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Falcochio DF, Brunelli JPF, Oliveira RKD, Ruggiero GM. Arthroscopy-assisted Procedures in Hand and Wrist Surgery: An Update. Where Are We So Far? Rev Bras Ortop 2024; 59:e349-e357. [PMID: 38911879 PMCID: PMC11193588 DOI: 10.1055/s-0044-1779336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 06/25/2024] Open
Abstract
Wrist and hand arthroscopy, despite being an old tool, has gained popularity and advanced in assisting in the treatment of various injuries and conditions in the region in recent years. Dorsal, volar, ulnar, and radial accessory portals are used to reach all points of the carpal and hand joints. The minimal tissue damage, lesser injury to the capsule and its mechanoreceptors, the assessment of injuries associated with the reason for surgery, and aesthetically more favorable scars have attracted many doctors and their patients. As a result, there has been an increase in publications and diversifications of arthroscopic techniques. The aim of this update article is to present the advances and the evidence available in the literature to assist readers in their decision on which technique to use in the treatment of wrist and hand conditions.
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Díaz HFS, Fernández FD, Horcajadas ÁB, Martínez MV, Yubero MEC. Usefulness of the Ultrasound in Hand Surgery: Part I. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1739295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractIn the last years, ultrasonography (US) of the wrist and hand have increased in popularity. Technical advances led us to improve image quality and have the ability to see superficial soft-tissue structures with high resolution with the patient in our office.The advantages of US are the fact that it is noninvasive, its lack of ionising radiation, low cost, and portability. The dynamic real-time assessment in the office is an additional benefit.Ultrasound can be used in hand surgery for both diagnostic and therapeutic purposes. We can use US for injections with needle guidance, for the evaluation of soft-tissue masses, foreign bodies, tendon injuries, compressive neuropathies, and rheumatologic joint disease. It also helps us perform ultrasound-guided procedures: carpal tunnel syndrome, trigger finger, and intersection syndrome or compartimental syndrome.The aim of the present review is to describe different uses of US in hand surgery to show its important role of providing to the surgeon more information on the diseases of their patients.
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Affiliation(s)
- Homid Fahandezh-Saddi Díaz
- Hand Surgery Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
- Orthopedic Surgery and Traumatology Unit, clínica AVANFI, Madrid, Madrid, Spain
| | - Fernando Dávila Fernández
- Orthopedic Surgery and Traumatology Unit, Clínica Pakea de Mutualia, Donostia/San Sebastián, Guipúzcoa, País Vasco, Spain
| | - Ángel Bueno Horcajadas
- Musculoskeletal Radiology Service, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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He B, Nan G. Use of a radiopaque localizer grid and methylene blue staining as an aid to reduce radiation exposure. MINIM INVASIV THER 2020; 31:84-88. [PMID: 32491922 DOI: 10.1080/13645706.2020.1771374] [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: 10/24/2022]
Abstract
Background: Localization of small femur lesions for resection can be challenging and may be associated with the need for significant fluoroscopic imaging and tissue dissection. This study was performed to evaluate the use of a radiopaque localizer grid along with methylene blue staining for resection of small femur lesions in children, and to determine the effectiveness of this effectiveness at reducing radiation exposure and tissue injury.Material and methods: A radiopaque localizer grid was used to identify the body surface site of bone lesions, and then 0.02-0.03 mL of methylene blue was injected into the bone lesions. After skin incision, the blue bone tissue was found and complete lesion resection performed.Results: A radiopaque localizer grid was utilized to plan the point of entry for lesion resection. The average operation time was shorter, and the C-arm was used less frequently, and the incision length was shorter in the grid and methylene blue group compared with the control group.Conclusion: A radiopaque localizer grid is a simple and practical device for efficient localization of the skin entry site, and methylene blue accurately pinpoints bone lesions, reducing radiation exposure and tissue injury.
