-
Medicina (Kaunas, Lithuania) Mar 2024We present the case of a 14-year-old patient who suffered fracture dislocation of the pisiform bone (PB) along with fractures of the scaphoid, proximal radius, and...
We present the case of a 14-year-old patient who suffered fracture dislocation of the pisiform bone (PB) along with fractures of the scaphoid, proximal radius, and proximal phalanx of the thumb due to high-energy trauma directly to the extended wrist. This combination of fractures has not been previously reported in the literature. Currently, there is no consensus in the literature regarding the optimal treatment approach for such cases. In our management, initial attempts at closed and open reduction were unsuccessful, leading to the decision for primary pisiformectomy. Our report includes a follow-up of 3.5 years, demonstrating a very good outcome. Based on this case and a few similar published cases, primary pisiformectomy appears to be a viable and well-accepted option, particularly among young patients. Additionally, we conducted a review of radiographic criteria and management strategies for this specific injury and related conditions.
Topics: Humans; Adolescent; Male; Pisiform Bone; Fracture Dislocation; Fractures, Bone; Wrist Injuries
PubMed: 38674178
DOI: 10.3390/medicina60040532 -
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 -
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 -
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 -
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 -
Computational and Mathematical Methods... 2020In carpal tunnel volume measurements, the angle of the hamatum curvature is not considered a variable, and its effect on carpal tunnel volume has not been investigated....
In carpal tunnel volume measurements, the angle of the hamatum curvature is not considered a variable, and its effect on carpal tunnel volume has not been investigated. We hypothesize that a change in the anatomical angle of the hamatum curvature changes the carpal tunnel volume. To prove our hypothesis, we used a mathematical simulation model considering the carpal tunnel as a truncated cone. We reviewed the wrist CT scans of 91 adults (>18 years of age), including 51 men and 40 women. We measured the angle of the hamatum curvature in the CT scans. We measured cross-sectional areas at the outlet of the carpal tunnel at the level of the trapezium and hook of hamate (1) and at the inlet at the level of the scaphoid and pisiform (2) and the length () of the carpal tunnel. We attempted to calculate the effect of 2 degree by 2-degree changes in the angle of the hamatum curvature between the angles of 98° and 140° on the carpal tunnel volume. The mean angle of the hook of hamatum of the subjects was 122.55° ± 8.20° (range, 97.20° - 139.31°). No suitable cutoff point was found for the angle values. There was no difference between the gender groups according to the angle value. The data clearly show that there is a high correlation between carpal tunnel volume and the angle of hamatum curvature. The results of our study emphasize the importance of taking into account the anatomical features of the hamatum bone, especially the angle of curvature, which may play a predisposing role in idiopathic carpal tunnel syndrome.
Topics: Adult; Carpal Bones; Carpal Tunnel Syndrome; Computational Biology; Computer Simulation; Female; Hamate Bone; Humans; Imaging, Three-Dimensional; Male; Models, Anatomic; Tomography, X-Ray Computed; Young Adult
PubMed: 32617118
DOI: 10.1155/2020/7582181 -
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 -
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 -
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 -
Asian Journal of Surgery Jun 2020Carpal tunnel syndrome is diagnosed based on history, physical examination, and nerve conduction testing; however, there are no clear criteria for the diagnosis of...
BACKGROUND
Carpal tunnel syndrome is diagnosed based on history, physical examination, and nerve conduction testing; however, there are no clear criteria for the diagnosis of carpal tunnel syndrome. Recently, studies have aimed to diagnose carpal tunnel syndrome through ultrasound or MRI. The purpose of this study was to compare and analyze the cross-sectional area of the median nerve between patients with carpal tunnel syndrome and a control group.
METHODS
From July 2015 to August 2017, we retrospectively analyzed fishery and white-collar workers (164 people, 37 men, 127 women). Carpal tunnel syndrome was diagnosed on the basis of both physical examination and nerve conduction testing. A negative result in either test led to exclusion from the study.
RESULTS
In total, 164 wrist MRI were retrieved, with 67 patients diagnosed with carpal tunnel syndrome and 97 patients allocated to the control group. The mean value of cross-sectional area at the pisiform was 18.8 mm in the MRI of the carpal tunnel syndrome patients and 12.1 mm (p-value <0.05) in the control group. The mean value of cross-sectional area at the hook of hamate was 11.70 mm and that at the control group was 11.67 mm (p-value 0.055).
CONCLUSION
Cross-sectional area at pisiform in MRI is a valuable factor in the diagnosis of carpal tunnel syndrome and in predicting the duration of pain.
Topics: Aged; Carpal Tunnel Syndrome; Female; Hamate Bone; Humans; Magnetic Resonance Imaging; Male; Median Nerve; Middle Aged; Neural Conduction; Pain; Physical Examination; Retrospective Studies
PubMed: 31473048
DOI: 10.1016/j.asjsur.2019.08.001