Variation in Treatment for Trapeziometacarpal Arthrosis.

Background: Treatment recommendations for trapeziometacarpal (TMC) arthrosis are highly variable from surgeon to surgeon. This study addressed the influence of viewing radiographs on a decision to offer surgery for TMC arthrosis.

Methods: In an online survey, 92 hand surgeons viewed clinical scenarios and were asked if they would offer surgery to 30 patients with TMC arthrosis.

Borderline Nerve Conduction Velocities for Median Neuropathy at the Carpal Tunnel.

Purpose: Patient knowledge of the frequency with which electrodiagnostic testing (EDx) for suspected median neuropathy at the carpal tunnel addresses nuance in the distinction between normal and abnormal neurophysiology might help them make an informed decision about whether or not to have this test. We reviewed a large set of consecutive EDx for possible carpal tunnel syndrome (CTS) and associated medical records to determine (1) the percentage of EDx measurements within 10% of threshold values; (2) discordance between clinician and EDx diagnosis of CTS using diagnostic performance characteristics; and (3) demographic and disease characteristics independently associated with EDx diagnosis of median neuropathy at the carpal tunnel.

Methods: We retrospectively reviewed nerve conduction study (NCS) results of 537 consecutive patients evaluated for possible idiopathic median neuropathy at the carpal tunnel.

Night Splinting for Idiopathic Trigger Digits.

Background: This study assessed nighttime splinting for 6 weeks as treatment for recent onset idiopathic trigger fingers.

Methods: Patients over 18 years with a Quinnell grade 1 or 2, idiopathic trigger finger or thumb causing symptoms for less than 3 months were eligible for a custom-made hand-based orthoplast night orthotic. Improvement of symptoms and/or resolution of triggering were recorded.

The Prevalence of Unanticipated Hamate Hook Abnormalities in Computed Tomography Scans: A Retrospective Study.

Background: It is possible that some hamate hook fractures are not diagnosed or treated, thereby affecting the study of their natural history. Study of the prevalence of incidental hamate hook fractures, nonunions, and other abnormalities on computed tomography (CT) ordered for another reason could document a subset of undiagnosed and untreated hamate hook fractures which might change our understanding about the natural history.

Methods: Reports of 2489 hand, wrist, and forearm CT scans for hamate hook abnormalities were searched.

A Slightly Dorsally Tilted Lunate on MRI can be Considered Normal.

Background: Abnormal angulation of the lunate can be an indication of intercarpal pathology. On magnetic resonance images (MRIs) the lunate often looks dorsally angulated, even in healthy wrists. The tilt on individual slices can also be different and might be misinterpreted as pathological, contributing to inaccurate diagnoses and unnecessary surgery.

The Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire: Development and Preliminary Validation.

Background: Symptoms and disability at the trapeziometacarpal (TMC) joint are typically assessed with general measures that may not be able to accurately discriminate between TMC arthrosis-specific versus other hand and arm condition concerns. The objective was to develop and preliminary validate the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire designed to assess symptoms and disability at the TMC joint.

Methods: English-speaking patients (50 years or older) were enrolled in 1 of 2 samples (sample 1, 64 patients specifically presented for treatment of TMC arthrosis; sample 2, 64 patients received an incidental diagnosis of previously undiagnosed TMC arthrosis when presenting for treatment of another, not thumb-related condition).

Interobserver Agreement of the Eaton-Glickel Classification for Trapeziometacarpal and Scaphotrapezial Arthrosis.

Purpose: To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarpal (TMC) joint arthrosis (eliminating evaluation of the scaphotrapezial [ST] joint) and information about the patient's symptoms and examination influence interobserver reliability. We also tested the null hypotheses that no patient and/or surgeon factors affect radiographic rating of TMC joint arthrosis and that no surgeon factors affect the radiographic rating of ST joint arthrosis.

Methods: In an on-line survey, 92 hand surgeons rated TMC joint arthrosis and ST joint arthrosis separately on 30 radiographs (Robert, true lateral, and oblique views) according to the (modified) E-G classification.

Early Patient Satisfaction with Different Treatment Pathways for Trigger Finger and Thumb.

