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Daniels SP, Kirby D, De Tolla J. Diagnosis and treatment of flexor tendon injuries of the hand: what the radiologist needs to know. Skeletal Radiol 2024; 53:597-608. [PMID: 37828095 DOI: 10.1007/s00256-023-04460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
This article reviews the diagnosis and treatment of flexor tendon injuries of the hand highlighting flexor tendon anatomy, important pre-operative imaging findings, surgical options, and post-operative complications. Imaging plays a key role in guiding treatment of these difficult to manage injuries. Thus, it is important for radiologists to have a sound understanding of factors important in treatment decision-making. In the pre-operative setting, accurately identifying the location of the torn proximal tendon stump in subacute and chronic injuries helps dictate whether the patient is a candidate for a primary flexor tendon repair or may require a tendon reconstruction to restore function. In the post-operative setting, the status of the repair and presence of surrounding adhesions help dictate if and when the patient will require subsequent surgery and whether that surgery will be a tenolysis, revision repair, reconstruction, or fusion.
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Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - David Kirby
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Jadie De Tolla
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
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Dong C, Gingery A, Amadio PC, An KN, Moran SL, Zhao C. Apoptotic Body-Rich Media from Tenocytes Enhance Proliferation and Migration of Tenocytes and Bone Marrow Stromal Cells. Int J Mol Sci 2022; 23:11475. [PMID: 36232777 PMCID: PMC9569589 DOI: 10.3390/ijms231911475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022] Open
Abstract
The intrinsic healing following tendon injury is ideal, in which tendon progenitor cells proliferate and migrate to the injury site to directly bridge or regenerate tendon tissue. However, the mechanism determining why and how those cells are attracted to the injury site for tendon healing is not understood. Since the tenocytes near the injury site go through apoptosis or necrosis following injury, we hypothesized that secretions from injured tenocytes might have biological effects on cell proliferation and migration to enhance tendon healing. Tenocyte apoptosis was induced by 24 h cell starvation. Apoptotic body-rich media (T-ABRM) and apoptotic body-depleted media (T-ABDM) were collected from culture media after centrifuging. Tenocytes and bone marrow-derived stem cells (BMDSCs) were isolated and cultured with the following four media: (1) T-ABRM, (2) T-ABDM, (3) GDF-5, or (4) basal medium with 2% fetal calf serum (FCS). The cell activities and functions were evaluated. Both T-ABRM and T-ABDM treatments significantly stimulated the cell proliferation, migration, and extracellular matrix synthesis for both tenocytes and BMDSCs compared to the control groups (GDF-5 and basal medium). However, cell proliferation, migration, and extracellular matrix production of T-ABRM-treated cells were significantly higher than the T-ABDM, which indicates the apoptotic bodies are critical for cell activities. Our study revealed the possible mechanism of the intrinsic healing of the tendon in which apoptotic bodies, in the process of apoptosis, following tendon injury promote tenocyte and stromal cell proliferation, migration, and production. Future studies should analyze the components of the apoptotic bodies that play this role, and, thus, the targeting of therapeutics can be developed.
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Affiliation(s)
- Chenhui Dong
- Biomechanics & Tendon and Soft Tissue Biology Laboratories, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
- Department of Sports medicine, The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou 730050, China
| | - Anne Gingery
- Biomechanics & Tendon and Soft Tissue Biology Laboratories, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Peter C Amadio
- Biomechanics & Tendon and Soft Tissue Biology Laboratories, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Kai-Nan An
- Biomechanics & Tendon and Soft Tissue Biology Laboratories, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Steven L Moran
- Biomechanics & Tendon and Soft Tissue Biology Laboratories, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Chunfeng Zhao
- Biomechanics & Tendon and Soft Tissue Biology Laboratories, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
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Bollard SM, Kelly B, McDermott C, Potter S. The Use of Point of Care Ultrasound in Hand Surgery. J Hand Surg Am 2021; 46:602-607. [PMID: 33832787 DOI: 10.1016/j.jhsa.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 02/02/2023]
Abstract
Point of care ultrasound (POCUS) is the use of ultrasound (US) imaging technology by non-sonographer, non-radiologist treating clinicians. Handheld US systems are increasing in popularity and becoming widely available and easily accessible to hand surgeons in clinical practice. Adapting POCUS into the repertoire of the hand surgeon can aid in the diagnosis of many common hand surgery presentations and shorten operative times. In this review, we outline the potential uses and advantages of incorporating POCUS into hand surgery practice incuding its use in emergencies such as trauma, infections, and foreign body localization, as well as elective presentations such as nerve compression, procedural guidance, and anesthesia. Finally, this review outlines the training and curriculum development required to ensure safe implementation of POCUS into a hand surgery practice.
