Incidence of Trigger Finger in Surgically and Nonsurgically Managed Carpal Tunnel Syndrome.

Purpose: The purpose of this study was to determine whether extremities undergoing carpal tunnel release (CTR) have an increased rate of trigger finger (TF) compared with conservatively managed carpal tunnel syndrome.

Methods: Data were collected from the Humana Insurance Database, and subjects were chosen on the basis of a history of CTR with propensity matching performed to develop a nonsurgical cohort. Following propensity matching, 16,768 patients were identified and equally split between surgical and nonsurgical treatments.

Incidence of Carpal Tunnel Syndrome after Distal Radius Fracture.

Purpose: Carpal tunnel syndrome (CTS) can present following distal radius fracture (DRF) and may progress to require carpal tunnel release (CTR). The primary aim of this study was to determine the incidence of CTS within 6 months of a DRF and the rate of CTR in this population.

Methods: We used the PearlDiver national insurance database to determine the incidence of CTS after DRF.

Trapeziometacarpal Joint Arthrodesis Using a Cannulated Compression Screw and Locking Plate Construct.

Trapeziometacarpal (TMC) arthrodesis is an established surgical option for the treatment of basal joint osteoarthritis. It has traditionally been indicated in younger, higher demand patients who would benefit from the increased strength afforded by a stable thumb base. Trapeziometacarpal arthrodesis has a higher reported complication rate than other treatment options, including nonunion and symptomatic hardware.

Outcomes of Acute Versus Subacute Scapholunate Ligament Repair.

Purpose: This study investigated the long-term outcomes of direct scapholunate ligament (SLL) repairs with or without dorsal capsulodesis performed within 6 weeks (acute repair) of a SLL tear versus 6 to 12 weeks following injury (subacute repair).

Methods: A review of medical records from April 1996 to April 2012 identified 24 patients who underwent SLL repair (12 acute, 12 subacute). Patients returned to the clinic for radiographic examinations of the injured wrist, standardized physical examinations, and validated questionnaires.

Team Approach: Management of Brachial Plexus Injuries.

»: Traumatic brachial plexus injuries are relatively rare but potentially devastating injuries with substantial functional, psychological, and economic consequences.

»: Prompt referral (ideally within 6 weeks of injury) to a center with a team of experts experienced in the diagnosis and management of these injuries is helpful to achieving optimal outcomes.

»: Preoperative and intraoperative decision-making to diagnose and plan reconstructive procedures is complex and must take into account a number of factors, including the time from injury, concomitant injuries, preservation of cervical nerve roots, and the availability of intraplexal and extraplexal donor nerves for nerve transfer.

Boston Carpal Tunnel Questionnaire Scores Alone Do Not Predict Surgical Intervention for Patients With Carpal Tunnel Syndrome.

Background: With the expanded indications for telemedicine, there is increased utility for screening methods to determine which patients are likely to progress to surgical intervention, requiring in-person visits. Patient-rated tools such as the Boston Carpal Tunnel Questionnaire (BCTQ) may be one such tool for screening patients with carpal tunnel syndrome (CTS). The aim of the study was to evaluate whether BCTQ scores were predictive of offering conservative treatment or surgical intervention for CTS.

Optimizing the Virtual Interview Experience for Hand Surgery Fellowships.

Similar to many other medical training programs, fellowship interviews for hand surgery will be conducted virtually for a second consecutive year. We provide strategies for applicants to ideally portray themselves and to learn about fellowship programs. We include approaches for fellowship programs to identify candidates that match their values as a program, as well as ways to provide useful information to applicants about the program's culture.

The Epidemiology of Carpal Tunnel Revision Over a 1-Year Follow-Up Period.

Purpose: To establish the incidence of revision carpal tunnel surgery within a 1-year postoperative period using a national administrative database. This information has been unknown until this point because of the absence of laterality-specific coding with the International Classification of Diseases, Ninth Edition and earlier coding systems.

Methods: Data were collected from the Humana insurance database using PearlDiver patient records from 2015 to 2017.

Do Medical Students Who Participate in a Research Gap Year Produce More Research During Residency?

Background: The research gap year has become increasingly popular among medical students. It is also a well-known factor in consideration for orthopaedic surgery residency programs. Although medical students who participated in a research gap year typically enter residency with more research experience than their counterparts, it is unknown whether this translates to increased research productivity during residency compared with their peers.

Pre-operative Two-Point Discrimination Predicts Response to Carpal Tunnel Release.

Background: Limited evidence informs whether pre-operative values of two-point discrimination (2PD) in patients with carpal tunnel syndrome predict response to surgery.

Questions/purposes: The primary aim of this study was to determine the predictive value of pre-operative 2PD scores on outcomes following carpal tunnel release (CTR). In particular, we sought to evaluate whether a clinically relevant 2PD threshold exists that can predict symptomatic response after surgery.

