Pub Date : 2019-07-17DOI: 10.1177/1558944719862646
M. Nazal, A. Parsa, S. Martin
{"title":"Letter to Editor: Comments on “Readability of the Most Commonly Accessed Online Patient Education Materials Pertaining to Pathology of the Hand”","authors":"M. Nazal, A. Parsa, S. Martin","doi":"10.1177/1558944719862646","DOIUrl":"https://doi.org/10.1177/1558944719862646","url":null,"abstract":"","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"14 1","pages":"709 - 710"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719862646","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46684651","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 : 2017-01-01DOI: 10.1177/1558944716643096
Matthew L Drake, Da Hensley, Wei Chen, K. Taylor
Background: The purpose of this study is to describe the demographics and duration of symptoms of patients with cubital tunnel syndrome who present with muscle atrophy. Methods: We identified 146 patients who presented to the hand surgery clinic at a single institution over a 5-year period with an initial diagnosis of cubital tunnel syndrome based on history and physical examination. Medical records were retrospectively reviewed to determine if there was a difference in demographic data, physical examination findings, and duration of symptoms in patients who presented with muscle atrophy from those with sensory complaints alone. Results: A total of 17/146 (11.6%) of patients presented with muscle atrophy, all of which were men. In all, 17.2% of men presented with atrophy. Age by itself was not a predictor of presentation with atrophy; however, younger patients with atrophy presented with significantly shorter duration of symptoms. Patients under the age of 29 years presenting with muscle atrophy on average had symptoms for 2.4 months compared with 16.2 months of symptoms for those over 55 years of age. Conclusions: Men with cubital tunnel syndrome are more likely to present with muscle atrophy than women. Age is not necessarily a predictor of presentation with atrophy. There is a subset population of younger patients who presents with extremely short duration of symptoms that rapidly develops muscle atrophy.
{"title":"Muscle Atrophy at Presentation of Cubital Tunnel Syndrome","authors":"Matthew L Drake, Da Hensley, Wei Chen, K. Taylor","doi":"10.1177/1558944716643096","DOIUrl":"https://doi.org/10.1177/1558944716643096","url":null,"abstract":"Background: The purpose of this study is to describe the demographics and duration of symptoms of patients with cubital tunnel syndrome who present with muscle atrophy. Methods: We identified 146 patients who presented to the hand surgery clinic at a single institution over a 5-year period with an initial diagnosis of cubital tunnel syndrome based on history and physical examination. Medical records were retrospectively reviewed to determine if there was a difference in demographic data, physical examination findings, and duration of symptoms in patients who presented with muscle atrophy from those with sensory complaints alone. Results: A total of 17/146 (11.6%) of patients presented with muscle atrophy, all of which were men. In all, 17.2% of men presented with atrophy. Age by itself was not a predictor of presentation with atrophy; however, younger patients with atrophy presented with significantly shorter duration of symptoms. Patients under the age of 29 years presenting with muscle atrophy on average had symptoms for 2.4 months compared with 16.2 months of symptoms for those over 55 years of age. Conclusions: Men with cubital tunnel syndrome are more likely to present with muscle atrophy than women. Age is not necessarily a predictor of presentation with atrophy. There is a subset population of younger patients who presents with extremely short duration of symptoms that rapidly develops muscle atrophy.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"12 1","pages":"64 - 67"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716643096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49519547","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 : 2017-01-01DOI: 10.1177/1558944716643095
K. Lutsky, Christopher M. Jones, Nayoung Kim, Juana Medina, Jonas L. Matzon, P. Beredjiklian
Background: Clinical studies using extensile approaches for carpal tunnel release (CTR) report a fairly high incidence of thenar motor branch (TMB) variants. As mini-open and endoscopic CTRs have become commonplace, the likelihood of encountering one of these variants in current practice is unknown. The purpose of the present study was to assess prospectively the frequency with which TMB variants are encountered during routine surgery. Methods: All patients who underwent a primary CTR between August 2014 and April 2015 by 11 hand fellowship–trained, orthopedic surgeons were prospectively evaluated. All surgeons performed releases in their usual technique and notified the lead investigator of any median nerve variations encountered. A total of 890 primary CTRs in 795 patients were performed during the study period. Results: Four TMBs seen were transligamentous variants (4/890 of procedures = 0.45%; 4/795 of patients = 0.50%). Three were identified during open CTR, and 1 during endoscopic CTR. In 2 cases, the transligamentous TMB originated from the volar aspect of the median nerve and penetrated the midportion of the transverse carpal ligament. One TMB originated from the volar and ulnar aspect of the median nerve. One TMB originated from the ulnar aspect of the median nerve proximal to the carpal tunnel. There were no cases of TMB injury during the course of the study. Conclusions: TMB variations are encountered infrequently during routine CTR. The most commonly encountered variant during routine mini-open or endoscopic CTR in our study was a transligamentous branch.
