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The rupture of the biceps tendon has either thraumatic or spontaneous degenerative etiology. Degenerative tears can occur during physiological abduction of shoulder, just it has been verified in woman affected by arthromyalgic chronic pain, due to arthrosis, or lifting light weight, like the second case showed Clinical suspect has been confirmed by ultrasound in emergency, validating surgical decision, that's the only treatment for this kind of pathology (arthroscopic or wide open surgery).

The Achilles tendon rupture (ATR) is a severe injury and requires a surgical treatment which can result in functional impairment, limiting unprofessional sports activities. In order to evaluate this potential impairment 20 subjects (SG) who had received surgical treatment for ATR and 20 healthy subjects (CG) were required to execute vertical jump according to counter movement jump and squat jump protocol. For both groups the flying time (Tv) of each foot has been acquired, adopting accelerometric transducers positioned posteriorly at the level of malleolar axis. The SG's Tv is significantly lesser than the CG's one, demonstrating an inferior global performance respect to healthy people and the operated leg has a Tv 6% higher than the contralateral, while in the CG there are no statistical difference between the Tv of the limbs. For seven operated subjects Tv values are lesser than threshold values obtained from CG. For them sports activity which implies high and cyclic stress on the lower limbs could be dangerous. Functional evaluation, consequently, allow to assess impairments not differently estimable.

Partial-thickness rotator cuff tears are a challenge for shoulder surgeons. There is still no standard treatment protocol. The recent introduction of new arthroscopic techniques and a better grasp of pathogenic mechanisms along with a greater functional demand from patients, have led to the need for a thorough analysis of the problem. This paper analyses the literature in order to simplify the approach to treating partial-thickness rotator cuff tears.

Background: Prevention of adhesions that restrain tendon gliding is based on early mobilization techniques. Such approach, anyway, does not guarantee positive outcomes., Methods: Seventy-five patients for a total number of 98 flexors tendons have been treated at the University Hospital of Messina between December 1993 and January 2000. Twenty-five patients, for a total number of 26 tendons, have been seen at follow-up. Seventeen lesions involved zone 2 and 9 involved zone 1. The modified Kessler suture has been generally used. All the repairs have been followed by an adequate early mobilization protocol, according to Kleinert (passive extension/active flexion) in nine patients and according to Risitano and Savage (active extension/active flexion) in 16., Results: Minimum follow-up was 12 months. We present results with an assessment performed according to Strickland and to Elliot for lesion in zone 1 and according to Strickland and using Total Active Motion of the finger for lesions in zone 2., Conclusions: The suturing technique and mobilization protocol did not affect results, but we made some considerations about respective advantages and disadvantages of either method.

Twenty flexor tendons in 13 children with a mean age of 7 years old (range from 9 months to 14 years) were treated by primary suture between 1994-1999. Both tendons were repaired in 12 (60%) digits and only FDP in 8 (40%) with excision of FDS. Mean follow-up was 19 months (from 6 to 55 months). In the 12 fingers with FDS repair, the results were excellent in 2, good in 4, fair in 3 and poor in 3. In the 8 fingers with FDS excision, 2 rated excellent, 5 good and 1 poor. In conclusion, repair of FDP alone with regional excision of FDS simplifies the operative procedure and reduces the number of tendon sutures inside the sheath.

Aims: To investigate demographics, modalities and type of injuries among a population of isolated traumatic injuries of extensor tendons in order to evaluate the consequences on health service and on prevention., Methods: Retrospective study of injuries treated at the divisions of Plastic Surgery and Orthopedics in a third level referral center among the years 1993-1999., Main Results: Data from 173 patients were analyzed, a prevalence of males (81%) and injuries at home (55%) has been observed. Especially young adults (46.88%) have been involved, the thumb has been most interested finger and the middle finger the least, with two peaks of incidence in spring and autumn. The lesions, exposed through an extension of the existing wound, have been usually sutured according to Kessler, adding an early protected motion protocol., Conclusions: We discuss the possible causes and consequences of data observed, with special reference to the possibility of treating isolated extensor tendon injuries at district hospitals by non-hand surgeons, and primary actions of prevention.

Between 1995 and 1997 a total of 5 patients with injury of the distal tendon of the biceps brachii were treated by reattachment to the radial tuberosity using Henry anterior access to the elbow. The results obtained through a clinical and instrumental evaluation, and the answers to a questionnaire, were good or excellent. What was particular about our work was that we treated all of the patients by a single Henry anterior access and not a double Boyd and Anderson one, which is more commonly used. Our decision was based on the minor amount of surgical invasiveness, the simpler method of reinsertion of the tendon and the minor incidence of possible radio-ulnar synostoses. This surgical approach requires particular care with regard to possible injuries of the radial nerve, that, moreover, are easily avoidable if surgery is performed by experts, with accurate and limited preparation of the site of reattachment.

