Displaying publications 1 - 20 of 74 in total

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  1. Fulltext Flexor tendon degeneration affects short-term outcomes of open trigger digit release
    Abdul Nasir M, Ahmad TS, Low TH, Devarajooh C, Gunasagaran J
    PLoS One, 2023;18(5):e0286301.
    PMID: 37252923 DOI: 10.1371/journal.pone.0286301
    We aimed to investigate the association between flexor tendon degeneration and outcome of open trigger digit release. We recruited 162 trigger digits (136 patients) who had open trigger digit release from February 2017 to March 2019. Intraoperatively, six features of tendon degenerations were identified: irregular tendon surface, tendon fraying, intertendinous tear, synovial thickening, hyperaemia of sheath and tendon dryness. Longer duration of preoperative symptoms was associated with worsening tendon surface irregularity and fraying; increased number of steroid injections was associated with worsening tendon surface irregularity and dryness; higher DASH score was associated with severe tendon fraying, dryness and intertendinous tear; limited proximal interphalangeal joint (PIPJ) motion was associated with severe tendon dryness. At 1-month post-surgery, DASH score remained high in severe intertendinous tear group while PIPJ motion remained limited in severe tendon dryness group. In conclusion, the severity of various flexor tendon degenerations influenced the outcome of open trigger digit release at 1-month but did not affect the outcome at 3- and 6-months post-surgery.
    Matched MeSH terms: Tendons/surgery
  2. An atavastic belly of the flexor digitorum profundus with absence of tendon of flexor digitorum superficialis to the little finger: morphological and histological considerations
    Das S, Norzana AG, Azian AL, Farihah HS, Faizah O
    Clin Ter, 2011;162(6):555-7.
    PMID: 22262329
    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.
    Matched MeSH terms: Tendons/abnormalities*; Tendons/pathology*
  3. The additional tendons of the extensor digitorum muscle of the hand: an anatomical study with a clinical significance
    Das S, Sulaiman IM, Hussan F, Latiff AA, Suhaimi FH, Othman F
    Bratisl Lek Listy, 2008;109(12):584-6.
    PMID: 19348385
    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.
    Matched MeSH terms: Tendons/abnormalities; Tendons/anatomy & histology*
  4. The potential mechanism of hypoxia-induced tenogenic differentiation of mesenchymal stem cell for tendon regeneration
    Zulkifli A, Ahmad RE, Krishnan S, Kong P, Nam HY, Kamarul T
    Tissue Cell, 2023 Jun;82:102075.
    PMID: 37004269 DOI: 10.1016/j.tice.2023.102075
    Tendon injuries account up to 50% of all musculoskeletal problems and remains a challenge to treat owing to the poor intrinsic reparative ability of tendon tissues. The natural course of tendon healing is very slow and often leads to fibrosis and disorganized tissues with inferior biomechanical properties. Mesenchymal stem cells (MSC) therapy is a promising alternative strategy to augment tendon repair due to its proliferative and multilineage differentiation potential. Hypoxic conditioning of MSC have been shown to enhance their tenogenic differentiation capacity. However, the mechanistic pathway by which this is achieved is yet to be fully defined. A key factor involved in this pathway is hypoxia-inducible factor-1-alpha (HIF-1α). This review aims to discuss the principal mechanism underlying the enhancement of MSC tenogenic differentiation by hypoxic conditioning, particularly the central role of HIF-1α in mediating activation of tenogenic pathways in the MSC. We focus on the interaction between HIF-1α with fibroblast growth factor-2 (FGF-2) and transforming growth factor-beta 1 (TGF-β1) in regulating MSC tenogenic differentiation pathways in hypoxic conditions. Strategies to promote stabilization of HIF-1α either through direct manipulation of oxygen tension or the use of hypoxia mimicking agents are therefore beneficial in increasing the efficacy of MSC therapy for tendon repair.
    Matched MeSH terms: Tendons/metabolism
  5. Fulltext Acromioclavicular Reconstruction using Autogenous Semitendinosus Tendon Graft and the Importance of Postoperative Rehabilitation: A Case Report
    Ho JP, Ahmad Faizal A, Sivapathasundaram N
    Malays Orthop J, 2013 Nov;7(3):30-2.
    PMID: 25674306 MyJurnal DOI: 10.5704/MOJ.1311.012
    We present a case of chronic acromioclavicular joint dislocation (Rockwood type 5) in which the choice of acromioclavicular reconstruction using autogenous semitendinosus tendon graft was made due to its superiority in anatomical reconstruction of the coracoclavicular ligaments, and the impact of postoperative rehabilitation on the recovery of this patient. We also discuss the rationale behind this.
    Matched MeSH terms: Hamstring Tendons
  6. Irreducible Dorsal Distal Interphalangeal Joint Dislocation of Finger: A Case Report and Perspectives on Management
    Sem SH, Omar MF, Muhammad Nawawi RF
    Cureus, 2019 May 02;11(5):e4588.
    PMID: 31309013 DOI: 10.7759/cureus.4588
    Irreducible closed dorsal dislocation of distal interphalangeal (DIP) joint of the finger is a rare injury. The causes of irreducibility of the DIP joint are volar plate interposition, entrapment of flexor digitorum profundus tendon behind the head of middle phalanx, and buttonholing of the middle phalanx head through the volar plate or flexor tendon. Open reduction with a volar approach is recommended with the advantages of better wound healing, ease of releasing entrapped structures, and possibilities of a volar plate, collateral ligaments, and/or flexor tendon repair. We report a case of irreducible dorsal dislocation of left ring finger DIP joint secondary to volar plate interposition treated successfully with open reduction.
    Matched MeSH terms: Tendons
  7. Pre-operative ultrasonographic prediction of hamstring autograft size for anterior cruciate ligament reconstruction surgery
    Mohd Asihin MA, Bajuri MY, Ahmad J, Syed Kamaruddin SF
    Ceylon Med J, 2018 03 31;63(1):11-16.
    PMID: 29754479
    Objectives: To evaluate the feasibility of ultrasonographic examination in predicting 4-strand semitendinosus and gracilis tendon (4S-STG) autograft size preoperatively in anterior cruciate ligament reconstruction and to evaluate the use of anthropometric measurement to predict the 4-strand semitendinosus and gracilis tendons (4S-STG) autograft size pre-operatively in anterior cruciate ligament reconstruction.

