Hand surgery & rehabilitation最新文献

A rupture of the distal insertion of the flexor digitorum profundus tendon is a serious avulsion that typically occurs when gripping a jersey. It is commonly known as the "Jersey Finger" or "Rugby Finger" in French literature. This injury, which primarily affects the ring finger (in 80% of cases), requires urgent diagnosis for optimal surgical management. Although rugby has seen a decrease in incidence thanks to advances in equipment, we present two cases that occurred in professional soccer, raising the question of whether the epidemiology of this pathology is changing. This discussion extends to the need for jerseys and refereeing rules to evolve to prevent this injury.

Purpose: This study sought to determine the incidence of Neuralgic Amyotrophy (NA) in the United States of America's health system, most common presenting symptoms, time from symptom onset and time from initial presentation to diagnosis, number and specialty of clinicians seen prior to diagnosis, and specialty of diagnosing clinician.

Methods: A retrospective chart review study was conducted to identify all patients diagnosed with ICD-10 G54.5 from September 1, 2016-December 31, 2023.

Results: 153 patients with NA diagnoses from 2016 to 2023 were included. The average incidence of NA in the United States of America's healthcare system was 1.77/100,000 per year. The most common chief concern upon presentation was shoulder pain, (n = 57, 37.2%) and the most common secondary or tertiary concern was shoulder weakness (n = 41, 26.7%). Average time from symptom onset to diagnosis was 101.3 days (SD = 155.4; median = 51 days), and from initial presentation to diagnosis was 78.1 days (SD = 145.6; median = 28 days). Sixty-three patients (41.2%) presented to one other clinician with similar symptoms prior to diagnosis, 37 (24.2%) saw two clinicians, 16 (10.5%) saw three, and 7 (4.6%) saw four or more clinicians. Patients most often initially presented to a family medicine, primary care, or urgent care clinician (n = 61, 39.9%). The most common specialties of diagnosing clinicians were orthopaedic surgery (100 diagnoses, 65.4%), neurology (23 diagnoses, 15%) and neurosurgery (15 diagnoses, 10%).

Conclusion: Diagnosis of neuralgic amyotrophy is historically rare, but the incidence may be higher than previously thought. Neuralgic amyotrophy is a debilitating disorder that is often initially unrecognized, ultimately leading to a months-long delay in diagnosis. Over 80% of patients were seen by at least one other clinician before diagnosis, and orthopaedic clinicians were most likely to make the diagnosis.

Clinical relevance: Maintaining a high clinical suspicion while recognizing the common presenting symptoms along with onset and evolution of symptoms would help facilitate timely referral to specialists trained in identifying and managing neuralgic amyotrophy, prevent unnecessary and unproductive appointments preceding the diagnosis, and allow earlier initiation of treatment.

Level of evidence: Diagnostic Type IV.

Introduction: Patients have become increasingly reliant on the internet to seek health-related information (HRI). The newfound popularity of artificial intelligence (AI) search engines has created interest in their ability to provide HRI. This study aimed to quantify and compare the readability of carpal tunnel syndrome (CTS) HRI from the American Academy of Orthopaedic Surgeons OrthoInfo and AI search engines.

Methods: Six prompts were developed using the OrthoInfo page on CTS. These prompts were entered to ChatGPT-4 and Google Gemini 2.0 Flash to generate AI responses. The readability of this information was calculated using the Flesch-Kincaid Reading Ease Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, FORCAST Readability Formula, Gunning Fog index, and Simple Measure of Gobbledygook Index. Statistical testing was performed using the Kruskal-Wallis nonparametric One-Way Analysis of Variance test.

Results: The mean grade level readability score across all platforms, questions, and testing metrics was 12.6. No significant differences were observed between the overall mean grade level readability scores of OrthoInfo, ChatGPT, and Gemini, nor were they observed for any specific prompt. The only significant differences were found using the Flesch-Kincaid Grade Level test, for which ChatGPT had the lowest scores.

