ifssh
ezine

www.ifssh.info ISSUE 1 FEBRUARY 2012

MEMBERS NEWS• IFSSH Secretary-General update• History of the ASSH

CONNECTING OUR GLOBAL HAND SURGERY FAMILYIFSSH Committee on
the musician’s hand:
Musculoskeletal conditions
affecting the musician

A NATIONAL QUALITY REGISTER
FOR HAND SURGERY IN SWEDENCTS EDUCATION CLASS BECOMESEFFECTIVE TREATMENT PATHWAY

February 2012

Contents
4 Editorial

22 Case study

6 Members news

21 Research roundup

8 Pulse24 Journal highlights

By Professor Ulrich Mennen, editor of the IFSSH ezine

An update from the Secretary General
History of the ASSH

Committee report on the musculoskeletal conditions
affecting the musician

18 IFSHT

A national quality register for hand surgery in Sweden

20 Pioneer profiles

Professors Raoul Tubiana and Claude Verdan

IFSSH ezine FEBRUARY 2012

Answers on the scaphoid non-union case

CTS education class becomes effective treatment
pathway

Tables of Contents from leading journals such as
The American Journal of Hand Surgery, Journal ofHand Surgery Asian Volume, Journal of Hand Surgery
European Volume and the Journal of Hand Therapy.

27 Upcoming events

List of global learning events and conferences forhand surgeons3

editorial

Editorial
Endorsement of hand meetings by the IFSSH
The International Federation of Societies forSurgery of the Hand (IFSSH) often receives requests
to sponsor or endorse hand surgery meetings.
The primary aim of the IFSSH, as stated in its
Charter, is to promote the “well-being of the Hand”
in various ways. We have seen a proliferation ofmany aspects of the Hand being presented atnumerous meetings, symposia and congresses,
including aesthetics, macro and micro surgery,rehabilitation, trauma management, sport
injuries, transplantation, prosthetics, congenital
dysplasias, etc. Such activities signify the exciting
developments of our specialty. However, it is theduty of the IFSSH as the umbrella organisation, toensure, and if necessary, give guidance, that these
activities are reasonable, scientific, credible, and not
driven by a purely profit or a promotional motive.
The IFSSH welcomes the requests by organisersof meetings to announce their events on the IFSSH
website and/or IFSSH ezine, and will gladly do so toallow all those interested to participate. However
it should be clear that the IFSSH can only do so if
it has adequate information about these meetings
before giving official approval.

The IFSSH cannot be held responsible or beheld accountable for any promotional material,
advertisement, statement, or suggestion by any
presenter, organisation or advertisement, either
written or verbal. Endorsing or supporting ameeting by the IFSSH does not mean that theviews expressed are the official views of the IFSSH.
The IFSSH has some 30 Scientific Committees who
on occasion will produce official reports. The IFSSH
cannot endorse a private meeting which is run as abusiness for financial gain.
The Executive of the IFSSH evaluates all requests
for endorsements of meetings. The required
information should include the aim, programme,faculty, budget, target audience, sponsors anda one page promotional advertisement fit for
publication in the ezine.

Ulrich Mennen
President: IFSSH
Editor: IFSSHezine

IFSSH disclaimer: The IFSSH ezine is the official mouthpiece of the International Federation of Societies for Surgery of the Hand. The IFSSH
does not endorse the commercial advertising in this publication, nor the content or views of the contributors to the
publication. Subscription to the IFSSH ezine is free of charge and the ezine is distributed on a quarterly basis. To
subscribe, please click here. Should you wish to support this publication through advertising, please click here.

IFSSH ezine editorial team:
Editor: Professor Ulrich Mennen (President of the IFSSH)
Deputy Editor: Professor Michael Tonkin (President-elect of the IFSSH)
Publication coordinator: Marita Kritzinger (Apex ezines)
Graphic Designer: Andy Garside

4

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SUBSCRIBE T

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ezine

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IFSSH ezine FEBRUARY 2012

members news

IFSSH Secretary
General’s update
Dear Delegates,
As discussed in Las Vegas, the 2012 Delegates’ Council Meeting will be held in Antwerp, Belgium,in conjunction with the annual FESSH Congress (www.fessh2012.org).
The Delegates’ Council Meeting will be held on Friday 22nd June, 10:15am-12:00pm. Further
details will be sent in the near future, including the agenda and minutes of the 2011 meeting.
It would be appreciated if you or an appointed member from your society could join thisannual meeting to discuss the progress and plans of the IFSSH. If your society wishes to appointa proxy, please inform the secretariat (administration@ifssh.info) and they will be included in all
future correspondence relating to the meeting.
We look forward to seeing you in Belgium.
Kind regards, Zsolt Szabo, Secretary-General, IFSSHASSH Founding Members

The initial meeting of the American Society for Surgery of the Hand, held at the Blackstone Hotelin Chicago in January 1946 was attended by 26 of the 35 designated founders.
A portion of that group is pictured above.
Left to right: Darrel T. Shaw, Joseph H. Boyes, Lot D. Howard, S. Benjamin Fowler, Sterling Bunnell, Arthur Barsky, Donald D. Slocum,
Walter C. Graham, J. William Littler, William Metcalf, Richard H. Mellen, Gilbert Hyroop, Donald R. Pratt, William F. Frackelton, Robert
L. Payne, Jr. Not pictured: Harvey S. Allen, Hugh Auchincloss, Julian M. Brunner, Condict W. Cutler, Homer D. Dudley, Alfred W.
Farmer, Gerald Gill, Edward Hamlin, Deryl Hart, Sumner L. Koch, William M. Krigsten, Clarence A. Luckey, Henry C. Marble, Michael L.
Mason, Joseph I. McDonald, James T. Mills, George S. Phalen, William H. Requarth, Thomas W. Stevenson, George V. Webster
IFSSH ezine FEBRUARY 20125

announcement

Reaching
new heights:
hand surgery for sport
By Loris Pegoli

The International Society for Sport
Traumatology of the Hand (ISSPORTH)
is devoted to the treatment ofconditions specifically regarding thehand and the wrist in athletes. It was
founded in Italy in March 2011 by agroup of hand surgeons and handtherapists from all over the world (fromEurope, Australia, Africa, Asia, Northand South America).
Membership is open to surgeons
as well as hand therapists with aneye to athletic trainers and allied
health professionals caring for the
sportsman. The idea of founding a
new scientific society addressing
the treatment of wrist and handconditions in athletes emerged fromthe frequent observation, worldwide,that meetings regarding hand surgery,sports, orthopaedics and traumatology
often lacked presentations specificallyregarding the subject of athletic
injuries.

