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Postle RD, Ahmad G, Forster BB. Extensor carpi ulnaris (ECU) tenosynovitis. Br J Sports Med 2024; 58:401-402. [PMID: 38050013 DOI: 10.1136/bjsports-2023-107479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Ryan D Postle
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Gulraiz Ahmad
- Radiology Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - Bruce B Forster
- Department of Radiology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Alves M. Lunotriquetral Synostosis as a Cause of Ulnar Sided Wrist Pain: A Case Report. Malays Orthop J 2024; 18:150-152. [PMID: 38638666 PMCID: PMC11023340 DOI: 10.5704/moj.2403.019] [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: 03/02/2023] [Accepted: 01/26/2024] [Indexed: 04/20/2024] Open
Abstract
The diagnostic workout of ulnar sided wrist pain may be challenging, since there can be many different causes for it, varying from ulnar nerve problems to fractures. Congenital lunotriquetral synostosis may present as a source of pain in some cases, but it is a rare diagnosis. The author presents a case of post-traumatic ulnar sided wrist pain in a patient with Minnaar's type 1 congenital lunotriquetral synostosis.
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Affiliation(s)
- Mpt Alves
- Department of Orthopaedic Surgery, Hospital Doutor José Maria Grande, Portalegre, Portugal
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Mitchell T, Hamilton N, Dean B, Rodgers S, Fowler-Davis S, McLean S. A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders. HAND THERAPY 2024; 29:3-20. [PMID: 38425437 PMCID: PMC10901165 DOI: 10.1177/17589983231219595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024]
Abstract
Introduction Non-traumatic wrist disorders (NTWD) are commonly encountered yet sparse resources exist to aid management. This study aimed to produce a literature map regarding diagnosis, management, pathways of care and outcome measures for NTWDs in the United Kingdom. Methods An interdisciplinary team of clinicians and academic researchers used Joanna Briggs Institute guidelines and the PRISMA ScR checklist in this scoping review. A mixed stakeholder group of patients and healthcare professionals identified 16 questions of importance to which the literature was mapped. An a-priori search strategy of both published and non-published material from five electronic databases and grey literature resources identified records. Two reviewers independently screened records for inclusion using explicit eligibility criteria with oversight from a third. Data extraction through narrative synthesis, charting and summary was performed independently by two reviewers. Results Of 185 studies meeting eligibility criteria, diagnoses of wrist pain, De Quervain's syndrome and ulna-sided pain were encountered most frequently, with uncontrolled non-randomised trial or cohort study being the most frequently used methodology. Diagnostic methods used included subjective questioning, self-reported pain, palpation and special tests. Best practice guidelines were found from three sources for two NTWD conditions. Seventeen types of conservative management, and 20 different patient-reported outcome measures were suggested for NTWD. Conclusion Substantial gaps in evidence exist in all parts of the patient journey for NTWD when mapped against an analytic framework (AF). Opportunities exist for future rigorous primary studies to address these gaps and the preliminary concerns about the quality of the literature regarding NTWD.
