1/61. Bilateral, simultaneous, spontaneous rupture of quadriceps tendons without trauma in an obese patient: a case report.This is a single case report of bilateral, simultaneous, spontaneous rupture of the quadriceps tendon caused by obesity without trauma. The patient was a 52-year-old, 350-pound, morbidly obese man with a sedentary life style whose quadriceps tendons ruptured while he was descending a staircase. He presented with a large deficit superior to the patella and an inability to straighten his knees. After surgery, his knees were immobilized in extension for 6 weeks, followed by gradual weight bearing and gait training with braces. He was weaned off the braces as he increased the range of motion and strength in his knees. The rehabilitation process was protracted, and he returned to full-time work 6 months postinjury. Physiatrists should be familiar with the diagnosis, treatment, and rehabilitation of this rare condition.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/61. Closed traumatic rupture of the flexor pulleys of a long finger associated with avulsion of the flexor digitorum superficialis.We report a closed rupture of the second, third and fourth annular pulleys associated with avulsion of the flexor digitorum superficialis tendon in the ring finger of a healthy, 48-year-old patient. It was caused by sudden and violent flexion of the finger and led to a serious impairment of the proximal interphalangeal joint motion, despite physiotherapy and dynamic splinting. The patient was treated surgically, 3 months after the injury, with reconstruction of the second (A2) and fourth (A4) annular pulleys and excision of the distal portion of the superficialis tendon. The final functional result was satisfactory.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/61. Tendon lengthening repair and early mobilization in treatment of neglected bilateral simultaneous traumatic rupture of the quadriceps tendon.Bilateral simultaneous traumatic rupture of the quadriceps tendon is a rare injury that is most frequently seen in elderly patients with predisposing diseases such as gout, hyperparathyroidism and diabetes. Delay in diagnosis is not uncommon. One of the main problems in treatment is loss of motion, especially flexion, after surgical repair. We report a case that was diagnosed 5 months after the trauma and was treated by Scuderi's tendon lengthening technique. Range-of-motion exercises were started early without using the generally recommended 4-6 weeks of immobilization in plaster cylinder or knee brace. Five years of follow-up showed full range of motion in both knees with sound tendons. Stable fixation makes starting early motion and accelerated rehabilitation feasible and thus the most common complication, loss of motion, is prevented.- - - - - - - - - - ranking = 5keywords = motion (Clic here for more details about this article) |
4/61. Split biceps femoris tendon reconstruction for proximal tibiofibular joint instability.Recurrent instability of the proximal tibiofibular joint is an infrequently diagnosed abnormality. We present a new technique for reconstructing the joint using a split biceps femoris tendon passed through a bone tunnel in both the proximal tibial metaphysis and fibular head. The case report is also presented. The procedure offers an anatomic reconstruction and firm stabilization. It allows normal motion of the proximal tibiofibular joint and preserves the normal mechanics of the ankle. This procedure is an excellent alternative to resection of the fibular head, transarticular arthrodesis, or pseudoarthrosis focus at the fibular head.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/61. Limitation of flexor tendon excursion by heterotopic ossification after isolated flexor tendon laceration.A patient, one year after flexor digitorum superficialis/profundus repair in the left index finger, was diagnosed with heterotopic ossification involving the palmar surface of the proximal phalanx creating a secondary proximal interphalangeal joint contracture. A Compass PIP Hinge facilitated the treatment. Flexor tendon excursion improved, and active range of motion increased from 60 to 90 degrees before surgery to 30 to 105 degrees 20 months after surgery. Ectopic bone involvement of the hand is rare. This article reports a successful treatment for a unique complication of flexor injury and repair.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/61. Closed rupture of the anterior tibial tendon. A case report and review of the literature.Closed rupture of the anterior tibial tendon is an unusual injury. It occurs in middle-aged to elderly males following forced plantar flexion of the ankle. A case is presented of a 69-year-old man with spondylolisthesis whose tendon ruptured during a physical examination. The injury was thought initially to represent an acute L5 root compression secondary to a herniated intervertebral disc at the level of his spondylolisthesis. The correct diagnosis was made after admission to the hospital. Surgical repair of the tendon resulted in normal ankle motion and strength. A review of the 12 previously reported cases indicates that treatment has been either surgical repair or conservative management. All patients recovered a normal gait but those treated surgically had more motion and dorsiflexion strength. This condition emphasizes the importance of exact history taking and thorough physical examination.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
