tag:blogger.com,1999:blog-62474118059542427792024-03-13T11:31:53.960-07:00Tetrahand researchReconstructive hand surgery and upper extremity surgery, assessment, rehabilitation and outcome in tetraplegia after spinal cord injury by Professor Jan Fridén, MD, PhD and his team.Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.comBlogger55125tag:blogger.com,1999:blog-6247411805954242779.post-68681540769421613392014-02-20T13:50:00.000-08:002014-02-20T13:50:30.682-08:00Simultaneous powering of forearm pronation and key pinch in tetraplegia using a single muscle-tendon unit<div dir="ltr" style="text-align: left;" trbidi="on">
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<b>Fridén J, Reinholdt Gohritz A,Peace WJ, Ward SR, Lieber RL. J Hand Surg Eur 37(4):323-8, 2012.</b></div>
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<br />
This study clinically assessed the concept that both thumb flexion and
forearm pronation can be restored by brachioradialis (BR)-to-flexor
pollicis longus (FPL) tendon transfer if the BR is passed dorsal to the
radius. Six patients [two women and four men, mean age 32.3 years (SD
4.9, range 23-56)] underwent BR-to-FPL transfer dorsal to the radius and
through the interosseous membrane (IOM). Lateral key pinch strength and
pronation range of motion (ROM) were measured 1 year after surgery. A
group of six patients [two women and four men, mean age 31.2 years (SD
5.0, range 19-52)] who underwent traditional palmar BR-to-FPL was
included for comparison. Postoperative active pronation was
significantly greater in the dorsal transfer group compared to the
palmar group [149 (SD 6) and 75 (SD 3), respectively] and pinch strength
was similar in the two groups [1.28 (SD 0.16) kg and 1.20 (SD0.21) kg,
respectively]. We conclude that it is feasible to reconstruct lateral
key pinch and forearm pronation simultaneously using only the BR motor.<br />
<br /></div>
Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-67660433766609924002012-03-11T13:13:00.007-07:002012-03-13T14:41:55.871-07:00A Single-stage Operation for Reconstruction of Hand Flexion, Extension, and Intrinsic Function in Tetraplegia: The Alphabet Procedure<div style="text-align: justify;"><span>Fridén J, Reinholdt C, Turcsányii, Gohritz A. </span><span style="font-weight: bold;">Tech Hand Up Extrem Surg 15:230-235, 2011.</span><br /><br />Surgical reconstruction is an established method to restore grip and grasp function after traumatic cervical spinal cord injury and tetraplegia. It can offer the patient improved ability to perform activities of daily living. Traditionally, surgical reconstruction of hand function has required separate operations for flexors and extensors. Here, we present a combination of procedures that provides key pinch and finger flexion together with opening of hand as a 1-stage operation. This reconstruction includes 7 individual operations that are performed in the following order: (1) split flexor pollicis longus-extensor pollicis longus distal thumb tenodesis, (2) reconstruction of passive interossei, (3) thumb CMC arthrodesis (4) brachioradialis-flexor pollicis longus tendon transfer, (5) extensor carpi radialis longus-flexor digitorum profundus tendon transfer, (6) EPL tenodesis, and (7) extensor carpi ulnaris tenodesis. We have chosen to entitle this reconstruction the alphabet or ABCDEFG procedure, an abbreviation for Advanced Balanced Combined Digital Extensor Flexor Grip reconstruction. To reduce the risk of adhesions after this extensive surgery and to facilitate relearning the activation of transferred muscles with new functions, early active training is performed. It is concluded that this 1-stage combination of operations can reliably provide grip, grasp, and release function in persons with C6 tetraplegia, patient satisfaction is high, time and effort for patient and caregivers are less, and incidence of complications is comparable with other published treatment modalities.<br /></div>Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-40511803420813151052011-05-23T06:09:00.000-07:002011-06-10T13:16:51.068-07:00Performance of prioritized activities is not correlated with functional factors after grip reconstruction in tetraplegia<span style="font-size:100%;">Wangdell J, Fridén J. </span><span style="font-size:100%;"><span style="font-weight: bold;">Rehabil Med 2011; 43: 626–630.</span></span><br /><span style="font-weight: bold;"><br />Objective: </span>To investigate the correlation between perceived performance in prioritized activities and physical conditions related to grip reconstruction. Design: Retrospective clinical outcome study. <span style="font-weight: bold;"><br />Patients:</span> Forty-seven individuals with tetraplegia were included in the study. Each participant underwent tendon transfer surgery in the hand between November 2002 and April 2009 and had a complete 1-year follow-up.<br /><span style="font-weight: bold;">Methods:</span> Functional characteristics and performance data were collected from our database and medical records. Patients' perceived performances in prioritized activities were recorded using the Canadian Occupational Performance Measurement. Preoperative data included age at surgery, time since injury, severity of injury, sensibility and hand dominance. At 1-year follow-up, grip strength, key pinch strength, finger pulp-to-palm distance, distance between thumb and index finger and wrist flexion were measured. Correlation rank coefficient was used to test the possible relationship between physical data and activity performance.<br /><span style="font-weight: bold;">Results:</span> There were improvements in both functional factors and in rated performance of prioritized activities after surgery. There was no correlation between performance change and any of the physical functions, the factors known before surgery, or the functional outcome factors.<br /><span style="font-weight: bold;">Conclusion:</span> No correlation exists between a single functional outcome parameter and the patients' perceived performance of their prioritized goals in reconstructive hand surgery in tetraplegia.Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-90593486605023474842011-05-23T05:08:00.000-07:002011-05-23T05:10:41.100-07:00Selective release of the digital extensor hood to reduce intrinsic tightness in tetraplegiaReinholdt C, Fridén J. <span style="font-size:100%;"><a title="Journal of plastic surgery and hand surgery."> <span style="font-weight: bold;">J Plast Surg Hand Surg.</span></a><span style="font-weight: bold;"> 2011 Apr;45(2):83-9.</span></span><br /><br />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.Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-22100116476107795512011-03-09T03:15:00.000-08:002011-06-09T04:19:45.010-07:00Muscle biopsies from the supraspinatus in retracted rotator cuff tears respond normally to passive mechanical testing: a pilot studyEinarssson F, Runesson E, Karlsson J, Fridén J. <span style="font-weight:bold;">Knee Surg Sports Traumatol Arthrosc. 2011 Mar;19(3):503-7.</span><br /><br />PURPOSE: The aim of the present study was to assess the function of the isolated muscle component in retracted rotator cuff tears.<br /><br />METHODS: Muscle biopsies were harvested from the supraspinatus and the ipsilateral deltoid in seven patients undergoing surgery for a large, retracted rotator cuff tear. Single fibres and fibre bundles were subjected to passive stretching in vitro with subsequent recordings of tension and sarcomere lengths using the laser diffraction technique. Stress-strain curves were plotted, and the elastic modulus was calculated for all preparations. Morphology was evaluated with regard to collagen fraction, ratio between fast and slow fibres, fibre size and fibre size variability using standard staining techniques.<br /><br />RESULTS: Intra-individual comparisons of the stress-strain curves showed a high degree of conformity in terms of both shape and tangent values, and there were no statistically significant differences in the elastic modulus for single fibres and bundles in the deltoid and supraspinatus muscles, respectively, supported by the analysis of the observed confidence interval of the differences between the paired values of the elastic modulus. There were no differences in collagen content, fibre size and ratio between fast and slow fibres in the deltoid and supraspinatus muscles, respectively.