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Bo Eissa AN, Almulhum AK, Alsaeed MN, Buanq AA. A rare case of carpal boss lesion with an overlying ganglion cyst: case report and literature review. J Surg Case Rep 2024; 2024:rjae287. [PMID: 38706485 PMCID: PMC11068473 DOI: 10.1093/jscr/rjae287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/13/2024] [Indexed: 05/07/2024] Open
Abstract
Carpal boss is a bony protrusion on the dorsal aspect of wrist quadrangular joint. The exact cause and prevalence are not well understood. Most of the patients are asymptomatic, although some experience pain, bony prominence, restricted mobility, and joint instability in sever neglected cases. We are presenting a case of a 24-year-old male had chronic dorsal wrist pain with bony prominence appearance underwent surgical excision of a carpal boss lesion in concomitant with soft tissue ganglion cyst over the carpal boss after failed conservative management, resulting in significant symptom improvement and restored range of motion. Carpal boss lesion is a common condition that can be undiagnosed due to asymptomatic presentation or the presence of overlying soft tissue pathology as ganglion cyst. Although conservative treatment is helpful in some patients, most symptomatic carpal boss lesion patients eventually need surgical excision.
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Affiliation(s)
- Ahmad Nasser Bo Eissa
- Department of Orthopedics, Almoosa Specialist Hospital, AlAhsa, Hofuf, Dhahran Road, Alkhars District, Saudi Arabia
| | - Ahmed Khalid Almulhum
- Department of Orthopedic Surgery, King Fahad Hufof Alhufayrah District, Saudi Arabia
| | - Mohammed Nooh Alsaeed
- Department of Orthopedic Surgery, King Fahad Hufof Alhufayrah District, Saudi Arabia
| | - Ali Ahmed Buanq
- Department of Orthopedic Surgery, Bahrain Defense Force Hospital Military Hospital, Riffa, Southern Governate Road, Wadi Alsail District, Bahrain
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Png C, Choudhury MM, Chin AYH. A Novel Technique Using the Dorsal Capsule of the Distal Radioulnar Joint for Extensor Carpi Ulnaris Tendon Subsheath Reconstruction. J Wrist Surg 2024; 13:158-163. [PMID: 38505206 PMCID: PMC10948236 DOI: 10.1055/s-0043-1762931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 01/16/2023] [Indexed: 03/21/2024]
Abstract
Background Ulnar-sided wrist pain is a common problem encountered by hand surgeons. Symptomatic recurrent subluxation of the extensor carpi ulnaris (ECU) tendon has become increasingly recognized as one of the pathological conditions leading to ulnar-sided wrist pain. Surgical reconstruction of the subsheath is usually needed. ECU tendon subsheath reconstruction with the periosteal flap was first described by Schlesinger in 1907. Since then, various other techniques have been widely used. We describe a technique of ECU subsheath reconstruction using the dorsal capsule of the distal radioulnar joint (DRUJ). Description of Technique Two hand surgeons performed the surgeries with the same steps taken each time. A detailed description of our surgical technique, with the dorsal capsule of the DRUJ used to reconstruct the ECU tendon subsheath, is illustrated. Patient and Methods Patients who presented with symptomatic ECU instability despite conservative treatment or who have failed primary subsheath repair were offered this surgical option. Patients were followed up postoperatively for an average duration of 6.7 months in our outpatient clinics for assessment of wrist function. The surgical outcomes were reviewed and graded with the Modified Mayo Wrist Score (MMWS). Results All but one of the seven patients had an overall improvement in their range of movement of the wrist, grip strength, and pain scores. Four patients had excellent outcomes on the MMWS, one of whom had an asymptomatic recurrence seen on dynamic ultrasound. Two patients required subsequent surgeries: one had an excellent outcome and the other had a poor outcome on the MMWS. Conclusion We present our first seven cases of ECU subsheath reconstruction with the dorsal capsule of the DRUJ. Our results in the short term have been satisfactory. The technique does not disrupt the integrity of the extensor retinaculum, which is essential for optimal extensor tendon function, and can also be considered as an option to salvage failed procedures.
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Affiliation(s)
- Christina Png
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Muntasir Mannan Choudhury
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
- SingHealth Duke-NUS Musculoskeletal Sciences ACP, Singapore
| | - Andrew Yuan Hui Chin
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Musculoskeletal Sciences ACP, Singapore
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Ratnani G, Phansopkar P, Nathani HR. Rehabilitation Strategies for Wrist Pain in a Patient With Thalassemia Major and Distal Ulnar Hypoplasia: A Case Report. Cureus 2024; 16:e55689. [PMID: 38586800 PMCID: PMC10997971 DOI: 10.7759/cureus.55689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
This case study examines the rehabilitation process of a 24-year-old female patient with thalassemia major (TM), a hereditary hemoglobinopathy, who also suffered from distal ulnar hypoplasia, a congenital anomaly that causes pain and affects the wrist joint's strength and range of motion. The patient underwent a comprehensive physical rehabilitation program that aimed to address the challenges posed by ulnar hypoplasia. This program included a combination of customized exercises, splinting, and orthotic interventions to improve hand and wrist function. By adopting a multidisciplinary approach, the patient experienced significant improvements in mobility, strength, and overall quality of life. This case highlights the significance of personalized rehabilitation strategies in managing complex medical conditions, demonstrating the potential for positive outcomes even in patients with dual diagnoses of TM and ulnar hypoplasia.
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Affiliation(s)
- Grisha Ratnani
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harsh R Nathani
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Mitchell T, Hamilton N, Dean B, Rodgers S, Fowler-Davis S, McLean S. A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders. Hand Ther 2024; 29:3-20. [PMID: 38425437 PMCID: PMC10901165 DOI: 10.1177/17589983231219595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024]
Abstract
Introduction Non-traumatic wrist disorders (NTWD) are commonly encountered yet sparse resources exist to aid management. This study aimed to produce a literature map regarding diagnosis, management, pathways of care and outcome measures for NTWDs in the United Kingdom. Methods An interdisciplinary team of clinicians and academic researchers used Joanna Briggs Institute guidelines and the PRISMA ScR checklist in this scoping review. A mixed stakeholder group of patients and healthcare professionals identified 16 questions of importance to which the literature was mapped. An a-priori search strategy of both published and non-published material from five electronic databases and grey literature resources identified records. Two reviewers independently screened records for inclusion using explicit eligibility criteria with oversight from a third. Data extraction through narrative synthesis, charting and summary was performed independently by two reviewers. Results Of 185 studies meeting eligibility criteria, diagnoses of wrist pain, De Quervain's syndrome and ulna-sided pain were encountered most frequently, with uncontrolled non-randomised trial or cohort study being the most frequently used methodology. Diagnostic methods used included subjective questioning, self-reported pain, palpation and special tests. Best practice guidelines were found from three sources for two NTWD conditions. Seventeen types of conservative management, and 20 different patient-reported outcome measures were suggested for NTWD. Conclusion Substantial gaps in evidence exist in all parts of the patient journey for NTWD when mapped against an analytic framework (AF). Opportunities exist for future rigorous primary studies to address these gaps and the preliminary concerns about the quality of the literature regarding NTWD.
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Affiliation(s)
- Thomas Mitchell
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Nick Hamilton
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Ben Dean
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Sarah Rodgers
- The Hand Unit, Northern General Hospital, Sheffield, UK
| | | | - Sionnadh McLean
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
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Abstract
Background Single- or bicolumn limited intercarpal fusion, also called one- or two-column fusion, has been introduced as an alternative to four-corner fusion. The rationale behind this is obtaining less need for bone grafting and consequently improving the chances of the union. Method From August 2014 to October 2020, 45 consecutive patients (15 women), with a mean age of 58.4 years (range: 35-79), have been treated for scapholunate advanced collapse or scaphoid nonunion advanced collapse wrist. In 33 cases, the surgery was performed as two-column fusion, and in 12 cases as one-column fusion. The union was determined by a computed tomography (CT) scan or X-ray follow-up studies. The pain assessments (visual analog score: 0-100), range of motion (ROM), grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand score were prospectively included. Results Of 45 patients, 43 were available for the follow-up, at a mean of 35 months (range: 12-68). All patients but two achieved union at a mean of 9.5 weeks (range: 5-25 weeks). Pain diminished from 60.3 (mean) preoperatively to 16.7 (mean) postoperatively ( p = 0.0001). Grip strength slightly increased from 28.2 KgF (mean) to 29 KgF (mean) (not significantly, p = 0.86). Quick Disability of the Arm, Shoulder, and Hand score improved from 39.5 (median) before the surgery to 11 (median) after the surgery ( p = 0.0004). The postoperative ROM of 62/37 degrees (mean) were recorded for total dorsovolar/radioulnar flexions, respectively. Three patients were converted to total wrist fusion and one to total wrist arthroplasty. One had a rearthrodesis to two-column fusion, which united. Conclusion One- and two-column fusion showed significant improvement in pain and function, with minimal impairment of the grip strength on the short- to mid-term follow-up. A union rate of 95% and an acceptable complication rate were achieved, without fusing all carpals. Level of Evidence Prospective, cohort study, level III.
