Accuracy of MRI in Assessment of High-Grade Partial Distal Biceps Tears.

Background: Magnetic resonance imaging (MRI) is commonly used to diagnose and assess the extent of partial distal biceps injuries. The aim of this study was to report on the accuracy of MRI and the effect of injury history and study timing on its performance.

Methods: A retrospective review of all patients who underwent surgical treatment of partial thickness distal biceps tears at a single center by multiple surgeons was performed.

Occult Amyloid Deposition in Older Patients Presenting With Bilateral Carpal Tunnel Syndrome or Multiple Trigger Digits.

Purpose: The diagnosis of amyloidosis is important for early intervention, disease monitoring, and prevention of complications and progression. Carpal tunnel syndrome (CTS) and trigger digit (TD) are two common conditions associated with early disease. The purpose of this study was to define disease prevalence among patients with bilateral CTS and multiple TDs and assess for an increased rate of diagnosis in the presence of both.

Application of Tendon With Z-Lengthening Technique.

Tendon deficiency limits repair and reconstructive options after tendon and nerve injuries of the upper extremity. Current treatment options include intercalary tendon autograft, tendon transfers, and two-stage tenodesis, with sacrifice of the flexor digitorum superficialis. These reconstructive techniques are associated with donor site morbidity and limited in the setting of multiple tendon deficiencies.

A Systematic Review and Meta-Analysis of Nerve Gap Repair: Comparative Effectiveness of Allografts, Autografts, and Conduits.

Background: Ideal nerve repair involves tensionless direct repair, which may not be possible after resection. Bridging materials include nerve autograft, allograft, or conduit. This study aimed to perform a systematic literature review and meta-analysis to compare the meaningful recovery (MR) rates and postoperative complications following autograft, allograft, and conduit repairs in nerve gaps greater than 5 mm and less than 70 mm.

Primary Repair of Chronic Distal Biceps Tendon Tears.

Background: This study reports the clinical results following primary repair of distal biceps tendon ruptures more 6 weeks after injury.

Methods: A retrospective review of distal biceps tendon repairs performed by 8 different hand surgeons from January 1, 2015 to October 15, 2020 was performed. Patients with complete tears surgically treated ≥6 weeks after injury without tendon graft were included.

Evidence-Based Approach to Timing of Nerve Surgery: A Review.

Events causing acute stress to the health care system, such as the COVID-19 pandemic, place clinical decisions under increased scrutiny. The priority and timing of surgical procedures are critically evaluated under these conditions, yet the optimal timing of procedures is a key consideration in any clinical setting. There is currently no single article consolidating a large body of current evidence on timing of nerve surgery.

Pseudoaneurysm of the Radial Artery After CMC Arthroplasty.

Pseudoaneurysm of the radial artery is an unusual condition. Most radial artery pseudoaneurysms occur as a result of catheterization; however, any traumatic event that damages the vessel can lead to a symptomatic pseudoaneurysm. This report presents a case of an unusual late presentation of clinical symptoms associated with a pseudoaneurysm of the radial artery after arthroplasty of the thumb carpometacarpal joint.

Efficacy of a single, image-guided corticosteroid injection for glenohumeral arthritis.

Background: Limited data are available on the efficacy of cortisone injections for glenohumeral osteoarthritis (GHOA). The amount and longevity of pain relief provided by a single cortisone injection are unclear. Additionally, it remains uncertain how the severity of radiographic GHOA and patient-reported function and pain levels impact the efficacy of an injection.

Ulnar Abutment Syndrome in the Athlete.

Ulnar abutment (ulnocarpal impaction) syndrome may be a source of ulnar-sided wrist pain in the athlete. This condition results from excessive load transfer across the triangular fibrocartilage complex and ulnocarpal joints with characteristic degenerative changes. It frequently occurs in patients with either static or dynamic ulnar positive variance.

Ulnar-Sided Wrist Pain in the Athlete.

Ulnar-sided wrist pain is a common problem in athletes that can be challenging owing to its frequent combination of overuse in conjunction with acute injury. Repetitive pronosupination, wrist flexion and extension, as well as radial and ulnar deviation can predispose the athlete to injury of ulnar structures. Careful understanding of the sport-specific injuries as well as the underlying biomechanics are key to understanding and treating the athlete.

Peripheral nerve repair throughout the body with processed nerve allografts: Results from a large multicenter study.

Background: Peripheral nerve damage resulting in pain, loss of sensation, or motor function may necessitate a reconstruction with a bridging material. The RANGER® Registry was designed to evaluate outcomes following nerve repair with processed nerve allograft (Avance® Nerve Graft; Axogen; Alachua, FL). Here we report on the results from the largest peripheral nerve registry to-date.

Palmar Radiocarpal Artery Vascularized Bone Graft for the Unstable Humpbacked Scaphoid Nonunion With an Avascular Proximal Pole.

