Hand surgery & rehabilitation最新文献

The purpose of this study was to evaluate the results of a novel retrograde ultrasound-guided A1 pulley release technique for the treatment of trigger thumb. We conducted a retrospective, single-center study of 42 patients who underwent ultrasound-guided A1 pulley release for clinically diagnosed trigger thumb between September 2022 and December 2023. All cases were graded according to the Green classification of trigger finger severity. Inclusion criteria were patients aged >18 years who failed conservative treatment (non-steroidal anti-inflammatory drugs, physical therapy, or steroid injections) for at least six weeks. Exclusion criteria were previous trigger thumb surgery, metacarpophalangeal or trapeziometacarpal arthrodesis, and documented allergy to local anesthetics. Outcome measures were pain intensity (visual analog scale, VAS), Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scores, and complication rates. The mean age of the patients was 37.8 years (range: 27-72). Based on Green's classification, we treated 5 grade I, 26 grade II, 6 grade IIIA, and 5 grade IIIB cases. At one month follow-up, all patients had resolution of the triggering. The mean VAS score improved significantly from 7.2 to 1.3 and the Quick-DASH score decreased from 51 to 9.1. There were no major complications. Open A1 pulley release for trigger thumb is effective but carries risks to the palmar radial digital nerve, especially in open surgery. Alternative methods such as ultrasound-guided and percutaneous release offer similar results with fewer complications. Recovery is faster for trigger thumb (2 weeks) compared to trigger finger (5 weeks). Some patients may experience prolonged symptoms after surgery. Open surgery has a 12% complication rate and a 2.4% revision rate. Ultrasound-guided percutaneous release is safer and allows real-time visualization during the procedure. Retrograde ultrasound-guided A1 pulley release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus. It offers advantages over traditional approaches, including improved cosmetic outcomes, the absence of sutures, and the ability for patients to resume daily activities and light work immediately postoperatively.

Dynamic compression of the median nerve under the lacertus fibrosus at the elbow causes pain and weakness. It is a frequently overlooked pathology and a cause of failed recovery after carpal tunnel release. The purpose was to present a technical note on minimally invasive ultrasound-guided lacertus syndrome surgical treatment under WALANT. We believe the technique is indicated in patients who present with a positive Hagert's triad of pain over the median nerve at the lacertus, weakness on testing of the flexor pollicis longus, second flexor digitorum profundus, and flexor carpi radialis, and a positive sensitive collapse test. Contraindications include static median nerve compression at the elbow and allergy to lidocaine. The technique is preceded by local anesthesia, which is completed under ultrasound guidance for deeper or more proximal structures. The entry point is calculated proximal to the lacertus and the special knife is introduced through a 0.5 cm incision. The lacertus is divided anterogradely under ultrasound guidance. Full recovery of strength is evidenced by the completion of the division. The patient returns to full activity within days to a week after surgery. Minimally invasive, ultrasound-guided release allows for rapid return of full-strength motion with minimal scarring.

An ulnar nerve (UN) palsy is devastating for hand function, resulting in an intrinsic minus position or claw hand with a loss of pinch grip. Distal nerve transfers facilitate faster reinnervation of hand intrinsic muscles in cases of proximal ulnar nerve lesions. The traditional anterior interosseous nerve (AIN) to UN motor transfer is commonly used, however, this still leads to long reinnervation times for the distal intrinsic muscles, important for the thumb to index pinch grip. This study investigated the feasibility of a more distal nerve transfer, from the median thenar to the deep branch of the UN (DBUN), in six cadaveric hands. A separate branch of the median nerve to the superficial head of flexor pollicis brevis (sFPB) arose distally of the thenar branch from the common digital nerve of the thumb shortly before the bifurcation of the ulnar palmar digital nerve to the thumb in all specimens, with a mean distance to the thenar branch of 8.3 ± 5.3 mm. The sFPB motor branch had a mean length of 11.5 ± 1.5 mm. The mean distance between the division of the dorsal cutaneous branch of the UN, where the AIN to UN motor transfer is usually performed, and the transfer between the sFPB branch to the DBUN was 132 ± 11 mm. A distal nerve transfer between the median innervated motor branch to the sFPB to the DBUN shortens the reinnervation distance for the first dorsal interosseous, the adductor pollicis, and the deep head of the FPB muscles, which is a prerequisite for restoration of the pinch grip.

Background: Patients are increasingly turning to the internet, and recently artificial intelligence engines (e.g., ChatGPT), for answers to common medical questions. Regarding orthopedic hand surgery, recent literature has focused on ChatGPT's ability to answer patient frequently asked questions (FAQs) regarding subjects such as carpal tunnel syndrome, distal radius fractures, and more. The present study seeks to determine how accurately ChatGPT can answer patient FAQs surrounding simple fracture patterns such as fifth metacarpal neck fractures.