{"title":"Frequency of Incidental Median Thenar Motor Nerve Branch Visualization During Mini-Open and Endoscopic Carpal Tunnel Release","authors":"K. Lutsky, Christopher M. Jones, Nayoung Kim, Juana Medina, Jonas L. Matzon, P. Beredjiklian","doi":"10.1177/1558944716643095","DOIUrl":"https://doi.org/10.1177/1558944716643095","url":null,"abstract":"Background: Clinical studies using extensile approaches for carpal tunnel release (CTR) report a fairly high incidence of thenar motor branch (TMB) variants. As mini-open and endoscopic CTRs have become commonplace, the likelihood of encountering one of these variants in current practice is unknown. The purpose of the present study was to assess prospectively the frequency with which TMB variants are encountered during routine surgery. Methods: All patients who underwent a primary CTR between August 2014 and April 2015 by 11 hand fellowship–trained, orthopedic surgeons were prospectively evaluated. All surgeons performed releases in their usual technique and notified the lead investigator of any median nerve variations encountered. A total of 890 primary CTRs in 795 patients were performed during the study period. Results: Four TMBs seen were transligamentous variants (4/890 of procedures = 0.45%; 4/795 of patients = 0.50%). Three were identified during open CTR, and 1 during endoscopic CTR. In 2 cases, the transligamentous TMB originated from the volar aspect of the median nerve and penetrated the midportion of the transverse carpal ligament. One TMB originated from the volar and ulnar aspect of the median nerve. One TMB originated from the ulnar aspect of the median nerve proximal to the carpal tunnel. There were no cases of TMB injury during the course of the study. Conclusions: TMB variations are encountered infrequently during routine CTR. The most commonly encountered variant during routine mini-open or endoscopic CTR in our study was a transligamentous branch.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"12 1","pages":"60 - 63"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716643095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45058902","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 : 2017-01-01DOI: 10.1177/1558944716648313
J. Choo, B. Wilhelmi, M. Kasdan
Background: A rare and disastrous complication of harvesting a tendon graft is the misidentification of the median nerve for the palmaris longus. Methods: The authors report a referred case in which the median nerve was harvested as a free tendon graft. Results: Few reports of this complication are found in the literature despite the frequency of palmaris longus tendon grafting and the proximity of the palmaris tendon to the median nerve. Given the obvious medicolegal implications, the true incidence of this complication is difficult to assess. Discussion: Safe harvesting of the palmaris longus mandates a thorough understanding of the relevant anatomy, in particular the proper differentiation between nerve and tendon and recognition of when the palmaris longus tendon is absent. Techniques to facilitate proper identification of the palmaris longus are outlined.
