• 대한한의학회지
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• 제26권1호
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• pp.11-17
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• 2005

This study was carried out to identify the components of the human heart meridian muscle, the regional muscle group being divided into outer, middle, and inner layers. The inner parts of the body surface were opened widely to demonstrate muscles, nerves, blood vessels and to expose the inner structure of the heart meridian muscle in the order of layers. We obtained the following results; $\cdot$ The heart meridian muscle is composed of muscles, nerves and blood vessels. $\cdot$ In human anatomy, the difference between terms is present (that is, between nerves or blood vessels which control the meridian muscle and those which pass near by). $\cdot$ The inner composition of the heart meridian muscle in the human arm is as follows: 1) Muscle H-l: latissimus dorsi muscle tendon, teres major muscle, coracobrachialis muscle H-2: biceps brachialis muscle, triceps brachialis muscle, brachialis muscle H-3: pronator teres muscle and brachialis muscle H-4: palmar carpal ligament and flexor ulnaris tendon H-5: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficialis tendon, flexor digitorum profundus tendon H-6: palmar carpal ligament & flexor retinaculum, flexor carpi ulnaris tendon H-7: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficial is tendon, flexor digitorum profundus tendon H-8: palmar aponeurosis, 4th lumbrical muscle, dorsal & palmar interrosseous muscle H-9: dorsal fascia, radiad of extensor digiti minimi tendon & extensor digitorum tendon 2) Blood vessel H-1: axillary artery, posterior circumflex humeral artery H-2: basilic vein, brachial artery H-3: basilic vein, inferior ulnar collateral artery, brachial artery H-4: ulnar artery H-5: ulnar artery H-6: ulnar artery H-7: ulnar artery H-8: palmar digital artery H-9: dorsal digital vein, the dorsal branch of palmar digital artery 3) Nerve H-1: medial antebrachial cutaneous nerve, median n., ulnar n., radial n., musculocutaneous n., axillary nerve H-2: median nerve, ulnar n., medial antebrachial cutaneous n., the branch of muscular cutaneous nerve H-3: median nerve, medial antebrachial cutaneous nerve H-4: medial antebrachial cutaneous nerve, ulnar nerve H-5: ulnar nerve H-6: ulnar nerve H-7: ulnar nerve H-8: superficial branch of ulnar nerve H-9: dorsal digital branch of ulnar nerve.

• Archives of Plastic Surgery
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• 제50권5호
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• pp.492-495
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• 2023

Extra-articular deposition of monosodium urate crystals is a widely recognized manifestation of gout. However, gouty infiltration of flexor tendons in the hand resulting in tendon rupture is exceedingly rare. This case report highlights a patient with gouty infiltration of flexor tendons in the right middle finger resulting in rupture of both the flexor digitorum profundus and flexor digitorum superficialis. Given the extent of gouty infiltration and need for pulley reconstruction, the patient was treated with two-stage flexor tendon reconstruction. Febuxostat was prescribed preoperatively to limit further deposition of monosodium urate crystals and continued postoperatively to maximize the potential for long-lasting results. Prednisone was prescribed between the first- and second-stage operations to prevent a gout flare while the silicone rod was in place. In summary, tendon rupture secondary to gouty infiltration is the most likely diagnosis in patients with a history of gout presenting with tendon insufficiency.

• Journal of Microbiology and Biotechnology
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• 제33권3호
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• pp.339-347
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• 2023

Transforming growth factor-β is a key factor in regulating adhesion formation during tendon healing. We investigated the effectiveness of SMAD family members, SMAD7 and SMAD3, in the TGF-β/Smad signaling during flexor tendon repair. Mouse flexor toe deep tendon rupture anastomosis models were made. On days 3, 7, 14, 21, and 28, the expressions of smad7 and smad3 in flexor tendon tissues were detected by RT-qPCR and western blot. Furthermore, postoperative intraperitoneal injections of SMAD7 agonists or SMAD3 antagonists were given. The degree of tendon healing was evaluated by adhesion testing and biomechanical experiments. Hematoxylin and eosin (HE) staining was used to observe the pathological changes. Immunohistochemistry was used to evaluate the expressions of collagen III, SMAD3, and SMAD7. The mRNA levels of matrix metalloproteinases, Mmp2 and Mmp9, and scleraxis (SCX) in flexor tendon tissue were detected by RT-qPCR. Smad3 expression increased and Smad7 expression decreased in flexor tendon tissue after injury. In addition, the SMAD7 agonist blocked SMAD3 phosphorylation. SMAD7 agonist and SMAD3 antagonist both improved adhesion formation during flexor tendon healing, and decreased the expressions of collagen III, Mmp9, and SCX, while increasing Mmp2 expression. This study provides a possible theoretical basis for the SMAD7-SMAD3 signal cascade during flexor tendon adhesion healing.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.708-711
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• 2010