    Method: Twenty-seven patients were included in this study conducted from 1st January to 31st December 2013. All patients were skeletally mature and scheduled to undergo primary anterior cruciate ligament reconstruction using 4S-STG autograft. Ultrasonographic examination of semitendinosus and gracilis tendons to measure the cross sectional area was conducted and anthropometric data (weight, height, leg length and thigh circumference) was measured one day prior to surgery. True autograft diameters were measured intraoperatively using closed-hole sizing block in 0.5 mm incremental size.

    Results: There is a statistically significant correlation between the measured combined cross sectional area (semitendinosus and gracilis tendons) and 4S-STG autograft diameter (p = 0.023). An adequate autograft size (at least 7 mm) can be obtained when the combined cross sectional area is at least 15 mm2. There was no correlation with the anthropometric data except for thigh circumference (p = 0.037). Autograft size of at least 7 mm can be obtained when the thigh circumference is at least 41 mm.

    Conclusions: Both combined cross sectional area (semitendinosus and gracilis tendons) and thigh circumference can be used to predict an adequate 4S-STG autograft size.

    Matched MeSH terms: Hamstring Tendons/anatomy & histology; Hamstring Tendons/transplantation; Hamstring Tendons/diagnostic imaging*
  8. Fulltext Outcome of anterior cruciate ligament reconstruction: a comparison between biotransfix screw and all-inside technique
    Nik Alyani Nik Abdul Adel, Mohd Shukrimi bin Awang, Zamzuri bin Zakaria
    International Medical Journal Malaysia, 2017;16(11):35-35.
    MyJurnal
    Anterior cruciate ligament (ACL) reconstruction has evolved during past
    decade. All inside technique is introduced aiming for less invasive procedure, bone stock
    preservation, preservation of tendon at its donor site, better graft positioning and
    fixation technique. This study is conducted to compare the outcomes of this new
    technique to the previous biotransfix screw. (Copied from article).
    Matched MeSH terms: Tendons
  9. Fulltext Chronic Traumatic Sagittal Band Injury with Extensor Tendon Dislocation: Report of a Case and New Surgical Technique
    Or SY, Khaw YC, Hwang PX, Ong TK
    Malays Orthop J, 2017 Jul;11(2):60-63.
    PMID: 29021881 MyJurnal DOI: 10.5704/MOJ.1707.007
    Chronic sagittal band injury with tendon dislocation of the extensor digitorum communis in the hand often requires operative stabilization. Various surgical techniques have been reported to repair and reconstruct the sagittal band. Nonetheless, most of the techniques are technically demanding and require donor graft. In this case report, we report a novel surgical technique to centralize and stabilize the tendon by reattaching the radial sagittal band with anchor sutures. The advantages of this new technique are simple, no donor morbidity and stable repair to restore the normal biomechanics of the tendon. The patient was able to return to work in three months and no recurrent dislocation was noted at review two years after surgery.
    Matched MeSH terms: Tendons
  10. Fulltext Development of a Tomography Technique for Assessment of the Material Condition of Concrete Using Optimized Elastic Wave Parameters
    Chai HK, Liu KF, Behnia A, Yoshikazu K, Shiotani T
    Materials (Basel), 2016 Apr 16;9(4).
    PMID: 28773416 DOI: 10.3390/ma9040291