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Affiliation(s)
- Stephanie Marie Bollard
- Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Brendan Kelly
- School of Medicine, University College Dublin, Dublin, Ireland; Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Cian McDermott
- Emergency Department and the Pillar Centre for Transformative Healthcare, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Shirley Potter
- Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
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Renfree KJ, Dahiya N, Kransdorf MJ, Zhang N, Patel KA, Drace PA. Comparative Accuracy of 1.5T MRI, 3T MRI, and Static Ultrasound in Diagnosis of Small Gaps in Repaired Flexor Tendons: A Cadaveric Study. J Hand Surg Am 2021; 46:287-294. [PMID: 33451904 DOI: 10.1016/j.jhsa.2020.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/07/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE We hypothesized that magnetic resonance imaging (MRI) would more accurately diagnose small gaps (<6 mm) after flexor tendon repair than static ultrasound (US) and that suture artifact would negatively impair accuracy. METHODS A laceration of the flexor digitorum profundus was created in 160 fresh-frozen cadaveric digits and randomized to either an intact repair (0-mm gap) or repairs using a locked 4-strand suture repair with either 4-0 Prolene, Ethibond, or and gaps of 2, 4,or 6 mm; or no suture in which 2-, 4-, or 6-mm gaps were created without a suture crossing the repair site. We performed 1.5T and 3T MRI and static US studies; gap widths were estimated by radiologists blinded to suture presence and true gap widths. RESULTS The 1.5 and 3.0T MRI had a lower mean error than US for gap sizes 0 and 2 mm. All 3 modalities performed similarly for 4- and 6-mm gaps. Documentation of imaging artifact worsened error, and odds of seeing artifacts were 1.72 higher with MRI than with US. Suture did not worsen artifact nor impair accuracy for any of the 3 modalities. When no suture was used, all 3 modalities significantly overestimated the true gap. CONCLUSIONS MRI is most accurate for small gaps less than 4 mm. Although all modalities overestimated gap sizes in specimens with a 0-mm gap (intact tendon repair), mean overestimation (<2 mm) was not clinically relevant. Ultrasound overestimated 2-mm gaps (clinically intact repairs), whereas MRIs did not. We recommend MRI for evaluation of gaps after flexor tendon repair. The 1.5T has slightly better sensitivity and specificity for distinguishing clinically intact (gap < 3 mm) from clinically impaired (gap > 3 mm) repairs than the 3T. CLINICAL RELEVANCE Accurate diagnosis of intact repairs or small gaps (<3 mm) might prevent unnecessary exploration or allow modification of rehabilitation protocols. Diagnosis of clinically relevant gaps (3-6 mm) may allow for earlier revision surgery before significant tendon retraction and adhesions develop, possibly necessitating a staged reconstruction.
