RESUMO
Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.
Assuntos
Humanos , Feminino , Adulto , Traumatismos dos Tendões/terapia , Traumatismos do Punho/terapia , Calcinose/complicações , Tendinopatia/complicações , Dor Aguda/etiologia , Calcinose/diagnóstico , Imageamento por Ressonância Magnética , Radiografia , Tendinopatia/diagnóstico , Dor Aguda/diagnósticoRESUMO
Spontaneous rupture of the digital extensor tendons of the hand has been reported after Kienbocks disease, rheumatoid arthritis, Vaughan-Jackson syndrome, distal radial fracture. Rupture may also occur as a consequence of unrecognized carpal lunate fracture. We present a case report of a man affected with spontaneous rupture of the digital extensor tendons secondary to unrecognized carpal lunate fracture with partial dorsal dislocation. The edges of the tendon were debrided and sutured using a locked modified Kessler suture. A dynamic splinting cast was applied in moderate extension of the wrist. The aim of this case report is to highlight that in absence of a clear etiology for rupture of the extensor tendons of the hand, carpal lunate fracture, though rare, is an important cause of spontaneous extensor tendons rupture.
La ruptura espontánea de tendones extensores digitales de la mano ha sido reportado después de la enfermedad de Kienböck, artritis reumatoide, síndrome de Jackson Vaughan, fractura del radio distal. La lesión del tendón también puede ocurrir como consecuencia de la fractura no reconocida de carpal semilunar. En este artículo, se presenta un caso de un hombre que sufre de rotura espontánea del tendón extensor digital secundaria a fractura semilunar no reconocida de los huesos del carpo con luxación dorsal del fragmento parcial. Los bordes del tendón se han limpiado y se sutura usando una sutura de Kessler. Un refuerzo dinámico se aplicó en extensión moderada de la muñeca. El propósito de este caso clínico es poner de relieve que, en ausencia de una etiología clara de la ruptura de los tendones extensores de la mano, una fractura de los huesos del carpo semilunar puede ser una causa importante de la ruptura espontánea de los tendones extensores de la mano.
Assuntos
Traumatismos dos Tendões , Ossos do Carpo , Humanos , Masculino , Ruptura Espontânea , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/cirurgia , Tendões , Articulação do PunhoRESUMO
Abstract: Spontaneous rupture of the digital extensor tendons of the hand has been reported after Kienbock's disease, rheumatoid arthritis, Vaughan-Jackson' syndrome, distal radial fracture. Rupture may also occur as a consequence of unrecognized carpal lunate fracture. We present a case report of a man affected with spontaneous rupture of the digital extensor tendons secondary to unrecognized carpal lunate fracture with partial dorsal dislocation. The edges of the tendon were debrided and sutured using a locked modified Kessler suture. A dynamic splinting cast was applied in moderate extension of the wrist. The aim of this case report is to highlight that in absence of a clear etiology for rupture of the extensor tendons of the hand, carpal lunate fracture, though rare, is an important cause of spontaneous extensor tendons rupture.
Resumen: La ruptura espontánea de tendones extensores digitales de la mano ha sido reportado después de la enfermedad de Kienböck, artritis reumatoide, síndrome de Jackson Vaughan, fractura del radio distal. La lesión del tendón también puede ocurrir como consecuencia de la fractura no reconocida de carpal semilunar. En este artículo, se presenta un caso de un hombre que sufre de rotura espontánea del tendón extensor digital secundaria a fractura semilunar no reconocida de los huesos del carpo con luxación dorsal del fragmento parcial. Los bordes del tendón se han limpiado y se sutura usando una sutura de Kessler. Un refuerzo dinámico se aplicó en extensión moderada de la muñeca. El propósito de este caso clínico es poner de relieve que, en ausencia de una etiología clara de la ruptura de los tendones extensores de la mano, una fractura de los huesos del carpo semilunar puede ser una causa importante de la ruptura espontánea de los tendones extensores de la mano.
