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Lameire DL, Khalik HA, Paul RA, von Schroeder HP, Chan AHW. Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options. J Wrist Surg 2024; 13:374-388. [PMID: 39027024 PMCID: PMC11254481 DOI: 10.1055/s-0043-1768133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/06/2023] [Indexed: 07/20/2024]
Abstract
Purpose This systematic review summarizes the existing evidence on treatment options and outcomes for partial scapholunate interosseous ligament (pSLIL) injuries. Methods A systematic electronic search of Medline, Embase, and CINAHL was performed from inception through to February 13, 2022. All primary research articles addressing the treatment of pSLIL tears were eligible for inclusion regardless of timing of surgery, surgical technique, or rehabilitation. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics and forest plots are presented. Results A total of 14 studies with 342 patients were included for analysis. Treatments were categorized into four groups: electrothermal shrinkage (ES), arthroscopic capsuloplasty (AC), open capsulodesis (OC), and no treatment (NT). There were five studies in the ES group ( N = 69, mean age = 34.3 ± 3.3 years), three studies in the AC group ( N = 138, mean age = 32.2 ± 3.8 years), five studies in the OC group ( N = 123, mean age of 30.7 ± 7.8 years), and one study in the NT group ( N = 12, mean age = 43 years, range = 28-67 years). The average postintervention visual analog scale pain score for the ES group was 1.4 ± 0.5 (from 5.7 ± 1.8), for the AC group was 3.2 ± 1.3 (from 6.6 ± 0), for the OC group was 2.3 ± 2.1 (from 5.6 ± 1.6), and for the NT group was 3.2 (from 7.6). The wrist extension range of motion improved postoperatively for all intervention groups (ES = 66.3°-70.7°; AC = 67°-74.5°; and OC = 48.9°-63.5°), whereas it remained unchanged for the NT group (46°-45°). Grip strength also improved in all intervention groups (ES = 17.9-29.9 kg; AC = 24.0-32.2 kg; and OC = 15.8-26.6 kg), while the NT group remained unchanged (25-24 kg). The radiographic scapholunate gap improved postoperatively in all groups that reported pre- and postintervention (ES = 2.2-1.9 mm; OC = 2.5-1.8 mm) and slightly worsened in the NT group (2.5-2.7 mm). In the ES group, there were three complications (11.5%, no major complications), in the AC group there was one major complication (0.9%, complex regional pain syndrome [CRPS]), and in the OC group there were six complications (15.4%, four major complications-CRPS). Conclusion All interventional treatment options (ES, AC, and OC) provided significant improvements in patient-reported pain, range of motion, grip strength, and radiographic parameters, with low complication rates. In comparison, no improvement in range of motion or grip strength was noted in the NT group. Therefore, surgical management of pSLIL injuries is an effective and relatively safe treatment option. Further studies comparing the outcomes of specific surgical treatments are warranted to further elucidate the optimal management option for pSLIL tears. Level of Evidence Level III, systematic review of Level III-IV studies.
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Affiliation(s)
- Darius Luke Lameire
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Ryan Augustine Paul
- Division of Orthopaedic Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
| | - Herbert P. von Schroeder
- Division of Orthopaedic Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
| | - Andrea H. W. Chan
- Division of Orthopaedic Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
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Zhou JY, Jodah R, Joseph LP, Yao J. Scapholunate Ligament Injuries. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:245-267. [PMID: 38817761 PMCID: PMC11133945 DOI: 10.1016/j.jhsg.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 06/01/2024] Open
Abstract
Injuries to the scapholunate interosseous ligament (SLIL) complex can result in a predictable cascade of incongruous motion in the carpus that leads to radiocarpal degeneration. Both acute traumatic impact and repetitive motion can render the SLIL insufficient. A thorough understanding of SLIL anatomy is required for appropriate diagnosis and treatment. Here, we review scapholunate ligament anatomy, prevention strategies, methods of diagnosis, nonoperative and operative treatments, and outcomes. A myriad of treatment options exist for each stage of the SLIL injury, and management should be an open discussion between the patient and physician.