Little is known about factors related to patient satisfaction with treatment for trigger digits. This study tested the null hypothesis that there are no factors associated with treatment satisfaction 2 months after completion of treatment (absence of triggering) or 4 months after the last visit for patients with a trigger thumb or finger. Secondary null hypotheses were: 1) There are no factors associated with a change in patients' preferred treatment before and after consultation with a hand surgeon; and 2) Initial treatment provided is not different from final received treatment.

Symptoms During or Shortly After Isolated Carpal Tunnel Release and Problems Within 24 hours After Surgery.

This study used the National Survey of Ambulatory Surgery (NSAS) database to measure the incidence of and risk factors for symptoms in the ambulatory surgery center and problems within 24 h after isolated carpal tunnel release (CTR). The NSAS contained records on 400,000 adult patients with carpal tunnel syndrome who were treated with CTR in 2006, based on ICD-9 codes. The type of anesthesia used and factors associated with symptoms and problems were sought in bivariate and multivariable statistical analyses.

Predictors of missed research appointments in a randomized placebo-controlled trial.

Background: The primary aim of this study was to determine predictors of missed research appointments in a prospective randomized placebo injection-controlled trial with evaluations 1 to 3 and 5 to 8 months after enrollment.

Methods: This study represents a secondary use of data from 104 patients that were enrolled in a prospective randomized controlled trial of dexamethasone versus lidocaine (placebo) injection for various diagnoses. Patients were enrolled between June 2003 and February 2008.

Progression of carpal tunnel syndrome according to electrodiagnostic testing in nonoperatively treated patients.

Background: This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS) over time according to median nerve distal motor latency (DML) on two electrodiagnostic tests.

Methods: This retrospective study analyzed sixty-two adult nonoperatively treated patients who were diagnosed with CTS confirmed by a minimum of two electrodiagnostic tests at our institution between December 2006 and October 2012. A Wilcoxon signed-rank test was conducted to test the difference between electrodiagnostic measurements between the first and last test.

How prevalent are hazardous attitudes among orthopaedic surgeons?

Background: So-called "hazardous attitudes" (macho, impulsive, antiauthority, resignation, invulnerable, and confident) were identified by the Federal Aviation Administration and the Canadian Air Transport Administration as contributing to road traffic incidents among college-aged drivers and felt to be useful for the prevention of aviation accidents. The concept of hazardous attitudes may also be useful in understanding adverse events in surgery, but it has not been widely studied.

Questions/purposes: We surveyed a cohort of orthopaedic surgeons to determine the following: (1) What is the prevalence of hazardous attitudes in a large cohort of orthopaedic surgeons? (2) Do practice setting and/or demographics influence variation in hazardous attitudes in our cohort of surgeons? (3) Do surgeons feel they work in a climate that promotes patient safety?

Methods: We asked the members of the Science of Variation Group-fully trained, practicing orthopaedic and trauma surgeons from around the world-to complete a questionnaire validated in college-aged drivers measuring six attitudes associated with a greater likelihood of collision and used by pilots to assess and teach aviation safety.

Disability in patients with trapeziometacarpal joint arthrosis: incidental versus presenting diagnosis.

Purpose: To test the hypothesis that there is no difference in trapeziometacarpal (TMC) joint arthrosis-related symptoms and disability between patients seeking treatment for symptoms of TMC arthrosis and those with incidental TMC joint arthrosis.

Methods: We compared 64 patients presenting for care of TMC joint arthrosis with 64 with incidental TMC joint arthrosis. For both groups, the diagnosis was based on crepitation on examination.

Excisional biopsy of suspected benign soft tissue tumors of the upper extremity: correlation between preoperative diagnosis and actual pathology.

Background: Tumors of the upper extremity are common and mostly benign. However, the prevalence of discordant diagnosis of a solid hand tumor is less studied. The objectives of this retrospective study were (1) to determine the proportion of patients with a different (discrepant or discordant) pathological diagnosis compared to the preoperative diagnosis, (2) to determine the prevalence of the types of pathologies encountered at excisional biopsy for suspected benign tumors, and (3) to determine the types of tumors diagnosed when the surgeon does not make a preoperative diagnosis.

Medical services and associated costs vary widely among surgeons treating patients with hand osteoarthritis.

Background: There are substantial variations in medical services that are difficult to explain based on differences in pathophysiology alone. The scale of variation and the number of people affected suggest substantial potential to lower healthcare costs with the reduction of practice variation. Our study assessed practice variation across three affiliated urban sites in one city in the United States and related healthcare costs following the diagnosis of hand osteoarthritis (OA) in patients.

