[The Linburg-Comstock phenomenon: a review]

Simultaneous flexion of thumb and fingers is described as the Linburg-Comstock phenomenon. Congenital and acquired coupling of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) tendons is the reason for this clinical entity. Additionally, coupling of the FPL and the flexor digitorum superficialis II or III has been described. The coupling can be between the muscles, the tendon sheaths or the tendons themselves. Asymptomatic and symptomatic coupling should be differentiated. In general symptomatic congenital or acquired coupling demands surgical intervention. We report about a 35-year-old patient with a congenital asymptomatic coupling of FPL and FDP-II who suffered a distorsion of the thumb. Afterwards she complained of pain and strength loss. An accessory tendon of 3 mm in diameter and 3.5 cm length between FPL and FDP-II was identified during surgery. The patient recovered completely after resection of this coupling.

[Symptomatic carpal coalition of scaphoid, trapezium and trapezoid with coexisting ipsilateral hypoplasia of the thumb]

We present the case of a 54-year-old woman with symptomatic coalition of scaphoid, trapezium and trapezoid as well as a coexisting ipsilateral hypoplasia of the thumb.

[Isolated capitate fractures in the frontal plane]

Isolated fractures of the capitate in the frontal plane are both very rare and most of the time very discreet. There is a great risk to miss such fractures with potential longterm consequences. The following report of two independent patients highlights the importance of computed tomography in order to verify fractures and initiate adequate treatment.

[Text mining, a method for computer-assisted analysis of scientific texts, demonstrated by an analysis of author networks]

Searching for relevant publications is becoming more difficult with the increasing number of scientific articles. Text mining as a specific form of computer-based data analysis may be helpful in this context. Highlighting relations between authors and finding relevant publications concerning a specific subject using text analysis programs are illustrated graphically by 2 performed examples.

[A 15-year-old adolescent presenting both Madelung deformity with Vickers' ligament and additional palmaris profundus muscle]

The palmaris profundus muscle is a rare entity which has been mentioned in association with nerve compressions. Madelung deformity is based both on an osteochondral lesion of the distal radial physis and often on the Vickers' ligament which originates around the lunate and inserts proximally in the radial physis. A 15-year-old right-handed female adolescent suffered from symptomatic left-sided Madelung deformity with Vickers' ligament and additional palmaris profundus muscle.

[Idiopathic palmar vein thrombosis of the fingers - rare but relevant]

Idiopathic thrombosis of palmar finger veins is rare and women suffer from it almost exclusively. Synovial cysts, epidermoid inclusion cysts, giant cell tumours and haemangiomatous lesions should be considered in the process of diagnosis. We present a 56-year-old woman with idiopathic and symptomatic thrombosis of palmar finger veins. Using the palmar approach the painful veins were identified and excised completely. An uncomplicated wound healing has followed with completely unrestricted and painless range of motion. Surgical excision of the finger vein thrombosis should be considered if there is continuing pain.

[Spontaneous fixation of MP-joint of the index finger in flexion]

Spontaneous fixations of MP-joints of fingers and thumbs are rare and are often a challenging task for hand surgeons. We present a 25-year-old female office employee with a fixed painless MP-joint of the left index finger in 90° flexion with normal PIP- und DIP-joint range of motion. Using the palmar approach to the MP-joint the entrapped accessory collateral ligament which was constrained by a prominent radial condylus could be identified. Operative removal of the prominence has released the joint. An uncomplicated wound healing has followed with completely unrestricted range of motion. If a closed reduction should be considered, it ought to be done cautiously without anaesthetics. A failed -reduction entails an operative revision using the palmar approach.

[Diagnostic value of preopratively performed MRI regarding lesions of the scapholunate ligament in clinical routine]

PURPOSE

The purpose of this retrospective study was to examine the sensitivity and specificity of preoperatively performed MRI of the wrist in identifying tears of the scapholunate ligament. Additionally, these findings were then compared with findings from a subsequently performed -arthroscopy of the wrist.

PATIENTS AND METHODS

The study was based on the MRI records of 401 patients who received MRI examinations between January 2004 and April 2012 in the context of ulnar-sided wrist pain. Subsequently, all patients received an arthroscopy of the wrist. The study included 218 male and 183 female patients with an average age of 42.4±14.3 years (range 12-84 years). The MRI examinations were conducted in various techniques and with various sequences. The MRI findings were evaluated by 88 experienced radiologists. The arthroscopies were performed by 16 experienced hand-surgeons who had seen the MRI results prior to the surgical intervention. -Arthroscopic findings were compared with MRI records and used as the benchmark.

RESULTS

Only 31 of 98 arthroscopically verified cases of a torn scapholunate ligament could be identified in an MRI examination. In contrast, MRI could correctly diagnose an intact ligament in 269 out of 276 arthroscopically verified cases. When compared with arthroscopy MRI sensitivity and specificity were 32% and 98%, respectively. In 91 out of 401 MRI examinations the use of a dedicated surface coil was recorded. In 66 out of 401 MRI examinations the use of contrast medium was documented. MRI specificity slightly improved upon use of contrast medium.

CONCLUSION

The comparison of MRI vs. arthroscopic sensitivity and specificity in the detection of scapholunate tears on a sufficiently large group of patients showed MRI to be a reliable method in excluding scapholunate ligament tears. Outside of clinical study conditions, however, it was found to be an unsuitable method in identifying and classifying scapholunate ligament tears. The high MRI sensitivity found by other studies could not be confirmed in our study.

