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JPRAS Open Mar 2024Although various treatments for advanced stages of Kienböck's disease have been reported, clinical evidence demonstrating the efficacy of lunate resection and...
Although various treatments for advanced stages of Kienböck's disease have been reported, clinical evidence demonstrating the efficacy of lunate resection and vascularized os pisiform transfer for Kienböck's disease is limited. Herein, we investigated the clinical and radiographic results of this procedure. We retrospectively investigated eight patients who were followed up for ≥1 year. The mean age at the time of surgery was 52 years. The mean follow-up period was 3.4 years. The preoperative and postoperative mean wrist flexion-extension ranges were 84° and 111°, respectively, and grip strengths were 18.5 and 26.3 kg, respectively. Pain decreased in five patients postoperatively. The mean preoperative and postoperative carpal height ratios were 0.47 and 0.46, respectively, and radio scaphoid angles were 63° and 65°, respectively. Osteoarthritic changes were observed in or around the transferred pisiform in all five patients who were surveyed using radiographs. Most patients demonstrated satisfactory clinical results, including pain relief and improved wrist motion and grip strength, regardless of osteoarthritic wrist changes on postoperative radiographs. In summary, this procedure was effective for treating Kienböck's disease, especially in the advanced stages. Level of evidence: Ⅳ.
PubMed: 38259863
DOI: 10.1016/j.jpra.2023.12.010 -
Genes Jul 2022The human capacity to speak is fundamental to our advanced intellectual, technological and social development. Yet so very little is known regarding the evolutionary...
The human capacity to speak is fundamental to our advanced intellectual, technological and social development. Yet so very little is known regarding the evolutionary genetics of speech or its relationship with the broader aspects of evolutionary development in primates. In this study, we describe a large family with evolutionary retrograde development of the larynx and wrist. The family presented with severe speech impairment and incremental retrograde elongations of the pisiform in the wrist that limited wrist rotation from 180° to 90° as in primitive primates. To our surprise, we found that a previously unknown primate-specific gene had been disrupted in the family. emerged de novo in an ancestor of extant primates across a 540 kb region of the genome with a pre-existing highly conserved long-range laryngeal enhancer for a neighbouring bone morphogenetic protein gene . We used transgenic mouse modelling to identify two additional long-range enhancers within that regulate expression in the wrist. Disruption of in the affected family blocked the transcription of across the 3 enhancers in association with a reduction in expression and retrograde development of the larynx and wrist. Furthermore, we describe how developed a human-specific promoter through the expansion of a penta-nucleotide direct repeat that first emerged de novo in the promoter of in gibbon. This repeat subsequently expanded incrementally in higher hominids to form an overlapping series of Sp1/KLF transcription factor consensus binding sites in human that correlated with incremental increases in the promoter strength of with human having the strongest promoter. Our research indicates a dual evolutionary role for the incremental increases in transcriptional interference of enhancers in the incremental evolutionary development of the wrist and larynx in hominids and the human capacity to speak and their retrogression with the reduction of transcription in the affected family.
Topics: Animals; Biological Evolution; Growth Differentiation Factor 6; Humans; Mice; Primates; Regulatory Sequences, Nucleic Acid; Speech
PubMed: 35885978
DOI: 10.3390/genes13071195 -
Journal of Nippon Medical School =... 2015The purpose of this study was to describe and evaluate the detailed anatomic locations and areas of ligamentous attachments and paths of the transverse carpal ligament...
PURPOSE
The purpose of this study was to describe and evaluate the detailed anatomic locations and areas of ligamentous attachments and paths of the transverse carpal ligament (TCL) on a three-dimensional (3-D) surface model.
METHODS
Ten fresh-frozen cadaver wrists were used to dissect and identify the TCL. Their ligament attachments and whole bone surfaces were digitized three-dimensionally and their areas evaluated. The attachments of each ligament were represented in a model combining CT surfaces overlaid by a digitized 3-D surface, and were also visually depicted with a different color for each on 3-D images of the bones.
RESULTS
The TCL was found to be composed of two or three discrete ligaments. Both the trapezium-hook of hamate ligament and the trapezium-pisiform ligament were identified in all ten specimens. The scaphoid-pisiform ligament was found in only two of the ten specimens. The average areas of the attachments of the TCL were 42.7 mm(2) on the trapezium, 30.0 mm(2) on the hook of hamate, 21.6 mm(2) on the pisiform, and 12.7 mm(2) on the scaphoid.
CONCLUSIONS
The anatomic 3-D attachment sites of the TCL were visually shown qualitatively, and their areas quantified. This 3-D information offers further knowledge and understanding of the anatomy and biomechanics of the TCL. It could also help in the accurate assessment of radiographic images and treatment of various wrist injuries and diseases when performing such procedures as carpal tunnel release, Guyon's canal release, trapeziectomy, hook of hamate excision, or arthroscopy.