    Concrete is the most ubiquitous construction material. Apart from the fresh and early age properties of concrete material, its condition during the structure life span affects the overall structural performance. Therefore, development of techniques such as non-destructive testing which enable the investigation of the material condition, are in great demand. Tomography technique has become an increasingly popular non-destructive evaluation technique for civil engineers to assess the condition of concrete structures. In the present study, this technique is investigated by developing reconstruction procedures utilizing different parameters of elastic waves, namely the travel time, wave amplitude, wave frequency, and Q-value. In the development of algorithms, a ray tracing feature was adopted to take into account the actual non-linear propagation of elastic waves in concrete containing defects. Numerical simulation accompanied by experimental verifications of wave motion were conducted to obtain wave propagation profiles in concrete containing honeycomb as a defect and in assessing the tendon duct filling of pre-stressed concrete (PC) elements. The detection of defects by the developed tomography reconstruction procedures was evaluated and discussed.
    Matched MeSH terms: Tendons
  11. Fulltext Congenital bilateral agenesis of the tibialis anterior muscles: a rare case report
    Htwe O, Swarhib M, Pei TS, Naicker AS, Das S
    Rom J Morphol Embryol, 2012;53(3):657-9.
    PMID: 22990563
    Congenital bilateral agenesis of the tibialis anterior muscles is a rare condition. We present a case of congenital absence of bilateral tibialis anterior muscles in a 6-year-old boy who presented with an abnormal gait. He was previously diagnosed to have bilateral congenital talipes equinovarus (CTEV) deformity for which he underwent corrective surgery two times. However, he still had a residual foot problem and claimed to have difficulty in walking. On examination, he walked with a high stepping gait and muscle power of both lower limbs was 5/5 on the medical research council scale (MRCS) except for both ankle dorsiflexors and long toe extensors. The sensation was intact. Magnetic Resonance Imaging (MRI) study of both legs revealed that tibialis anterior muscles were not visualized on both sides suggestive of agenesis of the tibialis anterior muscles. The rest of the muscles appeared mildly atrophied. The electrophysiological study showed normal motor and sensory conduction in both upper and lower limbs. Electromyographic (EMG) study of the vastus medialis was within normal limit and no response could be elicited for EMG of tibialis anterior muscles suggesting possible absence of tibialis anterior muscles, bilaterally. The patient underwent split tibialis posterior tendon transfer to achieve a balanced and functional foot and was well on discharge. The present case describes the normal anatomy and embryology of tibialis anterior muscles as well as possible causes of its agenesis along with its clinical implications.
    Matched MeSH terms: Tendons/abnormalities*
  12. In Vitro Evaluation of Human Hand Tendon Ingrowth into A Synthetic Scaffold
    Abdullah S, Mohtar F, Abdul Shukor N, Sapuan J
    J Hand Surg Asian Pac Vol, 2017 Dec;22(4):429-434.
    PMID: 29117830 DOI: 10.1142/S0218810417500459
    BACKGROUND: Synthetic scaffold has been used for tissue approximation and reconstructing damaged and torn ligaments. This study explores the ability of tendon ingrowth into a synthetic scaffold in vitro, evaluate growth characteristics, morphology and deposition of collagen matrix into a synthetic scaffold.

