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Hand (New York, N.Y.) Sep 2017Aneurysmal bone cysts are an uncommon form of benign primary bone tumors; affection of the hand is very rare.
BACKGROUND
Aneurysmal bone cysts are an uncommon form of benign primary bone tumors; affection of the hand is very rare.
METHODS
A rigorous review of the literature showed that this type of tumor has not previously been described in the pisiform. In this article, we report the occurrence of an aneurysmal bone tumor in the pisiform of the left hand of a 19-year-old male.
RESULTS
This tumor was successfully treated through surgical excision with an uneventful recovery. We describe the process behind the diagnosis of the lesion and the subsequent treatment in an attempt to highlight the rare but possible occurrence of aneurysmal bone cysts in the pisiform.
CONCLUSION
Appropriate treatment of aneurysmal bone cysts in this location is required, due to the anatomical nature of the pisiform itself with the risks of pathologic fracture and ulnar nerve compression.
Topics: Bone Cysts, Aneurysmal; Humans; Male; Pisiform Bone; Young Adult
PubMed: 28832208
DOI: 10.1177/1558944716670615 -
Plastic Surgery (Oakville, Ont.) May 2017Compression neuropathy of the ulnar nerve at the Guyon canal is commonly seen by hand surgeons. Different anatomical variations of structures related to the Guyon canal...
BACKGROUND
Compression neuropathy of the ulnar nerve at the Guyon canal is commonly seen by hand surgeons. Different anatomical variations of structures related to the Guyon canal have been reported in the literature. A thorough knowledge of the normal contents and possible variations is essential during surgery and exploration.
OBJECTIVES
To review the recognized anatomical variations within and around the Guyon canal.
METHODS
This study is a narrative review in which relevant papers, clinical studies, and anatomical studies were selected by searching electronic databases (PubMed and EMBASE). Extensive manual review of references of the included studies was performed. We also describe a case report of an aberrant muscle crossing the Guyon canal.
RESULTS
This study identified several variations in the anatomical structures of the Guyon canal reported in the literature. Variations of the ulnar nerve involved its course, branching pattern, deep motor branch, superficial sensory branch, dorsal cutaneous branch, and the communication with the median nerve. Ulnar artery variations involved its course, branching pattern, the superficial ulnar artery, and the dorsal perforating artery. Aberrant muscles crossing the Guyon canal were found to originate from the antebrachial fascia, pisiform bone, flexor retinaculum, the tendon of palmaris longus, flexor carpi ulnaris, or flexor carpi radialis; these muscles usually fuse with the hypothenar group.
CONCLUSION
The diverse variations of the contents of the Guyon canal were adequately described in the literature. Taking these variations into consideration is important in preventing clinical misinterpretation and avoiding potential surgical complications.
PubMed: 29026818
DOI: 10.1177/2292550317694851 -
Injury Mar 2020This study aimed to compare CT and XR images of patients admitted to the emergency department due to wrist injuries and to evaluate the accuracy of XR in the diagnosis... (Comparative Study)
Comparative Study
BACKGROUND
This study aimed to compare CT and XR images of patients admitted to the emergency department due to wrist injuries and to evaluate the accuracy of XR in the diagnosis of fractures.
METHODS
Patients; who admitted to ED with injuries due to wrist trauma and who underwent XR imaging and CT scans in the period from 1 January 2017 to 1 January 2018, were included in the study. CT scan image interpretation reports recorded in the hospital automation system were considered eligible to be included in the study. XR images were interpreted by an orthopedics and traumatology specialist. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and Kappa (κ) coefficient of XR were calculated according to CT. Inter-rater agreement was graded according to κ values.
RESULTS
A total of 274 patients were included in the study. Fractures were identified in the XR images in 180 (66%) patients and in the CT images in 196 (72%) patients. Compared to CT, the Sn, Sp, PPV, NPV and κ coefficient of XR were 89%, 92%, 97%, 77% and 0.764 respectively. Compared to CT, the highest sensitivity of XR was measured to detecting radius (Sn: 95%, κ: 0.896) and 5th metacarpal fractures (Sn: 77%, κ: 0.859), the lowest sensitivity of XR was calculated in detecting scaphoid, capitate, pisiform, trapezium hamate, and triquetrum fractures (Sn: 59-14%, κ: 0.619-0.240). The sensitivity and κ coefficient of XR were calculated 54% and 0.530 in the adjacent bone fracture, 83% and 0.830 in joint dislocation, 75% and 0.661 in the fractures extending to the joint space.
CONCLUSIONS
XR is the first-choice imaging modality in the evaluation of wrist injuries, but CT imaging should be preferred when fractures extending to the joint space, adjacent bone fracture and carpal bone fracture are being considered.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Emergency Service, Hospital; Female; Fractures, Bone; Humans; Male; Middle Aged; ROC Curve; Radiography; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Wrist Injuries; Young Adult
PubMed: 32014259
DOI: 10.1016/j.injury.2020.01.034 -
Hand (New York, N.Y.) Sep 2017Patients with suspected pisotriquetral osteoarthritis may show joint space narrowing. However, the extent of joint space narrowing and its deviation from the joint space...
