Long extensor injury thumb within the terminal phalanx. This damage does not differ from similar damage to the extensor of the remaining fingers. If there is damage localized proximal to the main joint, there are conditions for applying a primary tendon suture, however, after 3-4 weeks, a secondary tendon suture is not feasible due to the reduction of the tendon ends.
To fix a defect free tendon graft required or better to apply tendon transposition. During transposition, the tendon of the common extensor of the second finger is used, to which the distal end of the extensor tendon of the thumb is sutured.
extensor longus tear occurs quite frequently. This damage is divided into the following types:
1. direct or indirect rupture caused by trauma;
2. spontaneous rupture:
a) professional hazards,
b) tendon changes,
c) rupture due to damage to the limb.
tendon rupture due to direct trauma and the result of his treatment by tendon transposition are shown in the figure (own observation).
"Spontaneous" tendon ruptures due to occupational hazards, were described at the end of the last century by military doctors (Zander). The left hand of the army drummers, when holding the drumstick, was in a position of pronounced dorsiflexion, due to its unnatural position, tendovaginitis developed, degeneration of the tendons, which led to a "spontaneous" rupture.
A hand injury as a result of a fall of a log in a 47-year-old bricklayer, there is no active extension of the thumb of the right hand (a).Immediately after the injury, only the skin was sutured. Transposition of the tendon of the own extensor of the index finger was performed in conditions of scar tissue. The result of the intervention is shown in photo b.
Wurtenau described 59 cases of rupture tendons the drummers of the Prussian army. These typical breaks are known in the literature as "drummer's palsy" ("Trommerlahmung" or "Drummer's palsy").
IN Literature describes tendon ruptures due to various diseases. Thus, ruptures due to suppuration, gout, syphilis, tuberculous tendovaginitis (10 cases of Mezon), gonorrhea (Melchior), polyarthritis (Lederich, Herris) and rheumatism (Wadstein).
At post-traumatic tendon rupture from the moment of injury to tendon rupture, there is a latent period lasting from several days to several years. Linder (1885) and Geinicke (1913) first drew attention to the rupture of the tendon of the long extensor of the thumb after a fracture of the radius. Mek Master in 1932 collected a total of 27 such cases from the literature.
F. Steppelmore in 1940 he wrote a generalizing report on 148 cases already known. In 1955, G. Strendell, including his own 14 observations, reports 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 a dislocation or fracture of the radius without displacement of the fragments. The frequency of rupture of the tendon of the long extensor of the thumb, according to different authors, is different.
The frequency of this complications after fracture of the beam according to Gauk 6:100, according to Moore 3:500, according to Steppelmore 3:1000, according to Markus 4:2134, according to Böhler 1:500.
Long extensor thumb starts on dorso-radial surface middle third ulna and on the interosseous membrane. Its tendon at the level of the wrist passes in a separate tendon sheath. This space, the third dorsal tendon sheath, is essentially a canal to the bone. It is deeper and narrower than the other extensor sheaths. The tendon runs obliquely and, intersecting with the long and short radial extensors of the hand, forms the ulnar edge of the "anatomist's snuffbox".
extensor tendon within the proximal phalanx of the thumb, it expands and attaches to the base of the distal phalanx. The main function of the long extensor of the thumb is to extend it at the terminal, main and saddle joints. In addition, this muscle contributes to the retroposition of the thumb, is involved in dorsiflexion of the hand and, together with the adductor muscle of the thumb, in bringing the latter. Its most important function is to fix the saddle joint.
In view of the fact that the condition for good capture 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 gripping the thumb.
overwhelming most post-traumatic tears, a long time 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 a rupture, the thumb hangs down, the distal phalanx assumes a bent position and cannot be actively extended. Retroposition and adduction of the thumb may not be feasible. The contours of the ulnar edge of the "anatomical snuffbox" are smoothed out.
In view of the lack stabilization of the saddle joint the grip is not strong enough, so the patient is unable to use scissors, write, or button up.
Usually gap localized at the level of the distal edge of the dorsal transverse carpal ligament. Above this level, rupture is rare, occurring in about 7% of cases. The distal end of the tendon is felt over the first metacarpal bone in the form of a knot. 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 Lister's tubercle, which forms the radial edge of the canal, as a hypomochlion, over which the tendon elongates and deflates during movement.
The value of fractures of the radius for subcutaneous rupture of the extensor 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.