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Affiliation(s)
- Bo He
- Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, the Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guoxin Nan
- Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, the Children's Hospital of Chongqing Medical University, Chongqing, China
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Fernandes CH, Meirelles LM, Raduan Neto J, Fernandes M, dos Santos JBG, Faloppa F. Arthroscopic Resection of Dorsal Wrist Ganglion: Results and Rate of Recurrence Over a Minimum Follow-up of 4 Years. Hand (N Y) 2019; 14:236-241. [PMID: 29185350 PMCID: PMC6436138 DOI: 10.1177/1558944717743601] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dorsal wrist ganglia are the most common soft tissue tumor type of the upper limb. Surgical resection, open or arthroscopic, is one of the most frequent procedures performed by hand surgeons. This study sought to perform an objective evaluation of the outcomes of arthroscopic resection of dorsal wrist ganglia and their recurrence rates over 4 years. Patients treated with arthroscopic resection were expected to have favorable outcomes and low complication rates after 4 years of follow-up. METHODS We evaluated 34 cases of dorsal wrist ganglia in patients who underwent arthroscopic resection. The patients were evaluated using the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) for pain, range of motion of the wrist, palmar grip strength, rates of recurrence, and complications. RESULTS During the postoperative period, the QuickDASH score averaged 2.3 points, the mean residual pain by VAS was 0.54, full range of wrist movement was recovered by all patients, and the mean palmar grip strength was 29.4 kgf; there was 1 case with recurrence. There were no severe postoperative complications throughout the follow-up period. CONCLUSIONS The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion.
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Affiliation(s)
- Carlos H. Fernandes
- Universidade Federal de São Paulo, Brazil,Carlos H. Fernandes, Hand Surgery Unit, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Borges Lagoa 786, São Paulo, São Paulo 04038-032, Brazil.
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MRI and Arthroscopic Correlation of the Wrist. Sports Med Arthrosc Rev 2017; 25:e18-e30. [PMID: 29095398 DOI: 10.1097/jsa.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since its introduction in 1979, the practice of and indications for wrist arthroscopy in the diagnosis and treatment of pathologic conditions in the wrist continues to grow. Magnetic resonance imaging (MRI) is another commonly used tool to noninvasively examine the anatomy and pathology of the wrist joint. Here, we review the normal wrist anatomy as seen arthroscopically and through MRI. We then examine the various common pathologic entities and define both the arthroscopic findings and correlated MRI findings in each of these states.
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Gray J, Zuhlke T, Eizember S, Srinivasan R. Dry Arthroscopic Excision of Dorsal Wrist Ganglion. Arthrosc Tech 2017; 6:e207-e211. [PMID: 28409102 PMCID: PMC5382237 DOI: 10.1016/j.eats.2016.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 09/10/2016] [Indexed: 02/03/2023] Open
Abstract
Ganglions are common soft tissue masses of the hand. High recurrence rates are associated with nonsurgical treatment; thus, excision is often indicated. Arthroscopic excision and open excision have similar recurrence rates; however, the latter is associated with prolonged healing time and increased scarring. Recently, dry wrist arthroscopic techniques have been used. This technique allows easier confirmation of complete ganglion removal, easier conversion to open surgery, earlier return of motion, and stitch-less closure when compared with traditional "wet" arthroscopic excision.
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Affiliation(s)
- Jason Gray
- Department of Orthopaedics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Todd Zuhlke
- The Hand Center of San Antonio, San Antonio, Texas, U.S.A
| | - Shane Eizember
- Department of Orthopaedics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A.,Address correspondence to Shane Eizember, M.D., The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, U.S.A.The University of Texas Health Science Center at San Antonio7703 Floyd Curl DriveSan AntonioTX78229U.S.A.
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Su Y, Nan G. Using methylene blue as a marker to find and remove tiny metallic foreign bodies embedded in the soft tissues of children: A randomised controlled trial. Int J Surg 2016; 29:43-8. [PMID: 26975428 DOI: 10.1016/j.ijsu.2016.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/27/2016] [Accepted: 03/06/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Embedment of metallic foreign bodies in the soft tissues is commonly encountered in the emergency room. Most foreign bodies are easily removed, but removal is difficult if the foreign body is very small or deeply embedded. OBJECTIVE To determine the usefulness of methylene blue staining in the surgical removal of tiny metallic foreign bodies embedded in the soft tissue. METHODS This prospective study involved 41 children treated between May 2007 and May 2012. The patients were randomly divided into a methylene blue group and a control group. In the control group, foreign bodies were located using a C-arm and removed via direct incision. In the methylene blue group, foreign bodies were located using a C-arm, marked with an injection of methylene blue and then removed surgically. The clinical outcomes, complications, operation time, surgical success rate, incision length, frequency of C-arm use, and length and depth of the foreign body were compared between the two groups. RESULTS The surgical success rate was significantly higher in the methylene blue group. The average operation time was significantly shorter in the methylene blue group. The C-arm was used significantly less frequently in the methylene blue group than in the control group. The incision length was significantly shorter in the methylene blue group than in the control group. CONCLUSIONS Methylene blue staining facilitated the location and removal of tiny metallic foreign bodies from the soft tissue, and significantly reduced operation time, incision length and radiation exposure compared to the conventional method.