Purpose: The most challenging scaphoid nonunion is the unstable nonunion with humpbacked collapse coupled with an avascular proximal pole. Dorsal distal radius pedicled vascularized bone grafts (VBGs) are contraindicated in cases of humpback deformity. The free medial femoral condyle VBG is an excellent option but it is an extensive microsurgical procedure with lengthy operative times and dual-limb incisions.

Testing of Direct Neurorrhaphy Strain.

Purpose: To investigate the ideal suture material to test strain at nerve repair sites. Based on nerve strain tolerance, we aimed to determine which suture reliably failed by an average of 5% and a maximum of 8% strain when loaded to failure.

Methods: The median nerve of 19 cadavers was exposed in the distal forearm, transected proximally, and attached to a spring gauge.

Establishing the appropriate position of proximal humerus locking plates: a cadaveric study of five plating systems and their anatomic reference measurements.

Background: The present study aimed to determine anatomic references for the placement of five proximal humerus locking plates.

Methods: Five proximal humerus locking-plate systems were placed on six human shoulder cadavers. Plates were positioned by fluoroscopic confirmation so that the inferior oblique screw was within 5 mm of the inferomedial cortex.

Complications of Distal Biceps Repair.

Modern techniques to repair the distal biceps tendon include one-incision and 2-incision techniques that use transosseous sutures, suture anchors, interference screws, and/or cortical buttons to achieve a strong repair of the distal biceps brachii. Repair using these techniques has led to improved functional outcomes when compared with nonoperative treatment. Most complications consist of neuropraxic injuries to the lateral antebrachial cutaneous nerve, posterior interosseous nerve, stiffness and weakness with forearm rotation, heterotopic ossification, and wound infections.

Outcomes of short-gap sensory nerve injuries reconstructed with processed nerve allografts from a multicenter registry study.

Background: Short-gap digital nerve injuries are a common surgical problem, but the optimal treatment modality is unknown. A multicenter database was queried and analyzed to determine the outcomes of nerve gap reconstructions between 5 and 15 mm with processed nerve allograft.

Methods: The current RANGER registry is designed to continuously monitor and compile injury, repair, safety, and outcomes data.

Decreases in theta and increases in high frequency activity underlie associative memory encoding.

Episodic memory encoding refers to the cognitive process by which items and their associated contexts are stored in memory. To investigate changes directly attributed to the formation of explicit associations, we examined oscillatory power captured through intracranial electroencephalography (iEEG) as 27 neurosurgical patients receiving subdural and depth electrodes for seizure monitoring participated in a paired associates memory task. We examined low (3-8Hz) and high (45-95Hz) frequency activity, and found that the successful formation of new associations was accompanied by broad decreases in low frequency activity and a posterior to anterior progression of increases in high frequency activity in the left hemisphere.

Ulnar-sided wrist pain in the athlete.

The athlete's wrist, especially those using bats, sticks, racquets, or clubs, is subjected to extremely high torque loads during athletic activities. These loads stress the stabilizing elements of the ulnocarpal and distal radioulnar complexes. Lesions of these regions can lead to painful dysfunction and instabilities that negatively impact athletic performance.

Radiographic evaluation of the elbow.

Despite a number of advanced imaging modalities, plain film x-ray is essential for diagnostic evaluation of the elbow. Although computed tomography and magnetic resonance imaging continue to provide many uses in subtle processes or advanced evaluation, x-rays should typically provide initial, and often all, necessary imaging. Plain film imaging is used to evaluate trauma including fractures and dislocations, occult or suspected bony injury, instability patterns, tumor, arthritis and degenerative disease, and causes of associated pathology such as compression neuropathy.

Biomechanical analysis of the distal metaphyseal ulnar shortening osteotomy.

Purpose: To investigate the effect of a closing wedge osteotomy at the distal ulnar metaphysis on unloading the ulnar side of the wrist.

Methods: Seven fresh frozen cadaver arms mounted in a wrist simulator were used for the analysis. A 6-degrees-of-freedom load cell was mounted on the distal radius and another on the distal ulna.

Distal metaphyseal ulnar-shortening osteotomy: surgical technique.

Ulnar impaction is a common condition encountered by hand surgeons. Historically, treatment of this condition has been with wafer resection of the distal ulna, by either open or arthroscopic means, or diaphyseal ulnar shortening osteotomy; however, both of these have the potential for prolonged recovery or a need for additional procedures. Wafer procedures, whether done by open or arthroscopic techniques, can result in hemarthrosis, and diaphyseal osteotomies can require hardware removal.

Use of continuous marcaine irrigation in the management of suppurative flexor tenosynovitis.

We describe a surgeon, nursing, and patient-friendly method of treating acute pyogenic tenosynovitis using a 2-incision, closed sheath irrigation method and postoperative usage of a continuous marcaine ON-Q pain pump. The advantages of this technique include the ease of catheter placement intraoperatively and the use of a smaller diameter tubing within the flexor sheath. In addition, this technique eliminates the need for nursing staff to perform irrigation, and most importantly, the technique results in improved postoperative pain control allowing an early aggressive postoperative therapy protocol.