Rheumatoid Arthritis Tendon Transfers - Patrick Lusty 9/1/2001
Background
Principles of Tendon Transfers according to Boyes (Boyes J H: Bunnell's Surgery of the Hand. Edition 5 Philadelphia, J B Lippincott, 1970)
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Correction of contracture before transfer
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Adequate power, not too weak or strong
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Sufficient Amplitude
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Straight line of pull
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Maintenance of integrity of he muscle
, one muscle can not act in two different places
Pattern of tendon rupture in Rheumatoid Arthritis
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EPL often isolated, X rays may not show RA changes
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Extensor tendon rupture, EDM commonest, subsequently progressing radialward. Due to erosion of the distal ulna through the dorsal capsule (Vaughan-Jackson type)
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FPL most common flexor tendon to rupture
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Brief
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MOUNTNEY, J of Hand Surgery 1998
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Author
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Mountney J, Blundell C M, et al
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Title
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Free tendon interposition grafting for the repair of ruptured extensor tendons in the rheumatoid hand
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Reference
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Journal of Hand Surgery 1998; 23B: 5: 662-665
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Summary
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Discusses the use of interposition grafting using PL for ED rupture in rheumatoid arthritis rather than traditional end to side tendon transfer. Gives a biomechanical argument to support interposition grafts as well as a review of patients who had this procedure.
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Critique
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Good Biomechanical argument. 7 rheumatoid hands with 16 extensor tendon repairs, review average 17 months all had interposition grafting, retrospective no data on alternative methods to compare with.
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