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Affiliation(s)
- Lars Solgård
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark
| | - Robert Gvozdenovic
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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Koutas K, Papagiannis S, Giannatos V, Stavropoulos T, Kokkalis Z. Osteoid Osteoma of the Trapezium: A Rare Case Report and Literature Review. Cureus 2023; 15:e48889. [PMID: 38106747 PMCID: PMC10725046 DOI: 10.7759/cureus.48889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Osteoid osteoma is the most common benign osteogenic bone neoplasm. Osteoid osteomas are typically located in the metaphysis and diaphysis of long bones, especially the tibia and femur. However, less common sites of the skeleton can be affected as well, including carpal bones. Among carpal bones, the scaphoid and the capitate are the most affected. Osteoid osteoma of the trapezium is an extremely rare entity, with only seven cases reported in recent literature. We present a case of a 29-year-old male with persistent left wrist pain who was diagnosed with an osteoid osteoma of the trapezium bone. The diagnosis was based on the patient's history, clinical examination and findings from the CT scan, MRI, and plain radiographs. The patient was treated with an excision biopsy with no additional bone grafting. After a follow-up period of 12 months, no pain or signs of recurrence were present. We conducted a literature review to elucidate the clinical presentation as well as the proper diagnostic tools and therapeutic methods for this rare occurrence.
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Affiliation(s)
- Konstantinos Koutas
- Orthopaedics and Traumatology, University General Hospital of Patras, Patras, GRC
| | | | | | | | - Zinon Kokkalis
- Orthopaedic Surgery, Medical School, University of Patras, Patras, GRC
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Hart E, Whited A, Bae DS, Bauer AS, Sugimoto D. Wrist Guards/Supports in Gymnastics: Are They Helping or Hurting You? Am J Sports Med 2023; 51:3426-3433. [PMID: 37794701 DOI: 10.1177/03635465231199683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND The prevalence of wrist pain among gymnasts ranges from 46% to 79%. To alleviate wrist pain, gymnasts wear wrist guards/supports (WG/S). PURPOSE To investigate the effect of WG/S on the wrist joint through joint moment, angles, total joint range of motion (ROM) arc, and ground-reaction force (GRF). STUDY DESIGN Controlled laboratory study. METHODS A cross-sectional study design was used to investigate 23 female gymnasts (mean ± SD: age, 12.3 ± 1.5 years; height, 143.4 ± 7.6 cm; mass, 37.7 ± 6.6 kg; body mass index, 18.6 ± 2.9) who performed back handsprings (analyzed by first half [phase 1] and second half [phase 2]) with the following 3 conditions: no WG/S, Skids/Ultimate Wrist Supports (S/UWS), and Tiger Paws (TP). Wrist joint moments, angles, total ROM arc, and GRF were examined by the 3 conditions using analysis of variance with Bonferroni correction and effect size (Cohen d). RESULTS For mean wrist flexion moment, both S/UWS and TP showed significantly higher values than the no-WG/S condition in landing phase 1 (S/UWS: P = .001, d = 1.30; TP: P = .019, d = 0.87). In angle comparisons in landing phase 1, no WG/S showed greater mean wrist extension angles compared with S/UWS (P = .046; d = 0.80), but no significant differences with TP (P = .096; d = 0.65). Also, in landing phase 1, total ROM arc of the right wrist was greater in the no-WG/S condition compared with S/UWS (P = .018; d = 0.88), but there were no differences with TP (P = .400; d = 0.52). CONCLUSION These data show an increased wrist flexion moment using S/UWS and TP compared with the no-WG/S condition in landing phase 1 of back handsprings. Also, increased wrist extension angles and total arc ROM of the right wrist were found in the no-WG/S condition compared with S/UWS, but not with TP in landing phase 1. S/UWS may be helpful to reduce wrist joint angles, specifically wrist extension in landing phase 1, but both S/UWS and TP caused higher wrist flexion joint moment in landing phase 1. There were no differences found in GFG among the three variables. CLINICAL RELEVANCE In the first half of the back handspring, wrist guards can limit wrist extension joint angles and total arc ROM; however, an increased wrist flexion moment was found when wrist guards were worn, which may potentially lead to an increased risk of injury. Injury history, especially overuse signs/symptoms, and previous surgery on the wrist joint need to be well considered before the application or use of wrist guards. Also, the amount of time/exposure wearing wrist guards should be carefully controlled in young female gymnasts.
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Affiliation(s)
- Elspeth Hart
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Gymnastics Medicine: Education and Research, Pittsfield, Massachusetts, USA
| | - Amy Whited
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Donald S Bae
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea S Bauer
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Dai Sugimoto
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Lui H, Kakar S. Dorsal Subluxation of The Proximal Carpal Row with the Use of a Bridge Plate. J Wrist Surg 2023; 12:442-445. [PMID: 37841356 PMCID: PMC10569840 DOI: 10.1055/s-0042-1757440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/01/2022] [Indexed: 11/11/2022]
Abstract
Background Spanning bridge plates were first popularized for fixation of complex distal radius fractures. However, indications for their use have expanded including the surgical treatment algorithm for treating conditions such as Kienböck's disease. Traditionally, initial surgical treatment of Lichtman Stages II to III Kienböck's disease included lunate decompression, unloading, and revascularization procedures. The addition of a dorsal spanning bridge plate further facilitates lunate offloading and may improve bone revascularization. Case Description We report a complication of proximal carpal row dorsal subluxation secondary to dorsal spanning plate fixation in a patient with Stage IIIb Kienböck's disease. The patient had undergone wrist arthroscopy, lunate forage, radius core decompression, and spanning plate fixation. At 6 weeks after surgery, radiographic imaging demonstrated dorsal subluxation of the proximal carpal row that was corrected upon bridge plate removal. Serial radiographs during follow-up showed no further carpal subluxation without Kienböck's disease progression at 12 months postremoval of hardware. Patient remains pain free and has returned to elite level sport. Literature Review To our knowledge no previous cases of proximal carpal row subluxation with the use of dorsal bridge plate has been reported in the literature. Clinical Relevance Proximal row carpal subluxation can occur with dorsal bridge plate fixation.
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Affiliation(s)
- Hayman Lui
- Division of Hand Surgery, School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Strohmaier A, Häfeli M. [Ulnocarpal Wrist Pain - Tips for the Daily Practice]. Praxis (Bern 1994) 2023; 112:571-577. [PMID: 37823814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Ulnar wrist pain is a frequent symptom with many possible traumatic and non-traumatic causes. The complex anatomy and biomechanics of the wrist with the ulnocarpal complex including the triangular fibrocartilaginous complex (TFCC), the distal radio-ulnar joint (DRUJ) and the ulnar carpal bones make the differentiation between the possible causes difficult. A precise clinical investigation and appropriate imaging studies are essential for detecting the most important differential diagnoses, the first therapeutical steps and an early and appropriate referral to the hand surgeon.
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Affiliation(s)
- Alina Strohmaier
- Departement Chirurgie, Handchirurgie, Kantonsspital Graubünden, Chur, Schweiz
| | - Mathias Häfeli
- Departement Chirurgie, Handchirurgie, Kantonsspital Graubünden, Chur, Schweiz
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Prusmetikul S, Tawonsawatruk T. The Surgical Treatment of Bilateral Accessory Extensor Carpi Ulnaris: Case Report and Literature Review. J Wrist Surg 2023; 12:368-370. [PMID: 37564615 PMCID: PMC10411121 DOI: 10.1055/s-0042-1750873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022]
Abstract
Several abnormal pathologies, such as inflammation or degenerative change, can be causes of ulnar-sided wrist pain. This study demonstrated bilateral accessory extensor carpi ulnaris found in a patient who presented with bilateral wrist pain. The patient was initially treated with all conventional methods but failed to improve. Following the operation by releasing the sixth extensor compartment, the pain was completely relieved. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was remarkably improved and there was no limitation in daily living activities compared with preoperative status. We presented an uncommon condition of ulnar-sided wrist pain caused by bilateral accessory extensor carpi ulnaris which was successfully treated by releasing the extensor compartmental sheath without tendon resection.
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Affiliation(s)
- Suwimol Prusmetikul
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tulyapruek Tawonsawatruk
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Thirumavalavan J, Ibrahim Z, Byrne RA, Arant KR, Gil JA. Extensor Carpi Ulnaris Instability: A Comprehensive Review of Pathology and Operative Techniques. Hand (N Y) 2023:15589447231168908. [PMID: 37226412 DOI: 10.1177/15589447231168908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The extensor carpi ulnaris (ECU) is primarily responsible for extension and ulnar deviation at the wrist. Secondary to repetitive loading of, or acute trauma to the flexed, supinated and ulnarly deviated wrist, the ECU tendon can be a common source of ulnar-sided wrist pain. Common pathology includes ECU tendinopathy, tenosynovitis, tendon instability, and tendon rupture. Extensor carpi ulnaris pathology commonly occurs in athletes and patients with inflammatory arthritis. Given the multitude of available methods to treat ECU tendon pathology, the aim of our study was to outline operative management of ECU tendon pathology, with emphasis on reviewing techniques for addressing ECU instability. We acknowledge a continuing debate between anatomical and nonanatomical techniques for ECU subsheath reconstruction. However, use of a portion of the extensor retinaculum for nonanatomical reconstruction is commonly used and demonstrates successful outcomes. Future comparative studies on ECU fixation are required to increase data on patient outcomes, to further define and standardize these techniques.
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Abstract
Adolescence is a difficult time, both physically and emotionally. Rapid growth coupled with physical changes in the background of high levels of activity can be overwhelming. Meanwhile, unfamiliar life stressors coupled with undeveloped compensatory mechanisms can lead to overwhelming anxiety and emotional distress. Emotional factors can make injuries and overuse syndromes feel more catastrophic. Occasionally, an adolescent's emotional distress can manifest physically, without antecedent injury or physiologic cause. Understanding the psychological milieu is as important as understanding the disease processes that can affect adolescents if one hopes to manage these patients effectively.