<br /><br />CONCLUSION: We conclude that muscle biopsies from the supraspinatus in retracted rotator cuff tears respond normally to mechanical testing in vitro.Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-87055019373571808282010-09-30T14:17:00.000-07:002010-09-30T14:37:07.712-07:00Shortened rehabilitation period using a modified surgical technique for reconstruction of lost elbow extension in tetraplegia<span style="font-weight: bold;">Turcsanyi I, Fridén J. J Plast Surg Hand Surg 44(3):156-62, 2010.</span><br /><br />Our aim was to evaluate the functional outcome of reconstruction of elbow extension in tetraplegia using a new technique for improving the attachment sites of posterior deltoid-to-triceps transfer in conjunction with an active rehabilitation programme. Ten tetraplegic patients (15 arms) had modified deltoid-to-triceps transfer using a tibialis anterior tendon graft. The operation included large overlaps between the tendon attachments, and additional security by anchoring the distal stump of the tendon graft to the olecranon. During the first 3 weeks of immobilisation, isometric contractions were made and during the following 4 weeks the flexion angle of the elbow was increased by 15 degrees a week; weights were also used to reinforce muscle strength. The mean follow up was 10 months (range 5-19). The elbow extension strength after posterior deltoid-to-triceps transfer was measured in horizontal and vertical planes. After rehabilitation the active range of motion and strength of elbow extension had improved substantially. The mean active elbow extension range of motion was 132 degrees (range 120 degrees -145 degrees ) and the elbow could be extended actively in all planes. Elbow extension strength was restored to well above the counteraction of the weight of the arm. Mean (SEM) elbow extension was significantly greater in the horizontal shoulder plane compared with the vertical plane (10.4 (1.0) compared with 6.5 (1.2) Nm, p < 0.001) and strength increased roughly linearly as the degree of flexion of the elbow increased. The most dramatic increase was in the range between 120 degrees and 135 degrees of flexion, regardless of the plane of action of the shoulder. We have shown good functional results and a shorter rehabilitation period using a rigorous suturing technique that allows for active strength and mobility training without additional adverse effects.Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-73131610456381473112010-08-19T17:21:00.000-07:002010-09-05T12:55:16.903-07:00Mechanical Feasibility of Immediate Mobilization of the Brachioradialis Muscle After Tendon Transfer.Fridén J, Shillito MC, Chehab EF, Finneran JJ, Ward SR, Lieber RL. <span style="font-weight: bold;">J Hand Surg Am </span><span style="font-weight: bold;">35:1473-1478, 2010</span><br /><br />PURPOSE: Tendon transfer is often used to restore key pinch after cervical spinal cord injury. Current postoperative recommendations include elbow immobilization in a flexed position to protect the brachioradialis-flexor pollicis longus (BR-FPL) repair. The purpose of this study was to measure the BR-FPL tendon tension across a range of wrist and elbow joint angles to determine whether joint motion could cause repair rupture.<br /><br />METHODS: We performed BR-to-FPL tendon transfers on fresh-frozen cadaveric arms (n = 8) and instrumented the BR-FPL tendon with a buckle transducer. Arms were ranged at 4 wrist angles from 45 degrees of flexion to 45 degrees of extension and 8 elbow angles from 90 degrees of flexion to full extension, measuring tension across the BR-FPL repair at each angle. Subsequently, the BR-FPL tendon constructs were removed and elongated to failure.<br /><br />RESULTS: Over a wide wrist and elbow range of motion, BR-FPL tendon tension was under 20 N. Two-way analysis of variance with repeated measures revealed a significant effect of wrist joint angle (p<.001) and elbow joint angle (p<.001) with significant interaction between elbow and joint angles (p<.001). Because the failure load of the repair site was 203 +/- 19 N, over 10 times the loads that would be expected to occur at the repair site, our results demonstrate that the repair has a safety factor of at least 10.Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com1tag:blogger.com,1999:blog-6247411805954242779.post-5858906090637257192010-06-10T13:19:00.000-07:002010-09-03T02:34:14.369-07:00Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia.Wangdell J, Fridén J.<br /><span style="font-weight: bold;">J Hand Surg Eur </span><span style="font-weight: bold;">35(7):563-568</span><span style="font-weight: bold;">, 2010.</span><br /><br />Reconstruction of grip in tetraplegia aims to improve upper extremity performance and control in daily life. We evaluated the effects of surgery and rehabilitation on performance and satisfaction of patient identified activity goals in 20 patients (22 arms) who had grip reconstructions for both finger and thumb flexion. Patients assessed an improvement in both performance and satisfaction after surgery in all groups of activities assessed using the Canadian Occupational Performance Measure (COPM). The mean improvement at 6 and 12 months was 3.5 points better than the 2.5 points before surgery. Before surgery 36% of the goals identified were impossible to perform. After surgery, 78% of these goals were possible. The largest improvement was observed in the basic activity of 'eating' but significant improvement was also noted in activities generally regarded as complex and not measured in standard ADL such as 'doing housework' and taking part in 'leisure'.Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-62121062127079652462010-05-01T14:53:00.000-07:002010-05-02T11:04:23.333-07:00Perceived activity performance is not readily correlated with functional factors in reconstructive tetraplegia hand surgery<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_B32TnLIpjqk/S9ym9TDCTJI/AAAAAAAAAUQ/-Gp6Hx2rzxk/s1600/Johanna+photo.jpg"><img style="float: left; margin: 0pt 10px 10px 0pt; cursor: pointer; width: 183px; height: 200px;" src="http://2.bp.blogspot.com/_B32TnLIpjqk/S9ym9TDCTJI/AAAAAAAAAUQ/-Gp6Hx2rzxk/s200/Johanna+photo.jpg" alt="" id="BLOGGER_PHOTO_ID_5466427619736177810" border="0" /></a><b style=""><span style="" lang="EN-GB">Johanna Wangdell, </span></b><span style="" lang="EN-GB">occupational therapist at the National Center of Reconstructive Tetraplegia Hand Surgery, Sweden reports the results of a study among<b style=""> </b>48 persons (33 men and 15 women) with tetraplegia who underwent tendon transfer surgery in the hand between 2002 and 2008. In order to collect the patients’ activity goals and their performance of these activities, the Canadian Occupational Performance Measurement (COPM) was used. Difference between preop and 1 year postop COPM scores indicated activity change. The expressed activity goals were spread over a wide range of activities. Average activity improvement for each person was 3.3 scale steps (-0.7 - 7). Grip and pinch strength at 1 year was 7.5 and 2.1 kg, respectively. Distance between thumb and index finger was 5.5 cm (0-15). There were no strong or significant correlations between patients’ perceived performance with their activity goals and any of the functional outcomes. There are important improvements in both physical and activity perspective but the correlations between those dimensions are non-existing or low. The lack of correlation could be explained by the fact that individuals living with tetraplegia still, even after a grip reconstruction, have to perform many of their activities in an adjusted way, especially if the injury is high. Johanna Wangdell concludes that if the surgery is done in non-dominant hand or a hand without sensibility the relearning process is even more challenging.</span> <!--EndFragment-->Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com1tag:blogger.com,1999:blog-6247411805954242779.post-22464459159040278322010-04-15T06:15:00.000-07:002010-04-15T06:33:14.812-07:00Mechanical Strength of the Side-to-Side Versus Pulvertaft Weave Tendon Repair<span style=";font-family:Times New Roman;font-size:100%;" >Brown </span><span style=";font-family:Times New Roman;font-size:100%;" >SHM</span><span style=";font-family:Times New Roman;font-size:100%;" >, Hentzen </span><span style=";font-family:Times New Roman;font-size:100%;" >ER</span><span style=";font-family:Times New Roman;font-size:100%;" >, Kwan ABS, Ward </span><span style=";font-family:Times New Roman;font-size:100%;" >SR.