Topics: Aged; Carpal Joints; Female; Humans; Imaging, Three-Dimensional; Ligaments, Articular; Male; Middle Aged; Wrist
PubMed: 26156666
DOI: 10.1272/jnms.82.130 -
Rheumatology (Oxford, England) Jan 2015Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, affecting 9% of women, and it is responsible for significant morbidity and occupational absence.... (Review)
Review
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, affecting 9% of women, and it is responsible for significant morbidity and occupational absence. Clinical assessment is used for initial diagnosis and nerve conduction (NC) studies are currently the principal test used to confirm the diagnosis. Sensitivity of NC studies is >85% and specificity is >95%. There is now good evidence that US can be used as an alternative to NC studies to diagnose CTS. US can assess the anatomy of the median nerve and also identify pathology of the surrounding structures that may compress the nerve. Median nerve enlargement (cross-sectional area ≥10 mm(2) at the level of the pisiform bone or tunnel inlet) is the most commonly used parameter to diagnose CTS on US, and sensitivity has been reported to be as high as 97.9% using this parameter. US may also be used to guide therapeutic corticosteroid injection into the carpal tunnel--thus avoiding median nerve injury--and to objectively monitor the response to treatment. There is now sufficient evidence to propose a new paradigm for the diagnosis of CTS that incorporates US. US is proposed as the initial diagnostic test in CTS based on similar sensitivity and specificity to NC studies but higher patient acceptability, lower cost and additional capability to assess carpal tunnel anatomy and guide injection.
Topics: Adrenal Cortex Hormones; Carpal Tunnel Syndrome; Disease Management; Humans; Injections; Mass Screening; Median Nerve; Neural Conduction; Sensitivity and Specificity; Ultrasonography
PubMed: 25118315
DOI: 10.1093/rheumatology/keu275 -
Acta Radiologica (Stockholm, Sweden :... Mar 2023Magnetic resonance diffusion tensor imaging (MR-DTI) has been increasingly applied for carpal tunnel syndrome (CTS) diagnosis, but relatively little is known about the...
BACKGROUND
Magnetic resonance diffusion tensor imaging (MR-DTI) has been increasingly applied for carpal tunnel syndrome (CTS) diagnosis, but relatively little is known about the effect of CTS treatment on median nerve (MN) integrity and functional outcome prediction.
PURPOSE
To assess how structural changes in MR-DTI of the MN correlates with symptom severity, functional status, and electrophysiological parameters in patients suffering from CTS before and after decompression surgery.
MATERIAL AND METHODS
Nine wrists were prospectively enrolled to perform MR-DTI pre- and postoperatively. The apparent diffusion coefficients (ADC) and fractional anisotropy (FA) of the MN were examined in three different regions-distal radioulnar joint, pisiform bone, and hamate bone-and correlated with clinical and electrophysiological parameters.
RESULTS
Postoperatively, mean Boston Carpal Tunnel Questionnaire scores decreased 1.55 points (range = 0.08-3; = 0.0172) and 1.01 points (-0.13 to 1.88; = 0.0381) in the symptomatic and functional domains, respectively. Postoperative clinical improvement was reflected in proximal FA elevation ( = 0.0078), but not in diffusivity in comparison to baseline examination. Preoperative electrophysiological parameters were correlated with a reduction in the pre- (sensory latencies [rho = -0.6826; = 0.0312]) and postoperative (motor latencies [rho = -0.7488; = 0.0325]) distal FA values. Higher sensory amplitudes indicated higher postoperative proximal FA values (rho = 0.7618; = 0.0280) and lower postoperative proximal ADC values (rho = -0.9047; = 0.0020).
CONCLUSION
Our study demonstrated that pre- and postoperative proximal FA values are useful biomarkers for the structural evaluation of the MN in patients with CTS. Symptomatic improvement can be better predicted by analyzing FA changes.
Topics: Humans; Carpal Tunnel Syndrome; Diffusion Tensor Imaging; Prognosis; Biomarkers; Decompression
PubMed: 35876308
DOI: 10.1177/02841851221113518 -
Hand (New York, N.Y.) Jun 2015An isolated fracture of the pisiform bone is a rare condition, especially in children. The fracture may be missed in the emergency department because of the complex...
An isolated fracture of the pisiform bone is a rare condition, especially in children. The fracture may be missed in the emergency department because of the complex anatomy of the carpal region. Early diagnosis and treatment are, however, important for the functional outcome of the patient, since untreated dislocated carpal fractures may result in nonunion. We report one case of a 9-year-old boy with an unrecognized fracture of the pisiform bone who underwent a pisiformectomy 10 months after injury due to a nonunion of the pisiform bone. Good results were obtained and the wrist did not show any functional impairment.
