Carpal tunnel syndrome--can it be a work related condition?

Background: Carpal tunnel syndrome is one of the most common hand conditions seen in clinical practice. Many in the workforce, both male and female, will develop carpal tunnel syndrome and many will claim that their workplace has caused their condition.

Objective: This article seeks to guide the examining practitioner in answering the questions of patients and insurance companies as to whether a patient with the established diagnosis of carpal tunnel syndrome has an acceptable workers' compensation claim for treatment.

Chondrosarcoma of thumb metacarpal--a case report with literature review.

Function preserving management of a dominant thumb metacarpal chondrosarcoma is reported, with a literature review for this uncommon neoplasm. Wide local excision of the metacarpal followed by temporary silicone block interposition and definitive iliac crest bone grafting was performed. A persistent wound defect was managed by a radial artery forearm flap.

The symptomatic carpal boss. Is simple excision enough?

We reviewed 48 patients with symptomatic carpal boss seen during the 10 year period 1985-1994. Thirty-one patients had undergone either local excision of the boss or arthrodesis of the affected carpometacarpal joint. The mean follow-up was 3 years and nine cases have been revised.

Diagnostic ultrasound of the hand and wrist.

To assess the efficacy, role, and limitations of diagnostic ultrasound in the hand and wrist, the results of 98 examinations performed for a variety of surgical conditions were retrospectively analyzed. Ultrasound was shown to be reliable in evaluating radiolucent foreign body, tendon rupture versus tendon adhesion, tendinitis, peritendinitis, and ganglion cyst (specificity, 1; positive predictive value, 1). A correct suggestion of soft tissue mass histology was offered in six of eight operated cases.

Complications following surgical treatment for Dupuytren's contracture.

Dupuytren's disease is a proliferative fibroplasia that can lead to a significant contracture of the metacarpophalangeal (MCP) and interphalangeal (IP) joints, causing a functional disability. Surgical excision of the Dupuytren's tissue and release of the contracted joints may be necessary to restore function. Most patients require hand therapy postoperatively.

Biomechanical explanation of a simultaneous closed rupture of both flexor tendons in the same digit.

Closed ruptures of both normal flexor tendons in the same finger are extremely rare, only nine cases having been reported in the literature. The authors describe the case of a patient who sustained a closed rupture of both flexor digitorum profundus and flexor digitorum superficialis of the ring finger, following a forced hyperextension injury. The present paper highlights the importance of the mechanism of injury and explains biomechanical basis.

Post-traumatic triggering of extensor pollicis longus at the dorsal radial tubercle.

A case of post-traumatic triggering of the tendon of extensor pollicis longus around Lister's tubercle is described. This condition was successfully treated by surgical release.

Risk and complications in endoscopic carpal tunnel release.

Single portal endoscopic carpal tunnel release was carried out in 107 hands of 88 patients. There were 11 complications. These included incomplete release (2), post operative scarring around the median and ulnar nerves (2), laceration of the superficial palmar arterial arch (1), reflex sympathetic dystrophy (2), palmar fasciitis (1), and wound inflammation (3).

Silicone synovitis. A perspective.

Silicone implant arthroplasty is, arguably, the most effective treatment for the majority of patients with symptomatic arthritis in the hand and wrist. In 1985 the problem of silicone synovitis was first brought to our attention. Since that time there have been numerous reports on this condition leading to a worldwide trend against the use of silicone implants.

Revision procedures for complications of surgery for osteoarthritis of the carpometacarpal joint of the thumb.

Between the years 1980 to 1987, 17 patients had revision procedures for complications of surgery for osteoarthritis of the carpometacarpal joint of the thumb. 12 followed silastic implant arthroplasty, four trapeziectomy and one arthrodesis. The failed silastic arthroplasties were treated by removal of the implant, and soft tissue arthroplasty in eight, revision with another implant in three and intermetacarpal bone grafting in one.

Surgical management of arthritis of the carpo-metacarpal joint of the thumb.

