Patient Satisfaction with Pisiform Excision for Pisotriquetral Instability or Arthritis: A Prospective Review.

IF 0.7 Q4 ORTHOPEDICS Journal of Wrist Surgery Pub Date : 2022-12-29 eCollection Date: 2023-08-01 DOI:10.1055/s-0042-1758708
Mikaela J Peters, Avi Mazor, Zafeiria Glaris, Thomas Joseph Goetz
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Abstract

Background  Pisotriquetral pain and instability is an elusive cause of ulnar-sided wrist pain. Initial treatment of chronic pisotriquetral pathology should involve a trial of nonoperative therapy such as neutral wrist splint, anti-inflammatories, and intra-articular steroid injections. The mainstay of surgical management of pisotriquetral pain is pisiform excision. Purpose  This prospective study seeks to understand patient satisfaction after pisiform excision in patients with isolated pisotriquetral pathology. Patients and Methods  A consecutive series of nine cases of pisiform excision was performed by the senior surgeon. The primary outcome measure was determined a priori to be the Patient-Rated Wrist Evaluation (PRWE) score. Wrist range of motion, grip strength, and QuickDASH (shortened version of Disabilities of the Arm, Shoulder and Hand) scores were also collected preoperatively and at 3 and 12 months postoperatively as secondary outcome measures. Results  There was a very rapid improvement in the PRWE by 3 months, which was maintained at 12 months. The QuickDASH score was slower to improve, with a significant improvement by 12 months. There was no change in grip strength or wrist range of motion at any time point. Conclusion  Pisiform excision results in a very rapid improvement of symptoms and should be considered in cases of pisotriquetral instability or arthritis that fail conservative management. Level of Evidence  Level IV, case series.

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患者对肩胛骨切除术治疗肩关节不稳或关节炎的满意度:前瞻性回顾
背景 肩周疼痛和不稳定是尺侧腕痛的一个难以捉摸的原因。慢性腕对掌病变的初始治疗应包括试用非手术疗法,如中立腕夹板、消炎药和关节内类固醇注射。手术治疗肩胛骨疼痛的主要方法是肩胛骨切除术。目的 本前瞻性研究旨在了解孤立性右肩胛骨病变患者在接受肩胛骨切除术后的满意度。患者和方法 由资深外科医生连续进行了九例肩胛脓肿切除术。主要结果测量指标事先确定为患者评定的腕部评估(PRWE)得分。术前、术后 3 个月和 12 个月还收集了腕关节活动范围、握力和 QuickDASH(手臂、肩部和手部残疾的缩写版)评分,作为次要结果测量指标。结果 术后 3 个月,PRWE 快速改善,并在术后 12 个月保持不变。QuickDASH 评分的改善速度较慢,但在 12 个月后有显著改善。握力和腕关节活动范围在任何时间点都没有变化。结论 梨状肌切除术能迅速改善症状,对于保守治疗无效的肩胛骨不稳或关节炎病例,应考虑进行梨状肌切除术。证据等级 IV 级,病例系列。
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