1. A skin lesion was made in rats by dorsal incision and the insertion of a polythene tube. 2. Over a period of 25 days after wounding, assays were performed for ascorbic acid, DNA, hydroxyproline, methionine, tryptophan, tyrosine and free amino acids in the lesion tissue. 3. The neutral-salt-soluble proteins of the lesion tissue were fractionated on DEAE-Sephadex, with the separation of fibrinogen and gamma-globulin from a serum protein fraction. 4. Over a period of 20 days after wounding, in wounded rats and in controls, assays were conducted for: ascorbic acid in lens and liver, hydroxyproline, soluble protein, methionine and water in muscle and tendon, and free amino acids in muscle. 5. Relative to controls there was a decrease in lens and liver ascorbic acid, a rise in tendon hydroxyproline, a rise in muscle free amino acids, a fall in muscle protein and a rise in tendon and muscle water.
Many operations have been described for the correction of claw hands following involvement in leprosy, from Sir Harold Stiles (1922) of Edinburgh, through Bunnell, Brand and many others in India and USA. Some of these procedures are classified "static" and attempt mainly to correct hyper-extension at the metacarpo-phalangeal joint, while the "dynamic" procedures employ a variety of tendon graft operations to restore the function of the paralysed lumbrical muscles. This study is an analysis of the four-tailed tendon graft operation of Paul Brand, carried out in the National Leprosy Con. trol Centre, Sungei Buloh, Selangor, during the period 1965·175, by a host of surgeons, mainly by Dr M.K. Bhojwani, MRCP, FRCSEd, the Director of the Centre at that time. The analysis carried out during November. December 1976, was made on 36 hands in 33 patients; it revealed an average improvement in the metacarpo. Phalangeal joint flexion of nearly 90% and in the proximal interphalangeal joint extension in nearly 80%, and an improvement in the grafted lumbrical voluntary motor tone of nearly 70%.
Cerebrotendinous xanthomatosis (CTX), a rare inherited lipid storage disease is due to a defect in bile acid metabolism. Involvement of five members of a family is presented. The clinical features, laboratory and pathologic findings are discussed. Tendinous and tuberous xanthomatosis, bilateral cataracts, cerebral impairment and raised serum cholestanol are the salient features. We believe this is the first report of CTX in Malaysia.
Twelve patients with drop-foot secondary to sciatic or common peroneal nerve palsy treated with transfer of the tibialis posterior tendon were followed-up for a mean of 90 (24-300) months. In 10 patients the results were 'excellent' or 'good'. In 11 patients grade 4 or 5 power of dorsiflexion was achieved, although the torque, as measured with a Cybex II dynamometer, and generated by the transferred tendon, was only about 30% of the normal side. Seven patients were able to dorsiflex their foot to the neutral position and beyond. The results appeared to be better in men under 30 years of age with common peroneal palsies. A painful flatfoot acquired in adulthood does not appear to be a significant long-term complication despite the loss of a functioning tibialis posterior tendon.
This is a report of a case of peroneal subluxation caused by peroneus quartus, a supernumerary muscle in the peroneal muscle group. Peroneus quartus' anatomy and its clinical relevance in lateral ankle pain, swelling and peroneal subluxation are described. It may be accurately diagnosed by peroneal tendoscopy. The technical note of this procedure is also described.
Domestic paediatric hand injuries make up the bulk of overall paediatric hand injuries. This is a retrospective study of domestic paediatric hand injuries admitted into an urban hospital that required surgical intervention. The most common injuries sustained were tendon injuries (24%), total amputations (20%) and lacerations wounds (16%). Accordingly the most common surgical interventions were tendon repairs (28%), toilet suturing (24%) and refashioning (20%). Parents and care providers need to be more vigilant and careful when supervising children including ensuring the safe storage of dangerous items. Sharp items may require additional safety features and warning labels.
Palmaris longus is a dispensable muscle with a long tendon which is very useful in reconstructive surgery. It is absent 2.8 to 24% of the population depending on the race/ethnicity studied. Four hundred and fifty healthy subjects (equally distributed among Malaysia's 3 major ethnic groups) were clinically examined for the presence or absence of palmaris longus. This tendon was found to be absent unilaterally in 6.4% of study subjects, and bilaterally in 2.9% of study participants. Malays have a high prevalence of palmaris longus absence at 11.3% followed closely by Indians at 10.7% whilst Chinese had a low absence rate of 6.0%.
Abductor pollicis longus (APL) muscle is known to exhibit different variations with respect to its attachments. Various studies have reported the splitting of the APL muscle. Comparative anatomical findings of split insertion of APL is commonly found in chimpanzees, gorillas and gibbons. In the present study, we describe an anomalous APL muscle, which originated from the posterior surface of the shaft of the radius and ulna and traversed a course deep to the extensor retinaculum. Interestingly, immediately after emerging form the deeper aspect of extensor retinaculum, the thin tendon of the APL muscle continued again as a muscular belly in relation to the dorsolateral part of the 1st metacarpal bone, to end as a tendon with its attachment to the base of the proximal phalanx. Such an unusual variation of APL with its attachment into proximal phalanx is a rare finding and may be of importance in altering the mechanics of the thumb during abduction. The clinical significance of such an anatomical variation of APL may be important during reconstructive surgeries involving thumb and also of academic interest.