BACKGROUND
Patients with suspected pisotriquetral osteoarthritis may show joint space narrowing. However, the extent of joint space narrowing and its deviation from the joint space width (JSW) in normal anatomy is unknown. In this pathoanatomic study, we therefore compared the JSW in the pisotriquetral joint between osteoarthritic patient wrists and healthy wrists.
METHODS
We reviewed preoperative computed tomography (CT) scans of 8 wrists of patients with ulnar-sided wrist pain who underwent a pisiformectomy with confirmed pisotriquetral osteoarthritis at surgery. We also reviewed CT scans of 20 normal wrists from healthy volunteers serving as control group. Three-dimensional CT models of the pisiform and triquetrum were obtained from both affected and normal wrists, after which the minimum JSW was calculated in an automated fashion.
RESULTS
In the patient group, the median (interquartile range) of the minimum JSW was 0.1 mm (0.0-0.2), and in the control group, 0.8 mm (0.3-0.9) ( P = .007).
CONCLUSIONS
We showed that the pisotriquetral joint space in osteoarthritic patient wrists was significantly narrowed compared with healthy wrists. These results suggest that JSW evaluation has a potential diagnostic value in the work-up of patients with suspected pisotriquetral osteoarthritis. This is an interesting area for future clinical research, especially because no gold standard for diagnosing pisotriquetral osteoarthritis has been established yet.
Topics: Adult; Carpal Joints; Case-Control Studies; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Osteoarthritis; Pisiform Bone; Retrospective Studies; Tomography, X-Ray Computed; Triquetrum Bone; Young Adult
PubMed: 28832198
DOI: 10.1177/1558944716677542 -
Archives of Rheumatology Jun 2023In this study, we aimed to investigate ulnar and median nerve cross-sectional areas (CSAs) by ultrasonography in RA patients who had no signs or symptoms of neurologic...
OBJECTIVES
In this study, we aimed to investigate ulnar and median nerve cross-sectional areas (CSAs) by ultrasonography in RA patients who had no signs or symptoms of neurologic involvement.
PATIENTS AND METHODS
This case-control study was conducted with 76 participants (72 females, 4 males; mean age: 53.2+10.9 years; range, 18 to 65 years) between April 2011 and April 2013. Of the participants, 38 were RA patients without any signs or symptoms of ulnar or median nerve involvement, and 38 were healthy subjects. All participants were evaluated with ultrasound. The median and ulnar nerve CSAs were measured at the proximal inlet of the carpal tunnel using the pisiform bone as a landmark.
RESULTS
There were no statistically significant differences between patients and controls in terms of median and ulnar CSAs (p>0.05). There were no correlations between median and ulnar CSAs of the dominant hand and age, height, weight, and disease duration. The median nerve CSA was >10 mm in 24% of the RA patients and 14% of controls, but the difference was not statistically significant (p=0.20).
CONCLUSION
Similar median and ulnar CSAs were detected in RA patients and healthy controls. These findings cannot rule out a subclinical neurologic involvement.
PubMed: 37680523
DOI: 10.46497/ArchRheumatol.2023.9027 -
Journal of Wrist Surgery Feb 2019Radiocarpal or midcarpal arthritis can occur simultaneously with arthritis of the distal radioulnar joint (DRUJ), leading to functional impairment of the wrist....
Radiocarpal or midcarpal arthritis can occur simultaneously with arthritis of the distal radioulnar joint (DRUJ), leading to functional impairment of the wrist. Treatment often involves wrist arthroplasty or arthrodesis, either with simultaneous or secondary procedures, addressing the DRUJ. Successful treatment of solitary DRUJ arthritis with DRUJ replacement has been reported. However, outcomes in patients with multiple prior wrist surgeries are lacking. Surgery in these wrists is challenging because surgical scarring and advanced bone deformities make implant positioning more difficult. Therefore, the aim of this study was to evaluate the outcomes in patients that underwent total wrist arthrodesis and DRUJ replacement after multiple prior wrist surgeries. We prospectively enrolled patients that underwent total wrist arthrodesis and replacement of the DRUJ, either simultaneously or during separate procedures from 1999 to 2012. We included 14 patients with a median age of 43 years (interquartile range [IQR]: 35-47). As objective outcomes range of motion, weight-bearing ability, grip strength, was measured. For the subjective outcomes, we used an analogue pain score and the disabilities of the arm shoulder and hand (DASH) scores. At a median follow-up of 5.6 years (IQR: 3.2-7.1). The average DRUJ range of motion and weight lifting ability significantly improved. As for the subjective evaluations, postoperative pain scores improved significantly, as did the DASH scores. Four of the patients had a postoperative complication, including infection and heterotopic ossification, of which two required reoperations. Additionally, 5 patients developed pisotriquetral arthritis requiring, pisiform excision, triquetrum excision, or the combination of both. Distal radioulnar joint replacement with a semiconstrained prosthesis was an effective method to restore the function of the wrist and forearm. As the surgical anatomy and soft tissue envelope were compromised in these patients, additional surgical exposure is necessary, adding to the complexity in these patients. No radiographic loosening This is a therapeutic level IV study.
