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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 -
Journal of Rheumatic Diseases Jan 2023The aim of the present study is to assess carpal tunnel syndrome's (CTS's) ultrasonography (US) and magnetic resonance imaging (MRI) findings in patients with psoriatic...
OBJECTIVE
The aim of the present study is to assess carpal tunnel syndrome's (CTS's) ultrasonography (US) and magnetic resonance imaging (MRI) findings in patients with psoriatic arthritis (PsA) and compare them with healthy controls.
METHODS
Thirty-nine PsA and twenty-eight healthy volunteers were examined in this study. Demographic and clinical features were recorded. CTS-6, a diagnostic algorithm, was used to estimate the probability of CTS. Electrodiagnostic study (EDS) was applied to all wrists included in the report, where the diagnosis of CTS was made by EDS. The cross-sectional area (CSA) of the median nerve was measured at pisiform bone level by US and MRI.
RESULTS
Regarding to the demographic characteristics, no statistically significant difference was found between the groups. Twelve of 39 (30.76%) PsA patients had CTS, whereas CTS was not detected in the control group (p=0.001). US and MRI showed increased median nerve CSA in PsA patients compared to healthy controls (p=0.005, p<0.001; respectively). Also, US and MRI showed increased median nerve CSA in CTS patients compared to others (p=0.002, p<0.001; respectively). The Pearson correlation coefficient between MRI and US measurements of the CSA was 0.85 (p<0.001).
CONCLUSION
CTS frequency in PsA patients is found higher than healthy controls. The relationship between CTS diagnosed by EDS and CSA measured by both US and MRI was observed in PsA patients.
PubMed: 37476525
DOI: 10.4078/jrd.22.0028 -
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 -
Hand Surgery & Rehabilitation Oct 2023Fractures of carpal bones other than the scaphoid are rare in children. The aim of this study was to analyze results and identify risk factors for an unfavorable outcome.
OBJECTIVES
Fractures of carpal bones other than the scaphoid are rare in children. The aim of this study was to analyze results and identify risk factors for an unfavorable outcome.
MATERIAL AND METHODS
Children and adolescents up to the age of 16 years who sustained a carpal fracture other than in the scaphoid between 2004 and 2021 were reviewed in this single-center retrospective study.
RESULTS
In a series of 209 children and adolescents with carpal fractures, 22 had fractures other than the scaphoid. Mean age was 13 years (range 8-16) years, with a total of 41 fractures, with highest incidences for the capitate (10), trapezium (6), triquetrum (4) and pisiform (4). Twenty-nine of these 41 fractures were missed on initial X-ray. Non-displaced fractures were treated with a short arm spica cast including the thumb. Four patients were operated on for displacement fracture or carpometacarpal subluxation. All fractures united, and patients returned to full activities. At the final consultation at a median 14 months (range 6-89) post-injury, all patients with non-displaced fractures were free of symptoms, with excellent Mayo Wrist Scores (MWS). However, three patients with operated trapezium fractures developed early radiological signs of osteoarthritis, two of them with residual pain and MWS rated only good.
CONCLUSION
Non-displaced pediatric carpal fractures treated by forearm cast have excellent prognosis. Fractures of the trapezium with displacement or first carpometacarpal subluxation incur a risk of osteoarthritis despite anatomical reduction and internal fixation.
Topics: Adolescent; Humans; Child; Retrospective Studies; Fractures, Bone; Scaphoid Bone; Wrist; Wrist Injuries; Joint Dislocations; Hand Injuries; Osteoarthritis
PubMed: 37356568
DOI: 10.1016/j.hansur.2023.06.009 -
Anatomical Record (Hoboken, N.J. : 2007) Jun 2023The role of mechanical stimuli in promoting endochondral ossification during somatic growth and maturation remains an active area of research. This study employs a...
The role of mechanical stimuli in promoting endochondral ossification during somatic growth and maturation remains an active area of research. This study employs a pisiform model of endochondral ossification to investigate the potential role of mechanobiological signals in the appearance and development of ossification centers and to develop theoretical applications to the primate basicranium. We constructed finite element models based on the structure of a human pisiform within the flexor carpi ulnaris tendon. The pisiform was assigned initial material properties of hyaline cartilage, and tendon properties were based on in situ observations drawn from the literature. A macaque growth model was used to simulate increased load over time as a function of body mass. A load case of uniaxial tension from the tendon was applied over 208 iterations, to simulate weekly growth over a 4-year span. The mechanical signal was defined as shear stress. Element stresses were evaluated in each iteration, with elements exceeding the yield threshold subsequently assigned a higher elastic modulus to mimic mechanically driven mineralization. Three unique mineralization rates were tested. Regardless of rate, all ossification simulations predict a pisiform with heterogeneous stiffness through alternating periods of material stasis and active mineralization/ossification. Assuming metabolic processes underlying endochondral ossification are similar throughout the body, our model suggests that a mechanical signal alone is an insufficient stimulus in the etiology of bone formation through endochondral ossification. Consequently, given the general validity of the simulation, endochondral ossification cannot be fully explained in terms of mechanical stimuli.
PubMed: 37283209
DOI: 10.1002/ar.25274 -
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 -
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 Surgery & Rehabilitation Feb 2023Fractures of the triquetrum are the second most common form of isolated carpal bone fracture after the scaphoid. However, data on triquetrum morphology and morphometry...
Fractures of the triquetrum are the second most common form of isolated carpal bone fracture after the scaphoid. However, data on triquetrum morphology and morphometry are sparse. The aim of this study was to describe the morphology of triquetrum using anatomical landmarks, evaluate its morphometric features, and determine its vascular entry points. The morphological and morphometrical features of 87 adult dry triquetral bones (39 left, 48 right) were determined by measuring length, width and thickness. The number and locations of nutrient foramina wider than 0.5 mm were recorded. Mean length, width and thickness were 17.37 mm (range, 14.26-22.13), 12.65 mm (range, 10.37-15.85) and 11.41 mm (range, 8.98-18.23), respectively. The facet articulating with the pisiform was oval in 40 bones, round in 8 and amorphous (neither round nor oval) in 39. The mean length of the interarticular ridge was 7.09 ± 0.9 mm. The mean number of nutrient foramina was significantly greater on the dorsal than on the other aspects. The dorsal predominance of nutrient foramina makes the bone weaker in the dorsal region, which could explain why fractures are more common in this region. Also, the dorsal aspect is rich in blood supply, which could explain why avascular necrosis is less common in triquetral fractures. As most of the vascularization is on the dorsal side, there is need for caution when performing triquetrum surgery. LEVEL OF EVIDENCE: Level 2.
Topics: Adult; Humans; Triquetrum Bone; Scaphoid Bone; Upper Extremity; Fractures, Bone; Wrist Injuries
PubMed: 36400416
DOI: 10.1016/j.hansur.2022.11.002