Hand surgery & rehabilitation最新文献

Introduction: Chronic exertional compartment syndrome of the forearm is most commonly associated with exercise. It presents as cramping after a few minutes of activity, requiring cessation of exercise. We describe an ultrasound-guided surgical technique for the treatment of forearm chronic exertional compartment syndrome.

Anatomy and pathophysiology: The forearm consists of three compartments: the anterior, lateral, and dorsal compartments. These compartments are formed by the muscles of the forearm and are surrounded by a fibroelastic membrane composed of connective tissue. Repetitive activity in the forearm leads to an increase in muscle volume within a non-extensible compartment. This increase in pressure causes pain and cramping, forcing the individual to stop the activity. Diagnosis is based on measurement of intramuscular compartment pressures.

Surgical technique: Surgical treatment involves performing a fasciotomy. This can be done through an incision along the length of the forearm or through a minimally invasive approach using endoscopic or ultrasound guidance. The ultrasound-guided technique uses two small entry points and a specialized knife. No post-operative immobilization is required, allowing patients to quickly resume their activities.

Discussion: Chronic exertional compartment syndrome of the forearm is a condition that is particularly common among motorcyclists. Diagnosis is based on a combination of a suggestive clinical presentation and pathological intramuscular pressure. Treatment may be conservative or surgical (fasciotomy). Fasciotomy can be performed using an open approach or a minimally invasive ultrasound-guided technique. Published studies on ultrasound-guided treatment report excellent results with a rapid return to sports activities after surgery.

A non-invasive thermoplastic orthosis combined with targeted exercise effectively addresses proximal interphalangeal joint (PIPj) stiffness. Stabilizing the metacarpophalangeal joint at 60 ° enables optimal torque transfer, improving flexion and correcting compensatory patterns. Posture maintenance prevents elastic recoil,enhancing tissue elongation. Preliminary results show improved kinematic control and functional recovery.

Cornelis et al. reported an isolated DRUJ infection treated with open surgery to prevent spread to the radiocarpal joint. We suggest that arthroscopy, proven effective in other joint infections and technically feasible for the DRUJ without damaging the TFCC,could have been a less invasive and effective alternative.

We report a case of CAF in the hand of a young adult woman. This patient's age exceeded the usual range for CAF. While surgical excision led to fifth digit stiffness and bowstringing, further diagnostic delays could have resulted in much worse outcomes due to tumor invasion of the tendons. This case suggests reevaluating the upper age limit for diagnosis and considering CAF in adults with suggestive clinical features.

Compression of the median nerve in the carpal tunnel is a frequent pathology with severe functional impact. An ultrasound-guided technique was developed to preserve structures, diminish scar fibrosis and enable fast return to full activity. Its advantages are safety and low additional cost. Ultrasound-guided carpal tunnel release is indicated in moderate and severe carpal tunnel syndrome persisting after conservative treatment. A preoperative ultrasound scan is recommended to evaluate anatomy. Recurrent carpal tunnel syndrome, secondary carpal tunnel syndrome and anatomic variants compromising the safety of transverse carpal ligament division are contraindications. The procedure is performed under local anesthesia without tourniquet. The entry point is a short transverse incision proximal to the wrist crease. The transverse carpal ligament is divided anterogradely, using a dedicated blade under ultrasound control, making sure no nerves, tendons or blood vessels are injured. The final step is to check that the division is complete. Early return to use of the hand is permitted. Reports of similar techniques demonstrated early symptomatic relieve, favorable patient-reported outcome measures from within 1 week after surgery to 2 years' follow-up, with early return to normal daily activity and work. The complications rate is low: many series showed no complications. Comparative studies between ultrasound-guided carpal tunnel release and the mini-open technique reported similar or greater and quicker symptom relief, less scar pain and better strength. Final functional results tend to be similar.

Radial nerve compression at the arcade of Frohse is a rare but significant condition that typically presents with pain primarily after exertion and at night on the dorsal side of the forearm, more distally than tennis elbow pain, and weakness of the wrist extensors and the long fingers and thumb extensors. Traditional treatment often involves open surgery, resulting in significant scarring. This study introduces a novel percutaneous radial nerve release technique under complete ultrasound guidance and highlights its efficacy and safety. The procedure involves identifying the entry point, lateral of the radial nerve, allowing for targeted release of the superficial fascia surrounding the supinator muscle without damaging nearby vascular or nerve structures. A cadaveric study was performed on ten fresh-frozen specimens to validate the entry point and route, which successfully demonstrated complete fascial release without complications. Preliminary clinical results from five patients showed complete resolution of symptoms associated with radial tunnel syndrome with no reported complications. The technique results in a significantly smaller incision (<1 cm) compared to traditional methods (up to 10 cm) and can be performed under WALANT anesthesia, making it suitable for the outpatient setting. This approach offers a minimally invasive alternative for patients with isolated posterior interosseous nerve compression and highlights the importance of ultrasound guidance in achieving optimal results. Because the technique requires a learning curve, it is recommended for surgeons with experience in ultrasound-guided procedures.

Purpose: This study aimed to evaluate the outcomes of a novel antegrade, ultrasound-guided release of the first extensor tendon compartment for treating De Quervain's disease.

Methods: We conducted a retrospective, single-center study of 34 patients who underwent ultrasound-guided release of the first extensor compartment for clinically diagnosed De Quervain's disease between June 2022 and December 2023. Inclusion criteria included age >18 years and failure of conservative treatment (e.g., NSAIDs, physiotherapy, and steroid injection) for more than six weeks. Exclusion criteria were prior trigger thumb surgery and documented allergy to local anesthetics. Outcomes were assessed using pain intensity (visual analog scale, VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, and complication rates.

Results: The mean VAS for pain improved from 7.4 to 1.1, and the QuickDASH score improved from 55 to 9.4 at the final follow-up. We recorded three minor complications and no major complications.

Conclusion: Ultrasound-guided surgical release of the first extensor compartment for De Quervain's disease is a minimally invasive, technologically advanced, and effective treatment option.