Conclusion: The readability of carpal tunnel syndrome health-related information from OrthoInfo, ChatGPT, and Gemini is similar. Physicians should advise patients to continue using OrthoInfo as a primary source of carpal tunnel syndrome information, although artificial intelligence search engines are useful to supplement when patient concerns require more tailored responses. Notably, no text included in this study was at recommended reading level thresholds.

Osteoarthritis (OA) is a leading cause of disability, with diagnosis and management limited by inter-observer variability and the absence of individualized therapeutic strategies. This review critically examines recent applications of artificial intelligence (AI) in OA diagnosis, treatment planning, rehabilitation, and drug discovery, with a particular focus on clinically relevant imaging-based and predictive models. We synthesize evidence from radiographic and MRI-based AI systems used for disease grading, progression prediction, and surgical outcome forecasting, highlighting their performance, limitations, and translational barriers. Particular emphasis is placed on how AI-generated outputs can inform clinical decision-making, including treatment selection and rehabilitation monitoring. Current challenges related to dataset bias, external validation, and workflow integration are discussed using concrete examples from published studies. Finally, we outline future directions aimed at improving clinical utility through explainable AI, multi-modal data integration, and prospective validation. This focused synthesis underscores both the promise and the practical constraints of AI-driven osteoarthritis care.

Purpose: The relationship between glucagon-like peptide-1 receptor agonist (GLP-1 RA) use and trigger finger (TF) remains unknown. This study aims to compare rates of TF, TF release, and complications of TF release between diabetic patients with and without a history of GLP-1 RA use.

Methods: This study utilized the TriNetX database to identify adult patients with Type II diabetes mellitus. The primary analysis included patients with and without a history of GLP-1 RA use. The secondary analysis included patients with a history of TF separated by the presence or absence of GLP-1 RA use, respectively. The tertiary analysis included patients with and without a history of GLP-1 RA use within the 6 months prior to TF release. Cohorts were propensity-matched 1:1 based on demographic characteristics and medical comorbidities. The primary outcome was the incidence of TF; the secondary outcome was the incidence of TF release. Tertiary outcomes included postoperative complications within 90 days of surgery.

Results: GLP-1 RA use was associated with a significant reduction in the prevalence of trigger finger. In contrast, GLP-1 RA users demonstrated a higher prevalence of TF release and similar rates of surgical site infection, joint stiffness, wound dehiscence, and abscess irrigation and debridement following operative release.

Conclusions: Glucagon-like peptide-1 receptor agonist use in patients with type 2 diabetes mellitus is associated with a reduction in the prevalence of trigger finger without an elevation in complication risk following surgical release. Interestingly, we also observed increased prevalence of trigger finger release among glucagon-like peptide-1 receptor agonist users.

Introduction: Non-tobacco nicotine dependence (NTND) from products like e-cigarettes and pouches is rapidly rising. Studies have shown that tobacco can negatively impact outcomes following carpal tunnel release (CTR), but literature focusing specifically on NTND is sparse. As such, the purpose of this study was to compare outcomes following CTR between patients with versus without a history of NTND.

Methods: The TriNetX database was queried to identify patients over 18 years old who underwent primary CTR. Patients were stratified based on their history of NTND. Cohorts underwent propensity score matching in a 1:1 ratio using demographics, medical comorbidities, and substance use. The following outcomes were collected: 1) post-operative complications, surgical complications, and healthcare utilization within 90 days, 2) opioid use within 2 years, and 3) revision CTR within 2 years.

Results: Within 90 days, patients with NTND (n = 9811), compared to those without (n = 9811), had significantly higher rates of healthcare utilization, including emergency department visits (p < 0.001), and post-operative complications, like pneumonia (OR: 1.372, p = 0.036) and wound complications (OR: 1.501, p = 0.005). There were no differences in surgical complications. More patients with NTND were prescribed opioids at all time points within 2 years of CTR (all p < 0.001). There were no differences in revision surgery rates.

Conclusion: Non-tobacco nicotine dependence is associated with higher rates of healthcare utilization, medical complications, and opioid use following carpal tunnel release. Increased clinical awareness, targeted patient counseling, and pre-operative optimization may be warranted for this growing population.

