Nonoperative carpal tunnel syndrome treatment.

Many factors influence the development of CTS; therefore, nonoperative treatment should not be limited to only one intervention. Nonoperative treatment is most effective in the early stages, prior to irreparable damage to the nerve. Early intervention combined with a comprehensive treatment plan can help improve effectiveness of treatment during this phase.

Flexor tenolysis.

Tenolysis is a well-established salvage procedure, which can be applied when non-gliding adhesions form along the surface of a tendon after injury or repair and prevent gliding of the tendon in the performance of its intended function.(8,15,17,29,30,39,40,44,49) Tendon adhesions will occur whenever the surface of a tendon is damaged either through the injury itself, be it laceration or crush, or by surgical manipulation.(18) At any point on the surface of a tendon where violation occurs, an adhesion will form in the healing period.

Management of a proximal interphalangeal joint fracture dislocation with a compass proximal interphalangeal joint hinge and therapy: a case report.

The purpose of this report is to describe the management of a chronic proximal interphalangeal (PIP) joint fracture dislocation in a 46-year-old computer programmer. Twenty days following injury, a right ring finger volar plate arthroplasty was performed, loose fracture fragments were excised, and a Compass PIP joint hinge was applied. The hinge was locked at 10 degrees to 15 degrees extension and held in this position for 8 days.

Flexor tendon rupture caused by gout: a case report.

We present a case of primary gouty infiltration of flexor tendons in the hand, causing rupture of both flexor digitorum superficialis and profundus tendons in a single digit. The patient was managed by a single-stage reconstruction of the less involved flexor digitorum superficialis tendon using a segment of the proximal stump of flexor digitorum profundus tendon as a bridge graft. This uncommon etiology of tendon rupture should be considered in all patients with a history of gout presenting with tendon insufficiency.

Compartment syndrome of the leg after plantaris tendon harvest: a case report.

A case of lower extremity compartment syndrome following plantaris tendon harvest for use as an upper extremity tendon graft is described. Compartment syndrome seems to be a rare complication after plantaris harvest, but expedient management is required to avert adverse sequelae. Exploration of the course of the plantaris tendon may be a viable alternative to the traditional lateral approach in attempting to reverse the condition.

Postoperative management of functionally restrictive muscular adherence, a corollary to surgical tenolysis: a case report.

After a surgical release of adhered nongliding tendons, early active mobilization is encouraged to prevent the reformation of unfavorable adhesions that would limit functional tendon excursion. These restricting adhesions can also occur in non-synovial regions, such as within the flexor mass in the forearm. A "myolysis," or release of muscle fibers from tethering adhesions, can be performed surgically to restore the muscle's gliding and lengthening properties.

Scapholunate instability in athletes.

Sports medicine practitioners must be sensitive to even the smallest injuries that affect athletes. Often, less severe ligament injuries go undetected. Scapholunate dissociation is often overlooked in this manner.

Arthroscopy of the distal radioulnar joint.

Arthroscopy of the distal radioulnar joint is a natural extension of radiocarpal arthroscopy and can be a useful tool for certain conditions that affect this small joint. Arthroscopy provides a minimally invasive means of evaluating the distal radioulnar joint and enables visualization of the articular surfaces, synovium, and undersurface of the triangular fibrocartilage. In this article, indications, surgical techniques, and potential pitfalls of this technically demanding procedure are presented.

Percutaneous and arthroscopic screw fixation of scaphoid fractures in the athlete.

The authors prefer to treat nondisplaced acute scaphoid fractures in the athlete on an individualized basis. Percutaneous or arthroscopic-assisted fixation are valuable techniques to employ when prolonged immobilization is a concern. Return to athletic competition has been rapid using these methods.

Arthroscopic resection of the dorsal ganglia of the wrist.

Arthroscopic ganglion resection provides a means by which dorsal wrist ganglia may be safely resected while avoiding the requisite scar accompanying open resection. Use of the arthroscope provides a much more complete examination of the wrist, allowing assessment of the cause of the ganglion as well as associated intra-articular problems. In a previous pilot study, 50% of patients demonstrated visible intra-articular abnormalities, including SL ligament laxity and perforations, TFCC tears, or chondral degeneration at the radial and triquetral-hamate joints.

Arthroscopic repairs of triangular fibrocartilage complex tears.

Technical advancements in arthroscopic wrist procedures have improved our knowledge of normal and abnormal intraarticular wrist function. Triangular fibrocartilage complex (TFCC) tears from trauma injuries are a common source of ulnar-sided wrist pain. Fortunately, the TFCC is a structure that can be evaluated and treated arthroscopically with results that are comparable to open surgical procedures.

Left-hand dominance and hand trauma.

To investigate the relationship between hand dominance and the risk of major hand injury, the case records of 125 patients who had been treated for digital amputation were retrospectively reviewed. A second group of 116 patients treated for minor hand trauma was similarly evaluated. The incidence of left-hand dominance among the digital amputation group was 35%, and among the minor trauma group the incidence was 11%.

A complex free toe transfer after a reverse radial forearm flap.

A case is reported of the difficulties associated with late free toe transfer for thumb reconstruction after an initial reverse radial forearm flap.

Arthroscopic resection of dorsal ganglion of the wrist.

In summary, arthroscopic resection is a reasonable approach for operative treatment of the dorsal ganglion. Arthroscopy is safe and addresses the key anatomic pathology. Recurrences to date have been equal to or less than with the open technique.

The role of arthroscopy in the treatment of lunatotriquetral ligament injuries.

Disruption of the lunatotriquetral ligament is a common cause of ulnar-sided wrist pain. A review of the literature of the pathophysiology and treatment of LT ligament tears is presented. The authors report a series of 20 consecutive patients with arthroscopically confirmed LT ligament tears without a VISI collapse treated with arthroscopic reduction and pinning of the LT joint.

Complications of immobilization.

Immobilization is common after many surgical procedures performed on the hand, wrist, and elbow. Complications due to immobilization can often present more of a challenge in the rehabilitation of a patient than the initial injury. This article discusses the common complications associated with immobilization, their prevention, and their treatment.

Complications of common carpal injuries.

Interest in the diagnosis and treatment of common disorders of the carpus has intensified in recent years. Although newer nonoperative and surgical procedures have developed to improve outcome, complications and their treatment remain a challenging problem. To address complications of the more common carpal injuries, we have chosen fractures of the scaphoid, scapholunate ligament injuries, carpal fracture dislocations, and fractures of the hook of the hamate for discussion.