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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 -
Cureus Sep 2023Isolated pisiform dislocation is an uncommon condition, with a limited number of cases reported in the literature. We present a unique case of a 15-year-old male who...
Isolated pisiform dislocation is an uncommon condition, with a limited number of cases reported in the literature. We present a unique case of a 15-year-old male who experienced an atraumatic isolated dislocation of the pisiform bone in his left wrist and presented with pain, deformity, and ulnar nerve palsy in his little and ring fingers. Radiographic investigations confirmed the diagnosis of isolated pisiform dislocation, and the patient successfully underwent an open reduction, stabilization of pisiform, and exploration of the ulnar nerve.
PubMed: 37900515
DOI: 10.7759/cureus.46042 -
The Archives of Bone and Joint Surgery 2023A retrospective study was conducted to evaluate the diagnostic accuracy of a novel examination technique, the 'Pisiform Boost Test,' in diagnosing a triangular...
BACKGROUND
A retrospective study was conducted to evaluate the diagnostic accuracy of a novel examination technique, the 'Pisiform Boost Test,' in diagnosing a triangular fibrocartilage complex (TFCC) tear.
METHODS
Wrist arthroscopies performed between 2011-2021 were retrospectively reviewed. Patients' clinical records were evaluated to determine the result of the Pisiform Boost Test during clinical examination and TFCC tear within the body of the TFCC as seen at wrist arthroscopy. The Pisiform Boost Test is performed by first assessing for ulna fovea pain on passive ulna deviation of the wrist and then assessing pain while the clinician applies digital pressure over the pisiform and passive ulna deviation.
RESULTS
The pisiform Boost test was found to have a Sensitivity of 91% (95% CI, 81 - 97%) and a Specificity of 33% (95% CI, 14-59%) for the diagnosis of TFCC tears. Positive predictive value of 83%, a negative predictive value of 50%, and an accuracy of 78%. A chi-square test of independence was performed to examine the relation between a Positive Pisiform Boost Test and an arthroscopy-confirmed TFCC tear. The relation between these two variables was statistically significant, x2 (1, N = 82) = 6.4551, .
CONCLUSION
The Pisiform Boost Test demonstrates high sensitivity for TFCC tears (0.91). Specificity (0.33) is similar to that in the ulnar grinding test. Therefore, we propose this test be utilized with additional special tests for ulna-side wrist pain to allow clinicians to build a diagnostic picture, aiding decision-making and patient information.
PubMed: 37168823
DOI: 10.22038/ABJS.2022.67029.3188 -
Trauma Case Reports Aug 2024A 31-year-old woman had a seizure episode three weeks before, leading to a fall on her left hand. Following the accident, she had discomfort on the ulnar side of her...
A 31-year-old woman had a seizure episode three weeks before, leading to a fall on her left hand. Following the accident, she had discomfort on the ulnar side of her left wrist. She decided to seek treatment from a local bone setter; however, her hand discomfort continued and she then came to us for treatment. The radiography and computed tomography scan demonstrated a pisiform dislocation. The pisiform bone was surgically removed. The pisiform dislocation should be considered in the differential diagnosis of the ulnar side wrist discomfort following wrist trauma.
PubMed: 38799028
DOI: 10.1016/j.tcr.2024.101039 -
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 -
The Journal of Bone and Joint Surgery.... Sep 2023In scaphoid nonunion advanced collapse (SNAC) wrist arthritis, we analyzed the 3-dimensional (3-D) deformity patterns of carpal alignment secondary to scaphoid nonunion...
BACKGROUND
In scaphoid nonunion advanced collapse (SNAC) wrist arthritis, we analyzed the 3-dimensional (3-D) deformity patterns of carpal alignment secondary to scaphoid nonunion and quantified subchondral arthritis by investigating alterations in bone density.
METHODS
We constructed 3-D models of the carpal bones and radius from 51 patients with scaphoid nonunion (nonunion group) and 50 healthy controls (control group). We quantified the differences in 3-D geometric position of the distal carpal row relative to the distal radius in SNAC wrists versus controls. In addition, we assessed the bone density of anatomic regions of interest in the radiocarpal and capitolunate joints relative to the pisiform bone density to characterize degenerative changes in SNAC wrists.