Background: Pyrocarbon and silicone implants are the two main options for metacarpophalangeal (MCP) joint arthroplasty, but their comparative functional outcomes and long-term survivorship remain debated. Evidence is scattered across heterogeneous study designs, and no recent meta-analysis has directly compared both implant types.

Purpose: To compare functional outcomes and implant survival between pyrocarbon and silicone MCP joint arthroplasty.

Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, Embase, and Cochrane Library were searched from inception to July 2024. Studies reporting postoperative outcomes after silicone or pyrocarbon MCP arthroplasty were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale (with adapted criteria for single-group pre-post designs). Random-effects models were used due to anticipated heterogeneity. Functional outcomes (arc of motion, flexion, extension lag, DASH score, VAS pain) and implant survival (5- and 10-year) were pooled. Sources of heterogeneity were qualitatively explored.

Results: Twelve studies (1,023 implants) were included: 535 silicone and 488 pyrocarbon. Pooled analyses showed no significant differences between silicone and pyrocarbon implants for postoperative flexion, total arc of motion, or extension lag. DASH scores favored silicone implants, with significantly lower postoperative disability; however, the magnitude of this difference did not exceed the reported minimal clinically important difference. Five-year survival was high for both groups (silicone 82-97%, pyrocarbon 82-97%). Ten-year survival ranged from 70 to 89% for silicone and 81-88% for pyrocarbon. Considerable heterogeneity was present across several pooled analyses, related mainly to study design variability.

Conclusion: Both silicone and pyrocarbon MCP arthroplasties provide comparable improvements in pain, function, and medium-term survival. Differences in range of motion favor silicone, while long-term survivorship appears similar. Due to substantial heterogeneity and predominance of non-comparative studies, these findings should be interpreted with caution.

Level of evidence: III (based on retrospective comparative studies).

Aims/hypothesis: Beta cells within the pancreatic islet represent a heterogenous population wherein individual sub-groups of cells make distinct contributions to the overall control of insulin secretion. These include a subpopulation of highly-connected 'hub' cells, important for the propagation of intercellular Ca²⁺ waves. Functional subpopulations have also been demonstrated in human beta cells, with an altered subtype distribution apparent in type 2 diabetes. At present, the molecular mechanisms through which beta cell hierarchy is established are poorly understood. Changes at the level of the epigenome provide one such possibility which we explore here by focussing on the imprinted gene neuronatin (Nnat), which is required for normal insulin synthesis and secretion.

Methods: Single cell RNA-seq datasets were examined using Seurat 4.0 and ClusterProfiler running under R. Transgenic mice expressing eGFP under the control of the Nnat enhancer/promoter regions were generated for fluorescence-activated cell (FAC) sorting of beta cells and downstream analysis of CpG methylation by bisulphite and RNA sequencing, respectively. Animals deleted for the de novo methyltransferase, DNMT3A from the pancreatic progenitor stage were used to explore control of promoter methylation. Proteomics was performed using affinity purification mass spectrometry and Ca²⁺ dynamics explored by rapid confocal imaging of Cal-520 and Cal-590. Insulin secretion was measured using Homogeneous Time Resolved Fluorescence Imaging.

Results: Nnat mRNA was differentially expressed in a discrete beta cell population in a developmental stage- and DNA methylation (DNMT3A)-dependent manner. Thus, pseudo-time analysis of embryonic data sets demonstrated the early establishment of Nnat-positive and negative subpopulations during embryogenesis. NNAT expression is also restricted to a subset of beta cells across the human islet that is maintained throughout adult life. NNAT⁺ beta cells also displayed a discrete transcriptome at adult stages, representing a sub-population specialised for insulin production, reminiscent of recently-described "β_HI" cells and were diminished in db/db mice. 'Hub' cells were less abundant in the NNAT⁺ population, consistent with epigenetic control of this functional specialization.

Conclusions/interpretation: These findings demonstrate that differential DNA methylation at Nnat represents a novel means through which beta cell heterogeneity is established during development. We therefore hypothesise that changes in methylation at this locus may thus contribute to a loss of beta cell hierarchy and connectivity, potentially contributing to defective insulin secretion in some forms of diabetes.