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PubMed1988

Fracture of the hamate hook.

Twenty-one cases of hamulus fracture are presented. Diagnosis depends on clinical acuity. The most common symptom is pain in the palm that is aggravated by grasp. Weakness of grasp and dorsal wrist pain are also common. Ulnar nerve paresthesia or weakness and mild carpal tunnel syndrome are frequently present. Tenderness directly over the hamulus is always present, and grip strength typically is diminished. Tenosynovitis, tendon fraying, or tendon rupture may be demonstrated in 25% of the cases and is not related to the use of steroids. Lateral trispiral tomography is clearly superior to the other diagnostic methods. Excision produced generally excellent results, particularly in patients with an athletic injury or with no associated additional injury. A nonathletic injury or the presence of associated trauma adversely affected results. Immediate immobilization of acute fractures may result in fracture healing and obviate operative intervention. Open reduction and internal fixation is feasible but offers little advantage over excision.

Adolescent↗

PubMed1988

Flexor tendon ruptures in patients with rheumatoid arthritis.

One hundred fifteen flexor tendon ruptures were reviewed in 43 hands with rheumatoid arthritis, one hand with psoriatic arthritis, and one hand with lupus erythematosis. Ninety-one tendons were ruptured at the wrist, four ruptures occurred at the palm, and 20 ruptures occurred within the digits. At the wrist level, 61 ruptures were caused by attrition on a bone spur and 30 were caused by direct invasion of the tendon by tenosynovium. All ruptures distal to the wrist were caused by invasion of the tendon by tenosynovium. Patients whose ruptures were caused by attrition regained better motion than those whose ruptures were caused by invasion by tenosynovitis; however, motion overall was poor. Patients with isolated ruptures in the palm or at the wrist had the best functional results. Those patients with multiple ruptures within the carpal canal had a worse prognosis. Ruptures of both tendons within the fibro-osseous canal had the worst prognosis. The severity of the patient's disease and the degree of articular involvement had a great effect on the outcome of surgery. Prevention of tendon ruptures by early tenosynovectomy and removal of bone spurs should be the cornerstone of treatment.

Adult↗

PubMed1990

Triggering of the thumb with de Quervain's stenosing tendovaginitis.

Triggering with de Quervain's stenosing tenosynovitis has rarely been mentioned since de Quervain's original description. Either or both the abductor pollicis longus and extensor pollicis brevis tendons may be responsible. Without detailed examination testing specifically for triggering, the entity may be overlooked. We have encountered nine patients with triggering in the first dorsal compartment. The five with surgical release had complete resolution of symptoms; the four treated nonoperatively have improved but still have symptoms. Triggering may represent a more severe form of de Quervain's tendovaginitis.

Adult↗

PubMed1993

Abscesses of the upper extremity from drug abuse by injection.

A 4-year retrospective review of 59 consecutive upper extremity abscesses associated with drug abuse by injection is reported. There were 57 patients, with the most common location being the forearm. All abscesses were treated with incision, drainage, and intravenous antibiotics. Seventeen patients required more than one debridement; nine were complicated by fasciitis, osteomyelitis, septic arthritis, or septic tenosynovitis. Thirty-one patients had human immunodeficiency virus testing, and nine results were positive. Bacteriology showed the most common organisms to be streptococcus, Staphylococcus aureus, and Eikenella corrodens. Nineteen percent of the abscesses had anaerobes cultured. Most of the organisms cultured were common oral or skin flora.

Abscess↗

PubMedDate not supplied

Ultrasound findings of ganglions of the wrist.

Fifty-one patients with a palpable swelling of a wrist or finger of suspected ganglion origin were examined by ultrasound (US). Forty-five were operated on, and a ganglion was found in 35. The ganglions took the form of cysts 0.4-4 cm in diameter (mean 1.4 cm) with a projection into the joint or tendon in 19 cases. Two patients had multiple ganglia, and two a wrist lipoma, one echo-rich and the other echo-poor with a thick wall. One patient had a giant cell tumour of the tendon sheath which was moderately echogenic in appearance, one had carpal tunnel syndrome and a ganglion-like finding at US, one had tenosynovitis and negative US and one had a prominent tendon due to postoperative sequelae, with US showing a longish echo-poor lesion. Two had hypertrophied muscle forming a long echo-poor structure, one had an exostosis and one had no abnormality in the wrist at operation. Our experiences suggest that ultrasound is useful in many cases with impression of a ganglion at palpation showing multiplicity of a lesion or for assisting in differential diagnosis, although a physical examination is mostly sufficient for diagnostic purposes.

