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Selective release of the digital extensor hood to reduce intrinsic tightness in tetraplegia.

Reinholdt C, Fridén J - J Plast Surg Hand Surg (2011)

Bottom Line: Long fingers were consistently the most affected digits.The intrinsic tightness was released completely in all patients and the range of motion (ROM) was improved by 25%, and up to 45% in mild and severe cases, respectively.The good immediate effects of treatment as shown by increased ROM remained intact by 6 months postoperatively.

View Article: PubMed Central - PubMed

Affiliation: National Center of Reconstructive Hand Surgery in Tetraplegia, Department of Hand Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. carina.reinholdt@vgregion.se

ABSTRACT
Patients with tetraplegia may have various degrees of spasticity in the hand ranging from a completely clenched fist to reduced control of grip at triggered spasticity. The objective of the present study was to evaluate the functional effect of the distal ulnar intrinsic release procedure to reduce intrinsic tightness. Seventeen patients with tetraplegia (37 fingers) and with prominent intrinsic tightness were operated on for distal intrinsic release with a modification of the procedure to include only the ulnar side of the proximal phalanx. All the patients had more pronounced tightness on the ulnar than on the radial side of the affected finger. Long fingers were consistently the most affected digits. The intrinsic tightness was released completely in all patients and the range of motion (ROM) was improved by 25%, and up to 45% in mild and severe cases, respectively. The good immediate effects of treatment as shown by increased ROM remained intact by 6 months postoperatively. These data suggest that the distal ulnar intrinsic release procedure is a simple and valuable way of reducing intrinsic tightness and improving hand function and grip for patients with intrinsic tightness. This procedure can be added to other procedures such as lengthening and transfer of tendons.

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Bunnell's intrinsic tightness test involves passively holding the patient's MCP joint extended, and then passively flexing the PIP joint. There is intrinsic tightness if the PIP joint is difficult to flex.
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fig1: Bunnell's intrinsic tightness test involves passively holding the patient's MCP joint extended, and then passively flexing the PIP joint. There is intrinsic tightness if the PIP joint is difficult to flex.

Mentions: The diagnosis of intrinsic tightness was verified by using Bunnell's test [6], which has also been described by Finochietto (Figure 1) [7]. In addition, a test was done to distinguish between intrinsic tightness on the ulnar and the radial sides. The radial and ulnar interosseus insertions were tested with the MCP joint in a maximally-deviated position to the radial and to the ulnar side, respectively and the tightness test was done on both sides. The passive range of motion of the MCP and the PIP joints were also measured. The patients were all tetraplegic and reconstructive hand surgery was planned including distal intrinsic release as a single procedure, and multiple procedures such as reconstruction of grip with tendon transfers and lengthening. All patients had previously tried conservative treatment of spasticity with unsatisfactory results. The patients were divided into 2 groups: mild and severe, depending on the degree of involvement of the MCP joints according to Naidu and Heppenstall [2]. The patients in the mild group had focal spasticity, and those in the severe group had spasticity in both the deep and superficial flexor muscles and a clenched fist. In the severe cases, the intrinsic tightness was hidden behind the spastic superficial and deep flexor muscles. When the spastic extrinsic muscles were lengthened or transferred, the intrinsic tightness became obvious, and was corrected with a distal ulnar intrinsic release.


Selective release of the digital extensor hood to reduce intrinsic tightness in tetraplegia.

Reinholdt C, Fridén J - J Plast Surg Hand Surg (2011)

Bunnell's intrinsic tightness test involves passively holding the patient's MCP joint extended, and then passively flexing the PIP joint. There is intrinsic tightness if the PIP joint is difficult to flex.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3104283&req=5

fig1: Bunnell's intrinsic tightness test involves passively holding the patient's MCP joint extended, and then passively flexing the PIP joint. There is intrinsic tightness if the PIP joint is difficult to flex.
Mentions: The diagnosis of intrinsic tightness was verified by using Bunnell's test [6], which has also been described by Finochietto (Figure 1) [7]. In addition, a test was done to distinguish between intrinsic tightness on the ulnar and the radial sides. The radial and ulnar interosseus insertions were tested with the MCP joint in a maximally-deviated position to the radial and to the ulnar side, respectively and the tightness test was done on both sides. The passive range of motion of the MCP and the PIP joints were also measured. The patients were all tetraplegic and reconstructive hand surgery was planned including distal intrinsic release as a single procedure, and multiple procedures such as reconstruction of grip with tendon transfers and lengthening. All patients had previously tried conservative treatment of spasticity with unsatisfactory results. The patients were divided into 2 groups: mild and severe, depending on the degree of involvement of the MCP joints according to Naidu and Heppenstall [2]. The patients in the mild group had focal spasticity, and those in the severe group had spasticity in both the deep and superficial flexor muscles and a clenched fist. In the severe cases, the intrinsic tightness was hidden behind the spastic superficial and deep flexor muscles. When the spastic extrinsic muscles were lengthened or transferred, the intrinsic tightness became obvious, and was corrected with a distal ulnar intrinsic release.

Bottom Line: Long fingers were consistently the most affected digits.The intrinsic tightness was released completely in all patients and the range of motion (ROM) was improved by 25%, and up to 45% in mild and severe cases, respectively.The good immediate effects of treatment as shown by increased ROM remained intact by 6 months postoperatively.

View Article: PubMed Central - PubMed

Affiliation: National Center of Reconstructive Hand Surgery in Tetraplegia, Department of Hand Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. carina.reinholdt@vgregion.se

ABSTRACT
Patients with tetraplegia may have various degrees of spasticity in the hand ranging from a completely clenched fist to reduced control of grip at triggered spasticity. The objective of the present study was to evaluate the functional effect of the distal ulnar intrinsic release procedure to reduce intrinsic tightness. Seventeen patients with tetraplegia (37 fingers) and with prominent intrinsic tightness were operated on for distal intrinsic release with a modification of the procedure to include only the ulnar side of the proximal phalanx. All the patients had more pronounced tightness on the ulnar than on the radial side of the affected finger. Long fingers were consistently the most affected digits. The intrinsic tightness was released completely in all patients and the range of motion (ROM) was improved by 25%, and up to 45% in mild and severe cases, respectively. The good immediate effects of treatment as shown by increased ROM remained intact by 6 months postoperatively. These data suggest that the distal ulnar intrinsic release procedure is a simple and valuable way of reducing intrinsic tightness and improving hand function and grip for patients with intrinsic tightness. This procedure can be added to other procedures such as lengthening and transfer of tendons.

Show MeSH
Related in: MedlinePlus