According to Rau And Weigel, in tendon rupture, worsening of tendon vascularization at the age of over 25-30 years is of decisive importance, since in adults there are no longitudinal intratendonous vessels, and the external vascular network may suffer from various types of injuries. Strendell believes that the occurrence of a post-traumatic rupture of the tendon is associated with a violation of its blood supply due to trauma (hematoma, thrombosis, degenerative changes in the connective tissue), and the rupture occurs at the point of least resistance, that is, within the vagina.
Complete transection of the tendon with a sharp bone fragment is considered only in rare cases.
Treatment of post-traumatic rupture of the tendon of the long extensor of the thumb must 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.
Method of direct joints of tendon ends, due to stump reduction and tendon degeneration, is now rarely used. Methods for replacing tendon defects also did not lead to satisfactory results (free tendon grafting, replacement of the defect with fascia or artificial material, etc.).
Currently dominated tendon transposition method. This method was first applied by Duplay (1876). He attached the distal end of the long extensor of the thumb to the long radial extensor of the hand. The extensor tendons that can be used in transposition are shown in the table.
For transpositions As a rule, it is best to use a tendon whose direction of pull and amplitude of sliding does not differ from the tendon-muscle motor being replaced. When considering the extensor tendon from these two points of view, it turns out that the requirements are best met, firstly, by the tendon of the extensor extensor of the index finger, and secondly, by the tendon of the long radial extensor of the hand.
The first of these was first used for this purpose by Mensch (1925), and in the recent past its use has been recommended by many authors (Bunnell, Pulwertaft, Christoph) and especially J. Böhler. The advantage of the long radial extensor is its anatomical proximity to the rupture site and the fact that the direction of its thrust acts from the ulnar side. Given its anatomical location, the tendon is recommended for transposition by Schlatter and Fett. The disadvantage of this tendon is that it has less movement than the extensor pollicis longus tendon.
Transposition of the tendon of the own extensor of the index finger Strendell performs as follows: the tendon of the own extensor of the index finger is crossed over the head of the II metacarpal bone through a transverse skin incision of 1 - 2 cm. The distal end of the tendon is attached to the tendon of the common extensor 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 own extensor of the index finger is removed.
Then, using new cut at the level of the middle of the I metacarpal bone, the stump of the tendon of the long extensor of the thumb is released, and then it is connected "end to end" with the tendon of the own extensor of the index finger, held under the skin.
Rupture of the tendon of the long extensor of the thumb due to a fracture of the radius
Case of own observation: B. I., a 28-year-old teacher, received a fracture of the radius in a typical place with a slight displacement of the fragments. After reposition, four weeks of fixation and three weeks of functional therapy following the removal of the plaster cast (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. The position of the thumb, typical for a rupture of the extensor tendon, is shown in Fig. b.
Short extensor thumb, m. extensor pollicis brevis, located in the lower part of the forearm along the lateral edge of its dorsal surface.
The muscle originates from the interosseous membrane of the forearm and rear surface the body of the radius, goes obliquely down and is located next to the tendon m. abductor pollicis longus.
The tendons of these two muscles are surrounded by the tendon sheath of the long abductor muscle and the short extensor of the thumb, vagina tendinum mm. abductoris longi et extensoris brevis pollicis. After passing under the extensor retinaculum, the muscle attaches to the base of the dorsal surface of the proximal phalanx of the thumb.
Function: unbends and slightly abducts the proximal phalanx of the first finger of the hand.
Innervation: n. radialis.
Blood supply: a. interossea posterior, a. radialis.
- - m. extensor pollicis longus, has a spindle-shaped abdomen and a long tendon. Lies next to the previous muscle...
Atlas of human anatomy
- - m. extensor hallucis longus, lies between the two previous muscles, and the upper two-thirds of the muscle is covered with them. The muscle originates from the medial surface of the middle and lower thirds fibula and interosseous...
Atlas of human anatomy
- - m. flexor pollicis longus, has the appearance of a long unipennate flat muscle lying on the lateral edge of the forearm ...
Atlas of human anatomy
- - m. extensor hallucis brevis, lies medially from the previous muscle ...
Atlas of human anatomy
- - m. flexor poliicis brevis, lies medially from the previous muscle and also directly under the skin. It starts from the flexor retinaculum, trapezoid bone, trapezius and capitate bones and the base of the first metacarpal bone ...
Atlas of human anatomy
-
Big Medical Dictionary
- - see Symptom of the thumb of the hand ...
Big Medical Dictionary
- - see the list of anat. terms...
Big Medical Dictionary
- - see the list of anat. terms...
Big Medical Dictionary
- - see the list of anat. terms...