Adolescent↗

PubMedDate not supplied

Limitation of finger joint mobility in diabetes mellitus.

Diabetes mellitus, both insulin dependent and non-insulin dependent, is associated with limitation of joint mobility of the fingers, which can be due to connective tissue changes, neuropathy, vasculopathy, or combinations of these problems. Distinct clinical problems include Dupuytren disease, flexor tenosynovitis, carpal tunnel syndrome (diabetic hand), stiff hand syndrome, shoulder-hand syndrome (reflex dystrophy) and limited joint mobility (LJM). Stiff hand and LJM syndromes are only seen with diabetes; the others have distinct clinical characteristics in those with diabetes compared to the nondiabetic presentation. LJM is of particular interest because it is common in young patients and associated with an increased risk for the serious complications of nephropathy and retinopathy.

Diabetes Mellitus↗

PubMed2004

Mycophenolic acid inhibits avian reovirus replication.

Avian reoviruses (ARV) are economically important pathogens, especially in the poultry industry, where they cause viral arthritis and tenosynovitis. Mycophenolic acid (MPA) is an inhibitor of inosine monophosphate dehydrogenase (mainly used clinically for immunosuppression) that inhibits the replication of several viruses. We demonstrate in this study that MPA also is capable of inhibiting ARV replication in QM5 quail fibrosarcoma cells. The selectivity index of MPA in QM5 cells was determined as approximately 41. Concentrations of > or =3 microg/ml MPA inhibited infectious ARV progeny production in QM5 cells by more than 100-fold. Inhibition of ARV replication also was seen in other cell lines, including HD-11 and Vero. Addition of exogenous guanosine to MPA-treated ARV-infected QM5 cells restored viral replicative capacity to nearly normal levels.

Animals↗

PubMed2005

Peroneal tendon pathology.

Peroneal tendon pathology is a common entity but is infrequently reported in the literature. The lesion may be due to partial tears, complete ruptures, subluxation, tenosynovitis, a fractured os peroneum, or damage to the peroneal retinacula. Chronic lateral ankle instability and excessive subtalar and ankle varus rotation may cause damage to the peroneal tendons and their associated structures. This article reviews the pathophysiology, diagnostic imaging, and current surgical techniques for the repair of peroneal tendons.

Ankle↗

PubMed2004

MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases.

AIM: To describe the magnetic resonance imaging (MRI) features of posterior ankle impingement syndrome (PAIS) in classical ballet dancers. MATERIALS AND METHODS: A retrospective review was undertaken of 25 MRI examinations of the ankle performed on 23 ballet dancers over a 26-month period. Images were examined for the presence of osseous and soft-tissue anatomical variants at the posterior ankle and imaging signs of PAIS. All patients presented with symptoms and signs suggestive of PAIS including posterior ankle pain, swelling and stiffness during plantar flexion. RESULTS: Anatomical variants predisposing to PAIS including as os trigonum and tuberosity arising from the superior calcaneum were clearly depicted. The most common imaging feature of PAIS in our series was high T2 signal posterior to the talocalcaneal joint indicating synovitis (n = 25). Thickening of the posterior capsule (n = 13) and tenosynovitis of flexor hallucis longus (n = 17) were also common. An os trigonum was an infrequent finding (n = 7). Bone marrow oedema, commonly in the posterior talus (n = 10) or in a patchy distribution (n = 10) was often noted. CONCLUSION: MRI is a useful diagnostic tool in PAIS, and in the present series, clearly demonstrates the anatomical variants and range of osseous and soft-tissue abnormalities associated with this condition. Prospective studies are needed to understand the significance and importance of individual MRI findings in producing the symptoms of PAIS.

Adolescent↗

PubMed2005

Wounds of the distal limb complicated by involvement of deep structures.

The authors describe the clinically relevant structures of the distal limb and the current diagnostic and treatment modalities. Specific problems include tendon laceration, septic tenosynovitis, and sep-tic arthritis of the distal joints. A detailed description of tendon repair, tendon sheath lavage, and postoperative convalescent methodology is provided. This article makes available to the reader information necessary to appropriately diagnose and treat wounds of the distal equine limb involving deep structures. Information on the overall prognosis is also provided.

Animals↗

PubMed2005

Healing, diagnosis, repair, and rehabilitation of tendon conditions.

Management of tendon conditions can be frustrating due to difficulty with diagnosis, choice of treatment or repair technique, prolonged tissue healing, and potential for permanent compromise of limb function after surgery. This article reviews tendon healing and reported tendon conditions, focusing on bicipital tenosynovitis and common calcaneal tendon injuries. Surgical management options, research in enhancement of tendon healing, and postoperative rehabilitation are also reviewed.

