Pub Date : 2020-01-01DOI: 10.1177/1753193419871862
K. Ditsios, L. Kostretzis, Iosafat Pinto
We present a case of delayed dorsal tendon dislocation after surgery for de Quervain’s disease and a modified technique of pulley reconstruction. A 32year-old man had a 5-month history of persistent wrist pain. Finkelstein’s test and MRI results were positive for de Quervain’s disease. After an adequate period of unsuccessful non-operative treatment, we proceeded to surgery. Through a transverse skin incision, the retinaculum of the first dorsal compartment was divided longitudinally along its dorsal margin. The tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) were released and checked for subluxation through passive wrist flexion and extension – single APL and EPB tendons were found without the presence of a subcompartment. The patient’s hand and thumb were placed in a bulky bandage and sutures were removed at 2 weeks. We advised avoidance of heavy mechanical activities for 6 weeks. Eight months later, he returned describing a painful snapping in his wrist. Clinical examination revealed dorsal dislocation of APL and EPB tendons during wrist extension. The patient admitted starting weightlifting shortly after suture removal and stated that the symptoms began 3 months after surgery. We proceeded to secondary surgery. The former skin incision was extended proximally and distally in a zig-zag fashion. Both tendons dislocated dorsally during wrist extension (Video 1). A longitudinal incision was made in the remaining palmar extensor retinaculum, elevating a 3 by 1.5 cm strip, distally based (Figure 1). This was passed deep to APL and EPB tendons from palmar to dorsal side (Figure 2), and then superficial to the tendons suturing it back to its origin at the palmar retinaculum with two 4-0 nonabsorbable sutures. The dorsal border of this sling was secured with two 4-0 nonabsorbable sutures to the dorsal remnant of the retinaculum (Figure 3), ensuring that tendon gliding was unobstructed with no palmar or dorsal subluxation (Video 2). Postoperatively, a thumb spica was applied for 4 weeks. Three years postoperatively the patient remains asymptomatic, with no recurrence of tendon dislocation, a normal range of motion and a negative Finkelstein test. He has returned to work.
{"title":"Dorsal tendon dislocation after de Quervain's release and its surgical management: a case report","authors":"K. Ditsios, L. Kostretzis, Iosafat Pinto","doi":"10.1177/1753193419871862","DOIUrl":"https://doi.org/10.1177/1753193419871862","url":null,"abstract":"We present a case of delayed dorsal tendon dislocation after surgery for de Quervain’s disease and a modified technique of pulley reconstruction. A 32year-old man had a 5-month history of persistent wrist pain. Finkelstein’s test and MRI results were positive for de Quervain’s disease. After an adequate period of unsuccessful non-operative treatment, we proceeded to surgery. Through a transverse skin incision, the retinaculum of the first dorsal compartment was divided longitudinally along its dorsal margin. The tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) were released and checked for subluxation through passive wrist flexion and extension – single APL and EPB tendons were found without the presence of a subcompartment. The patient’s hand and thumb were placed in a bulky bandage and sutures were removed at 2 weeks. We advised avoidance of heavy mechanical activities for 6 weeks. Eight months later, he returned describing a painful snapping in his wrist. Clinical examination revealed dorsal dislocation of APL and EPB tendons during wrist extension. The patient admitted starting weightlifting shortly after suture removal and stated that the symptoms began 3 months after surgery. We proceeded to secondary surgery. The former skin incision was extended proximally and distally in a zig-zag fashion. Both tendons dislocated dorsally during wrist extension (Video 1). A longitudinal incision was made in the remaining palmar extensor retinaculum, elevating a 3 by 1.5 cm strip, distally based (Figure 1). This was passed deep to APL and EPB tendons from palmar to dorsal side (Figure 2), and then superficial to the tendons suturing it back to its origin at the palmar retinaculum with two 4-0 nonabsorbable sutures. The dorsal border of this sling was secured with two 4-0 nonabsorbable sutures to the dorsal remnant of the retinaculum (Figure 3), ensuring that tendon gliding was unobstructed with no palmar or dorsal subluxation (Video 2). Postoperatively, a thumb spica was applied for 4 weeks. Three years postoperatively the patient remains asymptomatic, with no recurrence of tendon dislocation, a normal range of motion and a negative Finkelstein test. He has returned to work.","PeriodicalId":73762,"journal":{"name":"Journal of hand surgery (Edinburgh, Scotland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753193419871862","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48531742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1177/1753193419878973
G. Tranchida, A. V. Van Heest
Surgical interventions for the spastic upper extremity secondary to stroke, traumatic brain injury, and cerebral palsy aim to correct the common deformities of elbow flexion, forearm pronation, wrist and finger flexion, ulnar deviation, and thumb-in-palm deformity. After appropriate evaluation, as well as determining the goals of surgery, deformity correction can be achieved through single-event, multi-level surgery. Surgery includes a combination of soft tissue lengthening, tendon transfer, and joint stabilization procedures. Surgical treatment for shoulder adduction/internal rotation, elbow flexion, forearm pronation, wrist flexion, thumb-in-palm, and clenched fist deformities due to spasticity are discussed, and treatment outcomes are reviewed.