</span><span style=";font-family:Times New Roman;font-size:100%;" >, Fridén </span><span style=";font-family:Times New Roman;font-size:100%;" >J</span><span style=";font-family:Times New Roman;font-size:100%;" >, Lieber </span><span style=";font-family:Times New Roman;font-size:100%;" >RL.<span style="text-decoration: underline;"></span> </span><span style=";font-family:Times New Roman;font-size:100%;" >Mechanical Strength of the Side-to-Side Versus Pulvertaft Weave Tendon Repair. <b>J Hand Surg 35A:540-545, 2010.</b></span><br /><br />Purpose<br />The side-to-side (SS) tendon suture technique was designed to function as a repair that permits immediate postoperative activation and mobilization of a transferred muscle. This study was designed to test the strength and stiffness of the SS technique against a variation of the Pulvertaft (PT) repair technique.<br /><br />Methods<br />Flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons were harvested from 4 fresh cadavers and used as a model system. Seven SS and 6 PT repairs were performed, using the FDS as the donor and the FDP as the recipient tendon. For SS repairs, the FDS was woven through one incision in the FDP and was joined with 4 cross-stitch running sutures down both sides and one double-loop suture at each tendon free end. For PT repairs, the FDS was woven through 3 incisions in the FDP and joined with a double-loop suture at both ends of the overlap and 4 evenly spaced mattress sutures between the ends. Tendon repairs were placed in a tensile testing machine, preconditioned, and tested to failure.<br /><br />Results<br />There were no statistically significant differences in cross-sectional area (p = .99) or initial length (p = .93) between SS and PT repairs. Therefore, all comparisons between methods were made using measures of loads and deformations, rather than stresses and strains. All failures occurred in the repair region, rather than at the clamps. However, failure mechanisms were different between the 2 techniques—PT repairs failed by the suture knots either slipping or pulling through the tendon material, followed by the FDS tendon pulling through the FDP tendon; SS repairs failed by shearing of fibers within the FDS. Load at first failure, ultimate load, and repair stiffness were all significantly different between SS and PT techniques; in all cases, the mean value for SS was higher than for PT.<br /><br />Conclusions<br />The SS repair using a cross-stitch suture technique was significantly stronger and stiffer than the PT repair using a mattress suture technique. This suggests that using SS repairs could enable patients to load the repair soon after surgery. Ultimately, this should reduce the risk of developing adhesions and result in improved functional outcome and fewer complications in the acute postoperative period. Future work will address the specific mechanisms (eg, suture-throw technique and tendon-weave technique) that underlie the improved strength and stiffness of the SS repair.Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-71380043746896811152010-03-12T16:59:00.000-08:002010-03-12T17:17:15.239-08:00Biomechanical Studies of Donor Muscle Tension in Tendon Transfer Surgery<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_B32TnLIpjqk/S5rlFEcb1kI/AAAAAAAAAQg/FNlvSkaLdi4/s1600-h/Safe+zone.jpg"><img style="float: left; margin: 0pt 10px 10px 0pt; cursor: pointer; width: 200px; height: 168px;" src="http://4.bp.blogspot.com/_B32TnLIpjqk/S5rlFEcb1kI/AAAAAAAAAQg/FNlvSkaLdi4/s200/Safe+zone.jpg" alt="" id="BLOGGER_PHOTO_ID_5447918574513149506" border="0" /></a>Based on recent biomechanical studies undertaken at the Department of Orthopaedics, University of California, San Diego, U.S.A. there is a safe zone during transfer of the brachioradialis to power the thumb flexor. This result is based on testing of the influence upon brachioradialis-to-flexor pollics longus attachment site using buckle transducer under manipulation of elbow and wrist joint position. The study indicates that passive tensions exceeding 10-12 N can barely be achieved. Even this tension level is far less than the potential breaking level for a comparable tendon-to-tendon attachment which is at approximately 200 N (safety factor of 10) according to recent load-to-failure study. The study implies that free motion of the elbow can be allowed without harming the reconstruction of thumb flexion using brachioradialis as donor muscle-tendon construct in the immediate postoperative mobilization after this kind of reconstruction.Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-4737228701508287312009-12-26T14:30:00.000-08:002009-12-26T15:45:34.997-08:00Current Trends in Surgical Treatment of Spasticity in Tetraplegia<div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_B32TnLIpjqk/SzaOoWGdANI/AAAAAAAAAHk/B8wpP6rLkRs/s1600-h/Slide1.jpg"><img style="cursor:pointer; cursor:hand;width: 226px; height: 320px;" src="http://3.bp.blogspot.com/_B32TnLIpjqk/SzaOoWGdANI/AAAAAAAAAHk/B8wpP6rLkRs/s320/Slide1.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5419676025365528786" /></a></div><br /><br />This poster was awarded best poster prize at the recent ISCOS Congress in Florence (October, 2009). It reports the modern treatment strategies and outcomes of surgical reconstruction and ensuing training in tetraplegia with spasticity.Jan Fridénhttp://www.blogger.com/profile/07779686485402805490noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-59904441587121495592009-10-10T04:07:00.000-07:002009-12-26T14:29:33.340-08:00Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injuryAnderson KD, Fridén J, Lieber RL. Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury. <span style="font-weight: bold;">Spinal Cord 47:334-338, 2009</span><br /><br />Study Design: Secure, web-based survey. Objectives: To determine how quadriplegics in the US view tendon transfer surgeries (TTS) and what activities of daily living (ADL) involving arm|[sol]|hand function are important in improving quality of life (QoL). Setting: World wide web. Methods: Individuals |[ges]|18 years of age living with a cervical spinal cord injury (SCI). Participants obtained a pass code to enter a secure website and answered survey questions. A total of 137 participants completed the survey. Results: Two-thirds of participants had injury levels between C4|[sol]|5 and C5|[sol]|6. Over 90|[percnt]| felt that improving their arm|[sol]|hand function would improve their QoL. ADL that were ranked most important to regain were dressing, feeding, transferring in|[sol]|out of bed, and handwriting. Less than half of the participants had never been told about TTS and only 9|[percnt]| had ever had TTS. Nearly 80|[percnt]| reported that they would be willing to spend 2–3 months being less independent, while recovering from surgery, to ultimately become more independent. Over 75|[percnt]| reported that the ideal time preferred to have TTS, if chosen, would be within 5 years post-injury. Conclusion: Regaining arm and hand function is of primary importance to individuals with cervical SCI, in particular, to increase independence in multiple ADL. There is a critical need in the US to improve awareness of TTS as a viable option for improving arm|[sol]|hand function in some people. This information needs to be provided early after injury so that informed choices can be made within the first 5 years. Sponsorship: Funded by the National Center for Muscle Rehabilitation Research (UCSD-39889) and the Reeve-Irvine Research Center. Spinal Cord (2009) 47, 334–338; doi:10.1038/sc.2008.148; published online 25 November 2008Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com1tag:blogger.com,1999:blog-6247411805954242779.post-84513926830240840112008-10-09T04:12:00.000-07:002009-11-01T03:25:59.481-08:00Subscapularis muscle mechanics in children with obstetric plexus palsy<div style="text-align: justify;"><span style=";font-family:Times New Roman;font-size:130%;" >Einarsson F, Hultgren T, Ljung B-O, Runesson E, Fridén J. Subscapularis muscle mechanics in children with obstetric plexus palsy. <b>J Hand Surg (E) 33:507-512, 2008.