The Outcomes of 2,154 Endoscopic Trigger Finger Releases

BACKGROUND

Trigger finger is one of the most frequent causes of hand pain and disability. Recently, an endoscopic trigger finger release technique was developed, but outcomes have rarely been reported. Here, we present the outcomes of 2154 endoscopic trigger finger release procedures in a single center.

METHODS

In this retrospective study, 2154 endoscopic trigger finger release procedures were performed on 2034 patients. Outcome assessment at 90 days after surgery was classified as excellent, good, fair or poor according to a combination of patient satisfaction with the scar and pain at rest or under load on a numeric rating scale.

RESULTS

The therapeutic outcomes were: 1027 excellent, 607 good, 400 fair, and none poor. No major surgical complications were observed. Minor complications occurred in 231 fingers (10.7%).

CONCLUSIONS

All patients were satisfied with their outcome after endoscopic trigger finger release. Endoscopic release can be an effective and efficient therapeutic method for the treatment of trigger finger.

Flexor Tenosynovial Fistula as a Complication after Endoscopic Trigger Finger Release: A Case Report

OBJECTIVE

We report a rare case of flexor tenosynovial fistula secondary to endoscopic release of the A1 pulley for treatment of trigger finger.

CASE PRESENTATION

A 72-year-old woman underwent endoscopic release of the A1 pulleys of her left ring and right middle fingers. Nine days after surgery, the wound at the base of the proximal phalanx of the ring finger (distal portal) remained open and a clear liquid discharge was seen. The volume of discharge increased with active finger motion. However, there was no evidence of infection. The patient was diagnosed with tenosynovial fistula as a complication of endoscopic release of the A1 pulley. At day 30, the fistula and drainage persisted and the condition was managed by surgical excision of the fistula and primary closure. The wound then healed completely.

CONCLUSION

Our report alerts hand surgeons to the potential development of flexor tenosynovial fistula as a very rare complication following endoscopic release of the A1 pulley for the treatment of trigger finger.

The New Smartphone Application for Wrist Rehabilitation

BACKGROUND

The rehabilitation after wrist surgery is extremely important. An instructed therapy in hospital is widely practiced. However, a dependent aging society and rush life style in younger generation have precluded patients to access to the frequent formal therapy. With the advancement in telecommunication technology, we have invented an application for smartphone for home-based wrist motion rehabilitation.

METHODS

Twenty participants were included in four-week wrist motion rehabilitation programme after wrist surgery. Participants were instructed to use the application by physical therapist and informed details of home-based wrist rehabilitation. The feasibility of application was evaluated by satisfaction level in various aspects and the adherence to the therapy was monitored by function provided in the application. The degrees of motion were compared at the end of prescribed programme.

RESULTS

Patient satisfaction was consistently high in every aspects. Also, the adherence to the therapy was high (90.42%). Ranges of motion significantly gained in every plane of wrist motion ([Formula: see text]).

CONCLUSIONS

This novel smartphone application seems to be a promising and convenient alternative for patients who need to gain wrist motion without formal rehabilitation in the hospital. Adherence to the therapy is also easily traced with this application.

Endoscopic Single Approach Forearm Fasciotomy for Chronic Exertional Compartment Syndrome: Long Term Follow-up

BACKGROUND

Chronic exertional compartment syndrome of the forearm is an uncommon condition, occurring in some populations such as athletes. The standard surgical treatment for professional athletes who cannot avoid trigger activity is an open forearm fasciotomy, which may require a long recovery time. The aim of this study is to present a new endoscopic single approach forearm fasciotomy technique and outcomes of at least 3 years follow up.

METHODS

We performed the endoscopic single approach forearm fasciotomy in 4 forearms in 3 men with the mean age of 25 years. All of the patients were evaluated at a mean follow up of 46 months using the Visual Analog Scale (VAS) for pain and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

RESULTS

DASH improved from 21.71 to 5.39, VAS score improved too All the patients referred pain absence after the stress test performed at 20 kilos and 40 kilos. In our series no post-operative complications were observed.

