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Management of digital tendon avulsion at the musculotendinous junction of the forearm: a systematic review

  • Surgery Articles
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HAND

Abstract

Background

Tendon avulsion at the musculotendinous junction caused by digit avulsion amputation or closed injury is a challenging problem, for which the literature lacks definitive recommendations regarding treatment. We have provided a systematic review and developed an algorithm to delineate optimal management of this injury.

Methods

Two independent reviewers undertook a systematic review of the literature to identify articles discussing management of forearm tendons avulsed at their musculotendinous junction. Patient demographics, injury mechanism, injury pattern, type of repair, and outcome were investigated. These data were analyzed to reveal tendencies in management, which were then organized into an algorithm.

Results

Twenty articles fit our criteria for a total of 91 tendons. Cases were mostly males involved in work accidents. Treatment options were tendon resection, reattachment to muscle, tendon transfer, and side-to-side repair. When the digit was replanted, tendons avulsed through avulsion amputations were preferentially treated by reattachment in the case of the thumb, transfers for the index and long fingers, and resection for the ring and small fingers. Reattachment was favored for metacarpophalangeal level amputations, while transfer was selected for proximal phalanx levels. For closed avulsion injuries, flexors were preferentially treated with reattachment or transfer, while extensors underwent transfer or side-to-side repair.

Conclusions

In the management of tendon avulsions at the musculotendinous junction, specific procedures are favored depending on the mechanism of injury, the type of tendon and digit involved, and the level of bone amputation. An algorithm is presented to facilitate optimal treatment based on these injury characteristics.

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References

  1. Blue AI, Spira M, Hardy SB. Repair of extensor tendon injuries of the hand. Am J Surg. 1976;132:128–32.

    Article  PubMed  CAS  Google Scholar 

  2. Boyes JH, Wilson JN, Smith JW. Flexor-tendon ruptures in the forearm and hand. J Bone Joint Surg Am. 1960;42:637–46.

    PubMed  Google Scholar 

  3. Brehaut JC, O’Connor AM, Wood TJ, et al. Validation of a decision regret scale. Med Decis Making. 2003;23:281–92.

    Article  PubMed  Google Scholar 

  4. Changulani M, Okonkwo U, Keswani T, et al. Outcome evaluation measures for wrist and hand—which one to choose? Int Orthop. 2008;32:1–6.

    Article  PubMed  Google Scholar 

  5. Chung KC, Pillsbury MS, Walters MR, et al. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998;23:575–87.

    Article  PubMed  CAS  Google Scholar 

  6. Chung KC, Hamill JB, Walters MR, et al. The Michigan Hand Outcomes Questionnaire (MHQ): assessment of responsiveness to clinical change. Ann Plast Surg. 1999;42:619–22.

    Article  PubMed  CAS  Google Scholar 

  7. Coroneos C, Ignacy T, Thoma A. Designing and reporting case series in plastic surgery. Plast Reconstr Surg. 2011;128:361–8e.

    Article  PubMed  CAS  Google Scholar 

  8. Culver JE Jr. Flexor digitorum superficialis rupture: a case report. Bull Hosp Joint Dis. 1976;37:30–3.

    PubMed  Google Scholar 

  9. Dias JJ, Bhowal B, Wildin CJ, et al. Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias? J Bone Joint Surg Br. 2001;83:235–40.

    Article  PubMed  CAS  Google Scholar 

  10. Gabel CP, Michener LA, Burkett B, et al. The Upper Limb Functional Index: development and determination of reliability, validity, and responsiveness. J Hand Ther. 2006;19:328–49.

    Article  PubMed  Google Scholar 

  11. Givissis P, Karataglis D, Christodoulou A, et al. Open traumatic avulsion of the flexor pollicis longus tendon from the musculotendinous area: a case report. J Hand Surg Am. 2005;30:850–3.

    Article  PubMed  Google Scholar 

  12. Green DP, Hotchkiss RN, Pederson WC, et al. Green’s operative hand surgery. 5th ed. Philadelphia: Elsevier; 2005. p. 216.

    Google Scholar 

  13. Hoffman S, Simon BE, Nachamie B. Unusual flexor tendon ruptures in the hand. AMA Arch Surg. 1968;96:259–62.

    Article  PubMed  CAS  Google Scholar 

  14. Holmes-Rovner M, Kroll J, Schmitt N, et al. Patient satisfaction with health care decisions: the satisfaction with decision scale. Med Decis Making. 1996;16:58–64.

    Article  PubMed  CAS  Google Scholar 

  15. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–8.

    Article  PubMed  CAS  Google Scholar 

  16. Huemer GM, Dunst KM. Finger avulsion with pulled-out flexor tendon. N Engl J Med. 2005;352:e5.

    Article  PubMed  Google Scholar 

  17. Hussain SA. Traumatic amputation of the finger with complete avulsion of flexor profundus tendon. J Trauma. 1977;17:241–2.

