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Archives of Rheumatology Dec 2019This study aims to investigate whether or not radial deviation developing after wrist involvement of rheumatoid arthritis (RA) is a cause of median nerve swelling.
OBJECTIVES
This study aims to investigate whether or not radial deviation developing after wrist involvement of rheumatoid arthritis (RA) is a cause of median nerve swelling.
PATIENTS AND METHODS
The study included 51 RA patients (12 males, 39 females; mean age 50.9±8.9 years; range, 18 to 65 years) without carpal tunnel syndrome (CTS) detected by electroneuromyography. Duruöz hand index, visual analog scale, and painDETECT questionnaire were performed in clinical assessment. Radiographic measurements including radial inclination (RI) angle were performed. Using ultrasonography, the median nerve cross-sectional areas (CSAs) were measured from the four levels of the distal one third of the forearm, radioulnar joint, pisiform bone, and hook of hamate, while the ulnar nerve CSAs were measured from the pisiform bone.
RESULTS
The study was completed with 102 hands of 51 patients. A negative correlation was found between the RI and the median CSAs measured from the radioulnar joint (R=-0.49; p=0.00), the pisiform bone (R= -0.45; p=0.00), and hook of hamate (R= -0.60, p=0.00). When the hands were divided into three groups according to the ranges of RI specified in the literature, the median nerve CSA was found to be significantly higher in the group with low RI at these levels (p<0.001).
CONCLUSION
In patients with RA without CTS, the increase in the median nerve CSAs may be associated with radiographic measures such as radial deviation.
PubMed: 32010886
DOI: 10.5606/ArchRheumatol.2019.7335 -
Journal of Hand Surgery Global Online Mar 2020This study aimed to report the outcomes of patients with stage III Kienböck disease after treatment with a vascularized bone graft (VBG) to the lunate combined with...
Vascularized Bone Graft to the Lunate Combined with Shortening of the Capitate and Radius for Treatment of Advanced Kienböck Disease After a Follow-Up for More Than 10 Years.
PURPOSE
This study aimed to report the outcomes of patients with stage III Kienböck disease after treatment with a vascularized bone graft (VBG) to the lunate combined with capitate shortening osteotomy (CS) after a more than 10-year follow-up.
METHODS
A VBG to the lunate was combined with CS in 10 patients with stage III Kienböck disease (6 patients with stage IIIA and 4 with stage IIIB). We performed VBG, CS, and radial shortening osteotomy (RS) on 7 patients. Among them, 4 had undergone RS previously. The passive wrist extension angle and wrist flexion angle, grip strength (GS), carpal height ratio, Stahl index, visual analog scale of wrist pain, and Mayo modified wrist score were assessed before surgery and at the final follow-up.
RESULTS
The flexion angle decreased markedly after surgery, when GS increased in all 10 patients. Radiographic examinations revealed that the carpal height ratio decreased in 9 of 10 patients, whereas the Stahl index increased in 8 patients and remained unchanged in 2. The oldest 3 of 7 patients who underwent VBG, CS, and RS exhibited fusion of the proximal carpals except the pisiform. The mean visual analog scale decreased from 27.6 before surgery to 5.7 afterward. The Mayo modified wrist score improved in 9 patients after surgery and remained unchanged in one.
CONCLUSIONS
In stage III Kienböck disease, VBG to the lunate combined with CS relieved wrist pain and increased GS and lunate height but was followed by severely restricted wrist motion. Fusion of the proximal carpals developed in 3 of 7 patients who received VBG with CS and RS.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic Ⅳ.
PubMed: 35415486
DOI: 10.1016/j.jhsg.2019.09.012 -
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 -
Surgical and Radiologic Anatomy : SRA Mar 2020Spasticity of the first web space is common in upper limb spasticity. Selective neurectomy is one of the treatments that can reduce spasticity. The purpose of this study...