6

The main purpose according to theby-laws of our society are:
1. to promote the unrestricted andcomplete exchange of knowledge
among the participating membersof the Society
2. to exchange knowledge throughpublications and scientificmeetings
3. to facilitate and expand theopportunities for study andresearch within and among theparticipating members and topromote cooperation between

hand surgeons, orthopaedic
surgeons, sports physicians,
hand therapists and other hand
specialists and other specialists andprofessional figures who have amajor interest in the anatomy andfunction of the hand and wrist.
The Governance of the society iscomposed by an executive board
formed by a President - Alejandro
Badia (USA), Vice-President –Riccardo Luchetti (Italy), General
Secretary - Loris Pegoli (Italy),
Treasurer- Paolo Cortese(Italy). Furthermore there is adelegate representatives fromeach continent: Mike Hayton(Europe), Micheal Solomons(Africa), Steven Topper (North
America), Eduardo Pereira (SouthAmerica), Moroe Beppu (Asia)
and Gregory Bain (Oceania), as
well as an Hand Therapist Delgate
Tracy Fairplay and an Olympic
IFSSH ezine FEBRUARY 2012

announcement

Committee Delegate Mike Loosemore.
ISSPORTH is still in its infancy as asociety, but very active and growing
in new members from all over theworld in a short period of time, as
well as gaining interest from figures
not strictly related to surgery or
rehabilitation. Many medical subspecialty societies are established eachyear. We, as
ISSPORTH and all its members,
would like to be a reference point, in
collaboration with IFSSH which we
consider as our parent organisation.
Our inaugural symposium wasorganised in Milan in March 2011 witha large number of participants thus
demonstrating that there is a great
IFSSH ezine FEBRUARY 2012

interest in this fascinating subject. This
on-going interest already has lead tothe organisation of other meetingsand symposiums that will be heldin the near future (February 2012 inMiami, May 2012 inEstonia and February 2013 inJapan). ISSPORTH has the goal ofbeing a society open to anybody who
would like contribute their specificknowledge concerning the global
treatment of athletic wrist and hand
injuries.
For more information
please contact us:
E mail: info@issporth.org
Website: www.issporth.org“Membership is
open to surgeons
as well as handtherapists withan eye to athletic
trainers andallied healthprofessionals
caring for the
sportsman”

7

pulse: committee reports

IFSSH Committee on the musician’s hand
The following Report is submitted under the auspices of the
IFSSH Committee on the Musician’s Hand
Chairman: Peter C. Amadio. Members: Ian Winspur, Naotaka Sakai and Massimo Ceruso

Musculoskeletal
conditions affecting
the musician
By Ulrich Mennen

Introduction
Since the dawn of mankind, music
has been an integral part of humanculture. Music has been used forvarious purposes, such as pleasure,entertainment, worship andcommunication.
Two important factors haveinfluenced these purposes of music
making. Firstly, the discovery thatmusic has a definite enhancing
influence on the mental and cognitive
development of children, whichtakes place even in utero. Secondly,
competition has become an integral
part of social activities, education andtraining in the modern word. This istransferred to young children whogrow up with the constant pressure

8

to perform. One may add that regular
practising cultivates a healthy selfdiscipline.
If the budding musician loses
the enjoyment of music making, it
eventually may become a burden.
When the effort to achieve becomes
greater than the reward of having
achieved, loss of interest is almost
guaranteed and a basis for ailments
could become a reality. Oncepressures, demands and stresses
become the overriding driving force
behind the child’s playing of music,
psychosomatic symptoms and signs
may develop.
Musicians could be compared toathletes. Although athletes may startat an early age, their full potential is

only known once they reach puberty.
The next stage is extensive training
under scientific supervision with thenecessary backup from teachers,
trainers, and a range of healthprofessionals. This period usually lasts
about 10 to 15 years.
Musicians on the other hand,usually start even before school
age. Their talent is recognised very
early on and is gradually promoted
through training and encouragement.
It is expected of them to perform ateach concert without any mistakes.
Musicians are also expected to adapt
to their instruments (which may beergonomically not suited for theparticular individual), as well as theirsurroundings. Often they live a lonely
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pulse: committee reports

life because of long hours of practising,and their support system may consist
only of close relatives and friends. Evenfrom their colleagues one may findsevere criticism, jealousy and evenoutright negative feelings. Furthermore,
the musician practises many more
hours than the average athlete, often
does not take a break over weekends
or holidays and may perform right up
into old age. Also, with the ‘normal’handicaps of everyday living such asarthritis, injuries and other ailments,
the musician often battles to adapt
or tolerate these handicaps without
seeking medical help.
The incidence of medical conditions
in musicians is unclear but some
reports claim that up to 90% ofmusicians may suffer some ailment
during their career. The aim of thisreport is to review the medical andsurgical conditions affecting themusician, and to provide a practical
approach for their management (1-5).

Preventative approach
1. Lifestyle and diet
The old dictum ‘practise makes perfect’is very applicable to the musician, andlong lonely hours are spent to masterpieces. These music students often
miss out on normal child’s play, sport,socials and other activities. Parents
and teachers should understandthat a balanced lifestyle will ensure abalanced and healthy child.
Some foods are heavy on thestomach and may interfere with thestudent’s concentration. Drinks withgas and stimulants like caffeine should
best be avoided. It is important tore-hydrate the musician before any
performance just as an athlete re-10“the musician
practises many
more hours than
the average
athlete, often does
not take a breakover weekends or
holidays and may
perform right up
into old age”

hydrates before an event. This keeps
the tissues soft, pliable and promotes
lubrication between tissue planes
and structures. The level of dexterity
required from top musicians can only
be achieved if the tissues are welllubricated to allow gliding, and themuscles, which move these tissues,
have enough energy (carbohydrates
and lipids) and building blocks(proteins).
2. Musculoskeletal system
The best performance can be achieved
from the mid-position of a muscle, i.e.
the resting or balanced position of themuscle. This will allow excursion of
the muscle, either side of this resting
position, and also enhances theamount of muscle power generated.
Athletes are well aware of thisimportant physiological principle, anduse stretching exercises to improvethe excursion on either side of the
mid-point. This should also apply tomusicians (6).
Another indispensable preparation

for any performance is warm-up
exercises. This will prevent micro- andmacro injuries to the muscle fibres,
tendons, ligaments, sliding tissue
planes, and all the various receptors
and nerve endings responsible forsensory input (such as two-point
discrimination, proprioception,
vibration sense, temperaturechanges, light and deep pressure andstereognosis).
A further aspect is the clear
understanding that peak performanceand endurance of fingers and thehand can only be achieved if the
supporting foundation also has thenecessary strength and endurance.
These foundations include the elbow,
shoulder, neck, back and the whole
torso. Most musicians severely neglect
this aspect of their training. They
should get into a habit of regularly
engaging in physical exercises, such as
non-contact sport or workout at homeor in a gym.
3. PostureMusicians and their teachers often
underestimate the importance ofa balanced posture. Many musicalinstruments are of a poor ergonomic
design. Teachers should also besensitive to normal anatomicalvariations in people. Some students
have difficulty in full pronation of
their forearms which make piano
playing rather difficult. Others may
have connections between theirtendons, which would make individual
finger playing difficult or impossible(e.g. Linburg-Comstock connection
between Flexor polices longus andFlexor digitorum profundus of theindex finger), or a non-functioning
Flexor digitorum superficialis to the
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pulse: committee reports

small finger. Many other examples exist.
It is of no use to force the child to do
certain movements, if it is physicallynot possible or very difficult. A fullneurovascular examination could
exclude anatomical variations, which insome cases could easily be rectified.
Musical instruments are notholy and should be considered foradaptation or change if musicians
have difficulty in reaching certain
keys. Extensions and modifications
could easily be fitted to instruments toallow for a more balanced hand andrelaxed posture. For example, a violin
may be too short or too long, twisting
the upper part of the body into an
awkward position, which will eventuallylead to muscle spasms and pain.