{"title":"Preferred options and evidence for upper limb surgery for spasticity in cerebral palsy, stroke, and brain injury","authors":"G. Tranchida, A. V. Van Heest","doi":"10.1177/1753193419878973","DOIUrl":"https://doi.org/10.1177/1753193419878973","url":null,"abstract":"Surgical interventions for the spastic upper extremity secondary to stroke, traumatic brain injury, and cerebral palsy aim to correct the common deformities of elbow flexion, forearm pronation, wrist and finger flexion, ulnar deviation, and thumb-in-palm deformity. After appropriate evaluation, as well as determining the goals of surgery, deformity correction can be achieved through single-event, multi-level surgery. Surgery includes a combination of soft tissue lengthening, tendon transfer, and joint stabilization procedures. Surgical treatment for shoulder adduction/internal rotation, elbow flexion, forearm pronation, wrist flexion, thumb-in-palm, and clenched fist deformities due to spasticity are discussed, and treatment outcomes are reviewed.","PeriodicalId":73762,"journal":{"name":"Journal of hand surgery (Edinburgh, Scotland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753193419878973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47881451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1177/1753193419871521
R. Fisch, Clifton Meals, R. Meals
sion, the first web space was widened, and the flap then tunnelled subcutaneously to the created defect (Figure 2(B) and (C)). Following skin closure, vascularization of the flap was verified after releasing the tourniquet. Six months postoperatively, at the final follow-up, the patient showed a well-aligned and mobile thumb with a well-preserved first web space (Figure 3). First web deepening using Z-plasty or other skin mobilization techniques from the surrounding skin are the usual methods to treat an associated contracted first web space in radial polydactyly (Ogino et al., 1996; Townsend et al., 1994). A random rotation flap from the removed thumb or from the index finger has been also used (Ogino et al., 1996). The use of a neurovascular island flap from the removed thumb has been mentioned, although no technical details or images were provided (Ogino et al., 1996). The advantages of using a flap to widen the first web space include improvement of the web contour by keeping the height of the web and avoiding a ‘cleftlike’ appearance, which can be seen following conventional skin mobilization techniques (Fraulin and Thomson, 1999). In addition, 95% of duplicated thumbs present at least one palmar collateral artery, which should increase the utility of this surgical option (Kitayama and Tsukada, 1983). Coexistence of the first web contracture with radial polydactyly treated with a vascularized palmar flap obtained from the ablated thumb can result in potentially better cosmetic results as compared with deepening techniques.