Big Medical Dictionary
- - see the list of anat. terms...
Big Medical Dictionary
- - see the list of anat. terms...
Big Medical Dictionary
- - see the list of anat. terms...
Big Medical Dictionary
- - see the list of anat. terms...
Big Medical Dictionary
- - see the list of anat. terms...
Big Medical Dictionary
- - involuntary flexion and adduction of the first finger with passive extension of the bent fingers II-V, as well as extension and abduction of the first finger with passive flexion of the fingers extended II-V ...
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"Extensor pollicis brevis" in books
"Rules of thumb" for spiral leaders
From the book Spiral Dynamics [Managing Values, Leadership, and Change in the 21st Century] author Beck DonRules of Thumb for Spiral Leaders 1. If the critical mass of thinking in the circle of followers is higher in the spiral than the leadership being offered, then that leadership can only impose its control through intimidation or force. As soon as it
thumb length
authorThe length of the thumb The longer the thumb, the more significant success such a person can achieve (Figure 40). It is known that Napoleon's thumbs were extremely large. Watch the fingers of people on television. you for sure
Thumb tip shape
From the book Fundamentals of Corrective Palmistry. How to change fate along the lines of the hand author Kibardin Gennady MikhailovichThe shape of the tip of the thumb She can tell you a lot of interesting things about her master (Figure 43). In the general case, when the thumb, when viewed from the side of the nail, looks wide, this indicates that a person is capable of a lot to achieve his goal.
Phalanges of the thumb
From the book Fundamentals of Corrective Palmistry. How to change fate along the lines of the hand author Kibardin Gennady MikhailovichPhalanges of the thumb Each finger on the human hand is naturally divided into three parts, which are called phalanges (Figure 49). Although, looking at the thumb of his hand, we believe that he has only two phalanges. In fact, the hill of Venus (the fleshy area of \u200b\u200bthe arm at
Thumb Angle
From the book Fundamentals of Corrective Palmistry. How to change fate along the lines of the hand author Kibardin Gennady MikhailovichAngle of inclination of the thumb The angle of inclination of the thumb relative to the index finger (Figure 53) is most often 45 °. This indicates the ability and desire of a person to maintain traditional social principles and his moderate conservatism. Generally speaking, the more
Thumb landing
From the book Fundamentals of Corrective Palmistry. How to change fate along the lines of the hand author Kibardin Gennady MikhailovichThumb landing The thumbs can be located at different heights in relation to the palms (Figure 56). Rice. 56. Placement of the thumbTherefore, they are divided into two types: high-set and low-set. The thumb is considered to be set high when
Thumb mobility
From the book Fundamentals of Corrective Palmistry. How to change fate along the lines of the hand author Kibardin Gennady MikhailovichMobility of the thumb Thumbs in their activity are mobile and motionless. If the finger freely bends back in the area of the joint, it is considered mobile (Figure 57). Rice. 57. Mobility of the thumb A person with movable thumbs
13. Dislocations of the shoulder, forearm, finger, hand, hip
From the book Traumatology and Orthopedics author Zhidkova Olga Ivanovna13. Dislocations of the shoulder, forearm, finger, hand, thigh
Arthrosis of the big toe
From the book Arthrosis. Get rid of joint pain author Evdokimenko Pavel ValerievichArthrosis of the big toe Arthrosis of the big toe, colloquially called gout, actually has nothing to do with gout. Although true gout does often affect the big toe, it is much less common than arthrosis.
"Bones" of the thumb and little finger
From the book Flatfoot [Most effective methods treatment] author Vasilyeva Alexandra"Bones" of the thumb and little finger DescriptionValgus deformity of the thumb, which is commonly called "bone" (we already mentioned it), or in Latin Hallux Valgus, is one of the most common deformities of the foot. foot deformity
Pranic channel of the thumb
From the book Yoga for fingers. Mudras of health, longevity and beauty author Vinogradova Ekaterina A.The pranic channel of the thumb Try to “remove” all momentary attachments from yourself and go as far as possible beyond the stereotype that was once accumulated. The meaning of the exercise is to understand if there is no movement in your life, what is in the way and how to get around the obstacle. Analyze
Rubbing the thumb on the index finger
From the book Body Language [How to read the thoughts of others by their gestures] author Piz AlanRubbing the Thumb on the Forefinger Rubbing the thumb on the index finger or on the tips of other fingers is usually used to indicate money and expect money to be received as payment. Sales agents often use this gesture when communicating with their
"Thumb Analysis"
From the book Secrets of Love. Taoist practice for women and men by Bing L"Analysis of the thumb" Some bodily characteristics can serve as an indication of the shape and length of the jade stem. For example, it has a shape similar to the shape of the thumb on a man's hand. The thumb is in the shape of a mushroom cap. If the thumb is shaped like this,
Chapter 8
From the book Intelligence. How does your brain work author Sheremetiev KonstantinCHAPTER 8 The Society of the Thumb No one is more indebted to anyone than the monkeys to Darwin. Man belongs to primates. The order of primates differs in that the thumb can be opposed to other fingers. Therefore, we can say that we, primates, are part of an elite
Etruscan without a thumb.