Methods: Internet queries were used to identify the ten most FAQs regarding boxer's fractures based on information from five trusted healthcare institutions. These ten questions were posed to ChatGPT 4.0, and the chatbot's responses were recorded. Two fellowship trained orthopedic hand surgeons and one orthopedic hand surgery fellow then graded ChatGPT's responses on an alphabetical grading scale (i.e., A-F); additional commentary was then provided for each response. Descriptive statistics were used to report question, grader, and overall ChatGPT response grades.

Results: ChatGPT achieved a cumulative grade of a B, indicating that the chatbot can provide adequate responses with only minor need for clarification when answering FAQs for boxer's fractures. Individual graders provided comparable overall grades of B, B, and B+ respectively. ChatGPT deferred to a medical professional in 7/10 responses. General questions were graded at an A-. Management questions were graded at a C+.

Conclusion: Overall, with a grade of B, ChatGPT 4.0 provides adequate-to- complete responses as it pertains to patient FAQs surrounding boxer's fractures.

Trigger finger, or stenosing tenovaginitis, is a common condition characterized by impaired flexor tendon sliding due to thickening of the A1 pulley. While open surgical release remains the gold standard for the treatment of persistent trigger finger, there is increasing interest in minimally invasive ultrasound-guided techniques to improve precision and outcomes. The purpose of this study is to evaluate the outcomes, safety, and complications associated with ultrasound-guided trigger finger release using a minimally invasive surgical knife. We performed a retrospective analysis of 297 trigger finger releases performed on 238 patients between April 2021 and December 2023. All procedures were performed on the long fingers, excluding the thumb, using ultrasound guidance under WALANT or regional anesthesia. Patients were evaluated at 6 weeks and 3 months postoperatively for symptom resolution, complications, and functional recovery. The procedure achieved a 100% success rate for complete release of the A1 pulley with no major complications or iatrogenic damage such as tendon or neurovascular injury. Minor complications, such as temporary postoperative loss of motion or localized pain, occurred in 33 cases (11.1%) and all resolved with conservative management by the three-month follow-up. Importantly, only one procedure required conversion to open surgery due to intraoperative uncertainty, where full release was confirmed. Ultrasound-guided minimally invasive trigger finger release is a safe and effective technique. It provides precise release with a low risk of complications or iatrogenic damage. As ultrasound technology advances and availability increases, this technique has the potential to become a reliable and patient-friendly alternative to classic open methods.

Background: Restoring elbow flexion following brachial plexus injury (BPI) is essential for improving arm function and quality of life in adults. This study aimed to compare the efficacy of Oberlin II and intercostal nerve (ICN) neurotization techniques for restoring elbow flexion in adults with upper and middle trunk brachial plexus palsy.

Methods: This prospective study included 36 patients aged 18 to 50 years with traumatic upper and middle trunk brachial plexus palsy. The patients were divided into two groups: Group A consisted of 19 patients who underwent the Oberlin II procedure, while Group B included 17 patients treated with ICN neurotization. All patients were followed for at least 60 months.

Results: Muscle reactivation occurred significantly earlier in the Oberlin II group compared to the ICN neurotization group (P = 0.012). Muscle strength grading also showed significant differences, with a higher proportion of patients achieving grade 4 and 4+ strength in the Oberlin II group compared to the ICN neurotization group (P = 0.041).

Conclusions: The Oberlin II neurotization technique demonstrated superior efficacy in restoring elbow flexion following BPI compared to ICN neurotization. It resulted in earlier muscle reactivation and higher levels of muscle strength, with a greater proportion of patients achieving grades 4 and 4+ strength.

Most patients with post-traumatic and/or degenerative wrist arthritis present with pain and limitation of activities of daily living. Wrist denervation using a two-incision technique is an alternative to proximal row carpectomy and partial or total wrist arthrodesis. The purpose of this study was to evaluate whether two-incision denervation is a valid procedure for reducing pain in wrist arthritis of different etiologies. A retrospective study of fifty-four patients, mean age 56 years, operated on by one senior surgeon at a single center was designed. Inclusion criteria were chronic wrist pain of various etiologies, patients with previous wrist surgery were excluded. Preoperative pain was reported on a visual analog scale, and at least twelve months postoperatively, patient-rated wrist/hand assessment, pain, and range of motion were assessed. RESULTS: 54.8% of the population presented with post-traumatic osteoarthritis of the wrist (scaphoid non-union advanced collapse or scapholunate advanced collapse). 71.5% of the population underwent surgery on the dominant extremity. After clinical evaluation, the mean PRWHE was 15.76 (±14.53), with total joint motion of 68 ° (±14.44), flexion 64.5 ° (±13.36), extension 76 ° (±7.71), pronation 72.4 ° (±6.20), and supination 74.8 ° (±9.21). The overall mean pain reduction was 60% and there were no re-operations. Two-incision total wrist denervation is a valid technique for the treatment of wrist pain of various etiologies, leaving a good range of motion and acceptable autonomy in activities of daily living. If this technique fails, more invasive techniques such as proximal row carpectomy, partial or total wrist arthrodesis, and wrist arthroplasty can be used.