Search

Purpose To determine whether median nerve dysfunction measured by electrophysiologic studies in carpal tunnel syndrome (CTS) is associated with thumb trapeziometacarpal (TMC) joint instability. Methods We evaluated 71 women with CTS and 31 asymptomatic control women. Patients with generalized laxity or TMC joint osteoarthritis were excluded. We classified the electrophysiologic severity of CTS based on nerve conduction time and amplitude and assessed radiographic instability of the TMC joint based on TMC joint stress radiographs. We compared subluxation ratio between patients with CTS and controls and performed correlation analysis of the relationship between the electrophysiologic grade and subluxation ratio. Results Thirty-one patients were categorized into the mild CTS subgroup and 41 into the severe CTS subgroup. There was no significant difference in subluxation ratio between the control group and CTS patients or between the control group and CTS subgroup patients. Furthermore, there was no significant correlation between electrophysiologic grade and subluxation ratio. Conclusions This study demonstrated that patients with CTS did not have greater radiographic TMC joint instability compared with controls, and suggests that TMC joint stability is not affected by impaired median nerve function. Further studies could investigate how to better evaluate proprioceptive function of TMC joint and whether other nerves have effects on TMC joint motor/proprioceptive function, to elucidate the relationship between neuromuscular control of the TMC joint, its stability, and its progression to osteoarthritis. Type of study/level of evidence Diagnostic II. [ABSTRACT FROM AUTHOR]

Summary Background and aim The purpose of this study was to evaluate the anatomical constancy of the direct small branches of the proper digital nerve. Methods A total of 208 digital nerves of the index, long, ring, and little fingers from 13 cadavers were studied. For each digital nerve, the number of direct small branches was counted at the proximal and middle phalanx levels. In addition, the diameter of these branches was measured at the level of the branch bifurcation. We also measured the diameter of the proper digital nerve at the level of the distal interphalangeal (DIP) joint. Results The direct small branches of the proper digital nerve were anatomically constant among the index, long, and ring fingers. The average number of direct small branches was 2.7 at the proximal phalanx level and 2.3 at the middle phalanx level. At the level of the DIP joint, the average thickness of the proper digital nerve was 0.85 mm in the index finger, 0.84 mm in the long finger, 0.72 mm in the ring finger, and 0.49 mm in the little finger. Conclusion In this study, we verified the anatomical constancy of the direct small branches of the proper digital nerve. The size of these branches at the proximal phalanx level was similar to that of the corresponding proper digital nerve at the level of the DIP joint. Therefore, these nerve branches at the proximal phalanx could be applied to the creation of various sensate flaps for the reconstruction of the fingertip injuries. [ABSTRACT FROM AUTHOR]

Background: Research suggests that phrases with negative content can affect patients' response to medical procedures and how they cope with medical illnesses. We hypothesized that patients with lateral epicondylitis who describe their condition in positive phrases cope better than those who do not. Methods: We prospectively followed up 91 patients with lateral epicondylitis for 12 months. The patients indicated their baseline coping status based on the Pain Catastrophizing Scale (PCS) and were discharged with a wait-and-see policy. During follow-up interviews, the patients described the nature of their condition in their own words and were then categorized into either positive or negative phrasing groups. We compared these two groups regarding current coping status and whether they had sought additional treatment. We also analyzed for the factors associated with these outcomes. Results: There were no significant differences in baseline PCS scores between the two groups. At follow-up, patients in the positive phrasing group (n = 62) had significantly lower PCS scores and were less likely to seek additional treatment than those in the negative phrasing group (n = 29). Multivariable analyses showed that positive phrasing and low pain levels were independently associated with improvement in PCS scores and that negative phrasing and depression were independently associated with patients' seeking additional treatment. Conclusion: Patients' positive phrasing about their condition are associated with improvement in their coping status and with less use of medical resources in the case of lateral epicondylitis. This study suggests that patients with more positive attitudes toward their illness cope and comply better when a wait-and-see treatment is recommended by their physicians. [Copyright &y& Elsevier]