PURPOSE
Spasticity of the first web space is common in upper limb spasticity. Selective neurectomy is one of the treatments that can reduce spasticity. The purpose of this study was to describe the variations of the deep motor branch of the ulnar nerve for the adductor pollicis (AP) and the first dorsal interosseous muscle (DIO) to assess the feasibility of selective neurectomy and suggest an ideal surgical approach.
METHODS
The deep branch of the ulnar nerve (DBUN) was dissected in 21 hands. Measurements included the distance between the point of passage of the DBUN between the two heads of the adductor and three anatomical landmarks: the bi-styloid line, the flexor carpi radialis and the pisiform bone, and the number and mode of divisions of each branch.
RESULTS
The point of passage of the DBUN between the two heads of the adductor is very constant respective to the landmarks. The DBUN gives off 1-3 branches each for the oblique head of the AP, the transverse head, and the first DIO. Muscles receive more than one branch in 95% cases for the oblique head and 62% of cases for the transverse head, and 100% for the DIO.
CONCLUSIONS
This anatomical study suggests that selective neurectomy is feasible for the AP and first DIO muscles in most cases. An ideal approach for selective neurectomy of these muscles should start from the point of passage of the DBUN between the two heads of the AP. This point is easily identified with the help of the described landmarks.
Topics: Aged; Anatomic Variation; Cadaver; Denervation; Feasibility Studies; Female; Hand; Humans; Male; Muscle Spasticity; Muscle, Skeletal; Ulnar Nerve
PubMed: 31745617
DOI: 10.1007/s00276-019-02380-y -
Asian Journal of Surgery Jun 2020Carpal tunnel syndrome is diagnosed based on history, physical examination, and nerve conduction testing; however, there are no clear criteria for the diagnosis of...
BACKGROUND
Carpal tunnel syndrome is diagnosed based on history, physical examination, and nerve conduction testing; however, there are no clear criteria for the diagnosis of carpal tunnel syndrome. Recently, studies have aimed to diagnose carpal tunnel syndrome through ultrasound or MRI. The purpose of this study was to compare and analyze the cross-sectional area of the median nerve between patients with carpal tunnel syndrome and a control group.
METHODS
From July 2015 to August 2017, we retrospectively analyzed fishery and white-collar workers (164 people, 37 men, 127 women). Carpal tunnel syndrome was diagnosed on the basis of both physical examination and nerve conduction testing. A negative result in either test led to exclusion from the study.
RESULTS
In total, 164 wrist MRI were retrieved, with 67 patients diagnosed with carpal tunnel syndrome and 97 patients allocated to the control group. The mean value of cross-sectional area at the pisiform was 18.8 mm in the MRI of the carpal tunnel syndrome patients and 12.1 mm (p-value <0.05) in the control group. The mean value of cross-sectional area at the hook of hamate was 11.70 mm and that at the control group was 11.67 mm (p-value 0.055).
CONCLUSION
Cross-sectional area at pisiform in MRI is a valuable factor in the diagnosis of carpal tunnel syndrome and in predicting the duration of pain.
Topics: Aged; Carpal Tunnel Syndrome; Female; Hamate Bone; Humans; Magnetic Resonance Imaging; Male; Median Nerve; Middle Aged; Neural Conduction; Pain; Physical Examination; Retrospective Studies
PubMed: 31473048
DOI: 10.1016/j.asjsur.2019.08.001 -
Journal of Surgical Case Reports Jun 2019The pisiform is a sesamoid bone with in flexor carpi ulnaris tendon. Isolated dislocation of the pisiform bone is not common. It is usually missed and diagnosed as a...
