Hand Surgery & Rehabilitation最新文献

英文中文

Ultrasound-guided anterograde Carpal Tunnel release: Anatomical landmarks of the distal boundary – A cadaveric study 超声引导的顺行腕管释放术：远端边界的解剖标志-一项尸体研究。

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation

Pub Date : 2026-02-01 Epub Date: 2025-12-11 DOI: 10.1016/j.hansur.2025.102562

Marion Mutschler , Bérénice Moutinot , Olivier Marès

Background

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Anterograde ultrasound-guided carpal tunnel release is now a widely adopted technique. However, identifying the distal limit of the transverse carpal ligament (TCL) on a longitudinal view remains challenging. This study investigates whether the ‘V’-shaped structure seen on longitudinal ultrasound can serve as a reliable landmark for complete TCL release.

Materials and methods

Ten fresh cadaveric upper limbs were examined. Four anatomical landmarks were identified and marked under ultrasound guidance, including the distal end of the 'V'-shaped structure seen on longitudinal view. An ultrasound-guided anterograde release of the transverse carpal ligament was then performed, advancing the instrument to the distal end of the V-shaped sonographic image. A final anatomical dissection verified the correspondence between ultrasound landmarks and underlying structures, particularly the superficial palmar arch.

Results

The distal end of the 'V'-shaped structure was consistently located distal to Kaplan’s line and trapezium–hook of hamate line. It averaged 6.8 mm from the superficial palmar arch. In 5 of 10 cases, this distance was ≤5 mm, and in one case, the section came into contact with the superficial palmar arch without causing injury.

Conclusion

The ‘V’-shaped structure extends beyond the anatomical limits of the carpal tunnel. Despite its proximity to the superficial palmar arch, no vascular injury occurred. These findings support the need for continuous ultrasound guidance and highlight that the ‘V’ sign does not represent the true distal limit of the carpal tunnel. Larger in vivo studies are required to confirm these results and establish consistent longitudinal ultrasound landmarks for safe carpal tunnel release.

背景：腕管综合征（Carpal tunnel syndrome， CTS）是最常见的外周神经病变。顺行超声引导下的腕管松解术目前已被广泛采用。然而，在纵向视图上确定腕横韧带（TCL）的远端极限仍然具有挑战性。本研究探讨纵向超声显示的“V”形结构是否可以作为TCL完全释放的可靠标志。材料与方法：对10例新鲜尸体上肢进行检查。在超声引导下识别并标记四个解剖标志，包括纵向视图上看到的“V”形结构的远端。然后在超声引导下顺行释放腕横韧带，将器械推进到v型超声图像的远端。最后的解剖解剖证实了超声标记和基础结构之间的对应关系，特别是掌浅弓。结果：“V”型结构的远端始终位于Kaplan线和钩骨线的远端。距掌浅弓平均6.8 mm。10例中有5例距离≤5mm， 1例与掌浅弓接触，未造成损伤。结论：“V”型结构超出了腕管的解剖极限。尽管其靠近掌浅弓，但未发生血管损伤。这些发现支持持续超声引导的必要性，并强调“V”标志并不代表真正的腕管远端界限。需要更大规模的体内研究来证实这些结果，并建立一致的纵向超声标志，以安全释放腕管。

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引用次数: 0

Adaptive fashion: enhancing confidence for children with hand and upper-limb differences 适应性时尚：增强手部和上肢差异儿童的自信心。

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation

Pub Date : 2026-02-01 Epub Date: 2026-01-08 DOI: 10.1016/j.hansur.2026.102568

Sarbjit Kaur , Carmen Burkett , Yangmyung Ma , Christina Lipede , Andrea Jester

引用次数: 0

Recurrent rotational instability after proximal interphalangeal silicone arthroplasty: a transosseous stabilization technique 近端指间硅胶关节置换术后复发性旋转不稳定：经骨稳定技术。

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation

Pub Date : 2026-02-01 Epub Date: 2026-01-21 DOI: 10.1016/j.hansur.2026.102581

Tim Philips , Michiel Cromheecke , Pieter-Bastiaan De Keyzer , Peter Coeman , Jean F. Goubau

Rotational instability following revision silicone arthroplasty of the proximal interphalangeal joint is rare and difficult to manage, especially in young patients with hyperlaxity. This paper sets out a novel surgical technique for recurrent prosthesis rotation. The technique consists of a transosseous fixation through both phalanges.