Purpose: To investigate whether patient-reported outcomes are different according to patients' preference or experience in surgical decision making for carpal tunnel release. Methods: We preoperatively surveyed 85 patients who underwent carpal tunnel release regarding their preferred role in the process of surgical decision making and assessed their experienced role in the actual decision making 6 months after surgery using a Control Preference Scale. For patient-reported surgical outcomes, we used the Disabilities of the Arm, Shoulder, and Hand questionnaire. We compared these outcomes with those of patients having different preferences or experiences in surgical decision making and also compared the outcomes according to whether the preferred roles match the experienced roles. Results: The Disabilities of the Arm, Shoulder, and Hand scores were not significantly different between patients with different preferences for involvement in decision making for surgery or between those with different experiences in the actual decision making. However, those who experienced the same level of involvement as they had preferred were found to have better Disabilities of the Arm, Shoulder, and Hand scores than those who experienced a more active role or a more passive role than they had preferred. Conclusions: This study demonstrates that patient-reported outcomes were not different between those with different preferences or experiences in surgical decision making for carpal tunnel release. However, this study suggests that patients whose experience in decision making matched with their preference may have better subjective outcomes after carpal tunnel release. This suggests that patients with carpal tunnel syndrome may benefit from physicians' efforts of identifying patients' preferences for involvement in decision making and matching the identified preferences to the decision-making process. Type of study/level of evidence: Prognostic II. [Copyright &y& Elsevier]

Purpose: Open carpal tunnel decompression under local anesthesia is routinely done by many surgeons. However, patients complain of pain during the injection of local anesthesia. This prospective, double-blind, randomized study was to compare the pain visual analog scale (VAS) scores of local anesthesia using lidocaine with and without sodium bicarbonate in patients with bilateral carpal tunnel syndrome. Methods: Twenty-five patients underwent bilateral simultaneous carpal tunnel decompression. All had topical anesthetic cream applied on the palm and wrist before the lidocaine block. In a randomized manner, half of the hands were blocked with nonbuffered lidocaine and half were blocked with buffered lidocaine. Pain was evaluated on a VAS score. Results: The mean pain VAS score in the hand with buffered lidocaine was 4.6 ± 1.5 and 6.5 ± 1.5 for the hand with nonbuffered lidocaine. After adjustment for individual threshold of the pain, the mean pain VAS score changed into 4.6 ± 1.3 with buffered lidocaine and 6.6 ± 1.7 without buffered lidocaine. Conclusions: In open carpal tunnel surgery, the use of buffered lidocaine for local anesthesia reduces the anesthetic pain effectively. Type of study/level of evidence: Therapeutic I. [ABSTRACT FROM AUTHOR]

Purpose: Neurogenic thoracic outlet syndrome (NTOS) is produced by compression of the brachial plexus in the thoracic outlet. The lower position of the shoulder girdle relative to the upper thorax may be related to NTOS. We investigated this hypothesis using plain cervical radiographs. Methods: We conducted this case-control study using plain cervical anteroposterior and lateral radiographs in 63 NTOS patients and 126 carpal tunnel syndrome patients who were matched for age and sex. To estimate the position of the shoulder girdle relative to the upper thorax, we analyzed the level of the clavicle using 2 parameters: the number of vertebrae visible in a lateral radiograph and the number of vertebrae above the line connecting both sternal ends of the clavicles in an anteroposterior radiograph. The number of vertebrae visible in a lateral radiograph was the parameter for the level of the lateral part of the clavicle relative to the upper thorax, whereas we used the number of vertebrae above the line connecting both sternal ends of the clavicles in an anteroposterior radiograph to determine the level of the medial part of the clavicle. Results: Both parameters were greater in the NTOS group than in the control group, which suggests that the level of the shoulder girdle was lower in the NTOS group than in the control group. In addition, the risk of NTOS was increased in patients with lower shoulder girdle position. Conclusions: The lower placement of the shoulder girdle relative to the upper thorax was related to NTOS. Physicians may be able to estimate the position of the shoulder girdle using plain cervical radiographs when NTOS is clinically suspected. Type of study/level of evidence: Diagnostic IV. [ABSTRACT FROM AUTHOR]

