Journal of Hand Surgery-Asian-Pacific Volume最新文献

Background: In carpal tunnel syndrome (CTS), pain and sensory disturbance are the main symptoms, but thumb palmar abduction (TPA) paralysis cannot be ignored as a concurrent symptom. The reliable quantitative measurement of TPA power was not established. The purpose of this study was to report on the reliability of TPA strength measurements by the hand-held dynamometry (HHD) in large samples of CTS and its superiority over other tests, including grip, pinch powers, TPA angles and manual muscle testing, in terms of clinical progress indicators. Methods: We examined the relative and absolute reliabilities of the perioperative TPA strength measured by HHD (HHD-TPA) in 566 participants with CTS and the correlation coefficient between the HHD-TPA and other clinical tests. Results: The reliability of the HHD-TPA was intraclass correlation coefficients: 97% or higher. The Bland-Altman absolute reliability showed a random pattern of bias, and the minimal detectable changes (MDC) of the inter-rater and intra-rater reliabilities indicated 9.0 N and 7.0 N individually. The HHD-TPA showed statistically significant recoveries between perioperative stages; however, the mean difference larger than the MDC was recognised only between the preoperative and 12-month postoperative stages by intra-rater comparison. More individual patients showed recovery of HHD-TPA beyond the MDC when the same examiner continuously measured HHD-TPA than when multiple examiners continuously measured HHD-TPA. Grip strength and pinch strength measurements showed a strong correlation with HHD-TPA and did not show statistically significant improvement during the perioperative period. Conclusions: HHD-TPA is the most reliable method for quantifying muscle strength in the perioperative course of TPA force in CTS. HHD-TPA is a more reliable assessment of CTS motor recovery when measured consistently for each patient by the same hand therapist. Level of Evidence: Level IV (Diagnostic).

Background: Currently, large-sample epidemiological studies on congenital upper limb differences (CULD) in China are relatively rare. This report presents our centre's experience on the spectrum of diseases and related factors. Methods: Information was collected from patients with CULD who underwent surgical treatment at our centre from September 2018 to October 2023. Data collection included patient name, gender, age, clinical features and diagnosis, family history, parents' age, parents' medical history, pregnancy history and family income. Bivariate relationships between these variables were examined. Results: The average age of the patients was 4 years; 1,398 patients (99%) were aged 9 months to 18 years, and 17 patients (1%) were adults. There were 848 males (60%) and 567 females (40%), with a statistically significant gender distribution (p < 0.05). The most common differences were polydactyly and syndactyly, accounting for 47% and 14%, respectively. Syndromic patients accounted for 14%, and cardiac conditions were the most prevalent non-musculoskeletal issue (55%). First-born patients accounted for 54% of patients, and the average age of parents for first-born patients was 30 ± 5 years for fathers and 29 ± 2 years for mothers. For non-first-born patients, the average age of parents was 33 ± 6 years for fathers and 32 ± 5 years for mothers, with a statistically significant difference between the two groups (p < 0.001). Conclusions: In China, congenital limb differences are still dominated by polydactyly and syndactyly. Heart conditions occur most frequently in patients with syndromes. Level of Evidence: Level IV (Epidemiological).

Synovial osteochondromatosis is a relatively rare condition of the hand. We present a rare case of a locked finger in a paediatric patient with synovial osteochondromatosis, in which a tumourous lesion was continuous with the flexor tendon and trapped proximal to the A1 pulley. After resection of the tumour and synovium, no recurrence was observed over a 6-month follow-up period. Synovial osteochondromatosis in the hand or fingers can lead to swelling and limited range of motion; however, symptom progression is usually slow. Moreover, it is uncommon for an extra-articular tumour to cause a sudden onset of locking symptoms without prior warning signs. Comprehensive excision of the synovium is essential, and ongoing observation for recurrence is necessary during follow-up. Level of Evidence: Level V (Therapeutic).

Background: Surgeons use anatomical landmarks like the scaphoid tubercle, pisiform, trapezial tubercle and hook of hamate, along with Kaplan cardinal line (KCL) to avoid injury to the recurrent motor branch (RMB) of the median nerve during carpal tunnel release. The presence of transverse muscle fibres (TMF) overlying the transverse carpal ligament (TCL) may suggest proximity of the RMB, but their anatomical relationship is unclear. In this study, we evaluated the accuracy of anatomical landmarks to the RMB, TMF origin and insertion, and examined the relationship between TMF presence and RMB running patterns. Methods: We dissected 30 hands from 16 fresh-frozen cadavers. After marking the superficial landmarks, we made a skin incision to confirm the presence of TMF and examined their origins and insertions. We then opened the carpal tunnel, dissected the RMB and recorded each position on a coordinate system using a fluoroscopic imaging system. Results: TMF were observed in 18 hands (60%): 13 were continuous with the abductor pollicis brevis (APB), 2 were continuous with the superficial head of the flexor pollicis brevis (FPB) and 3 were continuous with both. The bifurcation point of the RMB was significantly located 4.5 mm ulnar and 7.5 mm proximal to the superficial landmark at the median. The RMB was classified according to Poisel classification: 24 (80%) were of the extraligamentous type, 4 (13%) of the transligamentous type, 1 (3%) of the preligamentous type and 1 (3%) of the subligamentous type. Amongst these, the transligamentous/preligamentous/subligamentous types are at high risk for RMB injury during TCL incision. No significant association existed between TMF presence and these high-risk RMB types.. Conclusions: The actual RMB may be located ulnar and proximal to the superficial landmark, indicating that surgeons should be cautious about RMB damage even in the absence of TMF.

