Stenosing ligamentitis is a common condition that affects the annular muscle of the toe, and sometimes also affects the feet. The inflammatory process in the disease reduces mobility. In some cases, the enlarged muscle can grow together with nearby tissues.
About the disease
In common people, stenosing ligamentitis is called "snapping finger". The disease, for the most part, is not paid attention to, because they do not suspect the danger.
Ligamentitis affects the tendon of the hand, or foot. This problem occurs not only in adults, but also in children. Inflammatory reactions occurring in the affected tendon reduce the mobility of the fingers or feet. The number of people facing this problem is growing. Of all patients with diseases of the hand, about 8% suffer from "clicking finger".
The main types of the disease:
- Knott's disease. The most common type of problem.
- De Quervain's disease. Damage to the long conductor muscle and short extensor. The disease affects one finger, most often the thumb.
Neglecting treatment leads to complete rejection finger, or foot.
Stenosing ligamentitis is divided into three stages.
Stages of development:
- Stage 1. The finger begins to click, there are mild pains in the damaged area.
- Stage 2. Thickening of the tendon leads to decreased mobility of the toe. The pressure on the damaged area causes pain. Discomfort appears in the wrist joint.
- Stage 3. The toe remains bent. Only an operation can correct the situation. Surgery is available for children and adults.
It is highly undesirable to start the disease. Identifying a problem, even early on, is easy. You should contact a specialist immediately after the first symptoms are detected.
Causes
Stenosing ligamentitis can be called polyetiologic, since the disease occurs due to a variety of factors. What influences the development of the disease?
- Gout. The deposition of uric acid in the joint and nearby tissues is a background for inflammatory processes.
- Diabetes. Leads to inflammation of the connective tissues due to the deposition of abnormal protein.
- Rheumatoid arthritis. The disease leads to inflammation of the joints of the hand.
- Stable load on the fingers. Ligamentitis, most often, develops in people performing repetitive work with their hands.
- Heredity.
- Atherosclerosis.
- Incorrect structure of the annular ligament, tendons.
- Injuries.
- Infections.
In most cases, the "snap finger" occurs when there is inflammation in the hand or foot. People who work with their hands are especially susceptible to the disease. However, the disease also occurs in children.
At risk are:
- Musicians.
- Welders.
- Jewelers.
- Bricklayers.
- Dentists.
Ligamentitis causes the tendon to thicken. This interferes with his movement and makes the annular ligament an obstacle. A disease that occurs in children, in most cases, congenital, and in adults, associated with tissue inflammation.
Symptoms
Click finger syndrome has pronounced symptoms. It is not difficult to diagnose the disease even in the early stages.
The main symptoms of Knott's disease:
- Pain near the affected ligament. It appears when moving.
- Swelling on top of the joint.
- Increased sensitivity.
- Numbness of the toe.
- Pain in the area of the wrist joint.
- Problems with flexing the finger. Obstacles are felt.
- The finger does not bend.
- Movement of the wrist joint increases pain.
- Fingers click when moving.
- Poor functionality during operation.
- The appearance of swelling.
- Painful sensations with pressure on the arm.
- Echoes of pain in the shoulder or hand.
- Deterioration of joint mobility.
All stages of the disease are accompanied by swelling, which brings discomfort when pressure is applied to it. Tendons also harden. At the last stage of the disease, a thickening of the phalanx occurs. A patient with the final stage of the disease cannot do without surgery.
Symptoms of De Quervain's disease:
- Swelling.
- Pain in the affected tissues.
- Brush performance does not deteriorate.
- The pain comes from the wrist.
- Discomfort occurs in the shoulder area and fingertips.
This type of "snapping finger" affects people over 40 years old. Most often, ligamentitis affects women, among them this pathology is more common.
Diagnostics
Click finger syndrome does not require specific detection methods. An x-ray is prescribed by the doctor, and an examination is carried out. An examination is necessary to rule out degenerative joint problems with similar symptoms. This is necessary for the right choice treatment.
Palpation of the hand for Knott's disease helps detect:
- Thickening of the tendon located in the region of the distal fold.
- Clicking.
- A thickening that moves with the movement of the finger.
It is important to know that with a prolonged absence of movement in the injured finger, all symptoms intensify.
Palpation for Kervain's disease helps to detect:
- Painful sensations with pressure in the styloid process.
- Discomfort when abducting healthy fingers. Pain in the arm from shoulder to hand.
Some symptoms, such as numbness in the fingers, occur in each type of disease, so a specialist must make a diagnosis. Immediately after the detection of the disease, stress should be abandoned, and then, the limb should be fixed with the affected ligaments and joint.
Treatment
Stenosing ligamentitis can be treated with two methods. For the initial stages of the disease, a conservative method is used, and if the disease is advanced, surgical intervention is used.
Stenosing ligamentitis treatment in a conservative way:
- Electrophoresis.
- Ozokerite.
- Phonophoresis.
- Applications.
- Preparations.
The conservative method, if the disease is not neglected, gives results within a few weeks. During this time, the affected joints, ligaments and muscles of the hand are completely restored. The treatment plan must be drawn up by a specialist. Only a doctor can prescribe drugs.
It is important to know that massage is not included in the list of procedures, as it can aggravate the patient's condition.
