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Purpose Advanced-stage trapeziometacarpal (TMC) osteoarthritis of the thumb often presents with concomitant hyperextension deformity of the metacarpophalangeal (MCP) joint. Although several studies have reported simultaneous procedures to correct this deformity, the indication for these procedures remains controversial. The purpose of this study was to evaluate changes in the range of motion (ROM) of the thumb MCP joint before and after TMC arthrodesis . Methods We evaluated the functional flexion and extension and functional ROM of the MCP joints during the performance of 10 activities of daily living tasks before and after TMC arthrodesis in 10 thumbs of 9 patients with Eaton stage III TMC osteoarthritis and hyperextension deformity of the MCP joint. Results The mean functional flexion of the MCP joint increased from 26° to 38°, and the mean functional extension of the MCP joint decreased from 16° to 5° of hyperextension. There was no change in the mean total arc of functional ROM of the MCP joint. Conclusions The MCP joint motion shifted from extension to flexion after TMC arthrodesis, and the total arc of functional ROM of the MCP joint was similar before and after arthrodesis. Type of study/level of evidence Therapeutic V

Purpose To identify risk factors for tendon attrition after volar locking plate fixation of distal radius fractures. Methods We prospectively assessed attrition of the flexor pollicis longus tendon at volar plate removal in 127 hands in 126 patients. We also evaluated preoperative lateral wrist radiographs, sonographs, and crepitus with flexor pollicis longus tendon motion and compared the demographic and radiographic characteristics of patients with and without tendon attrition. Multivariate logistic regression analysis was employed to identify the factors independently associated with tendon attrition. Results We found 12 cases of tendon attrition (10%) and 1 that presented with tendon rupture in our cohort. Crepitus was recognized in 14 patients (11%): 6 cases (50%) were among the 12 hands in 12 patients with tendon attrition whereas 8 (7%) were detected in the remaining 114 hands in 113 patients. Logistic regression examination revealed that audible crepitus and volar placement of the plate in lateral radiographs were independent predictors of tendon attrition. Conclusions Crepitus and volar placement of hardware in lateral radiographs were independent risk factors for flexor tendon attrition after volar plating for distal radius fracture. These results may facilitate surgical decisions regarding early plate removal to prevent possible tendon rupture. Type of study/level of evidence Diagnostic II.

Purpose Imaging criteria for diagnosing compressive ulnar neuropathy at the elbow (UNE) have recently been established as the maximum ulnar nerve cross-sectional area (UNCSA) upon magnetic resonance imaging (MRI) and/or ultrasonography (US). However, the levels of maximum UNCSA and diagnostic cutoff values have not yet been established. We therefore analyzed UNCSA by MRI and US in patients with UNE and in controls. Methods We measured UNCSA at 7 levels in 30 patients with UNE and 28 controls by MRI and at 15 levels in 12 patients with UNE and 24 controls by US. We compared UNCSA as determined by MRI or US and determined optimal diagnostic cutoff values based on receiver operating characteristic curve analysis. Results The UNCSA was significantly larger in the UNE group than in controls at 3, 2, 1, and 0 cm proximal and 1, 2, and 3 cm distal to the medial epicondyle for both modalities. The UNCSA was maximal at 1 cm proximal to the medial epicondyle for MRI (16.1 ± 3.5 mm 2 ) as well as for US (17 ± 7 mm 2 ). A cutoff value of 11.0 mm 2 for MRI and US was found to be optimal for differentiating between patients with UNE and controls, with an area under the receiver operating characteristic curve of 0.95 for MRI and 0.96 for US. The UNCSA measured by MRI was not significantly different from that by US. Intra-rater and interrater reliabilities for UNCSA were all greater than 0.77. The UNCSA in the severe nerve dysfunction group of 18 patients was significantly larger than that in the mild nerve dysfunction group of 12 patients. Conclusions By measuring UNCSA with MRI or US at 1 cm proximal to the ME, patients with and without UNE could be discriminated at a cutoff threshold of 11.0 mm 2 with high sensitivity, specificity, and reliability. Type of study/level of evidence Diagnostic III.

