Moderate evidence was found for the effect of corticosteroid injection on the very short-term for trigger finger, DeQuervain'sdisease, and for injections with Collagenase on the very short-term (30 days) when looking at all joints, no evidence was found when looking at the PIP joint for Dupuytren's ...
De Quervain Disease (4), Contracture (1), Trigger Finger Disorder (1), more mentions
The onset of trigger digits after carpal tunnel release (CTR) have been reported inconsistently across different studies. The aim of this study is to assess the incidence of trigger digits after CTR using nationwide population cohort data.We conducted a retrospective cohort study using the Longitudinal Health Insurance Database 2000 (LHID2000) from the National Health Insurance Database (NHIRD) in Taiwan. The LHID2000 contained 1 million beneficiaries randomly selected from the year 2000 Registry for Beneficiaries in NHIRD. We identified 2605 carpal tunnel syndrome (CTS) patients received CTR from 2000 to 2010 (CTR cohort, n = 2605). For each CTR patient, 4 CTS patients without CTR were randomly selected in the control cohort from the general population frequency matched by age, sex, and diagnosed year (non-CTR cohort, n = 10,420). Both cohorts were followed up until the end of 2011 to investigate the occurrence of trigger digits. Adjusted hazard ratios (aHRs) with 95% confidence interval (CI) of trigger digits were estimated using the Cox proportional hazards model after controlling for age, sex, and comorbidities.The CTR cohort had a mean follow-up period of 5.58 ± 3.18 years and the non-CTR cohort had a mean follow-up period of 5.90 ± 3.10 years. The overall risk of trigger digits was 3.63-fold greater in the CTR cohort than in the non-CTR cohort (incidence rate: 12.6 vs 3.38/1000 person-years, aHR: 3.63, 95% CI, 2.97-4.44). The incidence of postoperative trigger digits was highest in the 1st 6 months (incidence rate: 27.9/1000 person-years, aHR: 9.65, 95% CI, 5.27-17.7) and then significantly decreased over time.CTR was significantly associated with the subsequent development of trigger digits, especially in the postoperative 6 months.
Trigger Finger Disorder (9), Carpal Tunnel Syndrome (2), more mentions
... to an initial consultation and whether provider or practice characteristics had an influence on requirements for preconsultation diagnostic tests AbstractText: Through online data sources, we identified 356 providers in 261 practices throughout the state of Michigan with profiles confirming handsurgery practice or surgical treatment of carpal tunnel syndrome (CTS.
Treatment of carpal tunnel syndrome (CTS) remains a challenge for hand surgeons. Carpal tunnel release (CTR) using nasal instruments has the advantages of both endoscopy and open surgery. In this study we aimed to explore the effectiveness of CTR using nasal instruments in Chinese patients.We present a case series of 49 cases of idiopathic CTS treated with the mini-incision technique using nasal instruments. The average recovery days before return to normal work and complications were recorded. The mean grip strength, pinch strength, and sensation were evaluated. Subjective results were evaluated using the visual analogue scale (VAS), Levine Carpal Tunnel Syndrome Questionnaire (LCTSQ), Disabilities of the Arm, Shoulder, and Hand (DASH), and Medical Outcomes Study (MOS) 36-item short-form health survey (SF-36).The mean follow-up was 13 months. No return of symptoms or blood vessel injury occurred. The incidence of scar tenderness was only 8.1%, later pillar pain (after 4 weeks) was 18.4%, and average recovery time to return to normal work was 23.7 days. The mean grip strength, pinch strength, and sensation were significantly improved (P < .001). The VAS, LCTSQ, and DASH survey postoperative mean scores were lower than the preoperative scores (P < .001). SF-36 scores were significantly increased following surgery (P < .001).We conclude that the mini-incision technique for CTR using nasal instruments in Chinese patients is safe, effective, and low cost. It is worthwhile for the technique to be promoted and used.
OBJECTIVE: To assess the 6-month effectiveness of ultrasound-guided perineural injection therapy (PIT) using 5% dextrose (D5W) in patients with mild-to-moderate carpal tunnel syndrome (CTS).
PATIENTS AND METHODS: A prospective, randomized, placebo-controlled, and double-blind study was conducted between May 1, 2016, through March 30, 2017. A total of 49 participants diagnosed with mild-to-moderate CTS were randomized into D5W and control groups. Participants in the D5W group received 1 session of ultrasound-guided PIT with 5 cc of D5W, and the control group received PIT with normal saline. The visual analog scale measured pain as a primary outcome. Secondary outcomes were Boston Carpal Tunnel Syndrome Questionnaire scores, the cross-sectional area of the median nerve, and electrophysiological measurement results. Assessment was performed before injection and at 1, 3, and 6 months post-injection.