Purpose: The sheath of tendon is uncommon site of tuberculous involvement as compared to other parts of the body. Especially, tuberculous tenosynovitis affecting flexor tendon of the hand is a rare condition. In recent years, furthermore, the incidence of tuberculosis is increasing in our country. Tuberculous tenosynovitis is a chronic, slowly destructive disease, which is difficult to diagnosis before operation, but can be definitively diagnosed by the pathologic microscopic examination. Early detection and surgical excision combined with antituberculous medication is important. We report a rare case of tuberculous tenosynovitis of the flexor tendon of the hand. Method: A 12-year-old woman presented with a painless, nontender mass on palmar side between distal interphalangeal joint and proximal area of metacarpophalangeal joint of the left third finger. We had surgical excision of the involved flexor tendon sheath and studied histopathologically. Result: The histopathological findings were chronic granulomatous inflammation with caseating necrosis consistent with tuberculosis. We started antituberculous medication. Conclusion: Tuberculous tenosynovitis is a rare condition, especially involving on the flexor tendon of the hand. But because of increasing tendency of tuberculosis, it is important to differentiate it from other tumors of the hand.

• Archives of Hand and Microsurgery
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• 제23권4호
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• pp.262-266
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• 2018

청소년에서 심수지굴곡건 파열은 주로 견열 파열로 나타나며 종적 파열은 매우 드물다. 수지의 굴곡건에 발생하는 건내 섬유종의 보고는 지금까지 1예가 있었지만, 건내 섬유종과 관련된 심수지굴곡건의 종파열은 아직까지 보고된 바 없었다. 저자들은 야구 중 충격에 의한 과신전 손상을 받은 이후 좌측 3수지의 건내 섬유종과 동반된 심수지굴곡건의 종 파열을 보고한다. 청소년에서 굴곡건의 종 파열은 드물지만 발생한 경우 병적 질환에 의한 파열일 수 있음을 고려하여야 하겠다.

• Archives of Plastic Surgery
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• 제49권6호
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• pp.750-754
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• 2022

Trigger wrist, characterized by a clicking or snapping sensation around the wrist joint during finger or wrist motion, and bifid or trifid median nerve, which occurs in carpal tunnel syndrome along with anatomical variation of median nerve, are rare conditions. We report the case of a patient with a thickened tendon caused by severe tenosynovitis and flexor tendon subluxation to the hamate hook due to bowing of the flexor retinaculum, thereby resulting in trigger wrist as well as an anatomical median nerve variation (bifid median nerve in the right wrist and trifid median nerve in the left wrist). A 59-year-old housewife visited our hospital with bilateral fingertip numbness, tingling sensation, and aggravated severe night cramping that began 2 months ago. She also complained about trigger wrist during small finger flexion. Based on magnetic resonance imaging, ultrasonography, and nerve conduction study, trifid median nerve and bilateral severe median nerve neuropathy of the wrist were diagnosed; therefore, transverse carpal tunnel release and exploration under wide-awake anesthesia were planned. Intraoperative findings showed trifid and bifid median nerves in left and right wrists, respectively. Additionally, bowing of flexor retinaculum and severe flexor tendon tenosynovitis were observed. Tenosynovitis with thickened flexor sheath resulted in subluxation of the small finger flexor tendon above the hamate hook. After transverse carpal ligament release with antebrachial fascia release and tenosynovectomy, subluxation of the flexor tendon was resolved. At 6 months postoperatively, the tingling and dullness in fingertips also resolved, and no trigger wrist or any other complications were noted.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.329-334
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• 2010