近端指间关节翻修后的旋转不稳定是罕见且难以控制的，特别是在年轻的高血压患者中。本文提出了一种治疗复发性假体旋转的新手术技术。该技术包括通过双指骨的经骨固定。

引用次数: 0

The ‘scaffold needles’ technique: A simple tip for maintaining arthroscopic reduction of distal radius fragments “支架针”技术：维持关节镜下桡骨远端碎片复位的简单技巧。

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation

Pub Date : 2026-02-01 Epub Date: 2025-12-05 DOI: 10.1016/j.hansur.2025.102543

Jean-Baptiste de Villeneuve Bargemon, Rémy Dubian, Lucas Audiffret

引用次数: 0

The CLEAR procedure: A five-step safety framework for ultrasound-guided carpal tunnel release CLEAR程序：超声引导下腕管松解术的五步安全框架。

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation

Pub Date : 2026-02-01 Epub Date: 2026-01-22 DOI: 10.1016/j.hansur.2026.102584

JeanMichel Cognet , Jasper De Geyter

Background

Ultrasound-guided carpal tunnel release (CTR-US) has emerged as a reliable and minimally invasive alternative to open or endoscopic surgery. However, the variability of techniques and the absence of a standardized framework may increase the risk of iatrogenic complications, particularly during the learning curve.

Purpose

To describe the CLEAR procedure, a five-step structured method designed to ensure safety, reproducibility, and educational consistency in ultrasound-guided median nerve release at the carpal tunnel.

Methods

The CLEAR procedure synthesizes current anatomical, technical, and interventional imaging data into five core principles:

C — Critical anatomical awareness, building a precise mental map of the carpal tunnel anatomy before starting.

L — Locate with ultrasound, to define a patient-specific safe zone.

E — Equip with the appropriate device, selecting a blade that provides constant visualization and reproducible mechanics.

A — Always visualize the blade, ensuring continuous ultrasound control during ligament section.

R — Rule out bleeding, with final Doppler verification performed without a tourniquet.

Results

This codified sequence standardizes the operative workflow, reducing operator-dependent variability. Continuous ultrasound visualization and final Doppler control significantly minimize iatrogenic events and postoperative hematomas.

Conclusion

The CLEAR procedure provides a pragmatic, safety-oriented pedagogical framework for CTR-US. It articulates the principle that no step is complete until safety has been verified. Prospective evaluation of CLEAR versus usual care is warranted.

背景：超声引导下的腕管松解术（cr - us）已成为一种可靠的微创手术，可替代开放或内窥镜手术。然而，技术的可变性和缺乏标准化框架可能会增加医源性并发症的风险，特别是在学习曲线期间。目的：描述CLEAR手术，这是一种五步结构化方法，旨在确保超声引导下腕管正中神经释放的安全性、可重复性和教育一致性。方法：CLEAR程序将当前的解剖、技术和介入成像数据综合为五个核心原则：C -关键解剖意识，在开始前建立精确的腕管解剖心理图。L -用超声波定位，以确定患者特定的安全区域；E -配备适当的设备，选择一个刀片，提供持续的可视化和可复制的力学；A -始终可视化叶片，确保在韧带切片过程中连续超声控制；R -排除出血，在没有止血带的情况下进行最后的多普勒验证。结果：该编码序列标准化了操作流程，减少了操作员依赖的可变性。持续的超声显像和最终的多普勒控制显著减少医源性事件和术后血肿。结论：CLEAR程序为cr - us提供了一个实用的、以安全为导向的教学框架。它阐明了在安全性得到验证之前任何步骤都不完整的原则。有必要对CLEAR与常规护理进行前瞻性评估。

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引用次数: 0

Resorbable suture cerclage fixation for spiral metacarpal fractures 可吸收缝线环扣固定治疗螺旋型掌骨骨折。

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation

Pub Date : 2026-02-01 Epub Date: 2025-12-03 DOI: 10.1016/j.hansur.2025.102544

Ruben Dukan , Remy Pichard , Salma Otayek , Marc Soubeyrand

引用次数: 0

Comment on: Morphometric and curvature CT-based study of the distal radius watershed line. Valerio T, Lupon E, Quemener-Tanguy A, Masse E, Brenac C, de Villeneuve Bargemon J-B. Hand Surg Rehabil. 2025;44:102168 点评：基于形态学和曲率ct的桡骨远端分水岭线研究。Valerio T, Lupon E, Quemener-Tanguy A, Masse E, Brenac C, de Villeneuve Bargemon J-B。中华手外科杂志[j]; 2015;44(4):1021。