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Affiliation(s)
- Yuxi Su
- Department II of Orthopaedics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 40014, China.
| | - Guoxin Nan
- Department II of Orthopaedics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 40014, China.
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Ahsan ZS, Yao J. Arthroscopic dorsal wrist ganglion excision with color-aided visualization of the stalk: minimum 1-year follow-up. Hand (N Y) 2014; 9:205-8. [PMID: 24839422 PMCID: PMC4022959 DOI: 10.1007/s11552-013-9570-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dorsal wrist ganglia (DWG) are a common, benign soft-tissue mass of the wrist. Excision of DWG is a common procedure performed by hand surgeons and may be performed using either open or arthroscopic techniques. This study aims to evaluate the frequency of stalk visualization with intralesional injection of inert dye in the course of arthroscopic excision along with incidence of recurrence with a minimum of 1-year follow-up. METHODS Upon IRB approval, a retrospective chart review was performed identifying 27 patients who had consecutively undergone arthroscopic excision of a DWG with the color-aided technique at our institution with a minimum follow-up duration of 12 months. Intraoperative findings were reviewed. Patients were contacted to investigate for incidence of recurrence. RESULTS Of the 27-patient cohort, the ganglion stalk was identified in 100 % of the color-aided arthroscopic DWG excisions. Ganglion recurrence was identified in one patient, an incidence of 3.7 %. CONCLUSIONS The color-aided technique for arthroscopic DWG visualization was found to be a safe and valuable tool for surgeons performing arthroscopic DWG resection. The intraarticular ganglion stalk was identified in 100 % of cases and patients responded well with a low incidence of recurrence.
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Affiliation(s)
- Zahab S. Ahsan
- />Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN 46202 USA
| | - Jeffrey Yao
- />Stanford University Medical Center, 450 Broadway Street, Suite C442, Redwood City, CA 94063 USA
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Abstract
Arthroscopy is an advancing field in orthopedics, the applications of which have been expanding over time. Traditionally, excision of ganglion cysts has been done in an open fashion. However, more recently, studies show outcomes following arthroscopic excision to be as good as open excision. Cosmetically, the incisions are smaller and heal faster following arthroscopy. In addition, there is the suggested benefit that patients will regain function and return to work faster following arthroscopic excision. More prospective studies comparing open and arthroscopic excision of ganglion cysts need to be done in order to delineate if there is a true functional benefit.
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Kim JP, Seo JB, Park HG, Park YH. Arthroscopic excision of dorsal wrist ganglion: factors related to recurrence and postoperative residual pain. Arthroscopy 2013; 29:1019-24. [PMID: 23726108 DOI: 10.1016/j.arthro.2013.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 03/28/2013] [Accepted: 04/03/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the recurrence rate and postoperative residual pain rate after arthroscopic excision of dorsal wrist ganglia and the risk factors for recurrence and residual pain. METHODS A total of 115 wrists (111 patients: 57 men, 54 women; average age 34 years; range, 9 to 72 years) treated with arthroscopic excision for wrist dorsal ganglia between April 2005 and December 2009 were enrolled. The follow-up averaged 32 months (range, 12 to 67 months). Demographic data and operative details, including the presence of a ganglion stalk, were retrospectively reviewed and tested against recurrence and residual pain at final follow-up. RESULTS The recurrence rate of dorsal wrist ganglia after arthroscopic excision was 11% (13 of 115 wrists). Recurrence was on the dominant side in 12 of 13 (91%) patients, which was the most important risk factor for recurrence (odds ratio [OR], 8.0; 95% confidence interval [CI], 0.94 to 68.49), followed by female sex (OR, 4.9; 95% CI, 0.84 to 28.39) and age 24 years or younger (OR, 3.1; 95% CI, 0.75 to 12.74). Twenty-seven wrists (23%) had postoperative residual pain at final follow-up. The results of logistic regression showed that pain before surgery was the most important risk factor for residual pain after surgery (OR, 4.9; 95% CI, 1.36 to 18.3), followed by female sex (OR, 3.2; 95% CI, 1.22 to 8.53). CONCLUSIONS Dominant side, female sex, and age of 24 years or younger are considered to be the most influential risk factors for recurrence after arthroscopic excision of dorsal wrist ganglia. However, the presence or absence of the cyst stalk was not a significant factor for recurrence. Female patients who have preoperative pain around the dorsal wrist ganglia were most likely to experience residual pain after surgery. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jong Pil Kim
- Department of Orthopaedic Surgery, Dankook University School of Medicine, Cheonan, Korea.
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