direct continuity with the proximal and distal parts of the nerve trunk, the exact level of the former injury being impossible to identify. Study data demonstrate an intrinsic capacity of human major nerve trunks to reconstruct themselves in a preformed space when an optimal environment is offered and the surgical trauma is minimized.
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| 4. |
- Lieber, Richard L, et al.
(författare)
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Sarcomere length changes after flexor carpi ulnaris-to-extensor digitorum communis tendon transfer
- 1996
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Ingår i: Journal of Hand Surgery-American Volume. - New York : Churchill Livingstone. - 0363-5023 .- 1531-6564. ; 21:4, s. 612-618
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Tidskriftsartikel (refereegranskat)abstract
- Sarcomere length was measured intraoperatively on five patients undergoing tendon transfer of the flexor carpi ulnaris (FCU) to the extensor digitorum communis (EDC) for radial nerve palsy. The most significant result was that the absolute sarcomere length and sarcomere length operating range of the FCU increased after transfer into the EDC (p <.001). Preoperatively, with the wrist fully extended and fingers flexed, FCU sarcomere length was 4.22 +/- .24 mu m and decreased to 3.19 +/- .05 mu m as the wrist was fully flexed. This represented an overall sarcomere length range of 1.03 mu m After the tendon transfer using standard recommended techniques, all sarcomere lengths were significantly longer (p <.001). Specifically, sarcomeres were 0.74 +/- .14 mu m longer with the muscle in its fully lengthened position (4.96 +/- .43 mu m with the wrist and digits flexed) and 0.31 +/- .16 mu m longer with the FCU in the fully shortened position (3.50 +/- .06 mu m with the wrist and digits extended). At these sarcomere lengths, the FCU muscle was predicted to develop relatively high force only during movement involving synergistic wrist flexion and finger extension. Under the conditions of the procedures performed, the transferred FCU muscle was predicted to produce maximum force over the range of about 30 degrees of wrist flexion and 0 degrees of finger flexion to 70 degrees of wrist extension and 90 degrees of finger flexion. While this is acceptable, a more desirable result was predicted to occur if the muscle was transferred at a longer length. In this latter case, greater stretch of the FCU during transfer (increasing sarcomere length to about 5 mu m) was predicted to improve the transfer. The more highly stretched FCU was predicted to result in maximum force as the wrist and fingers progressed from about 60 degrees of wrist extension and 0 degrees of finger flexion to 80 degrees of wrist extension and 70 degrees of finger flexion. These results quantify the relationship between the passive tension chosen for transfer, sarcomere length, acid the estimated active tension that can be generated by the muscle. The results also demonstrate the feasibility of using intraoperative laser diffraction during tendon transfer as a guide for optimal placement of the transferred muscle.
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| 5. |
- Angelidis, Ioannis K, et al.
(författare)
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Tissue Engineering of Flexor Tendons: The Effect of a Tissue Bioreactor on Adipoderived Stem Cell-Seeded and Fibroblast-Seeded Tendon Constructs
- 2010
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Ingår i: JOURNAL OF HAND SURGERY-AMERICAN VOLUME. - : Elsevier Science B.V., Amsterdam. - 0363-5023. ; 35A:9, s. 1466-1472
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Tissue-engineered flexor tendons could eventually be used for reconstruction of large tendon defects. The goal of this project was to examine the effect of a tissue bioreactor on the biomechanical properties of tendon constructs seeded with adipoderived stem cells (ASCs) and fibroblasts (Fs). Methods Rabbit rear paw flexor tendons were acellularized and seeded with ASCs or Fs. A custom bioreactor applied a cyclic mechanical load of 1.25 N at 1 cycle/minute for 5 days onto the tendon constructs. Three additional groups were used as controls: fresh tendons and tendons reseeded with either ASCs or Fs that were not exposed to the bioreactor treatment and were left in stationary incubation for 5 days. We compared the ultimate tensile stress (UTS) and elastic modulus (EM) of bioreactor-treated tendons with the unloaded control tendons and fresh tendons. Comparison across groups was assessed using one-way analysis of variance with the significance level set at pandlt;.05. Pairwise comparison between the samples was determined by using the Tukey test. Results The UTS and EM values of bioreactor-treated tendons that were exposed to cyclic load were significantly higher than those of unloaded control tendons. Acellularized tendon constructs that were reseeded with ASCs and exposed to a cyclic load had a UTS of 66.76 MPa and an EM of 906.68 MPa; their unloaded equivalents had a UTS of 47.90 MPa and an EM of 715.57 MPa. Similar trends were found in the fibroblast-seeded tendon constructs that were exposed to the bioreactor treatment. The bioreactor-treated tendons approached the UTS and EM values of fresh tendons. Histologically, we found that cells reoriented themselves parallel to the direction of strain in response to cyclic strain. Conclusions The application of cyclic strain on seeded tendon constructs that were treated with the bioreactor helped achieve a UTS and an EM comparable with those of fresh tendons. Bioreactor pretreatment and alternative cell lines, such as ASCs and Fs, might therefore contribute to the in vitro production of strong tendon material.