From the book Kunstkamera anomalies author Nepomniachtchi Nikolai NikolaevichEtruscan without a thumb. The large clay statue of an Etruscan warrior was over seven feet tall and weighed over a thousand pounds. She occupied almost the entire room in which Italian sculptors created her. The figure was covered with glaze and paint, and finally the one
longus.Beginning of the muscle: from the middle third of the posterior surface of the ulna.
Muscle Attachment: to the base of the second phalanx. Function: relieves pain-
my finger.
19. Extensor of the index finger, m. extensor indicator.The beginning of the mouse
tsy: from the distal third of the ulna. Muscle Attachment: to the tendon
common extensor. Function: extends the index finger.
MUSCLES OF THE HAND
In addition to the tendons of the muscles of the forearm, passing on the back and palmar
sides of the hand, the latter also has its own short muscles,
beginning and ending in this section of the upper limb. muscles
brushes are divided into three groups. Two of them are located along the radial and local
to the left edges of the palm, form the elevation of the thumb (thenar) and the little finger
tsa (hypothenar). The third (middle) group lies in the palmar cavity (palma
Muscles of the thumb.
The short muscle that abducts the thumb of the hand, m. abductor
pollicis brevis. It lies superficially in relation to the rest, next to the long
muscle that abducts the thumb of the hand. Function: takes a big pa-
2. Short flexor of the thumb, m. flexor pollicis brevis. Le-
lives more medially than the previous one and has two heads: superficial and deep,
between which the tendon passes long flexor thumb
brushes Function: flexes the proximal phalanx of the thumb.
The muscle that opposes the thumb of the hand, m. opponens
pollicis. It lies under the short muscle that removes the thumb of the hand. Funk-
tion: produces opposition of the thumb.
4. The muscle that leads the thumb, m. adductor pollicis. Le-
lives in the depths of the palm distal to the previous ones. Function: leads big
Muscles of the elevation of the little finger.
5. Short palmar muscle, m. palmaris brevis.Beginning of the muscle: from
ulnar edge of the palmar aponeurosis; ends in the skin at the elbow edge
palms. Function: stretches the palmar aponeurosis.
6. The muscle that removes the little finger, m. abductor digiti minimi. Lies on
superficially along the ulnar edge of the hypothenar. Function: retracts, bends and unfolds
little finger bends.
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 that opposes the little finger, m. opponens digiti minimi.
Covered by the previous two muscles. Function: draws the pinky to
thumb (opposes)
Muscles of the palmar cavity.
9. Vermicular muscles, mm. lumbricales, four narrow muscles
bundle located between the tendons of the deep flexor of the fingers. Starting-
coming from the tendons of the deep flexor of the fingers, go around the heads of the metacarpal
bones from the radial side and are attached on the back of the proximal phalanges to
tendon stretching of the common extensor of the fingers. Function: bend
proximal and straighten the middle and distal phalanges of the 2nd-5th fingers
10. Interosseous muscles, m. interossei. Occupy the spaces between five
bones, attaching to them, and are divided into three palmar and four
dorsal muscles. Function: abduction and adduction, flex the proximal
phalanx and unbend the middle and distal like worm-like muscles.
FASCIA AND TOPOGRAPHY OF THE UPPER LIMB
Shoulder fascia, fascia brachialis, surrounds the muscles of the shoulder. From her deep
depart two fibrous intermuscular septa (septum intermusculare
brachii mediale et laterale), which adhere to the scallops of the medial and la-
lateral edges of the humerus and separate the anterior and posterior
shoulder muscle groups. The fascia of the shoulder passes into 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 dorsal sides is
zuet transverse thickening (ligaments) - the retainer of the flexors and extension -
calves, retinaculum flexorum et extensorum. The dorsal ligament through the development
stkov fuses with the surface of the radius and ulna. Between these
sprouts under the ligament are six bone-fibrous canals through which
rye pass the tendons of the extensor fingers of the hand. In the first channel (counting
from the radial edge) are tendons 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.