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Affiliation(s)
- Joanne Y. Zhou
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | | | - Lauren P. Joseph
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
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Kale NN, Foote J, Medvedev G. Use of Wrist Denervation in the Treatment of SLAC and SNAC Wrist by ASSH Members. J Wrist Surg 2023; 12:280-286. [PMID: 37223381 PMCID: PMC10202580 DOI: 10.1055/s-0042-1756498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/30/2022] [Indexed: 10/10/2022]
Abstract
Background Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are common patterns of wrist arthritis, and surgical treatment options include partial and total wrist arthrodesis and wrist denervation, which maintains the current anatomy while relieving pain. Introduction The purpose of this study is to elucidate current practices within the hand surgery community with respect to the use of anterior interosseous nerve/posterior interosseous nerve (AIN/PIN) denervation in the treatment of SLAC and SNAC wrists. Methods An anonymous survey was distributed to 3,915 orthopaedic surgeons via the American Society for Surgery of the Hand (ASSH) listserv. The survey collected information on conservative and operative management, indications, complications, diagnostic block, and coding of wrist denervation. Results In total, 298 answered the survey. 46.3% ( N = 138) of the respondents used denervation of AIN/PIN for every SNAC stage, and 47.7% ( N = 142) of the respondents used denervation of AIN/PIN for every SLAC wrist stage. AIN and PIN combined denervation was the most common standalone procedure ( N = 185, 62.1%). Surgeons were more likely to offer the procedure ( N = 133, 55.4%) if motion preservation had to be maximized ( N = 154, 64.4%). The majority of surgeons did not consider loss of proprioception ( N = 224, 84.2%) or diminished protective reflex ( N = 246, 92.1%) to be significant complications. 33.5%, 90 respondents reported never performing a diagnostic block prior to denervation. Conclusion Both SLAC and SNAC patterns of wrist arthritis can result in debilitating wrist pain. There is a wide range of treatment for different stages of disease. Further investigation is required to identify ideal candidates and evaluate long-term outcomes.
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Affiliation(s)
- Nisha N. Kale
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Jake Foote
- Department of Orthopaedics, MSUCHM Ascension Providence Hospital, Southfield, Michigan
| | - Gleb Medvedev
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Curran MWT, Wieschollek S, Strauss R, Manzanero S, Hope B, Couzens G, Ross M. Clinical Outcomes of Arthroscopic Ligament-Sparing Dorsal Capsulodesis for Partial Scapholunate Ligament Tear. J Wrist Surg 2023; 12:218-224. [PMID: 37223389 PMCID: PMC10202575 DOI: 10.1055/s-0042-1757441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/01/2022] [Indexed: 10/10/2022]
Abstract
Introduction Various wrist arthroscopy techniques can be used in the management of scapholunate ligament (SLL) partial tears but their success has not been proven. Arthroscopic techniques including thermal shrinkage are becoming more popular in the management of partial SLL injuries. We hypothesized that arthroscopic ligament-sparing capsular tightening yields reliable and satisfactory results for the management of partial SLL tears. Methods A prospective cohort study was conducted on adult (age ≥18 years) patients with chronic partial SLL tears. All patients failed a trial of conservative management consisting of scapholunate strengthening exercises. Patients underwent an arthroscopic dorsal capsular tightening of the radiocarpal joint capsule radial to the origin of the dorsal radiocarpal ligament and proximal to the dorsal intercarpal ligament by either thermal shrinkage or dorsal capsule abrasion. Demographic data, radiological outcomes, patient-rated outcome measures and objective measures of wrist range of motion (ROM), and grip and pinch strength were recorded. Postoperative outcome scores were collected at 3, 6, 12, and 24 months. Data are reported as median and interquartile range, and comparisons were drawn between baseline and last follow-up. Clinical outcome data were analyzed using a linear mixed model method, while radiographic outcomes were assessed with nonparametric analysis with p < 0.05 indicating statistical significance. Results Twenty-three wrists (22 patients) underwent SLL treatment by thermal capsular shrinkage (19 wrists) or dorsal capsular abrasion (4 wrists). Median age at surgery was 41 years (range: 32-48) and median follow-up time was 12 months (range: 3-24). Pain significantly decreased from 62 (45-76) to 18 (7-41) and satisfaction significantly increased from 2 (0-24) to 86 (52-92). Patient-Rated Wrist and Hand Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand significantly improved from 68 (38-78) to 34 (13-49) and from 48 (27-55) to 36 (4-58), respectively. Median grip and tip pinch strength significantly increased at final review. Range of movement and lateral pinch strength were satisfactory and maintained. Four patients required further surgery for ongoing pain or reinjury. All were successfully managed with partial wrist fusion or wrist denervation. Conclusion Arthroscopic ligament-sparing dorsal capsular tightening is a safe and effective treatment for partial SLL tears. Dorsal capsular tightening demonstrates good pain relief and patient satisfaction while improving patient-reported outcomes, grip strength, and maintaining ROM. Longer term studies are required to determine the longevity of these results.