Animals↗

PubMed2006

MR-imaging of anterior tibiotalar impingement syndrome: agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography.

OBJECTIVE: To clarify the role of MR-imaging in the diagnosis of anterior ankle impingement syndromes. MATERIALS AND METHODS: We prospectively examined 51 consecutive patients with chronic ankle pain by MR-imaging. Arthroscopy was performed in 29 patients who previously underwent non-enhanced MR-imaging; in 11 patients, indirect MR-arthrography additionally was performed. MR-examinations were correlated with clinical findings; MR and arthroscopy scores were statistically compared, agreement was measured. RESULTS: Arthroscopy demonstrated granulation tissue in the lateral gutter (38%) and anterior recess (31%), lesions of the anterior tibiofibular (31%) and the anterior talofibular ligament (21%) as well as intraarticular bodies (10%). Stenosing tenosynovitis and a ganglionic cyst were revealed as extraarticular causes for chronic ankle pain by MR-examination (17%). Agreement of MR-imaging and arthroscopy was fair for the anterior talofibular ligament and the anterior joint cavity (kappa 0.40). Major discrepancy was found for non-enhanced MR scans (kappa 0.49) when compared with indirect MR-arthrography (kappa 0.03) in the anterior cavity. The sensitivity for lesions of the anterior talofibular and calcaneofibular ligament and the anterior cavity (0.91-0.87) detected by MR-imaging was superior in comparison to lesions of the anterior tibiofibular ligament and anteromedial cavity (0.50-0.24). CONCLUSION: MR-imaging provides additional information about the mechanics of chronic ankle impingement rather than an accurate diagnosis of this clinical entity. The method is helpful in differentiating extra- from intra-articular causes of ankle impingement. Indirect MR-arthrography has little or no additional value in patients with ankle impingement syndrome.

Adolescent↗

PubMed2006

Skin and soft tissue infections.

Primary skin infections (ie, pyodermas) typically are initiated by some breach in the epidermis, resulting in infection by organisms, such as Streptococcus pyogenes and Staphylococcus aureus, that normally colonize the skin. Host-associated factors, such as immunosuppression, vasculopathy, neuropathy, or decreased lymphatic drainage, may predispose to skin infection. The clinical syndromes associated with skin infections are often characteristic and are defined most simplistically by anatomic distribution. Although often mild and self-limited, skin infections can be more aggressive and involve deeper structures, including fascia and muscle. This article discusses skin and soft tissue infections, including impetigo, hair follicle-associated infections (ie, folliculitis, furuncles, and carbuncles) erysipelas, cellulitis, necrotizing fasciitis, pyomyositis, septic bursitis, and tenosynovitis.

Journal Article↗

PubMed2006

Vibrio infection associated with finning injury of the hand.

BACKGROUND: Penetrating injury by fish fins is common and often overlooked. Vibrio spp. are known worldwide for their virulence, quickly causing soft-tissue infection and lethal septicaemia. Vibrio infection following finning injury is rare, but can result in devastating complications in susceptible individuals. AIM: To elucidate the clinical significance of such injury. METHOD: Between July 2003 and September 2005, nine cases of Vibrio infection caused by finning injury to the hand were retrospectively reviewed. Clinical data, including skin presentations, treatment course and outcomes, were collected and reviewed. RESULTS: In our group of nine patients, seven had concurrent hepatoma, diabetes mellitus, cirrhosis, chronic renal insufficiency or the effects of long-term steroid use; three had wound infections manifested by cellulitis or tenosynovitis and six had life-threatening necrotising soft-tissue infections. Vibrio spp. were identified from the wound (n=4), blood (n=1), and both (n=4). Symptoms appeared within a few hours to 3 days after injury, with 50% of patients developing symptoms within 24h; three patients were hypotensive upon admission; one patient received antibiotic therapy only and eight required emergency fasciotomy. All patients survived and none required amputation. The mean hospital stay was 23.2 days. CONCLUSIONS: Vibrio infections after finning injury can produce bacteraemic necrotising soft tissue-infections, especially in individuals with a systemic illness. Health education should include a recommendation to wear protective gloves while handling fish. Early antibiotic and surgical treatment can avoid potentially life-threatening complications.

Adult↗

PubMed2006

Osteoid osteoma of the carpal bones. Two case reports.