Nine fresh-frozen normal human cadaveric long fingers were used to compare the kinematics of the proximal interphalangeal joint (PIP) before and after a resurfacing metal-polyethylene prosthetic replacement (Avanta prosthesis, San Diego, CA) using the magnetic Isotrak system (Polhemus Navigational Systems, Colchester, VT). The kinematics of the PIP joint after replacement were similar to that of the normal joint. The maximum angular displacement was 5° for lateral deviation and 9° for rotation during the passive flexion and extension motion. The center of rotation after implant insertion was nearly identical to the center of rotation of the normal joint. This anatomically designed PIP prosthesis has potential to restore normal motion to the finger PIP joint while resisting physiologic out-of-plane forces such as pinch and grasp. (J Hand Surg 2000;25A:305–312. Copyright © 2000 by the American Society for Surgery of the Hand.)

A biomechanical analysis of the trapeziometacarpal joint was performed in 7 fresh-frozen normal human cadaveric hands to compare the kinematics of the trapeziometacarpal joint before and after surface total joint replacement. Using a 3-space magnetic Isotrak system (Polhemus, Colchester, VT), which provides a 3-dimensional analysis of motion of joints as well as translation, we found that kinematics and stability of the trapeziometacarpal joint could be duplicated by joint surface replacement arthroplasty provided that normal ligament tensions were present.

We present a case of snapping dislocation of the flexor digitorum superficialis tendon to the small finger over the hook of the hamate that was noted after carpal tunnel release and trigger digit release.

Purpose Because pediatric trigger finger is much less common than pediatric trigger thumb, there is no consensus on the efficacy of splinting, owing to both the rarity of the condition and a lack of natural history and comparative therapeutic data. We performed the present retrospective study on 47 fingers to compare pediatric trigger finger treatment by splinting and nonsplinting. Methods We included 24 children with a total of 47 trigger fingers. Affected fingers included 4 index, 28 middle, 11 ring, and 4 little fingers. Patient age at initial examination ranged from 1 month to 9 years (mean, 2 y). We observed 24 fingers treated with a static splint and 23 fingers treated without it. The time from initial examination to follow-up ranged from 2 to 18 years. Results In the splinting group, 16 fingers (67%) resolved, 4 fingers (17%) improved, and 4 fingers (17%) remained unchanged. Seven fingers (29%) ultimately required surgery. In the nonsplinting group, 7 fingers (30%) resolved spontaneously, 1 (4%) improved, and 15 (65%) remained unchanged. Fifteen fingers (65%) later underwent surgical release. The rate of resolution in the splinting group was significantly higher than that in the nonsplinting group. The proportion of fingers needing surgical treatment in the splinting group was significantly lower than that in the nonsplinting group. Conclusions For treatment of pediatric trigger finger, it is advisable to fit a static splint at the first visit. Type of study/level of evidence Therapeutic IV.

We report a rare case of snapping in the dorsal wrist that was caused by extensor carpi radialis longus tenosynovitis occurring after rupture of the muscle in the middle forearm. After resection of the tendon at the wrist, the snapping disappeared.

Calcium pyrophosphate dihydrate crystal deposition disease can cause extra-articular pathology including nerve compression syndrome. We report a rare case of this complication in a 79-year-old woman.

This study provides additional radiographic information concerning the long-term effect of ulnar impingement. Films of 198 wrists of 102 patients with vibration disease observed over ten or more years were reviewed. All the wrists showed ulnar plus variance of more than 0 mm except seven. Degenerative changes were found in 58 wrists and were seen only on the ulnar side of the wrist, especially in the ulnoproximal area of the lunate. Most of the degenerative changes in the wrists with ulnar plus variance had progressed or changed during the ten or more years. Ulnar plus variance may play an important role in inducing or causing progression of degenerative change in the wrist.