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Affiliation(s)
- Kevin J Renfree
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ.
| | | | | | - Nan Zhang
- Department of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ
| | - Karan A Patel
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Patricia A Drace
- Department of Orthopaedic Surgery, Phoenix Children's Hospital, Phoenix, AZ
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Comparative Sensitivity and Specificity of Static and Dynamic High-Resolution Ultrasound in Diagnosis of Small Gaps in Repaired Flexor Tendons: A Cadaveric Study. J Hand Surg Am 2021; 46:247.e1-247.e7. [PMID: 33277100 DOI: 10.1016/j.jhsa.2020.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/31/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the sensitivity and specificity of high-resolution static and dynamic ultrasound (US) for diagnosing intact repairs and small, clinically relevant gaps (≥4 mm) in repaired flexor digitorum profundus tendons within zone 2 and, secondarily, to evaluate the effect of suture artifact from 3 commonly used suture types. METHODS Eighty-eight fresh-frozen cadaveric digits (thumbs excluded) were randomized to either an intact repair (0-mm gap) or repairs using a locked 4-strand suture repair with either 4-0 Prolene, Ethibond, or FiberWire and gaps of 2, 4, or 6 mm and no suture in which 2-, 4-, or 6-mm gaps were created without a suture crossing the repair site. Gap widths were estimated by a blinded musculoskeletal ultrasonographer in static and dynamic modes. RESULTS Both static and dynamic modalities tended to overestimate actual gap sizes. For the suture gaps, both modalities had poor sensitivity (29% static; 42% dynamic) for accurately diagnosing a clinically intact repair (<4 mm), but better specificity (83% static; 75% dynamic) for diagnosing a clinically failed repair (≥4-mm gap). Although suture presence decreased the sensitivity of gap width measurement for both modalities, no differences were seen between suture types. CONCLUSIONS Static and dynamic US have poor sensitivity for diagnosing clinically intact repairs (gaps < 4 mm) because they typically overestimate gap size. The ability to diagnose failed repairs (gap ≥ 4 mm), based on greater specificity, is much better, but still suboptimal. CLINICAL RELEVANCE Based on a receiver operating characteristic analysis cutoff of 5 mm, if a gap of 5 mm or larger is identified with US when evaluating a zone 2 flexor digitorum profundus tendon repair, a failed repair is likely in about 80% of cases. A gap measurement of less than 5 mm may miss a high percentage of repairs that are clinically failed.
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Wang MY, Yang TH, Huang H, Hsu HY, Kuo LC, Su FC, Huang CC. Evaluation of Hand Tendon Movement by Using High-Frequency Ultrasound Vector Doppler Imaging. IEEE Trans Biomed Eng 2020; 67:2945-2952. [PMID: 32078528 DOI: 10.1109/tbme.2020.2974244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Injuries to the hands, wrists, and fingers often involve damage to the tendons. The ability to measure tendon movements during the rehabilitation process can provide clinicians with important information in the quantification of tendon injuries. Conventionally, the tendon is considered a single spring-like structure during force transmission, and its twisted structure is neglected. Recently, clinicians believed that the twisted fiber structure (which enables tendon rotation during movement) of the tendon can provide it with a degree of elasticity and improve the efficiency of force transmission. However, observation of the hand tendon rotation in vivo by using the current imaging modalities is difficult. METHODS In this study, a 40-MHz high-frequency vector Doppler imaging (HFVDI) was used to visualize the movement of the hand tendon during muscle contraction. The performance of HFVDI was verified using a rotation phantom experiment. Two human experiments were designed in the present study: 1) participants were allowed to bend their distal and proximal interphalangeal (DIP and PIP) joints of fingers freely and 2) the PIP joint of the finger was fixed such that only the DIP could be moved. The HFVDIs of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons were obtained in the transverse and longitudinal views to observe the movements of the hand tendon during finger movements. RESULTS The average longitudinal displacements of the FDS and FDP were approximately 3-4 mm for free bending of the finger; however, it was reduced when only the DIP was moved. The rotational phenomenon of the FDS and FDP tendons was observed in the transverse view, which demonstrated the different rotational behaviors of the FDS and FDP fibers during muscle contraction. CONCLUSION All the results validated the potential of HFVDI as a novel tool for visualizing tendon rotation and would be useful in providing quantitative information regarding tendon function to determine the rehabilitation process following injuries.
