Flexor tendon

“ If the disease is confined to the hind feet, they are placed well forward to relieve the strain on the toe caused by the downward pull of the perforans (deep flexor) tendon, but in place of the front feet being kept in front of a perpendicular line, as they are when the disease is confined to the front ones, they are placed far back under the body, so they will carry the maximum share of the body weight of which they are capable. The position of the feet is of great importance and offers symptoms that should not be overlooked. ”

“ Near the distal end of the shank the muscle gives rise to a strong tendon which perforates the tibial cartilage along its lateral edge and passes through the anterolateral canal of the hypotarsus (Fig. 6) . The tendon crosses over to the medial surface of the tarsometatarsus, passes distally, and perforates the sheathlike tendon of the m. flexor hallucis brevis between the first metatarsal and the trochlea for digit II. The tendon continues along the posterior surface of the hallux and has a double insertion ”

“ The patient can spontaneously flex the foot, none of the flexor muscles being affected, and this flexion may be carried even beyond what is natural, because the divided tendon forms no obstacle to it behind. Spontaneous extension is also practicable, in as much as the peroneus longus, tibialis posticus, &c. which remain uninjured, are capable of producing that motion. Some have alleged that the calf of the leg must be increased in size by the swelling of the gastrocnemii and soleus muscles, in consequence of their state of contraction ”

“ The extensor pedis is usually attacked by extension of the disease from a necrotic cartilage, or results from the infliction of a severe tread in a hind-foot. In this case the diseased structure has nothing between it and the articulation, the synovial membrane in one position actually lining its inner face. The result is that a condition of synovitis is easily set up, and the case aggravated by that and by arthritis.
With the flexor tendons attacked pain is always very great, and lameness is excessive. ”

“ The extensor and flexor tendons essentially contribute to the strong union of the phalangeal bones, and especially to the support and stability of the fetlock-joint. The gliding of the tendons is made easy by the secretion of a lubricating fluid, called synovia, from the inner surface of the sheaths which surround them. In thin-skinned well-bred horses with sound limbs one can not only distinctly feel the tendons through the skin, but can see their outline. ”

“ The ambiens muscle, long and spindle-shaped, lying immediately beneath the skin, extending from the pectineal process or ilio-pubic spine to the knee, is the most median of the muscles of the thigh. When typically developed its long tendon passes the knee-joint, turning towards its outer side, and lastly, without being anywhere attached to the knee, it forms one of the heads of the flexor perforatus digit, ii. ”

“ In cases where the abnormality has been brought about by wounds to the flexor tendons, the alteration in the direction of the limb is often so great as to produce 'knuckling over' of the fetlock. This, to a very great extent, may be remedied by the use of a shoe with calkins and an extended toe-piece (see Fig. 84) . ”

“ Tendons may be cut across accidentally, especially in those wounds so commonly met with above the wrist as a result, for example, of the hand being thrust through a pane of glass. It is essential that the ends should be sutured to each other, and as the proximal end is retracted the original wound may require to be enlarged in an upward direction. When primary suture has been omitted, or has failed in consequence of suppuration, the separated ends of the tendon become adherent to adjacent structures, and the function of the associated muscle is impaired or lost. ”

“ Wounds implicating the flexors may occasionally lead to permanent contraction—either as a result of actual loss of substance, or in young subjects from interference with the development of the muscle (as in the case already mentioned) . Under these circumstances the operation of tendon lengthening may be required if the endeavours to secure gradual extension are unsuccessful. König describes a case of flexion of the hand and fingers in a newly-born child, caused by a tearing of the flexors at the moment of disengagement of the arm in the course of delivery. ”

“ To prevent the hands from swelling, a short stick or switch, carried in the hand will be efficacious while walking about. Strains are of frequent occurrence, and chiefly arise from the man making some sudden effort when the tendons or the fascia (the thin covering) of the muscles are stiff and sore from previous hard work. The tendon Achilles—from the heel to the calf of the leg—is the principal seat of the most dangerous of the strains of the tendons, and is incurable except by rest, and that of some duration. ”

“ There are no aponeuroses exactly like the tendons, except those which are essentially formed by their expansion or which are at their origin, as those spread upon the anterior rectus of the thigh, those which are concealed in the fleshy fibres of a muscle, and afterwards go out of it to become a tendon. In certain parts of the limbs, as at the top of the arm, for example, the aponeuroses of general covering are insensibly lost in the cellular texture, without our being able to draw the line of demarcation. ”

“ Therefore, in chronic tendinitis there is to be found at times the same conditions which characterize acute inflammation, except that there is usually a variance of symptoms because of the difference in the degree of inflammation and pain.
The diagnosis of contraction of tendons is an easy matter because of the fact that relations between the phalanges are constantly changed with tendinous contraction. If one bears in mind the attachments and function of the digital flexors, no difficulty is encountered in recognizing contraction of either tendon. ”

“ When the quadriceps is overcome by a contraction of the hamstrings, as in spastic paraplegia, the knee is fixed in the flexed position and the child is unable to walk. The flexion may be corrected by lengthening the hamstring tendons, bringing the divided biceps tendon through an opening in the vastus lateralis, and attaching it to the rectus and to the patella. If there is a combination of flexion and genu valgum, the knee-joint should be resected and ankylosed in the straight position. ”

“ The upper tendons, being fastened to the fixed shoulder-blade, cannot move; but the lower tendon is fixed to the radius; the radius, with the ulna to which it is fastened, readily moves up and down on the elbow-joint—the shape of bones in the joint and all the arrangements of the joint, as we have seen, readily permitting this. When the muscle, then, pulls on its lower tendon, its pulls on the radius at the point where the tendon is fastened on to the bone. The radius thus pulled on forms with the ulna a lever of the third order, working on the end of the humerus as a fulcrum ”