    METHODS: Upper limb tendons were harvested with consent from patients with crush injuries and non-replantable amputations. These tendons (both extensor and flexor) measuring 1 cm are sutured to either side of a 0.5 cm synthetic tendon strip and cultured in growth medium. At 2, 4, 6 and 8 weeks, samples were fixed into paraffin blocks, cut and stained with haematoxylin-eosin (H&E) and Masson's trichrome.

    RESULTS: Minimal tendon ingrowth were seen in the first 2 weeks of incubation. However at 4 weeks, the cell ingrowth were seen migrating towards the junction between the tendon and the synthetic scaffold. This ingrowth continued to expand at 6 weeks and up to 8 weeks. At this point, the demarcation between human tendon and synthetic scaffold was indistinct.

    CONCLUSIONS: We conclude that tendon ingrowth composed of collagen matrix were able to proliferate into a synthetic scaffold in vitro.

    Matched MeSH terms: Tendons/physiology*
  13. Fulltext Multiple variations of the tendons of the anatomical snuffbox
    Thwin SS, Fazlin F, Than M
    Singapore Med J, 2014 Jan;55(1):37-40.
    PMID: 24452976
    Multiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain's syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain's tenosynovitis.
    Matched MeSH terms: Tendons/anatomy & histology*
  14. Fulltext Joint torque reduction of a three dimensional redundant planar manipulator
    Yahya S, Moghavvemi M, Almurib HA
    Sensors (Basel), 2012;12(6):6869-92.
    PMID: 22969326 DOI: 10.3390/s120606869
    Research on joint torque reduction in robot manipulators has received considerable attention in recent years. Minimizing the computational complexity of torque optimization and the ability to calculate the magnitude of the joint torque accurately will result in a safe operation without overloading the joint actuators. This paper presents a mechanical design for a three dimensional planar redundant manipulator with the advantage of the reduction in the number of motors needed to control the joint angle, leading to a decrease in the weight of the manipulator. Many efforts have been focused on decreasing the weight of manipulators, such as using lightweight joints design or setting the actuators at the base of the manipulator and using tendons for the transmission of power to these joints. By using the design of this paper, only three motors are needed to control any n degrees of freedom in a three dimensional planar redundant manipulator instead of n motors. Therefore this design is very effective to decrease the weight of the manipulator as well as the number of motors needed to control the manipulator. In this paper, the torque of all the joints are calculated for the proposed manipulator (with three motors) and the conventional three dimensional planar manipulator (with one motor for each degree of freedom) to show the effectiveness of the proposed manipulator for decreasing the weight of the manipulator and minimizing driving joint torques.
    Matched MeSH terms: Tendons
  15. Fulltext A Modified Method for Reconstruction of Chronic Rupture of the Quadriceps Tendon after Total Knee Replacement
    Singh, S., Choon, S.K., Tai, C.C.
    Malays Orthop J, 2008;2(2):34-36.
    MyJurnal
    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.
    Matched MeSH terms: Tendons
  16. Fulltext Novel method to estimate the length of the palmaris longus tendon
    Manohar, A., Ramal, L.
    Malaysian Journal of Medicine and Health Sciences, 2013;9(2):19-24.
    MyJurnal
    Palmaris longus is tendon of choice in reconstructive, plastic and cosmetic surgeries. Thus, a suitable length is required and it would be more convenient if the length of the tendon of the palmaris longus could be estimated before harvesting. This study was carried out to determine the relationship between the length and width of the palmaris longus tendon and the length of forearm and hand, the relationship between the length and the width of the palmaris longus tendon and wrist width and wrist circumference, as well as to identify a technique to estimate the length of the tendinous part of palmaris longus before harvesting it. A standardized proforma was used to collect the data of each of the 31 cadavers upper limbs. These data were analysed using SPSS software version 17. It is important to note that p value less than 0.05 is considered as statistically significant in this study. Out of the 31 upper limbs, palmaris longus tendon was absent in 3 (9.68%). Meanwhile, the mean length and width of the palmaris longus tendon was found to be 16.20 cm and 0.48 cm, respectively. The mean length of the forearm and hand was 26.6 cm and 21.2 cm, respectively. The mean width of the wrist and wrist circumference was 8.2 cm and 14.82 cm, respectively. These indicate a significant and moderate relationship between the length of palmaris longus tendon and the length of forearm (r = 0.49, r2 = 0.24, p < 0.01). In addition, there was also a significant relationship between the length of palmaris longus tendon and the length of hand (r = 0.56, p < 0.01). This paper presents the technique used to estimate the length and width of the tendinous part of palmaris longus before harvesting. The length of palmaris longus can be estimated pre-operatively by measuring the length of the hand by using the technique explained in this paper.