</b></span><br /></div><br /><div style="text-align: justify;"> This study investigates the passive mechanical properties of the subscapularis muscle in children with a contracture as a result of obstetrical brachial plexus palsy. Muscle biopsies were harvested from nine children undergoing open surgery for shoulder contracture. Passive mechanical testing of single cells and muscle bundles was performed. Corresponding comparisons were made using muscle biopsies from seven healthy controls.<br /></div><br /><div style="text-align: justify;">Single muscle fibres from patients with obstetric brachial plexus palsy displayed a shorter slack sarcomere length, linear deformation of the fibre within a wider zone of sarcomere length and a greater relative increase in stiffness compared with muscle bundles. We conclude that secondary changes in muscle fibre properties will occur as a result of a longstanding lack of sufficient passive stretch, leading to compensatory changes in the extracellular matrix. These results suggest the presence of a dynamic feedback system constituting a muscle-to-extracellular matrix communication interface.</div>Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-8227225044789208992008-10-09T04:10:00.000-07:002009-11-01T03:25:14.231-08:00Current concepts in reconstruction of hand function in tetraplegia<p style="text-align: justify;"><span style=";font-family:Times New Roman;font-size:130%;" >Fridén J, Reinholdt C. Current concepts in reconstruction of hand function in tetraplegia. <b> Scand J Surg 97:341-346, 2008.</b></span><br /></p><div style="text-align: justify;"> Several recent developments in the field of reconstructive hand surgery in tetraplegia have created a foundation for further refinements of both surgical techniques and postoperative training strategies to improve the outcome of restoration of upper extremity functions. A remarkable means of improving function is the immediate activation of transferred muscle after surgery. Early active training of new motors not only prevents the formation of adhesions but facilitates the voluntary recruitment of motors powering new functions before swelling and immobilization-induced stiffness restrain muscle contractions.<br /></div><br /><div style="text-align: justify;">A common observation internationally over the past years is that the number of incomplete tetraplegics increases. This shift towards more incomplete injuries with spasticity as a common feature in addition to the paralysis has expanded and changed the spectrum of surgeries in this group of patients and also emphasizes the need for a revisit and further development of the different strategies for reconstruction of hand function.</div>Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-3127760932074903882008-08-07T04:15:00.000-07:002009-08-07T04:16:13.679-07:00Nervale und muskuläre Ersatzoperationen zur Wiederherstellung der gelähmten Ellenbogenfunktion<p style="text-align: justify;"><span style=";font-family:Times New Roman;font-size:130%;" >Gohritz A, Fridén J, Spies M, Herold C, Guggenheim M, Knobloch K, Vogt PM. Nervale und muskuläre Ersatzoperationen zur Wiederherstellung der gelähmten Ellenbogenfunktion. <b> Undfallchirurg 2:85-101, 2008.</b></span><br /></p><div style="text-align: justify;">Paralysis of elbow flexion or extension leads to major impairment of upper extremity function. Surgical reconstruction can be achieved using several procedures. If the time interval since the nerve injury is short, anatomic reconstruction by means of nerve suture or nerve transplantation should be attempted. Alternatively, nerve transposition is possible. If more than 12-18 months have elapsed, reinnervation of arm muscles can no longer be expected. In this case, muscle transposition is helpful.<br /><br />Restoring flexion is predominantly required following brachial plexus injury, when the function of the biceps, brachioradialis and brachialis muscles are lost. As donor muscles the latissimus dorsi, pectoralis major and triceps brachii can be used, alternatively a transfer of the flexor-pronator muscles of the forearm is possible. Latissimus dorsi transfer to reconstruct elbow flexion is also indicated in defects of the anterior upper arm muscle compartiment due to trauma, ischemia, or tumor. Patients with proximal radial nerve lesions may benefit from latissimus transfer to reachieve elbow flexion extension.In tetraplegic patients, elbow extension is restored mainly by transfer of the posterior deltoid muscle extended with a tendon graft, or by means of a biceps-to-triceps transfer.</div>Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-55590833602864798682008-08-07T04:14:00.000-07:002009-08-07T04:16:28.323-07:00Immobilization of the rabbit tibialis anterior muscle in a lengthened position causes addition of sarcomeres in series and extra-cellular matrix proli<p style="text-align: justify;"><span style=";font-family:Times New Roman;font-size:130%;" >Pontén E, Fridén J. Immobilization of the rabbit tibialis anterior muscle in a lengthened position causes addition of sarcomeres in series and extra-cellular matrix proliferation. <b>J Biomech 41:1801-1804, 2008.</b></span><br /></p><div style="text-align: justify;"> Rabbits were immobilized for 3 weeks with the ankle in plantar flexion, midrange position or dorsal extension (n=15). The left leg was used as control. Sarcomere lengths were measured by laser diffraction in vivo in the tibialis anterior (TA) muscle. Legs immobilized in the midrange position showed coherent diffraction patterns through the range of motion, but in those immobilized with TA in the stretched position no diffraction patterns in vivo could be obtained.<br /><br />Morphological analyses revealed increased fibrosis and occurrence of whorled fibers in these muscles. On 15 more likewise immobilized rabbits, a technique of measuring sarcomere lengths in vitro by first digesting the collagen in nitric acid was developed. These in vitro measurements showed shorter sarcomeres in the muscles immobilized in a lengthened position compared to the control, indicating an addition of sarcomeres in series.</div>Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-42976784853624396812008-08-07T04:13:00.000-07:002009-12-26T12:36:08.376-08:00StatementAt the recent world congress in reconstructive hand surgery and rehabilitation in tetraplegia, a resolution regarding assessment of individuals with tetraplegia was presented and accepted. Briefly, this resolution stated that every person who sustains a cervical spinal cord injury with tetraplegia should be examined, assessed and informed concerning the options of possible reconstruction of motor function of the hands and arms. It is of course a long way before this ambitious goal can be achieved but the resolution put forward by the leading experts in this field certainly stresses the necessity of increasing the awareness and improving the infrastructure to meet patients’ demand of informed discussions of options for improvement of hand function.Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-9974358198344025292008-08-07T03:52:00.007-07:002014-02-21T00:51:39.215-08:00Bibliography<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: 130%;"><span style="font-size: small;"><span style="font-weight: normal;">Fridén J, Reinholdt Gohritz A,Peace WJ, Ward SR, Lieber RL. J Hand Surg Eur 37(4):323-8, 2012. <b> </b>Simultaneous powering of forearm pronation and key pinch in tetraplegia using a single muscle-tendon unit. </span></span></span><span style="font-size: 130%;"><span style="font-size: small;"><span style="font-weight: normal;"><b>J Hand Surg Eur 37(4):323-8, 2012.</b></span></span></span></div>
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<span style="font-size: 130%;">2011</span><br />
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Fridén J, Reinholdt C, Turcsanyii I, Gohritz A. <a href="http://http//research.tetrahand.com/2012/03/single-stage-operation-for.html">A single-stage operation for reconstruction of hand flexion, extension, and intrinsic function in tetraplegia: the alphabet procedure.</a> <b>Tech Hand Up Extrem Surg 15(4):230-239, 2011.</b><span style="font-size: 100%;"><br /></span></div>
