IFSSH Flexor Tendon Committee report 2014: from the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang)

Hand surgeons continue to search for the best surgical flexor tendon repair and treatment of the tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating flexor tendon injuries.

Clinical primary flexor tendon repair and rehabilitation: The Bern Experience

In this chapter we present our experience with treatment of zone 2 flexor tendon repair using a six-strand repair technique combined with postoperative place-and-hold exercise. The six-strand Lim/Tsai repair technique combined with place-and-hold exercises demonstrated better digital function compared to a two-strand repair without place-and-hold exercises. Range of motion in the Lim/Tsai repair group appeared to be increased without a higher rate of ruptures but with a shorter rehabilitation period. The fact that the two groups differed in both suture techniques and rehabilitation programs made it impossible to know whether the better results in the group of Lim/Tsai were due to the six-strand repair or the place-and-hold exercises or both. Despite the obvious benefit of early active mobilization, an active motion protocol may not always be possible to apply in a substantial number of patients due to concomitant injuries, the quality of the surgical repair or patient factors (swelling, pain, limited compliance). Since August 2006 a staged rehabilitation program (“stop and go”) was introduced within our unit using early active controlled flexion (green), place-and-hold (yellow), or passive flexion exercises (red) introduced by Kleinert-Duran. Our experience using the six-strand suture repair technique and “stop and go” is outlined.

Elucidarius cabalisticus, sive reconditae Hebraeorum philosophiae brevis et succincta recensio

epitomare Joh. Georgio Wachtero

Brevis institutio linguae Syriacae ... Hebraicae antque Chaldaicae, nuper emissis, harmonica, ad collegiorum usum conscripta a Georgio Christiano Bürklino

Johann Heinrich Mai

Brevis institutio linguae Samaritanae, Hebraicae, Chalaicae atque Syriacae harmonica, contexta a Georgio Christiano Bürklino

Johann Heinrich Mai

Brevis institutio linguae Hebraicae, ad Schickardi atque Wasmuthi grammaticas praecipue accommodata, tertia vice auctius et emendatius emissa, opera ac studio Georgii Christiani Bürklini

Johann Heinrich Mai

Johannis Buxtorfii De abbreviaturis Hebraicis liber novus et copiosus : cui acc. operis Talmudici brevis recensio ... item Bibliotheca rabbinica nova, ordine alph. disposita

Text teilw. in hebr. Schr. und Sprache

Ioannis Buxtorfii De Abbreviaturis Hebraicis Liber Novus Et Copiosus : Cui Accesserunt Operis Talmudici Brevis Recensio Eiusdemque Librorum & Capitum Index: Item Bibliotheca Rabbinica Ordine Alphabetico Disposita Cum Adpendice Eidem Inserta

Teilw. in hebr. Schr.

De sacra poesi Hebræorum prælectiones academicæ Oxonii habitæ : Subjicitur metricae Harianae brevis confutatio et oratio Crewiana

Robert Lowth. Notas et Epimetra adjecit Ioannes David Michaelis ...

Via in Chaldæam brevis et expedita, in fundamentis linguæ, cum textu Chaldaico Danielis, Esræ, et Targum Obadiæ ...

ab Hermanno von der Hardt

J. C. Brucheri E. E. Isagoge grammatica, seu brevis & analytica methodo disposita delineatio syntaxeos, phraseologiæ, ut et accentuationis linguæ hebrææ : manuducens philebræos ad fusiora & ad rem grammaticam spectantia scripta, Buxtorfii, Glassii, Ouseelii, aliorumque philologorum; accedit appendix, de usu grammaticæ alatingianæ aliarumve ratiocinativo

J. C. Brucherus

The use of electromyography interference pattern analysis to determine muscle force of the deep digital flexor muscle in healthy and laminitic horses

BACKGROUND: In equine laminitis, the deep digital flexor muscle (DDFM) appears to have increased muscle force, but evidence-based confirmation is lacking. OBJECTIVES: The purpose of this study was to test if the DDFM of laminitic equines has an increased muscle force detectable by needle electromyography interference pattern analysis (IPA). ANIMALS AND METHODS: The control group included six Royal Dutch Sport horses, three Shetland ponies and one Welsh pony [10 healthy, sound adults weighing 411 ± 217 kg (mean ± SD) and aged 10 ± 5 years]. The laminitic group included three Royal Dutch Sport horses, one Friesian, one Haflinger, one Icelandic horse, one Welsh pony, one miniature Appaloosa and six Shetland ponies (14 adults, weight 310 ± 178 kg, aged 13 ± 6 years) with acute/chronic laminitis. The electromyography IPA measurements included firing rate, turns/second (T), amplitude/turn (M) and M/T ratio. Statistical analysis used a general linear model with outcomes transformed to geometric means. RESULTS: The firing rate of the total laminitic group was higher than the total control group. This difference was smaller for the ponies compared to the horses; in the horses, the geometric mean difference of the laminitic group was 1.73 [geometric 95% confidence interval (CI) 1.29-2.32], and in the ponies this value was 1.09 (geometric 95% CI 0.82-1.45). CONCLUSION AND CLINICAL RELEVANCE: In human medicine, an increased firing rate is characteristic of increased muscle force. Thus, the increased firing rate of the DDFM in the context of laminitis suggests an elevated muscle force. However, this seems to be only a partial effect as in this study, the unchanged turns/second and amplitude/turn failed to prove the recruitment of larger motor units with larger amplitude motor unit potentials in laminitic equids.