Level of Evidence and Publication Rates of Abstracts Presented at the American Society for Surgery of the Hand Annual Meetings: Comparison Over 23 Years.

Purpose: The primary aims of this study were to determine how level of evidence and publication rates of American Society for Surgery of the Hand (ASSH) abstracts presented at the national meeting have changed over the past 23 years.

Methods: Abstracts presented at the ASSH annual meeting from 1992 to 2014 were reviewed. Level of evidence (LoE) and publication status for each abstract were recorded.

Sports Injuries of the Hand, Wrist, and Elbow.

Sports injuries of the upper extremity are a common problem seen by those who care for athletes and those who manage upper extremity injuries. The term "high-level athlete" may include adolescents and high school students, collegiate athletes, and of course, the professional athlete. However, the "weekend warrior" can sustain similar injuries and can have a similar desire to return to play as quickly as possible.

Elbow contracture following operative fixation of fractures about the elbow.

Background: The rates of elbow contracture and contracture release after surgically treated elbow trauma are poorly defined. The purpose of this study was to define the incidence of elbow contracture diagnosis and release after surgical treatment for elbow trauma.

Methods: The Humana insurance database was queried using the PearlDiver Patient Records Database between 2007 and 2017.

The Critical Portions of Carpal Tunnel Release, Ulnar Nerve Transposition, and Open Reduction and Internal Fixation of the Distal Part of the Radius.

Background: Overlapping surgery is attracting increased scrutiny. The American College of Surgeons states that the attending surgeon must be present for all critical portions of a surgical procedure; however, critical portions of surgical procedures are not defined. We hypothesized that a Delphi panel process would measure consensus on critical portions of 3 common hand surgical procedures.

Safety of Overlapping Inpatient Orthopaedic Surgery: A Multicenter Study.

Background: Although overlapping surgery is used to maximize efficiency, more empirical data are needed to guide patient safety. We conducted a retrospective cohort study to evaluate the safety of overlapping inpatient orthopaedic surgery, as judged by the occurrence of perioperative complications.

Methods: All inpatient orthopaedic surgical procedures performed at 5 academic institutions from January 1, 2015, to December 31, 2015, were included.

An Epidemiologic Perspective on Scaphoid Fracture Treatment and Frequency of Nonunion Surgery in the USA.

Background: Scaphoid fractures treated non-operatively and operatively may be complicated by nonunion.

Questions/purposes: We sought to test the primary hypothesis that the incidence density of scaphoid fracture treatment is higher than previously estimated, to determine the frequency and risk factors for nonunion treatment, and to determine whether the frequency of surgical treatment increased over time.

Methods: The MarketScan database was queried for all records of treatment (casting and surgery) for closed scaphoid fractures over a 6-year period.

Prevalence of carpal tunnel syndrome presenting with symptoms in an ulnar nerve distribution: A prospective study.

Introduction: Patients presenting with symptoms of pain/paresthesias primarily in an ulnar nerve distribution may be noted to have exclusive median mononeuropathy at the wrist on subsequent electrodiagnostic testing. There has been limited research looking at the prevalence of this clinical presentation.

Methods: A cohort of adults were surveyed to assess for severity and localization of hand symptoms using the Katz hand diagram and Boston Carpal Tunnel Questionnaire Symptoms Severity Scale.

Opioid Prescriber Education and Guidelines for Ambulatory Upper-Extremity Surgery: Evaluation of an Institutional Protocol.

Purpose: Recent studies demonstrated the overprescription of opioids after ambulatory hand surgery in the setting of a national opioid epidemic. Prescriber education has been shown to decrease these practices on a small scale; however, currently no nationally standardized prescriber education or postoperative opioid prescribing guidelines exist. The purpose of this study was to evaluate the effect of prescriber opioid education and postoperative opioid guidelines on prescribing practices after ambulatory hand surgery.

Insulin Dependence Is Associated With Increased Risk of Complications After Upper Extremity Surgery in Diabetic Patients.

Unlabelled: Diabetes mellitus (DM) is associated with the development of carpal tunnel syndrome, Dupuytren disease, trigger digits, and limited joint mobility. Despite descriptions of poorer response to nonsurgical treatment, previous studies have not shown increased complication rates in diabetic patients after hand surgery. Few studies, however, differentiate between insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus.

A Prospective Observational Assessment of Unicortical Distal Screw Placement During Volar Plate Fixation of Distal Radius Fractures.

Purpose: Although volar plating of the distal radius is performed frequently, the necessity of distal bicortical fixation in the metaphyseal and epiphyseal areas of the distal radius has not been proven. This study aimed primarily to quantify the ability of unicortical distal screws to maintain operative reduction of adult distal radius fractures and secondarily to determine if unicortical screw lengths could be predicted based on anatomical measurements.

Methods: This prospective trial enrolled 75 adult patients undergoing volar locking plate fixation of a unilateral distal radius fracture at a tertiary center.