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Affiliation(s)
- Anna Watson
- Chelsea & Westminster Hospital, London, United Kingdom
| | | | - Maxim D Horwitz
- Chelsea & Westminster Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Sarah K Tolerton
- Sydney Hospital and Prince of Wales Hospital, Randwick, Australia; University of Sydney, Camperdown, Australia
| | - Dan A Zlotolow
- Thomas Jefferson University School of Medicine, Philadelphia, PA; Hospital for Special Surgery, New York, NY; Shriners Hospital for Children Philadelphia, Philadelphia, PA.
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Parsaoran Butarbutar JC, Suginawan ET. Calcified Tendinitis of the Flexor Carpi Ulnaris Tendon: A Case Report. J Orthop Case Rep 2022; 12:10-13. [PMID: 36659882 PMCID: PMC9826684 DOI: 10.13107/jocr.2022.v12.i07.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/10/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Calcification in the tendon (Calcific Tendinitis) occurs commonly in the shoulder, but this condition can happen in other tendon sites. Calcific tendinitis of the hand and wrist occurs rarely, which causes unfamiliarity toward the disease. With the symptoms mimicking other causes, misdiagnosis often happens. This can cause ineffective and over treatment. Case Report A 51-year-old man presented with a 2-week-pain on his right wrist with localized erythema and tenderness on physical examination. Imaging with ultrasound and X-ray shows calcification on the flexor carpi ulnaris tendon. Patient was treated with splinting for 2 weeks and NSAID for pain management and was free of pain afterwards. Conclusion Calcific tendinitis mimics the symptoms of various causes. The ability to differentiate this entity to other differential diagnosis leads to an effective and precise treatment.
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Affiliation(s)
- John Christian Parsaoran Butarbutar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universitas Pelita Harapan, Siloam Hospitals Lippo Village, Tangerang, Indonesia,Address of Correspondence: Dr. John Christian Parsaoran Butarbutar, Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Pelita Harapan, Siloam Hospital Lippo Village, Tangerang, Indonesia. E-mail:
| | - Earlene Tasya Suginawan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universitas Pelita Harapan, Siloam Hospitals Lippo Village, Tangerang, Indonesia
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Kamble R, Sahu A, Pandit S. Occupational ergonomic assessment of hand pain symptoms among Bagh hand block print artisans of the handicraft textile industry in Madhya Pradesh, India. Int J Occup Saf Ergon 2021;:1-9. [PMID: 34622747 DOI: 10.1080/10803548.2021.1991131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives. Hand block printing is a highly repetitive and precision job involving tasks such as hitting the wooden hand block with the hands as a hammer, causing chronic mechanical trauma to the ulnar side of the palm. This study aimed to determine the prevalence of work-related hand symptoms, to identify ergonomic risks and musculoskeletal disorders (MSDs) and evidence of mechanical trauma among artisans working in Bagh print of Madhya Pradesh. Methods. Occupational risk involved in the artisan's wrist area was identified using the modified Dutch musculoskeletal questionnaire (MDMQ) and modified Boston hand evaluation questionnaire. The Boston hand evaluation questionnaire helps in the measurement of the severity of the symptoms. A direct observation study was performed to identify the chronic effects of mechanical trauma (CEMT) on artisan's hands. Results. Symptoms like pain, weakness, numbness and tingling were highly prevalent among the artisans, those with experience <3 years were more likely to report pain during working hours (p < 0.001) and those with experience >13 years were more likely to report numbness (p < 0.001) and tingling (p < 0.001). Conclusion. This study supports the evidence that the new artisans are at higher risks of reporting pain and CEMT, including fever and body pain, ultimately causing job loss.
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Tajika T, Kuboi T, Endo F, Hatori Y, Chikuda H. Reverse wedge osteotomy for Madelung's deformity in a high school student: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211049898. [PMID: 34616556 PMCID: PMC8488512 DOI: 10.1177/2050313x211049898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Madelung deformity is a congenital disorder with the malformation of anterior ulnar bowing of radius and a dorsally protruding ulnar head caused by premature growth disturbance at the medial volar aspect of the distal radius. This report describes a bilateral idiopathic Madelung deformity in a 17-year-old woman treated successfully using reverse wedge osteotomy of the distal radius in a symptomatic left wrist. Reverse wedge osteotomy can orient the radial joint surface while correcting the whole radius length by reversely putting the wedge bone removed from the distal metaphysis of radius, the base of which is cut from the surplus of the radial and dorsal cortical bone in the hypotrophic portion. We corrected the palmar subluxation of the carpus, restored her good function, and relieved her wrist pain.
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Affiliation(s)
- Tsuyoshi Tajika
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Fumitaka Endo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Yuhei Hatori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
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16
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Guidi M, Nietlispach V, Huber N, Besmens IS, Rothenfluh E, Frueh FS, Calcagni M. [The Painful Wrist]. Praxis (Bern 1994) 2021; 110:661-665. [PMID: 34521271 DOI: 10.1024/1661-8157/a003732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Painful Wrist Abstract. Wrist pain is a problem that can significantly limit patients in their daily activities. The causes are manifold, and treatment is often challenging. A systematic approach is therefore helpful in working up the correct diagnosis. This article aims to demonstrate a straightforward approach to the evaluation of wrist pain in adults.
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Affiliation(s)
- Marco Guidi
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Viviane Nietlispach
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Nora Huber
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Inga S Besmens
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Esin Rothenfluh
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Florian S Frueh
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Maurizio Calcagni
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
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17
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Glazier MT, Schuette HB, Schnee BA, Skura B, Goubeaux C. Isolated Volar Dislocation of the Distal Radioulnar Joint Treated With Successful Closed Reduction. Cureus 2021; 13:e15656. [PMID: 34277249 PMCID: PMC8281106 DOI: 10.7759/cureus.15656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
We report the case of A 34-year-old right-hand-dominant male who presented with an isolated left volar dislocation of the distal radioulnar joint (DRUJ) without any associated fractures. The patient had sustained the injury in an altercation in the evening prior to the presentation and had woken up the next morning with left wrist pain and restricted wrist motion. Closed reduction was successful under conscious sedation and the patient was treated conservatively with splint immobilization without needing operative intervention. This report highlights a rare injury pattern - an isolated volar DRUJ dislocation - that was successfully closed reduced, despite reports that this injury pattern frequently requires open reduction.
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Affiliation(s)
| | | | | | - Brian Skura
- Orthopedic Surgery, OhioHealth, Columbus, USA
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18
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Farì G, Fischetti F, Zonno A, Marra F, Maglie A, Bianchi FP, Messina G, Ranieri M, Megna M. Musculoskeletal Pain in Gymnasts: A Retrospective Analysis on a Cohort of Professional Athletes. Int J Environ Res Public Health 2021; 18:5460. [PMID: 34065250 DOI: 10.3390/ijerph18105460] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 11/16/2022]
Abstract
Gymnastics athletes are exposed to a high risk of injury, but also of developing musculoskeletal pain. These data are still little investigated in the available scientific literature. An online survey was distributed to 79 professional athletes who practiced artistic and rhythmic gymnastics. The survey collected demographic and anthropometric data, information about the sport practice, the training sessions, the prevalence of musculoskeletal pain gymnastics-related, and lifestyle habits. Musculoskeletal pain had a high prevalence, involving 65 of 79 athletes (82.3%). A significant correlation was found between musculoskeletal pain and the duration of sports practice, both for general pain (p = 0.041) and for specific districts: right wrist pain (p = 0.031), left wrist pain (p = 0.028), right shoulder (p = 0.039), left hip (p = 0.031), right thigh (p = 0.031), and left knee (p = 0.005). Another statistical association was found between right wrist pain and BMI (p = 0.001), and hip pain and BMI (p = 0.030). Hours spent in a sitting position were also correlated with the incidence of pain (p = 0.045). Wrist pain and right shoulder pain had a statistically significant association with the age of the athletes (right wrist pain: p = 0.038; left wrist pain: p = 0.004; right shoulder pain: p = 0.035). The more the gymnasts practice this sport, the more likely they are to develop musculoskeletal pain. Increased age and a higher BMI, as well as daily prolonged sitting position, seem to be potential risk factors for the onset of musculoskeletal pain. Future studies could plan training strategies aimed at preventing musculoskeletal pain associated with gymnastics, in order to promote its further spread.
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19
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Abstract
Persons with spinal cord injury (SCI) are at high risk for developing neurogenic obesity due to muscle paralysis and obligatory sarcopenia, sympathetic blunting, anabolic deficiency, and blunted satiety. Persons with SCI are also at high risk for shoulder, elbow, wrist, and hand injuries, including neuromusculoskeletal pathologies and nociceptive pain, as human upper extremities are poorly designed to facilitate chronic weight-bearing activities, including manual wheelchair propulsion, transfers, self-care, and day-to-day activities. This article reviews current literature on the relationship between obesity and increased body weight with upper extremity overuse injuries, detailing pathology at the shoulders, elbows, and wrists that elicit pain and functional decline and stressing the importance of weight management to preserve function.