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation

Pub Date : 2026-02-01 Epub Date: 2025-10-17 DOI: 10.1016/j.hansur.2025.102300

Parth Aphale, Himanshu Shekhar, Shashank Dokania

引用次数: 0

Endoneurial damage is associated with chronic dysfunction and neuroma formation after stretch injury in the rat median nerve 大鼠正中神经牵张损伤后的神经内膜损伤与慢性功能障碍和神经瘤形成有关。

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation

Pub Date : 2026-02-01 Epub Date: 2025-11-19 DOI: 10.1016/j.hansur.2025.102538

Christoph A. Schroen , Damien Laudier , Philip Nasser , Satomi Hiya , Timothy E. Richardson , Michael R. Hausman , Paul J. Cagle

Purpose

Peripheral nerve stretch injuries are highly challenging to treat due to a poor understanding of the differences between injuries that recover naturally and those requiring surgical intervention. The rat median nerve exhibits two levels of mechanical and structural failure, epineuroclasis and endoneuroclasis, and this study investigated their long-term structural and functional outcomes. An investigation into the outcomes of distinct degrees of nerve stretch injury could help in accurately assessing the prognosis for recovery and the need for surgical treatment.

Methods

Left median nerves of 17 rats were stretched to an epineuroclasis (n = 8) and endoneuroclasis injury (n = 9), right nerves served as sham-control. Nerves were stretched using a hook attached to a load-cell, generating load-deformation curves in real-time. Epineuroclasis injury was induced with a first, endoneuroclasis injury with a second rapid force reduction. Handheld electrical stimulators were used to assess function before, immediately after and 12 weeks after injury. Tissue was harvested for histology and rats were euthanized.

Results

Epineuroclasis showed persistent epineurial disruption at 12 weeks, similar to an acute injury, while nerve function improved over time. Endoneuroclasis resulted in a traumatic neuroma in 8/9 nerves, in a neuroma-in-continuity in 5/6 intact nerves, and a chronic loss of function at 12 weeks.

Conclusions

The prognosis for recovery and the likelihood of neuroma formation after stretch injury worsens along an outside-in sequence of connective tissue failure in the rat median nerve.

Clinical relevance

The neuroclasis classification might be helpful in developing novel diagnostic tools and evaluating the prognosis for recovery and need for surgical treatment. This study further highlights a potential need for different classification systems for nerve stretch and crush injuries.

目的：由于对自然恢复损伤和需要手术干预的损伤之间的差异了解不足，周围神经拉伸损伤的治疗极具挑战性。大鼠正中神经表现出两种程度的机械和结构破坏，即神经外裂和神经内裂，本研究探讨了它们的长期结构和功能结局。探讨不同程度的神经牵拉损伤的预后，有助于准确评估康复预后和手术治疗的需要。方法：将17只大鼠左正中神经拉伸成神经外裂伤（n = 8）和神经内裂伤（n = 9），右正中神经作为假对照。神经用连接在测力元件上的钩子进行拉伸，实时生成荷载变形曲线。神经外裂伤是由第一次引起的，神经内裂伤是由第二次快速复位引起的。使用手持式电刺激器评估损伤前、损伤后立即和损伤后12周的功能。收集组织用于组织学研究，并对大鼠实施安乐死。结果：在12周时，神经外膜分裂表现为持续的神经外膜破坏，类似于急性损伤，而神经功能随着时间的推移而改善。内皮细胞分裂导致8/9的神经出现外伤性神经瘤，5/6的完整神经出现连续性神经瘤，12周时慢性功能丧失。结论：大鼠正中神经拉伸损伤后的恢复预后和神经瘤形成的可能性沿外向内的结缔组织衰竭顺序恶化。临床意义：神经断裂分类可能有助于开发新的诊断工具和评估预后的恢复和需要手术治疗。这项研究进一步强调了对神经拉伸和挤压损伤的不同分类系统的潜在需求。

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引用次数: 0

Low grade chondrosarcoma of the hand treated with curettage: Long term outcomes 手部低级别软骨肉瘤刮除治疗：长期结果。

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation

Pub Date : 2026-02-01 Epub Date: 2025-11-21 DOI: 10.1016/j.hansur.2025.102539

Shyama S. Chadha , David M.S. Bodansky , Kapil Sugand , Garikai Kungwengwe , Umar Rehman , Michael Khoo , Maxim D. Horwitz

Background

Chondrosarcomas are primary bone malignancies, with most lesions of the hand representing low grade chondral tumours (LGCT). Low grade (grade one) chondrosarcomas are defined as Atypical Cartilaginous Tumours by the 2020 World Health Organisation Classification. Grades two and three are termed high-grade chondral tumours (HGCT).

