A Simple and Versatile Test for Elbow Posterolateral Rotatory Instability.

Background: Posterolateral rotatory instability (PLRI) results from lateral ulnar collateral ligament (LCL) deficiency. The lateral pivot shift test is used to diagnose PLRI but can be difficult to perform and is poorly tolerated. We present a new maneuver, the Posterior Radiocapitellar Subluxation Test (PRST), that we believe is easier to perform.

Heterotopic ossification after local steroid injection.

Pachydermodactyly (PDD) is a rare, benign disease associated with progressive swelling of the periarticular soft tissue of phalangeal hand joints typically treated with local steroid injections. We present a case of a 37-year-old man with PDD treated with local steroid injections. He later developed heterotopic ossification and para-articular calcifications in the injection sites.

The Lumbricals Are Not the Workhorse of Digital Extension and Do Not Relax Their Own Antagonist.

That the lumbrical muscles are the workhorse of digital extension and that they can relax their own antagonist have been time-honored principles. However, we believe this dogma is incorrect and an oversimplification. We base our assertion on anatomy, innervation, and the notion that muscle architecture is the most important determinant of muscle function.

Management of soft tissue tumors of the upper extremity: a review.

Introduction: Management of malignant tumors of the hand and wrist is challenging and is generally approached by limb salvage or amputation. With advances in care, amputation has been superseded by limb salvage as the treatment of choice.

Methods: A narrative literature review was performed to identify articles on the topic of management of soft tissue tumors of the upper extremity, including surgical management, adjuvant radiation therapy, and chemotherapy.

Transhumeral Anterior Radial Nerve Transposition to Simplify Anticipated Future Humeral Reconstruction.

Anterior transhumeral radial nerve transposition has been described in the treatment of humeral shaft fracture to protect the nerve from implant irritation or callus entrapment. Transposing the radial nerve through a facilitating humeral defect also simplifies revision surgery should nonunion result. Here we describe a surgical technique for anterior transhumeral radial nerve transposition for complex humeral reconstruction when subsequent revision surgery is anticipated.

Scaphoid and Lunate Dislocation with Complete Soft-Tissue Avulsion: A Case Report.

Case: We describe an intercarpal dislocation with proximal and rotatory displacement of the lunate and with volar and radial dislocation of the scaphoid; both bones were stripped of soft tissue. Treatment involved ORIF (open reduction and internal fixation). Three years postoperatively, the patient had a DASH (Disabilities of the Arm, Shoulder and Hand) score of 10, equivalent grip strength and 50% wrist palmar flexion and 98% wrist dorsiflexion compared with the uninjured side, and radiographic evidence of posttraumatic arthritis.

Compartment Syndrome of the Hand.

Hand compartment syndrome has many etiologies; untreated, it has dire functional consequences. Intracompartmental pressure exceeding capillary filling pressure causes decreased tissue perfusion resulting in progressive ischemic death of compartment contents. Clinical findings can evolve.

Functional consequence of distal brachioradialis tendon release: a biomechanical study.

Purpose: Open reduction and internal fixation of distal radius fractures often necessitates release of the brachioradialis from the radial styloid. However, this common procedure has the potential to decrease elbow flexion strength. To determine the potential morbidity associated with brachioradialis release, we measured the change in elbow torque as a function of incremental release of the brachioradialis insertion footprint.

A randomized comparison of infraclavicular and supraclavicular continuous peripheral nerve blocks for postoperative analgesia.

Background: Although the efficacy of single-injection supraclavicular nerve blocks is well established, no controlled study of continuous supraclavicular blocks is available, and their relative risks and benefits remain unknown. In contrast, the analgesia provided by continuous infraclavicular nerve blocks has been validated in randomized controlled trials. We therefore compared supraclavicular with infraclavicular perineural local anesthetic infusion following distal upper-extremity surgery.

Quantification of partial or complete A4 pulley release with FDP repair in cadaveric tendons.