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A Novel Adhesion Index for Verifying the Extent of Adhesion for the Extensor Digitorum Communis in Patients with Metacarpal Fractures. Sci Rep 2016; 6:31102. [PMID: 27492808 PMCID: PMC4974625 DOI: 10.1038/srep31102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/13/2016] [Indexed: 11/21/2022] Open
Abstract
This study aims to determine if the relative displacement between the extensor digitorum communis (EDC) tendon and its surrounding tissues can be used as an adhesion index (AI) for assessing adhesion in metacarpal fractures by comparing two clinical measures, namely single-digit-force and extensor lag (i.e., the difference between passive extension and full active extension). The Fisher–Tippett block-matching method and a Kalman-filter algorithm were used to determine the relative displacements in 39 healthy subjects and 8 patients with metacarpal fractures. A goniometer was used to measure the extensor lag, and a force sensor was used to measure the single-digit-force. Measurements were obtained twice for each patient to evaluate the performance of the AI in assessing the progress of rehabilitation. The Pearson correlation coefficient was calculated to quantify the various correlations between the AI, extensor lag, and single-digit-force. The results showed strong correlations between the AI and the extensor lag, the AI and the single-digit-force, and the extensor lag and the single-digit-force (r = 0.718, −0.849, and −0.741; P = 0.002, P < 0.001, and P = 0.001, respectively). The AI in the patients gradually decreased after continuous rehabilitation, but remained higher than that of healthy participants.
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Abstract
Ultrasonography facilitates dynamic, real-time evaluation of bones, joints, tendons, nerves, and vessels, making it an ideal imaging modality for hand and wrist conditions. Ultrasonography can depict masses and fluid collections, help locate radiolucent foreign bodies, characterize traumatic or overuse tendon or ligament pathology, and help evaluate compressive peripheral neuropathy and microvascular blood flow. Additionally, this modality improves the accuracy of therapeutic intra-articular or peritendinous injections and facilitates aspiration of fluid collections, such as ganglia.
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Lai TY, Chen HI, Shih CC, Kuo LC, Hsu HY, Huang CC. Application of a novel Kalman filter based block matching method to ultrasound images for hand tendon displacement estimation. Med Phys 2016; 43:148. [PMID: 26745907 DOI: 10.1118/1.4937932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Information about tendon displacement is important for allowing clinicians to not only quantify preoperative tendon injuries but also to identify any adhesive scaring between tendon and adjacent tissue. The Fisher-Tippett (FT) similarity measure has recently been shown to be more accurate than the Laplacian sum of absolute differences (SAD) and Gaussian sum of squared differences (SSD) similarity measures for tracking tendon displacement in ultrasound B-mode images. However, all of these similarity measures can easily be influenced by the quality of the ultrasound image, particularly its signal-to-noise ratio. Ultrasound images of injured hands are unfortunately often of poor quality due to the presence of adhesive scars. The present study investigated a novel Kalman-filter scheme for overcoming this problem. METHODS Three state-of-the-art tracking methods (FT, SAD, and SSD) were used to track the displacements of phantom and cadaver tendons, while FT was used to track human tendons. These three tracking methods were combined individually with the proposed Kalman-filter (K1) scheme and another Kalman-filter scheme used in a previous study to optimize the displacement trajectories of the phantom and cadaver tendons. The motion of the human extensor digitorum communis tendon was measured in the present study using the FT-K1 scheme. RESULTS The experimental results indicated that SSD exhibited better accuracy in the phantom experiments, whereas FT exhibited better performance for tracking real tendon motion in the cadaver experiments. All three tracking methods were influenced by the signal-to-noise ratio of the images. On the other hand, the K1 scheme was able to optimize the tracking trajectory of displacement in all experiments, even from a location with a poor image quality. The human experimental data indicated that the normal tendons were displaced more than the injured tendons, and that the motion ability of the injured tendon was restored after appropriate rehabilitation sessions. CONCLUSIONS The obtained results show the potential for applying the proposed FT-K1 method in clinical applications for evaluating the tendon injury level after metacarpal fractures and assessing the recovery of an injured tendon during rehabilitation.
