Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions.

The diagnosis of thoracic outlet syndrome (TOS) has long been a controversial and challenging one. Despite common presentations with pain in the neck and upper extremity, there are a host of presenting patterns that can vary within and between the subdivisions of neurogenic, venous, and arterial TOS. Furthermore, there is a plethora of differential diagnoses, from peripheral compressive neuropathies, to intrinsic shoulder pathologies, to pathologies at the cervical spine.

Low-intensity pulsed ultrasound treatment as an alternative to vascular bone graft surgery for a 5-year-long ulnar non-union in a patient with haemochromatosis.

We present the case of a 75-year-old woman with haemochromatosis who developed a 5-year-long right ulnar non-union after a shortening osteotomy to correct a malunited Colles' fracture. Standard surgical treatment for ulnar non-unions was attempted on 19 March 2008 and again on 20 April 2009, but the non-union persisted on 8 May 2012, as confirmed by CT scan. Vascular bone grafting and refixation was then considered, but the patient declined this extensive operation, instead choosing to try non-invasive low-intensity pulsed ultrasound treatment with an Exogen device.

Treatment for thoracic outlet syndrome.

Background: Thoracic outlet syndrome (TOS) is one of the most controversial diagnoses in clinical medicine. Despite many reports of operative and non-operative interventions, rigorous scientific investigation of this syndrome leading to evidence-based management is lacking. This is the first update of a review first published in 2010.

Steroid injection for shoulder pain causes prolonged increased glucose level in type 1 diabetics.

Shoulder pain is very common in diabetic patients and often treated with steroid injections, with subsequent increases in blood glucose levels or the need for additional insulin being questioned. We report a case of significant and prolonged elevation of blood glucose levels and resultant insulin requirement in a type 1 diabetic man after a single 40 mg injection of triamcinolone for shoulder pain. Within 48 h, the shoulder pain as assessed by a visual analogue scale (0-10) was reduced to zero, but the elevated insulin requirements continued for 4 weeks after the injection.

What is the better treatment for single digit dupuytren's contracture: surgical release or collagenase clostridium histolyticum (Xiapex) injection?

Unlabelled: The purpose of this study was to compare the initial and final outcome range of motion in the MCP-J and PIP-J of single digit Dupuytren's Contracture treated with either open surgical excision or manipulation after collagenase clostridium histolyticum (CCH; Xiapex) injection.

Material: Ten patients in either group. The range of motion measurements were statistically compared using the student t-test with a p-value of 0.

Resource utilisation associated with single digit Dupuytren's contracture treated with either surgery or injection of collagenase Clostridium histolyticum.

Unlabelled: The gold standard treatment for Dupuytren's contracture is surgical excision of the cord. A non-surgical treatment with collagenase clostridium histolyticum injection is available but appears costly.

Objectives: To provide data on resource consumption related to surgical and non-surgical treatment for Dupuytren's contracture.

Acute double flexor tendon ruptures following injection of collagenase clostridium histolyticum (Xiapex) for Dupuytren's contracture.

We report a case of acute (24 h) double flexor tendon rupture of the little finger after a single injection of collagenase clostridium histolyticum into a palmar Dupuytren's contracture cord which caused metacarpophalangeal joint contracture. Tendon surgery was performed 48 h postinjury with primary repair and standard rehabilitation but it resulted in poor active flexion due to adhesions. Previous papers have suggested that a needle inserted into the flexor tendon can be detected prior to the injection of collagenase by asking the patient to actively move the finger, but our test on an awake patient showed that when a 27-gauge needle was inserted into the flexor tendons through a thick palmar cord, the syringe did not move significantly when the patient moved the finger, and therefore this test does not minimise the risk of iatrogenic tendon injury when using collagenase (Xiapex) for Dupuytren's contracture.

Long-term result and patient reported outcome of wrist splint treatment for carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the commonest peripheral neuropathy presenting to specialist hand and wrist clinics. This study investigated the long-term outcome of carpal tunnel syndrome treated with isolated night wrist splint and the factors determining the likelihood of success of this intervention. Seventy-five patients referred to a specialist hand clinic with CTS were given night wrist splint treatment for 3 months as per a previous study protocol.