“ There is no substance that could be used for this purpose that presents a harder, smoother surface than glass, and when in the shape of solid polished spheres, plying in perfectly fitted sockets, they are practically indestructible; there is no such thing as wearing them out. A linked steel rod and a back and front tendon securely connect the foot and ankle. The tendons, also the rubber springs, are the same as used in all of our legs, and are applied in the same manner. This is a somewhat lighter joint than the army and navy joint and is recommended for persons of light or medium weight. ”

“ This muscle, fusiform in shape, arises at its upper part from the external surface of the inferior extremity of the femur, then its tendon passes into a groove hollowed on the external tuberosity of the tibia. The fleshy body which succeeds is directed towards the tarsus, but before reaching it is replaced by a tendon. This tendon, at the level of the metatarsal bones, divides into four slips, which pass towards the toes, and are inserted into the second and third phalanges of the latter. ”

“ The subject requires much more investigation, but there is every reason to believe that it is a tendon which has sunk into the joint, though whether that of the pectineus is doubtful, since the intra-capsular tendon comes from the ischium in Reptiles. In many Mammals, and among them the Orang, there is no ligamentum teres. In others, such as the Armadillo, the structure has not sunk right into the joint, but is connected with the pubo-femoral part of the capsule.
The Knee Joint is a hinge formed by the condyles and trochlea of the femur, the patella, and the head of the tibia. ”

“ We may then divide the lateral ligaments, and keep the fingers straight by means of an extension splint while the tendons are relaxed by flexion of the wrist, trusting to subsequent massage and passive motion, or, failing [56] this, to tendon lengthening (by a process to be described later) , to overcome the resistance of the shortened muscles. Section of tendons within the theca is useless, because no uniting material is thrown out between the divided ends. As a last resource, amputation may be demanded to remove a useless and inconvenient member. ”

“ An incision midway between the internal malleolus and the tendo Achillis, parallel with both, will expose the very deep and strong fascia in which the tendons lie. The artery, with its venæ comites, occupies a central position, having the tendons of the tibialis posticus and flexor communis in front between it and the internal malleolus, and the posterior tibial nerve behind it, while the flexor longus pollicis lies still nearer the tendo Achillis. ”

“ As a rule, it is also advisable to 202 fix with the splint the joint above or below the fracture. In cases in which a splintering of the bone into a joint has taken place, more especially in those cases in which tendons have been injured, there may be a good deal of effusion into the joint and the tendon sheaths, and this may be organized into fibrous tissue leading to permanent stiffness. This is particularly apt to occur in old people. Care must be taken in such instances by gentle exercises, and by passive movement during the process of cure, to keep the joint and tendons free. ”

“ After the inflammation has subsided, active and passive movements are employed to prevent the formation of adhesions between the tendon and its sheath. If the tendon sloughs, the dead portion should be cut away, as its separation is extremely slow and is attended with prolonged suppuration.
Gonorrhœal Teno-synovitis.—This is met with especially in the tendon sheaths about the wrist and ankle. It may occur in a mild form, with pain, impairment of movement, and œdema, and sometimes an elongated, fluctuating swelling, the result of serous effusion into the sheath. ”

“ I say judicious and well directed, because it ought to bear chiefly on the fleshy portion, and not on the tendon, otherwise it will depress its divided ends, destroy their contact, and make them unite, not with each other, but with the adjacent parts, and thus produce considerable lameness. At the same time that care is taken not to depress the divided ends, these ends must not be permitted to move from side to side, a kind of displacement which may readily occur, in consequence of the hollow or depression situated on each side of the tendon. ”

“ Instead of being thus attached directly to the bone, they end in what we call tendons. These tendons are hard and strong, and a very small tendon will lift as much without breaking as quite a large muscle. The muscles are soft and would have to be attached over a large area in order to secure the required strength. The tendons, being so much stronger than the muscles, can be attached to a very small area and yet secure the same amount of power as would result from attaching the muscle itself.
The tendons pass directly into the periosteum, the thick, strong covering of the bones. ”

“ Such injury happens often in horses, in what is called breaking down. In them the tendon is occasionally snapped entirely through, and the ends widely separated. The same occurs in the human subject. Separation of the muscular fibres, however, is rare; laceration of the tendon itself, or separation of the tendon from the muscle, is more common. The yielding of the broad tendons on the upper and fore, lateral and under parts of the abdomen, affords an example of laceration of tendinous fibre from violent exertion. ”

“ There are no essential alterations of muscle or tendon except those secondary to the contraction of the joint—namely, an undue tension and prominence of the extensor tendon over the metatarso-phalangeal articulation, and an adaptive deficiency of length in the flexors, which are prevented by the permanently bent state of the articulation from keeping pace in growth with the osseous structures. ”

“ In the process of repair, one or both ends of the muscle or tendon may become fixed by adhesions to adjacent structures, and if the distal portion of a muscle is deprived of its nerve supply it may undergo degeneration and so have its function impaired.
Rupture of a muscle or tendon is usually the result of a sudden, and often involuntary, movement. As examples may be cited the rupture of the quadriceps extensor in attempting to regain the balance when falling backwards; of the gastrocnemius, plantaris, or tendo-calcaneus in jumping or dancing ”

“ The transverse diameter of this joint is long, thus giving it contacting surfaces that are sufficiently extensive to minimize the strain upon the mesial and lateral ligaments (internal and external lateral common ligaments) . Motion is that of flexion and extension; slight rotation is possible when the position is that of flexion. While supporting weight the carpus is fixed in position by a slight dorsal flexion, but undue dorsal flexion is prevented by the flexor muscles and tendons and volar-carpal or annular ligament, together with the superior check ligament. ”