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Acta Orthopaedica Et Traumatologica... Aug 2016Osteoid osteoma is an uncommon benign bone-forming tumor of the musculoskeletal system but it is the most common primary bone tumor of the carpal region. However, only...
BACKGROUND
Osteoid osteoma is an uncommon benign bone-forming tumor of the musculoskeletal system but it is the most common primary bone tumor of the carpal region. However, only seven cases of its pisiform involvement have been described.
CASE
We present a 19 year-old male patient with osteoid osteoma of the pisiform which initially could not be detected in any diagnostic study for long standing wrist pain. The patient was treated with excision and curettage. In 1 year of follow-up, the patient was asymptomatic without recurrence.
CONCLUSION
In cases with long standing ulnar wrist pain, one should consider osteoid osteoma of the pisiform in differential diagnosis. If an OO is suspected, thin slice CT scan in initial evaluation would be valuable in preventing the patient from misdiagnosis or delay in diagnosis.
Topics: Arthralgia; Bone Neoplasms; Humans; Magnetic Resonance Imaging; Male; Osteoma, Osteoid; Pisiform Bone; Tomography, X-Ray Computed; Wrist Joint; Young Adult
PubMed: 27555463
DOI: 10.1016/j.aott.2016.07.005 -
Journal of Wrist Surgery Aug 2016Carpal tunnel release (CTR) has been shown to change carpal arch morphology. However, the effect of CTR on the three-dimensional kinematics of the carpal bones has not...
BACKGROUND
Carpal tunnel release (CTR) has been shown to change carpal arch morphology. However, the effect of CTR on the three-dimensional kinematics of the carpal bones has not been demonstrated.
PURPOSE
This study examined whether release of the transverse carpal ligament (TCL) would alter the three-dimensional kinematics of the carpus, specifically the bony attachments of the TCL.
METHODS
The in vitro kinematics of the carpus was studied in five fresh-frozen cadaveric wrists before and after CTR using three-dimensional computed tomography. The specimens were evaluated in three positions: neutral, 60 degrees of flexion, and 60 degrees of extension.
RESULTS
The data indicate that carpal arch width increases significantly in all positions after CTR as measured between the trapezium and hamate. Second, the trapezium-hamate distance increases in both a translational and rotational component after CTR. Additionally, the pisiform rotates away from the triquetrum after CTR.
CONCLUSIONS
Carpal kinematics is significantly altered with a CTR, especially on the ulnar side of the wrist.
CLINICAL RELEVANCE
Although the kinematic changes are small, they may be clinically significant and potentially responsible for pillar pain or postoperative loss of grip strength.
PubMed: 27468373
DOI: 10.1055/s-0036-1578812 -
The British Journal of Radiology Jul 2016Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) commonly affect the small joints of the wrist and hand. We evaluated the performance of a new, high-resolution...
OBJECTIVE
Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) commonly affect the small joints of the wrist and hand. We evaluated the performance of a new, high-resolution extremity positron emission tomography (PET)/CT scanner for characterizing and quantifying pathologies associated with the two arthritides in the wrist and hand joints.
METHODS
Patients with RA or PsA underwent fluorine-18 fludeoxyglucose ((18)F-FDG) PET/CT wrist and hand imaging, respectively, on the high-resolution scanner. Calibrated CT images and co-registered PET images were reconstructed. PET/CT was derived for the radiocarpal and pisiform-triquetral compartments, joints with erosive changes, sites of synovitis or tenosynovitis and the nail bed and were correlated with clinical and MRI findings.
RESULTS
Significantly elevated (18)F-FDG uptake was measured for the radiocarpal and pisiform-triquetral compartments and at sites of bone erosion, synovitis, pannus and oedema, compared with unaffected joints (p < 0.05) in patients with RA, consistent with their clinical findings. In patients with PsA, significantly elevated (18)F-FDG uptake was measured for joints with synovitis compared with unaffected joints (p < 0.05), with patterns of (18)F-FDG uptake along the tendons, at the enthesis and in the nail bed, consistent with tenosynovitis, enthesitis and nail dystrophy, respectively.
CONCLUSION
High-resolution (18)F-FDG PET/CT imaging of the wrist and hand is feasible in an RA or PsA patient cohort and is capable of providing quantifiable measures of disease activity (synovitis, enthesitis, oedema and bone destruction).
ADVANCES IN KNOWLEDGE
High-resolution PET/CT imaging shows promise as a tool for understanding the pathogenesis of the arthritic process and for non-invasive, objective assessment of RA or PsA severity and therapy selection.