{"title":"Iatrogenic Injury to the Median Nerve During Palmaris Longus Harvest","authors":"J. Choo, B. Wilhelmi, M. Kasdan","doi":"10.1177/1558944716648313","DOIUrl":"https://doi.org/10.1177/1558944716648313","url":null,"abstract":"Background: A rare and disastrous complication of harvesting a tendon graft is the misidentification of the median nerve for the palmaris longus. Methods: The authors report a referred case in which the median nerve was harvested as a free tendon graft. Results: Few reports of this complication are found in the literature despite the frequency of palmaris longus tendon grafting and the proximity of the palmaris tendon to the median nerve. Given the obvious medicolegal implications, the true incidence of this complication is difficult to assess. Discussion: Safe harvesting of the palmaris longus mandates a thorough understanding of the relevant anatomy, in particular the proper differentiation between nerve and tendon and recognition of when the palmaris longus tendon is absent. Techniques to facilitate proper identification of the palmaris longus are outlined.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"12 1","pages":"NP6 - NP9"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716648313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47790187","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 : 2017-01-01DOI: 10.1177/1558944716646758
N. Vincken, T. Lauwers, R. R. van der Hulst
Background: In this study, biomechanical strength and bulkiness of the cow-hitch technique and Pulvertaft weave were compared. Our goal was to investigate whether the cow hitch can withstand equal strength in comparison with the Pulvertaft and to see if there is a difference in bulk, which could enhance gliding function and reduce friction and adhesion formation. Methods: Sheep tendons were used to perform 10 cow-hitch and 10 Pulvertaft repairs. Tensile strength was obtained with a cyclic loading tensile testing machine and tendon width and height measurements were obtained through digital analysis by photographs of the repairs. Results: The cow hitch showed significantly better ultimate strength and had less bulk. There was no statistical difference in displacement, defined as gain in total length of the tendon. Conclusions: The results in this study show that the cow hitch outperforms the Pulvertaft weave in both ultimate strength and bulk.
{"title":"Biomechanical and Dimensional Measurements of the Pulvertaft Weave Versus the Cow-Hitch Technique","authors":"N. Vincken, T. Lauwers, R. R. van der Hulst","doi":"10.1177/1558944716646758","DOIUrl":"https://doi.org/10.1177/1558944716646758","url":null,"abstract":"Background: In this study, biomechanical strength and bulkiness of the cow-hitch technique and Pulvertaft weave were compared. Our goal was to investigate whether the cow hitch can withstand equal strength in comparison with the Pulvertaft and to see if there is a difference in bulk, which could enhance gliding function and reduce friction and adhesion formation. Methods: Sheep tendons were used to perform 10 cow-hitch and 10 Pulvertaft repairs. Tensile strength was obtained with a cyclic loading tensile testing machine and tendon width and height measurements were obtained through digital analysis by photographs of the repairs. Results: The cow hitch showed significantly better ultimate strength and had less bulk. There was no statistical difference in displacement, defined as gain in total length of the tendon. Conclusions: The results in this study show that the cow hitch outperforms the Pulvertaft weave in both ultimate strength and bulk.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"12 1","pages":"78 - 84"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716646758","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47696812","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 : 2017-01-01DOI: 10.1177/1558944716646776
G. Cochran, Kathryn Hanna
Background: The Morel-Lavallee lesion (MLL) is a closed internal degloving injury that results from shearing of the skin and subcutaneous tissue from the underlying fascia. Disruption of the perforating blood vessels and lymphatics results in a lesion filled with serosanguinous fluid and necrotized fat. MLLs are most commonly described in association with pelvic and lower extremity trauma, and there are limited reports of these lesions in other locations. Methods: This case report describes a 58-year-old male referred from his primary care physician with a soft tissue mass in the upper arm. Careful history discovered prior trauma with extensive bruising and MRI revealed a large encapsulated mass consistent with MLL. Results: An open debridement with excision of pseudocapsule was performed. Meticulous closure over a drain was performed and the patient healed without complication or recurrence. Intra-operative cultures were negative and pathology was consistent with MLL. Conclusion: MLL should always be considered in the setting of previous trauma regardless the location. In the chronic setting an open approach with excision of pseudocapsule can have an acceptable result.
