A Survey of Burnout Among Members of the American Society for Surgery of the Hand.

Purpose: Physician burnout affects approximately half of US physicians, significantly higher than the general working population. The aims of this study were to determine the prevalence of burnout specifically among hand surgeons and to identify factors unique to the practice of hand surgery that may contribute to burnout.

Methods: A Web-based survey, developed in conjunction with the American Medical Association, was administered to all active and lifetime members of the American Society for Surgery of the Hand using the Mini Z Burnout assessment tool.

Impact of the Current United States Health Care Environment on Practice: A Private Practice Viewpoint.

The evolving healthcare landscape creates unique challenges for private practitioners. They experience the same issues that face physicians in general - including increased regulatory/documentation burdens and downward financial pressures - but without the safety nets that exist in larger healthcare systems. Costs are born more directly, as there are fewer providers over which to spread expenditures.

Misdiagnosis and Radial Tunnel Syndrome: Considering the Distal Biceps Tendon.

Radial tunnel syndrome (RTS) has long been a difficult therapeutic and diagnostic entity for upper extremity surgeons. The presentation is vague and the diagnosis is typically one of exclusion. Multiple clinical entities are known to mimic RTS, but little attention has been paid to the distal biceps.

Isolated loss of active external rotation: a distinct entity and results of L'Episcopo tendon transfer.

Background: The purpose of this study was to characterize a subgroup of cuff-deficient patients with isolated loss of active external rotation (ILER) but preserved active elevation and to evaluate the outcomes of the L'Episcopo procedure to restore horizontal muscle balance.

Methods: During a 10-year period, 26 patients (14 men, 12 women) were identified with ILER in the setting of massive irreparable posterosuperior cuff tears. A modified L'Episcopo tendon transfer was performed to restore active external rotation and to improve shoulder function.

Arthroscopic posterior bone block procedure: a new technique using suture anchor fixation.

We present a novel all-arthroscopic technique of posterior shoulder stabilization that uses suture anchors for both bone block fixation and capsulolabral repair. The bone graft, introduced inside the glenohumeral joint through a cannula, is fixed with 2 suture anchors. The associated posteroinferior capsulolabral repair places the bone block in an extra-articular position.

Massive irreparable rotator cuff tears: how to rebalance the cuff-deficient shoulder.

In its natural state, the shoulder is unbalanced in both the vertical and horizontal planes because the deltoid is stronger than the rotator cuff muscles and the internal rotator muscles are stronger than the external rotator muscles. With aging, this muscle imbalance can become worse, leading to tendon wear, irreversible fatty infiltration of the rotator cuff muscles, and upward migration of the humeral head. Most shoulders with tendon wear are functional and asymptomatic.

Arthroscopic Hill-Sachs Remplissage with Bankart Repair: Strategy and Technique.

Introduction: Arthroscopic Hill-Sachs remplissage describes the fixation of the posterior aspect of the capsule and the infraspinatus tendon into a posterosuperior humeral head impaction fracture in cases of recurrent anteroinferior glenohumeral instability.

Step 1 Anterior Capsulolabral Mobilization And Glenoid Preparation: Perform diagnostic arthroscopy through a standard posterior portal to rule out additional pathology and document the "engaging" nature of the Hill-Sachs defect.

Step 2 Preparation Of The Hill-sachs Defect: With the camera remaining in the posterior portal, the assistant provides visualization of the Hill-Sachs defect by translating the humeral head anteriorly over the glenoid rim with direct pressure on the proximal part of the humerus.

Proximal interphalangeal joint injection through a volar approach: anatomic feasibility and cadaveric assessment of success.

Purpose: The proximal interphalangeal (PIP) joint is a challenging joint to access reliably for corticosteroid injection. Literature has confirmed both a relatively high failure rate for injections performed with the traditional dorsal approach and an improved clinical response rate for confirmed intra-articular injections. We describe a technique for injecting the PIP joint through a volar approach, assess its reliability through cadaveric dissection, and determine its reproducibility by comparing success rates with the dorsal approach in a cadaver model.

Prognostic factors and limitations of anatomic shoulder arthroplasty for the treatment of posttraumatic cephalic collapse or necrosis (type-1 proximal humeral fracture sequelae).

Background: The aim of this study was to evaluate the prognostic factors and limitations of anatomic unconstrained shoulder arthroplasty, performed without tuberosity osteotomy, for the treatment of secondary glenohumeral arthritis following posttraumatic cephalic collapse or necrosis of the humeral head, defined as type-1 fracture sequelae.

Methods: Fifty-five patients with type-1 fracture sequelae treated with anatomic shoulder arthroplasty were included in this retrospective single-center cohort study. All anatomic humeral prostheses were implanted without performing a greater tuberosity osteotomy.

Palmaris profundus tendon prohibiting endoscopic carpal tunnel release: case report.

Palmaris profundus is an aberrant muscle of forearm and wrist anatomy. It has no discernible function, but its tendon has been implicated as a cause of carpal tunnel syndrome. Previously, all cases of palmaris profundus in the literature have been encountered during either open surgery or cadaveric dissection.

The clinical results of arthroscopic transtendinous repair of grade III partial articular-sided supraspinatus tendon tears.

Purpose: The purpose of this study was to evaluate the clinical results of arthroscopic transtendinous repair of deep partial articular-sided rotator cuff tears.

Methods: We retrospectively evaluated the results of 53 patients who underwent arthroscopic transtendinous repair for Ellman grade III articular-sided rotator cuff tears (>50% of the thickness of the rotator cuff). The intact bursal side of the cuff was not detached, and all associated pathology was treated.

Minimally invasive proximal biceps tenodesis: an anatomical study for optimal placement and safe surgical technique.

Background: An anatomic study specifically investigating the optimal location for proximal biceps tenodesis and detailing the topographic relationship to neurovascular structures has not been conducted.

Methods: Twelve cadaveric upper extremities were dissected to identify the proximal biceps musculotendinous junction and topographic relationships to neighboring neurovascular structures.

Results: The musculotendinous junction of the long head of the biceps tendon was on average 2.

Blunt vascular trauma in the extremity: diagnosis, management, and outcome.

Background: Blunt vascular trauma in an extremity is an uncommon diagnosis. Considering the complexity of these injuries, it is worthwhile to determine how select factors affect the outcome of the limb and the patient. The objectives of this study were to review the diagnosis, management, and outcomes of patients who sustained blunt vascular injuries in the extremities and relate factors in their treatment to the outcome of the injured extremity.