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Affiliation(s)
- Matthew W. T. Curran
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
- Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia
| | - Stefanie Wieschollek
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
- Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia
| | - Ruby Strauss
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
| | - Silvia Manzanero
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
| | - Benjamin Hope
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
- Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia
| | - Greg Couzens
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
- Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
- Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
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Loewenstein SN, Regent-Smith A, LoGiudice A, Hoben G, Dellon AL. Ulnar Wrist Denervation: Articular Branching Pattern and Selective Blockade of the Dorsal Branch of the Ulnar Nerve. J Hand Surg Am 2023:S0363-5023(23)00072-2. [PMID: 36966047 DOI: 10.1016/j.jhsa.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 01/16/2023] [Accepted: 02/08/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE Ulnar wrist denervation has been a successful treatment for patients with ulnar-sided wrist pain. The purpose of this study was to characterize the articular branches of the dorsal branch of the ulnar nerve (DBUN) and validate a technique for selective peripheral nerve blockade. METHODS In cadavers, we performed simulated local anesthetic injections using 0.5 mL of 0.5% methylene into the subcutaneous tissue at a point midway between the palpable borders of the pisiform and ulnar styloid. We then dissected the DBUN, characterized its articular branching pattern, and measured staining intensity of the DBUN and the ulnar nerve relative to a standard. RESULTS The DBUN branched from the ulnar nerve 7.0 ± 1.2 cm proximal to the ulnar styloid. Among 17 specimens, the DBUN provided an average of 1.2 (range, 0-2) ulnocarpal branches and 1.0 (range, 0-2) carpometacarpal articular branches. A simulated local anesthetic injection successfully stained 100% of the DBUN articular branches at or proximal to their takeoff. There was no staining of the proper ulnar nerves. In all specimens, the DBUN supplied at least one articular branch. CONCLUSIONS A point midway between the palpable border of the pisiform and ulnar styloid may be an effective location for selectively blocking the DBUN articular afferents. CLINICAL RELEVANCE In this study, we were able to identify a point halfway between the pisiform and ulnar styloid that has the potential to produce a selective peripheral nerve block of the portion of the DBUN that supplies articular fibers to the ulnocarpal joint and the fifth carpometacarpal joint. This technique may prove useful to surgeons treating ulnar-sided wrist pain.
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Affiliation(s)
- Scott N Loewenstein
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI; Department of Plastic and Hand Surgery, HealthPartners Regions Hospital, Saint Paul, MN; Division of Plastic & Reconstructive Surgery, University of Minnesota, Minneapolis, MN.
| | | | - Anthony LoGiudice
- Department of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Gwendolyn Hoben
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI
| | - Arnold Lee Dellon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
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Faucher GK, Moody MC. LT Ligament Tears. Hand Clin 2021; 37:537-543. [PMID: 34602133 DOI: 10.1016/j.hcl.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Lunotriquetral (LT) ligament injuries are uncommon, however, should be considered in patients with ulnar-sided wrist pain. LT injuries are often associated with other injuries but can occur in isolation. Understanding the anatomy and pathomechanics will aid in making the diagnosis. Similar to other injuries, a thorough history and focused physical examination is critical. Radiographs may show normal findings; however, advanced imaging can support the diagnosis. Arthroscopy remains the gold standard for diagnosis. Most patients do well with conservative management; however, injury acuity and severity will direct surgical management. Anatomy, pathophysiology, and treatment options are discussed.