Professional help in this regard could
be gained from trained occupational
therapists, who are knowledgeable
about the physical and psychologicaldemands of the performing arts.
4. Exercise and training
John Williams, the guitar player, isquoted saying that for every halfhour he practises he would rest for
one half-hour. During the half-hour
rest, he would do stretching exercises
as well as moving exercises. This is avery important physiological concept,
which needs to be understood by allmusicians. Movement encourages
blood flow and therefore function.
Function refers not only to muscle
power; but also to all the various
sensory modalities referred toearlier. These exercises could beeither isometric or isotonic muscle
contractions.
Isometric muscle contraction
is responsible for stable fixed joint
positions, i.e. no movement takes place,but the muscles stabilising the joints
are co-contracted, whereas isotonic
muscle contraction is responsible
for active movement of joints. This
contraction shortens and lengthens
the muscle with resultant movements,
such as the fingers. Stretching ofmuscles and nerves is an integral
part of exercise, which ‘resets’ thefull excursion of muscle and nerve
movement. All soft tissue structuresneed to glide, to prevent stiffness. Thisis particularly true for nerves as well.

REPORT OF THE COMMITTEE ON THE MUSICIAN’S HAND
The committee on the Musician’s Hand was establishedin 1995, and since then has continued with the same
members: Yves Allieu, MD, Peter Amadio, MD, Allen
Bishop, MD, Massimo Ceruso, MD, Naotaka Sakai, MD,
Raoul Tubiana, MD, and Ian Winspur, MD. Over the years,
the committee has given overviews on focal dystonia,
carpal tunnel syndrome, and cubital tunnel syndromeas they affect musicians. In addition, committee
members have edited two textbooks on the subject ofthe musician’s hand: The Musician’s Hand, edited by Ian
Winspur, MD, and Medical Problems of Instrumental
Musicians, edited by Raoul Tubiana MD and Peter C.
Amadio, MD. The former text has been translated into
Japanese and Korean.
Care of the musician’s hand has evolved greatly since
the committee was formed. Principally, there is a greaterappreciation of the importance of nonsurgical therapies,
especially reeducation and pedagogy. An alliance ofclinician, musician, therapist and teacher is necessary fortherapeutic success in many if not most cases.

IFSSH ezine FEBRUARY 2012

At this point, the Committee looks to the future andsees new opportunities. Firstly, an infusion of new
members is needed. Volunteers are welcome, and anyone
interested in joining the committee should contact either
the IFSSH Secretary General or the committee chair(pamadio@mayo.edu). Second, it is clear that the role ofreeducation requires emphasis, consideration should begiven to making this a combined IFSSH-IFSHT committee
in the future. Finally, over the past few decades a numberof multidisciplinary national societies of performing
arts medicine have been created. The groups in theUSA, UK, France, the Netherlands, Germany and Italy areparticularly active. IFSSH should consider both publicising
the dates and locations of these national meetings when
they are known, and encouraging participation of IFSSH
member societies in these performing arts organisations
where appropriate.
Respectfully submitted,
Peter C Amadio,
MD, Chair11pulse: committee reports

Nerves need to glide and be stretched.
However, prolonged continuous
stretching and compression, forexample, around corners at joints suchas the ulnar nerve at the elbow, causes
ischaemia because of reduced blood
flow. Short-term ischaemia causes ‘pins
and needles’ (paraesthesias), numbness
and a burning pain, whereas longerterm ischaemia causes external andTable I: History● Gender● Age● Musical history

internal scar tissue formation andfibrosis with permanent symptoms
and signs of nerve compression. It istherefore important to any performer
that whenever he or she has a chance
to relax between performances orpieces, soft tissues should be relaxed,
stretched and exercised to stimulate
blood flow(6). Active relaxation is atechnique which physiotherapists
could teach musicians to reducemuscle spasms, fatigue and improveblood flow. Relaxation exercises
can be attained by a number ofmethods, which include the Alexandertechnique(7), the Feldenkrais
method(8) and yoga.

● Symptoms – cramps/pain/

weakness/sensory deficit(pins & needles, dead feeling,burning sensation)/subjective
perception of difficulty incoordination and/or stiffness● Signs – sweating/heart
rate increase/dry mouth/
palpitations● Cognitive signs – forgetting/fright/fear● Behavioural signs – drugs/
medicine/tablets/pills/alcohol/
cancelling performances● Social activities – friends/
parents/teachers● Sporting activities – regularexercises/relaxation exercises● Hobbies● Financial● Career stresses – competition/
job security/conductor/fellow
musicians/parents● Triggering factors – overuse/
type of instrument (musicianinstrument interface)

12

Table II : Examination● General medical examination● Neurological examination –motor/sensation● Vascular examination –swelling/blood supply/
sweating/temperature● Physical examination –pinpoint tenderness/posture/muscle co-ordination/power● Perform with instrument/
simulate● Specific examination ofaffected part● Special investigations –sonar/x-rays/bone scans/nerve
conduction/MRI● Blood test (RA, DM, Gout,
Muscle enzymes, FBC, ESR, LFT,
CRP)
● Diagnostic measures – local
anaesthesia + steriods● Consultations

All stretching and active exercises
must be done without pain. Pain is thesignal that tissues have been damaged(torn), which leads to inflammationand swelling, and eventually to scar(fibrosis) formation. This fibrosis will
reduce the amount of gliding oftissue planes (because of adhesions)and reduce the amount of muscle
excursion (because of restrictedelasticity).