Aim

To establish whether low-grade chondral tumours of the hand can be safely treated with simple curettage and assess recurrence rates.

Methods

Retrospective data was analysed from a tertiary referral hospital for bone tumours in the UK over a 13-year period. 158 patients with histological proven chondral tumours of the hand, requiring curettage, resection or amputation were included.

Results

13 (8.2%) had HGCT and 145 (91.8%) had LGCT. 136 LGCTs underwent intralesional curettage (98.5%). 8 (5.1%) underwent wide local resection (6 LGCT and 2 HGCT). 14 (8.9%) underwent amputation (5 LGCT and 9 HGCT). All HGCT patients were free from recurrence at a median of 81.7 months. Patients expressing GD2/3 tumour marker antigens were more likely to be HGCT on histology compared with those not expressing GD2/3 and more likely to require extensive surgery.

Conclusion

In contrast to chondrosarcoma occurring in long bones, there is often discordance between histological and radiological appearance in lesions occurring in the small bones of the hand. These lesions may appear aggressive radiologically but prove to be low-grade on histology. We concluded that intralesional curettage was an effective method for managing LGCT of the hand, whilst more extensive surgery can be reserved for higher grade tumours. GD2/3 expression was associated with high-grade lesions.

Evidence level

III.

背景：软骨肉瘤是原发性骨恶性肿瘤，大多数手部病变代表低级别软骨肿瘤（LGCT）。根据2020年世界卫生组织分类，低级别（1级）软骨肉瘤被定义为非典型软骨肿瘤。二级和三级被称为高级别软骨肿瘤（HGCT）。目的：探讨手部低级别软骨肿瘤单纯刮除术能否安全治疗并评估复发率。方法：回顾性数据分析从三级转诊医院骨肿瘤在英国超过13年期间。158例经组织学证实需要刮除、切除或截肢的手部软骨肿瘤患者纳入研究。结果：HGCT 13例（8.2%），LGCT 145例（91.8%）。136例lgct行局内刮除（98.5%）。8例（5.1%）行局部广泛切除术（6例LGCT， 2例HGCT）。14例（8.9%）行截肢（LGCT 5例，HGCT 9例）。所有HGCT患者在中位81.7个月时均无复发。与不表达GD2/3的患者相比，表达GD2/3肿瘤标记抗原的患者在组织学上更有可能是HGCT，更有可能需要广泛的手术。结论：与发生在长骨的软骨肉瘤不同，发生在手部小骨的病变的组织学和影像学表现往往不一致。这些病变在放射学上表现为侵袭性，但在组织学上表现为低级别。我们的结论是，病灶内刮除是治疗手部LGCT的有效方法，而更广泛的手术可以保留用于更高级别的肿瘤。GD2/3表达与高级别病变相关。证据等级：III。

