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Journal of Orthopaedic Surgery and... Apr 2018To compare the clinical effectiveness of ultrasound-guided needle release of the transverse carpal ligament (TCL) with and without corticosteroid injection in carpal... (Comparative Study)
Comparative Study
BACKGROUND
To compare the clinical effectiveness of ultrasound-guided needle release of the transverse carpal ligament (TCL) with and without corticosteroid injection in carpal tunnel syndrome (CTS).
METHODS
From June 2016 to June 2017, 49 CTS patients (50 wrists) were included in this study. Twenty-five wrists were treated with ultrasound-guided needle release of the TCL plus corticosteroid injection (group A), and 25 wrists were treated with single ultrasound-guided needle release of the TCL (group B). The following parameters were assessed and compared including postprocedure results according to relief of symptoms, ultrasound parameters (cross-sectional area of the median nerve at the levels of pisiform, flattening ratio of median nerve at the levels of the hamate bone, and the thicknesses of TCL on the cross-section at the level of the hamate bone), and electrophysiological parameters (distal motor latency and sensory conduction velocity).
RESULTS
Group A had higher overall excellent and good rate 3 months after the procedure than group B (84 vs 52%, P < 0.05). There were significant differences regarding the above ultrasonic and electrophysiological parameters between the baseline and postprocedure values in both groups (all P < 0.05). There were significant differences regarding the postprocedure values of above ultrasonic and electrophysiological parameters between the two groups (all P < 0.05). No complications such as infection or tendon rupture were noted. No procedures were converted to the open release.
CONCLUSIONS
Both techniques are effective in treating CTS. Ultrasound-guided needle release of the TCL with corticosteroid injection had better treatment benefits than single ultrasound-guided needle release of the TCL in treating CTS.
Topics: Adult; Carpal Bones; Carpal Tunnel Syndrome; Combined Modality Therapy; Female; Glucocorticoids; Humans; Injections, Intralesional; Ligaments, Articular; Male; Median Nerve; Middle Aged; Neural Conduction; Treatment Outcome; Ultrasonography, Interventional
PubMed: 29615088
DOI: 10.1186/s13018-018-0771-8 -
Turkish Journal of Medical Sciences Feb 2018Background/aim: The aim of this study was to assess the diagnostic utility of the ultrasonographic ratio of median nerve cross-sectional area (m-CSA) to ulnar nerve...
Background/aim: The aim of this study was to assess the diagnostic utility of the ultrasonographic ratio of median nerve cross-sectional area (m-CSA) to ulnar nerve cross-sectional area (u-CSA), the m-CSA/u-CSA ratio, in carpal tunnel syndrome (CTS). Materials and methods: Fifty patients with positive symptoms and electromyography results of CTS and 50 healthy matched control subjects were evaluated. Ultrasonographic m-CSA and u-CSA measurements of each participant were made at the level of the pisiform bone and the m-CSA/u-CSA ratio was calculated. Results: Using the m-CSA cut-off value of 11.95 mm2 showed a sensitivity of 80% and a specificity of 80% while using a cut-off value 2.95 for the ratio of m-CSA/u-CSA showed a sensitivity of 86% and a specificity of 72% in the diagnosis of CTS. Conclusion: The ratio of m-CSA/u-CSA at the level of the pisiform bone was not detected to be superior to m-CSA in the diagnosis of CTS.
Topics: Adult; Aged; Carpal Tunnel Syndrome; Electromyography; Humans; Mathematical Concepts; Median Nerve; Middle Aged; Pisiform Bone; Reference Values; Sensitivity and Specificity; Ulnar Nerve; Ultrasonography; Young Adult
PubMed: 29479967
DOI: 10.3906/sag-1707-124 -
Plastic Surgery (Oakville, Ont.) May 2017Compression neuropathy of the ulnar nerve at the Guyon canal is commonly seen by hand surgeons. Different anatomical variations of structures related to the Guyon canal...
BACKGROUND
Compression neuropathy of the ulnar nerve at the Guyon canal is commonly seen by hand surgeons. Different anatomical variations of structures related to the Guyon canal have been reported in the literature. A thorough knowledge of the normal contents and possible variations is essential during surgery and exploration.
OBJECTIVES
To review the recognized anatomical variations within and around the Guyon canal.
METHODS
This study is a narrative review in which relevant papers, clinical studies, and anatomical studies were selected by searching electronic databases (PubMed and EMBASE). Extensive manual review of references of the included studies was performed. We also describe a case report of an aberrant muscle crossing the Guyon canal.
RESULTS
This study identified several variations in the anatomical structures of the Guyon canal reported in the literature. Variations of the ulnar nerve involved its course, branching pattern, deep motor branch, superficial sensory branch, dorsal cutaneous branch, and the communication with the median nerve. Ulnar artery variations involved its course, branching pattern, the superficial ulnar artery, and the dorsal perforating artery. Aberrant muscles crossing the Guyon canal were found to originate from the antebrachial fascia, pisiform bone, flexor retinaculum, the tendon of palmaris longus, flexor carpi ulnaris, or flexor carpi radialis; these muscles usually fuse with the hypothenar group.