Relationships between pain misconceptions, disability, patients' goals and interpretation of information from hand therapists.

Introduction: Patient interpretation of advice from hand therapists may be related to nonadaptive pain thoughts (automatic, overprotective, unduly pessimistic statements triggered by nociception and exacerbated by psychological distress).

Purpose Of The Study: This study aimed to determine whether there were correlations between participants' hand therapy goals, interpretation of advice from hand therapists, nonadaptive pain thoughts, and upper extremity-specific disability.

Methods: One hundred and five participants completed questionnaires assessing nonadaptive pain thoughts, upper extremity-specific disability, lessons from hand therapists, and hand therapy goals.

Diagnosis of carpal tunnel syndrome: interobserver reliability of the blinded scratch-collapse test.

The reliability of the scratch-collapse test for diagnosis of carpal tunnel syndrome (CTS) has not been tested by independent investigators. This study measured the reliability of the scratch-collapse test comparing the treating hand surgeon and blinded evaluators. We performed a prospective observational study of 41 patients with a provisional diagnosis of CTS or a combination of CTS and cubital tunnel syndrome and prescribed electrodiagnostic testing.

Contralateral electrodiagnosis in patients with abnormal median distal sensory latency.

Background: We hypothesized that electrodiagnostic evidence of carpal tunnel syndrome (CTS) on the contralateral, less-severe side correlates with disease severity.

Methods: We retrospectively reviewed 285 adults that had bilateral electrodiagnostic testing and a median distal sensory latency (DSL) greater than 3.6 ms on at least one side.

Disability and pain after cortisone versus placebo injection for trapeziometacarpal arthrosis and de Quervain syndrome.

Background: This study tested the null hypothesis that type of injection (corticosteroid vs. placebo) is not a predictor of arm-specific disability as measured with the Disabilities of Arm, Shoulder and Hand questionnaire 1 to 3 months after injection of dexamethasone or placebo for treatment of trapeziometacarpal (TMC) arthrosis or de Quervain syndrome. Secondly, we tested if type of injection was a predictor of pain intensity.

Benign upper extremity tumors: factors associated with operative treatment.

Background: Tumors are common in the upper extremity and are mostly benign and inconsequential. The purpose of this study was to determine factors associated with operative treatment for suspected benign tumors of the upper extremity.

Methods: Treated by three different hand surgeons between July 2001 and July 2011, 1,593 tumors were identified using billing records.

Replantation and revascularization vs. amputation in injured digits.

Background: The purpose of this study was to analyze factors associated with the decision to replant or revascularize rather than amputate an injured digit as well as factors associated with successful replantation or revascularization.

Methods: We reviewed 315 complete and subtotal amputations at or proximal to the distal interphalangeal joint in 199 adult patients treated over 10 years. Ninety-three digits were replanted (30 %), 51 were revascularized (16 %), and 171 were amputated (54 %), including 5 attempted replantations.

Resolution and recurrence rates of idiopathic trigger finger after corticosteroid injection.

Background: This study addresses factors associated with apparent resolution and recurrence of triggering using data from providers with various treatment strategies.

Methods: A retrospective review identified 878 adult patients with 1,210 Quinnell grade 2 or 3 trigger fingers that had one or more corticosteroid injections by one of three surgeons between 2001 and 2011. Two surgeons injected dexamethasone, but one had patients return 1 month after injection and was quick to recommend surgery (strategy A) and the other had patients return 2 months after injection, offered another injection or surgery, and followed the patient's preference.

Death, taxes, and trapeziometacarpal arthrosis.

Background: Hand surgeons treat trapeziometacarpal arthrosis as if everyone with the disease presents for treatment despite evidence that suggests that trapeziometacarpal arthrosis is a normal part of human aging for which--it seems safe to assume--most people never seek medical attention.

Questions/purposes: The aims of our study were (1) to confirm the prevalence of radiographic trapeziometacarpal arthrosis in a very large sample and to determine if age and sex are associated with (2) any radiographic evidence of trapeziometacarpal arthrosis; and (3) radiographic evidence of severe trapeziometacarpal arthrosis.

Methods: A total of 2321 patients 31 years or older with radiographs obtained during treatment of a distal radius fracture at a tertiary care medical center emergency department between 2002 and 2012 were analyzed.