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| 6. |
- Arner, Marianne, et al.
(författare)
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Hand Function in Cerebral Palsy. Report of 367 Children in a Population-Based Longitudinal Health Care Program
- 2008
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 33A:8, s. 1337-1347
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To describe aspects of hand function in a total population of children with cerebral palsy (CP). Methods Upper extremity data were collected for 367 children who were born between 1992 and 2001 and were registered in a population-based health care program for children with CP. Hand function was classified according to the Manual Ability Classification System (MACS), the House functional classification, and the Zancolli classification. The type of spastic thumb-in-palm deformity was evaluated according to House. Results In the total population of children with CP aged 4 to 14 years, 60% had more than minor problems with hand function (>MACS I). Independence in age-relevant, daily manual activities (MACS I-II) was noted in 87% of children with spastic unilateral CP and in 63% of children with spastic bilateral CP, but in only 20% of children with dyskinetic CP. According to the House functional classification, both hands were spontaneously and independently used in 55% of children (House 7-8), whereas 5% did not use either of their hands (House 0). Minor increase of flexor muscle tone (Zancolli level 1) was found in 69% of all children. Only 2% were in level 3 in both hands. Spastic thumb-in-palm deformity in 1 hand was found in 25% and in both hands in another 15%. Conclusions Limitations in hand function are common in all types of CP, but characteristics of the disability vary considerably between different CP subtypes. The MACS classification is useful to evaluate how well children can handle objects in daily activities. The House functional classification describes grip function in each hand separately; the Zancolli classification of finger and wrist extension and the classification of thumb-in-palm deformity according to House give an estimate of dynamic spasticity. All these classifications were shown to be useful in a population-based health care program, but further studies of the psychometric properties are required. (J Hand Surg 2008;33A:1337-1347. Copyright (C) 2008 by the American Society for Surgery of the Hand. All rights reserved.)
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| 7. |
- Atroshi, Isam, et al.
(författare)
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Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a randomized controlled trial.
- 2009
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 34:2, s. 266-272
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this investigation was to extend the previously reported short-term randomized trial of open and endoscopic carpal tunnel release in patients with carpal tunnel syndrome (CTS) to compare outcomes 5 years after surgery. METHODS: In a single-center randomized controlled trial, 128 patients (25 to 60 years) with clinically diagnosed and electrophysiologically confirmed idiopathic CTS were randomized immediately before surgery to open or 2-portal endoscopic release. The outcome measures included the validated CTS questionnaire's symptom severity and functional status scales (scored from 1 to 5) completed at baseline and 1 year postoperatively. At the extended follow-up of the trial 5 years after surgery, 2 patients had died and the other 126 participants (63 patients in each group) completed the CTS questionnaire. RESULTS: At the 5-year follow-up no difference between the groups was found in the CTS symptom severity score. The mean (SD) score in the open group was 1.42 (0.7) and in the endoscopic group was 1.45 (0.7), and the mean difference in score change from baseline was 0.03 (95% confidence interval, -0.21 to 0.27). Between 1 year and 5 years postoperatively, the CTS symptom severity score had deteriorated by at least 0.4 point in 9 patients in the open group and in 10 patients in the endoscopic group. The mean (SD) CTS functional status score was 1.29 (0.5) in the open group and 1.30 (0.5) in the endoscopic group. At 5 years, 11 patients in the open group and 10 patients in the endoscopic group reported persistent pain in the scar or proximal palm. Three patients in each group had repeat surgery on the operated hand because of persistent or recurrent symptoms. CONCLUSIONS: The improvements in symptoms of CTS and hand-related disability 5 years after open and 2-portal endoscopic carpal tunnel release were equivalent. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
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| 9. |
- Axelsson, Peter, 1963, et al.