Stenosing ligamentitis is a common disease that affects the ring-shaped muscle of the finger, and sometimes affects the feet. The inflammatory process during the disease reduces mobility. In some cases, the enlarged muscle may fuse with nearby tissues.
About the disease
In the common people, stenosing ligamentitis is called "snapping finger". For the most part, the disease is ignored because they are unaware of 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 toes. The number of people facing this problem is growing. Of all patients with hand disease, about 8% suffer from "trigger finger".
The main types of disease:
- Nott's disease. The most common type of problem.
- De Quervain's disease. Damage to the long conductive muscle and short extensor. The disease affects one finger, most often the thumb.
Neglect of treatment leads to complete failure of the finger or foot.
Stenosing ligamentitis is divided into three stages.
Stages of development:
- Stage 1. The finger begins to click, there are slight pains in the damaged area.
- Stage 2. Thickening of the tendon leads to a decrease in the mobility of the finger. Pressure on the injured area causes pain. There is discomfort in the wrist joint.
- Stage 3. The finger remains bent. Only surgery can correct the situation. Surgery is available for children and adults.
It is highly undesirable to start the disease. Identifying the problem, even in the early stages, is easy. You should contact a specialist immediately after the first symptoms are detected.
Causes
Stenosing ligamentitis can be called polyetiological, since the disease occurs due to a number of factors. What influences the development of the disease?
- Gout. The deposition of uric acid in the joint and nearby tissues is the background for inflammatory processes.
- Diabetes. Leads to inflammation of the connective tissues due to the deposition of pathological protein.
- Rheumatoid arthritis. The disease leads to inflammation of the joints of the hand.
- Stable fingers. Ligamentitis, most often, develops in people who perform monotonous work with their hands.
- Heredity.
- Atherosclerosis.
- Incorrect structure of the annular ligament, tendons.
- Injuries.
- Infections.
In most cases, a "trigger finger" occurs when inflammation occurs 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 leads to thickening of the tendon. This interferes with its 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
Trigger finger syndrome has pronounced symptoms. Diagnosing the disease is not difficult even in the early stages.
The main symptoms of Knott's disease:
- Pain near the injured ligament. Appears while moving.
- Swelling above the joint.
- Enhanced sensitivity.
- Finger numbness.
- Pain in the region of the wrist joint.
- Finger flexion problems. Feels like an obstacle.
- The finger does not flex.
- Movement of the wrist joint aggravates the pain.
- Fingers click when moving.
- Low functionality during operation.
- The occurrence of swelling.
- Painful sensations with pressure on the arm.
- Echoes of pain in the shoulder or hand.
- Decreased joint mobility.
All stages of the disease are accompanied by swelling, which brings discomfort under pressure on it. The tendons also harden. On last step disease occurs thickening of the phalanx. 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.
- The work of the brush does not deteriorate.
- The pain comes from the wrist.
- Discomfort occurs in the shoulder area and fingertips.
This kind of "trigger finger" affects people from 40 years old. Most often, ligamentitis affects women, among them this pathology is more common.
Diagnostics
Trigger finger syndrome does not require special methods for detection. The doctor orders an X-ray and examines you. Examination is necessary to rule out degenerative joint problems that have similar symptoms. This is necessary for right choice treatment.
Palpation of the hand with Knott's disease helps to 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 in Kerven's disease helps to detect:
- Painful sensations with pressure in the region of the styloid process.
- Discomfort when abducting healthy fingers. Pain in arm from shoulder to wrist.
Some symptoms, such as numbness of the fingers, occur in each type of disease, so a specialist should make a diagnosis. Immediately after the discovery of the disease, you should abandon the load, and then fix the limb with the affected ligaments and joint.
Treatment
Stenosing ligamentitis can be treated in two ways. For the initial stages of the disease, a conservative method is used, and if the disease is neglected, surgical intervention is used.
Stenosing ligamentitis conservative treatment:
- Electrophoresis.
- Ozokerite.
- Phonophoresis.
- Applications.
- Preparations.
A conservative method, if the disease is not neglected, gives results in a few weeks. During this time, the affected joints, ligaments and muscles of the hand are completely restored. A specialist should draw up a treatment plan. 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.
At the time of treatment, the patient should avoid any exercise, even the simplest. It is necessary to exclude any work, especially related to the brush. This applies even to cleaning, or embroidery. The recovery time 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 desired result will need an operation. The surgical method involves the dissection of a deformed tendon or 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 strokes. This will increase the chance of injury.