CONCLUSIONS

The new mini-invasive technique has proved to be safe, reliable in a long-term follow-up. The main advantage is the shortening of the recovering time, that leads to a faster return to the professional activity.

A case report of multi-compartmental lipoma of the hand

This report shows a multi-compartmental lipoma that occupied a vast area of the hand volar compartment, the distal aspect of the Parona's space and infiltrated the dorsal compartment between the IV and V metacarpal bones. The mass was entirely removed through a dorsal approach, minimizing risks of neurovascular and tendinous lesions.

Arthroscopic Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis

Scaphoid-trapezium-trapezoid (STT) joint arthritis is a common condition consisting of pain on the radial side of the wrist and base of the thumb, swelling, and tenderness over the STT joint. Common symptoms are loss of grip strength and thumb function. There are several treatments, from symptomatic conservative treatment to surgical solutions, such as arthrodesis, arthroplasties, and prosthesis implant. The role of arthroscopy has grown and is probably the best treatment of this condition. Advantages of arthroscopic management of STT arthritis are faster recovery, better view of the joint during surgery, and possibility of creating less damage to the capsular and ligamentous structures.

Scaphotrapeziotrapezoid Joint Arthritis: A Pilot Study of Treatment with the Scaphoid Trapezium Pyrocarbon Implant

Isolated scaphotrapeziotrapezoid osteoarthritis is rare but can cause weakness and wrist pain. We present the results of a pilot study of interposition arthoplasty with a scaphoid trapezium pyrocarbon implant (STPI) by an open and arthroscopic approach for this problem. We performed this procedure in 10 hands in eight patients, all women, with a mean age of 60.5 (range 51–70) years. The average follow-up was 19 (range 2–24) months. Pre-operative X-rays in all cases identified an isolated degenerative arthritis of the scaphotrapeziotrapezoid joint. Average DASH evaluation pre-operatively of 49 was reduced to 39. All of the patients had functional improvement and returned to daily activities after 3 months. The results of this pilot study suggest that the STPI may prove a useful compromise treatment for this problem.

Arthroscopic Resection of Distal Pole of the Scaphoid for Scaphotrapeziotrapezoid Joint Arthritis: Comparison between Simple Resection and Implant Interposition

BACKGROUND

Isolated scaphotrapeziotrapezoid is a relatively rare condition, and there is still not complete consensus on the treatment of this pathology.

PURPOSE

The aim of the present study is to assess the utility of implant interposition after arthroscopic scaphoid distal pole resection for scaphotrapeziotrapezoid arthritis.

MATERIAL AND METHODS

The authors present a prospective study after the arthroscopic resection of the distal pole of the scaphoid in 24 patients. In a group of 11 patients, the simple resection was performed while in the other 13 patients the scaphoid resection and pyrocarbone implant interposition.

RESULTS

All patients were clinically evaluated with disability of arm, shoulder, hand score. Dorsal intercalated segment instability deformity was also measured from X-ray analysis. Grip and pinch strength were measured too, and patients were also given a visual analog scale questionnaire. Both clinical and radiographic assessments were done at 24 months postoperatively.

CONCLUSIONS

The study showed comparable results with both the techniques.

LEVEL OF EVIDENCE II

A prospective comparative study.

Hand Injury in Rock Climbing: Literature Review

With the amazing increasing in number of participants, rock climbing has become a popular sport in the last decade. A growing number of participants, with different skill level, inevitably leads to an increased number of injuries related to this practice. The kind of lesions that can be observed in rock-climbers is very specific and often involves the hand. For this reason is very important for any hand surgeon that is exposed to sport injuries to know which and the most common injuries related to this sport and which are the basic principles for the treatment of those. The aim of this article is to review the literature that has been published in the last ten year in this topic. On the NCBI database 22 articles where found that where related to rock climbing lesion affecting the hand or the whole body. Differences where found according to kind of rock climbing activity that was analyzed, alpine climb leads to more serious injuries, often affecting the lower limb, while in sport and recreational rock climbing the upper limb and the hand are definitely the most affected parts. Flexor pulley lesions, followed by fractures and strains are the most common lesions affecting the hand that are related to this practice.