Approach to specific problems
One should emphasise a holistic
team approach to the managementof health problems in musicians(9).
Those most intimately involved withthe musician, such as parents andteachers, should be sensitive to pickup any ailments and concerns(10). The
musician should have the courage toapproach the teacher and the parents
with any problems that she or he may
face before serious conditions could
evolve. A case in point was a young,very talented musician, complainingof severe aches, pains and spasms
in both her arms, which would only
improve on rest. Physical examination
did not reveal any abnormalities.
However, her history indicated that
she would develop these symptoms
only after two hours of uninterrupted
high performance playing. This wasdemanded by her teacher to ‘improvemuscle power and endurance’. This kindof illogical approach, unsympathetic
behaviour with an unfounded scientificbasis should be strongly discouraged.
It is important to explain tomusician patients the basic anatomy
and workings of their bodies, andhow things could go wrong. This
will diminish fear, uncertainty and
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pulse: committee reports

Examination
Apart from the points summarised inTable II, the following should also be
considered:● The general clinical examination
which includes sensory, motor andvascular examination, should always
compare with the contra-lateral
normal side.
● Demonstration with the instrument
is often essential to highlight the
problem.
● Specific examination of the involved
part should be done systematically,
gently and meticulously.
● Specialised investigations may beneeded to confirm and complement
the clinical examination, e.g. sonar,
nerve conduction, x-rays, technetium
IFSSH ezine FEBRUARY 2012

Table lllb

DIAGNOSIS

Table llla

PHYSICALMANAGEMENT

anxiousness. It will also help to improve
communication and co-operation.
The musculoskeletal conditions
affecting musicians can be grouped
into three sections:
1. Common, everyday life ailments
such as injuries, arthritis, rheumaticconditions and nerve compressions.
2. Overuse (too much of a normal
activity), abuse (willfully causing
damage) or disuse (incorrect activity
or position). These are seen withpoor posture, imbalances, and overtraining.
3. Stress related ailments such asmusicians’ cramps, spasms, anddystonia.
In order to arrive at a diagnosis anda plan of management, a thoroughhistory and examination is mandatory.
Table I lists some of the pertinent
points that need to be clarified in orderto put the patient and his/her problem
into proper perspective.

PSYCHOLOGICALORGANICLOCAL
Ganglion
Arthritis
Dupuytren
Trigger Finger
Anatomical
abnormality
Tennis elbow
Nerve
compression• Central• Neck• LocalConservative
MedicalSurgical

GENERAL
Eg. RAOADM
GoutPOSTURAL
OveruseMisuseAbuse
Weakness
Imbalance
In-coordination

Relaxation
Strengthening exercise
Stretching exercise
Coordination exercise
Postural exercise
Sensory exercise

Patientinstrument
interface

Position change
Instrument change
Instrument adaptation
Technique change
Gadgets

MDP bone scans, blood tests (toexclude conditions such as gout,rheumatoid arthritis, diabetes),
biopsies from nerve, muscle orsynovium .
● Diagnostic therapy, e.g. local
anaesthetic with or without steroid
injections may be indicated to
exclude or confirm certain painful
conditions.
● Consultations with the other teammembers or experts for second
opinions are often helpful before a
final diagnosis is made.

Diagnosis
It may not always be easy to arrive
at a diagnosis. Table IIIa indicates theinterrelationship between physical andpsychological conditions; e.g. a tennis
elbow could lead to poor posture
which in turn presents as a dystonia.
Cautionary note: NEVER label apatient with an ‘arbitrary’ diagnosis,

EXTERNAL

INTERNAL

StressFinancial

Dystonia
Emotional• Death• Fear• AnxietyPsychologist
Counsellor‘Begin at the beginning’
Limited gradedexercises
Limited graded practise
Re-education
Hypnosis
Acupuncture
Botulinum toxin

when the clinician is uncertain about
the diagnosis.

Management
This depends on the diagnosis and may
be multipronged as depicted in Table
IIIb.
Once a diagnosis is madethe management from the handsurgeon’s point of view is relatively
straightforward. An anatomicalvariation may be corrected, a tumour
may be removed, a web space may
be deepened or widened and arthritic
joints may be dealt with in various
ways. Special consideration should ofcourse be given when dealing with themusician’s hand, such as placing thesurgical scar in a position which would
not interfere with the performance ofthe musician’s hands and fingers. An
arthroplasty for an arthritic proximal
interphalangeal joint may be more
appropriate than an arthrodesis in13

pulse: committee reports

certain instrument players, whereas
the reverse may be true in others. The
range of excursion (arc of movement)of finger joints need to be consideredwhen reconstructive surgery is done
and may differ depending on the typeof instrument played.
During the medical examination
the emphasis should be on evaluatingbalance and coordination, and not only
strength and endurance. Sometimes
one sees an unbalanced posture of
non-physiological position, which
distorts the whole body resulting in astrained back, twisted neck, elevatedshoulders, bent elbows and flexed
wrists. Aches, pains and spasms will
surely follow; and need to be addressedby restoring balance, prescribing
appropriate exercises and attending to
the musician-instrument interface.
Hyperlaxity of ligaments andtherefore of the joints, may be a severe
handicap to musicians. This laxity may
be generalised, involving joints and/or tendons and ligaments; or localised,involving sets of joints, ligaments or
tendons or only one joint, ligament ora tendon. Surgical plication, shorteningor tightening of these structures may
be needed.
Repetitive strain injuries (RSI),
sometimes referred to as ‘cumulative
trauma disorders’, is a very controversial
topic. It would be prudent to either
make a definite diagnosis or regard
the problem as disuse, overuse orabuse rather than label the patientwith RSI. Under normal circumstances,tissues can handle extensive exposure
to repetitive movements over long
periods without tissue damage,provided the general precautions havebeen taken, e.g. warming up, stretching

14“peak performance some swelling) ending in a painful
syndrome. Conservativeand endurance of compartment
management may include an antifingers and theinflammatory drug, ice, and pressure
garment. If this prooves to behand can only
unsuccessful, a surgical decompression
be achieved if(fasciotomy) may be indicated.
The gliding of tissues can be
the supporting
curtailed severely by swelling. The
foundation also
synovium, is an anatomical structure to
has the necessary enhance gliding. Once this gliding layer
which is responsible for lubrication
strength andis inflicted by disease and swelling,
movement will be severely affected.
endurance”
Stiff joints and fingers can often betreated with an anti-inflammatory drug
to reduce the swelling and increase
movement. Swollen fingers can benefit
and strengthening exercises, hydration, greatly by wearing elastic gloves.
Sensory education andposture, etc. RSI is an artificial
development has never been stressed
diagnosis seeking to place blame
when training musicians. One modality
on some ‘other cause’ and thereforeof sensation, namely proprioception,compensation may be claimed. To
is such a fundamental function of alllabel a condition as RSI is dangerous
the joints of the body that without thisand often unsupportable. Mostly one
would find an underlying condition (eg modality no musical instrument can beplayed. Therapists should concentrate
De Quervain stenosingtenosynovitis)on proprioceptive acuity after an injury,
which is being aggravated by thesurgery or in patients with hyperlaxity.
playing of an instrument. This needs
During the rehabilitation phase, theto be treated. It is not the instrument
playing which caused the condition in measurement of improvement helps
as a psychological boost, however it is
the first instance(11), (12), (13).
important to set limited, graded goals
Other indications
for a slow build-up especially if theCompartment syndrome of certain
original problem was due to overuse,muscles or muscle groups, eg
misuse or disuse.
hypothenar muscles and more
Occupational cramps, or to be
specific the Abductor digiti minimi,
more specific, musicians’ cramps arecan develop in piano players withalso referred to as focal dystonia.
relatively small hands who have toProvided physical conditions, postural
over-stretch to reach all the keys.
imbalances and overuse injuries have
Certain demanding pieces, and having been eliminated, one may considerpractised with great effort, may causea diagnosis of dystonia. The cause of
hypertrophy of the muscle (withdystonia is still poorly understood. It

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pulse: committee reports

is suggested that the ‘strain is in thebrain’, i.e. that the normal intricate
interaction between the many parts inthe brain which work together during
music playing, becomes somehow
disorganised. The delicate and complex
integration between sensory input,
interpretation, and motor execution
becomes scrambled. It may betriggered by many factors. It may
occur with one instrument, but notwith another. Only one finger may be
involved, or more than one including
other parts of the arm. Only certain
music pieces may elicit the spasms.
The management thereof should bevery sensitive and with a great deal of
empathy, understanding and patience.
Stressful situations such as overbearing
parents or unreasonable teachers
should be identified and dealt withcircumspection.
Assessments by occupational,
physical and hand therapists as well as
the psychologist could prove helpful.
Once the problem is unraveled,analysed and understood it is advisable
to start right at the beginningand slowly build up to a level of
performance, which would match theability of the musician. Again, slow,
graded, and attainable goals should be
set. The brain therefore needs to be ‘reset’ (14), (15), (16).