Background: Decellularised nerve transplantation has limited therapeutic efficacy for peripheral nerve injuries. In this study, we tested the hypothesis that nerve regeneration can be promoted by increasing blood circulation to the decellularised nerve through the surrounding blood-flow environment. Methods: We transplanted 20 mm decellularised nerves into sciatic nerve defects in Sprague-Dawley rats (female, 12 weeks old). In the intramuscular group, the decellularised nerve was implanted into the biceps femoris muscle and covered with the muscle to provide blood circulation. In the avascular group, the decellularised nerve was sutured to the sciatic nerve and the surrounding nerve bed was cauterised to create a non-bleeding field. In the intramuscular without repair group, the decellularised nerve was implanted in the biceps femoris muscle, but not sutured to the sciatic nerve. Axonal elongation and angiogenesis were evaluated immunohistochemically using anti-neurofilament, anti-S100 and anti-CD31 antibodies in sagittal and transverse sections of the nerve 3 weeks later. Results: In the intramuscular group, the number of neurofilaments per unit area and S100 were higher than those in the other groups (p < 0.05). CD31 staining was predominant in the intramuscular group. Axial images of the nerves confirmed the localisation of CD31-positive cells, and positive cells were found in the centre of the decellularised nerves in the intramuscular group. Conclusions: Decellularised nerve grafts wrapped with vascular-rich tissue promoted nerve regeneration by enhancing angiogenesis in transplanted nerve grafts and preventing ischemia in the centre of the nerve graft.

A 42-year-old man suffered an avulsion amputation of his right middle finger. He had undergone several surgeries since the age of 24, including amputation plasty and implantation of the injured nerve into fat and bone, but had difficulty returning to work due to persistent severe pain. He underwent nerve capping with an artificial nerve conduit at a university hospital, and his symptoms improved slightly, but immediately flared up again. Therefore, he was referred to our hospital and was treated with a blocking splint in addition to resection of the traumatic neuroma, covering with an artificial nerve conduit and wrapping with an adiposal flap. The lumen of the conduit was observed without collapse until it was resorbed, and he returned to work without pain 10 months after surgery. The blocking splint to an angle that preserves the lumen of the conduit was useful for artificial nerve surgery near the joint. Level of Evidence: Level V (Therapeutic).

Background: Amputated neuromas, a common consequence of peripheral nerve injury, can cause significant pain and may impair daily life. Herein, we conducted a retrospective study on patients who underwent a nerve-capping technique using the bioabsorbable nerve conduit Renerve®, with a minimum follow-up period of 6 months. Methods: We conducted a retrospective study to assess patients with amputation neuromas of the finger or palm who underwent surgical treatment using the capping technique with the Renerve® conduit between October 2018 and September 2022. The data on demographics, operative details, pre- and postoperative evaluations (visual analogue scale [VAS] pain scores and Tinel sign) and complications were analysed. Results: Seven patients (seven nerves) with a median age of 51 years (three men and four women) were assessed. The median follow-up duration was 15 months. Renerve® conduits of varying sizes (1.0-2.3 mm) and lengths (15-25 mm) were used. The median duration until surgery was 195 days. After the procedure, VAS pain scores significantly decreased from a baseline of 53.1 mm to 5.7 mm at the 6-month follow-up. Tinel sign persisted in four patients, and no postoperative complications occurred. Conclusions: Our study demonstrates the clinical usefulness of the Renerve® conduit as a nerve-capping technique for amputation neuroma. Considering the limited availability of real-world data on Renerve® conduits for nerve capping, our findings provide valuable insights for clinical practitioners. Level of Evidence: Level IV (Therapeutic).

Background: Due to the rapid evolution of generative artificial intelligence (AI) and its implications on patient education, there is a pressing need to evaluate AI responses to patients' medical questions. This study assessed the quality and usability of responses received from two prominent AI platforms to common patient-centric hand and wrist surgery questions. Methods: Twelve commonly encountered hand and wrist surgery patient questions were inputted twice into both Gemini and ChatGPT, generating 48 responses. Each response underwent a content analysis, followed by assessment for quality and usability with three scoring tools: DISCERN, Suitability Assessment of Materials (SAM) and the AI Response Metric (AIRM). Statistical analyses compared the features and scores of the outputs when stratified by platform, question type and response order. Results: Responses earned mean overall scores of 55.7 ('good'), 57.2% ('adequate') and 4.4 for DISCERN, SAM and AIRM, respectively. No responses provided citations. Wrist question responses had significantly higher DISCERN (p < 0.01) and AIRM (p = 0.02) scores compared to hand responses. Second responses had significantly higher AIRM (p < 0.01), but similar DISCERN (p = 0.76) and SAM (p = 0.11), scores compared to the first responses. Gemini's DISCERN (p = 0.04) and SAM (p < 0.01) scores were significantly higher than ChatGPT's corresponding metrics. Conclusions: Although responses are generally 'good' and 'adequate', there is variable quality with respect to platform used, type of question and response order. Given the diversity of publicly available AI platforms, it is important to understand the quality and usability of information patients may encounter during their search for answers to common hand and wrist surgery questions. Level of Evidence: Level IV (Therapeutic).