{"title":"Morel-Lavallee Lesion in the Upper Extremity","authors":"G. Cochran, Kathryn Hanna","doi":"10.1177/1558944716646776","DOIUrl":"https://doi.org/10.1177/1558944716646776","url":null,"abstract":"Background: The Morel-Lavallee lesion (MLL) is a closed internal degloving injury that results from shearing of the skin and subcutaneous tissue from the underlying fascia. Disruption of the perforating blood vessels and lymphatics results in a lesion filled with serosanguinous fluid and necrotized fat. MLLs are most commonly described in association with pelvic and lower extremity trauma, and there are limited reports of these lesions in other locations. Methods: This case report describes a 58-year-old male referred from his primary care physician with a soft tissue mass in the upper arm. Careful history discovered prior trauma with extensive bruising and MRI revealed a large encapsulated mass consistent with MLL. Results: An open debridement with excision of pseudocapsule was performed. Meticulous closure over a drain was performed and the patient healed without complication or recurrence. Intra-operative cultures were negative and pathology was consistent with MLL. Conclusion: MLL should always be considered in the setting of previous trauma regardless the location. In the chronic setting an open approach with excision of pseudocapsule can have an acceptable result.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"12 1","pages":"NP10 - NP13"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716646776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45053250","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 : 2017-01-01DOI: 10.1177/1558944716654660
Justin Koh, K. Azari, P. Benhaim
Background: Coincident carpal and cubital tunnel syndromes present a diagnostic challenge, exacerbated by the limitations of nerve conduction study (NCS) for confirming cubital tunnel syndrome. This study develops a diagnostic scoring system, the Koh-Benhaim (KB) score, to identify patients with coincident compression neuropathies. Methods: A retrospective review of 515 patients was performed from patients surgically treated for carpal and/or cubital tunnel release. These patients were divided as patients with isolated carpal tunnel syndrome (n = 337) or coincident carpal and cubital tunnel syndromes (n = 178), then characterized according to demographics, medical history, physical examination, and NCS results. Univariate and multivariate logistic regression identified predictors of coincident neuropathy. A clinical score was constructed by integerizing regression coefficients of predictive factors. Receiver operating characteristic (ROC) curves were generated for each iteration of the score. Sensitivities, specificities, and positive and negative predictive values were calculated to identify the best cutoff value. Results: Decreased intrinsic muscle strength, decreased ulnar sensation, positive elbow flexion test, positive cubital tunnel Tinel’s sign, and abnormal NCS result were selected. The cutoff value for high risk of coincident compression was 3 points: positive predictive value, 82.9% and specificity, 93.4%. Model performance was very good—ROC area under the curve of 0.917. Conclusions: A KB score of 3 or greater represents high risk of coincident cubital tunnel compression. The variables involved are routinely used to assess the cubital tunnel, and all component factors of the KB score were of equivalent clinical weight in assessing patients with potential coincident compression neuropathy.