Purpose: Adhesion after flexor tendon injury is a result of fibrosis between tendon and tendon sheath. This, finally interfere with gliding mechanism of tendon and results in functional problem of hands. Therefore, there have been many trials to reduce adhesion around the tendon. However, there is no standard procedure clinically practiced in hospitals. Mitomycin-C is an antineoplastic alkylating agent that decrease fibroblast proliferation and scar formation. It is commonly used in many surgery to reduce postoperative adhesion. This study was designed to observe the effect of Mitomycin-C on preventing adhesion in injured flexor tendon. Methods: The deep flexor tendon of digit 2 and 4 in the left forepaw of 15 New Zealand White rabbits were subjected to partial tenotomy. In study group, injury site was exposed to a single 5-minute application of Mitomycin-C, and in control group was left untreated. Digit 2 and 4 in the right forepaw of each rabbit were considered as nonadhesion control group. After 2 weeks, the animals were sacrificed and digits were amputated for biomechanical test and histological study. Results: In biomechanical study to measure yield point, mean yield point of non-adhesion control was $17.43{\pm}2.33$ and $25.07{\pm}4.03$ for adhesion control, which proves increase of adhesion in adhesion control group (p<0.05) in 95% confidence. In Mitomycin-C group, mean yield point was $12.71{\pm}4.97$. Compared with adhesion control, there was decrease in adhesiveness in Mitomycin-C group (p<0.05) in 95% confidence. In histological study, the result of adhesion control revealed massive adhesions of bony structure, fibrotic tissue and tendon structure with ablation of the border. However in Mitomycin-C group, we could find increased fibrotic tissue, but adhesion is much lesser than adhesion group and borders between structures remain intact. Conclusion: This study suggests that Mitomycin-C can significantly reduce adhesion of injured flexor tendon in rabbit model.

• 대한족부족관절학회지
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• 제15권2호
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• pp.110-113
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• 2011

Ossification of the Achilles tendon is a rare condition that is characterized by the presence of an ossific mass contained within the substance of the tendon. The ossified mass is usually asymptomatic but when it grows large and painful, it deteriorates the function of Achilles tendon. We report a case of ossification of the Achilles tendon, which was successfully treated by removal of the ossific mass and proximal flexor hallucis longus (FHL) tendon transfer.

• 해부∙생물인류학
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• 제30권2호
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• pp.61-65
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• 2017

이 연구는 엄지발가락으로 가는 긴발가락굽힘근 힘줄 변이를 관찰하여 기술하였고, 또한 다섯 발가락으로 가는 긴굽힘근 힘줄의 구성을 확인하였다. 재료는 한국 성인 시신 발 66쪽을 사용하였다. 발꿈치뼈와 발허리발가락관절에서 긴엄지굽힘근 힘줄과 긴발가락굽힘근 힘줄들을 벌레근과 함께 자른 후, 특히 엄지발가락으로 가는 긴엄지굽힘근 힘줄과 긴발가락굽힘근의 힘줄들을 관찰하였다. 발에서 긴발가락굽힘근 힘줄로부터 힘줄가닥이 갈라져 나와 엄지발가락으로 들어가는 경우가 52세 남성 시신의 양쪽 발에서 관찰되었다. 이 경우는 66쪽의 발에서 2예(3.0%)의 빈도로 나타났다. 엄지발가락으로 가는 긴발가락굽힘근 힘줄가닥은 엄지발가락으로 가는 긴굽힘근 힘줄의 얕은 부분을 구성하였고, 긴엄지굽힘근 힘줄은 엄지발가락으로 가는 긴굽힘근 힘줄의 깊은 부분을 구성하였다. 이 연구는 긴엄지굽힘근 힘줄과 긴발가락굽힘근 힘줄 사이 연결의 해부학적 변이를 나타내었으며, 이 결과는 다양한 수술과 생체역학 연구에 유용할 것으로 생각된다.

• 대한정형외과스포츠의학회지
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• 제10권2호
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• pp.117-120
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• 2011

심수지 굴건의 견열성 파열은 상대적으로 드문 손상으로 심수지 굴건의 파열은 주로 심수지 굴건이 수축된 상태에서 순간적으로 일어나는 원위지절의 신전에 의해 일어나거나 중립위의 수지 말단에 강한 신전력이 작용하여 과신전되어 발생한다. 본 증례는 22세 남자 전투 경찰대원으로 방패를 쥔 상태에서 진압훈련 후 2일째 심수지 굴건의 파열이 발생한 드문 경우로 문헌 고찰과 함께 보고하고자 한다.