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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 -
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 -
Plastic and Reconstructive Surgery.... Nov 2018Guyon's syndrome results from a lesion of the ulnar nerve at the wrist caused by several conditions. The most common causes are ganglion, lipomas, fractures of the...
Guyon's syndrome results from a lesion of the ulnar nerve at the wrist caused by several conditions. The most common causes are ganglion, lipomas, fractures of the radius or pisiform bone, occupational trauma, neuritis, musculotendinous arch, and diseases of the ulnar artery. The clinical presentation varies with the site of lesion, as described by Sean and McClain in 1969, and can involve combined sensory and motor deficits, motor deficit alone, or sensory deficit alone. We present a case of bilateral Guyon's canal syndrome caused by a lipoma with Pacinian corpuscles on both wrists. Patient presented with sensory deficit as it is described by Shea and McClain with a negative electroneuromyography for ulnar compression. Articles correlating clinical presentation, etiology, and electrophysiological findings relating to ulnar nerve compression on the wrist are still uncommon in the literature.
PubMed: 30881781
DOI: 10.1097/GOX.0000000000001946 -
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 -
Medicine Nov 2018No surgical procedure perfectly treats advanced Kienböck disease. Although vascularized os pisiform transferring (VOPT) is one of the main therapeutic approaches,...
No surgical procedure perfectly treats advanced Kienböck disease. Although vascularized os pisiform transferring (VOPT) is one of the main therapeutic approaches, reports on long-term follow-up and case series for this technique are scarce.We collected postoperative results in 11 patients with advanced Kienböck disease who underwent VOPT between 1986 and 2001 in our Hospital. Follow-up durations ranged from 15 to 26 years.At the last follow-up, excellent and good results were found in 81.8% according to the Modified Green and O'Brien score. Postoperative imaging revealed significantly reduced pisiform bone; carpal height ratio and Nattrass index were decreased, while the radioscaphoid angle was increscent, compared with preoperative and mid-term follow-up results.The favorable long-term results demonstrated that VOPT is a dependable and durable procedure for the treatment of advanced Kienböck disease, with pain relief and functional improvement despite some radiographic findings such as wrist osteoarthritis occurrence.
Topics: Adult; Female; Follow-Up Studies; Humans; Male; Middle Aged; Osteonecrosis; Pisiform Bone; Postoperative Complications; Retrospective Studies; Time Factors; Young Adult
PubMed: 30508905
DOI: 10.1097/MD.0000000000013229 -
Journal of Wrist Surgery Nov 2018Pisiform excision and pisotriquetral arthrodesis are two surgical options for the treatment of pisotriquetral joint pain when conservative methods fail. However, it...
Pisiform excision and pisotriquetral arthrodesis are two surgical options for the treatment of pisotriquetral joint pain when conservative methods fail. However, it is unclear which option is best for patients who experience substantial, repetitive loading on their wrists and wish to preserve wrist flexibility and function. We present a case of bilateral ulnar-sided wrist pain related to the pisotriquetral joint in a 19-year-old collegiate diver. The pain was exacerbated by activities specific to this sport that requires wrist hyperextension, namely full weight-bearing on the hands (handstands), and has an impact on the hands and wrists upon water entry during dives due to direct palmar pressure. There were no radiographic signs of arthritis; however, there were bone marrow changes on magnetic resonance imaging (MRI). Management with rest, splinting, and corticosteroid injection failed to relieve the pain and precluded his ability to return to full-time diving. Treatment consisted of bilateral pisiform excision. Postoperatively, the patient returned to full-time competitive diving with resolution of his painful symptoms. Pisiform excision has been shown to have successful outcomes in terms of return to play for lower impact athletes (such as badminton) but has not been reported in athletes who experience a high degree of force repetitively (such as gymnasts or divers). There is one report of pisotriquetral arthrodesis in a young gymnast with suboptimal results. This case report demonstrates that pisiform excision is a successful treatment for elite athletes who experience repetitive, palmar force on hyperextended wrists and subsequently develop ulnar-sided wrist pain.
PubMed: 30349756
DOI: 10.1055/s-0038-1642047 -
Hand (New York, N.Y.) Jan 2020Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of...
Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of recovery after carpal tunnel release (CTR). The purpose of this study is to compare the cross-sectional area (CSA) of the median nerve in patients with severe and nonsevere CTS as defined by NCS. Ultrasound CSA measurements were taken at the carpal tunnel inlet at the level of the pisiform bone by a hand fellowship-trained orthopedic surgeon. Severe CTS on NCS was defined as no response for the distal motor latency (DML) and/or distal sensory latency (DSL). A total of 274 wrists were enrolled in the study. The median age was 51 years (range: 18-90 years), and 72.6% of wrists were from female patients. CSA of median nerve and age were comparatively the best predictors of severity using a linear regression model and receiver operator curves. Using cutoff of 12 mm for severe CTS, the sensitivity and specificity are 37.5% and 81.9%, respectively. Ultrasound can be used to grade severity in younger patients (<65 years) with a CTS-6 score of >12.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carpal Tunnel Syndrome; Electrodiagnosis; Female; Humans; Linear Models; Male; Median Nerve; Middle Aged; Neural Conduction; Pisiform Bone; ROC Curve; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Ultrasonography; Wrist; Young Adult
PubMed: 30027757
DOI: 10.1177/1558944718788642 -
Investigative Radiology Dec 2018The aim of this study was to describe the development of morphologic and diffusion tensor imaging sequences of peripheral nerves at 7 T, using carpal tunnel syndrome...
OBJECTIVES
The aim of this study was to describe the development of morphologic and diffusion tensor imaging sequences of peripheral nerves at 7 T, using carpal tunnel syndrome (CTS) as a model system of focal nerve injury.
MATERIALS AND METHODS
Morphologic images were acquired at 7 T using a balanced steady-state free precession sequence. Diffusion tensor imaging was performed using single-shot echo-planar imaging and readout-segmented echo-planar imaging sequences. Different acquisition and postprocessing methods were compared to describe the optimal analysis pipeline. Magnetic resonance imaging parameters including cross-sectional areas, signal intensity, fractional anisotropy (FA), as well as mean, axial, and radial diffusivity were compared between patients with CTS (n = 8) and healthy controls (n = 6) using analyses of covariance corrected for age (significance set at P < 0.05). Pearson correlations with Bonferroni correction were used to determine association of magnetic resonance imaging parameters with clinical measures (significance set at P < 0.01).
RESULTS
The 7 T acquisitions with high in-plane resolution (0.2 × 0.2mm) afforded detailed morphologic resolution of peripheral nerve fascicles. For diffusion tensor imaging, single-shot echo-planar imaging was more efficient than readout-segmented echo-planar imaging in terms of signal-to-noise ratio per unit scan time. Distortion artifacts were pronounced, but could be corrected during postprocessing. Registration of FA maps to the morphologic images was successful. The developed imaging and analysis pipeline identified lower median nerve FA (pisiform bone, 0.37 [SD 0.10]) and higher radial diffusivity (1.08 [0.20]) in patients with CTS compared with healthy controls (0.53 [0.06] and 0.78 [0.11], respectively, P < 0.047). Fractional anisotropy and radial diffusivity strongly correlated with patients' symptoms (r = -0.866 and 0.866, respectively, P = 0.005).
CONCLUSIONS
Our data demonstrate the feasibility of morphologic and diffusion peripheral nerve imaging at 7 T. Fractional anisotropy and radial diffusivity were found to be correlates of symptom severity.
Topics: Adult; Artifacts; Carpal Tunnel Syndrome; Diffusion Tensor Imaging; Echo-Planar Imaging; Feasibility Studies; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Peripheral Nerves; Prospective Studies; Signal-To-Noise Ratio
PubMed: 29979328
DOI: 10.1097/RLI.0000000000000492 -
Journal of Hand and Microsurgery Apr 2018Pisiform dislocation is a rare wrist injury. The limited literature available describes this pathology in the form of case reports. An immediate closed reduction and...
Pisiform dislocation is a rare wrist injury. The limited literature available describes this pathology in the form of case reports. An immediate closed reduction and immobilization is indicated for acute injury while there is a debate in the management of cases with delayed diagnosis or failed closed reduction. In this case, a 32-year-old, right-handed man visited the emergency department with pain at the ulnar side of his left wrist after a fall. The initial management involved immobilization, and the patient was referred to the authors' specialized clinic 10 days later because of persistence of important ulnar wrist pain. The choice of treatment was pisiform excision without ligament reconstruction with excellent functional results.
PubMed: 29706735
DOI: 10.1055/s-0037-1606206