Minimally invasive procedure for the stabilization of the painful "prearthritic" carpometacarpal joint of the thumb

The painful thumb carpometacarpal joint without arthritic changes with joint laxity is a common condition mainly affecting the female population in their early decades. Despite this, there is a lack of literature on the available treatment options. In the existing literature ligament reconstruction and extension osteotomy have both been described. In these methods the surgical trauma is quite extensive. In this paper, the authors document and present a new minimally invasive procedure for the treatment of this condition. Patients with painful and lax thumb carpometacarpal joint who did not benefit from conservative treatment underwent surgical treatment. The integrity of the cartilage was checked arthroscopically and it was considered an absolute indication to perform the technique consisting of stabilizing the space between the first and second metacarpal base with a suture button device. A standard postoperative protocol followed. No major complications occurred. According to preliminary experience and short-term follow-up results this technique is a comparatively safer, less invasive, and less aggressive procedure.

Single portal endoscopic treatment for chronic exertional compartment syndrome of the forearm

Chronic exertional compartment syndrome of the forearm is an unusual disease not commonly found in the daily practice of a hand surgeon. This condition is quite rare in the general population but occurs more frequently among musicians and athletes, with the highest incidence found in professional motorcycle drivers. It is mainly because of a critical augmentation of the extracellular pressure of the forearm compartments. The diagnosis is mainly clinical, based on stress dynamic tests and intracompartmental pressure measurements. Traditionally, the treatment of this disease has revolved around trigger activity suspension. In the case of professional athletes, this solution cannot be considered and thus the standard surgical treatment consists of an open forearm fasciotomy. This procedure usually requires a lengthy operation period and has a long recovery time before patients can resume their regular activity. Different surgical endoscopic solutions with mini-open techniques have been proposed to shorten this time and reduce the incision size. The aim of this study was to present a new technique for endoscopic-assisted fasciotomy of the forearm in chronic exertional compartment syndrome using a single mini-incision. Four surgical procedures were performed in 3 patients. They were all treated at our center for this condition, and in one case the disease was found on both sides.

THE SURGICAL TREATMENT OF THE FIRST CARPOMETACARPAL JOINT ARTHRITIS: EVALUATION OF 400 CONSECUTIVE PATIENTS TREATED BY SUSPENSION ARTHROPLASTY

Arthritis of the first carpometacarpal joint is a widespread disease in Western countries. It affects predominantly women with marked impairment in daily life activities. Its aetiopathogenesis is well described, while its treatment still controversial. The authors report their experience with 400 consecutive patients with established clinical and radiological findings of carpometacarpal joint arthritis treated by suspension arthroplasty with Ceruso's modified Weilby's technique. At 12 months follow-up, we were able to assess 315 patients using MAYO's score pre- and post-operatively, obtaining 86 excellent results, 134 good, 62 fair and 33 poor. As for complications, there were seven infections, 32 persistent pain and 42 limited range of motion. According to our experience the treatment modality of suspension arthroplasty with Ceruso's modified Weilby's technique represents the procedure of choice in indicated cases of first carpometacarpal joint arthritis in advanced stages according to Eaton-Littler classification.

ENDOSCOPIC CARPAL TUNNEL RELEASE: OUR EXPERIENCE WITH 12,702 CASES

Carpal tunnel syndrome (CTS) is still today the most common nerve entrapment syndrome at the level of the upper extremity. When surgery is indicated, the surgical treatment of choice is the opening of the retinaculum. The authors describe their experience on 12,702 carpal tunnel decompressions, by the endoscopic procedure in a period of 14 years, outlining the indications, post-operative treatment, complications and results.

A COMPARISON OF ENDOSCOPIC AND OPEN TRIGGER FINGER RELEASE

The main complaint of the patients after an open trigger finger release is a discomfort at the incision site. In this prospective study, we compared the two consecutive groups of patients with trigger fingers. One was treated by an open approach and the other by the endoscopic release of the A1 pulley. Pre- and post-operative evaluation at seven, 30 and 90 days showed a faster recovery from the discomfort with a faster return to daily and working activities, after the endoscopic procedure.