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Affiliation(s)
- Jose R Vives Alvarado
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Elizabeth R Felix
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.,Research Service, Miami Veterans Affairs (VA) Healthcare System, Miami, Florida
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.,The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
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20
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Hatta T, Goto H, Sonofuchi K, Nobuta S, Toh S, Itoi E. Surgical treatment for persistent second carpometacarpal joint pain. Orthop Rev (Pavia) 2021; 13:9085. [PMID: 33953892 PMCID: PMC8077286 DOI: 10.4081/or.2021.9085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/15/2021] [Indexed: 11/22/2022] Open
Abstract
The purposes of this study were to demonstrate the clinical characteristics of patients with persistent second carpometacarpal (CMC) joint pain without bony abnormalities known as the carpal boss, and to assess the clinical efficacy of surgical stabilization of the second CMC joint. Eleven patients had persistent wrist pain with characteristic symptoms, including tenderness over the second CMC joint, increased symptoms when the involved hand was placed on the ground or gripped strongly with the involved hand, a positive metacarpal stress test and temporary pain relief with the intra-articular injection of the lidocaine. The patients underwent arthrodesis of the second CMC joint. All cases showed radiologically confirmed fusion of the second CMC joint. At the final followup examination, 10 of 11 patients resulted in satisfactory clinical outcomes, excepting one patient with remnant pain and restricted range of wrist motions. This report highlights the importance of conducting a careful assessment of patients who present with persistent second CMC joint pain without the bony abnormalities, such as carpal bossing. Surgery to stabilize the second CMC joint may be an option to improve their symptoms when conservative treatment fails.
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Affiliation(s)
| | | | | | - Shingo Nobuta
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital
| | - Satoshi Toh
- Department of Orthopaedic Surgery, National Hospital Organization, Hirosaki National Hospital
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine
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21
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Jung KS, Jung JH, Shin HS, Park JY, In TS, Cho HY. The Effects of Taping Combined with Wrist Stabilization Exercise on Pain, Disability, and Quality of Life in Postpartum Women with Wrist Pain: A Randomized Controlled Pilot Study. Int J Environ Res Public Health 2021; 18:ijerph18073564. [PMID: 33808137 PMCID: PMC8037921 DOI: 10.3390/ijerph18073564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the effects of wrist stabilization exercise combined with taping on wrist pain, disability, and quality of life in postpartum women with wrist pain. Forty-five patients with wrist pain were recruited and randomly divided into three groups: wrist stabilization exercise + taping therapy (WSE + TT) group (n = 15), wrist stabilization exercise (WSE) group (n = 15), and control group (n = 15). The WSE + TT and WSE groups performed wrist stabilization exercises for 40 min (once a day, five times a week for eight weeks), and the control group performed passive range of motion (P-ROM) exercise for the same amount of time. Additionally, the WSE + TT group attached taping to the wrist and forearm during the training period. The visual analogue scale (VAS) was used to assess pain level of the wrist. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Short Form-36 (SF-36) were used to evaluate the degree of wrist disability and quality of life, respectively. The WSE + TT group showed a significant decrease in wrist pain and functional disability compared to two groups (p < 0.05). Significant improvement in the SF-36 score was observed in the WSE + TT and WSE groups compared to that in the control group (p < 0.05). However, there was no significant difference between the WSE + TT and WSE groups in the SF-36. Our findings indicate that wrist stabilization exercise combined with taping is beneficial and effective in managing wrist pain and disability in postpartum women with wrist pain.
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Affiliation(s)
- Kyoung-Sim Jung
- Department of Physical Therapy, Gimcheon University, Gimcheon 39528, Korea;
| | - Jin-Hwa Jung
- Department of Occupational Therapy, Semyung University, Jecheon 27136, Korea;
| | - Hyung-Soo Shin
- Department of Physical Therapy, Kyungwoon University, Gumi 39160, Korea; (H.-S.S.); (J.-Y.P.)
| | - Jae-Young Park
- Department of Physical Therapy, Kyungwoon University, Gumi 39160, Korea; (H.-S.S.); (J.-Y.P.)
| | - Tae-Sung In
- Department of Physical Therapy, Gimcheon University, Gimcheon 39528, Korea;
- Correspondence: (T.-S.I.); (H.-Y.C.)
| | - Hwi-Young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea
- Correspondence: (T.-S.I.); (H.-Y.C.)
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22
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Kachare SD, Vivace BJ, Meredith LT, Kachare MD, Kapsalis CN, Ablavsky M, Safeek RH, Muresan C, Choo JH, Kasdan ML, Wilhelmi BJ. Anatomic surface landmarks to guide injection for posterior interosseous nerve block. J Plast Surg Hand Surg 2020; 55:17-20. [PMID: 33043751 DOI: 10.1080/2000656x.2020.1828895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Proper injection of the posterior interosseous nerve (PIN) is important for both the therapeutic and diagnostic management of wrist pain. However, no anatomical study exists describing the site of injection based on individual wrist width. We sought to develop a reproducible anthropometric ratio utilizing external wrist surface anatomy to predict a safe and accurate injection site for the PIN. Fresh frozen cadaver forearms were dissected at the University of Louisville tissue lab. Several anthropometric measurements were obtained in order to develop a reproducible ratio to calculate location of injection. A total of 16 cadaver forearms of equal male to female ratio were obtained. On average, the male forearm had a greater mean wrist circumference obtained at the level of Lister's tubercle compared to female forearms, 17.1 cm vs. 13.5 cm. An injection given ulnar to proximal edge of Lister's tubercle at a length of one-fourth the distance between Lister's tubercle and radial aspect of ulnar styloid resulted in 100% accurate perineural injection without intraneural injection. An anthropometric ratio of one-fourth the distance from Lister's tubercle to the ulnar styloid was able to predict accurate injection sites for the distal PIN in cadaveric specimens of varying anatomical proportions.
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Affiliation(s)
- Swapnil D Kachare
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Bradley J Vivace
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Luke T Meredith
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Milind D Kachare
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christina N Kapsalis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Ablavsky
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Rachel H Safeek
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Claude Muresan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Joshua H Choo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Morton L Kasdan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Bradon J Wilhelmi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY, USA
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23
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McNamara CT, Colakoglu S, Iorio ML. A Systematic Review and Analysis of Palmer Type I Triangular Fibrocartilage Complex Injuries: Outcomes of Treatment. J Hand Microsurg 2020; 12:116-122. [PMID: 32788827 DOI: 10.1055/s-0040-1713580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Triangular fibrocartilage complex (TFCC) injuries can present incidentally as an asymptomatic lesion or can cause acute and chronic pain. This study compared different treatment approaches for symptomatic Palmer Type 1 TFCC injuries and rates of improvement using a systematic review of the literature. Two hundred thirty-one articles were identified, 43 met criteria and were included. Two of these articles indicated conservative therapy may be adequate. Patients who underwent debridement for any Type 1 Palmer class returned to work at a rate of 92% ( n = 182), but only 44% ( n = 38) were free of pain. For 1B lesions that underwent repair, 68.3% ( n = 226) were able to return to work and 41% ( n = 52) had persistent pain. 1D lesions were treated with both repair and debridement with similar results. Data for Types 1A and 1C were limited as no authors solely addressed these lesions. For 1A lesions, those treated with traditional treatment of debridement still had high rates of being unable to return to work. The literature remains insufficient, making comparison between studies and techniques difficult. For asymptomatic injuries, there is no need for treatment. For patients with recalcitrant symptoms, surgery improves pain, grip strength, and increases return to work and activity. The level of evidence is IV.
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Affiliation(s)
- Colin T McNamara
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
| | - Salih Colakoglu
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
| | - Matthew L Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
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24
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Gnanarajah S, Barabas A. Bonney's blue dye for occult ganglion cyst removal: Technical Note. JPRAS Open 2020; 24:77-8. [PMID: 32426443 DOI: 10.1016/j.jpra.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 03/27/2020] [Indexed: 11/26/2022] Open
Abstract
We describe a technique using Bonney's blue dye for occult ganglion cyst removal that can help reduce incision size, extent of dissection and operative time, as well as predicting the likely success of surgery based on location of the ganglion relative to the blue dye.
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25
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Rodriguez RM, Ernat JJ. Ultrasonography for Dorsal-Sided Wrist Pain in a Combat Environment: Technique, Pearls, and a Case Report of Dynamic Evaluation of the Scapholunate Ligament. Mil Med 2020; 185:e306-e311. [PMID: 31247089 DOI: 10.1093/milmed/usz157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/18/2019] [Indexed: 11/12/2022] Open
Abstract
Ultrasonography is a commonly utilized tool in orthopedic surgery for the diagnosis and treatment of a variety of musculoskeletal conditions, including pathology about the wrist. Its value should not be underestimated when other diagnostic resources are unavailable - such as in a combat setting where ultrasounds, but not X-ray, are a standard equipment item. An active duty soldier presented to an orthopedic provider in an austere environment with chronic dorsal wrist pain due to a previous fall. Physical examination and dynamic ultrasound examination allowed the deployed provider to diagnose a scapholunate ligament injury. The patient was appropriately evacuated to a higher level of care without the need for X-ray or other advanced imaging modalities. Making this readily available resource a standard tool for providers deployed to a forward location could be beneficial for efficient and appropriate patient evacuation for musculoskeletal injuries. It can also rule out injuries that would otherwise have required unnecessary soldier movement through hostile territory for diagnostic tests such as X-rays. In addition, a simple technique and pearls for ultrasonography of the wrist are provided.
