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Anaesthesia Reports 2022A 63-year-old woman had sustained a subcutaneous rupture of the flexor digitorum profundus tendon of the little finger due to osteoarthritis of the pisotriquetral joint....
A 63-year-old woman had sustained a subcutaneous rupture of the flexor digitorum profundus tendon of the little finger due to osteoarthritis of the pisotriquetral joint. She underwent excision of the pisiform bone and reconstruction of the flexor digitorum profundus tendon of the little finger using an autogenous palmaris longus tendon graft. After surgery, a continuous ulnar nerve block was performed at the forearm under ultrasound and nerve stimulator guidance. During rehabilitation, she could not actively extend her little finger independently due to the block; however, she could actively extend it when the dorsum of the metacarpophalangeal joint was pressed by the occupational therapist, resulting in successful early active mobilisation. A continuous ulnar nerve block at the forearm may help to facilitate early active mobilisation after reconstructive surgery for little finger flexor tendon rupture. However, it may restrict the active extension of the little finger because the block does not spare the innervation of the intrinsic muscles responsible for little finger extension.
PubMed: 36237495
DOI: 10.1002/anr3.12180 -
The Journal of Hand Surgery, European... Apr 2023
Re: Rothenfluh E, Mürset A, Vögelin E. Avascular necrosis of the pisiform bone in a child. J Hand Surg Eur. 2022 Jun 1; 17531934221101825. doi: 10.1177/17531934221101825.
Topics: Humans; Child; Pisiform Bone; Hand; Osteonecrosis; Upper Extremity
PubMed: 35949179
DOI: 10.1177/17531934221114957 -
Genes Jul 2022The human capacity to speak is fundamental to our advanced intellectual, technological and social development. Yet so very little is known regarding the evolutionary...
The human capacity to speak is fundamental to our advanced intellectual, technological and social development. Yet so very little is known regarding the evolutionary genetics of speech or its relationship with the broader aspects of evolutionary development in primates. In this study, we describe a large family with evolutionary retrograde development of the larynx and wrist. The family presented with severe speech impairment and incremental retrograde elongations of the pisiform in the wrist that limited wrist rotation from 180° to 90° as in primitive primates. To our surprise, we found that a previously unknown primate-specific gene had been disrupted in the family. emerged de novo in an ancestor of extant primates across a 540 kb region of the genome with a pre-existing highly conserved long-range laryngeal enhancer for a neighbouring bone morphogenetic protein gene . We used transgenic mouse modelling to identify two additional long-range enhancers within that regulate expression in the wrist. Disruption of in the affected family blocked the transcription of across the 3 enhancers in association with a reduction in expression and retrograde development of the larynx and wrist. Furthermore, we describe how developed a human-specific promoter through the expansion of a penta-nucleotide direct repeat that first emerged de novo in the promoter of in gibbon. This repeat subsequently expanded incrementally in higher hominids to form an overlapping series of Sp1/KLF transcription factor consensus binding sites in human that correlated with incremental increases in the promoter strength of with human having the strongest promoter. Our research indicates a dual evolutionary role for the incremental increases in transcriptional interference of enhancers in the incremental evolutionary development of the wrist and larynx in hominids and the human capacity to speak and their retrogression with the reduction of transcription in the affected family.
Topics: Animals; Biological Evolution; Growth Differentiation Factor 6; Humans; Mice; Primates; Regulatory Sequences, Nucleic Acid; Speech
PubMed: 35885978
DOI: 10.3390/genes13071195 -
Acta Radiologica (Stockholm, Sweden :... Mar 2023Magnetic resonance diffusion tensor imaging (MR-DTI) has been increasingly applied for carpal tunnel syndrome (CTS) diagnosis, but relatively little is known about the...
BACKGROUND
Magnetic resonance diffusion tensor imaging (MR-DTI) has been increasingly applied for carpal tunnel syndrome (CTS) diagnosis, but relatively little is known about the effect of CTS treatment on median nerve (MN) integrity and functional outcome prediction.
PURPOSE
To assess how structural changes in MR-DTI of the MN correlates with symptom severity, functional status, and electrophysiological parameters in patients suffering from CTS before and after decompression surgery.
MATERIAL AND METHODS
Nine wrists were prospectively enrolled to perform MR-DTI pre- and postoperatively. The apparent diffusion coefficients (ADC) and fractional anisotropy (FA) of the MN were examined in three different regions-distal radioulnar joint, pisiform bone, and hamate bone-and correlated with clinical and electrophysiological parameters.
RESULTS
Postoperatively, mean Boston Carpal Tunnel Questionnaire scores decreased 1.55 points (range = 0.08-3; = 0.0172) and 1.01 points (-0.13 to 1.88; = 0.0381) in the symptomatic and functional domains, respectively. Postoperative clinical improvement was reflected in proximal FA elevation ( = 0.0078), but not in diffusivity in comparison to baseline examination. Preoperative electrophysiological parameters were correlated with a reduction in the pre- (sensory latencies [rho = -0.6826; = 0.0312]) and postoperative (motor latencies [rho = -0.7488; = 0.0325]) distal FA values. Higher sensory amplitudes indicated higher postoperative proximal FA values (rho = 0.7618; = 0.0280) and lower postoperative proximal ADC values (rho = -0.9047; = 0.0020).
CONCLUSION
Our study demonstrated that pre- and postoperative proximal FA values are useful biomarkers for the structural evaluation of the MN in patients with CTS. Symptomatic improvement can be better predicted by analyzing FA changes.
Topics: Humans; Carpal Tunnel Syndrome; Diffusion Tensor Imaging; Prognosis; Biomarkers; Decompression
PubMed: 35876308
DOI: 10.1177/02841851221113518 -
Handchirurgie, Mikrochirurgie,... Jun 2023We report a case of a 67-year-old patient with avascular necrosis of the metacarpal head of the right middle finger reconstructed using an osteochondral autograft from...