Osteoid osteoma rarely develops in the wrist. The symptoms resemble atypical tenosynovitis, with variations according to the location of the tumor. As a result, diagnostic wanderings are common. In addition, the pain may seem related to an injury, as illustrated by two cases reported herein. Conventional investigations often fail to contribute to the diagnosis. The most specific investigation is thin-slice computed tomography (CT), which can be coupled to magnetic resonance imaging. CT typically visualizes a round lucency surrounded by a rim of sclerosis; in addition, CT shows the exact location of the tumor, particularly relative to neighboring joints. Complete excision of the nidus must be achieved to ensure a permanent cure. Same-stage carpal bone fusion may be required in patients with extensive joint involvement.

Adult↗

PubMed2005

Causative microorganisms in surgically treated pediatric hand infections.

PURPOSE: The causative organisms in many pediatric musculoskeletal infections are distinct from their adult counterparts. We investigated the organisms found in surgically treated hand infections in the pediatric population. METHODS: We reviewed the hospital charts and computer records of all patients who had surgical intervention for infections of the forearm, wrist, and hand from 1996 through 2002 at The Children's Hospital of Boston. RESULTS: Thirty-eight surgical procedures were performed on 31 children for 32 different upper-extremity infections. One patient was treated for 2 separate infections. In the 32 primary procedures 7 cultures grew mixed aerobic/anaerobic organisms, 19 grew aerobic organisms only, 6 grew no organisms, and 2 patients had no cultures. One culture from a secondary surgery was positive for Candida parapsilosis. Staphylococcus aureus was isolated in 15 of the primary cases and was the primary organism in 12. Five of 7 mixed infections were associated with paronychia; 2 of the paronychial infections were complicated by flexor tenosynovitis. Chronic nail biting caused 2 infections and 1 was associated with thumb sucking. CONCLUSIONS: In the adult population S aureus is the primary organism cultured in 50% to 80% of cases and anaerobic or mixed infection may occur in upward of 29% of patients. In this series S aureus was the primary organism in only 37%. Group A Streptococcus pyogenes was present in 20% of cases. The percentage of children with a mixed aerobic/anaerobic infection was similar to that found in adults; however, the presumed route of introduction was digital sucking/biting. Based on the number of anaerobic/mixed infections without predisposing factors we recommend a broad-spectrum antibiotic regimen including anaerobic coverage as the initial antibiotic in the setting of pediatric hand infections.

Adolescent↗

PubMedDate not supplied

Hand span and digital motion on the keyboard: concerns of overuse syndrome in musicians.

PURPOSE: To investigate the hand motion of pianists when they performed an octave and a chord, which accounted for 74% of the piano techniques that the subjects practiced at the onset of overuse hand problems. The octave position was to strike 2 keys that were 16.7 cm apart simultaneously with the thumb and small finger, and the chord position was to strike 3 keys with 4.8 cm between the borders. METHODS: The abduction angle of both the thumbs and the small fingers of 10 pianists while playing a chord and an octave were measured repeatedly with a video-based passive marker detection system. The angles were compared between pianists with large hand spans and those with small hand spans. RESULTS: When playing the octave both the maximal and minimal abduction angles of the thumb were significantly larger for the smaller-hand pianists as compared with the pianists with larger hand spans. When playing the chord the maximal abduction angle of the thumb of small-hand-span pianists was significantly larger than that of large-hand-span pianists. The abduction of the small finger, however, did not differ during performance of either the octave or the chord. CONCLUSIONS: These results suggest that the small-hand-span pianists must abduct the thumb more than large-hand-span pianists while minimizing movement of the small finger. This may cause de Quervain's tenosynovitis in pianists.

Adult↗

PubMed2005

Dorsal plating of unstable distal radius fractures using a bio-absorbable plating system and bone substitute.

This study reports the results of open reduction and internal fixation of 26 unstable, intraarticular, dorsally displaced fractures of the distal radius using a bio-absorbable dorsal distal radius (Reunite) plate and calcium phosphate (Biobon) bone substitute. The bio-absorbable plate has the advantage of being low profile, easily contourable and angularly stable. In the majority of cases, this plate produces functional results comparable with metal plates. The Gartland and Werley score was excellent or good in 21 patients. The theoretical advantage over metal plates is in eliminating the need to remove the plate and hence the need for a second operation if implant-related extensor tenosynovitis occurs. Inflammatory tissue reaction to the degradation products of the plate is a potential concern, although the co-polymer ratio used in this plate appears to have reduced the severity of this reaction, which was seen in two patients in this series. The reduction was lost in five patients with severe dorsal comminution. Following this experience, we do not recommend this plating system for fractures with a metaphyseal gap of greater than 7 mm following reduction.

Absorbable Implants↗