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<span style="font-size: 100%;"><span style="font-size: 100%;">Wangdell J, Fridén J. <a href="http://research.tetrahand.com/2011/05/performance-of-prioritized-activities.html">Performance of prioritized activities is not correlated with functional factors after grip reconstruction in tetraplegia.</a> <span style="font-weight: bold;">Rehabil Med 2011; 43: 626–630.</span></span></span><br />
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<span style="font-size: 100%;">Reinholdt C, Fridén J. <span style="font-size: 100%;"><a href="http://research.tetrahand.com/2011/05/selective-release-of-digital-extensor.html">Selective release of the digital extensor hood to reduce intrinsic tightness in tetraplegia.</a><a href="https://www.blogger.com/null" title="Journal of plastic surgery and hand surgery."> <span style="font-weight: bold;">J Plast Surg Hand Surg.</span></a><span style="font-weight: bold;"> 2011 Apr;45(2):83-9.</span></span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 100%;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Einarsson%20F%22%5BAuthor%5D" style="color: black;">Einarsson F</a><span style="color: black;">, </span><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Runesson%20E%22%5BAuthor%5D" style="color: black;">Runesson E</a><span style="color: black;">, </span><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Karlsson%20J%22%5BAuthor%5D" style="color: black;">Karlsson J</a><span style="color: black;">, </span><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Frid%C3%A9n%20J%22%5BAuthor%5D" style="color: black;">Fridén J</a><span style="color: black;">.</span></span><span style="color: black;"> <a href="http://research.tetrahand.com/2011/05/performance-of-prioritized-activities.html"> </a></span><a href="http://research.tetrahand.com/2011/05/performance-of-prioritized-activities.html"><span style="color: black; font-size: 100%;">Muscle biopsies from the supraspinatus in retracted rotator cuff tears respond normally to passive mechanical testing: a pilot study.</span></a><a href="http://research.tetrahand.com/2011/06/muscle-biopsies-from-supraspinatus-in.html"> </a><span style="font-weight: bold;">Knee Surg Sports Traumatol Arthrosc.</span><span style="color: black; font-weight: bold;"> 2011 Mar;19(3):503-7.</span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">2010</span></span><br />
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<span style="font-size: 100%;">Fridén J, Shillito MC, Chehab EF, Finneran JJ, Ward SR, Lieber RL.<span style="font-size: 100%;"><a href="http://research.tetrahand.com/2010/08/mechanical-feasibility-of-immediate.html">Mechanical Feasibility of Immediate Mobilization of the Brachioradialis Muscle After Tendon Transfer.</a></span> <span style="font-weight: bold;">J Hand Surg Am </span><span style="font-weight: bold;">35:1473-1478, 2010.</span></span><br />
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<span style="font-size: 100%;">Wangdell J, Fridén J. <span style="font-size: 100%;"><a href="http://research.tetrahand.com/2010/06/satisfaction-and-performance-in-patient.html">Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia.</a></span><span style="font-weight: bold;"> J Hand Surg Eur </span><span style="font-weight: bold;">35(7):563-568</span><span style="font-weight: bold;">, 2010.</span></span><br />
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<span style="font-size: 100%;">Turcsanyi I, Fridén J. <span style="font-size: 100%;"><a href="http://research.tetrahand.com/2010/09/shortened-rehabilitation-period-using.html">Shortened rehabilitation period using a modified surgical technique for reconstruction of lost elbow extension in tetraplegia.</a><span style="font-weight: bold;"> </span><a href="https://www.blogger.com/null" style="font-weight: bold;">J Plast Surg Hand Surg</a><span style="font-weight: bold;"> 44(3):156-62, 2010.</span></span></span><br />
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Brown </span><span style="font-family: Times New Roman; font-size: 100%;">SHM</span><span style="font-family: Times New Roman; font-size: 100%;">, Hentzen </span><span style="font-family: Times New Roman; font-size: 100%;">ER</span><span style="font-family: Times New Roman; font-size: 100%;">, Kwan ABS, Ward </span><span style="font-family: Times New Roman; font-size: 100%;">SR.</span><span style="font-family: Times New Roman; font-size: 100%;">, Fridén </span><span style="font-family: Times New Roman; font-size: 100%;">J</span><span style="font-family: Times New Roman; font-size: 100%;">, Lieber RL. </span><a href="http://research.tetrahand.com/2010/04/mechanical-strength-of-side-to-side.html">Mechanical Strength of the Side-to-Side Versus Pulvertaft Weave Tendon Repair</a><span style="font-family: Times New Roman; font-size: 100%;">. </span><span style="font-family: Times New Roman; font-size: 100%;"><b>J Hand Surg 35A:540-545, 2010.</b></span></span><br />
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<span style="font-size: 100%;"><span style="font-size: 130%;">2009</span></span><br />
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;"><span style="font-size: 100%;">Anderson KD, Fridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2009/08/acceptable-benefits-and-risks.html">Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury.</a> <b> Spinal Cord 47:334-338, 2009.</b></span></span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">2008</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J, Reinholdt C. <a href="http://tetrahand-research.blogspot.com/2009/08/current-concepts-in-reconstruction-of.html">Current concepts in reconstruction of hand function in tetraplegia. </a><b> Scand J Surg 97:341-346, 2008.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Einarsson F, Hultgren T, Ljung B-O, Runesson E, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/subscapularis-muscle-mechanics-in.html">Subscapularis muscle mechanics in children with obstetric plexus palsy</a>. <b>J Hand Surg (E) 33:507-512, 2008.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Einarsson F, Runesson E, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/passive-mechanical-features-of-single.html">Passive mechanical features of single fibers from human muscle biopsies – effects of storage</a>. <b>J Orthop Surg Res 3:22, 2008.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Pontén E, Fridén J. <a href="http://tetrahand-research.blogspot.com/2009/08/immobilization-of-rabbit-tibialis.html"> Immobilization of the rabbit tibialis anterior muscle in a lengthened position causes addition of sarcomeres in series and extra-cellular matrix proliferation</a>. <b>J Biomech 41:1801-1804, 2008.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Gohritz A, Fridén J, Spies M, Herold C, Guggenheim M, Knobloch K, Vogt PM. <a href="http://tetrahand-research.blogspot.com/2008/08/nervale-und-muskulare-ersatzoperationen.html">Nervale und muskuläre Ersatzoperationen zur Wiederherstellung der gelähmten Ellenbogenfunktion</a>. <b> Undfallchirurg 2:85-101, 2008.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">M.deltoideus auf den M.triceps. <b> Undfallchirurg 2:102-106, 2008.</b></span><span style="font-style: italic;"> Abstract not available</span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">2007</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Gohritz A, Fridén J, Herod C, Spies M, vogt PM. Tenodes des Daumenendgelenks mit geteilter Flexor-pollicis-longus-Sehne. <b>Undfallchirurg 110:777-779, 2007.</b></span><span style="font-family: Times New Roman; font-size: 100%;"><i> Abstract not available</i></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Gohritz A, Fridén J, Herold C, Aust M, spies M, Vogt PM. <a href="http://tetrahand-research.blogspot.com/2008/08/erstazoperationen-bei-ausfall.html">Erstazoperationen bei Ausfall motorisher Funktionen and der Hand</a>. <b>Undfallchirurg 110:759-776, 2007.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Dahlgren A, Karlsson A-K, Lundgren-Nilsson Å, Fridén J, Claesson L. <a href="http://tetrahand-research.blogspot.com/2009/08/activity-performance-in-cervical-spinal.html">Activity performance in cervical spinal cord injury patients according to the Klein-Bell ADL Scale</a>. <b>Spinal Cord 45:475-484, 2007.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">2006</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J, Ward SR, Smallwood L, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/passive-muscle-tendon-amplitude-may-not.html">Passive muscle-tendon amplitude may not reflect skeletal muscle functional excursion</a>. <b>J Hand Surg 31A:1105-1110, 2006.