During treatment, the patient should avoid any stress, even the simplest. It is necessary to exclude any work, especially related to the brush. This even applies to cleaning or embroidery. The time of recovery depends on compliance with this requirement.
Conservative treatment is especially effective for children. More than 70% of patients under 3 years of age fully recover.
Surgical intervention
If the conservative method did not have the desired result, an operation will be required. The surgical method involves the dissection of the deformed tendon or the annular ligament. The intervention is safe for both adults and children.
Before surgery, during an exacerbation, the patient must follow some recommendations.
Requirements:
- Avoid brush movements. This will increase the chance of injury occurring.
- The use of drugs that reduce inflammation and pain. Medicines are prescribed by a doctor.
- Tendon injections. Injections are given only by a doctor.
After the inflammatory processes have decreased, and the period of exacerbation has passed, an operation is prescribed. Intervention will help to avoid relapse, as well as loss of performance.
Children who underwent surgery before 2 years of age have a 90% chance of complete recovery. Doctors carry out the intervention by an open method. It avoids exacerbations and does not damage nerve cells.
Open method operation
Surgical intervention in both adults and children follows the same plan.
Operation stages:
- General anesthesia.
- Dissection of the ligament around the thickening.
- Align the fingers.
- Wound treatment.
- Bandage application.
- Installing the tire.
The operation is very simple and has many advantages over other types of treatment.
Advantages:
- Low likelihood of tissue damage.
- There is no possibility to injure blood vessels, nerves.
- Decompression cut.
- No damage to anatomical relationships.
The brush starts to work fully in a couple of days. The stitches are removed two weeks after the operation.
Closed method operation
Surgical intervention in this way lasts only 20 minutes.
Operation plan:
- Local anesthesia is used.
- A small puncture is performed.
- The annular ligament is dissected.
- The fingers straighten.
- A bandage is applied.
On the surface, the operation seems quick and easy. However, this method has several significant disadvantages. Therefore, especially for children, it is advisable to use the open method.
Disadvantages:
- The likelihood of injury to the flexor tendon.
- The possibility of relapse.
- Lack of visual control increases the chance of injury.
- The appearance of a hematoma.
The appropriate method should be chosen after consulting a doctor.
Alternative methods
Folk remedies have a positive effect on the ligaments, muscles and the wrist joint.
Treatment methods:
- Warming up. Heated salt is poured into the bag and applied to the damaged area. It is advisable to repeat the procedure several times a day.
- Healing mud. Healing clay is brought to the thickness of sour cream. Then 5 teaspoons of apple cider vinegar are added to the mass. The gruel must be applied to the damaged finger, wrapped and kept for about 2 hours. The hand should rest at this time.
- Mix six teaspoons of chopped elecampane rhizome with 1 liter of hot water and boil for 20 minutes. Boil the resulting liquid, apply on paper towels, and then apply to the damaged area.
- Brew pine and coniferous branches in a 1: 3 ratio. Cook for 20 minutes, then strain. Apply a cloth moistened with liquid to a sore spot.
- Steaming the limb. Coniferous oil and sea salt are added to a liter of boiling water. During the steaming process, wiggle your fingers.
- Calendula flowers should be crushed and mixed with baby cream in a 1: 1 ratio. The resulting ointment is infused in the refrigerator for a day.
Folk remedies are especially effective in the early stages of the disease. Snap finger responds well to alternative treatments. Since folk remedies have no contraindications and are suitable even for children.
Gymnastics
Gymnastics can help remove pain in the wrist joint, ligaments, and arm muscles.
Exercises:
- Elbows rest on the table, palms up. Shaking movements are made with the brush.
- Playing an imaginary flute.
- Elbow on the table. Rotations are performed with a brush.
- Hands at chest level, palms folded together. Pressure is alternately performed with the fingers of one limb on the other.
- The position is the same. The wrists are spread apart, the pads of the fingers do not come off each other.
Exercise is effective on early stages illness.
Prophylaxis
Detecting the snap finger is easy. Therefore, if there is a suspicion of a disease (crunching in the fingers), in adults or children, it is worth immediately reducing the load on the hand. Compresses and light massage will also help. Self-medication is not worth it, you must immediately contact a specialist.
Should not be neglected and folk remedies which help with tendon inflammation. It is quite possible to cure the "clicking finger", especially at an early age.
