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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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Related in: MedlinePlus

Distal ulnar intrinsic release. An oblique dorsal incision on the proximal phalanx exposes the extensor hood apparatus on the ulnar side and a triangular piece is resected. The triangle is roughly 5 mm at the base, 12–15 mm at the side, and the hypotenuse is 15–16 mm.
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fig3: Distal ulnar intrinsic release. An oblique dorsal incision on the proximal phalanx exposes the extensor hood apparatus on the ulnar side and a triangular piece is resected. The triangle is roughly 5 mm at the base, 12–15 mm at the side, and the hypotenuse is 15–16 mm.

Mentions: The patients were operated on with distal intrinsic release, when the oblique fibres of the extensor hood are excised [3,4]. The original procedure was modified to include only the ulnar side of the dorsal aponeurosis. The extensor mechanism is exposed through a dorsal oblique incision on the proximal phalanx. The ulnar side of the aponeurosis is identified and a triangular piece containing the lateral band and the oblique fibres is resected (Figures 2, 3). Release is sufficient when the intrinsic tightness as described by Bunnell's intrinsic tightness test is gone.


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

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

Distal ulnar intrinsic release. An oblique dorsal incision on the proximal phalanx exposes the extensor hood apparatus on the ulnar side and a triangular piece is resected. The triangle is roughly 5 mm at the base, 12–15 mm at the side, and the hypotenuse is 15–16 mm.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: Distal ulnar intrinsic release. An oblique dorsal incision on the proximal phalanx exposes the extensor hood apparatus on the ulnar side and a triangular piece is resected. The triangle is roughly 5 mm at the base, 12–15 mm at the side, and the hypotenuse is 15–16 mm.
Mentions: The patients were operated on with distal intrinsic release, when the oblique fibres of the extensor hood are excised [3,4]. The original procedure was modified to include only the ulnar side of the dorsal aponeurosis. The extensor mechanism is exposed through a dorsal oblique incision on the proximal phalanx. The ulnar side of the aponeurosis is identified and a triangular piece containing the lateral band and the oblique fibres is resected (Figures 2, 3). Release is sufficient when the intrinsic tightness as described by Bunnell's intrinsic tightness test is gone.

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