CONCLUSION
The diverse variations of the contents of the Guyon canal were adequately described in the literature. Taking these variations into consideration is important in preventing clinical misinterpretation and avoiding potential surgical complications.
PubMed: 29026818
DOI: 10.1177/2292550317694851 -
Hand (New York, N.Y.) Sep 2017Aneurysmal bone cysts are an uncommon form of benign primary bone tumors; affection of the hand is very rare.
BACKGROUND
Aneurysmal bone cysts are an uncommon form of benign primary bone tumors; affection of the hand is very rare.
METHODS
A rigorous review of the literature showed that this type of tumor has not previously been described in the pisiform. In this article, we report the occurrence of an aneurysmal bone tumor in the pisiform of the left hand of a 19-year-old male.
RESULTS
This tumor was successfully treated through surgical excision with an uneventful recovery. We describe the process behind the diagnosis of the lesion and the subsequent treatment in an attempt to highlight the rare but possible occurrence of aneurysmal bone cysts in the pisiform.
CONCLUSION
Appropriate treatment of aneurysmal bone cysts in this location is required, due to the anatomical nature of the pisiform itself with the risks of pathologic fracture and ulnar nerve compression.
Topics: Bone Cysts, Aneurysmal; Humans; Male; Pisiform Bone; Young Adult
PubMed: 28832208
DOI: 10.1177/1558944716670615 -
Hand (New York, N.Y.) Sep 2017Patients with suspected pisotriquetral osteoarthritis may show joint space narrowing. However, the extent of joint space narrowing and its deviation from the joint space...
BACKGROUND
Patients with suspected pisotriquetral osteoarthritis may show joint space narrowing. However, the extent of joint space narrowing and its deviation from the joint space width (JSW) in normal anatomy is unknown. In this pathoanatomic study, we therefore compared the JSW in the pisotriquetral joint between osteoarthritic patient wrists and healthy wrists.
METHODS
We reviewed preoperative computed tomography (CT) scans of 8 wrists of patients with ulnar-sided wrist pain who underwent a pisiformectomy with confirmed pisotriquetral osteoarthritis at surgery. We also reviewed CT scans of 20 normal wrists from healthy volunteers serving as control group. Three-dimensional CT models of the pisiform and triquetrum were obtained from both affected and normal wrists, after which the minimum JSW was calculated in an automated fashion.
RESULTS
In the patient group, the median (interquartile range) of the minimum JSW was 0.1 mm (0.0-0.2), and in the control group, 0.8 mm (0.3-0.9) ( P = .007).
CONCLUSIONS
We showed that the pisotriquetral joint space in osteoarthritic patient wrists was significantly narrowed compared with healthy wrists. These results suggest that JSW evaluation has a potential diagnostic value in the work-up of patients with suspected pisotriquetral osteoarthritis. This is an interesting area for future clinical research, especially because no gold standard for diagnosing pisotriquetral osteoarthritis has been established yet.
Topics: Adult; Carpal Joints; Case-Control Studies; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Osteoarthritis; Pisiform Bone; Retrospective Studies; Tomography, X-Ray Computed; Triquetrum Bone; Young Adult
PubMed: 28832198
DOI: 10.1177/1558944716677542 -
Romanian Journal of Morphology and... 2017Chondrosarcoma is a malignant hyaline cartilage forming tumor. It is a rare pathology, with an estimated incidence of one in 200 000 individuals per year. It appears in...
Chondrosarcoma is a malignant hyaline cartilage forming tumor. It is a rare pathology, with an estimated incidence of one in 200 000 individuals per year. It appears in two forms: primary, representing 90% of all cases and secondary emergence that develops on preexistent lesions. Primary chondrosarcomas are uncommon in the hand, with a frequency of only 1.5-3.2% of all chondrosarcomas. In conventional chondrosarcoma (cCS), the histological malignancy grading represents the main prognostic factor for surgical planning and prognosis. We present the case of a 60-year-old male, examined in the First Department of Orthopedics and Traumatology, "Dr. Pius Branzeu" Clinical Hospital, Timisoara, Romania, with non-specific symptoms in the right hand. After clinical examination and imagistics, surgery and histopathological examination of the tumor were performed. This showed a conventional well differentiated - G1 chondrosarcoma, as suggested also by imagistic and clinical context.
Topics: Bone Neoplasms; Chondrosarcoma; Hamate Bone; Hand; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pisiform Bone; Synovial Membrane
PubMed: 28523331
DOI: No ID Found -
Annals of Rehabilitation Medicine Dec 2016To investigate the relationship between electrodiagnosis and various ultrasonographic findings of carpal tunnel syndrome (CTS) and propose the ultrasonographic standard...
OBJECTIVE
To investigate the relationship between electrodiagnosis and various ultrasonographic findings of carpal tunnel syndrome (CTS) and propose the ultrasonographic standard that has closest consistency with the electrodiagnosis.
