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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 -
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 -
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 -
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 -
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 -
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 -
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 -
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