Purpose: To test the hypothesis that division of muscle fibers lying over or within the transverse carpal ligament (TCL) in an open carpal tunnel release does not have an effect on outcomes in patients with carpal tunnel syndrome (CTS). Methods: A total of 152 patients with a mean age of 57 years (range, 31–83 y) diagnosed with CTS were enrolled for intraoperative observation of the muscles overlying or within the TCL as seen through a 3-cm incision. These muscles when present were incised layer by layer in line with division of the TCL. Patients were divided into 3 groups according to the extent of the muscles covering the TCL. We compared the 3 groups for outcomes of surgery at 6 months in terms of the Boston and Disabilities of the Arm, Shoulder, and Hand (DASH) scores, grip and pinch powers, and scar pain. Results: Of the 152 patients, 75 had a purely ligamentous TCL (group 1), 52 had muscle fibers covering 50% or less of the incision length (group 2), and 25 had muscle fibers covering more than 50% of the incision length (group 3). There were no differences in the postoperative Boston symptom and function scores and the DASH scores among the groups. In addition, there were no differences in the grip and pinch strengths and scar pain. Conclusions: Division of the muscles overlying or within the TCL in line with the third web space incision does not affect postoperative outcomes after carpal tunnel release in terms of the Boston and DASH scores, grip and pinch powers, and scar pain. Type of study/level of evidence: Prognostic I. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have investigated the effectiveness of early postoperative pain control regimens after volar plating for distal radius fractures. This study evaluated postoperative levels of pain after volar plating of distal radius fractures under axillary nerve block in patients with and without injections of local anesthetics, narcotics, and epinephrine around the fracture site. Methods: Perioperative pain levels were prospectively assessed in 44 consecutive patients who had had volar plating for a distal radius fracture under axillary nerve block at a mean time of 2.8 days after trauma. Intravenous, patient-controlled analgesia and prescheduled analgesic medications were administered to all patients. In addition, patients were randomly allocated to 2 groups: perifracture site injection (PI; n = 22) and no perifracture site injection (no-PI; n = 22). At the end of surgery, PI group patients were administered perifracture site injections and blocks of the superficial radial and interosseous nerves with a local anesthetic mixture consisting of ropivacaine, morphine, and epinephrine. During the first 48 hours after surgery, pain visual analog scale (VAS) scores (0 to 100), total amount of narcotic consumption, incidences of additional narcotic requirement, and opioid-related side effects were assessed. Results: The overall mean pain VAS scores among all 44 study subjects were 29 before surgery, and 58, 47, 40, and 27 at 4, 8, 24, and 48 hours after surgery, respectively. Thirteen patients needed additional pain rescue despite the multimodal analgesic approach used. No intergroup differences were observed between the PI and no-PI groups in terms of VAS pain scores, total narcotic consumption, adjuvant pain rescue incidence, and opioid-related side effects. Conclusions: Postoperative mean pain VAS scores after volar plating of distal radius fractures were found to be 58 at 4 hours and 47 at 8 hours. Perifracture site injections were not found to provide any additional pain control benefit. Type of study/level of evidence: Therapeutic II. [Copyright &y& Elsevier]

Purpose: To present the effectiveness of passive stretching as a treatment for camptodactyly, without any other form of physiotherapy or splinting. Methods: From May 2003 to August 2008, 61 digits of 22 patients were treated conservatively using passive stretching exercises. All children were less than 3 years old and had no other anomalies. Flexion contractures before and after treatment in mild, moderate, and severe groups were measured and changes were analyzed statistically. The correlations between various clinical factors and treatment outcome were also analyzed statistically. The average follow-up period was 26 months (range, 12–47 mo). Results: Mean flexion contracture improved from 20° to 1° in the mild group (p < .001), from 39° to 12° in the moderate group (p < .001), and from 75° to 28° in the severe group (p < .001). Of the clinical factors examined, only initial flexion contracture was found to be significantly correlated with treatment outcome (r = −0.287, p = .0025). Conclusions: Passive stretching can effectively improve flexion deformity in camptodactyly in infants and young children. Type of study/level of evidence: Therapeutic IV. [Copyright &y& Elsevier]

Purpose: Most epidemiologic studies on carpal tunnel syndrome (CTS) have been performed on specific regional or occupational groups, or on general populations in the West. The authors undertook to determine the incidence of clinically diagnosed and surgically treated CTS in the Korean general population. Methods: A retrospective, nationwide cohort study was performed using data collected from 2005 to 2007 (inclusive) by the Korean Health Insurance Review Agency, which covers 97% of the population. We analyzed the incidence of clinically diagnosed, electrophysiologically diagnosed, and surgically treated CTS in patients aged over 20 years, and the influences of gender and age on incidence. Results: The incidence of total clinically diagnosed CTS and electrophysiologically diagnosed CTS in patients over 20 years of age was 4.96 and 0.98 per 1,000 person-years, respectively. The incidence of surgically treated CTS was 0.29 per 1,000 person-years. The age-adjusted female to male incidence ratio of diagnosed CTS was 2.58 (95% confidence interval, 2.56–2.59) and that of surgically treated CTS was 5.82 (95% CI, 5.64–6.00). Women aged 50 to 59 years had the highest incidence of CTS (18.11 per 1,000 person-years), whereas men showed a slow increase in incidence with age, highest at 60 to 69 years. Conclusions: Compared with Western studies, our study of the Korean population shows a similar incidence of CTS but a lower incidence of surgery. Korean women with CTS are more likely to be treated surgically than men. Further studies may be warranted to identify ethnic, gender, and socioeconomic factors that influence surgical treatment rates. [ABSTRACT FROM AUTHOR]