HAND最新文献

Background: Understanding the median nerve's position relative to surrounding anatomy is essential; however, there are many variations among individuals. This study assesses differences in median nerve position with or without palmaris longus (PL). We hypothesize that PL presence alters median nerve position, resulting in a greater distance to the skin volar surface, a decreased distance to the radius volar surface, and an increased distance to the flexor carpi radialis (FCR).

Methods: 1193 wrist magnetic resonance imaging (MRI) studies were retrospectively reviewed from 2019 to 2023. One hundred adults ages 18 to 50 meeting criteria were included for a power > 80%: 50 wrist axial plane MRIs (distal radial-ulnar joint level) with PL and 50 without PL. Measurements included the distance from the median nerve center to the skin volar surface, radius volar surface, and FCR center. Statistical analysis included Fisher exact tests and Mann-Whitney U Test (median, ranges), with significance at P-value < 0.05.

Results: Individuals with PL had a greater distance between the median nerve and skin volar surface. The presence of PL exhibited no discernable difference in the distance between the median nerve to the radius volar surface or the FCR center. Palmaris longus presence or absence did not affect the radial/ulnar positioning of the median nerve to the FCR center.

Conclusions: PL presence results in a deeper median nerve position within the wrist in relation to the skin volar surface. This knowledge is crucial for musculoskeletal specialists, especially during volar approach wrist surgeries and when administering anesthetic or therapeutic injections to the median nerve.

Background: Vascular malformations (VMs) are a collection of rare diseases that result from abnormal overgrowth of vascular tissue and can lead to pain, infection, disfigurement, and decreased mobility. Vascular malformations can invade or impinge on nearby structures, including nerves, causing pain, numbness, and/or functional impairment. If nonsurgical therapy fails, surgical resection is considered. However, VMs' thin walls and tendency to infiltrate and/or recur makes resection difficult or impossible. Rather than resecting, we have found that patients can still benefit from surgery in the form of nerve decompression. Here, we present a series of patients with VMs causing symptomatic nerve compression that were successfully treated with nerve decompression, with or without VM resection. It is the purpose of this study to demonstrate that VM patients with nerve pain and/or sensorimotor dysfunction should be referred for evaluation by a peripheral nerve surgeon, regardless of whether the VM is considered "resectable."

Methods: Retrospective chart review of patient undergoing nerve decompression surgery for symptoms of peripheral nerve compression (pain and/or motor/sensory dysfunction) attributable to a nearby VM (confirmed on preoperative magnetic resonance imaging), with or without VM resection.

Results: Six patients with peripheral nerve compression attributable to VM were treated with nerve decompression. One also underwent VM resection. Five of the 6 patients had undergone previous surgical intervention (resection or sclerotherapy) without clinical improvement in radiculopathy. Following intervention, all patients demonstrated improvement of their pain and motor/sensory dysfunction.

Conclusions: Patients with VM nerve pain and/or sensorimotor dysfunction should be referred for evaluation by a peripheral nerve surgeon, regardless of whether the VM is deemed resectable. Even when unresectable, patients may still benefit from surgery in the form of nerve decompression.

Background: Documentation burden is a major contributor to surgeon burnout, particularly in high-volume outpatient specialties such as hand surgery. These encounters often involve multiple concurrent diagnoses, procedural planning, and longitudinal care. Ambient artificial intelligence (AI) tools, which passively transcribe and summarize clinical encounters in real time, have the potential to streamline note generation and reduce cognitive load.

Methods: Following institutional rollout of a commercially available ambient AI tool in early 2025, the system was adopted across all outpatient visits in a hand surgery clinic. Observations were collected regarding workflow adaptation, documentation quality, and perceived cognitive impact. To assess note characteristics, 14 carpal tunnel syndrome visit notes (7 AI-generated and 7 surgeon-written) were compared by word count, Flesch-Kincaid readability score, and inclusion of social and medical history.

Results: AI-generated histories were longer and exhibited greater linguistic complexity compared with surgeon-written notes. Surgeon-written assessments were longer, more readable, and more consistent in structure and tone. Social history was documented more frequently in AI-generated notes. All AI-generated assessment and plan sections followed a structured, problem-based format.

Conclusions: Ambient AI documentation can support the creation of more structured and contextually rich clinical notes in hand surgery settings. However, successful integration requires active clinician engagement and workflow alignment to balance efficiency with clinical accuracy. These findings highlight both the promise and the practical considerations of incorporating ambient AI into surgical documentation workflows.

Background: Dupuytren's disease causes progressive flexion contractures and impaired hand function. While percutaneous needle aponeurotomy (PNA) provides rapid correction with low morbidity, the effect on grip strength remains unclear. Grip strength is a key surrogate of hand function and overall health, yet it has been inconsistently evaluated as an outcome in Dupuytren's disease.