PubMed: 26034450
DOI: 10.1007/s11552-014-9613-2 -
Annals of Medicine and Surgery (2012) Feb 2022Several studies have been conducted on the variations and branching pattern of the ulnar nerve in the hand. There are few studies conducted on defining the distance of...
OBJECTIVES
Several studies have been conducted on the variations and branching pattern of the ulnar nerve in the hand. There are few studies conducted on defining the distance of ulnar nerve from bony landmarks in the palm. Ulnar nerve is closely related to the pisiform and hook of hamate which act as important landmarks.
METHODS
The study was conducted on 30 formalin fixed adult hand specimens in the department of Anatomy. Various measurements related to the ulnar nerve in the palm were taken using a divider and Vernier Calipers and the values were tabulated after obtaining the mean and standard deviation.
RESULTS
The average distance seen in the hand specimens [n = 30] from pisiform to the division of ulnar nerve into superficial and deep branch was 0.89 ± 0.25cm and the distance between pisiform bone up to the division of superficial branch of ulnar nerve into proper and common digital branches was 1.36 ± 0.59 cm. The average distance from the origin of proper digital branch of ulnar nerve to the head of fifth metacarpal bone was 5.25 ± 0.59 cm. The length of common digital branch of ulnar nerve from its origin to division into 2 sensory branches was 4.31 ± 1.09 cm.
CONCLUSION
This study provides the metric parameters of the ulnar nerve in the hand from its significant bony landmarks which should be kept in mind during surgical procedures to minimize the incidence of injury to its branches. It would assist the orthopedic surgeon in the treatment of ulnar nerve compression in the Guyon's canal.
PubMed: 35145657
DOI: 10.1016/j.amsu.2022.103259 -
Revista Espanola de Cirugia Ortopedica... 2021Osteochondroma is the most common bone tumour, which appears most commonly in the long bones. However, cases have been described in the scaphoid, capitate, lunate,...
Osteochondroma is the most common bone tumour, which appears most commonly in the long bones. However, cases have been described in the scaphoid, capitate, lunate, trapezium, and trapezoid bones, which can be a cause of pain in the hand and wrist. Osteochondromas can occur concomitantly with other traumatic or degenerative processes or generate complications in adjacent structures. Below we present an osteochondroma in the pisiform bone associated with pisotriquetral osteoarthritis.
PubMed: 32605850
DOI: 10.1016/j.recot.2020.05.006 -
Journal of Clinical Ultrasound : JCU 2014Pisiform bursitis is a disease often forgotten in both everyday practice and medical literature. The pisiform bursa is not constant; when present, it is located between...
Pisiform bursitis is a disease often forgotten in both everyday practice and medical literature. The pisiform bursa is not constant; when present, it is located between the tendon of the flexor carpi ulnaris and pisiform bone. Bursitis causes pain in the medial side of the wrist and enters into the differential diagnosis of various diseases of this anatomic region, in particular, with enthesitis of the flexor carpi ulnaris and the ganglion of piso-pyramidal compartment. We present the sonographic appearance of pisiform bursitis in a symptomatic patient.
Topics: Adult; Anti-Inflammatory Agents; Bursitis; Diagnosis, Differential; Female; Humans; Pisiform Bone; Rest; Ultrasonography; Wrist Joint
PubMed: 24865328
DOI: 10.1002/jcu.22170 -
Journal of Physical Therapy Science Sep 2016[Purpose] The aim of this study was to investigate the usefulness of ultrasonography for the diagnosis of polyneuropathy in diabetic patients by examination of the...
[Purpose] The aim of this study was to investigate the usefulness of ultrasonography for the diagnosis of polyneuropathy in diabetic patients by examination of the median and ulnar nerves. [Subjects and Methods] Sixty-three diabetic patients and fourteen controls were enrolled in the study. Nerve conduction studies were performed on both upper and lower limbs. Median and ulnar nerve cross-sectional areas were measured at the wrist and forearm levels in 140 hands by ultrasound. [Results] The median nerve cross-sectional area was increased at the hook of hamatum, pisiform bone, and radioulnar joint levels in patients with carpal tunnel syndrome. The ulnar nerve area at the medial epicondyle was significantly increased in the diabetic polyneuropathy (9.2 ± 1.6), diabetic polyneuropathy plus carpal tunnel syndrome (9.3 ± 1.4), and carpal tunnel syndrome (9.2 ± 1.9) groups compared with the control group (7.7 ± 1.1). In receiver operating characteristics analysis, the cutoff value of the ulnar nerve was 8.5 mm at ulnar epicondyle with 71.4% specificity and 70.4% sensitivity, corresponding to the highest diagnostic accuracy for diabetic polyneuropathy. [Conclusion] Ultrasonographic examination of the median and ulnar nerves can be an alternative or additional diagnostic modality for the evaluation of neuropathies in diabetic patients.
PubMed: 27799707
DOI: 10.1589/jpts.28.2620