Is typing speed proportional to the severity of pain in keyboard workers with work-related upper limb disorder.

Objectives: To investigate if typing speed is proportional to the severity of pain in keyboard workers with work-related upper limb disorder (WRULD).

Design: Standardized functional typing test with participants scoring pain before and after typing; calculation of typing speed.

Participants: Fifty-nine patients and six controls.

Physical rehabilitation with ergonomic intervention of currently working keyboard operators with nonspecific/type II work-related upper limb disorder: a prospective study.

Objective: To evaluate the effect of a physical training program in combination with ergonomic changes in a group of keyboard operators with nonspecific/type II work-related upper limb disorder (WRULD).

Design: Prospective study.

Setting: Hospital department.

Low typing endurance in keyboard workers with work-related upper limb disorder.

Objective: To compare results of typing endurance and pain before and after a standardized functional test.

Design: A standardized previously published typing test on a standard QWERTY keyboard.

Setting: An outpatient hospital environment.

High incidence of absent nerve conduction in older patients with bilateral carpal tunnel syndrome.

Introduction: Carpal tunnel syndrome has been reported by some to have a less satisfactory outcome in older patients following surgery. However, this impression is not supported by other investigators but no objective explanation has been suggested for these differences. In our department, such patients are routinely treated with night wrist splints and, if this is unsatisfactory, they are investigated with nerve conduction studies prior to surgery.

Outcome of late presentation of injuries of the volar plate of the proximal interphalangeal joint.

Early recognition and treatment of volar plate injuries within two weeks is reported to give a good outcome, but there is no published information about the consequences of delayed presentation. We present a series of 14 patients with 16 injuries, who presented more than two weeks after the initial injury. All patients were referred to a specialist hand trauma clinic over a 10 months period and were evaluated prospectively and treated with immediate mobilisation by a specialist hand therapist.

Treatment for thoracic outlet syndrome.

Background: Thoracic outlet syndrome (TOS) is one of the most controversial clinical entities in medicine. Despite many reports of operative and non-operative interventions, rigorous scientific investigation of this syndrome leading to evidence based management is lacking.

Objectives: To evaluate the beneficial and adverse effects of the available operative and non-operative interventions for the treatment of thoracic outlet syndrome.

Managing type II work-related upper limb disorders in keyboard and mouse users who remain at work: a case series report.

Work-related upper limb disorders (WRULDs) are difficult to diagnose due to the limited availability of recognized objective assessment methods. This case series report demonstrates the use of the "typing capacity cycle" test and standardized clinical tests as outcome measures to assess work capacity in four high-intensity keyboard and mouse users who remain at work before and after the implementation of a six-month treatment program. Pain intensity, the duration of pain before treatment, the duration of treatment, type of work, and the location of the pain were recorded for each patient.

Functional evaluation of regenerated and misrouted low threshold mechanoreceptors and polymodal nociceptors in the skin of rat hindfeet after crush lesions to the sciatic nerve.

Tracer studies on motor axons after nerve crush injuries have indicated that misrouting may occur even when the endoneurium is intact. Misrouting of regenerated polymodal nociceptive C-fibres and low threshold mechanoreceptive axons have been studied functionally in 50 rats three months after unilateral crush lesions to the sciatic nerve. Two weeks before evaluation the tibial fascicle (or the peroneal fascicle) above the lesion was cut and tied off.

Outcome of surgery in patients with painful dorsal wrist ganglia and arthroscopic confirmed ligament injury: a five-year follow-up.

We report the outcome of a five-year follow-up after wrist arthroscopy and excision of painful dorsal wrist ganglia. The findings at the time of surgery have previously been published. Patients responded to a validated postal questionnaire regarding ganglion recurrence, wrist pain and function.

Primary repair of a flexor tendon after a human bite.

Successful uncomplicated primary closure of a human bite injury of the hand with simultaneous zone II flexor tendon injury has not been previously reported to our knowledge. We report the case of a man who was bitten on his left ring and right middle and index fingers. He was treated with antiseptic lavage, intravenous antibiotics, and operation.