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Prices
| Primary consultation of an orthopedic traumatologist in an outpatient clinic | 1450 RUB | |
| Consultation with a traumatologist-orthopedist, head of the department, K.M.N., chief specialist, primary in the outpatient clinic | RUB 1800 | |
| Consultation with a traumatologist-orthopedist repeated at the outpatient clinic | RUB 1100 | |
| Consultation with a traumatologist-orthopedist, head of department, K.M.N., chief specialist, repeated in the outpatient clinic | RUB 1,500 | |
| Dressing as part of an outpatient consultation | RUB 530 | |
| Dressing outside the consultation at the outpatient clinic | RUB 740 | |
| Removal of stitches in an outpatient clinic | RUB 530 | |
| Reduction of joint dislocation | RUB 2760 | |
| Closed reduction in fracture with displacement of fragments | RUB 2760 | |
| The imposition of a plaster cast small and medium in the outpatient clinic | 1270 RUB | |
| Applying a large plaster cast in the outpatient clinic | 1730 RUB | |
| Applying a large polymer immobilizing dressing (cellocast) | RUB 4440 | |
| The imposition of a polymer immobilizing dressing medium (cellocast) | 3840 RUB | |
| Applying a small polymer immobilizing dressing (cellocast) | RUB 2760 | |
| Turbocast overlay (large) | 1730 RUB | |
| Turbocast overlay (small and medium) | 1270 RUB | |
| Circular plaster cast in the outpatient clinic (large) | 1730 RUB | |
| Applying a circular plaster cast in an outpatient clinic (small, medium) | 1270 RUB | |
| Puncture of the joint with introduction into the joint medicines in the outpatient clinic (excluding the cost of the drug) | 1660 RUB | |
| Puncture for hemarthrosis | 2000 RUB | |
| Plaster remodeling, shortening of the fixation bandage within the framework of an outpatient consultation | RUB 940 | |
| Removing the circular immobilizing dressing at the outpatient clinic | RUB 980 | |
| Removing any splint in the outpatient clinic | RUB 740 | |
| Outpatient shockwave therapy | RUB 1800 | |
| Taping for injuries and diseases of the capsular-ligamentous apparatus within the framework of the consultation | RUB 820 | |
| Taping for injuries and diseases of the capsular-ligamentous apparatus out of consultation | 1020 RUB | |
| Osteosynthesis with plates for fractures of the bones of the hand, clavicle, foot | RUB 12,000 | |
| Osteosynthesis with wires for fractures of the bones of the hand and foot | RUB 3200 | |
| Dupuytren's contracture operation | RUB 12,000 | |
| Surgery for stenosing ligamentitis, De Quervain's disease | RUB 9750 | |
| Snap Finger Surgery | RUB 9,000 | |
| Removal of Baker's cyst | RUB 9500 | |
| Removal of metal structures (plates) from the clavicle, ankle, forearm bones, hands and feet | RUB 12,000 | |
| Removing a spoke | RUB 1,500 | |
| Achilles tendon suture (up to 2 weeks after injury) | RUB 12,000 | |
| Achilles tendon suture late after injury (more than 2 weeks after injury) | RUB 14,000 | |
| Suture of the flexor tendon of the finger with PCO, including PCO on the day of injury | RUB 5600 | |
| Finger flexor tendon suture late after injury (more than 2 weeks) | RUB 12,000 | |
| Suture of the extensor tendon of the hand with PCO, including PCO on the day of injury | RUB 3200 | |
| The suture of the extensor tendon of the hand, incl. late after injury (1-2 weeks) | RUB 8,000 | |
| Home doctor consultation, primary | RUB 2700 | |
| Doctor's consultation at home, repeated | RUB 2100 | |
| Consultation of a leading specialist doctor / head of the department / K.M.N. at home, primary | RUB 3300 | |
| Consultation of a leading specialist doctor / head of the department / K.M.N. at home, repeated | RUB 2700 |
What is the danger of a tendon rupture on a finger? The mobility of the hand is ensured by the well-coordinated work of the flexors and extensors. The former are on the palmar surface of the hand, the latter are on the back of the hand. The fingers do not have muscles, so their movements are carried out through the connective tissues. Flexors can be superficial or deep. Some of them are located on the middle phalanges, others on the nail. Tendon injuries rank first among the injuries to the hands and fingers. About 30% of them are accompanied by complete or partial tendon ruptures. This is due to the special arrangement of tissues, which makes them easy to damage.
Classification
Injuries to the ligaments of the thumb reduce the functionality of the hand by 50%, the index and middle - by 20%. They are most common among people who prefer amateur sports activities... Tendon ruptures are classified as open or closed, depending on the presence of skin damage. The first occurs when injured by piercing and cutting objects. The latter are diagnosed in athletes. The tendon is damaged when it is overstretched.
Tears are divided into partial and complete, the severity of the injury is assigned depending on the number of torn fibers. It is more difficult to cure total damage. A rupture of one ligament is considered isolated, several - multiple. About concomitant injury it comes in case of damage to muscle tissue, blood vessels and nerve endings.
When prescribing treatment, it is important to determine the duration of the damage. A subcutaneous rupture that occurred less than 3 days ago is considered fresh. Injuries that occurred more than 3 days ago are called stale. Those that happened 21 or more days ago are old.
Common causes of injury
Damage to the tendons and joint capsule can be traumatic or degenerative in origin. The latter type is the result of tissue thinning, the first occurs with a sharp increase in weight. Sports injury may be of mixed origin.
The provoking factors are considered:
- a short break between workouts;
- lack of warm-up during the lesson;
- reassessment of their capabilities;
- non-observance of safety measures.
The risk group includes people who have excess weight, and the elderly.
Characteristic signs
Symptoms of rupture of the ligaments of the finger are determined by its localization. Damage to the tissues located on the anterior surface of the hand is accompanied by impaired flexion functions. In this case, the fingers acquire an over-extended position. When the tendons of the back of the hand are injured, the extensor abilities suffer. Damage to the nerve endings can lead to numbness and paresthesia. If at least one of the above symptoms appears, you should consult a doctor. Fresh injuries heal faster than old ones.
If a person notices that the functions of the hand are seriously impaired, he should apply a sterile bandage and a cold compress. This prevents hemorrhage and the development of puffiness. The limb needs to be raised above the head, this will slow down the speed of blood movement.