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Murray WM, Hentz VR, Fridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/variability-in-surgical-technique-for.html">Variability in surgical technique for brachioradialis tendon transfer</a>. <b>J Bone Joint Surg 88A:2009-2016, 2006.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Ward SR, Peace WJ, Fridén J, Lieber RL. <a href="http://www.blogger.com/post-edit.g?blogID=6247411805954242779&postID=7971498375046449017">Dorsal transfer of the brachioradialis to the flexor pollicis longus enables simultaneous powering of key pinch and forearm pronation</a>. <b>J Hand Surg (Am) 31A:993-997, 2006.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Ward SR, Hentzen ER, Smallwood LH, Eastlack RK, Burns KA, Fithian DC, Fridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/rotator-cuff-muscle-architecture.html">Rotator cuff muscle architecture; implications for glenohumeral joint stability</a>. <b> Clin Orthop Rel Res 448:157-163, 2006.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">2005</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Abrams GD, Ward SR, Ridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2009/08/pronator-teres-in-appropriate-donor.html">Pronator teres in an appropriate donor muscle for restoration of wrist and thumb extension</a>. <b>J Hand Surg (Am) 30A:1068-1073, 2005.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J. <a href="http://tetrahand-research.blogspot.com/2009/08/pronator-teres-in-appropriate-donor.html">Neue Konzepte zur Rekonstruktion der Arm- und Handfunktion bei Tetraplegie – Grundlagenforschung und klinische Anwendung</a>. <b>Handchir Mikrochir Plast Chir 37:223-229, 2005.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Ejeskär A, Dahlgren A, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/clinical-and-radiographic-evaluation-of.html">Clinical and radiographic evaluation of surgical reconstruction of finger flexion in tetraplegia</a>. <b>J Hand Surgery (Am) 30A:842-849, 2005.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Pontén E, Fridén J, Thornell L-E, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/spastic-wrist-flexors-are-more-severely.html">Spastic wrist flexors are more severely affected than wrist extensors in children with cerebral palsy</a>. <b>Dev Med Child Neurol 47:384-389, 2005.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Murray W, Clark DL, Hentz VR, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/biomechanical-properties-of.html">Biomechanical Properties of the Brachioradialis Muscle: Implications for Surgical Tendon Transfer</a>. <b>J Hand Surg (Am) 30A:273-282, 2005.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">2004</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J, Lovering R, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/fiber-length-variability-within-flexor.html">Fiber length variability within the flexor carpi ulnaris and flexor carpi radialis muscles: Implications for surgical tendon transfer</a>. <b> J Hand Surgery (Am)</b> <b>29A:909-914, 2004.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/implications-of-muscle-design-on.html">Implications of Muscle Design on Surgical Reconstruction of Upper Extremities</a>. <b> Clin Orthop Rel Res 419: 267-279, 2004.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">2003</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Runesson E, Einarsson F, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/inferior-mechanical-properties-of.html">Inferior mechanical properties of spastic muscle bundles due to hypertrophic but compromised extracellular matrix material.</a> <b> Musle & Nerve 28:464-471, 2003.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/reconstructive-hand-surgery-improves.html">Reconstructive hand surgery improves hand function in tetraplegia. Basic research and clinical studies paved the way for this development</a>. <b>Läkartidningen 24:2133-39, 2003.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Fridén J, Hobbs T, Rothwell AG. <a href="http://tetrahand-research.blogspot.com/2008/08/analysis-of-posterior-deltoid-function.html">Analysis of posterior deltoid function one year after surgical restoration of elbow extension</a>. <b>J Hand Surg (Am) 28A: 288-293, 2003.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/spastic-muscle-cells-are-shorter-and.html"> Spastic muscle cells are shorter and stiffer than normal cells</a>. <b> Muscle & Nerve 26: 157-164, 2003.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">2002</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/tendon-transfer-surgery-clinical.html">Tendon Transfer Surgery-Clinical Implications of Experimental Studies</a>. <b> Clin Orthop Rel Res 403S: S163-170, 2002.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/mechanical-considerations-in-design-of.html">Mechanical Considerations in the Design of Surgical Reconstructive Procedures</a>. <b> J Biomech 35: 1039-1045, 2002.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Ejeskär A, Dahlgren A, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/split-distal-flexor-pollicis-longus.html">The split distal flexor pollicis longus tenodesis – longterm results</a>. <b>Scand J Plast Reconstr Surg Hand Surg 36:96-99, 2002.</b></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Fridén J. <a href="http://tetrahand-research.blogspot.com/2009/08/spasticity-causes-fundamental.html">Spasticity causes a fundamental rearrangement of muscle-joint interaction</a>. <b> Muscle & Nerve 25: 265-270, 2002.</b></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">2001</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/clinical-significance-of-skeletal.html"> Clinical significance of skeletal muscle architecture</a>. <b>Clin Orthop Rel Res 383:140-151, 2001.</b></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"></span><br />
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J, Albrecht D, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/biomechanical-analysis-of.html">Biomechanical analysis of the brachioradialis as a donor in tendon transfer</a>. <b>Clin Orthop Rel Res 383:152-161, 2001.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;"><span style="font-size: 100%;">Fridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/quantitative-evaluation-of-posterior.html">Quantitative evaluation of the posterior deltoid-to-triceps tendon transfer based on architectural properties</a>. <b> J Hand Surg (Am) 26A:147-155, 2001.</b></span></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">2000</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/functional-and-clinical-significance-of.html">Functional and clinical significance of skeletal muscle architecture.</a> <b>Muscle & Nerve 23:1647-1666, 2000.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J, Ejeskär A, Dahlgren A, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/protection-of-deltoid-to-triceps-tendon.html">Protection of the deltoid to triceps tendon transfer repair sites</a>. <b>J Hand Surg 25A:144-149, 2000.</b></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J, Pontén E, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/effect-of-muscle-tension-during-tendon.html">Effect of muscle tension during tendon transfer on sarcomerogenesis in a rabbit model</a>. <b>J Hand Surg 25A:138-143, 2000.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">1999</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Ljung B-O, Fridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/sarcomere-length-varies-with-wrist.html">Sarcomere length varies with wrist ulnar deviation but not forearm pronation in the extensor carpi radialis brevis muscle</a>. <b> J Biomech</b> <b>32:199-202, 1999.</b></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">1998</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/rekonstruktiv-handkirurgi-efter.html">Rekonstruktiv handkirurgi efter cervikal spinal skada: Ny teknik ökar möjligheterna att återskapa viktiga funktioner</a>. <b>Läkartidningen 95:3072-3074, 1998. </b></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/musculoskeletal-balance-of-human-wrist.html">Musculoskeletal balance of the human wrist elucidated using intraoperative laser diffraction</a>. <b> J Electromyog Kinesiol 8:93-100, 1998.