7/61. Triceps brachii rupture: case report.A 44-year-old man has been seen by the present authors, apparently the third reported case of triceps brachii rupture. He had had bilateral nephrectomies one year earlier and since then has been medicated with Dilantin for grand mal seizures which followed hypovolemia during dialysis. A grand mal seizure immediately preceded the patient's right triceps brachii rupture and other multiple orthopaedic injuries. Following repair of the tendon defect the patient regained an active range of motion. The possible relationship of tendon rupture and avulsion to primary and secondary hyperparathyroidism is discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/61. Patellar tendon rupture and marked joint instability after total knee arthroplasty.BACKGROUND: Patellar tendon rupture is a rare complication of total knee arthroplasty (TKA). Multiple repair methods have been described in the literature. methods: A 66-year-old woman suffered a patellar tendon re-rupture and marked joint instability within 6 months after revision TKA. She underwent re-revision TKA and extensor mechanism reconstruction with femoral quadriceps tendon and augmentation by a Leeds-Keio ligament. RESULT: It was fairly difficult to acquire a satisfactory range of motion as well as gain in knee extension capacity by eliminating the extension lag. CONCLUSION: Patellar tendon ruptures after TKA should be repaired as soon as they are recognized.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/61. A simultaneous distal phalanx avulsion fracture with profundus tendon avulsion. A case report and review of the literature.Avulsion injuries of the flexor digitorum profundus are fairly common injuries, yet simultaneous avulsion fractures of the insertion of this tendon associated with rupture of the tendon from the bony fragment is rarely described and is more complicated. In the 24-year-old athlete, the injury was classified according to the system of Leddy and Packer. The authors' method of treatment is also described. Similar cases presented in the literature are reported, with emphasis on pathomechanism, physical findings, and surgical repair method. In this rare injury, stabilization of the distal interphalangeal joint is necessary even at the expense of early motion.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/61. Surgical treatment of distal triceps ruptures.BACKGROUND: Distal triceps tendon ruptures occur rarely, and the diagnosis is often missed when the injury is acute. The literature provides little guidance regarding treatment or the outcome of treatment of these injuries. The goal of this report was to present our experience with the diagnosis, timing and technique of surgical treatment, and outcome of treatment of distal triceps tendon ruptures in twenty-two patients. None of the ruptures followed joint replacement. methods: Twenty-three procedures were performed in twenty-two patients with an average age of forty-seven years. The average duration of follow-up was ninety-three months (range, seven to 264 months). Data were obtained by a retrospective review of records and radiographs before and after surgery. Also, thirteen patients returned for follow-up and were examined clinically. Six additional patients responded to a telephone questionnaire. One patient was lost to follow-up, and two had died. Formal biomechanical evaluation of isokinetic strength and isokinetic work was performed in eight patients, at an average of eighty-eight months after surgery. Isokinetic strength data were available from the charts of two additional patients. RESULTS: Ten of the triceps tendon ruptures were initially misdiagnosed. At the time of diagnosis, triceps weakness with a decreased active range of motion was found in most patients, and a palpable defect in the tendon was noted after sixteen ruptures. Operative findings revealed a complete tendon rupture in eight cases and partial injuries in fifteen. Fourteen primary repairs and nine reconstructions of various types were performed. Three of the primary repairs were followed by rerupture. At the time of follow-up, the range of elbow motion averaged 10 degrees to 136 degrees. All but two elbows had a functional range of motion; however, the lack of a functional range in the two elbows was probably due to posttraumatic arthritis and not to the triceps tendon rupture. Triceps strength was noted to be 4/5 or 5/5 on manual testing in all examined subjects. Isokinetic testing of ten patients showed that peak strength was, on the average, 82% of that of the untreated extremity. Testing showed the average endurance of the involved extremity to be 99% of that of the uninvolved arm. The results after repair and reconstruction were comparable, but the patients' recovery was slower after reconstruction. CONCLUSIONS: The diagnosis of distal triceps tendon rupture is often missed when the injury is acute because of swelling and pain. Primary repair of the ruptured tendon is always possible when it is performed within three weeks after the injury. When the diagnosis is in doubt immediately after an injury, the patient should be followed closely and should be reexamined after the swelling and pain have diminished so that treatment can be instituted before the end of this three-week period. Reconstruction of the tendon is a much more complex, challenging procedure, and the postoperative recovery is slower. Thus, we believe that early surgical repair, within three weeks after the injury, is the treatment of choice for distal triceps tendon ruptures. of evidence.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
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