Purpose: Repair of a lacerated flexor digitorum profundus (FDP) tendon underneath or just distal to the A4 pulley can be technically challenging, and success can be confounded by tendon triggering and scarring to the pulley. The purpose of this study was to quantify the effect of partial and complete A4 pulley release in the context of a lacerated and repaired FDP tendon just distal to the A4 pulley.

Methods: Tendon biomechanics were tested in 6 cadaveric hands secured to a rigid frame, permitting measurement of tendon excursion, tendon force, and finger range of motion.

Immediate interpersonal and intermanual referral of sensations following anesthetic block of one arm.

Objectives: To explore whether interpersonal and intermanual sensory referral occurs following anesthetic block of a limb and to test theories of disinhibition of mirror neuron activity and transcallosal referral.

Design: Case series.

Setting: Outpatient surgery at the University of California San Diego Medical Center.

Simultaneous dorsal dislocations of the carpometacarpal joints of all four fingers.

A 57-year-old right-hand-dominant woman was involved in a motor vehicle collision. Upon examination, her right hand was markedly deformed and swollen, with limited range of movement. Plain radiographs revealed dorsal dislocations of the index, long, ring, and small finger carpometacarpal joints and an avulsion fracture of the dorsal aspect of the capitate.

Ultrasound guidance versus electrical stimulation for infraclavicular brachial plexus perineural catheter insertion.

Objective: Electrical stimulation (ES)- and ultrasound-guided placement techniques have been described for infraclavicular brachial plexus perineural catheters but to our knowledge have never been previously compared in a randomized fashion, leaving the optimal method undetermined. We tested the hypothesis that infraclavicular catheters placed via ultrasound guidance alone require less time for placement and produce equivalent results compared with catheters placed solely via ES.

Methods: Preoperatively, patients receiving an infraclavicular perineural catheter for distal upper extremity surgery were randomly assigned to either ES with a stimulating catheter or ultrasound guidance with a nonstimulating catheter.

Ultrasound-guided perineural catheter and local anesthetic infusion in the perioperative management of pediatric limb salvage: a case report.

Local anesthetic perineural infusion has emerged as an effective analgesic technique in pediatric patients, but it can also complement surgical perioperative management in complex cases that require optimal tissue perfusion such as limb salvage. We report the successful use of brachial plexus perineural infusion in the care of a child following near-amputation of her dominant hand. An ultrasound-guided infraclavicular brachial plexus catheter was placed in the recovery room after complex reconstructive surgery and a continuous infusion of 0.

Microvascular hepatic artery reconstruction in pediatric abdominal transplantation: pearls and pitfalls.

The "back-wall first" hepatic artery microanastomosis in pediatric liver transplantation saves lives and reduces morbidity. We describe our technique of hepatic artery reconstruction and offer a systematic and multi-team collaborative approach that optimizes surgical outcomes.

Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial.

Background: Carpal tunnel syndrome is a common condition causing hand pain and numbness. Endoscopic carpal tunnel release has been demonstrated to reduce recovery time, although previous studies have raised concerns about an increased rate of complications. The purpose of this prospective, randomized study was to compare open carpal tunnel release with single-portal endoscopic carpal tunnel release.

In vitro cyclic tensile testing of combined peripheral and core flexor tenorrhaphy suture techniques.

Early tenorrhaphy mobilization increases repair site strength and decreases adhesions. Preliminary unpublished data suggest that early active mobilization improves clinical outcome compared with traditional passive motion protocols. We loaded cadaver flexor profundus tendon repairs to 8.

Differential expression of neural cell adhesion molecule (NCAM) after tenotomy in rabbit skeletal muscle.

Tenotomy is a commonly encountered event in orthopaedic surgery. In 23 rabbit extensor digitorum longus (EDL) muscles, within 24 h after tenotomy, a marked drop in maximum force production occurred. This was not explainable based on architectural changes and histological examination using standard markers for muscle injury, i.