- The use of drugs that reduce inflammation and pain. Medicines are prescribed by a doctor.
- Tendon injections. Injections are made 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 working capacity.
In children who underwent surgery before the age of 2, the chance of a complete recovery is about 90%. Doctors perform open surgery. It avoids exacerbations, and also does not damage nerve cells.
open surgery
Surgical intervention in both adults and children is carried out according to the same plan.
Operation steps:
- General anesthesia.
- Dissection of the ligament around the thickening.
- Finger alignment.
- Wound treatment.
- Bandage application.
- Tire installation.
The operation is very simple and has many advantages over other types of treatment.
Advantages:
- Low potential for tissue damage.
- There is no possibility to injure blood vessels, nerves.
- Decompression cut.
- No damage to anatomical relationships.
The brush begins to fully work 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 hole is made.
- The annular ligament is dissected.
- Fingers straighten.
- A bandage is applied.
On the face of it, the operation seems quick and simple. However, this method has several significant drawbacks. Therefore, especially for children, it is advisable to use the open method.
Flaws:
- Potential for flexor tendon injury.
- Possibility of relapse.
- Lack of visual control increases the chance of injury.
- The occurrence of a hematoma.
Choosing the appropriate method should be after consulting a doctor.
Alternative Methods
Folk remedies have a positive effect on the ligaments, muscles and 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 density of sour cream. Then 5 teaspoons are added to the mass apple cider vinegar. The gruel must be applied to the injured finger, wrapped and held for about 2 hours. The hand should rest during this time.
- Mix six teaspoons of crushed elecampane rhizome with 1 liter 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 ratio of 1:3. Boil for 20 minutes, then strain. Apply a wet cloth to the affected area.
- Dissection of the limb. Coniferous oil and sea salt are added to a liter of boiling water. In the process of steaming, you should move your fingers.
- Calendula flowers should be crushed and mixed with baby cream in a ratio of 1:1. The resulting ointment is infused for a day in the refrigerator.
Folk remedies are especially effective in the early stages of the disease. Trigger finger responds well to alternative treatments. Since folk remedies have no contraindications and are suitable even for children.
Gymnastics
Gymnastics can help relieve pain in the wrist joint, ligaments, muscles of the hand.
Exercises:
- Elbows rest on the table, palms look up. Shaking movements are made with the brush.
- Playing an imaginary flute.
- Elbow on the table. Brush rotations are performed.
- Hands at chest level, palms folded together. Alternately, pressure is applied with the fingers of one limb to the other.
- The position is similar. The wrists are spread apart, the fingertips do not come off each other.
Exercise is effective in the early stages of the disease.
Prevention
Finding a "trigger 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. Do not self-medicate, you must immediately contact a specialist.
should not be neglected and folk remedies which help with inflammation of the tendons. Treat trigger finger, especially in early age, quite possible.
Nothing is more valuable than health and time. That is why the main principle of the activity of the multidisciplinary Medical Center "XXI century" is the provision of a wide range of services. highest quality at the most convenient time for the patient. We work daily from 8:00 to 22:00. The specialists of our 24-hour Coordination Center provide comprehensive advice on the provision of medical care. In addition, highly qualified doctors provide different kinds services not only on an outpatient basis, but also on the territory of enterprises and directly at home. For this purpose, the center "XXI century" has more than 90 equipped vehicles. At the same time, our specialists are constantly expanding the list of medical services, using the most advanced and effective methods diagnostics and therapy. To do this, our professional staff regularly attends refresher courses.
Since the specialists of our center work in various medical areas, each of our patients, turning to us, will be able to quickly get advice from an experienced narrowly specialized specialist. After conducting a comprehensive diagnosis and establishing the correct diagnosis, the specialist will prescribe an individual treatment method for the patient. The following specialists work in our center: therapists, surgeons, cardiologists, otolaryngologists, urologists, pediatricians, gynecologists, dentists, gerontologists and other doctors.
The main areas of work of our center:
Medicine for all age groups patients;
surgery;
rehabilitation after diseases, injuries and surgical intervention;
dentistry.
We have a program to encourage loyal customers. Our center makes every effort to ensure that each of our clients becomes healthy and happy as soon as possible.