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Affiliation(s)
- Ting-Yu Lai
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan
| | - Hsiao-I Chen
- Department of Occupational Therapy, National Cheng Kung University, Tainan 701, Taiwan
| | - Cho-Chiang Shih
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan and Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, National Cheng Kung University, Tainan 701, Taiwan
| | - Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan
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Bűhler M, Johnson G, Meikle G. Longitudinal In Vivo Ultrasound Observations of the Surgically Repaired Zone II Flexor Digitorum Profundus Tendon. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:3018-3022. [PMID: 26304499 DOI: 10.1016/j.ultrasmedbio.2015.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 05/06/2015] [Accepted: 07/07/2015] [Indexed: 06/04/2023]
Abstract
The link between the healing process and functional outcomes in the surgically repaired digital flexor tendon is poorly understood. This clinical note describes those gray-scale and power Doppler (PD) ultrasound parameters that can be used to document longitudinal change in the morphologic and dynamic properties of the surgically repaired zone II flexor digitorum profundus (FDP) tendon. The method is supported by ultrasound data obtained from three participants at five points in time post-surgically (two, four, six, 12 and 18 weeks). Longitudinal documentation of the ultrasound properties of echogenicity, defect size, tendon excursion and power Doppler signal is feasible and has the potential to explore the possible link between changes in the structural status of surgically repaired flexor tendons and associated clinical outcomes.
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Affiliation(s)
- Miranda Bűhler
- Centre for Health, Activity and Rehabilitation Research, University of Otago, Dunedin, New Zealand; Physiotherapy Outpatient Department, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand.
| | - Gillian Johnson
- Centre for Health, Activity and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | - Grant Meikle
- Radiology Department, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand; Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Starr HM, Sedgley MD, Murphy MS. Ultrasound in hand surgery. J Hand Surg Am 2014; 39:2522-4. [PMID: 25240435 DOI: 10.1016/j.jhsa.2014.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/04/2014] [Accepted: 08/08/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Harlan M Starr
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Orthopaedics and Sports Medicine, Ellicott City, MD
| | - Matthew D Sedgley
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Orthopaedics and Sports Medicine, Ellicott City, MD
| | - Michael S Murphy
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Orthopaedics and Sports Medicine, Ellicott City, MD.
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McAlindon T, Kissin E, Nazarian L, Ranganath V, Prakash S, Taylor M, Bannuru RR, Srinivasan S, Gogia M, McMahon MA, Grossman J, Kafaja S, FitzGerald J. American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis Care Res (Hoboken) 2013; 64:1625-40. [PMID: 23111854 DOI: 10.1002/acr.21836] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Functional inference of complex anatomical tendinous networks at a macroscopic scale via sparse experimentation. PLoS Comput Biol 2012; 8:e1002751. [PMID: 23144601 PMCID: PMC3493461 DOI: 10.1371/journal.pcbi.1002751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 09/01/2012] [Indexed: 12/17/2022] Open
Abstract
In systems and computational biology, much effort is devoted to functional identification of systems and networks at the molecular-or cellular scale. However, similarly important networks exist at anatomical scales such as the tendon network of human fingers: the complex array of collagen fibers that transmits and distributes muscle forces to finger joints. This network is critical to the versatility of the human hand, and its function has been debated since at least the 16(th) century. Here, we experimentally infer the structure (both topology and parameter values) of this network through sparse interrogation with force inputs. A population of models representing this structure co-evolves in simulation with a population of informative future force inputs via the predator-prey estimation-exploration algorithm. Model fitness depends on their ability to explain experimental data, while the fitness of future force inputs depends on causing maximal functional discrepancy among current models. We validate our approach by inferring two known synthetic Latex networks, and one anatomical tendon network harvested from a cadaver's middle finger. We find that functionally similar but structurally diverse models can exist within a narrow range of the training set and cross-validation errors. For the Latex networks, models with low training set error [<4%] and resembling the known network have the smallest cross-validation errors [∼5%]. The low training set [<4%] and cross validation [<7.2%] errors for models for the cadaveric specimen demonstrate what, to our knowledge, is the first experimental inference of the functional structure of complex anatomical networks. This work expands current bioinformatics inference approaches by demonstrating that sparse, yet informative interrogation of biological specimens holds significant computational advantages in accurate and efficient inference over random testing, or assuming model topology and only inferring parameters values. These findings also hold clues to both our evolutionary history and the development of versatile machines.