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Affiliation(s)
- Gregory K Faucher
- Division of Hand Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, The Hand Center, 1011 Frontage Drive, Greenville, SC 29615, USA.
| | - Mark Christian Moody
- Division of Hand Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, The Hand Center, 1011 Frontage Drive, Greenville, SC 29615, USA
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Hearon BF, Frantz LM, Helsper EA, Morris HA. Experience with Diagnosis and Management of Distal Radioulnar Joint Instability. J Wrist Surg 2021; 10:392-400. [PMID: 34631291 PMCID: PMC8489992 DOI: 10.1055/s-0041-1726408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Objective The aim of this study is to review our cumulative experience with diagnosis and treatment of distal radioulnar joint (DRUJ) instability and to present our treatment algorithm. Materials and Methods Retrospective review identified 112 patients who had 126 episodes of care for DRUJ instability at a single institution over a 21-year period. Those diagnosed acutely or subacutely were treated with immobilization of the wrist and elbow for 6 weeks, while those with chronic instability had anatomic reconstruction of the dorsal and palmar radioulnar ligaments with tendon autograft or an alternative arthroscopic treatment with our thermal annealing technique. Short-term treatment failures and surgical complications were recorded. Nonparametric statistical tests were used to analyze key long-term outcome measures including ulnar wrist pain and DRUJ stability indicated by the dorsopalmar stress test. Results At mean 7-year follow-up, eight patients in the acute-injury cohort had statistically significant improvements in wrist pain and DRUJ instability ( p < 0.001). In both the 22-patient anatomic reconstruction cohort and the 37-patient arthroscopically treated group, there were also statistically significant improvements in wrist pain and DRUJ stability ( p < 0.001) at mean 9-year follow-up. The majority of patients in all three groups was satisfied with treatment outcome, though some required secondary procedures. Conclusion Early clinical diagnosis of DRUJ instability using the dorsopalmar stress test provides an opportunity for effective nonsurgical treatment. For chronic presentation, we recommend our arthroscopic thermal annealing technique for mild or moderate instability and open anatomic reconstruction of the radioulnar ligaments for severe instability. Level of Evidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Bernard F. Hearon
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas
- Advanced Orthopaedic Associates, Wichita, Kansas
| | - Lisa M. Frantz
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas
| | - Elizabeth A. Helsper
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas
| | - Harry A. Morris
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas
- Advanced Orthopaedic Associates, Wichita, Kansas
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Helsper EA, Frantz LM, Adams JM, Morris HA, Hearon BF. Arthroscopic thermal stabilization for distal radioulnar joint instability: 3 to 19 years follow-up. J Hand Surg Eur Vol 2020; 45:916-922. [PMID: 32515266 DOI: 10.1177/1753193420927882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This retrospective study investigated the clinical outcomes of patients treated for chronic distal radioulnar joint instability with arthroscopic thermal annealing of the superficial radioulnar ligaments, ulnar palmar wrist ligaments, and dorsoulnar wrist capsule using a radiofrequency probe. Sixty patients (62 wrists) were treated over an 18-year period. At mean follow-up of 10 years (range 3 to 19), 30 of 33 patients were satisfied with their surgical outcomes. There were statistically significant improvements in ulnar-sided wrist pain on a visual analogue scale and in distal radioulnar joint stability on the dorsopalmar stress test after surgery compared with preoperative status. The modified Mayo Wrist Score and Quick Disabilities of the Arm, Shoulder, and Hand score of the patients were favourable. Early failure occurred in 11 of 62 wrists. Nine of these 11 wrists needed a secondary procedure. We conclude that arthroscopic thermal shrinkage is effective for the majority of the patients with mild to moderate chronic distal radioulnar joint instability in long-term follow-up. Secondary open ligament reconstruction is an option in the case of early failure.Level of evidence: IV.
