Search Results (9)

Background: Distal intersection tenosynovitis (DIT) is a rare and recently described condition that affects the extensor pollicis longus (EPL), extensor carpi radialis brevis (ECRB), and longus (ECRL). Based on surgical observations, this study aimed to provide new insights into its physiopathology. Methods: This was a retrospective study of all patients who underwent surgery for DIT at our institution from 2015 to 2024. Five patients were included in the study. Results: Wrist joint issues clearly explained the occurrence of DIT in three cases. Tendon lesions were observed either on the extensor carpi radialis brevis or extensor pollicis longus. Conclusions: These additional data complement the existing literature, which primarily focuses on the anatomical mechanisms of DIT without fully explaining its causes. Our observations suggest that wrist joint or bone disorders may play a significant role in its occurrence. Lesions in different tendons suggest the involvement of distinct pathological mechanisms. Full article

Background: This study reported a case of zone VII multiple neglected extensor tendons reconstruction with a palmaris longus tendon autograft in a 15-year-old boy 3 months after the initial trauma. Case presentations: Preoperative examinations revealed complete damage of the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), abductor pollicis longus (APL), and partial injury of the extensor pollicis brevis (EPB). The extensor tendons were reconstructed with a palmaris longus tendon autograft combined with graft tunnel reconstruction within the scar at the level of the damaged retinaculum. After the surgical treatment, short immobilization and early rehabilitation were applied, providing passive sliding of the reconstructed tendon supplemented with actively mediated extension. Results: Despite the neglectful nature of the injury, surgical treatment and early postoperative rehabilitation resulted in an excellent functional outcome. At the follow-up visit, 6 months postoperative, the patient presented a full range of motion of the radiocarpal joint and thumb without any limitations on hand function. Conclusions: (1) Palmaris longus tendon autograft is a viable option for the treatment of multiple zone VII extensor tendon damage. (2) The combination of early passive motion and actively mediated extension provides tendon gliding and results in good functional outcomes for a hand with zone VII extensor tendon injury. (3) Ultrasound examination can evaluate early results and detect complications, mainly tendon/graft adhesions, after extensor tendon reconstruction surgery. Full article

Background: Lateral epicondylitis impacts 1–3% of the population. It affects nearly half of all tennis players, primarily due to repetitive forearm muscle use leading to pain at the lateral elbow, particularly at the extensor carpi radialis brevis tendon. While conservative treatments resolve most cases, 4–11% of patients with persistent pain require surgery. Tenotomy is the gold standard for repair, but the research comparing the benefits of specific types of tenotomies (open, arthroscopic, percutaneous, ultrasonically assisted, and Tenex forms) is lacking. Methods: PubMed and Embase searches were conducted for articles focused on four tenotomy techniques. The inclusion criteria allowed for the use of randomized controlled trials (RCTs), prospective cohort studies, and comparative observational studies, while the exclusion criteria excluded meta-analyses. Following the PRISMA guidelines, the initial search resulted in 2327 articles. Once the inclusion and exclusion criteria were applied, 1702 articles underwent abstract screening. Finally, 232 articles proceeded to full-text screening, resulting in 37 articles undergoing data extraction. Results: The primary outcomes included functional improvement, pain relief, overall performance, and postoperative disability. The secondary outcomes included patient-reported satisfaction, return-to-work timeframes, and procedural complications. Conclusions: The tenotomy outcomes were similar, regardless of the method, indicating that discussions with patients about their specific outcome preferences may help guide tenotomy method selection. Full article

A novel combination of variations involving the extensor carpi radialis (ECR) muscle group was observed bilaterally in a 75-year-old female cadaver during routine dissection. An accessory tendon was observed arising from the extensor carpi radialis longus (ECRL) and traveling with the primary tendon through the second compartment of the extensor retinaculum. While the primary tendon inserted on the base of the second metacarpal, as is typical of ECRL, the accessory tendon inserted on the base of the third metacarpal. This insertion is typical of the extensor carpi radialis brevis (ECRB) muscle. Additionally, bilateral agenesis of the ECRB was reported. Thirty-two additional forearms were assessed for similar variations, with none being observed. This combination of variations adds to the literature regarding the ECR muscle group, while also being of interest to clinicians, specifically regarding tendon reconstructive procedures as well as accessing the distal radial artery via the anatomical snuffbox. Full article

Background: Chronic lateral epicondylitis challenges the therapeutical approach; underlying mechanisms are incompletely understood; neuropathic pain and central and peripheral sensitization may explain the fact that botulinum toxin has been found to play a role in pain and function management. Methods: We searched the literature for MeSH terms: lateral epicondylitis or synonyms and botulinum toxin. Results: We found 14 papers containing trials on botulinum toxin injection into the tendon or into the extensor muscles (specifically, extensor carpi radialis brevis and extensor communis digitorum). We followed the administration pathways, doses, timing, and side effects. Conclusions: With a chronic course, the focus of the therapy shifts from the afflicted tendon to the inserting muscles, as muscle contracture may create a vicious loop to perpetuate and aggravate the disease. Doses, timing, and side effects are discussed. Full article