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Affiliation(s)
- Ryan M Rodriguez
- Madigan Army Medical Center, 9040 Jackson Ave., Joint Base Lewis-McChord, WA 98433
| | - Justin J Ernat
- Blanchfield Army Community Hospital, 650 Joel Dr., Fort Campbell, KY 42223
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26
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Dreckmann SC, von Schroeder HP, Novak CB, Baltzer HL. Utility of Specialized Imaging for Diagnosis of Chronic Wrist Pain. J Wrist Surg 2019; 8:497-502. [PMID: 31815065 PMCID: PMC6892649 DOI: 10.1055/s-0039-1697022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
Background Patients with chronic wrist pain often undergo imaging (such as magnetic resonance imaging [MRI], computed tomography [CT], or ultrasound [US]) prior to specialist assessment. Questions Is specialized wrist imaging performed prior to expert consultation necessary? Are there demographic differences between patients who do or do not receive preconsultation imaging? Patients and Methods A total of 115 patients referred to a tertiary hand center for chronic wrist pain and assessed by a hand surgeon were included. At initial consultation, surgeons were blinded to referral information and previous imaging results. The specialist performed a history, physical examination and reviewed X-rays. They established a clinical diagnosis and whether any additional investigations were needed. Prior MRI, CT, and/or US results were then reviewed and the specialists' clinical diagnosis was compared with the blinded referral diagnosis. Preconsultation imaging was categorized as having no value for diagnosis/management, some value, or high value. Results A total of 82 patients had imaging prior to specialist referral (69 MRIs, 11 CTs, and 16 ultrasounds). The majority of additional imaging (73%) was classified as unnecessary, including 77% of the MRIs and 100% of the ultrasounds. Of all the investigations performed, two CT scans were labeled highly valuable clinical aids. Older patients and those with radial-sided pain were less likely to receive preconsultation imaging. Six patients required further imaging after consultation. Conclusion Clinical assessment and X-rays are typically sufficient for a hand specialist to diagnose and manage chronic wrist pain and few patients require additional imaging. Level of Evidence This is a Level III study.
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Affiliation(s)
- Stephanie C. Dreckmann
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Herbert P. von Schroeder
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Christine B. Novak
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Heather L. Baltzer
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Hand Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
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27
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Abstract
Carpal coalition is the fusion of two or more carpal bones in the wrist. This has a prevalence of 0.1% in Caucasian populations, with lunotriquetral coalition being the most common type. The incidence in Asian populations, including Pakistan, is not known. Usually, these fused carpal bones are asymptomatic. However, they can be the cause of undiagnosed wrist pain. We present the case of a 26-year-old female who presented with right-sided wrist pain. On X-ray, she was diagnosed to have a lunotriquetral coalition. We emphasize the role of radiographic imaging in cases of carpal coalition. Most patients are treated conservatively. However, in severe cases, surgical treatments may be considered.
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Affiliation(s)
- Rabia Ali
- Miscellaneous, Shifa College of Medicine, Shifa Tameer-E-Millat University, Islamabad, PAK
| | - Fahim Khan
- Orthopaedics and Traumatology, Shifa International Hospital, Islamabad, PAK
| | - Sikandar Saeed
- Surgery, Shifa College of Medicine, Shifa Tameer-E-Millat University, Islamabad, PAK
| | - Nismat Javed
- Internal Medicine, Shifa College of Medicine, Shifa Tameer-E-Millat University, Islamabad, PAK
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28
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Abstract
Background: Wrist pain is often nonspecific. Magnetic resonance imaging (MRI) is regularly obtained to evaluate wrist pain. Variations and pathophysiology identified on MRI may not account for patient's clinical symptoms. This study aims to quantify the prevalence of flexor carpi radialis (FCR) tendinopathy on MRI and the coexistence of trapeziometacarpal (TMC) or scaphotrapeziotrapezoid (STT) osteoarthritis. Methods: Using an institutional research database, we identified 3631 adult patients who obtained an MRI of the wrist during a 15-year period. Text search in the radiology reports identified 302 patients with possible FCR signal abnormalities. After reviewing the medical records, 98 patients were identified with FCR tendinopathy. Furthermore, medical records were used to identify pain located on the volar radial part of the wrist. In the absence of a documented examination consistent with FCR tendinopathy, we considered any signal change in the FCR incidental. Results: We identified 55 patients (55%) with incidental FCR tendinopathy. In a bivariate analysis, we found FCR signal changes on the MRI were associated with older age, white race, clinically suspected FCR tendinopathy, volar-radial sided wrist pain, and TMC and STT arthritis. Using multivariable logistic regression to account for confounding, older age and volar-radial sided wrist pain were independently associated with FCR signal changes on MRI. Conclusions: Signal changes in the FCR are infrequent and often incidental (asymptomatic) or associated with peritrapezial osteoarthritis.
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Affiliation(s)
| | | | | | | | - David Ring
- Harvard Medical School, Boston,
USA,David Ring, Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin, 1400
Barbara Jordan Boulevard, Austin, TX 78723, USA.
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29
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Abstract
Background: This study reviews long-term outcomes of partial wrist denervation focusing on need for and time to revision procedure. Methods: A retrospective study was conducted of all patients undergoing partial wrist denervation between 1994 and 2014. At average latest follow-up of 6.75 years (range, 1-21 years), clinical and radiographic data and need for revision surgery were recorded. Results: There were 100 wrists in 89 patients (61 male, 28 female) with average age at surgery of 54 years (range, 26-80). Principal diagnoses were arthritis (58%), inflammatory (19%), and posttraumatic arthritis (7%). Average flexion-extension arc was 83% and grip strength 75% of unaffected extremity. Average Mayo Wrist Scores improved from 48 preoperatively to 77 postoperatively. Sixty-nine percent of patients did not undergo other procedures during the time interval studied. Thirty-one percent underwent revision at an average of 26 months following denervation (range, 2-165). Conclusions: Partial wrist denervation is a motion-preserving procedure for patients with refractory wrist pain with 69% in this series requiring no further procedures. The remaining 31% experienced average symptom relief for 2 years prior to ultimately undergoing revision operation.
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Affiliation(s)
| | | | | | - Sanjeev Kakar
- Mayo Clinic, Rochester, MN, USA,Sanjeev Kakar, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA.
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30
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Mehta NH, Garg B, Ansari T, Srivastava DN, Kotwal PP. Comparison of Magnetic Resonance Arthrography and Wrist Arthroscopy in the Evaluation of Chronic Wrist Pain in Indian Population. Indian J Orthop 2019; 53:769-775. [PMID: 31673180 PMCID: PMC6804379 DOI: 10.4103/ortho.ijortho_92_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain. MATERIALS AND METHODS Thirty three patients with chronic wrist pain suspected to have ligament injuries of the wrist were prospectively recruited. They underwent MRA examinations followed by wrist arthroscopy. Arthroscopic findings were compared with radiological findings focusing on three important structures - triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL). RESULTS For the 17 patients with TFCC tears/perforations on arthroscopy, MRA gave a sensitivity (SEN) = 88%, specificity (SPE) = 87.5%, positive predictive value (PPV) = 88%, and negative predictive value (NPV) = 87.5%. For the 13 patients with SLL tears on arthroscopy, MRA gave SEN = 77%, SPE = 100%, PPV = 100%, and NPV = 87%. For the 7 patients with LTL tears on arthroscopy, MRA gave SEN = 29%, SPE = 100%, PPV = 100%, and NPV = 84%. A composite correlation between findings on MRA and wrist arthroscopy revealed an overall SEN = 73%, SPE = 96%, PPV = 93%, and NPV = 85% for MRA, with overall accuracy = 88%. CONCLUSIONS The presented diagnostic results of MRA are superior to those of magnetic resonance imaging quoted in literature. MRA is a potent tool for evaluating chronic wrist pain but tends to miss lesions of intrinsic carpal ligaments (SLL and LTL) more than TFCC. Wrist arthroscopy may be recommended when the clinical suspicion is strong.
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Affiliation(s)
- Nishank H Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Bhavuk Garg, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail:
| | - Tahir Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Deep N Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash P Kotwal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Kim SJ, Kim SJ, Cha YH, Lee KH, Kwon JY. Effect of personalized wrist orthosis for wrist pain with three-dimensional scanning and printing technique: A preliminary, randomized, controlled, open-label study. Prosthet Orthot Int 2018; 42:636-643. [PMID: 30009672 DOI: 10.1177/0309364618785725] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Three-dimensional printer technology can produce the personalized orthosis in various forms. OBJECTIVE: To develop a personalized wrist orthosis using a three-dimensional scanner and three-dimensional printer for patients with wrist pain. STUDY DESIGN: A preliminary, prospective, randomized, open-label study. METHODS: A total of 22 patients with wrist pain were randomly assigned to the control and experimental groups. The control group wore a cock-up orthosis and the experimental group wore a three-dimensional-printed wrist orthosis for 1 week. The Patient-Rated Wrist Evaluation, Jebsen Hand Function Test, and Orthotics and Prosthetics Users' Survey were checked before and 1 week after the application. RESULTS: The Patient-Rated Wrist Evaluation showed significant pain relief in both groups. Two items of the 28 Orthotics and Prosthetics Users' Survey questions, "Put toothpaste on brush and brush teeth" and "Dial a touch tone phone," showed high satisfaction scores, with statistically significant difference in the experimental group ( p = 0.036 and 0.004). CONCLUSION: The three-dimensional-printed wrist orthosis was superior to the cock-up orthosis for two items of the Orthotics and Prosthetics Users' Survey. Wrist pain was reduced in the group wearing the three-dimensional-printed wrist orthosis as well as the group wearing the cock-up orthosis, so the three-dimensional-printed wrist orthosis could possibly play the same role as the cock-up orthosis. CLINICAL RELEVANCE A three-dimensional-printed wrist orthosis can be a substitute for a conventional ready-made wrist orthosis for patients with wrist pain with more satisfaction.