RESULTS
The distal carpal row pronated by a difference of 14° (7.2° versus -6.7°; p < 0.001), deviated ulnarly by a difference of 19° (7.7° versus -11.2°; p < 0.001), shifted dorsally by a difference of 17% of the dorsovolar width of the distal radius (21.0% versus 4.4%; p < 0.001), shifted radially by a difference of 8% of the radioulnar width of the distal radius (13.2% versus 5.3%; p < 0.001), and migrated proximally by a difference of 12% of the lunate height (96.3% versus 108.8%; p < 0.001) in the nonunion group compared with the control group. Additionally, it was found that bone density was greater at the capitolunate joint (capitate head: 140.4% versus 123.7%; p < 0.001; distal lunate: 159.9% versus 146.3%; p < 0.001), the radial styloid (157.0% versus 136.3%; p < 0.001), and the radiolunate joint (proximal lunate: 134.8% versus 122.7%; p < 0.001; lunate fossa: 158.6% versus 148.1%; p = 0.005) in the nonunion group compared with the control group.
CONCLUSIONS
Scaphoid nonunion exhibited a unique deformity pattern and alteration in bone-density distributions. The distal carpal row not only shifted dorsally and migrated proximally but also pronated, deviated ulnarly, and shifted radially. Bone density was greater at the capitolunate joint, the radial styloid, and surprisingly, the radiolunate joint. Our findings give insight into the natural history and progression of arthritis of the SNAC wrist. Additionally, future studies may give insight into whether successful treatment of scaphoid nonunion arrests the progression of arthritis.
LEVEL OF EVIDENCE
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Wrist; Pronation; Scaphoid Bone; Wrist Joint; Carpal Bones; Arthritis; Tomography, X-Ray Computed
PubMed: 37471563
DOI: 10.2106/JBJS.22.01350 -
JBJS Case Connector Dec 2019A 32-year-old man presented to the emergency department with several carpal bone fractures and a locked distal pisiform dislocation after trauma. Treatment consisted of...
CASE
A 32-year-old man presented to the emergency department with several carpal bone fractures and a locked distal pisiform dislocation after trauma. Treatment consisted of open surgical and reduction, osteosynthesis with a single Kirschner wire, and ligament repair. The patient's functional outcome was excellent, and his Mayo wrist score was 90 at 36 months after injury.
CONCLUSIONS
Pisiform dislocations may be difficult to diagnose because anteroposterior and lateral radiographs may not be sufficient to visualize the injury. A 30° semisupinated wrist x-ray and computed tomography can be helpful. A satisfactory clinical result may be achieved if distal pisiform dislocations are detected early and managed surgically with open reduction and ligament repair.
Topics: Adult; Bone Wires; Carpal Bones; Fracture Fixation, Internal; Humans; Joint Dislocations; Male; Pisiform Bone; Wrist Injuries; Wrist Joint
PubMed: 31770115
DOI: 10.2106/JBJS.CC.18.00278 -
Acta Orthopaedica Belgica Dec 2021Scaphoidectomy and 4-corner arthrodesis is a common salvage surgery for degenerative wrist pathology. The purpose of this study was to evaluate the results of this...
Scaphoidectomy and 4-corner arthrodesis is a common salvage surgery for degenerative wrist pathology. The purpose of this study was to evaluate the results of this procedure performed with headless compression screws, with a special focus on postoperative complications and their treatment. We assessed 36 wrists in 31 patients that were treated between 2009 and 2017. Mean follow-up was 5.2 years (range 2.9- 9.4). Pain was expressed on a Visual Analog Scale. The Quick Disabilities of the Arm, Shoulder and hand (qDASH) questionnaire and Michigan Hand Outcome Questionnaire (MHOQ) were used to assess patient functionality and satisfaction. Range of motion and grip strength of both wrists were measured. Radiographs of the operated wrist were evaluated. Mean pain score was 1.5 ± 2.3 with 19% of patients being completely free of pain also during activity. Mean qDASH was 44 ± 20 and mean MHOQ was 10 ± 5. Mean flexion-extension arc of the operated wrist was 69° and 61% of the contralateral wrist. Mean grip strength was 35kg and 89% of the opposite wrist. Non-union was observed in two patients. Two patients required hardware removal and in three patients a pisiformectomy was performed. Conversion to total wrist arthrodesis was needed in one patient. We observed postoperative complications in 28% of our patients. Most complications can successfully be treated with additional surgery. The presence of pisotriquetral arthritis should be assessed before surgery and treated with pisiform excision.
Topics: Arthrodesis; Bone Screws; Hand Strength; Humans; Range of Motion, Articular; Retrospective Studies; Scaphoid Bone; Wrist Joint
PubMed: 35172447
DOI: 10.52628/87.4.25 -
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