Topics: Arthritis, Psoriatic; Arthritis, Rheumatoid; Disease Progression; Female; Fluorodeoxyglucose F18; Hand Joints; Humans; Male; Middle Aged; Pilot Projects; Positron Emission Tomography Computed Tomography; Prospective Studies; Radiopharmaceuticals; Reproducibility of Results; Wrist Joint
PubMed: 27109738
DOI: 10.1259/bjr.20160138 -
Journal of Clinical Neurology (Seoul,... Jul 2016We determined the reliability of ultrasonography (US) measurements for diagnosing carpal tunnel syndrome (CTS) and their correlation with symptom duration and...
BACKGROUND AND PURPOSE
We determined the reliability of ultrasonography (US) measurements for diagnosing carpal tunnel syndrome (CTS) and their correlation with symptom duration and electrophysiology findings. We determined whether the ratio of the median-to-ulnar cross-sectional areas (CSAs) can support CTS diagnoses.
METHODS
The pisiform CSA (CSA(pisiform)), swelling ratio (SR), palmar bowing, and CSA(pisiform)/ulnar CSA (CSA(ulnar)) measurements made in two subgroups of CTS patients (having sensory affection alone or having both sensory and motor affection) were compared with controls. CSA(ulnar) was measured in Guyon's canal at the level of most-protuberant portion of the pisiform bone.
RESULTS
The values of all of the measured US parameters were higher in patients with CTS (n=50) than in controls (n=62). CSA(pisiform) could be used to diagnose CTS of mild severity. All of the parameters were positively correlated with the distal latency of the compound muscle action potential, and all of them except for SR were negatively correlated with the sensory nerve conduction velocity. A CSA(pisiform)/CSA(ulnar) ratio of ≥1.79 had a sensitivity of 70% and a specificity of 76% for diagnosing CTS.
CONCLUSIONS
Only CSA(pisiform) measurements were reliable for diagnosing early stages of CTS, and CSA(pisiform)/CSA(ulnar) had a lower diagnostic value for diagnosing CTS.
PubMed: 27095524
DOI: 10.3988/jcn.2016.12.3.289 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Apr 2016To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome (CTS).
OBJECTIVE
To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome (CTS).
METHODS
In this study, 48 patients (unilateral hand) with CTS were analyzed. The thickness of transverse carpal ligaments at the pisiform bone was measured using high-frequency ultrasound. Open carpal tunnel release procedure was performed in the 48 CTS patients, and the thickness of transverse carpal ligaments at the hamate hook bone measured using vernier caliper under direct vision. The accuracy of thickness of transverse carpal ligaments was evaluated using high-frequency ultrasound. high-frequency ultrasound measurement of thickness of transverse carpal ligaments at the hamate hook bone and pisiform bone, and determination of the diagnostic threshold measurement index using receiver operating characteristic (ROC) curve, sensitivity and specificity were performed and the correlation between the thickness of transverse carpal ligaments and nerve conduction study (NCS) analyzed.
RESULTS
The thickness of transverse carpal ligaments in the CTS patients were (0.42±0.08) cm (high-frequency ultrasound) and (0.41±0.06) cm (operation) at hamate hook bone, and there was no significant difference between the two ways (t=0.672, P>0.05). The optimal cut-off value of the transverse carpal ligaments at hamate hook bone was 0.385 cm, the sensitivity 0.775, and the specificity 0.788. The optimal cut-off value of the transverse carpal ligaments at the pisiform bone was 0.315 cm, the sensitivity 0.950, and the specificity 1.000. The transverse carpal ligaments thickness and wrist-index finger sensory nerve conduction velocity (SCV), wrist-middle finger SCV showed a negative correlation.
CONCLUSION
High frequency ultrasound measurements of thickness of transverse carpal ligaments is a valuable method for the diagnosis of CTS.
Topics: Carpal Tunnel Syndrome; Fingers; Humans; Ligaments, Articular; ROC Curve; Sensitivity and Specificity; Ultrasonography; Wrist Joint
PubMed: 27080293
DOI: No ID Found -
Journal of Ultrasonography Sep 2015Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early...
UNLABELLED
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical) are essential for optimal patient management.
AIM
The aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment.
MATERIAL AND METHODS
The study involved 62 patients (50 women and 12 men, aged 28-70, mean age 55.2) with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confirm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS.
RESULTS
US examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confirmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm(2) (min. 12 mm(2), max. 31 mm(2)). Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%). Increased nerve vascularity on the transverse section was present in 50 patients (80.65%).
CONCLUSIONS
Ultrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment efficacy.
PubMed: 26673415
DOI: 10.15557/JoU.2015.0025 -
Advanced Biomedical Research 2015Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Diagnosis of CTS is usually based on a combination of clinical symptoms and electrodiagnostic study...
BACKGROUND
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Diagnosis of CTS is usually based on a combination of clinical symptoms and electrodiagnostic study (EDS). Ultrasonography (US) also has been shown to be a useful diagnostic tool in CTS and is based on an increase in the median nerve cross-sectional area (CSA) at the level of the pisiform bone. In this study we assessed findings in US in correlation with severity of CTS.