In the emergency room, the primary treatment of the wound is carried out, including the application of antiseptic solutions to the skin, stopping bleeding and suturing. After that, a tetanus vaccine is given and antibacterial drugs are administered. If a rupture of the finger extensor tendon is detected, the patient is referred to the surgeon. Without performing an operation, the brush may lose its function.
Therapeutic activities
Treatment of extensor tendon injuries can be carried out not only surgically, but also conservatively. However, this does not apply to flexor damage. For finger injuries, prolonged wearing of a plaster cast or other fixing device is indicated.
Injuries in the wrist area are treated exclusively with surgery. The ends of the torn ligament are sutured. If the damaged tissue is in the area of the distal interphalangeal joint, the splint is applied for 5-6 weeks.
Faster restoration of finger function is observed after the "suture of the extensor tendon" operation.
A fixation device after surgery is necessary to provide the joint with an extended position. You will have to wear it for at least 3 weeks. The splint must be worn on the finger at all times. Its early removal can contribute to the rupture of the scar that has begun to form, as a result of which the nail phalanx will again take bent position... In such cases, repeated splinting is indicated. During the treatment period, it is recommended to be under the supervision of a doctor.
In case of boutonniere-type deformation, the joint is fixed in a straight position until the damaged tissues are completely healed. Suture is necessary when the tendon contracts and completely ruptures. In the absence of treatment or improper application of the splint, the finger takes a curved state and freezes in this position. It is necessary to follow all the instructions of the traumatologist and wear the splint for at least 2 months. The doctor will tell you exactly when you can take it off.
Rupture of the extensor tendons at the level of the metacarpal, wrist, and forearm requires surgery. Spontaneous muscle contraction leads to pulling of the tendons and significant separation of the damaged fibers.
The operation is performed under local anesthesia. First, the bleeding is stopped, after which the torn ligament is sutured to the distal phalanx. If the injury is accompanied by a fracture, the bone fragment is fixed with a screw. The pin in the finger acts as a retainer.
Surgical intervention is performed on an outpatient basis, after its completion, the patient can go home.
Recovery period
Rehabilitation for a ruptured finger flexor tendon includes:
- massage;
- taking medications.
Rubbing accelerates the process of restoration of damaged tissues, increases their strength. The ligament must be worked out with the pads of the fingers, the load must be increased gradually. Movements are carried out along the damaged area of the tendon. Massage can only be started after the inflammation stage is over. The procedure should not last more than 10 minutes.
Finger development is an important part of rehabilitation. It helps to increase blood supply and tissue nutrition. You need to squeeze your hand and hold it in this position for 10 seconds. After that, the fingers are extended as far as possible and fixed in this position for 30 seconds.
You can not stretch the tendon sharply, you can do the exercises as often as you like. Do not forget that classes should be regular.
In some cases, anti-inflammatory drugs are prescribed after the splint. However, inhibition of the inflammatory process can interfere with normal tissue healing, which will lead to dysfunction of the hand.
If pain persists, stop exercise therapy classes until the condition of the ligament improves.
How long does a ruptured tendon heal? With minor injuries, recovery takes no more than a month. With a complete rupture, this period can last up to six months.
longus.Muscle start: from the middle third of the back surface of the ulna.
Muscle Attachment: to the base of the second phalanx. Function: unbends pain
second finger.
19. Extension of the index finger, m. extensor indicis.Start mouse
tsy: from the distal third of the ulna. Muscle Attachment: to the tendon
common extensor. Function: extends the index finger.
MUSCLES OF THE BRUSH
In addition to the tendons of the muscles of the forearm, passing on the dorsum and palmar
sides of the hand, on the latter there are also its own short muscles,
starting and ending in this section of the upper limb. Muscle
brushes are divided into three groups. Two of them are located along the beam and
the side of the palm, form the elevation of the thumb (thenar) and the little
tsa (hypothenar). The third (middle) group lies in the palmar cavity (palma
Muscles of the eminence of the thumb.
Short muscle, abductor thumb, m. abductor
pollicis brevis. Lies in relation to the rest superficially, next to the length
the muscle that abducts the thumb of the hand. Function: takes away big pa-
2. Short flexor of the thumb, m. flexor pollicis brevis. Le-
vein medial to the previous one and has two heads: superficial and deep,
between which passes the long flexor of the thumb tendon
brushes Function: flexes the proximal phalanx of the thumb.
The muscle opposing the thumb of the hand, m. opponens
pollicis. Lies under the abductor thumb muscle. Funk-
tion: produces thumb opposition.
4. Muscle leading the thumb of the hand, m. adductor pollicis... Le-
lives in the depths of the palm distal to the previous ones. Function: leads a big
Muscles of the eminence of the little finger.
5. Short palmar muscle, m. palmaris brevis.Muscle start: from
ulnar edge of the palmar aponeurosis; ends in the skin at the elbow
palms. Function: stretches the palmar aponeurosis.
6. Muscle abductor little finger, m. abductor digiti minimi. Lies on
superficially along the ulnar edge of the hypothenar. Function: deflects, flexes and unfolds
the little finger dies.
7. Short little finger flexor, m. flexor digiti minimi brevis. Lies
along the radial edge of the previous muscle. Function: flexes the proximal
phalanx of the little finger.
The muscle opposing the little finger, m. opponens digiti minimi.