The pisiform is a sesamoid bone with in flexor carpi ulnaris tendon. Isolated dislocation of the pisiform bone is not common. It is usually missed and diagnosed as a soft tissue injury or a sprain of the wrist by the emergency physicians. We present an unusual and unique case of a young man involved in a rugby tackle and who himself presented to the emergency department with a painful wrist. The diagnosis of a dislocated pisiform was initially missed; however it was later successfully treated with an open reduction leading to a satisfactory outcome.Early diagnosis and reduction is imperative to avoid prolonged morbidity and loss of earnings. A high index of suspicion is needed in young patients with wrist trauma displaying ulnar sided wrist pain.
PubMed: 31214321
DOI: 10.1093/jscr/rjz183 -
Orthopedics Sep 2019Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Its diagnosis is based on clinical symptoms and neurophysiological evaluation....
Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Its diagnosis is based on clinical symptoms and neurophysiological evaluation. Recently, ultrasonography has been introduced as a promising noninvasive diagnostic alternative. In this study, the authors compared ultrasonography with neurophysiological findings for the diagnosis of CTS in 96 patients/hands with clinical symptoms of CTS. The latency, amplitude, distance, and velocity of the median and ulnar nerves were measured. Needle electromyography was performed in the abductor pollicis brevis, in addition to muscles of the arm and forearm, to exclude proximal median nerve, brachial plexus, or radicular abnormalities. Ultrasonography was based on the morphologic/anatomic changes of the median nerve cross-sectional area in the sagittal plane of the wrist at the level of the pisiform bone, the changes of its regional echogenicity, and the identification of coexisting pathologies, such as tenosynovitis, space-occupying lesions, supplementary muscles, and vessels, that may provoke indirectly an increase of the pressure in the carpal tunnel. Eighty-seven (90%) of the 96 patients/hands with clinical symptoms of CTS showed positive findings in both ultrasonography and nerve conduction studies. Six (6%) patients showed positive findings only in nerve conduction studies, and 3 (3%) patients showed positive findings only in ultrasonography; the difference was not statistically significant. The sensitivity and the specificity of nerve conduction studies compared with ultrasonography was 97% and 89% compared with 94% and 55%, respectively. A positive correlation and proportional increase of the ultrasonography measurements compared with the increase of the nerve conduction studies severity was observed. [Orthopedics. 2019; 42(5):e460-e464.].
Topics: Carpal Tunnel Syndrome; Electromyography; Female; Humans; Median Nerve; Neural Conduction; Sensitivity and Specificity; Ulnar Nerve; Ultrasonography
PubMed: 31185120
DOI: 10.3928/01477447-20190604-02 -
Hand Clinics Aug 2019Vascularized bone flaps (VBFs) improve union rates for scaphoid nonunions compared with nonvascularized grafts. Volar VBFs are indicated in cases of scaphoid nonunion... (Review)
Review
Vascularized bone flaps (VBFs) improve union rates for scaphoid nonunions compared with nonvascularized grafts. Volar VBFs are indicated in cases of scaphoid nonunion with avascular necrosis and/or humpback deformity. Four volar VBFs are described in this article. The volar carpal artery and pronator quadratus VBFs are most commonly used. The pisiform VBF can be used for replacement of the proximal pole of the scaphoid; it is covered by articular cartilage. The ulna VBF has greater donor morbidity; the ulnar artery is harvested and a palpable donor site deformity results.
Topics: Cancellous Bone; Cortical Bone; Fracture Fixation, Internal; Fractures, Ununited; Humans; Muscle, Skeletal; Osteonecrosis; Pisiform Bone; Postoperative Care; Radius; Scaphoid Bone; Ulna
PubMed: 31178092
DOI: 10.1016/j.hcl.2019.03.012 -
Current Problems in Diagnostic Radiology 2020To use anatomic measurements on magnetic resonance imaging (MRI) and ultrasonography (USG) in diagnosing and grading carpal tunnel syndrome (CTS) using nerve conduction... (Comparative Study)
Comparative Study
OBJECTIVE
To use anatomic measurements on magnetic resonance imaging (MRI) and ultrasonography (USG) in diagnosing and grading carpal tunnel syndrome (CTS) using nerve conduction studies (NCS) as the gold standard.