Assuntos
Humanos , Masculino , Traumatismos dos Tendões/cirurgia , Traumatismos dos Tendões/diagnóstico , Ruptura Espontânea , Tendões , Articulação do Punho , Ossos do CarpoRESUMO
A ruptura traumática do tendão extensor digital longo (TEDL) apresenta alta incidência entre as afecções que acometem o aparelho locomotor dos equinos, estando frequentemente associada aos acidentes em cercas de arame liso. O sinal clínico evidente é a perda da capacidade de extensão das falanges e do casco, trazendo déficit de propriocepção e claudicação aparente. Estas lesões tendíneas possuem prognóstico reservado, sendo que em alguns casos podem ser fatais. O objetivo deste artigo é relatar três casos de equinos com ruptura total do TEDL, submetidos a tratamentos de cicatrização de ferida por segunda intenção e modelo de fisioterapia extensora. As cicatrizações e retorno de função extensora ocorreram em média com 52,7± 7,36 dias, com retorno às atividades anteriormente desempenhadas em tempo inferior a 120 dias. Conclui-se que a cicatrização por segunda intenção com aparato de fisioterapia extensora apresenta-se como opção viável em situações que a sutura não é indicada ou nas deiscências relacionadas às lacerações de TEDL.
The traumatic rupture of the long digital extensor tendon has a high incidence of diseases that affect the locomotor system of horses, and is often associated with accidents in smooth wire fences. The obvious clinical sign is the loss of extensibility of the phalanges and the hull, bringing proprioception deficit and limping apparent. These tendon injuries have a poor prognosis, and in some cases can be fatal. The purpose of this article is to report three cases of horses with total TEDL rupture undergoing healing treatments wound by secondary intention and model extensor physiotherapy. The scarring and extensor function return occurred on average 52.7 ± 7.36 days, with return to activities previously performed in less than 120 days. It was concluded that the healing by secondary intention with extensor physiotherapy apparatus is presented as a viable option in situations where the suture is not indicated or the dehiscence related to lacerations TEDL.
Assuntos
Animais , Cavalos , Lacerações/veterinária , Modalidades de Fisioterapia/veterinária , Traumatismos dos Tendões/reabilitação , Traumatismos dos Tendões/terapia , Traumatismos dos Tendões/veterináriaRESUMO
A ruptura traumática do tendão extensor digital longo (TEDL) apresenta alta incidência entre as afecções que acometem o aparelho locomotor dos equinos, estando frequentemente associada aos acidentes em cercas de arame liso. O sinal clínico evidente é a perda da capacidade de extensão das falanges e do casco, trazendo déficit de propriocepção e claudicação aparente. Estas lesões tendíneas possuem prognóstico reservado, sendo que em alguns casos podem ser fatais. O objetivo deste artigo é relatar três casos de equinos com ruptura total do TEDL, submetidos a tratamentos de cicatrização de ferida por segunda intenção e modelo de fisioterapia extensora. As cicatrizações e retorno de função extensora ocorreram em média com 52,7± 7,36 dias, com retorno às atividades anteriormente desempenhadas em tempo inferior a 120 dias. Conclui-se que a cicatrização por segunda intenção com aparato de fisioterapia extensora apresenta-se como opção viável em situações que a sutura não é indicada ou nas deiscências relacionadas às lacerações de TEDL.(AU)
The traumatic rupture of the long digital extensor tendon has a high incidence of diseases that affect the locomotor system of horses, and is often associated with accidents in smooth wire fences. The obvious clinical sign is the loss of extensibility of the phalanges and the hull, bringing proprioception deficit and limping apparent. These tendon injuries have a poor prognosis, and in some cases can be fatal. The purpose of this article is to report three cases of horses with total TEDL rupture undergoing healing treatments wound by secondary intention and model extensor physiotherapy. The scarring and extensor function return occurred on average 52.7 ± 7.36 days, with return to activities previously performed in less than 120 days. It was concluded that the healing by secondary intention with extensor physiotherapy apparatus is presented as a viable option in situations where the suture is not indicated or the dehiscence related to lacerations TEDL.(AU)
Assuntos
Animais , Traumatismos dos Tendões/reabilitação , Traumatismos dos Tendões/terapia , Traumatismos dos Tendões/veterinária , Modalidades de Fisioterapia/veterinária , Lacerações/veterinária , CavalosRESUMO