</b></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Fridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/evidence-for-muscle-attachment-at.html">Evidence for muscle attachment at relatively long lengths in tendon transfer surgery</a>. <b>J Hand Surg 23A:105-110, 1998.</b></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">1997</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/intraoperative-measurement-and.html"> Intraoperative measurement and biomechanical modeling of the flexor carpi ulnaris-to-extensor carpi radialis longus tendon transfer</a>. <b> J Biomech E 119:386-391, 1997.</b></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Ljung B-O, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/sarcomere-length-in-wrist-extensor.html">Sarcomere length in wrist extensor muscles</a>. <b>Acta Orthop Scand 68:249-254, 1997</b>.</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Ljung B-O, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/intraoperative-sarcomere-length.html">Intraoperative sarcomere length measurements reveal differential design of long and short human wrist extensor muscles</a>. <b>J Exp Biol 200: 19-25, 1997.</b></span></span></div>
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<span style="font-size: 100%;"><span style="font-size: 130%;">1996</span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Lieber RL, Pontén E, Burkholder TJ, Fridén J. <a href="http://tetrahand-research.blogspot.com/2008/08/sarcomere-length-changes-after-flexor.html">Sarcomere length changes after flexor carpi ulnaris-to-extensor digitorum communis tendon transfer</a>. <b>J Hand Surg</b> <b>21A:612-618, 1996.</b></span><span style="font-size: 100%;"> </span></span></div>
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<span style="font-size: 100%;"><span style="font-family: Times New Roman; font-size: 100%;">Loren GJ, Shoemaker SD, Burkholder TJ, Jacobson MD, Fridén J, Lieber RL. <a href="http://tetrahand-research.blogspot.com/2008/08/human-wrist-motors-biomechanical-design.html">Human wrist motors: biomechanical design and application to tendon transfers</a>. <b>J Biomech 29:331-342, 1996.</b></span><span style="font-size: 100%;"> </span></span></div>
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Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-33227761755182348262007-08-07T04:20:00.000-07:002009-11-01T03:27:11.606-08:00Activity performance in cervical spinal cord injury patients according to the Klein-Bell ADL Scale<p style="text-align: justify;"><span style=";font-family:Times New Roman;font-size:130%;" >Dahlgren A, Karlsson A-K, Lundgren-Nilsson Å, Fridén J, Claesson L. Activity performance in cervical spinal cord injury patients according to the Klein-Bell ADL Scale. <b>Spinal Cord 45:475-484, 2007.</b></span><br /></p><div style="text-align: justify;"> STUDY DESIGN: Cross-sectional study. OBJECTIVES: (1) To examine whether the Klein-Bell ADL Scale (K-B Scale) discriminates cervical spinal cord injury (SCI) patients in daily activities and to explore its applicability in this group of patients. (2) To examine the association between basic ADL and upper extremity function. (3) To investigate if grip ability can be discerned in the scale.<br /><br />SETTING: Spinal Cord Injury Unit, Sahlgrenska University Hospital, Göteborg, Sweden.<br /><br />METHODS: Fifty-five patients with cervical SCI with no prior reconstructive hand surgery were included in the study. Analyses of the patient's independence were made according to the K-B Scale. Three additional analyses were carried out, the first examined whether the use of assistive devices and house and car adaptations influenced independence. The last two used different approaches to investigate whether arm and grip function could be detected in the K-B scale.<br /><br />RESULTS: Raw score in the K-B Scale can discriminate for independence in daily activities but the scale's weight scheme does not function for cervical SCI patients. Assistive devices and car and house adaptations can compensate for dependence in daily activities. Lack of grip function decreases the patient's ability to become independent. Diagnosis-related activities cannot be assessed in all items.<br /><br />CONCLUSION: The K-B Scale's raw score was useful assessing daily activities in cervical SCI patients. Its reliability in conjunction with arm and grip function in patients with cervical SCI has yet to be proven.</div>Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-90941402892145048302007-08-07T04:17:00.000-07:002009-11-01T03:27:02.677-08:00Erstazoperationen bei Ausfall motorisher Funktionen and der Hand<p style="text-align: justify;"><span style=";font-family:Times New Roman;font-size:130%;" >Gohritz A, Fridén J, Herold C, Aust M, spies M, Vogt PM. Erstazoperationen bei Ausfall motorisher Funktionen and der Hand. <b>Undfallchirurg 110:759-776, 2007.</b></span><br /></p><div style="text-align: justify;"> Nerve injuries in the upper extremity can result in severe disability. In the last three decades, progress in microsurgical techniques has improved the outcome for nerve injuries and if the prognosis is reasonably good, nerve repair should usually be performed prior to tendon transfer procedures. However, above all proximal lesions of peripheral nerves such as high radial nerve palsy still often yield unsatisfactory results, despite a technically well-executed nerve repair. Prognosis further depends on the time interval since the injury and also on the age of the patient, as the regenerative process is delayed in older patients.<br /></div><br /><div style="text-align: justify;">The indication for tendon transfers strongly depends on the personal and professional profiles of the individual patient. Tendon transfer procedures alleviate the suffering from functional hand impairment providing a superior alternative to permanent external splints. Tendon transfers are usually secondary procedures for replacing function after evaluation of the functional motor loss. Numerous transfer procedures have been described for every nerve trunk of the upper extremity, their prognosis depending mainly on the extent and pattern of nerve loss, local effects of the trauma (e.g. involvement of soft tissues, joints), and the physiological characteristics of the transferred muscle.<br /></div><div style="text-align: justify;"><br />Even if the results of the tendon transfers may finally be less satisfactory in cases of complex nerve damage than in isolated motor nerve lesions, they offer a valuable functional benefit, often being the only possibility to restore hand function. Although regrettably underused, tendon transfer improve upper extremity function in more than 70% of patients with cervical spinal cord injury. Reconstruction of key elements such as wrist extension, key grip between the thumb and the index finger, or digital flexion and extension leads to highly improved use of the tetraplegic hand and thus provides new mobility and independence from the help of others. This article presents an overview of the most common procedures to restore hand function in peripheral nerve injuries and tetraplegia in order to provide a systematic approach for decision making.</div>Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-32165210276444664712006-08-07T04:30:00.000-07:002009-11-01T03:28:30.955-08:00Rotator cuff muscle architecture; implications for glenohumeral joint stability<p style="text-align: justify;"><span style=";font-family:Times New Roman;font-size:130%;" >Ward SR, Hentzen ER, Smallwood LH, Eastlack RK, Burns KA, Fithian DC, Fridén J, Lieber RL. Rotator cuff muscle architecture; implications for glenohumeral joint stability. <b> Clin Orthop Rel Res 448:157-163, 2006.</b></span><br /></p><div style="text-align: justify;">We examined the architectural properties of the rotator cuff muscles in 10 cadaveric specimens to understand their functional design. Based on our data and previously published joint angle-muscle excursion data, sarcomere length operating ranges were modeled through all permutations in 75 masculine medial and lateral rotation and 75 masculine abduction at the glenohumeral joint. Based on physiologic cross-sectional area, the subscapularis would have the greatest force-producing capacity, followed by the infraspinatus, supraspinatus, and teres minor. Based on fiber length, the supraspinatus would operate over the widest range of sarcomere lengths.