21st century specialists
Prices
| Primary consultation of a traumatologist-orthopedist in an outpatient clinic | 1450 rub. | |
| Consultation of a traumatologist-orthopedist, head of department, K.M.N., leading specialist, primary in an outpatient clinic | 1800 rub. | |
| Repeated consultation of a traumatologist-orthopedist in an outpatient clinic | 1100 rub. | |
| Consultation of a traumatologist-orthopedist, head of department, K.M.N., leading specialist, repeated in an outpatient clinic | 1500 rub. | |
| Dressing as part of an outpatient consultation | 530 rub. | |
| Bandaging outside the consultation in the outpatient clinic | 740 rub. | |
| Removal of sutures in the outpatient clinic | 530 rub. | |
| Reduction of a dislocated joint | 2760 rub. | |
| Closed reposition for a fracture with displacement of fragments | 2760 rub. | |
| The imposition of a small and medium gypsum splint in an outpatient clinic | 1270 rub. | |
| Imposition of a large plaster splint in an outpatient clinic | 1730 rub. | |
| Applying a polymeric immobilizing bandage large (cellocast) | 4440 rub. | |
| Applying a polymeric immobilizing medium bandage (cellocast) | 3840 rub. | |
| Imposition of a small polymeric immobilizing bandage (cellocast) | 2760 rub. | |
| Turbocast overlay (large) | 1730 rub. | |
| Turbocast overlay (small and medium) | 1270 rub. | |
| Imposition of a circular plaster cast in the outpatient clinic (large) | 1730 rub. | |
| Imposition of a circular plaster cast in an outpatient clinic (small, medium) | 1270 rub. | |
| Joint puncture with the introduction of drugs into the joint in an outpatient clinic (without the cost of the drug) | 1660 rub. | |
| Puncture for hemarthrosis | 2000 rub. | |
| Cast remodeling, shortening of the fixation bandage as part of an outpatient consultation | 940 rub. | |
| Removal of a circular immobilizing dressing in an outpatient clinic | 980 rub. | |
| Removal of the splint any in the outpatient clinic | 740 rub. | |
| Shock wave therapy in the outpatient clinic | 1800 rub. | |
| Taping for injuries and diseases of the capsular-ligamentous apparatus as part of a consultation | 820 rub. | |
| Taping for injuries and diseases of the capsular-ligamentous apparatus without consultation | 1020 rub. | |
| Osteosynthesis with plates for fractures of the bones of the hand, collarbone, foot | 12000 rub. | |
| Osteosynthesis with wires for fractures of the bones of the hand and foot | 3200 rub. | |
| Surgery for Dupuytren's contracture | 12000 rub. | |
| Surgery for stenosing ligamentitis, De Quervain's disease | 9750 rub. | |
| Trigger finger surgery | 9000 rub. | |
| Removal of a Baker's cyst | 9500 rub. | |
| Removal of metal structures (plates) from the collarbone, ankle, bones of the forearm, hands and feet | 12000 rub. | |
| Needle removal | 1500 rub. | |
| Achilles tendon suture (up to 2 weeks from the moment of injury) | 12000 rub. | |
| Achilles tendon suture late dates after injury (more than 2 weeks after injury) | 14000 rub. | |
| The suture of the tendon of the flexor of the finger in PHO, including PHO on the day of injury | 5600 rub. | |
| Finger flexor tendon suture late after injury (more than 2 weeks) | 12000 rub. | |
| The suture of the extensor tendon of the hand in case of PHO, including PHO on the day of injury | 3200 rub. | |
| The suture of the extensor tendon of the hand, incl. late terms after injury (1-2 weeks) | 8000 rub. | |
| Doctor's consultation at home, primary | 2700 rub. | |
| Doctor's consultation at home, repeated | 2100 rub. | |
| Consultation of the doctor of the leading specialist / head of the department / K.M.N. home, primary | 3300 rub. | |
| Consultation of the doctor of the leading specialist / head of the department / K.M.N. at home, repeated | 2700 rub. |
Why is a tendon rupture in the finger dangerous? The mobility of the hand is provided by the coordinated work of the flexors and extensors. The first are on the palmar surface of the hand, the second - on its back side. Fingers do not have muscles, so their movements are carried out through connective tissues. Flexors can be superficial or deep. Some of them are on the middle phalanges, others are on the nails. Tendon injuries occupy the first place among the injuries of 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 fingers - by 20%. They are most common among people who prefer amateur sports activities. Depending on the presence of skin damage, tendon ruptures are divided into open and closed. The first occur when injured with piercing-cutting objects. The latter are diagnosed in athletes. The tendon is damaged when it is overstretched.