ARTHROSCOPIC ASSISTED BONE GRAFTING FOR EARLY STAGES OF KIENBÖCK'S DISEASE

Kienböck's disease is known for its difficulty in being diagnosed and treated at early stages; option treatments are few and most of them quite aggressive. The author describes his experience with arthroscopic assisted lunate bone grafting. Three patients with diagnosis of stage I avascular necrosis of the lunate (average age: 45 years), were treated. Before surgical procedure, the patients underwent to a conservative treatment. After harvesting the bone graft from the volar surface of the radius, arthroscopic bone grafting was performed.

At an average follow-up of 13.5 months (9–15), all the patients show a normal density of the lunate and no arthritic changes in radiographs. The MRI confirmed the lunate vascularity.

The number of patients is definitely small, due also to the rarity of the disease and the difficulty in diagnosis, but, despite the very high learning curve, could be the proper first choice of treatment.

[Comparison of two arthroscopic classifications for scapholunate instability]

The W. Geissler's and G. Dautel's arthroscopic classifications for scapholunate instability have been compared in a prospective, multicentric study. Physical, radiographic and arthroscopic data from 50 patients were reported by eight operators working in eight different institutions. Two questions were asked for each study case: Which classification seemed to be the more easy to use? Which classification seemed to give the best treatment algorithm? The good and bad points of each classification are presented. Neither of these two classifications is ideal, so the authors propose a classification incorporating the important points gleaned from the study. The proposed classification is simple, reproducible and precise, especially in terms of scapholunate ligament status.

Arthroscopic evaluation and treatment by tendon interpositional arthroplasty of first carpometacarpal joint arthritis

Basal joint arthritis of the thumb is usually seen in females beginning from the fourth and fifth decades. In the last two decades, arthroscopic techniques have brought new chances of diagnosis and treatment for this condition. In this paper, the authors describe the indications and their experience concerning arthroscopic hemitrapezectomy and tendon interposition using the palmaris longus tendon. A series of 16 patients with a maximum follow-up of 12 months is analysed. All of the 16 patients were followed and assessed with grasp strength, pinch strength, DASH and MAYO evaluation score both pre- and post-operatively at 12 months follow-up. According to the MAYO score, there were six excellent results, six good, three fair and one poor. No complications occurred. According to our preliminary results, this procedure with the proper indications gives a valid option for the treatment of thumb carpometacarpal joint arthritis in stages I and II according to Eaton's classification.

Long-term follow-up of a malunited, isolated fracture of the capitate in a 6-year-old boy

A 6-year-old boy with an isolated fracture of the capitate was presented. First radiograghs at our clinic revealed an oblique fracture with a displacement of 5 mm on the lateral view, which we successfully treated with immobilization. When complete union was recognized in the radiographs, the capitate had a deformity consisting of a large prominence on the palmar aspect. During follow-up, the capitate showed marked remodeling and at four and a half years after injury it had regained an almost normal shape. Eleven years after injury, there were no radiographic changes such as malalignment or arthrosis in the carpal bones.

The Ishiguro extension block technique for the treatment of mallet finger fracture: indications and clinical results

The results of extension block Kirschner wire fixation for the treatment of mallet fractures of the distal phalanx were retrospectively assessed in 65 consecutive patients. The indications for this technique were the presence of a large bone fragment, and palmar subluxation or the loss of joint congruity of the distal interphalangeal joint. Using the Wehbé and Scheider classification there were 27 type IB, 19 type IIB, 17 type IA, and 2 type IIA fractures. According to the Crawford rating system there were 46% excellent, 32% good, 20% fair and 2% poor results. We believe that this technique, when properly applied, produces satisfactory results.

The TACK knee prosthesis. Analysis of a uniform case series

We implanted the total arthroplasty knee or TACK prosthesis in 40 patients with degenerative osteoarthritis. We used the same surgical technique in all patients. Full extension and flexion more than 90 degrees were achieved in all 40 knees. All patients obtained a HSS score of more than 88 points. The results confirm that the TACK prosthesis provides excellent results in patients with degenerative osteoarthritis if there is no significant bone loss, serious ligament laxity or extensive deformation.