    Matched MeSH terms: Tendons
  17. Fulltext Ganglion of the Flexor Tendon Sheath at the A2 Pulley - Case Report
    Gunaseelan P, Jeremy P, Chua CK, Rashdeen F
    Malays Orthop J, 2015 Mar;9(1):28-29.
    PMID: 28435592 MyJurnal DOI: 10.5704/MOJ.1503.002
    There are few reported cases of flexor tendon sheath ganglion arising from the A2 pulley. We report a case of a flexor tendon sheath ganglion in a 17-year old female who presented with pain, triggering and a swelling at the base of her right ring finger. During the excision biopsy, a ganglion measuring 0.5×0.8×0.4 cm in size was removed from the A2 pulley area.
    Matched MeSH terms: Tendons
  18. Fulltext A mini review on the basic knowledge on tendon: revisiting the normal & injured tendon
    Tan, S.L., Selvaratnam, L., Ahmad, T.S.
    JUMMEC, 2015;18(2):1-14.
    MyJurnal
    Tendon is a dense connective tissue that connects muscle to bone. Tendon can adapt to mechanical forces passing across it, through a reciprocal relationship between its cellular components (tenocytes and tenoblasts) and the extracellular matrix (ECM). In early development, the formation of scleraxis-expressing tendon progenitor population in the sclerotome is induced by a fibroblast growth factor signal secreted by the myotome. Tendon injury has been defined as a loss of cells or ECM caused by trauma. It represents a failure of cells and matrix adaptation to mechanical loading. Injury initiates attempts of tendon to repair itself, which has been defined as replacement of damaged or lost cells and ECM by new cells or new matrices. Tendon healing generally consists of four different phases: the inflammatory, proliferation, differentiation and remodelling phases. Clinically, tendons are repaired with a variety of surgical techniques, which show various degrees of success. In order to improve the conventional tendon repair methods, current tendon tissue engineering aims to investigate a repair method which can restore tissue defects with living cells, or cell based therapy. Advances in tissue engineering techniques would potentially yield to a cell-based product that could regenerate functional tendon tissue.
    Matched MeSH terms: Tendons
  19. Fulltext Separate Belly and Tendon of Flexor Digitorum Superficialis to the Fifth Digit
    Rao M, Ashwini LS, Somayaji SN, Mishra S, Guru A, Rao A
    Oman Med J, 2011 Nov;26(6):e027.
    PMID: 28861181 DOI: 10.5001/omj.2011.120
    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.
    Matched MeSH terms: Tendons
  20. Fulltext Current Progress in Tendon and Ligament Tissue Engineering
    Lim WL, Liau LL, Ng MH, Chowdhury SR, Law JX
    Tissue Eng Regen Med, 2019 Dec;16(6):549-571.
    PMID: 31824819 DOI: 10.1007/s13770-019-00196-w
    BACKGROUND: Tendon and ligament injuries accounted for 30% of all musculoskeletal consultations with 4 million new incidences worldwide each year and thus imposed a significant burden to the society and the economy. Damaged tendon and ligament can severely affect the normal body movement and might lead to many complications if not treated promptly and adequately. Current conventional treatment through surgical repair and tissue graft are ineffective with a high rate of recurrence.

    METHODS: In this review, we first discussed the anatomy, physiology and pathophysiology of tendon and ligament injuries and its current treatment. Secondly, we explored the current role of tendon and ligament tissue engineering, describing its recent advances. After that, we also described stem cell and cell secreted product approaches in tendon and ligament injuries. Lastly, we examined the role of the bioreactor and mechanical loading in in vitro maturation of engineered tendon and ligament.

    RESULTS: Tissue engineering offers various alternative ways of treatment from biological tissue constructs to stem cell therapy and cell secreted products. Bioreactor with mechanical stimulation is instrumental in preparing mature engineered tendon and ligament substitutes in vitro.

    CONCLUSIONS: Tissue engineering showed great promise in replacing the damaged tendon and ligament. However, more study is needed to develop ideal engineered tendon and ligament.

    Matched MeSH terms: Tendons/anatomy & histology; Tendons/pathology; Tendons/physiology*
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