Ruptures are divided into partial and complete, the severity of the injury is assigned depending on the number of torn fibers. Total damage is more difficult to cure. Rupture of one ligament is considered isolated, several - multiple. We are talking about a combined injury in case of damage to muscle tissues, blood vessels and nerve endings.
Important in the appointment of treatment is to determine the duration of 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
Tendon and joint capsule injury can be traumatic or degenerative in origin. The latter type is the result of tissue thinning, the first occurs with a sharp rise in weight. sports injury may be of mixed origin.
The provoking factors are:
- a short break between workouts;
- lack of warm-up during class;
- reassessment of their capabilities;
- failure to comply with safety regulations.
The risk group includes those who have excess weight, and elderly people.
Characteristic features
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 a violation of flexion functions. In this case, the fingers acquire an overbent position. When the tendons of the back of the hand are injured, extensor abilities suffer. Damage to the nerve endings can lead to numbness and paresthesia. If at least one of the symptoms listed above 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 swelling. The limb must be raised above the head, this will slow down the speed of blood flow.
In the emergency room, the initial treatment of the wound is carried out, including the application of antiseptic solutions to the skin, stopping bleeding and suturing. After that, a tetanus toxoid vaccine is given and antibacterial drugs are administered. If a rupture of the extensor tendon of the finger is detected, the patient is sent to the surgeon. Without the 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 injury. In case of finger injuries, long-term wearing of a cast or other fixing device is indicated.
Injuries that occur in the wrist area are treated exclusively by surgery. The ends of the torn ligament are sewn together. If the damaged tissues are located in the area of the distal interphalangeal joint, the splint is applied for 5-6 weeks.
A faster recovery of finger functions is observed after the operation "extensor tendon suture".
A fixation device after surgery is necessary to ensure that the joint is in 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 assume a bent position. In such cases, repeated splinting is indicated. During the treatment period, it is recommended to be under medical supervision.
With boutonniere-type deformation, the joint is fixed in a straight position until the damaged tissues are completely healed. The suture is necessary for reduction and complete rupture of the tendon. In the absence of treatment or improper splinting, the finger assumes a bent state and freezes in this position. It is necessary to follow all the instructions of the traumatologist and wear a splint for at least 2 months. The doctor will tell you exactly when it will be possible to remove it.
Rupture of the extensor tendons at the level of the metacarpal bone, carpal joint and forearm requires surgical intervention. Spontaneous muscle contraction leads to a tightening of the tendons and a significant divergence 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 needle in the finger plays the role of a retainer.
Surgical intervention is performed on an outpatient basis, after its completion, the patient can recover home.
Recovery period
Rehabilitation for a torn 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 fingertips, the load must be increased gradually. Movements are carried out along the damaged section of the tendon. Massage can be started only after the completion of the stage of inflammation. The procedure should not last more than 10 minutes.
Finger development is an important part of rehabilitation. It enhances blood circulation and tissue nutrition. You need to squeeze your hand and hold it in this position for 10 seconds. After that, the fingers are unbent as far as possible and fixed in this position for 30 seconds.
You can not stretch the tendon sharply, you can perform the exercises as often as you like. Do not forget that classes should be regular.
In some cases, anti-inflammatory drugs are prescribed after splinting. However, the inhibition of the inflammatory process can interfere with the normal healing of tissues, which will lead to dysfunction of the hand.
If the pain syndrome does not disappear, it is necessary to stop exercise therapy classes until the condition of the ligament improves.
How long does it take for a tendon rupture to heal? With minor injuries, recovery takes no more than a month. With a complete break, this period can last up to six months.
The extensor hallucis longus is highlighted in blue. |
|
| Latin name |
Musculus extensor pollicis longus |
|---|---|
| Start | |
| attachment |
distal phalanx of the first finger |
| blood supply |
a. interossea posterior, a. radialis |
| innervation |
n. radialis (C VI-C VIII) |
| Function |
extends the thumb |
| Catalogs | |
Long extensor thumb(lat. Musculus extensor pollicis longus ) - muscle of the forearm of the posterior group.
It has a spindle-shaped abdomen and a long tendon. Lies next to the short extensor of the thumb. It starts from the interosseous membrane of the forearm, the interosseous edge and the posterior surface of the ulna. It goes down and passes into the tendon, which is surrounded by the tendon sheath of the long extensor of the thumb (lat. vagina tendinis musculi extensoris pollicis longi ). Then, having rounded the I metacarpal bone and reaching its back surface, the tendon reaches the base of the distal phalanx, to which it is attached.
Function
Unbends the thumb, pulling it to the back.
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