(författare)
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Forearm Torque and Lifting Strength: Normative Data
- 2018
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Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier BV. - 0363-5023. ; 43:7
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To establish reference values for new methods designed to quantitatively measure forearm torque and lifting strength and to compare these values with grip strength. Methods A total of 499 volunteers, 262 males and 237 females, aged 15 to 85 (mean, 44) years, were tested for lifting strength and forearm torque with the Kern and Baseline dynamometers. These individuals were also tested for grip strength with a Jamar dynamometer. Standardized procedures were used and information about sex, height, weight, hand dominance, and whether their work involved high or low manual strain was collected. Results Men had approximately 70% higher forearm torque and lifting strength compared with females. Male subjects aged 26 to 35 years and female subjects aged 36 to 45 years showed highest strength values. In patients with dominant right side, 61% to 78% had a higher or equal strength on this side in the different tests performed. In patients with dominant left side, the corresponding proportions varied between 41% and 65%. There was a high correlation between grip strength and forearm torque and lifting strength. Sex, body height, body weight, and age showed a significant correlation to the strength measurements. In a multiple regression model sex, age (entered as linear and squared) could explain 51% to 63% of the total variances of forearm torque strength and 30% to 36% of lifting strength. Conclusions Reference values for lifting strength and forearm torque to be used in clinical practice were acquired. Grip strength has a high correlation to forearm torque and lifting strength. Sex, age, and height can be used to predict forearm torque and lifting strength. Prediction equations using these variables were generated. Copyright (C) 2018 by the American Society for Surgery of the Hand. All rights reserved.
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| 10. |
- Axelsson, Peter, 1963, et al.
(författare)
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New Methods to Assess Forearm Torque and Lifting Strength: Reliability and Validity
- 2018
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Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier BV. - 0363-5023. ; 43:9
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To determine the repeatability and validity of new methods designed to objectively measure forearm torque and lifting strength in a clinical setting. Methods Twenty-eight healthy volunteers, 19 women and 9 men, were tested for lifting strength and forearm torque with the Kern and Baseline dynamometers. Two raters tested each participant on 3 occasions in the standing position. One of the raters also examined 15 subjects, 3 times, for forearm torque in the seated position and for lifting strength and forearm torque by the Work Simulator II, Baltimore Therapeutic Equipment (BTE II). Intraclass correlation coefficients (ICC) model 2,1 was used to calculate ICCs for intra- and intenater reliability. The same ICC model and Bland-Altman plots were used to analyze the validity and agreement between the new test methods and the BTE II equipment and for comparison between tests performed in the standing and seated positions. Results Intra- and interrater reliability for forearm torque measurements with both the Baseline and the BTE II demonstrated ICCs between 0.88 and 0.96. The comparison between the Baseline and the BTE equipment yielded lower ICCs of 0.74 to 0.88 but they were still substantial and in good agreement. The ICCs for torques recorded in the standing and seated position were 0.89 to 0.96. Lifting strength, measured in 3 different positions of forearm rotation, yielded ICC values between 0.84 and 0.96 for both raters and with both the Kern and the BTE II instruments. Similarly, comparisons between the Kern and the BTE II methods showed ICC values between 0.91 and 0.95. Conclusions Both the Baseline and the Kern dynamometers demonstrated excellent intra- and interrater repeatability. Except for forearm torque test in direction of pronation, which had a slightly lower ICC of 0.74, our new methods were valid when the BTE II was used as the reference standard. Assessments in the standing or seated position for torque measurements made little difference. Thus, we found the quality of measurements performed with our new methods sufficient for future studies of forearm torque and lifting strength. Copyright (C) 2018 by the American Society for Surgery of the Hand. All rights reserved.
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