Long-term strategies
Since many conditions may beinterrelated and may have an
emotional or a psychological overlay,
a combination of treatment options
need to be considered. This includes
drug therapy for stage fright, anxiety,excessive sweating and tremors.
Musicians should not use sedative
IFSSH ezine FEBRUARY 2012

THE IFSSH AND ITS COMMITTEES:AN IMPORTANT ANNOUNCEMENT
One of the tasks of the President of the IFSSH is to appoint Chairpersons andCommittee Members for the 30 Committees which form the backbone of
the IFSSH. These Committees are extremely important in that they compile
reports on all the many aspects of the Hand. These include amongst others:
terminology, anatomy, function, evaluation, management, classification,therapy, prognosis, etc. These reports should be seen as ‘oracles’ of the
IFSSH, since they represent a balanced view of respected colleagues
internationally. Serving on any of these Committees is an achievement, andan honour, but also carries a responsibility.
You may want to volunteer to offer your expertise and make a very
important contribution. If so, please contact the IFSSH President.

Guidelines that regulate the IFSSH Committee System

1. The President and the President -Elect shall work together to ensure acontinuity in soliciting Reports from appointed Committees. (ie reports
from committees should be an ongoing process, and not restricted to the
3 year term of a president)
2. The Committee Chairpersons are identified for their expertise by the
President (and assisted by the President-Elect) and requested to solicit
additional committee members (max 4) to assist in producing a report on:a. a specific topic
b. which can be published as an ‘oracle’ of the IFSSH,
c. which will not be controversial or be the view of an individual,
d. but reflect the view of the current ethos of the Hand Surgery Fraternity,
e. will present the report within a designated time (max 6-9 months),
f. which will be published in the IFSSHezine and posted on the IFSSH
website for the benefit of all the members of the IFSSH.
3. The reports should be concise, could be overview reports, but to the point,
non-controversial, universally acceptable information, and include thelatest available information on the topic. It will therefore be a formal
document which will reflect the viewpoint of the IFSSH community
4. The Committee shall serve for a period of 3 years, which may notnecessarily coincide with the term of office of the president, ie theCommittee term may overlap presidential terms. Since these are official
IFSSH committees, serving on them will be regarded as an honour andprofessional achievement.

15

pulse: committee reports

drugs such as the benzodiazepines,
since they cloud judgment, cause
sleepiness and depression and leadto addiction. Alcohol may ‘calm thenerves’ and boost one’s confidence,but also may cloud the judgment andsuppresses reflex time. It may be wise
to follow the general rule: Don’t drink
and play.
Caffeine, which is containedin coffee, tea and cola, may cause
tremour, anxiety and insomnia.
Other drugs, such as beta-adrenergic
receptor antagonists (e.g. propranolol)
block the physical effects of adrenaline
such as anxiety, tremour, sweating
and reduce the heartbeat. Generally,
they are safe in healthy people,
but should not be used in patientswith asthma, heart problems andpulmonary obstructive disease. Side
effects may however include slowingof finger movement and insomnia.
These drugs do not enhance
performance, but will allow a more

References
1. Winspur I, and Wynn Parry CB.
The Musician’s Hand. J Hand Surg
1997;22B(4):433-40
2. Winspur I. The professionalmusician and the hand surgeon.
In: Vastamaki M et al (Eds):
Proceedings of the 6th Congressof IFSSH. Helsinki, Bologna,
Monduzi Editori, 1995:1207-11.
3. Wynn Parry CB. Musicians suffer avariety of problems. J Hand Surg
1994; 19B (Supplement):11-12.
4. Amadio PC, Russotti GN.
Evaluation and treatment ofhand and wrist disorders inmusicians. Hand Clinics 1990;
6:405-162.

16“proprioception
become psychologically dependent
on this ‘crutch’, so that performanceis such awithout these drugs may become
fundamental
difficult or even impossible.
function of all
Conclusion
the joints of the
Very often factors such as job securitypressure from peer and support
body that without andgroups prevent the musician fromthis modality no
making an issue of his or her specificmusical instrument ailment. Musicians should develop theconfidence to approach their teachers,
can be played”
conductors, parents and peers when
optimal performance. When these areprescribed for the first time, the dose
and timing should be tried during
a non-important event. However,on a cautionary note, one shouldemphasise that these medicines
should only be used as single doses
for the exceptional occasion. If a drug
is used regularly the musician may

5. Brockman R, Chamagne
P,Tubiana R. The upper extremity
in musicians. In:Tubiana R (Ed.):
The Hand, Philadelphia, W B
Saunders 1990 4:873-85
6. Eins M, Dedekind K, Mennen
U. Mobilization of the Nervous
System of the Upper Limb;
SA Bone & Joint Surgery
1966;6(3):110-23
7. Rosenthal E. The Alexander
Technique, what it is and how
it works. Medical Problems of
performing Artists, (Journal)
1987; 2:53-57
8. Spire M. The Feldenkreis Method.
An interview with Anat Baniel.
Medical Problems of Performing

they have a problem. It is better tosolve the problem earlier rather thanlater, as it will make rehabilitationand the earlier achievement of peak
performance much easier. Musicians
should also have the right to have ‘offdays’, make mistakes and be ‘out ofsynch’ with their biological clockwork.
Often insurmountable problems, asseen from the musician’s perspective,
may indeed be a simple medical
problem that could easily be solved.