Covered by the previous two muscles. Function: pulls the little finger to
thumb (opposes)
Muscles of the palmar cavity.
9. Worm-like muscles, mm. lumbricales, four narrow muscle
the bundle located between the tendons of the deep flexor of the fingers. Having started
stick from the tendons of the deep flexor of the fingers, bend around the heads of the metacarpals
bones from the radial side and are attached on the back of the proximal phalanges to
tendon extension of the common extensor digitorum. Function: flex
proximal and straighten the middle and distal phalanges of the 2nd to 5th palms
10. Interosseous muscles, m. interossei. Occupy the intervals between the five
stony bones, attaching to them, and are divided into three palms and four
dorsal muscles. Function: abduction and adduction, flex the proximal
phalanx and extend the middle and distal like worm-like muscles.
FASTS AND TOPOGRAPHY OF THE UPPER LIMB
Fascia of the shoulder, fascia brachialis, surrounds the muscles of the shoulder. From her deep into
two fibrous intermuscular septum (septum intermusculare
brachii mediale et laterale), which grow on the crests of the medial and lac-
teral edges humerus and separate the front and rear
muscle groups of the shoulder. The fascia of the shoulder becomes fascia of the forearm fascia
antebrachii, which, covering all the muscles of the forearm, forms between them
fibrous septa.
In the lower third of the forearm, the fascia on the palmar and back sides of the
lateral thickening (ligaments) - retainer of flexors and extensions
bodies, retinaculum flexorum et extensorum. Dorsal ligament by means of
The stack grows together with the surface of the radius and ulna. Between these
sprouts under the ligament are six osteo-fibrous canals, through which
rye pass the extensor tendons of the fingers of the hand. In the first channel (counting
from the radial edge) are the tendons of m. abductor pollicis longus etc. extensor
pollicis brevis, in the second, m. extensor carpi radialis longus and brevis; in third-
m. extensor pollicis longus; in the fourth-m. extensor digitorum and m. extensor
indici; in the fifth - m. extensor digiti minimi; in the sixth - m. extensor carpi ulnaris.
The long extensor of the thumb of the hand is highlighted in blue. |
|
| Latin name |
Musculus extensor pollicis longus |
|---|---|
| Start | |
| Attachment |
distal phalanx of I toe |
| Blood supply |
a. interossea posterior, a. radialis |
| Innervation |
n. radialis (C VI -C VIII) |
| Function |
extends the thumb |
| Catalogs | |
Long extensor of the thumb of the hand(lat. Musculus extensor pollicis longus ) - muscle of the forearm of the posterior group.
It has a fusiform abdomen and a long tendon. It lies next to the short extensor of the thumb of the hand. It starts from the interosseous membrane of the forearm, the interosseous edge and the posterior surface of the ulna. Goes down and into the tendon, which is surrounded by the tendon sheath extensor longus thumb of the hand (lat. vagina tendinis musculi extensoris pollicis longi ). Then, going around the first metacarpal bone and coming out to its back surface, the tendon reaches the base of the distal phalanx, to which it attaches.
Function
Extends the thumb, pulling it in back side.
Write a review on the long extensor of the thumb of the hand
Notes (edit)
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Injury of the long extensor of the thumb within the terminal phalanx. This injury is no different from similar injuries to the extensors of the remaining fingers. In the presence of damage localized proximally to the main joint, there are conditions for the application of a primary tendon suture, however, after 3-4 weeks, a secondary tendon suture is not feasible due to the contraction of the ends of the tendon.
To eliminate the defect free tendon graft required or better to apply tendon transposition. The transposition uses the common extensor tendon of the second toe, to which the distal end of the extensor tendon of the thumb is sutured.
Long extensor rupture occurs quite often. This damage is divided into the following types:
1.direct or indirect rupture caused by trauma;
2.spontaneous rupture:
a) professional hazards,
b) changes in the tendon,
c) rupture due to damage to the limb.
Tendon rupture due to direct trauma and the result of its treatment with the tendon transposition method are shown in the figure (own observation).
"Spontaneous" tendon ruptures due to occupational hazards, they were described at the end of the last century by military doctors (Zander). The left hand of army drummers, while holding the drumstick, was in a position of pronounced dorsiflexion, due to its unnatural position, tendovaginitis and tendon degeneration developed, which led to a "spontaneous" rupture.
A 47-year-old bricklayer suffered a hand injury as a result of a fall of a log; active extension of the thumb of the right hand was absent (a).Immediately after the injury, only the skin was sutured. The transposition of the index finger's own extensor tendon was performed in conditions of scar tissue. The result of the intervention is shown in photo b
Würtenau described 59 cases of rupture tendons from the drummers of the Prussian army. These typical breaks are known in the literature as "drummer paralysis" ("Trommerlahmung" or "Drummer" s palsy).
V the literature describes tendon ruptures due to various diseases of it. So, ruptures due to suppuration, gout, syphilis, tuberculous tendovaginitis (10 cases of Meson), gonorrhea (Melchior), polyarthritis (Lederich, Herris) and rheumatism (Wadstein).
At post-traumatic tendon rupture from the moment of injury to rupture of the tendon, a latent period lasts from several days to several years. Linder (1885) and Heinicke (1913) were the first to draw attention to the rupture of the long extensor tendon of the thumb after a fracture of the radius. Mek Master in 1932 collected from literature only 27 such cases.
