Diagnostic Accuracy of Neuromuscular Ultrasound vs. Electrodiagnostic Studies for Carpal Tunnel Syndrome: Systematic Review and Meta-analysis of Paired Accuracy Studies.

This systematic review with meta-analysis compared the diagnostic accuracy of neuromuscular ultrasound (NMUS) and electrodiagnostic studies (EDX) as confirmatory tests for carpal tunnel syndrome (CTS) diagnosis. We used bivariate random-effects models to estimate pooled sensitivity and specificity and generate hierarchical summary receiver-operating characteristic curves to assess diagnostic test accuracy. Nine paired accuracy studies were included, representing 1751 hands (743 clinically diagnosed CTS; 1008 without CTS) that underwent NMUS and EDX.

Usability of Nerve Tape: A Novel Sutureless Nerve Coaptation Device.

Purpose: Microsuture neurorrhaphy is technically challenging and has inherent drawbacks. This study evaluated the potential of a novel, sutureless nerve coaptation device to improve efficiency and precision.

Methods: Twelve surgeons participated in this study-six attending hand/microsurgeons and six trainees (orthopedic and plastic surgery residents or hand surgery fellows).

Three-Dimensional Analysis of Metacarpal Head Articular Defects Created by Headless Screws.

Objectives: Headless screw fixation used to treat metacarpal neck and metacarpal shaft fractures is gaining popularity. The aim of the study is to determine the proportion of the metacarpal head articular surface that is compromised during retrograde insertion of headless screws.

Methods: Metacarpal screw fixation through a metacarpal head starting point was performed using fluoroscopic guidance on 14 metacarpals.

Wide Awake Local Anesthesia No Tourniquet Endoscopic Cubital Tunnel Release.

As demands for faster return to function, improvement in surgical scarring, and minimal disruption to personal schedule have increased, so also have the demands increased for minimally invasive procedures under the wide awake, local anesthetic, no tourniquet method. However, owing to the subcutaneous yet constrained position of the ulnar nerve at the elbow, wide-awake endoscopic cubital tunnel release has remained a technical challenge. We describe a 2-stage local anesthetic injection method that safely introduces local anesthetic within the cubital tunnel and simultaneously achieves comfort, sufficient visualization, and the ability to decompress multiple compression sites through a minimal incision.

Hand Abscesses: Volar and Dorsal.

A high index of suspicion coupled with excellent knowledge of hand anatomy and function allows for accurate diagnosis and effective management of deep space infections. This article describes surgical approaches for closed-space infections. Drainage, debridement, and intraoperative irrigation are initial steps along with the decision for continuous postoperative irrigation based on intraoperative findings.

Neurolysis with Amniotic Membrane Nerve Wrapping for Treatment of Secondary Wartenberg Syndrome: A Preliminary Report.

Background: Entrapment of the superficial sensory branch of the radial nerve (SRN) commonly results in debilitating pain of the dorsoradial wrist. Symptom relief following SRN neurolysis is often incomplete or temporary due to recurrent perineural scarring.

Methods: We performed a retrospective review with prospective follow-up of all patients with SRN neuropathy who were treated with neurolysis and nerve wrapping using an amnion-based allograft adhesion barrier over a one-year interval.

Recurrent cubital tunnel syndrome treated with revision neurolysis and amniotic membrane nerve wrapping.

Background: Perineural scarring of the ulnar nerve is a predominant cause of symptom recurrence after surgical treatment for primary cubital tunnel syndrome (CuTS). We report our preliminary experience in revision ulnar nerve decompression and nerve wrapping with an amniotic membrane allograft adhesion barrier for treatment of recurrent CuTS.

Methods: We performed a retrospective review with prospective follow-up of patients with recurrent CuTS who were treated with revision neurolysis with amniotic membrane nerve wrapping.

Four-corner arthrodesis with a radiolucent locking dorsal circular plate: technique and outcomes.

Background: Scaphoid excision and four-corner arthrodesis (FCA) is an acceptable motion sparing procedure used to treat wrist arthritis. Recently, a locking dorsal circular plate composed of polyether-ether-ketone has been introduced (Xpode®; TriMed Inc.).

Olecranon osteotomy fixation using a novel device: the olecranon sled.

A posterior approach to the elbow utilizing an olecranon osteotomy has been shown to provide excellent visualization of the distal humerus articular surface. However, many bony stabilization and fixation methods for the olecranon osteotomy are usually prominent, frequently symptomatic, and often require a second operation for removal. This paper evaluates the use of an innovative device, the olecranon sled, in fixation of olecranon osteotomies for exposure of intra-articular distal humerus fractures and provides follow-up results.

Distal ulna arthroplasties.

The distal radioulnar joint (DRUJ) is the distal link between the radius and the ulna, and forms a pivot for forearm pronation and supination. As well as being susceptible to idiopathic arthritis, any injury or deformity of the DRUJ involving the radius or ulna can alter the function of this joint. Treatment options for irreparable destruction of this joint have ranged from fusion of the DRUJ joint to a variety of excision techniques with soft-tissue reconstructions, and are ever evolving.

The use of Teno Fix tendon repair device in a patient with multiple flexor tendon ruptures.

Flexor tendon laceration repairs remain challenging despite numerous advances in hand surgery. Although progress on this vital subject matter has been achieved, there continues to be discussion over which surgical technique produces the optimal result. Currently there are several recommended surgical repair options for the lacerated flexor tendon.

Botulinum toxin use as an adjunctive modality in a patient with multiple flexor tendon ruptures.

Botulinum toxin A has been described in treatment protocols for several disease processes, from primary axillary hyperhydorosis to esophageal dysfunction. It is best known for its use in plastic and dermatological practices. Botulinum toxin has a straightforward mechanism of action.

Sonographic Diagnosis Of Posterior Interosseous Nerve Entrapment Syndrome.

Posterior interosseous nerve entrapment is a potential cause of upper extremity muscle weakness and pain. The diagnosis may be difficult to make clinically, and electrodiagnostic tests may not identify the exact site of nerve compression. We report a case of posterior interosseous nerve entrapment in which electrodiagnostic studies suggested radial neuropathy at the level of the spiral groove, but the sonographic evaluation pinpointed the arcade of Frohse as the level of compression.