RESULTS: All patients (data from 30 wrists in each group) completed the study. Compared with the control group, at all post-injection time points, the D5W group had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve.
CONCLUSION: Our study reveals that ultrasound-guided PIT with D5W is an effective treatment for patients with mild-to-moderate CTS.
TRIAL REGISTRATION: www.ClinicalTrials.gov: NCT02809261.
BACKGROUND: Corticosteroid injection is a recommended treatment option for carpal tunnel syndrome, before considering surgery. Nevertheless, injections remain controversial because there is strong evidence of only short-term benefits. This study aimed to determine the reintervention rate and to identify prognostic indicators for subsequent treatment after corticosteroid injection for carpal tunnel syndrome.
METHODS: This study evaluated residents of Olmsted County treated with a corticosteroid injection for carpal tunnel syndrome between 2001 and 2010. Treatment failure was the primary outcome of interest. Two definitions for failure were examined: (1) the patient receiving subsequent procedural intervention and (2) the patient undergoing carpal tunnel release. Survival was estimated using Kaplan-Meier methods, and association of covariates with increased failure was modeled using Cox proportional hazards regression.
RESULTS: The study included 774 affected hands in 595 patients. The median follow-up period was 7.4 years. Reintervention was performed in 68 percent of cases, of which 63 percent resulted in eventual surgery. Injectate volume was significant for the outcome of any retreatment [hazard ratio, 0.879 (95 percent CI, 0.804 to 0.96)] and surgery [hazard ratio, 0.906 (95 percent CI, 0.827 to 0.99)]. Rheumatoid arthritis was also significant in both models, with a hazard ratio of 0.627 (95 percent CI, 0.404 to 0.97) for any retreatment and 0.493 (95 percent CI, 0.292 to 0.83) for surgery.
CONCLUSIONS: In this cohort, 32 percent of patients did not receive subsequent treatment after a single injection, which indicates that there is a therapeutic role for corticosteroid injections in treating carpal tunnel syndrome. Further research is necessary to identify those patients who will benefit from an injection, to provide more individually tailored treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Immune System Diseases (1) Carpal Tunnel Syndrome (6), Rheumatoid Arthritis (1), more mentions
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Create a safe and effective plan for management of carpal tunnel syndrome. 2. Support his or her rationale for the use of diagnostic tests. 3. Discuss elements of management that have been controversial, including anesthesia, the use of a tourniquet, postoperative pain control, and cost of care.
SUMMARY: This is the fourth MOC-PS CME article on carpal tunnel syndrome. Each of the prior three has had a slightly different focus, and the reader is invited to review all to generate a comprehensive view of the management of this common, and often controversial, topic. The operative goal-to release the transverse carpal ligament-is straightforward: diagnosis, cause, and technique have generated more vibrant discussions.
Syndactyly is a cutaneous and/or bony digital malformation with possible webbing of adjacent fingers or toes and uni- or bilateral occurrence. We report an 84-year old woman with a novel non-syndromic congenital malformation of her left hand. Clinical examination showed that she only had four digits. Radiograph of the hand revealed synostosis of the second and third proximal phalanx, resulting in a triangular shaped bone with relatively normal articulations at both ends. The phalangeal base of the fused finger tapers distally and is broader than the middle phalangeal bases of the ring and little finger. This malformation does not fit in any of the known types of syndromic or non-syndromic syndactylies. Our case report highlights that radiological imaging is crucial for identification of bony syndactyly and correct classification of a given syndactyly. Knowledge of the different types of syndactylies is important because certain malformations may occur as a defining part of a syndromic disease.
The metacarpal-like hand is a severe handinjury, never addressed before... The goal is to utilize the reliable techniques of toe-to-handsurgery to reconstruct more opposable units, at least two fingers, whether adjacent to each other or not, as well as the thumb, when needed, to achieve ...
AbstractText: We aimed to: (i) estimate the prevalence of Dupuytren's disease, trigger finger, carpaltunnelsyndrome and frozen shoulder; (ii) assess stiffness of the hand, shoulder and back; and (iii) explore the association of joint stiffness with both long-term HbA1c and collagen advanced glycation end-products (AGEs) in long ...