{"title":"Effectiveness of extensor carpi ulnaris tendon lengthening in treating four patients with tendinopathy","authors":"R. Fisch, Clifton Meals, R. Meals","doi":"10.1177/1753193419871521","DOIUrl":"https://doi.org/10.1177/1753193419871521","url":null,"abstract":"sion, the first web space was widened, and the flap then tunnelled subcutaneously to the created defect (Figure 2(B) and (C)). Following skin closure, vascularization of the flap was verified after releasing the tourniquet. Six months postoperatively, at the final follow-up, the patient showed a well-aligned and mobile thumb with a well-preserved first web space (Figure 3). First web deepening using Z-plasty or other skin mobilization techniques from the surrounding skin are the usual methods to treat an associated contracted first web space in radial polydactyly (Ogino et al., 1996; Townsend et al., 1994). A random rotation flap from the removed thumb or from the index finger has been also used (Ogino et al., 1996). The use of a neurovascular island flap from the removed thumb has been mentioned, although no technical details or images were provided (Ogino et al., 1996). The advantages of using a flap to widen the first web space include improvement of the web contour by keeping the height of the web and avoiding a ‘cleftlike’ appearance, which can be seen following conventional skin mobilization techniques (Fraulin and Thomson, 1999). In addition, 95% of duplicated thumbs present at least one palmar collateral artery, which should increase the utility of this surgical option (Kitayama and Tsukada, 1983). Coexistence of the first web contracture with radial polydactyly treated with a vascularized palmar flap obtained from the ablated thumb can result in potentially better cosmetic results as compared with deepening techniques.","PeriodicalId":73762,"journal":{"name":"Journal of hand surgery (Edinburgh, Scotland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753193419871521","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45939329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1177/1753193419870100
J. Rodrigues
For the first of these, where the comparison is ‘before’ and ‘after’ for the same person, the noun ‘change’ is used (minimal important change, MIC). For the second, where the comparison is between a person’s outcome and a different person’s experience, ‘difference’ is used (minimal important difference, MID), for example when two people have undergone different types of surgery for the same disorder (fasciectomy versus collagenase would be an example). The schematic in Figure 1 shows how these terms apply to comparing operation A to operation B to operation C. All three groups of patients have the same average preoperative hand function score (the red, green and purple circles, respectively). Both operation A and operation B work, hence both of these groups have a hand-function score improvement following treatment. For both operations A and B, the improvement in score exceeds the MIC. Thus, both treatments were considered worthwhile by the patients and delivered real-world improvement. In contrast, the improvement from operation C is smaller than the MIC, and so this treatment does not deliver meaningful change, even if the preto postoperative change turns out to be statistically significant (as might occur if the group was large). Taking this further, the two effective treatments work differently: operation B achieves a greater hand function improvement than operation A, and the difference between the groups is larger than the MID. Thus, the patients who received operation A might say ‘I did get better from operation A – it was worthwhile . . . but I would have been noticeably happier if I’d had operation B’.
{"title":"Different terminologies that help the interpretation of outcomes","authors":"J. Rodrigues","doi":"10.1177/1753193419870100","DOIUrl":"https://doi.org/10.1177/1753193419870100","url":null,"abstract":"For the first of these, where the comparison is ‘before’ and ‘after’ for the same person, the noun ‘change’ is used (minimal important change, MIC). For the second, where the comparison is between a person’s outcome and a different person’s experience, ‘difference’ is used (minimal important difference, MID), for example when two people have undergone different types of surgery for the same disorder (fasciectomy versus collagenase would be an example). The schematic in Figure 1 shows how these terms apply to comparing operation A to operation B to operation C. All three groups of patients have the same average preoperative hand function score (the red, green and purple circles, respectively). Both operation A and operation B work, hence both of these groups have a hand-function score improvement following treatment. For both operations A and B, the improvement in score exceeds the MIC. Thus, both treatments were considered worthwhile by the patients and delivered real-world improvement. In contrast, the improvement from operation C is smaller than the MIC, and so this treatment does not deliver meaningful change, even if the preto postoperative change turns out to be statistically significant (as might occur if the group was large). Taking this further, the two effective treatments work differently: operation B achieves a greater hand function improvement than operation A, and the difference between the groups is larger than the MID. Thus, the patients who received operation A might say ‘I did get better from operation A – it was worthwhile . . . but I would have been noticeably happier if I’d had operation B’.","PeriodicalId":73762,"journal":{"name":"Journal of hand surgery (Edinburgh, Scotland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753193419870100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41430152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1177/1753193419882875
M. Marks
Nowadays, the use of patient-reported outcome measures to monitor a treatment effect in daily practice or to quantify study outcomes is indispensable. In hand surgery, there is a wide variety available. This article provides an overview about the most common hand-specific, upper-extremity specific and general quality of life patient-reported outcome measurement instruments with adequate psychometric properties. A checklist and a decision tree are provided for choosing the appropriate instrument when evaluating patients with hand conditions.