MATERIAL AND METHODS
In this prospective study, 26 patients with CTS (45 wrists; 22 female and 4 male patients; mean ± SD age of 49.42 + 14.47 years) and 19 age and sex matched healthy volunteers (32 wrists; 15 female and 4 male volunteers, mean ± SD age of 42.52 + 10.85 years) underwent MRI and USG. Cross-sectional area (CA) of median nerve was measured using free hand ROI at four levels: hamate hook (H0), pisiform bone (PI0), 1 cm proximal (PI1) and 2 cm proximal to PI0 (PI2). Relative median nerve signal intensity (MNSI) was calculated as ratio of median nerve signal intensity with hypothenar muscle signal intensity. Flexor retinacular bowing was calculated at hamate hook level. Echogenicity and Power Doppler vascularity of median nerve were assessed on USG. Independent t-test, chi square test and receiver operating characteristic curve analysis were used as appropriate.
RESULTS
On USG, CA measured at PI0 (95% confidence interval of 0.872-0.987) and retinacular bowing (0.816-0.912), while, on MRI, CA at PI1 (0.874-0.997) were most useful in diagnosing CTS based on the ROC and Zombie plot analysis. Area under curves for CA measurements on USG and MRI were not significantly different. CA at PI1 on MRI (0.752-0.965) was significantly different between minimal to moderate CTS and severe to extreme CTS groups (on NCS).
CONCLUSION
CA of median nerve is the most useful parameter to diagnose and grade CTS and USG and MRI are comparable for measurements. Increased retinacular bowing on USG and hypoechogenicity of median nerve increase the diagnostic confidence while MRI helps in picking up important associated conditions.
Topics: Adult; Carpal Tunnel Syndrome; Female; Humans; Magnetic Resonance Imaging; Male; Median Nerve; Middle Aged; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Ultrasonography; Wrist Joint
PubMed: 31126663
DOI: 10.1067/j.cpradiol.2019.04.004 -
Hand Surgery & Rehabilitation Jun 2019Pisiformectomy is the gold standard treatment for pisotriquetral arthritis resistant to conservative treatment. We evaluated the long-term clinical and functional...
Pisiformectomy is the gold standard treatment for pisotriquetral arthritis resistant to conservative treatment. We evaluated the long-term clinical and functional outcomes after pisiformectomy in resistant pisotriquetral arthritis cases. We retrospectively evaluated 11 patients (12 wrists), mean age of 59 years (49-69) treated by pisiformectomy using a standardized surgical technique. Pisiformectomy was performed for primary osteoarthritis in 10 cases, for post-traumatic osteoarthritis in 1 case and for pisotriquetral instability in 1 case. The clinical and functional evaluation was carried out by an independent examiner. Mean time to review was 90 months (63-151). Pain on a Visual Analog Scale (/10) decreased significantly to 1.1 from 6.8 preoperatively. Mean range of motion was 79° in flexion, 61.5° in extension, 18° in ulnar deviation and 36° in radial deviation. Mean grip strength of the operated wrist was 86% of the non-operated wrist. Functional scores significantly improved with a gain of 40 points for the QuickDASH and 53 points for the PRWE. Based on this long-term follow-up study, pisiformectomy seems to alleviate wrist pain and improve the quality of life in a low-demand population with pisotriquetral osteoarthritis resistant to conservative treatment. When compared to the pisotriquetral arthrodesis, pisiformectomy is easier to perform, allows quicker mobilization of the wrist and leads to good functional outcomes.
Topics: Aged; Carpal Joints; Follow-Up Studies; Hand Strength; Humans; Middle Aged; Osteoarthritis; Pisiform Bone; Range of Motion, Articular; Retrospective Studies; Triquetrum Bone; Visual Analog Scale
PubMed: 30904496
DOI: 10.1016/j.hansur.2019.01.005