Introduction: The role of ultrasound (US) in the postoperative assessment of tendon reconstruction is not clearly defined and there is no systematic arrangement of US patterns., Material and Methods: We examined 34 patients submitted to surgery or conservative treatment for total/partial tear or musculotendinous detachment of patellar or Achilles tendon in the last 5 years. All patients underwent physical and US examinations., Results: The surgical tendon exhibited the same US patterns in 23/28 patients: it was markedly enlarged (three-/fourfold the normal diameter) and more rounded, with inhomogeneous and hypoechoic appearance not only at the tear/surgical site but also above and below it, for some cm. Small hyperechoic images, mainly dots, were seen in 19 cases, which were referrable to small calcifications and stitches. More and larger calcifications were found in 8 patients, where they were associated with anechoic degeneration areas. Color Doppler US showed moderate or strong hypervascularization around the tear in the first months postinjury. US patterns did not correlate with physical findings, but color Doppler patterns did. In 6 cases of musculotendinous detachment submitted to conservative treatment, US showed enlargement and hypoechogenicity in the injury site only, with no involvement of the remaining tendon. US was also used to time and guide drainage of perilesional hematomas, which were often quite large., Conclusions: US is the method of choice in the postoperative follow-up of tendon tears and musculotendinous detachments because it shows abnormal signs which are missed at clinics and provides additional information needed for treatment planning.

Eighty patients complaining of shoulder pain were examined with MRI from January, 1993, through December, 1994. Thirty of them were submitted to surgery, with an exhaustive inspection of shoulder structures and the treatment of abnormal findings. In this subgroup of surgical patients, MRI had depicted 16 complete tears of the rotator cuff, 4 partial tears, 8 cases of subacromial impingement, I humeral head osteochondritis and, finally, I humeral head osteochondritis with complete rotator cuff tear. Surgical findings confirmed MR diagnosis in 97% of cases. MR findings were then compared with literature data and some atypical features were observed in our series. MRI was totally reliable in complete cuff tears (16/30 patients), always showing the involvement of supraspinatus tendons and, in some cases, of other cuff tendons. In partial cuff tears (4/30 patients), besides the classic pattern of a fissure in the deep/superficial supraspinatus tendon, we observed intra- and peritendinous changes, with no tendon interruption, due to diffuse microlesions. When impingement due to subacromial space narrowing, with no cuff tear, was present (8/30 patients), MRI depicted different causes--e.g., acromioclavear arthrosis, coracoacromial ligament hypertrophy and posttraumatic changes. MRI showed tendinosis in all patients but overestimated it in one case where partial cuff tear was not confirmed surgically--the only false positive in our series. At surgery, all these cases were classified as stage I-II impingement (according to Neer's classification). Finally, MRI was very reliable in the study of bone conditions (osteochondritis), both isolated and associated with cuff tears. The diagnostic accuracy of MRI in the study of the painful shoulder was very high (97%), in agreement with literature data. This is very important because many different causes of shoulder conditions (abnormal tendons, bones and mechanics) may present with similar clinical symptoms. MRI appears as the only imaging method yielding complete and accurate pieces of information in the patients with a painful shoulder.

A total of 62 patients submitted to the surgical treatment of subcutaneous rupture of the Achilles tendon were followed up after a period of time ranging from 2 to 8 years. End-to-end suturing and reinforcement plastic surgery obtained excellent clinical results in more than 80% of the cases, with complications which were principally inherent to scarring. There were no cases of rupture. In cases with a longer follow-up, ultrasound examination revealed aspects of fibrillate restructuring of the tendon.

The validity of surgical treatment about "Mallet finger" with avulsion of tendon insertion (Bush lesion's) is presented. Are exposed 25 cases treated from 1980 to January 1983 with optimal results.

The authors present the results of 13 cases operated for subcutaneous rupture of the extensor pollicis longus. Transferral of the extensor indicis proprius was employed in 12 cases and tenodesis involving the extensor pollicis brevis was performed in 1. Results are best when abduction and retropulsion of the thumb are restored. Testing of the correct tension of the transferral procedure is emphasized.

The Authors report 74 cases of subcutaneous hole of Achille's tendon that were treated surgically. 52 patients were clinically controlled at a distance from 1 to 5 years. The functional result at a distance is good in 67,3% of cases, satisfactory in 25%, insufficient in 4%. They point out an hig incidence of local post-operating complications (29,8%), especially when the paratendinea medial incision has been made. The authors suggest to opt for a paratendinea lateral incision and, experimentally, to drop the use of hemostatic string.