F. Steppelmore in 1940 he wrote a summary report on 148 cases already known. In 1955, G. Strendell, including his own 14 observations, reported 60 new cases of these injuries. Thus, 208 cases of post-traumatic tendon rupture are known in the literature. This type of injury prevails in women in 67-37%. In most cases, ruptures occur with dislocation or fracture of the radius without displacement of the fragments. The frequency of rupture of the long extensor tendon of the thumb, according to different authors, is different.
The frequency of this complications after beam fracture according to Gauck 6: 100, Moore 3: 500, Steppelmore 3: 1000, Marcus 4: 2134, Boehler 1: 500.
Long extensor of the thumb begins on the dorso-radial surface of the middle third of the ulna and on the interosseous membrane. Its tendon at the level of the wrist runs in a separate tendon sheath. This space - the third dorsal tendon sheath - is essentially a channel for the bone. It is deeper and narrower than the other extensor sheaths. The tendon runs obliquely and, crossing with the long and short radial extensors of the hand, forms the ulnar edge of the "anatomical snuffbox" ("anatomist" s snuffbox).
Extensor tendon within the proximal phalanx of the thumb expands and attaches to the base of the distal phalanx. Main function the long extensor of the thumb - its extension in the terminal, main and saddle joints. In addition, this muscle contributes to the retroposition of the thumb, participates in dorsiflexion of the hand and, together with the adductor muscle of the thumb, in adduction of the latter. Its most important function is to fix the saddle joint.
Due to the fact that the condition for good grip is fixation muscles of the centrally lying joints, the loss of the function of the long extensor of the thumb leads to an almost complete loss of the function of the thumb grip.
Overwhelming most post-traumatic ruptures, long after the moment of injury, occurs not as a result of unusual efforts, but in the process of habitual daily movements. Tendon rupture in these cases is not accompanied by pain. After the rupture, the thumb hangs down, the distal phalanx assumes a bent position and cannot be actively straightened. Thumb retroposition and adduction may not be feasible. The contours of the ulnar edge of the "anatomical snuffbox" are smoothed out.
In the absence of stabilization of the saddle joint the grip is not strong enough, so the patient is unable to use scissors, write or button buttons.
Usually break localized at the level of the distal edge of the dorsal transverse carpal ligament. Above this level, rupture is rare, in about 7% of cases. The distal end of the tendon is felt over the first metacarpal bone in the form of a nodule. The proximal end of the tendon contracts and moves quite far in the central direction. The tendon sheath collapses.
In a relationship pathogenesis of long extensor tendon rupture thumb, the opinions of the authors agree. Emphasis is placed on the special role of the canal and the course of the tendon. Levy and Cohen consider the Lister's tubercle, which forms the radial edge of the canal, as a hypomochlion, over which the tendon lengthens and looses during movement.
Significance of fractures of the radius for subcutaneous rupture of the extensor of the thumb has been studied by many authors. According to most researchers, the callus formed after a fracture of the radius narrows the tendon canal, and the existing bone fragments, gradually damaging the tendon, can contribute to its rupture.
By opinion Rau and Weigel, in a tendon rupture, deterioration of tendon vascularization at the age of over 25-30 years is of decisive importance, since in adults there are no longitudinal intra-tendon vessels, and the external vascular network may suffer from of various kinds injuries. Strendell believes that the occurrence of post-traumatic tendon rupture is associated with a violation of its blood supply due to trauma (hematoma, thrombosis, degenerative changes in connective tissue), and the rupture occurs at the place of least resistance, that is, within the vagina.
Complete transection of the tendon with a sharp bone fragment is suggested only in rare cases.
Treatment of PTSD Tendon Rupture of the Long Extension of the Big Toe should always be operational. According to their principle, operations are divided into two groups, namely: methods of direct connection of the ends of the tendon and methods of tendon transposition - connection of the distal end of the torn tendon with another extensor tendon located nearby.
Direct way tendon ends, due to the contraction of the stumps and tendon degeneration, is now rarely used. Methods for replacing tendon defects also did not lead to satisfactory results (free tendon graft, fascia defect replacement or artificial material etc.).
Currently dominated by tendon transposition method... This method was first applied by Dupley (1876). He attached the distal end of the long extensor of the thumb to the long radial extensor of the hand. The extensor muscle tendons that can be used for transposition are shown in the table.
For transpositions It is generally best to use a tendon that has the same thrust direction and sliding amplitude as the tendon-muscle motor being replaced. When examining the extensor tendons from these two points of view, it turns out that the requirements are best met, firstly, by the tendon of the index finger's own extensor, and, secondly, by the long radial extensor tendon of the hand.
The first of these was first used for this purpose by Mensch (1925), and in the recent past its use was recommended by many authors (Bunnell, Pulvertaft, Christoph), and especially by I. Böhler. The advantage of the long radial extensor is its anatomical proximity to the rupture site and the fact that the direction of its traction acts from the ulnar side. Given its anatomical location, this tendon is recommended for transposition by Schlatter and Fett. The disadvantage of the tendon of this muscle is that it has less significant movement than the tendon of the extensor longus of the thumb.