    Article  PubMed  CAS  Google Scholar 

  18. Kameyama M, Shiraishi T. Traumatic rupture of the extensor digitorum communis and extensor digiti minimi at the musculotendinous junction associated with volar dislocation of the distal radioulnar joint—a case report. Hand Surg. 2000;5:165–8.

    Article  PubMed  CAS  Google Scholar 

  19. Komura S, Yokoi T, Nonomura H. Traumatic closed index extensor tendon rupture at the musculotendinous junction: a report of two cases. Hand. 2010;6:90–2.

    Article  PubMed  Google Scholar 

  20. LaStayo PC, Wheeler DL. Reliability of passive wrist flexion and extension goniometric measurements: a multicenter study. Phys Ther. 1994;74:162–76.

    PubMed  CAS  Google Scholar 

  21. Madhavan P, Nadim Y, Cutting C. Complete avulsion of a tendon of flexor digitorum profundus from its myotendinous junction. Injury. 1995;26:697.

    Article  PubMed  CAS  Google Scholar 

  22. McMaster PE. Tendon and muscle ruptures: clinical and experimental studies on the causes and location of subcutaneous ruptures. J Bone Joint Surg Am. 1933;15:705–22.

    Google Scholar 

  23. Milch E, Epstein MD. Traumatic rupture of the extensor pollicis longus tendon. Ann Plast Surg. 1987;19:460–2.

    Article  PubMed  CAS  Google Scholar 

  24. Mudgal CS, Mudgal S. Closed traumatic rupture of the extensor digitorum communis and extensor indicis proprius at the musculo-tendinous junction. J Hand Surg Eur. 2007;32:675–6.

    Article  CAS  Google Scholar 

  25. Redden JF. Closed acute traumatic rupture of extensor pollicis longus tendon—a report of two cases. Hand. 1976;8:173–5.

    Article  PubMed  CAS  Google Scholar 

  26. Riddell DM. Spontaneous rupture of the extensor pollicis longus. J Bone Joint Surg Br. 1963;45:506–10.

    PubMed  CAS  Google Scholar 

  27. Scanlan MW, Ehrlich RV, Strauch RJ. Partially retained small finger flexor digitorum profundus function despite complete tendon loss in the forearm. J Hand Surg Am. 2004;29:591–4.

    Article  PubMed  Google Scholar 

  28. Stevanovic MV, Vucetic C, Bumbasirevic M, et al. Avulsion injury of the thumb. Plast Reconstr Surg. 1991;87:1099–104.

    Article  PubMed  CAS  Google Scholar 

  29. Sunagawa T, Harada A, Ochi M. Traumatic closed index extensor tendon rupture: a case report. J Hand Surg Eur. 2009;34:554–5.

    Article  Google Scholar 

  30. Takami H, Takahashi S, Ando M, et al. Rupture of the flexor pollicis longus tendon at the musculotendinous junction in a bowler. Arch Orthop Trauma Surg. 1998;117:277–8.

    Article  PubMed  CAS  Google Scholar 

  31. Takami H, Takahashi S, Ando M, et al. Traumatic rupture of the extensor tendons at the musculotendinous junction. J Hand Surg Am. 1995;20:474–7.

    Article  PubMed  CAS  Google Scholar 

  32. Thoma A, McKnight L, McKay P, et al. Forming the research question. Clin Plast Surg. 2008;35:189–93.

    Article  PubMed  Google Scholar 

  33. Towfigh H. Muscular rupture of the extensor pollicis longus. Handchir Mikrochir Plast Chir. 1984;16:234–5.

    PubMed  CAS  Google Scholar 

  34. Vlastou C, Earle AS. Avulsion injuries of the thumb. J Hand Surg Am. 1986;11:51–6.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors thank Leslie McKnight for editorial assistance.

Conflicts of Interest

The authors declare no conflicts of interest, commercial associations, or intent of financial gain regarding this research.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Department of Surgery, McMaster University, 1200 Main Street West, HSC 4E12, Hamilton, Ontario, Canada, L8N 3Z5

    Jessica Collins

  2. Department of Chemistry, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA

    Yoshihiro Ishihara

  3. Division of Plastic and Reconstructive Surgery, Department of Surgery, McMaster University, 101-206 James Street South, Hamilton, Ontario, Canada, L8P 3A9

    Achilleas Thoma

  4. Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4K1

    Achilleas Thoma

  5. Surgical Outcomes Research Centre (SOURCE), McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S4L8

    Achilleas Thoma

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  1. Jessica Collins
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  3. Achilleas Thoma
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Correspondence to Achilleas Thoma.

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Collins, J., Ishihara, Y. & Thoma, A. Management of digital tendon avulsion at the musculotendinous junction of the forearm: a systematic review. HAND 7, 134–142 (2012). https://doi.org/10.1007/s11552-012-9402-8

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  • DOI: https://doi.org/10.1007/s11552-012-9402-8

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