Peripheral nerve symptoms are common in the worker. Great care must be given to obtain an accurate diagnosis. Diagnostic labels should not be used unless one is sure of the diagnosis. A detailed evaluation of the worker, job, and medical and psychosocial conditions must be performed. Nonoperative treatment is primary. Understanding at-risk patients and managing them carefully can decrease disability and improve results following treatment. The results from surgery are less successful in work-related disorders and disability is often prolonged. Surgery should only be performed for clear diagnoses and clear indications after adequate nonoperative treatment, with careful consideration of the job to which the worker will return.

Carpal Tunnel Syndrome↗

PubMed1996

The rheumatoid thumb.

The thumb frequently is involved in rheumatoid arthritis and often is a source of significant functional loss, pain, and deformity. Fortunately, much can be done to provide pain relief, improve function, enhance appearance, and slow the progression of disease. Specific surgical interventions should be based on the nature and stage of deformity as well as the status of tendons, ligaments, and adjacent joints. Treatment options, in isolation or in combination, include synovectomy, arthrodesis, arthroplasty, and tendon repair or transfer. Although most thumb deformities can be classified as one of six common types, other patterns of deformity also are seen. It therefore is imperative not to operate on pattern recognition alone, but to examine each patient carefully and individualize treatment.

Arthritis, Rheumatoid↗

PubMed1995

Refracture of a proximal pole scaphoid fracture: a case report.

Explore the source record for details and available documents.

Adolescent↗

PubMed1993

Camitz palmaris longus abductorplasty for severe thenar atrophy secondary to carpal tunnel syndrome.

This is a retrospective review of 29 patients (33 hands) who underwent a palmaris longus transfer because of severe thenar atrophy secondary to median nerve entrapment at the wrist. The mean follow-up was 17 months. Ninety-four percent of our patients were satisfied because their thumb function improved. Twenty-six of the patients had the transfer at the time of initial release of the carpal tunnel, and three patients had the transfer when the carpal tunnel was released a second time. The transfer helps with thumb palmar abduction, and the palmaris longus is an expendable muscle for transfer.

Adult↗

PubMed1993

Injury to the deep motor branch of the ulnar nerve during carpal tunnel release.

Explore the source record for details and available documents.

Adult↗

PubMed1992

Factors that determine reexploration treatment of carpal tunnel syndrome.

Eighteen patients (20 hands) underwent reexploration of the carpal tunnel after a primary carpal tunnel release. The patients complained of unrelieved symptoms after their initial surgical procedures. We recommend reexploration for patients with unrelieved carpal tunnel syndrome if they have a positive Phalen's test, have symptoms that cause nocturnal wakening or are exacerbated by activities, or have a short or transverse initial incision. If the incision is adequate and these symptoms are not present, we believe that reexploration will not result in a satisfactory outcome.

Adult↗

PubMed1992

Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome.

Partial resection of the distal ulna (wafer resection) has been used to treat patients with symptomatic tears of the triangular fibrocartilage complex or mild ulna impaction syndrome. In this procedure, the distal 2 to 4 mm of the distal ulnar head is resected while preserving the ulnar styloid process and the ligaments attached to it. The triangular fibrocartilage is debrided, repaired, or partially excised as necessary. The procedure is contraindicated if there is more than 4 mm of positive ulnar variance. Thirteen wafer resections of the distal ulna were performed in 12 patients. All had good to excellent results after a minimum follow-up of 1 year. Wafer resection has specific advantages and avoids many of the potential complications of distal ulna recession and ulnar head resection for patients with the conditions described. The procedure is not indicated if instability or degenerative arthritis of the distal radioulnar joint is present or if there is carpal instability.

Adolescent↗

PubMed1992

Reconstruction of the rheumatoid thumb.

Most rheumatoid patients will present with one or more thumb deformities at some stage of their clinical history. The goal of treatment is restoration and maintenance of stable and painless motion. Treatment is based on the type and stage of the deformity. The boutonniere thumb is the most common deformity. Metacarpophalangeal arthrodesis is preferred for isolated metacarpophalangeal involvement. For advanced cases in a low-demand patient, metacarpophalangeal arthroplasty with interphalangeal arthrodesis is performed. In the higher demand hand with an uninvolved carpometacarpal joint, arthrodesis of both metacarpophalangeal and interphalangeal joints may be considered. The less common swan neck is approached by treating the carpometacarpal joint with a hemiarthroplasty or a total resection with capsulodesis or arthrodesis of the metacarpophalangeal joint. Adduction contracture is treated by Z-plasty of the skin of the first web space and release of the adductor aponeurosis. Gamekeeper's deformity is treated with reconstruction of the ulnar collateral ligament. Arthrodesis is recommended for those patients with articular erosion of the metacarpophalangeal joint. Flexor pollicis longus and extensor pollicis longus tendon ruptures are common in rheumatoid patients. Extensor pollicis longus ruptures are usually treated with EIP transfer or observation. Flexor pollicis longus ruptures are more disabling and usually require a tendon transfer, tendon graft, or an interphalangeal joint fusion in patients with radiographic destruction of that joint.

Arthritis, Rheumatoid↗

PubMed1992

The "wafer" procedure. Partial distal ulnar resection.

A technique of partial resection of the distal ulna ("wafer" procedure) for the treatment of patients with symptomatic tears of the triangular fibrocartilage complex or mild ulnar impaction syndrome or both is described. The distal 2-4 mm of the distal ulna is resected while preserving the distal radioulnar joint and the styloid process of the ulna and the ligaments attached to it. The triangular fibrocartilage can be debrided, repaired, or partially excised. The wafer procedure has several advantages and avoids some of the potential complications of other treatment methods.

Adult↗

PubMed1991

Silicone rubber arthroplasty of the wrist.

The wrist is often referred to as the keystone of the hand. It is often affected in rheumatoid arthritis. Salvage procedures for patients with rheumatoid arthritis involving the wrist include silicone wrist arthroplasty, total joint arthroplasty, and wrist arthrodesis. In 1967, Swanson developed a double-stem, flexible-hinge implant for the radial carpal joint. In 1982, metal titanium bone liners (grommets) were added to help decrease the incidence of fractures. The authors feel that the gold standard is still wrist arthrodesis. However, they would use a flexible wrist arthroplasty in a patient who has bilateral wrist involvement with marked digital deformity and/or proximal interphalangeal stiffness. This is especially true in low-demand patients who have good alignment, good bone stock, and the associated proximal and distal disease. If these criteria are met and meticulous technique used, successful reconstruction of the wrist with a flexible wrist silicone implant can be performed in the patient with rheumatoid arthritis.

Arthritis, Rheumatoid↗