Transposition of the index finger's own extensor tendon Strendell performs as follows: the tendon of the index finger's own extensor is intersected over the head of the second metacarpal bone through a 1 - 2 cm transverse skin incision.The distal end of the tendon is attached to the common extensor tendon of the index finger so that when the finger is straightened it resists the rotation of the index finger. Within the wrist, according to the location of the tendon, a longitudinal skin incision is made, through which the cut tendon of the index finger's own extensor is removed.
Then, using new cut at the level of the middle of the first metacarpal bone, the stump of the long extensor tendon of the thumb is released, and then it connects “end-to-end” with the tendon of the index finger's own extensor, held under the skin.
Tendon rupture of the extensor longus of the thumb due to a fracture of the radius
Case of own observation: BI, a 28-year-old teacher, received a fracture of the radius in a typical location with a slight displacement of the fragments. After reduction, four weeks of fixation and subsequent removal of the plaster cast, three weeks of functional therapy (Fig. A), the patient felt healthy. However, on the eighth week, while cleaning the apartment, in the absence of any strong movements, the patient felt a crunch in her thumb, after which it became impossible to straighten it. A typical thumb position for an extensor tendon rupture is shown in Fig. b.
64. Muscles flexing and extending the hand and fingers.
Flex the brush: Flexor elbow of the wrist, radial flexor of the wrist, superficial flexor of the fingers, deep flexor of the fingers, long flexor of the thumb of the hand, long palmar muscle.
Elbow wrist flexor starts from the medial epicondyle of the humerus, from the ulna and fascia of the forearm. With its distal end, it reaches the pisiform bone, to which it attaches. From the pisiform bone to the hooked bone and to the 5th metacarpal bones, there are ligaments, which are a continuation of the traction of this muscle.
Radial flexor of the wrist starts from the medial epicondyle of the shoulder and the intermuscular septum, the muscle passes to the hand under the flexor ligament and attaches to the base of the 2nd metacarpal bone. Being a polyarticular muscle, it is involved not only in the movements of the hand, but also in the flexion of the forearm at the elbow joint.
Superficial finger flexor starts from the medial epicondyle of the humerus, as well as from the ulna and radius. It has four tendons that pass to the hand through the canal of the wrist, located under the flexor ligament, and reach, splitting each into two legs, the lateral surfaces of the middle phalanges of the 2nd to 5th fingers, to which they attach. The function of this muscle is to flex the middle phalanges. Being polyarticular, the muscle also causes flexion in all joints of the hand, except for the distal interphalangeal joints.
Deep finger flexor lies directly on the anterior surface of the ulna and on the square pronator; starts from the two upper thirds of the palmar surface of the ulna and partly from the interosseous membrane. It is divided into four tendons, which run in the canal of the wrist to the distal phalanges of the 2nd to 5th fingers of the hand through the cleavage of the tendons of the superficial flexor of the fingers. Being a polyarticular muscle, it flexes all joints of the hand, including the distal interphalangeal joints. Tendons diverge on the hand in a fan-like direction towards the fingers, due to which this muscle not only flexes the fingers, but also leads them.
Long flexor of the thumb- a single-pinnate muscle that has a fusiform shape. It starts from the palmar surface of the radius, passes through the carpal tunnel in a separate synovial sheath and reaches the distal phalanx of the thumb, to which it is attached. The muscle produces flexion in all joints around which it passes (in particular, flexes the distal phalanx of the thumb).
Palmar muscle is not permanent. Starting from the medial epicondyle of the humerus and from the fascia of the forearm, this muscle is located on its front side so superficially that, when contracted, it is easy to see it under the skin and feel the tendon. Attaching to the palmar aponeurosis and pulling it, with a strong contraction, it can also take some indirect part in flexion of the fingers.
Unbend the brush: long and short radial extensor of the wrist, ulnar extensor of the wrist, extensor of fingers, long extensor of the thumb of the hand, extensor of the little finger, extensor of the index finger.
Long radial extensor of the wrist starts from the lateral edge of the humerus, intermuscular septum and lateral epicondyle, passes under the extensor retainer ligament and the extensor longus tendon of the thumb, and attaches to the base of the 2nd metacarpal bone. Due to the fact that the resultant of this muscle passes very close to the transverse axis of the elbow joint, its participation in flexion of the forearm is insignificant. Being a strong extensor of the hand, it also produces some abduction during isolated contraction.
Short radial extensor of the wrist starts from the lateral epicondyle of the humerus, the fascia of the forearm and attaches to the base of the 3rd metacarpal bone. As an extensor of the hand, the muscle also abducts it.
Elbow wrist extensor starts from the lateral epicondyle of the humerus, collateral radial ligament and fascia of the forearm. Descending to the hand, the muscle goes between the head and the styloid process of the ulna and attaches to the base of the 5th metacarpal bone. Being the extensor of the hand, the ulnar extensor of the wrist also leads it.
Flex the thumb: the long flexor of the thumb, the short flexor of the thumb.
Finger extensor starts from the lateral epicondyle of the humerus, radial collateral ligament, annular radial ligament and fascia of the forearm. In the middle of the forearm, this muscle passes into the tendons that go under the extensor ligament to the dorsum of the proximal phalanges of the 2nd to 5th digits. Each tendon, in turn, has three legs, of which the middle is attached to the middle phalanx, and two lateral ones reach the distal phalanx of the fingers.