Artists 1989; 4:159-62.
9. Rietveld B. Performing arts clinics– a Dutch approach. Performing
Arts medical News, 1995; 3:12-18.
10. Graffman G. Doctor; can you
lend an ear? Medical Problems of
Performing Artists, (Journal) 1986;
1:3-4.
11. Vender MI, Kasdan ML, Truppa
KL. Upper extremity disorders.
A literature review to determine
work-relatedness. J Hand Surg
1995; 20A:534-41.
12. Barton NJ, Hooper G, Noble J,
Steel WM. Occupational causes ofdisorders in the upper limb. BMJ
1992; 304:309-11.
13. Hadler NM, Hill C. Repetitive

Upper Extremity Motions in the
Workplace Are Not Hazardous. J
Hand Surg: 1997,22A(l):19-29.
14. Critchley N. Occupational
palsies in musical performs.
In: Critchley N, Henson R(Eds): Music and the brain.
London,Heinemann,1977:365.
15. Lederman R. Neuromuscular
problems in the performing arts.
Muscle and Nerve 1994, 17:569577.
16. Altenmüller E. Focal dystonia:
advances in brain imaging andunderstanding of fine motor
control in musicians. Hand Clinics
2003:19; 523-538

IFSSH ezine FEBRUARY 2012

COMING SUMMER 2012
Thieme is pleased to announce the launch of the
Journal of Wrist Surgery, a new original research publication
devoted to open and arthroscopic surgery of the wrist joint.

editorial board
Editor in Chief
David J. Slutsky M.D.
Deputy Editors
Gregory Bain (Australia)
Luc De Smet (Belgium)
Guillaume Herzberg (France)
Pak-Cheong Ho (Hong Kong)
Philippe Liverneaux (France)
Christophe Mathoulin (France)
Toshiyasu Nakamura (Japan)

We look forward to receiving your manuscripts via our online submission website:

http://mc.manuscriptcentral.com/jws
For author instructions and further information about publishing in or
subscribing to the Journal of Wrist Surgery, visit www.thieme.com/jws

IFHST Hand Therapy

IFSHT: Hand Therapy

HAKIR

A national quality register forhand surgery in Sweden

Editor’s note: “The Hand Therapy
contribution in this issue comes from
Sweden. In an effort to measure theoutcome of surgery and therapy
as well as various methods andprocedures, a broad based national
registry is being introduced to monitor
the efficacy of the managementof various hand conditions. This
National Registry could reveal
interesting information, such as‘claimed results’ (third party involved)
vs ‘ perceived results’(second party
involved) vs. ‘ patient satisfaction’(firstparty involved) !”Relevance and purpose
Many medical disorders manifest in
the hands and one out of five injuries
in an emergency ward is a hand injury,
often in young and active patients.
Hand function is important for theindividual’s independence in activities
of daily living, as well as for the ability
to work. The seven specialised handsurgery departments in Sweden
together perform approximately 20000 operations per year. Within thespeciality of hand surgery there has
been no previous national quality
register. HAKIR aims to continuously
and with standardised methods, follow
up hand surgical quality of care, using
patient reported outcomes, as well as
objective measurements in order togradually increase effectiveness andimprove patient care and safety.
National coverage and annual volume
All seven departments specialised inhand surgery in Sweden take active
part in HAKIR and will in time start to18

register. We are aiming for a complete
national coverage within the next 2-3
years.

Design and outcome measures
All patients that are operated on at
the hand surgery department areincluded in a basic registration. This
includes data on which operation has
been performed, all complications
that may have lead to a second
operation, e g, infection, tendon
rupture, nerve damage etc, and theuse of prophylactic antibiotics. In thebasic registration, all patients also
receive a questionnaire before theoperation, as well as 3 and 12 months
postop. The questionnaire includes
8 visual analogue scales on specifichand symptoms, as well as a validated
disability score (QuickDASH). After
surgery, patient satisfaction is alsoscored. For ten selected operation
types, an extended registration isadded including more informationon the procedure performed and also
IFSSH ezine FEBRUARY 2012

IFHST Hand Therapyfunctional outcome measures, such asrange of motion and grip strength.

Reporting data
Reporting of data into the register
takes place on four occasions; before
surgery, at the time of surgery, 3 and12 months post surgery. HAKIR isentirely web-based; including thequestionnaire, but it is also possible
to register on paper. Patients get
reminders for postop questionnaires
through a sms-service and register
their data on-line.
National measurement manual
In order to reach high reliability
and validity in the register, therehabilitation units in all Hand Surgery
departments have developed a
Swedish clinical assessment. This
assessment is called the National
Measurement Manual and includes
range of motion and strength
measurements of the elbow handand fingers. Physiotherapists andIFSSH ezine FEBRUARY 2012

Feedback and data analysis
All participating departments havecomplete and continuous access totheir own data and are responsible
for giving feedback to the individual
patient, as well as for using the data
in clinical improvement. A data reportis presented at the annual meetingof the Swedish Society for Surgery of
the Hand and at the annual registerday. Continuous feedback, general
information and all protocols areavailable at the register website: www.
hakir.se.

and implants for fracture surgery.
The relatively small number ofpatients makes it difficult to perform
randomised controlled trials with
sufficient statistical power. Throughstandardised and continuous followup of hand surgical quality of care,including patient reported outcomesas well as functional outcomes,
surgical techniques can be comparedand techniques associated with ahigher risk of complications are moreeasily sorted out. Quality registries
also promote the standardisation ofsurgical methods and postoperative
treatments, which can help optimise
health care. Last but not least, this new
register will ensure that the patientreported experience of care receives
more attention.

Why is HAKIR important?
During the last decades, several newand expensive surgical techniques
have been introduced in the practiceof hand surgery; e g, joint prostheses

Annika Elmstedt RPT
Head of the Rehabilitation unit, Dept. ofHand Surgery,
Södersjukhuset, Stockholm
www.hakir.se

occupational therapists mostly
perform the measurements, since
they are accustomed to measuring
and able to show good reliability forcomparison.

19Remembering our Pioneers

Pioneers in Hand Surgery
IFSSH Pioneer profile:

Professor Raoul Tubiana
Professor Tubiana has made major contributions to Hand
Surgery in his authorship of major texts and scientificarticles, his promotion and development of specialised
hand surgery centers and his leadership in organisation ofhand societies and teaching programmes.
Professor Tubiana was born in Constantine. He studied
medicine at the University of Paris, and completed his
Medical Thesis in 1939. Following a year in the French Army,
he was an intern of the Paris Hospitals from 1940 to 1942.
Professor Tubiana’s excellence in Hand Surgery is partly
the result of a remarkable multidisciplinary exposure andtraining as he relates so well in his book The Hand*. For three
years he served as an Army Medical Officer with the French
Liberation Forces in North Africa, Corsica, and France. While atthe Reconstructive Surgery Unit of the First French Army, he
was exposed to the Orthopaedic Surgery discipline, throughthe influence of Merle d’Aubigne and to the Plastic Surgery
discipline through John M. Converse after completing his
training in Orthopaedic Surgery. He developed a strong
interest in hand injuries and burns. This has stimulated him
to take a series of study trips, first to England, visiting Gillies,
McIndoe, Mowlem, Seddon, and Pulvertaft. He spent further
time in the United States with Sterling Bunnell, Sumner Koch,
Michael Mason, and Harvey Allen.
Professor Tubiana was a Founding Member andSecretary General of the French Society for Surgery of
the Hand from 1964 to 1972 and its President in 1973. He
was President of the French Society of Plastic Surgery in
1972, and President of the British Society for Surgery of theHand in 1973. Professor Tubiana was the President of theInternational Federation of Societies for Surgery of the Hand
from 1972 to 1974.
Professor Tubiana was Associate Professor at the
University of Paris, Scientific Director of the Hand Institutesince 1972, Chief Editor of the G.E.M.’s Monographs since20