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Affiliation(s)
- Sang Jun Kim
- Samsung Medical Center, Seoul, Republic of Korea
| | - Sung Jae Kim
- Samsung Medical Center, Seoul, Republic of Korea
| | - Yong Ho Cha
- Samsung Medical Center, Seoul, Republic of Korea
| | - Keun Ho Lee
- Samsung Medical Center, Seoul, Republic of Korea
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Sgromolo NM, Cho MS, Gower JT, Rhee PC. Partial Wrist Denervation for Idiopathic Dorsal Wrist Pain in an Active Duty Military Population. J Hand Surg Am 2018; 43:1108-1112. [PMID: 29935773 DOI: 10.1016/j.jhsa.2018.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 04/16/2018] [Accepted: 05/09/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Treating dorsal wrist pain of unknown etiology provides a challenge to the most experienced hand surgeon. Therefore, we conducted a study aimed to determine outcomes of patients undergoing a posterior interosseous nerve (PIN) or anterior/posterior interosseous nerve (AIN/PIN) neurectomy for wrist pain without a known cause, in patients who responded to preoperative injection. METHODS A retrospective chart review was performed of all active duty patients undergoing isolated PIN or AIN/PIN neurectomy for idiopathic dorsal wrist pain with a documented response to preoperative injection between December 2011 and April 2017. Demographic data, return to duty status, pain scores, and range of motion were among the data collected and reviewed. RESULTS The initial search yielded 108 patients of whom 13 met inclusion criteria for our study. Overall, only 2 of 13 patients were able to return to full duty without restrictions, 5 went on to medical discharge, and 6 were placed on permanent duty restrictions. No patients within our study were deployed. Patients had improvement in their pain scores from 4.0 to 2.2. Range of motion was similar before and after surgery. CONCLUSIONS A PIN or AIN/PIN neurectomy resulted in improvement in pain scores in patients, but was not successful in returning the majority of patient to full active duty status without restrictions. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Nicole M Sgromolo
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - Mickey S Cho
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX
| | | | - Peter C Rhee
- Department of Orthopaedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Rochester MN.
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Abstract
BACKGROUND Although national efforts to minimize gender biases exist, gender differences in surgery persist. This study aims to investigate gender differences in preoperative resource use of patients undergoing wrist arthroscopy for nontraumatic wrist pain. METHODS Patients who underwent a wrist arthroscopy for nontraumatic pain from 2009 to 2015 were selected from the Truven MarketScan databases. Demographic and preoperative resource use data were recorded. Multivariable regression models were performed to examine the relationship between gender and preoperative resource use and to investigate the cost of these services. RESULTS A total of 8792 patients, 3805 men and 4987 women, met our inclusion criteria. Women were less likely to use imaging modalities preoperatively (OR, 0.08; 95 percent CI, 0.07 to 1.00; p = 0.02). However, women used more occupational therapy (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.002), nonnarcotic analgesia (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.001), and narcotic analgesia (OR, 1.6; 95 percent CI, 1.5 to 1.8; p < 0.001). Preoperative costs during the 12 months before surgery were similar between genders ($1308 versus $1367, respectively; p = 0.07). However, women accrued more costs from occupational therapy ($130 versus $93; p = 0.003), and nonnarcotic ($65 versus $46; p < 0.001) and narcotic medications ($568 versus $197; p < 0.001). CONCLUSIONS Significant gender differences exist in the preoperative care for patients undergoing wrist arthroscopy. Men use more imaging, implying more intense preoperative investigation for wrist pain, whereas women use more conservative measures, highlighting possible implicit provider biases in preoperative management and potential gender differences in disease presentation.
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Affiliation(s)
- Jessica I. Billig
- Co-First Author, Resident, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Jennifer M. Sterbenz
- Co-First Author, Research Assistant, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Lin Zhong
- Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Dean for Faculty Affairs, University of Michigan Medical School, Ann Arbor, MI
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Abstract
Background Imaging of the triangular fibrocartilaginous complex (TFCC) remains difficult, as no single imaging modality demonstrates perfect sensitivity and specificity. Purpose This study performs a meta-analysis of multiple previous publications to guide noninvasive imaging selection for the diagnosis of TFCC injuries. Methods A literature search was performed and conducted. Studies were included that compared the diagnostic accuracy of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and computed tomography (CT)/computed tomographic arthrography (CTA) for the evaluation of TFCC injuries. All studies included either arthroscopic or open surgical findings as the "gold standard." A meta-analysis was performed comparing the diagnostic accuracy of MRA, MRI, and CT for the detection of TFCC injuries. Results Initial search returned 2,568 candidate articles. Studies were then reviewed and narrowed yielding a total of 28 independent studies (20 MRI, 9 MRA, 4 CT/CTA with some studies including multiple modalities) considered in the qualitative data synthesis. Pooling of the raw data in a meta-analysis demonstrated sensitivities of 0.76 (0.72-0.80), 0.78(0.70-0.84), and 0.89 (0.81-0.95) for MRI, MRA, and CT arthrogram, respectively, with specificities of 0.82 (0.77-0.86), 0.85 (0.77-0.92), and 0.89 (0.81-0.95), respectively. Additionally, across all imaging modalities, diagnostic accuracy was highest for central TFCC lesions versus peripheral lesions. Conclusion This study represents the largest meta-analysis to date to compare multiple imaging modalities for the diagnosis of TFCC injuries. Pooled data demonstrated that CTA and MRA had statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries. Diagnostic accuracy was highest for central TFCC injuries.
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Affiliation(s)
- Matthew D. Treiser
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kayva Crawford
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Matthew L. Iorio
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Plastic and Reconstructive Surgery, University of Colorado Medical Center, Aurora, Colorado
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Abstract
Background Patients with Madelung deformity exhibit a spectrum of mild to severe deformity and distortion of wrist geometry. It may be difficult to reliably distinguish mild Madelung deformity from normal. Purpose This study thus tested the reliability of the diagnosis of mild Madelung deformity on a single posteroanterior (PA) radiograph. Materials and Methods An online survey was sent to hand and wrist surgeons of the Science of Variation Study Group for evaluation of 25 PA wrist radiographs comprising five adults with suspected mild Madelung deformity and 20 radiographs without any evident wrist pathology. Interobserver agreement was evaluated both via average percent agreement and Fleiss' kappa. To evaluate the relationship of rater characteristics and accuracy, a linear regression model was computed. Results The interobserver agreement among the 69 participating surgeons was low ( Κ = 0.12). The overall sensitivity, specificity, and accuracy were 0.30, 0.86, and 0.75, respectively. The mean confidence was 7.4 ± 0.4 for mild Madelung and 7.8 ± 0.5 for normal ( p = 0.112). The observers' confidence level was the only factor which had a mild but significant effect on the accuracy of the ratings. Conclusion The diagnosis of mild Madelung deformity on a single PA radiograph is unreliable. Level of Evidence The level of evidence is II, diagnostic study.
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Affiliation(s)
- Sebastian Farr
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
| | - Thierry G. Guitton
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - David Ring
- Dell Medical School, The University of Texas at Austin, Austin, Texas
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Charre A, Delclaux S, Apredoai C, Ayel JE, Rongieres M, Mansat P. Results of scaphocapitate arthrodesis with lunate excision in advanced Kienböck disease at 10.7-year mean follow-up. J Hand Surg Eur Vol 2018; 43:362-368. [PMID: 29105588 DOI: 10.1177/1753193417739247] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Scaphocapitate arthrodesis with lunate excision was performed for treatment of advanced Kienböck disease in 17 patients (18 wrists). Ten were women and seven men. Five were Lichtmann Stage IIIA, 12 Stage IIIB, and one Stage IV. Minimum follow-up period was 24 months; mean follow-up was 10.7 years (range 2.3 to 22 years, SD 7.1). At the latest follow-up, six patients were very satisfied, nine were satisfied and two were disappointed. Pain was significantly decreased in all cases. Wrist mobility was unchanged. Grip strength was significantly increased. Consolidation of the arthrodesis was confirmed in 17 wrists. We encountered a scaphocapitate nonunion at 12 years follow-up and two cases of styloscaphoid arthritis at 17 and 22 years. Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Amaury Charre
- 1 Institut locomoteur University Hospital, Toulouse, France
| | | | | | | | | | - Pierre Mansat
- 1 Institut locomoteur University Hospital, Toulouse, France
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Iwata H, Mori E, Maehara K, Sakajo A, Aoki K, Tamakoshi K. Shoulder stiffness, back pain, and wrist pain: Are older primiparas more vulnerable? Int J Nurs Pract 2018; 24 Suppl 1:e12654. [PMID: 29667315 DOI: 10.1111/ijn.12654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM To describe changes in prevalence of shoulder stiffness, back pain, and wrist pain during the first 6 months postpartum, and to examine the association of these symptoms with maternal age and parity. METHODS Participants were recruited from 13 Japanese hospitals between 2012 and 2013. A total of 2709 (response rate 71.9%) women provided longitudinal data, using self-report questionnaires at 5 time points: during their hospital stay, and at 1, 2, 4, and 6 months postpartum. Shoulder stiffness, back pain, and wrist pain were measured, using checklists with yes-no responses. The effects of age and parity were assessed in 4 groups of younger (<35 years) and older (≥35 years) mothers: 983 younger primiparas, 481 older primiparas, 649 younger multiparas, and 596 older multiparas. Chi-square tests and Cochran's Q tests were used to assess effects of group and time. RESULTS Prevalence of shoulder stiffness, back pain, and wrist pain during the hospital stay significantly increased up to 1 month postpartum for older primiparas, who were also the most vulnerable to back pain and wrist pain at 1 month postpartum. CONCLUSION Special attention should be given to older primiparas in assessing and providing nursing care for physical symptoms, especially during the first month postpartum.