Methods: A prospective study was conducted at a tertiary referral center including 53 patients (80 digits) treated with PNA between February 2024 and March 2025. Standardized assessments included grip strength (Jamar dynamometer, American Society of Hand Therapists protocol), joint extension deficits, patient-reported outcomes (Southampton, Unité Rhumatologique des Affections de la Main [URAM]), and return-to-work data. Grip strength was reassessed at 2 months postprocedure to capture early functional recovery. Statistical analysis used paired t tests and Wilcoxon signed-rank tests, with significance set at P < .05.

Results: Mean grip strength improved from 24.9 to 28.7 kg (mean change + 3.8 kg, P < .001). Extension deficits decreased significantly at all levels, with mean correction of 25.5° at the metacarpophalangeal joint (MCPJ) and 29.3° at the proximal interphalangeal joint (PIPJ) (P < .001). At 2 months, the median URAM score was 4 out of 45, and the Southampton score was 3 out of 20, reflecting excellent functional recovery. Forty-four employed patients returned to work within 1 week. Complications were minor (skin tears n = 9, transient hypersensitivity n = 1) with no major adverse events.

Conclusions: Percutaneous needle aponeurotomy (PNA) not only corrects digital contracture but also yields clinically significant improvements in grip strength, reinforcing its value as a functional outcome measure. These findings support PNA as a safe, effective first-line treatment for selected patients with Dupuytren's disease.

Upper-limb spasticity after stroke, traumatic brain injury, cerebral palsy, multiple sclerosis, or spinal cord injury limits function and care. Hyperselective neurectomy (HSN)-partial resection of selected motor branches at the muscle entry point-aims to lower tone while preserving voluntary strength. Following PRISMA 2020 guidelines, 10 studies (260 adults) were identified, almost all performed under general anesthesia, with 1 small series using wide-awake local anesthesia with no tourniquet (WALANT). Across studies, HSN reduced spasticity by about 1 to 2.5 points on the Modified Ashworth Scale; where data allowed pooling (6 studies), the average improvement was 1.64 points on the 0 to 4 scale (95% CI, 1.36-1.92). These reductions were durable up to 4 to 5 years and were accompanied by better function (higher House scores), improved resting posture and range of motion, and easier care. Recurrence was uncommon and usually manageable with revision or staged treatment of untreated synergists. Complications were rare and transient, and no modern series reported permanent weakness in treated muscles. Early experience with WALANT is limited to a single small case series but suggests that intraoperative testing of tone and voluntary movement is feasible and may help titrate resection. Overall, HSN appears to provide safe, effective, and durable tone reduction with meaningful functional gains; future studies should refine patient selection, use more robust spasticity measures, and formally compare anesthesia strategies, including WALANT.Level of Evidence: IV (Systematic review of non-comparative case series).

Background: Proximal phalanx fractures are common upper extremity injuries; surgical fixation is often recommended for unstable patterns. Intramedullary screw (IMS) fixation has emerged as a minimally invasive technique with potential benefits of earlier motion and reduction of soft tissue disruption compared with traditional methods. However, its resistance to fracture displacement in rotationally unstable fracture patterns requires further investigation. This study compares the biomechanical stability of single IMS, dual crossing IMS, and 2 interfragmentary cortical screw constructs in short oblique proximal phalanx fractures.

Methods: Eleven cadaveric hands were used in the study. Sixty-degree oblique extra-articular proximal phalanx fractures were created in middle, index, and ring fingers and then randomly assigned to 1 of 3 constructs: single 3.5-mm IMS, dual crossing 2.5-mm IMS, or two 1.5-mm cortical screws perpendicular to the fracture. The hands underwent a flexion-extension protocol of 2000 cycles at 0.25 Hz, simulating postoperative motion. The fractures' angular rotation (degrees) and displacement in coronal and sagittal planes (millimeters) were subsequently measured. Statistical analysis was conducted using analysis of variance with P value <.05 defined as statistically significant.

Results: There was no significant difference in average angular rotation, or sagittal and coronal displacement across the 3 constructs after simulated early postoperative range of motion. None of the specimen reached clinically significant displacement more than 2 mm.

Conclusion: The biomechanical stability of single IMS, dual IMS, and interfragmentary screws does not differ when considering angular rotation or displacement during simulated early postoperative range of motion in short oblique proximal phalanx fractures.

Background: Patients with end-stage renal disease (ESRD) requiring dialysis are at increased risk for postoperative complications due to immune dysfunction, impaired healing, and vascular fragility. While dialysis has been studied in various surgical contexts, limited data exist on outcomes following hand fracture fixation. This study evaluates complication rates in dialysis-dependent versus nondialysis patients undergoing surgical fixation of distal radius, metacarpal, and phalangeal fractures.

