Using Acellular Dermal Matrix to Treat Repetitive Tendon Rupture after Excision of Ruptured Intratendinous Ganglion

Existing literature has not explored repeated tendon ruptures caused by torn intratendinous ganglions. The treatment of intratendinous ganglion of the hand remains a challenge, as it is difficult to completely excise the ganglion while also preserving the tendon. Herein is a report on a case of ruptured intratendinous ganglion in the extensor digitorum communis which resulted in repeated tendon reconstruction surgeries. The authors incorporated an acellular dermal matrix with tendon transfer, demonstrating great clinical improvement and successful repair thus far.

Duplication of the Extensor Pollicis Longus and Index Extensor Digitorum Communis: Report of a Novel Anomaly and Review of Literature

Accessory extensor tendons in the hand are not rare, usually asymptomatic, and recognized incidentally during elective surgery or cadaveric dissection. This report describes a novel case of symptomatic duplication of accessory extensor tendons to both the thumb and the index finger causing a painful dorsal wrist tenosynovitis. Excision of the accessory tendons with decompression and tenosynovectomy of the fourth extensor compartment alleviated the patient’s symptoms without compromising motion or function.

Extensor Tendon Dislocation at the Metacarpophalangeal Joint of Both Ring Fingers Caused by a Specific Hand Posture in a Shiatsu Therapist

A 43-year-old female shiatsu therapist complained of sudden snapping of the metacarpophalangeal joints (MCPjs) of both ring fingers during a specific hand posture. The extensor tendon of the ring finger was dislocated ulnarly when the MCPj of the ring finger was flexed and deviated ulnarly and the MCPj of the middle finger was extended. Surgical exploration revealed an attenuated radial sagittal band. We plicated the juncturae tendinum of the extensor digitorum communis between the middle and ring fingers and released the ulnar sagittal band partially to centralise the extensor tendon excursion. Twenty-six months postoperatively, the patient regained full active and passive range of motion of all fingers without extensor tendon dislocation or snapping in either hand during work.

Multiple Huge Tendinous Xanthomas with Normal Lipid Profiles in All Extremities

Xanthomas are grayish-yellow masses composed of lipid-filled foamy histiocytes and are usually accompanied by familial hypercholesterolemia or some other disease associated with dysfunctional lipid metabolism. Here, we report a case of multiple huge tendinous xanthomas with normal lipid profiles involving all extremities. These masses were large enough to cause pain, dysfunction of extremities, and cosmetic compromise and the condition was accompanied by cerebrotendinous xanthomatosis. Due to the presence of many masses in all extremities, a two-stage operation was planned with a time gap of several months. At 1-month follow-up visits after first and second surgeries, although extension of the left middle finger was poor as a result of sacrificing the 3rd extensor digitorum communis tendon, no problems such as wound dehiscence, hematoma formation, or infection at operative sites were noted.

Effect of Power-Assisted Functional Electrical Stimulation (PAFES) and Occupational Exercise on Motor Unit Activity of Extensor Digitorum Communis and Hand Dexterity in Post-stroke Patient

Background: Weakness of upper extremity can affect the ability to perform daily activities in post-stroke patients. Power-Assisted Functional Electrical Stimulation (PAFES) may give motor reeducation and sensory feedback to improve motor recovery through neuroplasticity.Aim: To evaluate the effect of PAFES and occupational exercise on post-stroke patient hand dexterity and motor unit activity of extensor digitorum communis muscle.Material and methods: Twenty post-stroke patients enrolled in the study were divided intervention group whom received PAFES and occupational exercise, and control group whom received occupational exercise only. Each group underwent 30 minutes per session of treatment, 5 times a week, for 3 weeks. The Root Mean Square (RMS) for measuring motor unit activity of extensor digitorum communis muscle; Box and Block Test (BBT) and Nine Hole Peg Test (NHPT) for measuring hand dexterity were evaluated before and after intervention.Result: There were significant improvements of RMS (p<0.001), BBT (p<0.001) and NHPT (p=0.002) in intervention group after receiving PAFES and occupational exercise. The improvement of BBT in intervention group was significant compared with control group (p=0.028), however, no significant improvement of NHPT was found between groups.Conclusion: PAFES and occupational exercise could improve motor unit activity of the extensor digitorum communis muscle and hand dexterity in post-stroke patient.

Effect of High Frequency Transcranial Magnetic Stimulation (TMS) on Extensor Digitorum Communis Muscle Strength in Ischemic Stroke Patients

Background: Stroke may disrupt a patient’s motor function, consequently affecting the quality of life. A stroke surviving brain has the ability to repair itself through neuroplasticity mechanism. Transcranial Magnetic Stimulation (TMS) is a non-invasive device which can be used to stimulate the lesioned part of the brain in hope of triggering neuroplasticity.Aims: To find prove of the repetitive Transcranial Magnetic Stimulation (rTMS) effect on extensor digitorum communis muscle strength improvement in ischemic stroke patients.Methods: Subjects suitable with the inclusion criteria (N=18) were divided into two groups, control group and intervention group. The control group underwent conventional therapy exclusively every day for 5 days in a row, while the intervention group underwent rTMS therapy and conventional therapy every day for 5 days in a row. Extensor digitorum communis muscle strength was measured using surface electromyography (sEMG) before and after treatment.Result: Significant increase of sEMG numbers were found on control group (p=0,003) and intervention group (p=0,001). The increase from the intervention group was not different when compared to the control group (p=0,067).Conclusion: TMS can increase extensor digitorum communis muscle strength but with no difference with a conventional therapy.