Long extensor of the thumb of the hand starts from the back surface of the ulna and radius, the interosseous membrane of the forearm and attaches to the distal phalanx of the thumb. The tendon of this muscle passes under the extensor ligament in a separate channel, crossing the tendons of the radial extensors of the wrist. Extending the distal phalanx, the muscle simultaneously pulls back the thumb a little. If it is fixed, then the muscle participates in the abduction of the entire hand.
Little finger extensor starts from the lateral epicondyle of the humerus, radial collateral ligament, annular ligament of the radial bone and fascia of the forearm, goes down and attaches to the dorsal aponeurosis of the 5th finger. Extending this finger, the muscle also extends and leads the entire hand somewhat.
Index finger extensor starts from the dorsum of the ulna and the interosseous membrane. This muscle, with its tendon, merges with the extensor tendon of the fingers, going to the 2nd finger, reaches the dorsal aponeurosis of the index finger and attaches to its distal and middle phalanges. It extends the index finger and also contributes to the extension of the entire hand.
Also in progress flexion and extension of the fingers muscles are involved: the short extensor of the thumb of the hand, the vermiform muscles, the palmar interosseous muscles, the dorsal interosseous muscles, the short muscle abducting the thumb of the hand, the short flexor of the thumb of the hand, the muscle opposing the thumb of the hand, the muscle of the abductor of the thumb, the short palmar muscle, muscle, abductor little finger, short flexor of the little finger, muscle opposing the little finger.
Short extensor of the thumb starts from the back surface of the ulna and radius, attaches to the proximal phalanx of the thumb, which unbends, simultaneously withdrawing the entire finger. If the finger is fixed, then the muscle participates in the abduction of the entire hand.
Vermiform muscles start from the deep flexor tendon of the fingers. These muscles go to all fingers, except for the 1st. Attached to the dorsal aponeurotic stretches of the proximal phalanges. The function of these muscles is to flex the proximal phalanges of the 2nd to 5th digits.
Palmar interosseous muscles(there are 3 of them) are located in the intervals between the metacarpal bones of the 2-5th fingers and start from these bones. They are attached to the articular capsules of the metacarpophalangeal joints and to the dorsal aponeurosis of the 2nd, 4th and 5th fingers. By flexing their proximal phalanges, these muscles simultaneously bring these fingers to the middle finger.
Dorsal interosseous muscles in the amount of four located in the spaces between the metacarpal bones. The place of their beginning is the lateral surfaces of the metacarpal bones facing each other. Reaching the dorsum of the proximal phalanges, they are woven with thin tendons into the aponeurotic extension of the extensors of the fingers. The function of these muscles is that they, bending the proximal phalanges of the 2-5th fingers, simultaneously contribute to the extension of the middle and distal phalanges of these fingers. In addition, they move the 2nd and 4th fingers away from the 3rd and tilt the 3rd toe towards both the radius and ulna.
Short abductor thumb muscle, has an extensive origin on the flexor retainer ligament and on the scaphoid. Attaching to the proximal phalanx of the thumb facilitates its abduction.
Short flexor of the thumb starts from the flexor ligament and trapezius bone. This muscle attaches to the sesamoid bone and, bending the 1st phalanx of the thumb, contributes (due to the tension of the antagonists) the extension of its 2nd, distal, phalanx. The muscle is also involved in the opposition of the thumb.
The muscle opposing the thumb of the hand starts from the flexor ligament and the trapezium bone, and attaches to the 1st metacarpal bone. Its function is that it opposes the thumb to everyone else.
Adductor thumb muscle, has two heads - transverse and oblique. The transverse begins from the palmar surface of the body of the 3rd metacarpal bone, oblique - from the base of the 2nd and 3rd metacarpal bones and the capitate bone. The muscle attaches to the sesamoid bone in front of the metacarpophalangeal joint of the thumb, as well as to the capsule of this joint and the proximal phalanx of the thumb. Its function is that by bringing the thumb to the median plane of the palm, it contributes to its opposition to the other four fingers.
Short palmar muscle starts from the palmar aponeurosis and attaches to the skin. When clenching the hand into a fist or when hitting with the palmar surface of the hand, this muscle helps to protect the vessels and nerves running along the ulnar side from the front surface of the forearm to the hand.
The muscle that abducts the little finger begins on the pisiform bone and attaches to the base of the proximal phalanx of the 5th toe. The function of the muscle is to abduct this finger, bend its proximal phalanx, and extend the middle and distal phalanges.
Short little finger flexor starts from the flexor ligament and the uncinate bone and attaches to the ulnar edge of the base of the proximal phalanx of the 5th toe. The function of the muscle is to flex and adduct it.
Muscle opposing the little finger, begins together with the previous muscle, and attaches to the body and head of the 5th metacarpal bone, which bends somewhat and brings it closer to the middle of the palm.
Muscles of the hand, right (the tendons of the superficial flexor of the fingers are partially removed)
1 - flexor retainer; 2 - muscle abducting the little finger; 3 - short little finger flexor; 4 - tendons of the deep flexor of the fingers; 5 - muscle opposing the little finger; 6 - worm-like muscles; 7 - tendons of the superficial flexor of the fingers; 8 - muscle leading the thumb of the hand; 9 - tendon of the long flexor of the thumb; 10 - short muscle flexing the thumb of the hand; eleven - short muscle abducting the thumb of the hand.