Three-Month Evaluation of Vital Tooth Bleaching Using Light Units—A Randomized Clinical Study

The aim of this study was to evaluate the color stability of vital bleaching using a halogen unit, laser, or only chemical activation up to three months after treatment. A total of 60 patients were divided into three groups, and their teeth were bleached with 38% hydrogen peroxide using three methods: acceleration of the bleaching process with halogen (eight minutes), laser (30 seconds), or chemical activation only. All teeth were bleached a maximum of four times (4 × 15 minutes) until a change of six shade tabs took place. The color was evaluated both visually and with a spectrophotometer before bleaching, immediately after bleaching, and one and three months after bleaching. Directly after bleaching, the use of halogen showed better results than laser (p≤0.05). One and three months after bleaching, no significant difference was found between the tested methods relative to the shade change, independent of the method of shade evaluation (p>0.05). As far as the color stability is concerned, bleaching with halogen resulted in stable color throughout the three months (p>0.05), whereas the other two methods resulted in whiter teeth after one and three months compared with the color directly after bleaching (p≤0.05). Bleaching with laser needed more time than halogen for the desired shade change (p≤0.05). Although directly after treatment bleaching with halogen resulted in better results, one and three months after bleaching the kind of acceleration used in the bleaching process did not have any effect on the esthetic results.

Carpal tunnel syndrome caused by supernumerous lumbrical muscle in hemihyperplasia of the upper extremity

INTRODUCTION

Hemihyperplasia of the upper extremity is a rare pathology that occurs in 1/86,000 births. Carpal tunnel syndrome may be associated with this disease.

CLINICAL PRESENTATION

We describe the case of a 74-year-old male who has hemihyperplasia of both upper extremities since birth. At the age of 73, he started experiencing continuous, progressive and high intensity pain that occurred more frequently at night and was localized in the right hand. It was associated with paresthesia and hypoesthesia predominantly of the thumb, index finger and middle finger. Clinical examination and electrodiagnosis led to diagnosis of carpal tunnel syndrome.

RESULTS

The patient underwent surgical carpal tunnel release to treat the disease. The enlarged nerve was compressed by a supernumerous lumbrical muscle, which was resected intraoperatively. After six months of follow-up the patient has normal sensitivity and grip strength in the right hand.

CONCLUSION

Hemihyperplasia should be clearly distinguished from other complex pathologies that may also entail CTS. Since significant variation in the anatomy of the hemihyperplasic extremities is the rule rather than the exception, a conventional open approach should be taken to localize and treat the compression.

[Oscar Vulpius and tendon transfer in the hand]

Oscar Vulpius dealt extensively with the problem of tendon transfer for motoric deficits. An analysis of his works shows that the knowledge of tendon healing, aftercare and operative techniques was already very widely advanced at the beginning of the last century.

[Endoscopic decompression of the ulnar nerve in the cubital tunnel syndrome: about 55 patients]

INTRODUCTION

Sulcus ulnaris syndrome is the second most common neurocompression syndrome in the upper limb after carpal tunnel syndrome. Its severity can be appreciated by the Dellon Classification. We present our experience and results after endoscopic decompression.

PATIENTS AND METHODS

A retrospective chart review of 55 patients operated over a 3-year period was performed. The patients, 37 men and 18 women, had an average age of 54 years (range: 27-82 years) at the time of surgery. The clinical diagnostic was always confirmed by a neurophysiological examination of the nerve conduction. According to the Dellon Classification, 11 patients had mild sulcus ulnaris syndrome, 31 had moderate and 13 had severe. The mean follow-up time was 21 months (range: 6-42 months).

RESULTS

The sensibility was normalised in 85% of the patients. Compared to the contralateral non-operated side, the mean grip strength improved from 68 to 94% and the mean pinch grip from 72 to 95%. The rate of nerve luxation did not change (5.5%). According to the modified Bishop rating system, 38 patients (69%) had excellent, 13 patients (23.5%) good and four patients (7.5%) fair results. One haematoma necessitating a revision, a minimal lesion of the ulnar nerve with restitution ad integrum and a hypoesthesia of the elbow, occurred after surgery resulting in a complication rate of 5.5%. Ninety-eight percent of the patients responded that they would undergo the endoscopic procedure again if needed.

CONCLUSION

Endoscopic decompression of the ulnar nerve in sulcus ulnaris syndrome is very well appreciated by patients and also provides promising clinical results.

Evidence for a 58-kilodalton polypeptide as precursor of the coat protein of cauliflower mosaic virus

Purified cauliflower mosaic virus subjected to agarose gel electrophoresis separated into two zones, slow and fast, with the latter consisting of less than 5-10% of the total. When these two types of virions were excised from gels and subjected to analysis in dodecyl sulfate impregnated gels, the fast component consisted mainly of the 58- and 44-kilodalton (kd) phosphorylated forms of the coat protein whereas the slow component contained only lower molecular weight forms of the same protein. Pulse labeling experiments with 32P (as orthophosphate) or tritiated thymidine showed the fast electrophoretic form of the virus to become labeled more rapidly than the slow form. With long labeling periods the slow form accumulated more label than the fast form suggesting a precursor-product relationship between the fast and slow electrophoretic forms. With [32P]orthophosphate or [35S]methionine labeling, the 58-kd phosphorylated protein showed a much higher relative level of labeling than that obtained with protein stains such as Coomassie blue. With longer labeling periods greater amounts of activity appeared in the 44-kd and lower molecular weight forms of the coat protein. These results supported previous results suggesting that the 58-kd protein is the primary translation product of the coat protein gene and that this is the form used in encapsidation to produce mature virions.