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Affiliation(s)
- Thomas Mitchell
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Nick Hamilton
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Ben Dean
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Sarah Rodgers
- The Hand Unit, Northern General Hospital, Sheffield, UK
| | | | - Sionnadh McLean
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
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Kim S, Salloum M, Millrose M, Goelz L, Eisenschenk A, Haralambiev L, Bakir S, Asmus A. Weight-bearing test of traumatic triangular fibrocartilage complex lesion with unstable radioulnar joint. J Hand Ther 2024; 37:38-43. [PMID: 37777442 DOI: 10.1016/j.jht.2023.08.002] [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] [Received: 03/06/2022] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Ulnar-sided wrist pain might be caused by a lesion of the triangular fibrocartilage complex (TFCC). Patients with TFCC lesion may show an instability of the distal radioulnar joint (DRUJ). Before arthroscopic assessment, conservative therapy using a brace or splint may result in alleviation of symptoms. The results of our previous study showed that patients with a traumatic TFCC lesion and instability of the DRUJ had the smallest weight-bearing capacity and had the largest increase in application of the wrist brace (WristWidget). PURPOSE In this prospective study, we wanted to test if the weight-bearing capacity with and without the wrist brace can be used as a diagnostic tool to differentiate between patients with traumatic TFCC lesion and instability of the DRUJ. We tested if patients with traumatic TFCC lesion and instability of the DRUJ (1) have a lower weight-bearing capacity and (2) show a higher increase of weight-bearing capacity after application of a wrist brace compared to all other types of injury. STUDY DESIGN This was a prospective cohort study. METHODS Forty-eight patients presented to an outpatient clinic with suspected TFCC lesion. We measured the dynamic weight-bearing capacity of both hands with and without the wrist brace (WristWidget) by letting the patients lean on an analog scale with extended arm and wrist. The stability of the DRUJ was assessed by clinical examination by a hand surgeon preoperatively and intraoperatively. Forty-five patients received an arthroscopy and were included in the analysis. During arthroscopy, the surgeon determined if there was a traumatic TFCC lesion and DRUJ instability. Patients with a traumatic lesion of the TFCC and DRUJ instability were compared to all other cases. We used the t-test for normally distributed values, Mann-Whitney U test for nonnormally distributed values, and the Chi-square test for categorical variables, respectively Fisher's exact if the expected cell count was less than five. RESULTS Patients with a traumatic TFCC lesion and DRUJ instability had a higher weight-bearing capacity (22.8 kg) than all other cases (13.8 kg; p < 0.01). This is in contrast to our previous study, in which patients with a traumatic lesion of the TFCC had the tendency to show lower values of weight-bearing capacity than those with a degenerative lesion. While the wrist brace was worn, the relative gain was not significantly lower in patients with traumatic TFCC lesions and DRUJ instability compared to all other cases (21% vs 54%, p = 0.16). All included cases showed the same absolute increase of about 4 kg in weight-bearing capacity with the wrist brace (p = 0.93) CONCLUSIONS: The weight-bearing test cannot be used to identify patients with traumatic TFCC lesion and DRUJ instability among those with suspected TFCC lesion. The results of our previous study could be confirmed that the weight-bearing capacity on the injured side was higher with brace than without.
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Affiliation(s)
- S Kim
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Leibniz Institut für Plasmaforschung und Technologie (INP Greifswald), Greifswald, Germany.
| | - Mouataz Salloum
- Abteilung für Hand-, Replantations, und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Michael Millrose
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Abteilung für Unfallchirurgie, Sportorthopädie und Kindertraumatologie, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany; Klinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Germany
| | - Leonie Goelz
- Institut für Radiologie und Neuroradiologie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Andreas Eisenschenk
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Abteilung für Hand-, Replantations, und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Lyubomir Haralambiev
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Sinan Bakir
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Ariane Asmus
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Abteilung für Hand-, Replantations, und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
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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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Effect of Acupotomy Combined with Electroacupuncture Therapy on Finger Mobility and Pain Relief in Patients with Carpal Tunnel Syndrome. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2550875. [PMID: 35872928 PMCID: PMC9303111 DOI: 10.1155/2022/2550875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
Objective. To explore the effect of acupotomy in combination with electroacupuncture therapy on the finger mobility and pain relief in patients who had carpal tunnel syndrome (CTS). Methods. The clinical data of 60 CTS patients in our hospital from November 2020 to November 2021 received retrospective analysis. With 30 cases in each group, they were randomly divided into the treatment group and the control group. The control group underwent hot compress, oral medication, and local injection during hospitalization, while the treatment group received acupotomy and electroacupuncture therapy on top of the above treatments, and the clinical effects, finger mobility, and pain relief were compared between both groups. Results. The clinical indexes in the treatment group after treatment were remarkably better than those in the control group (
), with the remarkably higher number of cured cases in the treatment group (
). After treatment, the treatment group had remarkably higher mean total active motion (TAM) and score of the 36-item short form (SF-36) health survey and a remarkably lower mean score of visual analog scale (VAS) than those in the control group (
). Conclusion. The quality of life and finger mobility of CTS sufferers can be improved with acupotomy in conjunction with electroacupuncture therapy. In-depth research will help build better procedures for these patients because this approach lessens the discomfort and shortens the symptom duration in CTS sufferers.
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