METHODS
Ultrasonography was performed on 50 female patients (65 cases) previously diagnosed with CTS and 20 normal female volunteers (40 cases). Ultrasonography parameters were as follows: cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the levels of hamate bone, pisiform bone, and lunate bone; anteroposterior diameter (AP diameter) of the median nerve in the carpal tunnel; wrist to forearm ratio (WFR) of median nerve area at the distal wrist crease and 12 cm proximal to distal wrist crease; and compression ratio (CR) of the median nerve. Independent t-test was performed to compare the ultrasonographic findings between patient and control groups. Significant ultrasonographic findings were compared with the electrodiagnosis results and a kappa coefficient was used to determine the correlation.
RESULTS
CSA and FR of median nerve at the hamate bone level, CSA of median nerve at pisiform bone level, AP diameter of median nerve within the carpal tunnel, CSA of median nerve at the distal wrist crease and WFR showed significant differences between patient and control groups. WFR showed highest concordance with electrodiagnosis (κ=0.71, p<0.001).
CONCLUSION
These findings suggested the applicability of ultrasonography, especially WFR, as a useful adjunctive tool for diagnosis of CTS.
PubMed: 28119834
DOI: 10.5535/arm.2016.40.6.1040 -
Journal of Hand and Microsurgery Dec 2016
PubMed: 27999466
DOI: 10.1055/s-0036-1588022 -
Journal of Physical Therapy Science Sep 2016[Purpose] The aim of this study was to investigate the usefulness of ultrasonography for the diagnosis of polyneuropathy in diabetic patients by examination of the...
[Purpose] The aim of this study was to investigate the usefulness of ultrasonography for the diagnosis of polyneuropathy in diabetic patients by examination of the median and ulnar nerves. [Subjects and Methods] Sixty-three diabetic patients and fourteen controls were enrolled in the study. Nerve conduction studies were performed on both upper and lower limbs. Median and ulnar nerve cross-sectional areas were measured at the wrist and forearm levels in 140 hands by ultrasound. [Results] The median nerve cross-sectional area was increased at the hook of hamatum, pisiform bone, and radioulnar joint levels in patients with carpal tunnel syndrome. The ulnar nerve area at the medial epicondyle was significantly increased in the diabetic polyneuropathy (9.2 ± 1.6), diabetic polyneuropathy plus carpal tunnel syndrome (9.3 ± 1.4), and carpal tunnel syndrome (9.2 ± 1.9) groups compared with the control group (7.7 ± 1.1). In receiver operating characteristics analysis, the cutoff value of the ulnar nerve was 8.5 mm at ulnar epicondyle with 71.4% specificity and 70.4% sensitivity, corresponding to the highest diagnostic accuracy for diabetic polyneuropathy. [Conclusion] Ultrasonographic examination of the median and ulnar nerves can be an alternative or additional diagnostic modality for the evaluation of neuropathies in diabetic patients.
PubMed: 27799707
DOI: 10.1589/jpts.28.2620 -
Anatomical Record (Hoboken, N.J. : 2007) Feb 2017A long-standing issue in squirrel evolution and development is the origin of the styliform cartilage of flying squirrels, which extends laterally from the carpus to...
Evolutionary Transformation of the Palmaris Longus Muscle in Flying Squirrels (Pteromyini: Sciuridae): An Anatomical Consideration of the Origin of the Uniquely Specialized Styliform Cartilage.
A long-standing issue in squirrel evolution and development is the origin of the styliform cartilage of flying squirrels, which extends laterally from the carpus to support the gliding membrane (patagium). Because the styliform cartilage is one of the uniquely specialized structures permitting gliding locomotion, the knowledge of its origin and surrounding transformation is key for understanding their aerodynamic evolution. The developmental study that would definitely answer this question would be difficult due to the rarity of embryological material. Instead, anatomical examinations have suggested two major hypotheses on the homology of the styliform cartilage: the pisiform bone of other mammals, or an additional carpal structure, such as the ulnar sesamoid of some of the other mammals or the hypothenar cartilage of the non-gliding squirrels. To test these hypotheses, a detailed examination of the anatomy of the carpus of gliding and non-gliding squirrels, and the colugo were undertaken. Based on physical and virtual dissections of the carpus, this study showed that both the pisiform bone and styliform cartilage were present in flying squirrels. This finding is further supported by demonstration that a "true Palmaris longus," with innervation typical for this muscle, inserts on the styliform cartilage. Taken together, our osteological, muscular, and neurological results suggest that the styliform cartilage was transformed in flying squirrels from an initially superficial and ulnar-derived anlagen into its current form. Anat Rec, 300:340-352, 2017. © 2016 Wiley Periodicals, Inc.
Topics: Animals; Biological Evolution; Cartilage; Flight, Animal; Muscle, Skeletal; Sciuridae
PubMed: 27611816
DOI: 10.1002/ar.23471