Endocrine Disorders (7), Muscular and Skeletal Diseases (1) Diabetes Mellitus, Type 1 (3), Frozen Shoulder (2), Diabetes Mellitus (2), more mentions
AbstractText: To determine the rate of glove perforation during handsurgery AbstractText: We prospectively examined the rate of glove perforations among 10 fellowship-trained hand surgeons at our institution ... dominant ring and nondominant little fingers each had a single perforation AbstractText: The rate of glove perforation during handsurgery is low.
Abstract: Toe-to-fingertransplantation is intimately related to the development of microsurgical free tissue transplantation, which is one of the most important advances in the history of reconstructive surgery. It is also generally acknowledged that a mangled hand with massive tissue loss and amputation of multiple digits presents a challenge for plastic and reconstructive surgeons.
We defined the beginning of the hand as the distal wrist crease, and 3-D forms of the hands were captured by the 3-D scanning system. Second, 238 volunteers (87 men, 151 women) with no disease or history of handsurgery underwent 3-D scanning. Data collected included age, height, weight, and shoe size.
Most of the plain radiographs were normal (62. The most common ultrasonographic findings were small joint synovitis (84%), wrist synovitis (74%), fingertenosynovitis (70%), and cellulitis (50. In most cases, power Doppler did not show an increase in synovial vascular flow. The plain radiographs showed no specific findings, whereas the ultrasound images revealed synovial compromise and neural thickening Keyword: Chikungunya ...
We reference techniques used by other surgeons and identify the most suitable technique for different clinical situations. Indications and techniques for microsurgical partial or composite transfer of the great or second toe for thumbreconstruction are summarized... We recommend individualized surgical design and reconstruction because each case of thumb amputation is unique Keyword: Thumbreconstruction. Keyword: microsurgery.
AbstractText: Refinements in microsurgery have made distal fingerreplantation an established technique with high success rates and good functional and aesthetic outcomes. However, it still represents a technically demanding procedure due to the small vessel caliber and frequent lack of vessel length, requiring the use of interpositional venous grafts in some instances.
Immune System Diseases (1) Venous Insufficiency (1), more mentions
Abstract: This article reviews historical background, essential practice principles, and the new emerging area of wide awake handsurgery. It outlines the reasons that wide awake, local anaesthesia, no tourniquet surgery has emerged so quickly in the last 10 years over the world. I explain the origin of the concepts and some of the challenges of getting the technique accepted ...
... is being understood in terms of psychological variables AbstractText: To examine the role of illness beliefs and coping strategies in adjustment to handinjury... 0.24-0.53), and avoidance-based (r = 0.41-0.64) coping strategies AbstractText: Illness beliefs and coping play an important role in adjustment after handinjury... Keyword: Handinjury.
The ratio of the lengths of the second and fourth digits (2D:4D) has been described as reflecting endogenous prenatal androgen exposure. In general, 2D:4D is lower in men than in women and has potential as a biomarker or predictor for various diseases, athletic ability, and academic performance. Dupuytren disease has digital flexion contractures and is known to predominate in men, but the pathogenesis of the disease remains unclear. To clarify the relationships between Dupuytren disease and endogenous androgens, we performed a retrospective analysis of hand radiographs to investigate 2D:4D in Dupuytren disease. The study included male patients with Dupuytren disease (n = 22) and a control group (n = 18) of male patients with carpal tunnel syndrome. Only unaffected hands, without contractures or osteoarthritis, were evaluated for the purpose of radiographic assessment. The lengths of the phalanx and metacarpal bones in the second and fourth digits were measured by 2 independent observers who each performed 2 sets of measurements separated by a minimum 1-week interval. The 2D:4D was calculated separately for the phalanges and metacarpals, and a combined (phalanx + metacarpal) 2D:4D was also calculated. The reliability of the observer measurements was established using the intraclass correlation coefficient, and both the intra- and interobserver reliability showed excellent agreement. We found that compared with control group, the Dupuytren disease group had significantly lower phalanx and combined 2D:4D. These findings suggest that endogenous prenatal androgens could contribute to the development of Dupuytren disease, leading to its characteristic clinical presentation predominantly in men and affecting the ulnar rays.
Muscular and Skeletal Diseases (1) Contracture (2), Dupuytren Contracture (1), Carpal Tunnel Syndrome (1), more mentions
... contacts, whereas self-referrals more often led to immediate exclusion AbstractText: This study gives an overview of the demographic composition of our UET contacts, with a specific emphasis on mode of referral. We have identified that physician referrals have led to more screened and accepted patients versus self-referred individuals AbstractText: Therapeutic, Level IV Keyword: Handtransplantation. Keyword: patient referrals.