1966 and was Chief Editor of the Annals of Hand Surgery.
Professor Tubiana was an honorary or corresponding
member of many international societies including the
British Orthopaedic Association, the American Society for
Surgery of the Hand, the German, Italian, South American,
Dutch and Canadian Societies for Surgery of the Hand.
Professor Tubiana was a member of the Academy of Surgery
and a Chevalier of the Legion of Honor.
Professor Tubiana and his wife Claude lived on the banksof the River Seine in Paris, overlooking the Notre Dame
Cathedral. He was a collector and connoisseur of the fineart which was reflected in an outstanding collection of art
masterpieces.
“The Hand”, Vol 1 p XXI – XXXII, W B Saunders, Philadelphia, 1981
IFSSH ezine FEBRUARY 2012

Remembering our Pioneers

IFSSH Pioneer profile:

Professor Claude Verdan
Professor Verdan developed the first clinic especiallydevoted to Hand Surgery. His work on primary suture of
flexor tendons influenced world thinking on this subject.
His writings and presentations on the care of wounds of thehand are classical. He has had great interest in History andArt as related to the hand.
Professor Verdan was a graduate of the Faculty of
Medicine of Lausanne, Switzerland, where he distinguishedhimself by receiving the Medaille d’Or de la Faculte et le PrixCèsar Roux. He did his postgraduate training in Lausanne,
Geneva and Zurich, where he studied medicine, pathology,
bacteriology and surgery. In 1946 he founded the Clinique
Chirurgicale et Permanence de Longeraie in Lausanne andlater became Chief of the Surgical Clinic of the Universityof Lausanne. He was Professor of Surgery at the Medical
Faculty of the University of Lausanne where he also served
as Dean from 1972 to 1974, and later as Professor Honoris
Causa. Professor Verdan was made a member of the Senateof the Swiss Academy of Medical Sciences in 1974.
Professor Verdan was a member of many national andinternational societies of Plastic and Reconstructive Surgery,
Hand Surgery, Orthopaedic Surgery, and Surgery, including
societies from France, Germany, Austria, Belgium, Spain, Italy,
England, and the United States. He is a founding member of
the Swiss Society for Surgery of the Hand which he served as
Secretary General from 1966 to 1972. He served as Presidentof several prestigious groups including the Sociètè Suissede Medecine des Accidents et des Maladies Professionnelles(1961-1966), the French Society of Plastic and Reconstructive
Surgery (1964), the Swiss Society of Plastic and Reconstructive
Surgery (1973-19074), and the Groupe d’Etude de la Main
(1975-1976). Professor Verdan was an Emeritus Member of
the International Society of Surgery and of the International
Society of Orthopaedic and Traumatology.
IFSSH ezine FEBRUARY 2012

Professor Verdan has been guest professor at many
renowned Hand Surgery centers throughout the world.
He delivered the Sterling Bunnell Memorial Lecture in
San Francisco in 1971. He is the author of more than 320
publications and of three textbooks, including one on the“History of the Swiss Society of Plastic, Reconstructive andAesthetic Surgery.” Professor Verdan was a writer and an
artist who has created several sculptures on his topic offascination, the Hand.
Following his retirement from practice, Professor Verdan
was the dedicated Chief Editor of the Annals of Hand
Surgery from 1981 to 1985. In Lausanne, he has created theMusèe de la Main de L’Homme, a museum dedicated to thestudy of the human hand and its fundamental importancein the hierarchy of human evolution and values.
Professor Verdan iwas an associate member of the
Surgical Academy, Paris, and a Chevalier of the Legion of
Honor.
He and his wife Sylva resided in Lausanne, Switzerland.

21

Case Study

Case Study

In our previous issue we posted this x-ray and asked what further management you would recommend.

HISTORY: 25 year old, male, right dominant, auditor, enjoys sport
Injury: fell on left hand. November 2007
Diagnosis: Scaphoid fractureFirst operation: 2008 screw fixation
Second operation: 2009 screw fixation & bone grafting
Third operation: 2010 K-wire fixation & bone grafting and radius stylodectomy
Now: avascular necrosis proximal pole left scaphoid non-union
Clinically: slight discomfort, more with axial pressure, no pain, wrist extension 0-30°, wrist flexion 0-35°

Here is what some of our readers suggested:● Vascularized bone graft or resect
distal scaphoid – Jim Urbaniak, USA● My proposal to the patient would
be vascularized bone graft as a freefrom the medial femoral condyl
or pediculated from the secon
metacarpal on the FDMA - Binka
Popova, UK

22● Scaphoidectomy + 4-corner
fusion – Mario Luc, Canada● If nearly no pain: let it be andprotection splint for sports. If
symptomatic : large cortico-cancellous
bone graft (iliac crest = good quality)and fixation with 2 mini screws andcasting for 3 months, rx controls 4,8

and 12 weeks. Two mini (2.0) screws:
better rotational stability, no « empty» space between the threads, small
volume. Should be at least equal toa vascularized bone graft, because
big defect. - Michael Sturzenegger,
Switzerland
Thank you for sharing your answers!
IFSSH ezine FEBRUARY 2012

research roundup

CTS education class becomes
effective treatment pathway
United Kingdom

A study led by Sarah Dalton, a highly
specialised Hand Therapist, undertookto evaluate the carpal tunnel classof patients and to assess outcomeand efficiency. In order to determine
the efficiency and efficacy of the
management of patients with CTS
within a class setting, the results wereassessed and reviewed over a one-year
period.
During this time, patients were
provided with an appointment for the
CTS class. All attendees completed
an initial assessment form and a 1:1
assessment by a physiotherapist. A
computer-based presentation wasdelivered within the class and patientswere provided with prefabricated wrist
splints in a neutral position and an
education leaflet. Eighty-nine patientswere followed up by a telephone
call at six weeks and completed a
telephone outcome form. A discharge
letter was completed and sent to
the referrer advising of the patients’outcome with further treatment
recommendations if appropriate.
For Sarah, the most interestingoutcome of this research was thatmost patients had improved or
resolved their nocturnal symptoms
with nocturnal splinting, many did
not have cervical referred symptoms,
however some patients referred had
IFSSH ezine FEBRUARY 2012

ulnar nerve symptoms or trigger
finger/thumb.
“Many patients are referred with
CTS to the hand therapy department
and seeing patients in a class situation
helped to standardise advice andtreatment and allow efficient working
practice,” she explained, adding that at
the six-week telephone follow-up 47%
patients required no further treatment,
42% patients were recommended
for further investigation, and 11% of
patients either had or planned to havecarpal tunnel decompression.
Sarah believes the new CTS classprovides an efficient and effective
treatment pathway for patients with
CTS. “It’s important to understandthat early referral to hand therapy
is advisable if splinting is to help
minimise/resolve symptoms. In
addition, the role of nocturnal splinting
and the use of neutral splinting (versus
splinting in classic future position ofextension) are also important. This
also demonstrates the role of patient
education in helping with ergonomic
induced symptoms,” she concluded.