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Affiliation(s)
- Elizabeth A Helsper
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, KS, USA
| | - Lisa M Frantz
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, KS, USA
| | | | - Harry A Morris
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, KS, USA.,Advanced Orthopaedics Associates, 2778 N. Webb Road, Wichita, KS, USA
| | - Bernard F Hearon
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, KS, USA.,Advanced Orthopaedics Associates, 2778 N. Webb Road, Wichita, KS, USA
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Gire JD, Yao J. Surgical Techniques for the Treatment of Acute Carpal Ligament Injuries in the Athlete. Clin Sports Med 2020; 39:313-337. [PMID: 32115087 DOI: 10.1016/j.csm.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The treatment of athletes with carpal ligament injuries provides many challenges. Our initial goals remain to make a timely and accurate diagnosis, provide treatment options, and create an environment for shared decision making. To optimize outcomes and facilitate return to play, early surgical intervention may be warranted. This article reviews common carpal ligament injury patterns in the athlete with a focus on both classic and newer surgical techniques.
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Affiliation(s)
- Jacob D Gire
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, MC 6342, Redwood City, CA 94063, USA
| | - Jeffrey Yao
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, MC 6342, Redwood City, CA 94063, USA.
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Crespo Romero E, Arias Arias A, Domínguez Serrano D, Palomino Nieto D, Peñuela Candel R, Sánchez Lopez D, Crespo Romero R, Picazo Belinchón J. Arthroscopic electrothermal collagen shrinkage for partial scapholunate ligament tears, isolated or with associated triangular fibrocartilage complex injuries: a prospective study. Musculoskelet Surg 2020; 105:189-194. [PMID: 32124329 DOI: 10.1007/s12306-020-00655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND To present the outcomes of arthroscopic electrothermal shrinkage for partial scapholunate (SL) ligament tears, isolated or with associated triangular fibrocartilage complex (TFCC) injuries. METHODS A prospective study of 20 patients with symptomatic instability of SL ligament (14 of them also with TFCC wrist injuries) treated with arthroscopic electrothermal shrinkage was conducted using a monopolar radiofrequency probe. No patient showed radiologic signs of static dissociation (mean SL interval 2.2 ± 0.6 mm; mean SL angle 41.4° ± 6.7°) before surgery. All patients underwent follow-up at our clinic regularly for an average of 50.6 months (range 29-80 months). RESULTS The modified Mayo wrist score improved from a mean of 59 ± 17.1 points preoperatively to 88.3 ± 16.2 points at the final follow-up. At the final clinical examination, a painful Watson scaphoid shift test was found in 3 patients (15%). The mean flexion-extension arc was unchanged (132° ± 19°), and mean grip strength improved 12 kg. No patient showed radiologic signs of arthritis or instability after surgery (mean SL interval 1.9 ± 0.7 mm; mean SL angle 42.7° ± 7.3°). Of the 14 patients with combined TFCC injuries, 3 patients continued complaining of ulnar-sided point tenderness. At the end of the follow-up, 80% of the subjects were satisfied or very satisfied. CONCLUSIONS SL ligament and TFCC electrothermal shrinkage effectively provided pain relief and grip strength increase for most of the patients treated. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- E Crespo Romero
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain.