In the years 1970-90, 118 procedures were performed on 100 patients with arthritis (osteoarthritis in all but 13) of the carpo-metacarpal joint of the thumb. The patients were aged 17 to 83 years (mean 54.5 years); 75 were females and 25 males; there were 73 right and 45 left hands; 18 patients had bilateral procedures.

Closed rupture of both flexor tendons in the same digit.

Closed ruptures of both normal flexor tendons in the same finger are extremely rare, only nine cases having been reported in the literature. We describe the case of a patient who sustained a closed rupture of both flexor digitorum profundus and flexor digitorum superficialis of the ring finger, following a forced hyperextension injury. The patient was treated by a two stage reconstruction of the flexor digitorum profundus.

Iatrogenic injection injuries of the hand and upper limb.

30 cases of iatrogenic injection injuries to the hand and upper limb are reported. 16 followed therapeutic injections (steroids--11 cases, infusions--five cases) and 14 occurred during anaesthetics procedures (local blocks--ten cases, general anaesthetics--four cases). Guidelines for minimizing the risk of injection injury are outlined.

Fracture of the proximal phalanx. An unusual complication of pulley reconstruction in a child.

We report a case of a fracture occurring in the proximal phalanx of a child following pulley reconstruction. The operative technique and the difficulties of pulley reconstruction in the immature skeleton are discussed.

Silastic implant arthroplasty for post-traumatic stiffness of the finger joints.

In the years 1981 to 1987, 50 patients had 59 replacements of the finger joints. Of these, 41 patients with 49 joint operations were reviewed, with follow-up ranging from two to eight years (average 32 months). About 80% of these patients were satisfied that silastic implant arthroplasty had relieved their pain and stiffness and improved function of the finger and hand.

Pitfalls in carpal tunnel decompression.

In the period 1972 to 1977, 35 patients with persistent pain and other disabilities after carpal tunnel decompression were referred for treatment. The pitfalls included: (i) wrong diagnosis--5 patients; (ii) inadequate decompression--9 patients; (iii) recurrent compression--4 patients; (iv) iatrogenic nerve injury--7 patients; and (v) postoperative complications--10 patients. The patients in Groups 1 and 5 were treated by non-operative measures.

Anaerobic metabolism and wound healing: an hypothesis for the initiation and cessation of collagen synthesis in wounds.

The implanted cylinder model was used to measure LDH activity and lactate and pyruvate concentrations in the extracellular fluid of wounds and wound tissue. Total LDH activity corresponded directly to lactic acid concentration and inversely to oxygen availability. LDH isoenzymes in wound fluid were in an anaerobic pattern soon after injury and evolved toward the aerotic pattern as oxygen supply more nearly matched metabolic capacity.

Electro-analgesia.

Between May 1975 and March 1976, 19 patients with pain or hypersensitivity, or both, in the distribution of a peripheral nerve were treated with electro-analgesia in the physiotherapy department of Sydney Hospital. The rationale for this treatment is the work of Melzack and Wall (1965). The current selected was that used by Meyer and Field (1972), a unidirectional square wave current with pulse length of 0.

The place of peripheral nerve blocks in reconstructive hand surgery.

Seventy reconstfuctive operations on the hand were done with the patient's full co-operation during the procedure. Anaesthesia was provided by a peripheral nerve block at the level of the wrist or the metacarpo-phalangeal joint. This technique enabled the surgeon to estimate the required extent of such operations as tenolysis, arthrolysis, arthroplasty, and tendon graft.

Residual disability after industrial hand injuries. A review of 218 patients.

The case records of 218 patients with residual hand disability were reviewed. Sixty-six per cent had significant stiffness of the digital joints (metacarpophalangeal and proximal interphalangeal); 25% had amputation of part or whole of the digit; 33% of these had troublesome neuromata; 7% had residual numbness; 25% had more than one operation on their injured hand. The average age of the patients was 44 years.

Clinical evaluation of the masman pressure unit in the reduction of limb oedema.

A clinical evaluation of the Masman Pressure Unit (M.P.U.