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Affiliation(s)
- Hiroko Iwata
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Emi Mori
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Kunie Maehara
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Akiko Sakajo
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Kyoko Aoki
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Koji Tamakoshi
- Graduate School of Medicine, Nagoya University, Chiba, Japan
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Abstract
BACKGROUND This study evaluates the results of ulnar shortening using the ulna osteotomy locking plate system (UOL; I.T.S. GmbH, Graz, Austria) with special regard to the time-dependent recovery of subjective and objective outcome parameters and surgeons' experiences. METHODS Ulnar shortening using the UOL was performed on 11 patients (3 men, 8 women) with an average age of 47 ± 19.6 years. Range of motion (ROM) and grip strength were compared with the contralateral hand. Patient-rated outcomes were measured using a visual analogue scale (VAS) for pain and the Disability of the Arm, Shoulder and Hand (DASH) and the Patient Rated Wrist Evaluation (PRWE) survey for subjective outcomes. Ulnar variance and bony union were assessed using conventional wrist radiographs. The surgeons evaluated intraoperative handling through a standardized feedback form. RESULTS ROM improved and grip strength increased significantly between preoperative values and final follow-up. Flexion and supination improved significantly between weeks 8 and 12 and grip strength from week 8 onward. Patient-rated outcomes changed significantly with a final DASH score of 14.2 ± 12.4 and a PRWE score of 24.3 ± 17.0. Pain levels improved significantly with no pain at rest and a mean VAS of 0.8 ± 1.2 during activity. The average amount of shortening was 4.0 ± 1.9 mm with a final ulnar variance of 0.2 ± 1.8 mm. All osteotomies healed with 2 cases of delayed union. CONCLUSIONS In ulnar shortening with the UOL, wrist function recovered after an initial decrease from week 8 onward. Subjective outcome parameters showed early recovery and improved continuously over time.
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Affiliation(s)
- Gernot Schmidle
- Medical University of Innsbruck, Austria
- Gernot Schmidle, Division of Hand Surgery, Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
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Abstract
Cases of Kienböck's disease combined with gout are rare; to the best of our knowledge, the current report is the third such case reported in the literature. The current report presents the case of a 49-year-old male patient with Kienböck's disease combined with gout. The patient had experienced swelling and pain of their right wrist for 1 month. Through a combination of clinical history, physical examination, laboratory results, radiological and intraoperative findings, the patient was diagnosed with stage IIIB-IV Kienböck's disease and gout. The patient recovered well following a synovectomy and medication for gout. The rarity of the present case makes it difficult to examine the potential association between gout and Kienböck's disease. Kienböck's disease combined with gout tends to be ignored and is easily misdiagnosed. However, the surgical procedure selection for Kienböck's disease combined with gout is markedly different from the conventional surgery for Kienböck's disease or gout alone. The current study outlines a successful treatment strategy for gout combined with Kienbock's disease.
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Affiliation(s)
- Hui Lu
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Qiang Chen
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Hang Yu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Zhenfeng Liu
- Department of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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Abstract
We present a 15-year-old male patient with persistent localized pain on the dorsal side of the left wrist between the base of the 2nd and 3rd metacarpal bones and over the third carpometacarpal joint. It was diagnosed as an accessory metacarpal bone -Os styloideum. This entity may be detected on plain radiographs and in ultrasound examination and is often asymptomatic. Symptomatic os styloideum occurs more frequently in the dominant hand and may be treated conservatively with corticosteroid infiltration. A palpable prominence on the dorsal side of the wrist and focal pain evoked anxiety of the adolescent patient who searched medical consultation. In the clinical examination, a bony protrusion was confirmed and different possible diagnoses have been considered. After treatment with a corticosteroid infiltration of the third carpometacarpal joint under fluoroscopy the pain resolved completely. We would like to draw attention of clinicians and radiologists to this rare anatomical variant that normally is asymptomatic, and therefore not immediately recognized. Acquaintance with this entity and its early detection may lead to conservative treatment instead of surgical excision. A comprehensive literature search, review and discussion about os styloideum are provided in the article.
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Affiliation(s)
| | - Mathias Haefeli
- Department of Hand Surgery, Kantonsspital Baden, Baden AG, Switzerland
| | - Urs Laesser
- Department of Paediatrics, Kantonsspital Baden, Baden AG, Switzerland
| | - Tilo Niemann
- Department of Radiology, Kantonsspital Baden, Baden AG, Switzerland
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Twoon M, Jones CD, Foley J, Davidson D. Reversed palmaris longus muscle: a report of two cases. Case Reports Plast Surg Hand Surg 2017; 4:73-76. [PMID: 28804743 PMCID: PMC5532760 DOI: 10.1080/23320885.2017.1353424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/06/2017] [Indexed: 11/17/2022]
Abstract
The palmaris longus muscle is the most superficial muscle of the volar forearm which demonstrates significant anatomical variance. A reversed palmaris longus muscle is one such variant. Here we discuss two cases in which reversed palmaris longus was postulated as a cause of wrist discomfort.
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Affiliation(s)
- Mark Twoon
- Department of Plastic Surgery, St John's HospitalEdinburghScotland
| | | | - Jon Foley
- Department of Radiology, St John's HospitalEdinburghScotland
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Nourbakhsh MR, Bell TJ, Martin JB, Arab AM. The Effects of Oscillatory Biofield Therapy on Pain and Functional Limitations Associated with Carpal Tunnel Syndrome: Randomized, Placebo-Controlled, Double-Blind Study. J Altern Complement Med 2016; 22:911-920. [PMID: 27487406 DOI: 10.1089/acm.2016.0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Biofield treatments have been used for pain control in patients with cancer and chronic pain. However, research on the effect of biofield treatment on specific somatic disorders is lacking. This study intends to investigate the effect of oscillating biofield therapy (OBFT) on symptoms of carpal tunnel syndrome. DESIGN Randomized, placebo-controlled, double-blind study. PARTICIPANTS Thirty patients with chronic carpal tunnel syndrome participated in the study. INTERVENTION Patients were randomly assigned to active or placebo treatment groups. Those in the treatment group received six sessions of OBFT with intention to treat during a period of 2 weeks. Patients in the placebo group had the same number of treatment sessions with mock OBFT treatment. OUTCOME MEASURE The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; Symptom Severity Scale (SSS); and Functional Status Scale (FSS) were used for outcome assessment. RESULTS Both clinically and statistically significant changes in intensity of pain with activity (95% confidence interval [CI], 2.5-4.2; p = 0.000), night pain (p = 0.000, 95% CI, 3.2-5.7), DASH questionnaire (95% CI, 12.0-21.9; p = 0.000), SSS (95% CI, 0.64-1.15; p = 0.003), and FSS (95% CI, 0.41-0.97; p = 0.029) were found between the treatment and placebo groups. Statistically significant reduction in number of patients with positive results on the Phalen test (87%; p = 0.000), Tinel sign (73%; p = 0.000), and hand paresthesia (80%; p = 0.000) was noted in the treatment group. During 6-month follow-up, 86% of patients in the treatment group remained pain free and had no functional limitations. CONCLUSION OBFT can be a viable and effective treatment for improving symptoms and functional limitations associated with chronic carpal tunnel syndrome.
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Affiliation(s)
| | | | | | - Amir Massoud Arab
- 4 Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences , Tehran, Iran
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Abstract
Midcarpal instability is a collective term for a number of conditions where the instability of the wrist is predominantly between the proximal and distal carpal rows. It has been regarded as relatively rare and infrequently requires surgical treatment. Palmar midcarpal instability is the most commonly found type of midcarpal instability and can be responsible for causing a clunking and painful wrist. The diagnosis is made on clinical grounds using the midcarpal instability provocative tests. Standard imaging and arthroscopic inspection do not usually confirm a definite diagnosis, but are important in excluding other pathologies. The classification and staging has been described using the extent of palmar translocation of the distal carpal row, which is elicited on passive stress tests. As this is a functional instability, it may be that a functional staging description might be better, and a proposed scheme is described. Treatment options including partial wrist fusions, tenodesis stabilizations and arthroscopic capsular shrinkage have been described in small case series with limited follow-up. There are no comparative series or randomized studies because of the relative rarity of this condition.
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Affiliation(s)
- D G Hargreaves
- Department of Orthopaedics, University Hospital Southampton, Southampton, UK
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Abstract
The intersection syndrome, described since the 19th century, is an uncommon disorder associated with rubbing at the crossing point between the first dorsal compartment muscles and the radial wrist extensor muscles. Imaging modalities used to diagnosis this syndrome includes ultrasonography and magnetic resonance imaging. We reported a case of a 60-year-old man presented to our formation with painful swelling on the dorsum of the wrist and forearm. An MRI and an ultrasound were performed, and objectified a dual cross syndrome of the forearm.