Background: Forearm intersection syndrome causes pain, swelling, and a rub at the dorsal distal forearm where the first extensor compartment muscles intersect with the second compartment tendons. Although primary care settings tend to treat mild cases, high-performance athletes may suffer from severe symptoms that require surgery. This proof-of-concept study aims to help detect the anatomical substrate of forearm intersection syndrome using palpation and ultrasonography when available. Methods: Five individuals were studied using independent palpation and ultrasonography to identify the first dorsal compartment muscles and the second dorsal compartment tendons. The distances between the dorsal (Lister’s) tubercle of the radius and the ulnar and radial edges of the first dorsal compartment muscles were measured to determine the location and extent of the muscle–tendon intersection. The palpatory and ultrasonographic measurements were compared using descriptive statistics and the paired t-test. Results: The mean distances from the dorsal tubercle of the radius to the ulnar and radial borders of the first dorsal compartment muscles were 4.0 cm (SE 0.42) and 7.7 cm (SE 0.56), respectively, based on palpation. By ultrasonography, the corresponding distances were 3.5 cm (SD 1.05, SE 0.47) and 7.0 cm (SD 1.41, SE 0.63). Both methods showed a similar overlap length. However, ultrasonography revealed a shorter distance between the dorsal tubercle of the radius and the ulnar border of the first compartment than palpation (p = 0.0249). Conclusions: Our findings indicate that a basic knowledge of anatomy should help health professionals diagnose forearm intersection syndrome through palpation and, if available, ultrasonography. Full article

Background: This study attempted to clarify the innervation pattern of the muscles of the distal arm and posterior forearm through cadaveric dissection. Methods: Thirty-five cadavers were dissected to expose the radial nerve in the forearm. Each muscular branch of the nerve was identified and their length and distance along the nerve were recorded. These values were used to determine the typical branching and motor entry orders. Results: The typical branching order was brachialis, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, supinator, extensor digitorum, extensor carpi ulnaris, abductor pollicis longus, extensor digiti minimi, extensor pollicis brevis, extensor pollicis longus and extensor indicis. Notably, the radial nerve often innervated brachialis (60%), and its superficial branch often innervated extensor carpi radialis brevis (25.7%). Conclusions: The radial nerve exhibits significant variability in the posterior forearm. However, there is enough consistency to identify an archetypal pattern and order of innervation. These findings may also need to be considered when planning surgical approaches to the distal arm, elbow and proximal forearm to prevent an undue loss of motor function. The review of the literature yielded multiple studies employing inconsistent metrics and terminology to define order or innervation. Full article

How effective and safe are incobotulinumtoxinA injections in adult patients with lateral epicondylitis refractory to other treatments? In this experimental study, ultrasound-guided incobotulinumtoxinA 10–30 U/muscle was injected into extensor carpi ulnaris, extensor digiti minimi, extensor digitorum longus and extensor carpi radialis brevis muscles. Pain (visual analogue scale [VAS], 0 to 10 [no pain to severe pain]) and upper-limb functionality (QuickDASH scale, 0 to 100 [best to worst]), assessed at baseline, 1, 3 and 6 months post-treatment, were analysed using repeated-measures analysis of variance (ANOVA) and Tukey post-hoc tests. Secondary analyses stratifying patient population by sex and baseline VAS were performed. Adverse events were reported. Twenty-four patients (mean [standard deviation] age 46.8 years) were included. Compared with baseline, mean VAS and QuickDASH scores improved at all follow-ups (p < 0.001 and p = 0.001, respectively; repeated-measures ANOVA). Secondary analyses revealed significant differences between baseline and all follow-ups in the group with baseline VAS ≥ 6 and in males and females (all p < 0.05, Tukey post-hoc test). No adverse events, except for the expected third finger weakness, were reported. In conclusion, ultrasound-guided incobotulinumtoxinA injections may be an effective treatment for lateral epicondylitis in the appropriate patient population. Full article

Loss of hand function after cervical spinal cord injury (SCI) impacts heavily on independence. Multiple nerve transfer surgery has been applied successfully after cervical SCI to restore critical arm and hand functions, and the outcome depends on nerve integrity. Nerve integrity is assessed indirectly using muscle strength testing and intramuscular electromyography, but these measures cannot show the manifestation that SCI has on the peripheral nerves. We directly assessed the morphology of nerves biopsied at the time of surgery, from three patients within 18 months post injury. Our objective was to document their morphologic features. Donor nerves included teres minor, posterior axillary, brachialis, extensor carpi radialis brevis and supinator. Recipient nerves included triceps, posterior interosseus (PIN) and anterior interosseus nerves (AIN). They were fixed in glutaraldehyde, processed and embedded in Araldite Epon for light microscopy. Eighty percent of nerves showed abnormalities. Most common were myelin thickening and folding, demyelination, inflammation and a reduction of large myelinated axon density. Others were a thickened perineurium, oedematous endoneurium and Renaut bodies. Significantly, very thinly myelinated axons and groups of unmyelinated axons were observed indicating regenerative efforts. Abnormalities exist in both donor and recipient nerves and they differ in appearance and aetiology. The abnormalities observed may be preventable or reversible. Full article