The cost-effectiveness of nonsurgical versus surgical treatment for carpal tunnel syndrome.

Purpose: To compare direct costs and results for patients with electrodiagnostically proven carpal tunnel syndrome treated with surgery versus nonsurgical care.

Methods: There is a retrospective study of 120 patients divided into 2 groups: subjects in group 1 had chosen nonsurgical treatment, whereas subjects in group 2 had chosen surgery with no nonsurgical treatment. Patients were matched on age, gender, severity of nerve conduction abnormalities, body mass index, smoking history, job category, and insurance coverage.

Early outcome of spherical ceramic trapezial-metacarpal arthroplasty.

Purpose: A retrospective review of 50 ceramic, spherical implants for the treatment of trapezial-metacarpal osteoarthritis in 49 patients assessed clinical and radiographic outcome.

Methods: Thirty-five patients returned for a clinical examination and completed an outcome survey at a mean follow-up of 3 years. A radiographic review was available for all 50 implants with a mean follow-up of 3 years.

Outcomes of carpal tunnel surgery with and without supervised postoperative therapy.

Purpose: To assess if a formal 2-week hand therapy improves outcomes and justifies its expense.

Methods: A prospective randomized study was completed using a contemporary short incision and a 2-week program of therapy. Patients were randomized into 2 treatment groups: one group received instruction on home therapy exercises to be followed after carpal tunnel release, and a second group received the home program in addition to a therapist-directed program for 2 weeks.

Outcome after repair of the scapholunate interosseous ligament and dorsal capsulodesis for dynamic scapholunate instability due to trauma.

Purpose: To retrospectively assess outcomes in 17 patients treated with scapholunate (SL) interosseous ligament repair and capsulodesis for dynamic SL instability due to trauma.

Methods: A retrospective review of 17 consecutive patients included clinical and radiographic examinations to determine outcome after SL interosseous ligament repair and dorsal capsulodesis. The average age at the time of surgery was 36 years, and the postoperative follow-up period averaged 66 months.

Plate removal after ulnar-shortening osteotomy.

Purpose: Ulnar-shortening osteotomy using plate and screw fixation is a reliable method for treating various wrist disorders. In some patients the plate remains as a source of discomfort even after the osteotomy has healed and the preoperative complaints have resolved. There is not a large body of information to guide the surgeon in the timing of plate removal should it be needed to address persistent forearm complaints caused by prominent hardware.

Radiographic analysis of lateral epicondylitis.

Lateral epicondylitis is one of the most commonly diagnosed elbow disorders, but the role of radiographs in clinical evaluation is unclear. The purpose of this study was to review a consecutive series of 294 radiographs in patients diagnosed with lateral epicondylitis to determine whether radiographic findings had an impact on patient management. Standard anteroposterior, lateral, and radiocapitellar views for each elbow were taken at a single upper extremity practice.

Treatment decisions for newborns at the threshold of viability: an ethical dilemma.

The major ethical issues involved in decision-making in the care of extremely low birth weight newborns are analyzed here. We propose a schema for assessment and management of these infants that is consistent with ethical principles broadly accepted by the pediatric community, and which takes into account mortality risk at any given institution rather than arbitrary weight limits, with a major decision-making role for the infant's parents. When possible, the decision of whether or not to resuscitate should be made before delivery; when not possible, delivery room resuscitation is recommended, and the decision to continue or withdraw care should be made subsequently based on likelihood of survival and the wishes of the parents.

Evaluation of neonates born with intrauterine growth retardation: review and practice guidelines.

Intrauterine growth retardation affects approximately 10% of live-born infants. Causes of intrauterine growth retardation are heterogeneous, and frequently the care of these infants poses a diagnostic and therapeutic challenge. Diagnosis of impaired fetal growth is an area in which close collaboration among the obstetrician, pediatrician, and dysmorphologist is essential for proper care of these newborns.

Staged opposition transfer.

Six patients sustained extensive hand and upper limb trauma, including median nerve and/or thenar muscle loss. Initial treatment consisted of various median nerve and/or soft tissue reconstructions. Because of extensive palmar scarring and lack of useful opposition (Kapandji stage 3), a 2-stage opposition transfer was performed.

Replantation and revascularization of the digits in a community microsurgical practice.

One-hundred and twenty-seven digits in Verdan zones I and II, and 24 thumbs in 106 patients were reviewed from 1979 to 1995. Patients were all followed for a minimum of 5 months to assess early results and complications, and to determine if a short course (minimum 3 days) of dextran 40 anticoagulation adversely affected digit survival. The total survival rate was 88 percent.

Effects of theophylline on renal function in premature infants.

Xanthines are frequently being used in the management of premature babies. Studies in adult subjects have demonstrated a diuretic effect of aminophylline due to the inhibition of solute reabsorption in various segments of the nephron. We evaluated the effects of aminophylline on the developing kidney.