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Affiliation(s)
- Bouchra Zhari
- Imaging Department, Mohamed V Military Hospital, Rabat, Morocco
| | - Meryem Edderai
- Imaging Department, Mohamed V Military Hospital, Rabat, Morocco
| | - Hassan Boumdine
- Imaging Department, Mohamed V Military Hospital, Rabat, Morocco
| | - Touriya Amil
- Imaging Department, Mohamed V Military Hospital, Rabat, Morocco
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van Kampen RJ, Bayne CO, Moran SL. A New Technique for Volar Capsulodesis for Isolated Palmar Scapholunate Interosseous Ligament Injuries: A Cadaveric Study and Case Report. J Wrist Surg 2015; 4:239-245. [PMID: 26539326 PMCID: PMC4626223 DOI: 10.1055/s-0035-1556854] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Most surgical techniques for scapholunate interosseous ligament (SLIL) repair address only the dorsal component of the ligament, potentially leading to high surgical failure rates. We introduce a new technique to reconstruct the volar SLIL using a portion of the long radiolunate ligament (LRL). A biomechanical evaluation was performed to evaluate the rupture strength of this repair, and a subsequent anatomic study was performed to verify that this repair would not compromise the blood supply to either the scaphoid or the lunate. Methods A reconstruction of the volar SLIL was developed utilizing a lunate-based strip of the LRL. Fourteen cadaver arms were injected with red-colored epoxide and latex. The blood supply of the volar wrist capsule was dissected. The vascular supply to the ligaments, scaphoid, and lunate were investigated. The biomechanical strength of this reconstruction was tested on five cadaver arms by potting the scaphoid, lunate, and radius and subjecting the repair to a tensile load using a servohydraulic vertical displacement testing machine. Results In all arms, a branch of the radial artery or radiocarpal arch supplied the radioscapholunate ligament at the medial border of the LRL. The proximal half of the scaphoid was supplied by dorsal branches of the radial artery. In all cases, a vessel entered the lunate on its ulnar volar side, away from the repair. The average strength of the intact LRL strip was 97.4 N, and the average strength of the ligament-suture interface used for the capsulodesis was 43.5 N. Conclusion This volar approach to the SLIL does not compromise the vascularity of the scaphoid or the lunate. This approach allows the possibility of repairing or augmenting the volar SLIL. The strength of this repair appears to be less than the strength of the native SLIL. Further clinical studies are warranted.
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Affiliation(s)
| | | | - Steven L. Moran
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
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Abstract
Purpose In an attempt to restore natural carpal kinematics more closely, bone-ligament-bone (BLB) grafts have been described for treating scapholunate (SL) injury. In this article we report the long-term results of capitohamate BLB autograft for the treatment of SL dissociation. Methods The medical records of patients treated with capitohamate BLB grafts for SL dissociation were retrospectively reviewed. Twenty-three patients were available for evaluation. Patients were sent a Disabilities of the Arm, Shoulder, and Hand (DASH) and a Patient-Rated Wrist Evaluation (PRWE) questionnaire and returned for exam. Thirteen patients returned the questionnaire, and 12 wrists were examined. Range of motion, grip strength, pain, complications, return to work, and radiographic parameters were documented. Results The average length of follow-up evaluation was 9.2 years. The average SL gap was 4.5 mm preoperatively and 3.6 mm at final follow-up. The average SL angle was 70 degrees preoperatively and 73 degrees at final follow-up. There was no statistically significant difference in preoperative versus postoperative flexion, extension, radial deviation, ulnar deviation, or grip strength. The average postoperative visual analog scale (VAS) score was 1.25 at rest and 3.58 with activity. The average Mayo Wrist Score was 66.8 preoperatively and 70.9 postoperatively (p = 0.158). The average postoperative PRWE was 20.5, and average postoperative DASH was 15.1. At final follow-up, four patients had no radiographic evidence of arthritis. Two patients had evidence of early-stage radiocarpal arthritis, four had evidence of midcarpal arthritis, and two had radiographic evidence of mild scaphotrapeziotrapezoid arthritis. One patient required a salvage procedure with four-corner fusion. Discussion BLB reconstruction can be used to treat SL instability. At final follow-up, the majority of patients did not worsen clinically or functionally or require secondary salvage procedures; however, radiologic progression of arthritis was not prevented. These outcomes are comparable to midterm results of other SL reconstructive options; thus, we have abandoned this technique for other less technically demanding procedures. Level of Evidence IV.
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Affiliation(s)
| | | | - Steven L. Moran
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
| | - Richard A. Berger
- Division of Hand Surgery, Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota
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Serban D, Celea C, Celea C. OCULAR AND OSTEOARTICULAR TUBERCULOSIS IN A YOUNG PATIENT. CASE REPORT. Rom J Ophthalmol 2015; 59:123-125. [PMID: 26978876 PMCID: PMC5712931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2015] [Indexed: 06/05/2023] Open
Abstract
CASE REPORT A young healthy patient, health-care worker in a state hospital, presented in the eye department complaining of pain and blurred vision in the left eye for approx. 2 weeks. Examination revealed a VA of 12/20 in the left eye, an interstitial keratitis, some signs of vitreal inflammation and two chorioretinal mass lesions (at echography appearing cystic) in the affected eye. She also mentioned a chronic pain in the right wrist. No systemic association was found. Based on the orthopaedic examination, biopsy, and surgical intervention, a strong suspicion of ocular tuberculosis was made and the patient was advised to start tuberculostatic treatment for 12 months and ocular steroidian treatment for 4 months. The ocular manifestations regressed totally after 3 months of treatment, the VA of the left eye improving at 20/ 20. CONCLUSION Tuberculosis can present many manifestations, with multi systemic involvement. Ocular tuberculosis is a difficult diagnosis and thus requires thorough multi-disciplinary investigations.
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Kumka M. A variant extensor indicis muscle and the branching pattern of the deep radial nerve could explain hand functionality and clinical symptoms in the living patient. J Can Chiropr Assoc 2015; 59:64-71. [PMID: 25729087 PMCID: PMC4319448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this study is to document the topographic anatomy of an extensor indicis (EI) muscle with a double tendon and the associated distribution of the deep branch of the radial nerve (DBRN). Both EI tendons were positioned deep to the tendons of the extensor digitorum as they traversed the dorsal osseofibrous tunnel. They then joined the medial slips of the extensor expansion of the second and third digits. In all other dissected forearms, a tendon of the EI muscle joined the medial slip of the extensor expansion to the index finger. The DBRN provided short branches to the superficial extensor muscles, long branches to the abductor pollicis longus and extensor pollicis brevis muscles, and terminated as the posterior interosseous nerve. Descending deep to the extensor pollicis longus muscle, the posterior interosseous nerve sent branches to the extensor pollicis brevis and EI muscles. Understanding of the topographic anatomy of an EI with a double tendon, and the associated distribution of the DBRN, may contribute to accurate diagnosis and treatment of hand lesions.
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Affiliation(s)
- Myroslava Kumka
- Department of Anatomy, Canadian Memorial Chiropractic College, Ontario, Canada
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Galvis EJ, Pessa J, Scheker LR. Total joint arthroplasty of the distal radioulnar joint for rheumatoid arthritis. J Hand Surg Am 2014; 39:1699-704. [PMID: 24996676 DOI: 10.1016/j.jhsa.2014.03.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical and radiological results of primary total distal radioulnar joint (DRUJ) replacement as well as reconstruction following ulnar head excision in patients with rheumatoid arthritis (RA). METHODS Seventeen patients with RA underwent 19 total DRUJ replacement between 2005 and 2011. Mean age at the time of the surgery was 57 years. Mean follow-up was 39 months (range, 12-79 mo). Pain level was evaluated using a visual analog scale (VAS). Pronation and supination were recorded before and after surgery. A patient satisfaction survey was used, as well as postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Related Wrist Evaluation (PRWE) scores. Ulnar translocation of the carpus was assessed radiographically, and the presence or absence of radiolucent zones around the implant were recorded. RESULTS The preoperative average VAS score for the 19 joints was 7.3. Pain decreased after surgery to 2.2. Pronation improved from 56° before surgery to 78° afterward, a 39% improvement. Supination improved from 57° before surgery to 71° afterward, a 27% improvement. Final scores were 24 for the DASH and 24 for the PRWE. Fifteen patients reported substantial pain relief. All patients were satisfied with their surgical result. CONCLUSIONS The results of this study suggest that total replacement of the DRUJ is of benefit to the patient with RA. Pronation was significantly increased and supination was increased but did not approach significance. Improvement in VAS score suggests that pain was decreased. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Elkin J Galvis
- Christine M. Kleinert Institute for Hand and Microsurgery, Kleinert Kutz Hand Center, Louisville, KY
| | - Joel Pessa
- Christine M. Kleinert Institute for Hand and Microsurgery, Kleinert Kutz Hand Center, Louisville, KY
| | - Luis R Scheker
- Christine M. Kleinert Institute for Hand and Microsurgery, Kleinert Kutz Hand Center, Louisville, KY.
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50
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del Piñal F, Klausmeyer M, Moraleda E, de Piero GH, Galindo C, Studer A, Cerezal L. Vascularized graft from the metatarsal base for reconstructing major osteochondral distal radius defects. J Hand Surg Am 2013; 38:1883-95. [PMID: 24079523 DOI: 10.1016/j.jhsa.2013.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/11/2013] [Accepted: 07/12/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To present our experience of reconstructing distal radius articular defects with a vascularized osteochondral graft from the metatarsal base and to present the mid-term outcomes. METHODS Seven patients (average age, 36 y; range, 26-55 y) who had reconstruction of major defects of the articular surface of the radius are presented. In 5, the lunate facet and sigmoid notch were reconstructed; in 1, an isolated defect on the surface of the lunate facet was reconstructed; and in 1, the scaphoid facet was reconstructed. In 6, the base of the third metatarsal was transferred, and in 1, the base of the second was transferred. RESULTS All flaps survived without complications. At the latest follow-up (range, 20 mo to 8 y), the flexion-extension arc improved an average of 50°, and the pain on a visual analog scale decreased from 8 to 1 on average. Disabilities of the Arm, Shoulder, and Hand score improved from 54 to 11 on average. One patient did not improve. No major complaints related to the donor site were mentioned (average American Orthopedic Foot and Ankle Society score of 96/100). CONCLUSIONS Our mid-term results are promising; however, the decision-making process and the operation are complex. The operation is not indicated when the carpals are devoid of cartilage or when the defect involves the whole radius surface.
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