{"title":"Which patient-reported outcomes shall we use in hand surgery?","authors":"M. Marks","doi":"10.1177/1753193419882875","DOIUrl":"https://doi.org/10.1177/1753193419882875","url":null,"abstract":"Nowadays, the use of patient-reported outcome measures to monitor a treatment effect in daily practice or to quantify study outcomes is indispensable. In hand surgery, there is a wide variety available. This article provides an overview about the most common hand-specific, upper-extremity specific and general quality of life patient-reported outcome measurement instruments with adequate psychometric properties. A checklist and a decision tree are provided for choosing the appropriate instrument when evaluating patients with hand conditions.","PeriodicalId":73762,"journal":{"name":"Journal of hand surgery (Edinburgh, Scotland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753193419882875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41572342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1177/1753193419876208
Lucy E Homer, G. Cheung, Daniel J Brown
{"title":"Hypermobility at the carpometacarpal joint of the little finger presenting as metacarpophalangeal joint instability: A case report","authors":"Lucy E Homer, G. Cheung, Daniel J Brown","doi":"10.1177/1753193419876208","DOIUrl":"https://doi.org/10.1177/1753193419876208","url":null,"abstract":"","PeriodicalId":73762,"journal":{"name":"Journal of hand surgery (Edinburgh, Scotland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753193419876208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49027483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1177/1753193419878981
K. Chung, Sarah E. Sasor, Kelly A Speth, Lu Wang, Melissa J Shauver
The Wrist and Radius Injury Surgical Trial (WRIST) collaboration is the largest clinical trial ever conducted in hand surgery. We applied data from this study to examine the relationship between functional outcomes and patient satisfaction after treatment of distal radial fractures. Patients aged 60 years and older with isolated distal radial fractures were enrolled at 24 health systems. Grip strength and the arc of wrist motion were measured after treatment. The Michigan Hand Outcomes Questionnaire was used to measure patient satisfaction. Receiver operating characteristic curves were created using patient satisfaction as the reference standard and each functional measure as a predictor. At 12 months after treatment, mean grip strength was 82% of normal and mean arc of motion was 88% of normal. The optimal cut-off points to distinguish satisfaction from dissatisfaction occurred when patients recovered 59% of hand strength and 79% of wrist motion. Continuing therapy to increase functional gains beyond this point unnecessarily utilizes healthcare resources without additional patient-reported gains. Level of evidence: IV
{"title":"Patient satisfaction after treatment of distal radial fractures in older adults","authors":"K. Chung, Sarah E. Sasor, Kelly A Speth, Lu Wang, Melissa J Shauver","doi":"10.1177/1753193419878981","DOIUrl":"https://doi.org/10.1177/1753193419878981","url":null,"abstract":"The Wrist and Radius Injury Surgical Trial (WRIST) collaboration is the largest clinical trial ever conducted in hand surgery. We applied data from this study to examine the relationship between functional outcomes and patient satisfaction after treatment of distal radial fractures. Patients aged 60 years and older with isolated distal radial fractures were enrolled at 24 health systems. Grip strength and the arc of wrist motion were measured after treatment. The Michigan Hand Outcomes Questionnaire was used to measure patient satisfaction. Receiver operating characteristic curves were created using patient satisfaction as the reference standard and each functional measure as a predictor. At 12 months after treatment, mean grip strength was 82% of normal and mean arc of motion was 88% of normal. The optimal cut-off points to distinguish satisfaction from dissatisfaction occurred when patients recovered 59% of hand strength and 79% of wrist motion. Continuing therapy to increase functional gains beyond this point unnecessarily utilizes healthcare resources without additional patient-reported gains. Level of evidence: IV","PeriodicalId":73762,"journal":{"name":"Journal of hand surgery (Edinburgh, Scotland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753193419878981","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47131500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1177/1753193419883579
Z. J. Pan, Lei Pan, Y. Xu, Tao Ma, Lei Hui Yao
We reviewed outcomes of 230 flexor tendon repairs in 27 thumbs and 203 fingers in Zone 1 and 2 over 7 years. In 2013, we used a 2-strand modified Kessler method followed by passive motion exercise in repairing flexor digitorum profundus tendon injuries in Zone 2 in 30 fingers; 24 fingers were followed, five (26%) had repair ruptures. Between 2014 and 2017, we used a 4- or 6-strand method to repair 111 flexor digitorum profundus tendons in Zone 2, followed by true early active motion. Two had repair ruptures. Among 101 fingers followed over 6 months, two fingers had tenolysis and 87 (87%) good or excellent outcomes. In 2018 to 2019, we used a 6-strand method to repair 42 flexor digitorum profundus tendons in Zone 2 with out-of-splint early active motion. None had repair ruptures or tenolysis. From 2014 to 2019, 27 flexor pollicis longus tendons were repaired in Zone 1 or 2, and 20 fingers had end-to-end flexor digitorum profundus repairs in Zone 1; none had repair ruptures or tenolysis. We conclude that a strong repair and true active motion are necessary for best outcomes of flexor tendon repairs in the thumb and fingers, and out-of-splint true active motion is safe.