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Soubeyrand M, Begin M, Pierrart J, Gagey O, Dumontier C, Guerini H. L’échographie pour le chirurgien de la main (conférence d’enseignement XLVe congrès de la Société française de chirurgie de la main). ACTA ACUST UNITED AC 2011; 30:368-84. [DOI: 10.1016/j.main.2011.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 08/30/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022]
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15
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Hashefi M. Ultrasound in the Diagnosis of Noninflammatory Musculoskeletal Conditions. Semin Ultrasound CT MR 2011; 32:74-90. [DOI: 10.1053/j.sult.2010.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bajaj S, Pattamapaspong N, Middleton W, Teefey S. Ultrasound of the hand and wrist. J Hand Surg Am 2009; 34:759-60. [PMID: 19345884 DOI: 10.1016/j.jhsa.2009.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 02/11/2009] [Indexed: 02/02/2023]
Affiliation(s)
- Sanjiv Bajaj
- Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA.
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Pandey T, Al Kandari SR, Al Shammari SA. Sonographic diagnosis of the entrapment of the flexor digitorum profundus tendon complicating a fracture of the index finger. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:371-373. [PMID: 18366091 DOI: 10.1002/jcu.20460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Flexor digitorum tendon entrapment is a known complication of proximal phalangeal fractures and is commonly diagnosed clinically. However, it can sometimes be subtle and may not be suspected initially. A case of proximal phalangeal fracture of the index finger complicated by entrapment of the flexor digitorum profundus tendon is presented in which the diagnosis was made based on sonographic findings subsequently confirmed by CT and later surgical findings. This case demonstrates that tendon entrapment complicating phalangeal fractures can be diagnosed using sonography.
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Affiliation(s)
- Tarun Pandey
- Department of Radiology, University of Arkansas for Medical Sciences (UAMS), 4301 W. Markham Street # 556, Little Rock, AR 72205, USA
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Iwasaki N, Ishikawa J, Minami A. Trigger wrist caused by tendon adhesion between the flexor pollicis longus and flexor digitorum superficialis tendons. J Hand Surg Eur Vol 2007; 32:472-3. [PMID: 17275976 DOI: 10.1016/j.jhsb.2006.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 11/25/2006] [Accepted: 12/04/2006] [Indexed: 02/03/2023]
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Jacob D, Cohen M, Bianchi S. Ultrasound imaging of non-traumatic lesions of wrist and hand tendons. Eur Radiol 2007; 17:2237-47. [PMID: 17404737 DOI: 10.1007/s00330-007-0637-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Revised: 02/04/2007] [Accepted: 03/09/2007] [Indexed: 11/25/2022]
Abstract
Non-traumatic tendon lesions are common and diverse at the wrist and hand. Improvements in high-resolution ultrasound (US) are producing increasingly high-quality images of superficial structures, thus expanding the indications for this imaging modality as a tool for investigating musculoskeletal disorders. The objective of this work is to provide an update on the uses and performance of US in non-traumatic tendon disorders of the wrist and hand. The relevant anatomy is reviewed, and the normal and abnormal ultrasound scan features are described in detail, with attention not only to the tendons but also to closely related structures such as synovial sheaths and bands. The contribution of US to the evaluation of each of the most common disorders is discussed.
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Affiliation(s)
- D Jacob
- Département d'Imagerie Médicale, Centre Hospitalier Régional Universitaire, BP 77908, 21079 Dijon, France.
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