| | - A Arias Arias
- Research Support Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, Alcázar de San Juan, Ciudad Real, Spain
| | - D Domínguez Serrano
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
| | - D Palomino Nieto
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
| | - R Peñuela Candel
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
| | - D Sánchez Lopez
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
| | - R Crespo Romero
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
| | - J Picazo Belinchón
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
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Burn MB, Sarkissian EJ, Yao J. Long-Term Outcomes for Arthroscopic Thermal Treatment for Scapholunate Ligament Injuries. J Wrist Surg 2020; 9:22-28. [PMID: 32025350 PMCID: PMC7000267 DOI: 10.1055/s-0039-1693973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
Background Arthroscopic electrothermal treatment of low-grade Geissler's scapholunate interosseous ligament (SLIL) tears has shown clinical benefit at short-term follow-up. Questions/Purpose This study aims to evaluate the long-term functional outcomes in patients undergoing this treatment. Patients and Methods A retrospective review of all patients treated between 2005 and 2013 was performed. Patients were excluded with less than 5 years of follow-up, the presence of static SLIL injuries, prior wrist surgery, and concomitant denervation. Symptom resolution, return to activity, postoperative complications, range of motion, grip strength, and subsequent treatment were recorded. Each patient completed Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Modified Mayo Wrist (MMW), and Patient-Rated Wrist Evaluation (PRWE) questionnaires. Results Nine patients underwent treatment for Geissler's grade I, II, and III SLIL injuries with a mean 7 years (range: 5-11 years) of follow-up. Mean grip strength was 99% of the nonsurgical extremity. Wrist motion was near symmetric with a mean of 76 (±14), 74 (±8), 21 (±13), and 40 degrees (±13) for wrist flexion, extension, radial deviation, and ulnar deviation. QuickDASH improved significantly by a mean 39 points (50 (preoperative)-11 [postoperative], p = 0.009). Postoperative MMW and PRWE scores were 83 and 14, respectively. Visual analog scale (VAS) score was 1.4. A total of 90% was returned to their preinjury level of function or higher. Conclusions Arthroscopic electrothermal treatment of low-grade Geissler's SLIL tears demonstrates excellent objective and subjective outcomes at a minimum 5-year follow-up, providing evidence that this is an effective, safe, and, most importantly, durable-therapeutic modality. Level of Evidence This is a Level IV, case series study.
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Affiliation(s)
- Matthew B. Burn
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California
| | - Eric J. Sarkissian
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California
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Belyea CM, Krul KP, Shin EH, Gumboc RD. Outcomes After Wrist Arthroscopy for the Treatment of Scapholunate Predynamic Instability in the Young Active Patient. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
PURPOSE OF REVIEW The goal of this manuscript is to review key historic and recent literature regarding extensor carpi ulnaris (ECU), triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) injuries, particularly in athletes. RECENT FINDINGS Many recent studies examining the ECU focus on clinical and radiographic diagnosis. Several physical exam findings are described in addition to the use of MRI and US. Imaging studies must be clinically correlated due to high incidence of findings in asymptomatic patients. In regard to the TFCC/DRUJ, there are numerous recent studies that support the use of MRA as an adjunctive diagnostic study. There are also a number of repair constructs that are described for the various different kinds of TFCC pathology reviewed here. In summary, there are a number of options for the diagnosis and treatment of ulnar-sided wrist pain. Patient factors, especially in the athletic population, must be taken into account when approaching any patient with these pathologies.
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Morrell NT, Moyer A, Quinlan N, Shafritz AB. Scapholunate and perilunate injuries in the athlete. Curr Rev Musculoskelet Med 2017; 10:45-52. [PMID: 28101827 DOI: 10.1007/s12178-017-9383-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF THE REVIEW Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries. RECENT FINDINGS Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season. The treatment of static scapholunate ligament injury remains controversial. Newer SL reconstructive techniques that aim to restore scapholunate function without compromising wrist mobility as much as tenodesis procedures show promise in athlete patients. Acute injuries to the scapholunate ligament are best treated aggressively in order to prevent the sequelae of wrist arthritis associated with long-standing ligamentous injury. Acute repair is favored. Reconstructive surgical procedures to manage chronic scapholunate injury remain inferior to acute repair. The treatment of lunotriquetral ligament injuries is not well defined.
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Affiliation(s)
- Nathan T Morrell
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive Stafford Hall, Burlington, VT, 05405, USA
| | - Amanda Moyer
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive Stafford Hall, Burlington, VT, 05405, USA
| | - Noah Quinlan
- University of Vermont College of Medicine, The University of Vermont Medical Center, Burlington, VT, USA
| | - Adam B Shafritz
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive Stafford Hall, Burlington, VT, 05405, USA.
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