{"title":"Outcomes of 200 digital flexor tendon repairs using updated protocols and 30 repairs using an old protocol: experience over 7 years","authors":"Z. J. Pan, Lei Pan, Y. Xu, Tao Ma, Lei Hui Yao","doi":"10.1177/1753193419883579","DOIUrl":"https://doi.org/10.1177/1753193419883579","url":null,"abstract":"We reviewed outcomes of 230 flexor tendon repairs in 27 thumbs and 203 fingers in Zone 1 and 2 over 7 years. In 2013, we used a 2-strand modified Kessler method followed by passive motion exercise in repairing flexor digitorum profundus tendon injuries in Zone 2 in 30 fingers; 24 fingers were followed, five (26%) had repair ruptures. Between 2014 and 2017, we used a 4- or 6-strand method to repair 111 flexor digitorum profundus tendons in Zone 2, followed by true early active motion. Two had repair ruptures. Among 101 fingers followed over 6 months, two fingers had tenolysis and 87 (87%) good or excellent outcomes. In 2018 to 2019, we used a 6-strand method to repair 42 flexor digitorum profundus tendons in Zone 2 with out-of-splint early active motion. None had repair ruptures or tenolysis. From 2014 to 2019, 27 flexor pollicis longus tendons were repaired in Zone 1 or 2, and 20 fingers had end-to-end flexor digitorum profundus repairs in Zone 1; none had repair ruptures or tenolysis. We conclude that a strong repair and true active motion are necessary for best outcomes of flexor tendon repairs in the thumb and fingers, and out-of-splint true active motion is safe.","PeriodicalId":73762,"journal":{"name":"Journal of hand surgery (Edinburgh, Scotland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753193419883579","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48628086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1177/1753193419873552
N. O'Hara, S. Opel, M. Horwitz
{"title":"Re: Kang et al. Wrist inflammation: a retrospective comparison between septic and non-septic arthritis. J Hand Surg Eur. 2018, 43: 431–7","authors":"N. O'Hara, S. Opel, M. Horwitz","doi":"10.1177/1753193419873552","DOIUrl":"https://doi.org/10.1177/1753193419873552","url":null,"abstract":"","PeriodicalId":73762,"journal":{"name":"Journal of hand surgery (Edinburgh, Scotland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753193419873552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47958436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-10DOI: 10.1177/1753193419890770
B. Reynolds, V. Tobin, Julian A. Smith, W. Rozen, D. Hunter-Smith
Timing of manipulation of digits after collagenase injection for Dupuytren’s disease varies and often takes place within the first few days post-injection. We prospectively investigated the effectiveness of performing manipulation under local anaesthesia 7 days after injection in 100 patients. Demographic data, passive extension deficit, and patient-reported outcome measures were recorded before collagenase injection. Four to 7 weeks after manipulation, passive extension deficit and patient-reported outcome measures improved significantly without the development of any tendon ruptures. Clinical success was achieved in 41% and clinical improvement in 76% of the patients. Adverse events were reported by 85%. The outcomes were comparable with studies with early manipulation, and demonstrate a safe and effective variation to current protocols. We conclude that delaying manipulation to 7 days after collagenase injection is safe and efficient, which allows for flexibility in clinical appointments without negatively affecting outcome. Level of evidence: III
{"title":"The effectiveness of manipulation of fingers with Dupuytren's contracture 7 days after collagenase clostridial histolyticum injection","authors":"B. Reynolds, V. Tobin, Julian A. Smith, W. Rozen, D. Hunter-Smith","doi":"10.1177/1753193419890770","DOIUrl":"https://doi.org/10.1177/1753193419890770","url":null,"abstract":"Timing of manipulation of digits after collagenase injection for Dupuytren’s disease varies and often takes place within the first few days post-injection. We prospectively investigated the effectiveness of performing manipulation under local anaesthesia 7 days after injection in 100 patients. Demographic data, passive extension deficit, and patient-reported outcome measures were recorded before collagenase injection. Four to 7 weeks after manipulation, passive extension deficit and patient-reported outcome measures improved significantly without the development of any tendon ruptures. Clinical success was achieved in 41% and clinical improvement in 76% of the patients. Adverse events were reported by 85%. The outcomes were comparable with studies with early manipulation, and demonstrate a safe and effective variation to current protocols. We conclude that delaying manipulation to 7 days after collagenase injection is safe and efficient, which allows for flexibility in clinical appointments without negatively affecting outcome. Level of evidence: III","PeriodicalId":73762,"journal":{"name":"Journal of hand surgery (Edinburgh, Scotland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753193419890770","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47305183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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