<br /><br />The supraspinatus and infraspinatus had relatively long sarcomere lengths in the anatomic position, and were under relatively high passive tensions at rest, indicating they are responsible for glenohumeral resting stability. However, the subscapularis contributed passive tension at maximum abduction and lateral rotation, indicating it plays a critical role in glenohumeral stability in the position of apprehension.<br /><br />These data illustrate the exquisite coupling of muscle architecture and joint mechanics, which allows the rotator cuff to produce near maximal active tensions in the midrange and produce passive tensions in the various end-range positions. During surgery relatively small changes to rotator cuff muscle length may result in relatively large changes in shoulder function.<br /></div>Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-79714983750464490172006-08-07T04:28:00.000-07:002009-11-01T03:28:21.973-08:00Dorsal transfer of the brachioradialis to the flexor pollicis longus enables simultaneous powering of key pinch and forearm pronation<p style="text-align: justify;"><span style=";font-family:Times New Roman;font-size:130%;" >Ward SR, Peace WJ, Fridén J, Lieber RL. Dorsal transfer of the brachioradialis to the flexor pollicis longus enables simultaneous powering of key pinch and forearm pronation. <b>J Hand Surg (Am) 31A:993-997, 2006.</b></span><br /></p><div style="text-align: justify;"> PURPOSE: To show biomechanically that the brachioradialis (BR) muscle can be transferred to restore key pinch and forearm pronation simultaneously.<br /><br />METHODS: Nine fresh-frozen forearms were thawed and instrumented with a custom muscle-tendon excursion jig. Maximum BR muscle-tendon excursion was measured with the wrist and thumb mobile. Muscle-tendon excursion then was measured from 60 degrees of supination to 60 degrees of pronation in 15 degrees increments with the wrist and thumb fixed. Measurements were performed in 3 configurations: the native BR, the BR transferred volarly to the flexor pollicis longus (FPL) tendon, and the BR transferred dorsally (posterior to the radius) through the interosseous membrane to the FPL tendon. Muscle excursion-joint angle data were differentiated to compute pronation/supination moment arms. Two-way analyses of variance and post hoc Tukey tests were used to compare transfer conditions.<br /><br />RESULTS: Maximum muscle excursion was nearly identical when volar and dorsal transfer conditions were compared. When pronation/supination motions were isolated, however, the volar transfer was associated with muscle shortening and small pronation moment arms through 30 degrees +/- 9 degrees of supination. Importantly, the dorsal transfer was associated with muscle shortening and larger pronation moment arms through 28 degrees +/- 10 degrees of pronation, a significant difference of 58.0 degrees +/- 16.0 degrees compared to the traditional volar transfer.<br /><br />CONCLUSIONS: These data suggest that dorsal BR-to-FPL transfers can power key pinch and forearm pronation simultaneously even in the absence of other functional pronators. This transfer can be accomplished without changes to total muscle excursion compared with the traditional volar BR-to-FPL transfer. This result may enable the use of the BR-to-FPL transfer in patients who need key pinch but who lack functional pronation muscle groups (eg, ocular cutaneous 3). As result a larger patient population may benefit from the BR-to-FPL reconstructive procedure.<br /></div>Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-85691866356934590772006-08-07T04:25:00.000-07:002009-11-01T03:28:11.285-08:00Variability in surgical technique for brachioradialis tendon transfer<p style="text-align: justify;"><span style=";font-family:Times New Roman;font-size:130%;" >Murray WM, Hentz VR, Fridén J, Lieber RL. Variability in surgical technique for brachioradialis tendon transfer. <b>J Bone Joint Surg 88A:2009-2016, 2006.</b></span><br /></p><div style="text-align: justify;">BACKGROUND: Transfer of the tendon of the brachioradialis muscle to the tendon of the flexor pollicis longus restores lateral pinch function after cervical spinal cord injury. However, the outcomes of the procedure are unpredictable, and the reasons for this are not understood. The purpose of this study was to document the degree of variability observed in the performance of this tendon transfer.<br /><br />METHODS: The surgical technique used for the brachioradialis tendon transfer was assessed in two ways. First, the surgical attachment length of the brachioradialis was quantified, after transfer to the flexor pollicis longus, with use of intraoperative laser diffraction to measure muscle sarcomere length in eleven individuals (twelve limbs) with tetraplegia. Second, ten surgeons who regularly performed this procedure were surveyed regarding their tensioning preferences. Using a biomechanical model of the upper extremity, we investigated theoretically the effect of different surgical approaches on the active muscle-force-generating capacity of the transferred brachioradialis in functionally relevant elbow, wrist, and hand postures.<br /><br />RESULTS: The average sarcomere length (and standard deviation) of the transferred brachioradialis was 3.5 +/- 0.3 mum. That length was significantly correlated to the in situ sarcomere length (r(2) = 0.53, p <0.05).></div>Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0tag:blogger.com,1999:blog-6247411805954242779.post-47992478108369455172006-08-07T04:22:00.000-07:002009-11-01T03:27:43.374-08:00Passive muscle-tendon amplitude may not reflect skeletal muscle functional excursion<p style="text-align: justify;"><span style=";font-family:Times New Roman;font-size:130%;" >Fridén J, Ward SR, Smallwood L, Lieber RL. Passive muscle-tendon amplitude may not reflect skeletal muscle functional excursion. <b>J Hand Surg 31A:1105-1110, 2006.</b></span><br /></p><div style="text-align: justify;">PURPOSE: To quantify the gain in muscle mobility with progressive release of surrounding connective-tissue structures and to compare this property with the known architecture of each muscle.<br /><br />METHODS: Each of 5 different muscle tendon units (extensor carpi radialis brevis, extensor carpi radialis longus, flexor carpi ulnaris, flexor digitorum superficialis, pronator teres) was released from its insertion and secured into the jaws of a clamp attached to a servomotor that could be operated under length or force control to simulate the load placed on the tendon by a surgical assistant.<br /><br />A constant load of 5 N was applied to the tendon while the muscle-tendon unit was released surgically from the surrounding tissue in 1-cm increments. Mobility was plotted against release distance and analyzed by linear regression to yield mobility gain, the slope of the regression equation. One-way analysis of variance was used to compare mobility gain among muscles.<br /><br />RESULTS: In contrast to previous results from the brachioradialis muscle in which the mobility gain was large and highly nonlinear, mobility gain was small, consistent, and linear for all muscles studied. The smallest mobility gain was for the flexor digitorum superficialis and was highly linear. The largest gain was for the pronator teres and again was highly linear. In general, the mobility gain for the extensor carpi radialis brevis was similar to that of the extensor carpi radial longus. The flexor carpi ulnaris muscle was difficult to mobilize, and its gain was modest. There was no significant correlation between mobility gain of the forearm muscles during progressive release and the length of their fibers.<br /><br />CONCLUSIONS: The small mobility and complete lack of correlation with fiber length provide strong evidence that mobility gain does not accurately reflect muscle excursion as it is typically described. This calls into question the general practice of tensioning muscles by first passively extending the muscle and then choosing the attachment length as a particular portion of that passive relationship.<br /></div>Björn Fridénhttp://www.blogger.com/profile/05830445739529169406noreply@blogger.com0