Methods: A retrospective cohort analysis was performed using the PearlDiver Mariner database to identify adults who underwent open reduction and internal fixation (ORIF) for distal radius, metacarpal, or phalangeal fractures. Patients were stratified by dialysis status. Complications, including infection, hematoma, delayed healing, and revision, were assessed at 30 days, 90 days, and 1 year. Rates were compared between groups, with subgroup and univariate logistic regression analyses conducted to evaluate associations between dialysis and outcomes..

Results: Dialysis-dependent patients had significantly higher complication rates. For distal radius ORIF, complication rates were 16.72% in dialysis patients versus 5.3% in controls (P < .001), with infection rates of 12.67% versus 3.63% (P < .001). Metacarpal ORIF showed a complication rate of 21.77% versus 10.48% (P = .016), largely due to infection (16.94% vs 4.03%, P = .001). Phalanx ORIF showed no difference in overall complications, but infection was more common in dialysis patients (17.65% vs 0%, P = .001). Regression confirmed increased complication odds in dialysis patients.

Conclusions: Dialysis-dependent patients undergoing hand fracture fixation face significantly higher complication rates, primarily due to infection, highlighting the need for specialized perioperative management.

Background: This study aimed to determine whether trapezium morphology, specifically trapezial inclination, is a risk factor for the failure of primary conservative or minimally invasive treatment for acute traumatic thumb carpometacarpal (CMC) joint dislocations in the relatively early period. We hypothesized that an elevated trapezial inclination would be associated with a higher rate of treatment failure.

Methods: We retrospectively reviewed patients treated for acute thumb CMC joint dislocations between 1976 and 2025 with closed reduction and subsequent immobilization or percutaneous pinning. Patients were classified into "failure" (recurrent dislocation or subsequent symptomatic subluxation) or "non-failure" groups. Trapezial inclination, measured on oblique hand radiographs, was compared between the groups using the Mann-Whitney U test.

Results: Fourteen patients met the inclusion criteria (7 failure, 7 non-failure). While demographics were not significantly different, the failure group demonstrated a significantly higher mean trapezial inclination (19.1° vs 8.7°; P = .0012). This significant difference persisted in a subgroup analysis that excluded associated Gedda type 3 Bennett fracture (P = .0318)Conclusions:Elevated trapezial inclination may predict the failure of primary conservative or minimally invasive treatment in the relatively early period for acute thumb CMC joint dislocation. Our findings suggest that patients with this steep trapezium may be poor candidates for conservative or minimally invasive management and should be considered for primary definitive surgery.

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for glycemic control, but their relationship with diabetes-related musculoskeletal conditions remains unclear. This study compared rates of carpal tunnel syndrome (CTS), carpal tunnel release (CTR), and CTR complications in patients with type 2 diabetes mellitus (T2DM) with and without GLP-1 RA use.

Methods: Adult T2DM patients were identified using the TriNetX database. The primary analysis compared patients with versus without GLP-1 RA use. The secondary analysis examined T2DM patients with CTS, stratified by GLP-1 RA exposure. The tertiary analysis included T2DM patients with GLP-1 RA use within 6 months before CTR versus controls without preoperative exposure. Cohorts were propensity-matched for demographics and comorbidities. Outcomes included CTS incidence (primary analysis), CTR incidence (secondary analysis), and 90-day postoperative complications (tertiary analysis).

Results: The primary analysis identified 555 267 matched pairs. Carpal tunnel syndrome incidence was 4.8% in GLP-1 RA users versus 5.5% in nonusers (relative risk [RR] 0.886, 95% confidence interval [CI] 0.872, 0.901). Conversely, GLP-1 RA use was associated with higher CTR prevalence (RR 1.138, 95% CI 1.104, 1.174). Postoperative complication rates, including infection, wound dehiscence, complex regional pain syndrome (CRPS), and stiffness, were comparable between groups.

Conclusions: Glucagon-like peptide-1 receptor agonist use was associated with reduced CTS incidence but higher CTR prevalence, without differences in postoperative complication rates. These findings suggest GLP-1 RAs may exert protective effects on musculoskeletal pathology and do not necessitate cessation before CTR.

Background: A Streamlined Care In Pediatric Hand Injuries (SCI-PHI) pathway was developed to reduce unnecessary follow-ups and improve health care resource utilization. This study aimed to investigate the post-implementation outcomes of patients treated with this previously developed SCI-PHI pathway.

Methods: Participants were contacted 12 months post-injury to complete a questionnaire, including a modified version of the Michigan Hand Questionnaire and the Patient-Reported Outcomes Measurement Information System upper extremity score.

Results: Ninety-four percent of patients had a pain-free return to activity, and 93% were satisfied with the appearance and function of their injured hand. Five patients (4%) had questions that were answered over the phone, and 5 patients (4%) requested follow-up with the surgical team. No patients required any intervention beyond reassurance. There was a consequent 27% reduction in visits.

Conclusions: The SCI-PHI pathway for children with simple hand injuries demonstrates good patient-reported outcomes and satisfaction. This has the potential to save significant resources for both families and the health care system.