{"title":"Low grade chondrosarcoma of the hand treated with curettage: Long term outcomes","authors":"Shyama S. Chadha , David M.S. Bodansky , Kapil Sugand , Garikai Kungwengwe , Umar Rehman , Michael Khoo , Maxim D. Horwitz","doi":"10.1016/j.hansur.2025.102539","DOIUrl":"10.1016/j.hansur.2025.102539","url":null,"abstract":"<div><h3>Background</h3><div>Chondrosarcomas are primary bone malignancies, with most lesions of the hand representing low grade chondral tumours (LGCT). Low grade (grade one) chondrosarcomas are defined as Atypical Cartilaginous Tumours by the 2020 World Health Organisation Classification. Grades two and three are termed high-grade chondral tumours (HGCT).</div></div><div><h3>Aim</h3><div>To establish whether low-grade chondral tumours of the hand can be safely treated with simple curettage and assess recurrence rates.</div></div><div><h3>Methods</h3><div>Retrospective data was analysed from a tertiary referral hospital for bone tumours in the UK over a 13-year period. 158 patients with histological proven chondral tumours of the hand, requiring curettage, resection or amputation were included.</div></div><div><h3>Results</h3><div>13 (8.2%) had HGCT and 145 (91.8%) had LGCT. 136 LGCTs underwent intralesional curettage (98.5%). 8 (5.1%) underwent wide local resection (6 LGCT and 2 HGCT). 14 (8.9%) underwent amputation (5 LGCT and 9 HGCT). All HGCT patients were free from recurrence at a median of 81.7 months. Patients expressing GD2/3 tumour marker antigens were more likely to be HGCT on histology compared with those not expressing GD2/3 and more likely to require extensive surgery.</div></div><div><h3>Conclusion</h3><div>In contrast to chondrosarcoma occurring in long bones, there is often discordance between histological and radiological appearance in lesions occurring in the small bones of the hand. These lesions may appear aggressive radiologically but prove to be low-grade on histology. We concluded that intralesional curettage was an effective method for managing LGCT of the hand, whilst more extensive surgery can be reserved for higher grade tumours. GD2/3 expression was associated with high-grade lesions.</div></div><div><h3>Evidence level</h3><div>III.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"45 1","pages":"Article 102539"},"PeriodicalIF":1.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Revisiting psychopathological hand as a functional neurological disorder: Time to reframe? 重新审视精神病理手作为一种功能性神经障碍：是时候重新定义了？

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation

Pub Date : 2026-02-01 Epub Date: 2025-12-13 DOI: 10.1016/j.hansur.2025.102563

Florent Julien , Nicolas Bigorre , Frédéric Degez , Sylvain Celerier

Objectives

The "psychopathological hand" or "psychogenic hand", long regarded as a clinical curiosity, remains underdiagnosed today and is sometimes confused with other hand conditions. The aim of this article is to reframe the psychopathological hand syndrome within the field of functional neurological disorders, in order to clarify its clinical, pathophysiological and therapeutic specificities.

Methods

A narrative review of the literature was conducted using international medical databases and reference works in functional neurology, psychiatry and hand surgery. The main data were synthesized along four axes: historical aspects, diagnostic and clinical criteria, comorbidities and pathophysiological models, therapeutic strategies and organization of care.

Results

Functional neurological disorders of the hand are characterized by anatomo-clinical inconsistencies, symptom variability, and frequent presentations such as functional dystonias, tremors, paresis or atypical pain. They occur in a context of vulnerability due to early trauma, heightened bodily vigilance, and psychiatric or somatic comorbidities. From a neurofunctional perspective, they reflect a disorganization of the networks of agency, interoception and emotion. Treatment is based on a positive diagnosis announcement, recovery by combined action, psychotherapeutic support and multidisciplinary coordination.

Conclusion

The psychopathological hand constitutes a localized manifestation of a functional neurological disorder and should no longer be regarded as a marginal entity. Its recognition as a specific functional disorder helps to avoid inappropriate treatments and paves the way for integrated care strategies and a better structuring of specialized pathways.

目的：“精神病理性手”或“心因性手”，长期以来被认为是临床的好奇心，至今仍未得到充分诊断，有时与其他手病混淆。本文的目的是在功能性神经障碍领域内重新定义精神病理手综合征，以阐明其临床、病理生理和治疗特异性。方法：利用国际医学数据库和参考文献对功能神经病学、精神病学和手外科进行文献综述。主要数据从四个方面进行综合：历史方面、诊断和临床标准、合并症和病理生理模型、治疗策略和护理组织。结果：手部功能性神经系统疾病的特点是解剖-临床不一致、症状多变性和频繁的表现，如功能性肌张力障碍、震颤、瘫瘫或非典型疼痛。它们发生在由于早期创伤、身体警惕性提高和精神或躯体合并症而易受伤害的背景下。从神经功能的角度来看，它们反映了代理、内感受和情感网络的紊乱。治疗是基于积极的诊断公告，通过联合行动恢复，心理治疗支持和多学科协调。结论：精神病理性手构成了功能性神经障碍的局部表现，不应再被视为边缘实体。它被认为是一种特殊的功能障碍，有助于避免不适当的治疗，并为综合护理策略和更好地构建专业途径铺平了道路。

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