We report a case of a 67-year-old patient with avascular necrosis of the metacarpal head of the right middle finger reconstructed using an osteochondral autograft from the ipsilateral os pisiforme.
Topics: Humans; Aged; Pisiform Bone; Metacarpal Bones; Osteonecrosis; Metacarpus; Intra-Articular Fractures
PubMed: 35853470
DOI: 10.1055/a-1868-5629 -
SAGE Open Medical Case Reports 2022Carpal joint osteoarthritis and the formation of bony irregularities of the carpal bone cause closed flexor tendon ruptures. This report describes a case of a flexor...
Closed rupture of a flexor profundus tendon to the little finger caused by asymptomatic pisotriquetral osteoarthritis: A case required differentiation from the tendon rupture due to hamate bony irregularity by bone erosion.
Carpal joint osteoarthritis and the formation of bony irregularities of the carpal bone cause closed flexor tendon ruptures. This report describes a case of a flexor profundus tendon closed rupture of the little finger due to asymptomatic pisotriquetral osteoarthritis in a 73-year-old woman, which required differentiation from tendon rupture due to hamate bony irregularity due to bone erosion. Computed tomography showed cortical bone irregularities of the hamate and the narrowing of the pisotriquetral joint space, and a bony spur on the radial side of the pisiform. Intraoperative findings revealed the capsule of the pisotriquetral joint was torn on the radial side. Pisiform-hamate ligament disruption and the bony spur on the pisiform were found on this side. However, the flexor tendon floor on the hamate was intact. Surgical resection of the pisiform and a free tendon interposition graft for tendon rupture restored the good function of the little finger. Particular attention should be paid in making the diagnosis in cases with multiple possible triggers for closed flexor tendon rupture.
PubMed: 35747244
DOI: 10.1177/2050313X221104314 -
The Journal of Hand Surgery, European... Oct 2022
Topics: Carpal Bones; Child; Humans; Osteonecrosis; Pisiform Bone
PubMed: 35642533
DOI: 10.1177/17531934221101825 -
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 -
Journal of Plastic, Reconstructive &... Aug 2022Although good clinical results have been reported following lunate resection and vascularized os pisiform transfer for advanced stages of Kienböck's disease, the...
Although good clinical results have been reported following lunate resection and vascularized os pisiform transfer for advanced stages of Kienböck's disease, the occurrence of wrist osteoarthritis has been highlighted. We aimed to investigate the postoperative condition of the pisiform and the surrounding bones in patients who underwent surgery for advanced stages of Kienböck's disease using magnetic resonance imaging. We retrospectively reviewed the data of six patients (mean age, 45 years; Lichtman stage, IIIb) who underwent lunate resection and vascularized os pisiform transfer for advanced stages of Kienböck's disease and postoperative magnetic resonance imaging examination. We extracted clinical data on pre- and postoperative range of motion, grip strength, wrist pain, Hand20 and Lichtman's criteria, and pre- and postoperative radiographic and magnetic resonance imaging examinations. Bone marrow lesions in the transferred pisiform were found in five patients. Signal changes of bones around the transferred pisiform were found in these five patients; the greatest change was observed in the capitate bone in three patients. These signal changes were found in the opposite parts of the bones around the transferred pisiform. No patient exhibited signal changes in the transferred pisiform bone only. Wrist osteoarthritis after lunate resection and vascularized os pisiform transfer for advanced stages of Kienböck's disease is more likely to be attributed to the low congruency of the transferred pisiform and surrounding bones than to the compromised perfusion of the pisiform. Signal changes in the opposite bone parts around the transferred pisiform were confirmed in all patients with signal changes in the pisiform.
Topics: Humans; Lunate Bone; Magnetic Resonance Imaging; Middle Aged; Osteoarthritis; Osteonecrosis; Pisiform Bone; Retrospective Studies; Wrist Joint
PubMed: 35501258
DOI: 10.1016/j.bjps.2022.04.016 -
Diagnostics (Basel, Switzerland) Mar 2022: We investigated whether opportunistic screening for osteoporosis can be done from computed tomography (CT) scans of the wrist/forearm using machine learning. A...
: We investigated whether opportunistic screening for osteoporosis can be done from computed tomography (CT) scans of the wrist/forearm using machine learning. A retrospective study of 196 patients aged 50 years or greater who underwent CT scans of the wrist/forearm and dual-energy X-ray absorptiometry (DEXA) scans within 12 months of each other was performed. Volumetric segmentation of the forearm, carpal, and metacarpal bones was performed to obtain the mean CT attenuation of each bone. The correlations of the CT attenuations of each of the wrist/forearm bones and their correlations to the DEXA measurements were calculated. The study was divided into training/validation (n = 96) and test (n = 100) datasets. The performance of multivariable support vector machines (SVMs) was evaluated in the test dataset and compared to the CT attenuation of the distal third of the radial shaft (radius 33%). There were positive correlations between each of the CT attenuations of the wrist/forearm bones, and with DEXA measurements. A threshold hamate CT attenuation of 170.2 Hounsfield units had a sensitivity of 69.2% and a specificity of 77.1% for identifying patients with osteoporosis. The radial-basis-function (RBF) kernel SVM (AUC = 0.818) was the best for predicting osteoporosis with a higher AUC than other models and better than the radius 33% (AUC = 0.576) ( = 0.020). Opportunistic screening for osteoporosis could be performed using CT scans of the wrist/forearm. Multivariable machine learning techniques, such as SVM with RBF kernels, that use data from multiple bones were more accurate than using the CT attenuation of a single bone.
PubMed: 35328244
DOI: 10.3390/diagnostics12030691