PURPOSE: We hypothesized that a side-to-side (STS) tendon repair has biomechanical characteristics that match those of a Pulvertaft (PT) weave. METHODS: Thirty extensor tendons were harvested (4 extensor digitorum communis and 1 extensor indicis proprius from 6 cadaver arms). Three hand surgery fellows with similar backgrounds of training under the same conditions and precise standardized technique performed the repairs (5 PT and 5 STS per surgeon). After the repairs, the tendons were passed through a graft-sizing guide to determine bulk and results were expressed as a repaired versus native diameter ratio. The specimens were then tested for ultimate strength and fatigue properties. Failure type and mechanical properties were recorded and compared with those of the native tendon. RESULTS: The average peak force to failure was 93 ± 20 N for the STS and 62 ± 32 N for PT group. Relative strength ratio (repair strength compared with native tendon strength) was 37% ± 21% for the STS and 22% ± 11% for the PT group. In the STS group, all failures occurred as a result of tissue failure; however, in the PT, suture failures occurred in 3 tendons before tissue failure. The mean bulk ratio of the repaired site versus native proximal tendon was 37 ± 14% and 40% ± 22% more for the STS and PT groups, respectively. These values for native distal tendon were 28% ± 9.9% and 26% ±24 %, respectively for STS and PT repair. Furthermore, the bulk of the repaired site for the STS and PT groups was 4.2 ± 0.50 and 4.7 ± 1.2 mm, respectively. CONCLUSIONS: Side-to-side repair technique showed superior biomechanical properties while demonstrating comparable repair bulk of the tendon coaptation compared with the Pulvertaft weave. CLINICAL RELEVANCE: The results of this study may help guide a surgeon's choice of repair technique when addressing tendon injuries or tendon transfers.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Técnicas de Sutura , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia , Braço , Fenômenos Biomecânicos , Cadáver , Humanos , Resistência à TraçãoRESUMO
As lesões tendinosas são muito frequentes nos traumatismos da mão. Vidro e arma branca são os agentes mais comuns. Classificam-se como aberta e fechada e invariavelmente estão associadas a lesões de pele, nervos e artérias. O conhecimento anatômico da mão é fundamental, pois mesmo traumas menores podem trazer sequelas se não forem tratados adequadamente. Uma anamnese e um exame físico minucioso permitirão identificar corretamente as lesões. O diagnóstico, o tratamento precoce e o seguimento pós-operatório especializado de fisioterapeuta ou terapeuta da mão serão fundamentais para o melhor resultado funcional. Este artigo revisa o diagnóstico e a conduta nas lesões tendinosas da mão.
Tendon injuries are very common in injuries in the hand. Glass and knives are the most common agents. They are classified as open and closed and are invariably associated with lesions of skin, nerves and arteries. Knowing the anatomy of the hand is crucial, because even minor trauma can bring consequences if not treated properly. A medical history and physical examination will allow the correct identification of the injuries. The diagnosis, early treatment and postoperative follow-up by a hand specialist or physical therapist will be key to a better functional outcome. This article reviews the diagnosis and management of tendon injuries in the hand.
Assuntos
Humanos , Procedimentos de Cirurgia Plástica , Traumatismos da MãoRESUMO
Objetivou-se estudar os aspectos macroscópicos, ultra-sonográficos e histopatológicos do tecido neoformado no local da ressecção parcial do tendão extensor digital longo em 10 eqüinos, no momento do restabelecimento funcional do membro com o animal em locomoção à passo. O exame macroscópico foi realizado a cada 48 horas, o planimétrico das feridas a cada 10 dias, o ultra-sonográfico a cada 15 dias e o histopatológico no final do experimento. As feridas mostraram tecido de granulação em retração e exuberante, sem epitelização total, com aspectos ultra-sonográficos desorganizados diferentes do tendão íntegro e os exames histopatológicos revelaram tecido cicatricial em formação. O restabelecimento funcional médio foi de 45,9 dias, com o tecido neoformado na região da tenectomia permitindo o restabelecimento funcional do membro operado.(AU)
The objective of this work was to study the macroscopic, ultrasonographic and histopathologic aspects from the newly formed cicatricial tissue at the site of the partial resection of the long digital extensor tendon in 10 equines at the moment of functional restoration of the limb with the animal in walk locomotion. The macroscopic exam was performed every 48 hours, the planimetric mensuration every 10 days, the ultrasonographic exam every 15 days and the histopathologyc exam at the end of the study. The wounds showed granulation tissue in retraction, without total lesion epithelization, and the aspects ultrasonographics revealed wound healing with newly formed tissues with variable density and high neovascularization without tendon structural reorganization. The histopathology showed newly formed vascularized tissue, with leukocytic infiltrate and collagenous deposition without full epithelization. The cicatrization tissue formed in the resection region of the tendon, immature and without the structural organization of the normal tendon, showed to be able to functional restoration of the operated limb.(AU)