PubMed: 30723603
DOI: 10.1055/s-0038-1670681 -
Journal of Radiology Case Reports Apr 2022The pisiform is a sesamoid bone that acts as one of the key medial stabilizers of the wrist. We present a case of a 35-year-old gentleman who presented with medial wrist...
The pisiform is a sesamoid bone that acts as one of the key medial stabilizers of the wrist. We present a case of a 35-year-old gentleman who presented with medial wrist pain following a fall while rollerblading. Radiographs and Magnetic resonance imaging (MRI) revealed a rare combination of an acute pisiform dislocation with associated triquetral fracture. Subsequently, he was successfully treated with excision of the pisiform. Pisiform dislocation is an uncommon injury and can easily be missed in an acute emergency presentation. Therefore, it is important to be aware of the characteristic imaging appearance to avoid a delay in diagnosis and treatment.
Topics: Accidental Falls; Adult; Humans; Joint Dislocations; Male; Pisiform Bone; Radiography; Wrist Joint
PubMed: 35530418
DOI: 10.3941/jrcr.v16i4.4474 -
Median Nerve Recovery and Morphological Change on MRI at 24 Months after Open Carpal Tunnel Release.The Journal of Hand Surgery... Apr 2023This study aimed to investigate the relationship between postoperative clinical results and long-term morphological changes in patients with carpal tunnel syndrome...
This study aimed to investigate the relationship between postoperative clinical results and long-term morphological changes in patients with carpal tunnel syndrome (CTS) as observed on magnetic resonance imaging (MRI) before and after open carpal tunnel release (OCTR). We retrospectively analysed data for 28 hands that had undergone OCTR with at least 24 months of follow-up data. Two-point discrimination (2PD) test results were examined for the first three fingers, as were the distal motor latency (DML) and sensory conduction velocity (SCV) of the median nerve. We also calculated the cross-sectional area (CSA) of the carpal tunnel and the distance from the median nerve to the volar carpal bone at the hamate and the pisiform levels using MRI images. Variables were compared before and 24 months after OCTR. Significant improvements in all variables were observed, including average 2PD scores (Finger I: 13.1 ± 6.2 vs. 7.7 ± 4.3, < 0.01, Finger II: 11.9 ± 6.6 vs. 7.0 ± 3.5, < 0.01, Finger III: 13.6 ± 6.1 vs. 7.8 ± 4.5, < 0.01), average DML (8.3 ± 3.3 vs. 4.3 ± 0.6 m/s, < 0.01), average SCV (30.8 ± 11.0 vs. 41.3 ± 5.3 m/s, < 0.01), CSA of the carpal tunnel (hamate level: 194.9 ± 30.6 vs. 254.2 ± 47.6 mm, < 0.01, pisiform level: 244.2 ± 46.5 vs. 274.7 ± 75.1 mm, = 0.01) and the distance between the median nerve and volar carpal bone (hamate level: 8.7 ± 1.4 vs. 11.2 ± 1.6 mm, < 0.01, pisiform level: 11.8 ± 1.7 vs. 13.8 ± 2.5 mm, < 0.01). Our results demonstrate that OCTR is successful in achieving long-term decompression and recovery of the median nerve in patients with CTS. Level III (Therapeutic).
Topics: Humans; Carpal Tunnel Syndrome; Magnetic Resonance Imaging; Median Nerve; Retrospective Studies; Wrist
PubMed: 37120302
DOI: 10.1142/S2424835523500212 -
Hand (New York, N.Y.) Oct 2023Flexor tendon entrapments as a result of fractures or dislocations in the upper extremity are rare. Diagnosis by clinical examination is not always possible, and imaging...
Flexor tendon entrapments as a result of fractures or dislocations in the upper extremity are rare. Diagnosis by clinical examination is not always possible, and imaging such as magnetic resonance imaging and ultrasound is often obtained. These modalities have the disadvantages of reduced sensitivity or increased cost and time, respectively. We present a unique case of a triquetral fracture and pisiform dislocation causing index finger flexor digitorum profundus (FDP-I) entrapment that was diagnosed preoperatively with computed tomography (CT) imaging with 3-dimensional (3D) volume rendering. A 30-year-old man presented in delayed fashion 4 weeks after a dune buggy accident. Among other injuries noted on examination, his index finger was held in flexion and unable to be passively extended. The CT source images showed dislocation and interposition of the FDP-I tendon within a fracture-dislocation of the triquetrum and pisiform. Postprocessed 3D volume renderings obtained from the CT source images confirmed this finding. The patient underwent operative intervention, where FDP-I entrapment between the triquetral fracture fragments and the dislocated pisiform was confirmed and released. Practitioners should be aware of this injury pattern and evolving advanced CT techniques which may be used to aid in soft-tissue diagnoses and obviate the need for additional advanced imaging.
Topics: Male; Humans; Adult; Trigger Finger Disorder; Fractures, Bone; Fracture Dislocation; Tendons; Joint Dislocations; Tomography, X-Ray Computed
PubMed: 37489114
DOI: 10.1177/15589447231185857