{"title":"A Clinical Scoring System for Distinguishing Patients With Coincident Cubital Tunnel Syndrome Among Patients With Carpal Tunnel Syndrome","authors":"Justin Koh, K. Azari, P. Benhaim","doi":"10.1177/1558944716654660","DOIUrl":"https://doi.org/10.1177/1558944716654660","url":null,"abstract":"Background: Coincident carpal and cubital tunnel syndromes present a diagnostic challenge, exacerbated by the limitations of nerve conduction study (NCS) for confirming cubital tunnel syndrome. This study develops a diagnostic scoring system, the Koh-Benhaim (KB) score, to identify patients with coincident compression neuropathies. Methods: A retrospective review of 515 patients was performed from patients surgically treated for carpal and/or cubital tunnel release. These patients were divided as patients with isolated carpal tunnel syndrome (n = 337) or coincident carpal and cubital tunnel syndromes (n = 178), then characterized according to demographics, medical history, physical examination, and NCS results. Univariate and multivariate logistic regression identified predictors of coincident neuropathy. A clinical score was constructed by integerizing regression coefficients of predictive factors. Receiver operating characteristic (ROC) curves were generated for each iteration of the score. Sensitivities, specificities, and positive and negative predictive values were calculated to identify the best cutoff value. Results: Decreased intrinsic muscle strength, decreased ulnar sensation, positive elbow flexion test, positive cubital tunnel Tinel’s sign, and abnormal NCS result were selected. The cutoff value for high risk of coincident compression was 3 points: positive predictive value, 82.9% and specificity, 93.4%. Model performance was very good—ROC area under the curve of 0.917. Conclusions: A KB score of 3 or greater represents high risk of coincident cubital tunnel compression. The variables involved are routinely used to assess the cubital tunnel, and all component factors of the KB score were of equivalent clinical weight in assessing patients with potential coincident compression neuropathy.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"12 1","pages":"43 - 49"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716654660","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41578148","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 : 2017-01-01DOI: 10.1177/1558944715627634
Ricardo Kaempf de Oliveira, P. Delgado, J. Geist
Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.
{"title":"Pediatric Trigger Finger due to Osteochondroma","authors":"Ricardo Kaempf de Oliveira, P. Delgado, J. Geist","doi":"10.1177/1558944715627634","DOIUrl":"https://doi.org/10.1177/1558944715627634","url":null,"abstract":"Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"12 1","pages":"105 - 99"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944715627634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42552309","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 : 2017-01-01DOI: 10.1177/1558944716647101
Marc D. Lipman, S. Carstensen, D. Deal
Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased (P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.
{"title":"Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014","authors":"Marc D. Lipman, S. Carstensen, D. Deal","doi":"10.1177/1558944716647101","DOIUrl":"https://doi.org/10.1177/1558944716647101","url":null,"abstract":"Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased (P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"12 1","pages":"13 - 20"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716647101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47494316","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 : 2017-01-01DOI: 10.1177/1558944715628005
S. Farnebo, L. Farnebo, Maxwell Kim, Colin Y. L. Woon, H. Pham, James Chang
Background: Tendon-derived extracellular matrix (ECM) hydrogel has been shown to augment tendon healing in vivo. We hypothesized that reseeding of the gel with adipose-derived stem cells (ASCs) could further assist repopulation of the gel and that combinations of growth factors (GFs) would improve the survival of these cells after reseeding. Methods: A tendon-specific ECM solution was supplemented with varying concentrations of basic fibroblast growth factor (bFGF), insulin-like growth factor–1 (IGF-1), and platelet-derived growth factor–BB (PDGF-BB). Gels were then seeded with ASCs transfected with a green fluorescent protein/luciferin construct. Cell proliferation was determined using the MTT assay and histology, and GF and ASC augmented gels were injected into the back of Sprague Dawley rats. Bioluminescence of seeded gels was continuously followed after reseeding, and cell counts were performed after the gels were explanted at 14 days. Results: Synergistic effects of the GFs were seen, and an optimal combination was determined to be 10 ng/mL bFGF, 100 ng/mL IGF-1, and 100 ng/mL PDGF-BB (2.8-fold increase; P < .05). In vivo bioluminescence showed an improved initial survival of cells in gels supplemented with the optimal concentration of GF compared with the control group (10.6-fold increase at 8 days; P < .05). Cell counts of explants showed a dramatic endogenous repopulation of gels supplemented by GF + ASCs compared with both gels with GF but no ASCs (7.6-fold increase) and gels with ASCs but no GF (1.6-fold increase). Conclusion: Synergistic effects of GFs can be used to improve cellular proliferation of ASCs seeded to a tendon ECM gel. Reseeding with ASCs stimulates endogenous repopulation of the gel in vivo and may be used to further augment tendon healing.
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