MATERIALS AND METHOD
This was a cross-sectional case-control study, which was carried out on November 2012 to July 2013. Subjects were chosen from patients who referred to the Alzahra Hospital (Isfahan, Iran). Patients were classified as having mild, moderate, and severe CTS according to EDS and high-resolution US was performed for CSA measurement at the tunnel inlet.
RESULTS
A total of 87 individuals screened and 52 subjects (81 hands) met all inclusion and no exclusion criteria. The mean ± SD of the CSA was 0.12 ± 0.03 cm(2) (range, 0.08-0.18) in mild, 0.15 ± 0.03 cm(2) (range, 0.08-0.19) in moderate, and 0.19 ± 0.06 cm(2) (range, 0.11-0.32) in severe CTS. We detected a significant correlation between MN CSA and the severity of CTS (P < 0.001).
CONCLUSION
In conclusion it is expected that sonography may serve as an additional or complementary method which is useful and reliable in assessing the severity of CTS.
PubMed: 26322286
DOI: 10.4103/2277-9175.161537 -
Journal of Nippon Medical School =... 2015The purpose of this study was to describe and evaluate the detailed anatomic locations and areas of ligamentous attachments and paths of the transverse carpal ligament...
PURPOSE
The purpose of this study was to describe and evaluate the detailed anatomic locations and areas of ligamentous attachments and paths of the transverse carpal ligament (TCL) on a three-dimensional (3-D) surface model.
METHODS
Ten fresh-frozen cadaver wrists were used to dissect and identify the TCL. Their ligament attachments and whole bone surfaces were digitized three-dimensionally and their areas evaluated. The attachments of each ligament were represented in a model combining CT surfaces overlaid by a digitized 3-D surface, and were also visually depicted with a different color for each on 3-D images of the bones.
RESULTS
The TCL was found to be composed of two or three discrete ligaments. Both the trapezium-hook of hamate ligament and the trapezium-pisiform ligament were identified in all ten specimens. The scaphoid-pisiform ligament was found in only two of the ten specimens. The average areas of the attachments of the TCL were 42.7 mm(2) on the trapezium, 30.0 mm(2) on the hook of hamate, 21.6 mm(2) on the pisiform, and 12.7 mm(2) on the scaphoid.
CONCLUSIONS
The anatomic 3-D attachment sites of the TCL were visually shown qualitatively, and their areas quantified. This 3-D information offers further knowledge and understanding of the anatomy and biomechanics of the TCL. It could also help in the accurate assessment of radiographic images and treatment of various wrist injuries and diseases when performing such procedures as carpal tunnel release, Guyon's canal release, trapeziectomy, hook of hamate excision, or arthroscopy.
Topics: Aged; Carpal Joints; Female; Humans; Imaging, Three-Dimensional; Ligaments, Articular; Male; Middle Aged; Wrist
PubMed: 26156666
DOI: 10.1272/jnms.82.130 -
Hand (New York, N.Y.) Jun 2015An isolated fracture of the pisiform bone is a rare condition, especially in children. The fracture may be missed in the emergency department because of the complex...
An isolated fracture of the pisiform bone is a rare condition, especially in children. The fracture may be missed in the emergency department because of the complex anatomy of the carpal region. Early diagnosis and treatment are, however, important for the functional outcome of the patient, since untreated dislocated carpal fractures may result in nonunion. We report one case of a 9-year-old boy with an unrecognized fracture of the pisiform bone who underwent a pisiformectomy 10 months after injury due to a nonunion of the pisiform bone. Good results were obtained and the wrist did not show any functional impairment.
PubMed: 26034450
DOI: 10.1007/s11552-014-9613-2 -
Singapore Medical Journal Mar 2015We herein present a case of right triquetral fracture with associated pisiform and flexor carpi ulnaris subluxation in a 29-year-old man. Initial radiography showed a...
We herein present a case of right triquetral fracture with associated pisiform and flexor carpi ulnaris subluxation in a 29-year-old man. Initial radiography showed a right triquetral fracture. Computed tomography and magnetic resonance imaging demonstrated a triquetral fracture with a subluxated pisiform. Open reduction and lag screw fixation of the right triquetrum was performed, with good subsequent recovery of function. Although triquetral fracture with subluxation of the pisotriquetral joint is uncommon, attending clinicians should bear in mind the possibility of such an injury when managing traumatic ulnar-sided wrist pain.
Topics: Accidental Falls; Adult; Fracture Fixation; Fractures, Bone; Humans; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Tendons; Tomography, X-Ray Computed; Treatment Outcome; Wrist Joint
PubMed: 25820858
DOI: 10.11622/smedj.2015049