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BMJ Case Reports Jan 2021A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from...
A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from case reports. In this case, we present a 51-year-old right-hand dominant male who sustained the injury after a fall. He attended the emergency department on the same day and a closed reduction was able to be performed under a haematoma block. On review in follow-up clinic the patient's symptoms had completely resolved.
Topics: Accidental Falls; Casts, Surgical; Closed Fracture Reduction; Humans; Joint Dislocations; Male; Middle Aged; Pisiform Bone; Treatment Outcome; Wrist Injuries
PubMed: 33408102
DOI: 10.1136/bcr-2020-237482 -
Australasian Journal of Ultrasound in... Aug 2020Numerous works of literature have assessed the use of ultrasound to detect carpal tunnel syndrome, suggesting various techniques and cut-off values. Currently, an... (Review)
Review
Numerous works of literature have assessed the use of ultrasound to detect carpal tunnel syndrome, suggesting various techniques and cut-off values. Currently, an effective parameter and cut-off value are still debated. The aim of this review is to determine if these parameters have sufficient rigour to allow their use in clinical practice. Twenty-one studies using sonographic parameters to identify carpal tunnel syndrome in comparison with electrodiagnostic testing (EDx) were selected for review. Methodological differences were found between studies in the use of EDx criteria, scanning and recruitment protocols, with participant biometrics often not reported. Parameters including the cross-sectional area of the median nerve at the level of the pisiform bone in addition to the wrist-to-forearm difference demonstrated high diagnostic utility for set cut-off values. Doppler techniques and mobility are promising, and further research is required to understand the effectiveness of these techniques.
PubMed: 34760599
DOI: 10.1002/ajum.12219 -
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 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2020To provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate (Kienböck's disease) by studying its...
OBJECTIVE
To provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate (Kienböck's disease) by studying its morphology and blood supply pattern based on digital technique.
METHODS
Twelve adult fresh wrist joint specimens were selected and treated with gelatin-lead oxide solution from ulnar or radial artery. Then the three-dimensional (3D) images of the pisiform and lunate were reconstructed by micro-CT scanning and Mimics software. The morphologies of pisiform and lunate were observed and the longitudinal diameter, transverse diameter, and thickness of pisiform and lunate were measured. The main blood supply sources of pisiform were observed. The number, diameter, and distribution of nutrient foramina at proximal, distal, radial, and ulnar sides of pisiform were recorded. The anatomic parameters of the pedicles (branch of trunk of ulnar artery, carpal epithelial branch, descending branch of carpal epithelial branch, recurrent branch of deep palmar branch) were measured, including the outer diameter of pedicle initiation, distance of pedicle from pisiform, and distance of pedicle from lunate.
RESULTS
There were significant differences in the longitudinal and transverse diameters between pisiform and lunate ( =6.653, =0.000; =6.265, =0.000), but there was no significant difference in thickness ( = 1.269, =0.109). The distal, proximal, radial, and ulnar sides of pisiform had nutrient vessels. The nutrient foramina at proximal side were significantly more than that at distal side ( <0.05), but there was no significant difference in the diameter of nutrient foramina between different sides ( >0.05). The outer diameter of pedicle initiation of the recurrent branch of deep palmar branch was significantly smaller than the carpal epithelial branch and descending branch of carpal epithelial branch ( <0.05). There was no significant difference in the distance of pedicle from pisiform/lunate between branch of trunk of ulnar artery and recurrent branch of deep palmar branch ( >0.05), and between carpal epithelial branch and descending branch of carpal epithelial branch ( >0.05). But the differences between the other vascular pedicles were significant ( <0.05).
CONCLUSION
There are abundant nutrient vessels at the proximal and ulnar sides of pisiform, so excessive stripping of the proximal and ulnar soft tissues should be avoided during the vascularized pisiform transfer. It is feasible to treat advanced Kienböck's disease by pisiform transfer with the carpal epithelial branch of ulnar artery and the descending branch.
Topics: Adult; Carpal Bones; Feasibility Studies; Humans; Lunate Bone; Osteonecrosis; Ulnar Artery
PubMed: 32410427
DOI: 10.7507/1002-1892.201907128 -
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 -
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 -
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 -
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