The extensor digitorum (ED) muscle of the hand originates from the lateral condyle of the humerus and splits into four tendons; each for one phalanx except the thumb. Literature reports have described multiple tendons (usually two) to each digit but in the presented study we observed four tendons to the ring finger, what is rare. During a routine dissection of the cadavers, we observed an anomalous arrangement of the ED tendon on the left hand of a 42-year-old male. The anomalous tendons to the ring finger were studied in detail, the surrounding structures were carefully delineated and the specimen was photographed. The ED muscle originated as usual from the lateral condyle of the humerus, continued downwards, passing inferiorly to the extensor retinaculum to split into individual tendons for each of the digits. There was a single tendon to the index, middle and ring finger as usual but the ring finger displayed four tendons. All the tendons attached to the phalanges were as described in anatomy textbooks. The arrangement of the anomalous tendons of ED to each of the digits is not uncommon, but existence of four tendons to the ring finger is extremely rare. The increased number of tendons to the ring finger may increase the extension component of the ring finger. Anatomical knowledge of the tendons of the extensor muscles of the hand may be also beneficial for hand surgeons performing graft operations (Fig. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.
We describe herein a modified technique for reconstruction of chronic rupture of the quadriceps tendon in a patient with bilateral total knee replacement and distal realignment of the patella. The surgery involved the application of a Dacron graft and the ‘double eights’ technique. The patient achieved satisfactory results after surgery and we believe that this technique of reconstruction offers advantages over other methods.
This study evaluates the outcome of anterior cruciate ligament (ACL) reconstruction with arthroscopy using the bone–patella tendon-bone method. We performed this procedure in 24 patients with the average age of 33.1 years (range: 17-51 years ) between 2004 and 2006. Sixteen of the 24 patients were available for evaluation using the Lysholm Knee Score and International Knee Documentation Committee (IKDC) system. Based on the Lysholm score, there was a statistically significant improvement in knee function when comparing pre- and post-surgical scores (p
During routine dissection classes to undergraduate medical students, we have observed some important anatomic variations in the right upper limb of a 45-year-old cadaver. The anomalies were superficial ulnar artery, persistent median artery, variant superficial palmar arch, third head for biceps brachii, accessory head for flexor pollicis longus, variant insertion of pectoralis major, absence of musculocutaneous nerve, coracobrachialis muscle supplied by lateral root of median nerve and anomalous branching of median nerve in arm and forearm. Although there are individual reports about these variations, the combination of these variations in one cadaver has not previously been described in the literature consulted. Awareness of these variations is necessary to avoid complications during radiodiagnostic procedures or surgeries in the upper limb.
Giant cell tumors are commonly found over the flexor tendon sheath of the hand and wrist. However, giant cell tumors in the knee joint are rare, especially in children. We report an interesting case of an 11-year-old girl who presented with a painful lump on her right knee that enlarged over time. Clinically, she had fullness over the anterolateral part of her knee. Magnetic resonance imaging revealed an encapsulated mass inferior to the patella. The tumor measured 3 x 3.5 x 1.5 cm. Histopathological findings confirmed that it was a tenosynovial giant cell tumor. Because of initial mild symptoms, there was a delay of 2 years from the initial symptoms until tumor excision. Her follow-up period was 35 months, and her health to date is excellent with no recurrence. We believe that reporting this rare case will help clinicians update their knowledge on possible causes of lumps in the knee, and avoid diagnostic delay. It could also prove to be beneficial in arriving at a diagnosis in future cases.
We report a case of a 59-year-old female who presented in the general orthopaedic clinic with triggering of her right middle finger. She did not respond to conventional treatment methods; subsequently she underwent surgical open release under local anaesthesia. Five months postoperatively, the patient presented with signs and symptoms of acute flexor tenosynovitis, and was thought to have a postoperative infection. Re-examination by a hand surgeon raised the possibility of a different aetiology. Based on clinical findings and response to initial treatment, giant cell tumour of the flexor tendon sheath was suspected and later confirmed following surgical biopsy. A high index of suspicion and knowledge of the variegated presentations of giant cell tumour in the hand are beneficial in these types of cases.
Cervical spondylotic myelopathy (CSM) represents a spectrum of pathologies with progressive compression of the spinal cord. The clinical signs and symptoms play a key role in diagnosis. The characteristic hand myelopathy signs are of significant clinical importance. The aim of this descriptive study was to report a relatively easy to elicit new hand myelopathy sign. The basis for this is finger and wrist flexor disinhibition, which is used for the spinal specificity of cord compression at or above the C5/6 level.
Variation in the origin of long flexor tendons in the anterior compartment of forearm is common. During routine cadaveric dissection at Melaka Manipal Medical College (Manipal Campus), we observed a separate muscle belly and tendon of flexor digitorum superficialis (FDS) to the fifth digit in the right upper limb of a 60 year-old male cadaver. The anomalous muscle belly originated from the common flexor tendon from the medial epicondyle of the humerus and continued as a thin tendon at the middle of the forearm to get inserted into the middle phalanx of the fifth digit. This can be considered as a case of split flexor digitorum superficialis. Such muscle variations and knowledge of their frequency, appearance, and location can be helpful for surgeons.
In this case report, we report the absence of the fourth tendon of flexor digitorium superficialis (FDS) to the little finger with a concurrent anomalous muscular belly of flexor digitorum profundus (FDP) in the palm. The FDS originated from the medial epicondyle, divided into three tendons for the index, middle and ring fingers with the little finger devoid of any attachment. The FDP exhibited a muscular belly which passed deep to the flexor retinaculum (FR) and continued for another 4 cm thereby dividing into four slips for the index, middle, ring and little fingers. The presence of the muscular belly of the FDP lead us to think whether it was an adhesion between the tendons of the FDP, so we proceeded to histological analysis. The tissue was processed and stained with Hematoxylin and Eosin. Abundant longitudinal muscle fibers with peripherally situated nuclei confirmed it to be a skeletal muscle. Absence of the tendon of FDS to little finger may influence the flexion movement in the middle and proximal interphalangeal joints. Presence of anomalous muscle belly of FDP in the palm may mimic any soft tissue tumour, compress neurovascular structures or even pose difficulty while performing tendon transplant surgeries.