“the new CTS
class provides
an efficient andeffective treatment
pathway forpatients with CTS”

JOURNAL REFERENCE
Service development andevaluation of a new carpal tunnel
syndrome education class
Hand Therapy March 2010 vol. 15
no. 1 13-19[http://ht.rsmjournals.com/
content/15/1/13.abstract]23

Journal Highlights
Below is a selection of contents pages from the latest issues of the following leading hand surgery journals.
Hover your mouse over each article heading and click to go to the original abstract page of the article.

Hand

Volume 6, Number 4, December 2011
■ Percutaneous fasciotomy for thetreatment of Dupuytren’s disease—asystematic review - Saoussen Salhi, Etienne
Cardin-Langlois and Mario Luc■ Retrospective analysis demonstrates noadvantage to operative management of
distal ulna fractures - Emily A. Williams andJeffrey B. Friedrich■ Upper extremity and digital replantation- Marco Maricevich, Brian Carlsen, Samir
Mardini and Steven Moran■ Analysis of the inter- and intra-observer
agreement in radiographic evaluationof wrist fractures using the multimedia
messaging service - Andrea Ferrero, Guido
Garavaglia, Roland Gehri, Ferruccio Maenza
and Gianfranco John Petri, et al.

■ A retrospective multicenter studyof the Artelon® carpometacarpal joint
implant - Robert Bell, Sanjay Desai, HughHouse, Terrence O’Donovan and Andrew
K. Palmer■ Surgical management for malignant
tumors of the thumb - Mark E. Puhaindran,
Corey P. Rothrock and Edward A.
Athanasian■ Transillumination of hand tumors: acadaver study to evaluate accuracy andintraobserver reliability - Holger C. Erne,
Thomas R. Gardner and Robert J. Strauch■ Changing trends in pediatric upper
extremity electrical burns - Simon G.
Talbot, Joseph Upton and Daniel N. Driscoll■ Tendon injury produces changes in
SSCT and nerve physiology similar to
carpal tunnel syndrome in an in vivo rabbit
model - Tamami Moriya, Chunfeng Zhao,
Stephen S. Cha, James D. Schmelzer andPhillip A. Low, et al.
■ A new technique of locked, flexible
intramedullary nailing of spiral andcomminuted fractures of the metacarpals:
a series of 21 cases - Mandar V. Agashe,
Sanjay Phadke, Vikas M. Agashe andHemant Patankar■ Transverse anatomic landmarks for theA1 pulley of the thumb - Ron Hazani, Josh
Elston and Bradon J. Wilhelmi

Journal of Hand Surgery (European Volume)
Volume 37, Issue 2, February 2012

■ Two-year outcomes of Elektra prosthesis
for trapeziometacarpal osteoarthritis: alongitudinal cohort study■ Accuracy of intrasheath injection
techniques for de Quervain’s disease: acadaveric study■ Bioreactor optimization of tissue
engineered rabbit flexor tendons in vivo

■ Addition–subtraction osteotomy withligamentoplasty for symptomatic trapezial
dysplasia with metacarpal instability■ Comparison of surgical treatment andnonoperative management for radial
longitudinal deficiency■ Severe ulnar nerve entrapment at the
elbow: functional outcome after minimallyinvasive in situ decompression■ Improvement in pinch function after
surgical treatment for thumb in the planeof the hand

■ Socioeconomic deprivation and theepidemiology of carpal tunnel syndrome■ Arthrodesis of the wrist with bone
autograft and Hoffmann external fixation■ Bone bridge resection for correctionof distal radial deformities after partial
growth plate arrest: two cases and surgical
technique■ Simplifying four-strand flexor tendon
repair using double-stranded suture:
a comparative ex vivo study on tensile
strength and bulking

24

IFSSH ezine FEBRUARY 2012

journal highlights

Journal of Hand Therapy

Volume 25, Issue 1, January 2012
■ Effectiveness of Different Methodsof Resistance Exercises in Lateral
Epicondylosis—A Systematic Review Jayaprakash Raman, Joy C. MacDermid,
Ruby Grewal■ Effect of Lateral Epicondylosis on Grip
Force Development - Amrish O. Chourasia,
Kevin A. Buhr, David P. Rabago, Richard
Kijowski, et al.
■ The Long-term Relationshipbetween Duration of Treatment andContracture Resolution Using Dynamic
Orthotic Devices for the Stiff Proximal
Interphalangeal Joint: A Prospective
Cohort Study - Celeste Glasgow, Jenny
Fleming, Leigh R. Tooth, Richard L. Hockey■ Effect of Total End Range Time on
Improving Passive Range of Motion Kenneth R. Flowers, Paul C. LaStayo■ A Retrospective Review to Determine
the Long-term Efficacy of Orthotic Devices
for Trigger Finger - Kristin Valdes■ Common Interlimb Asymmetries and
Neurogenic Responses during Upper Limb
Neurodynamic Testing: Implications for
Test Interpretation - Benjamin S. Boyd

■ The Hamilton Inventory for Complex
Regional Pain Syndrome: A Cognitive
Debriefing Study of the Clinician-based
Component - Tara Packham, Joy C.
MacDermid, James Henry, James R. Bain

■ Cross-cultural Adaptation andPsychometric Testing of the Hindi Versionof the Patient-rated Wrist Evaluation Saurabh P. Mehta, Bhavna Mhatre, Joy C.
MacDermid, Amita Mehta■ Management of Dominant Upper
Extremity Injuries: A Survey of PracticePatterns - Kathleen E. Yancosek

Hand surgery: Asia PacificVolume 16, Issue 3 2011
■ Ultrasonographic findings in cubital
tunnel syndrome caused by a cubitus
varus deformity H. Shimizu, M. Beppu, T.
Arai, H. Kihara and K. Izumiyama■ Locking palmar plate fixation for dorsallydisplaced fractures of the distal radius: apreliminary report - Koji Moriya, Hidehiko
Saito, Yuji Takahashi and Hiroyuki Ohi■ High definition ultrasound as diagnostic
adjunct for incomplete carpal tunnel
release - Ter Chyan Tan, Chong Jin Yeo andEinar Wilder Smit

■ Continuous peripheral nerve block inforearm for severe hand trauma Ryusuke
Osada, Mineyuki Zukawa, Eiko Seki andTomoatsu Kimura■ Prevention of flexor pollicis longus
tendon rupture after volar plate fixation of
distal radius fractures - Kaoru Tada, Kazuo
Ikeda, Kenji Shigemoto, Seigo Suganuma
and Hiroyuki Tsuchiya■ Opponoplasty without postoperative
immobilization - Ichiro Okutsu, Ikki
Hamanaka and Aya Yoshida■ The flexor carpi radialisbrevis muscle— an anomaly in forearm musculature:a review article - S. Y. M. Ho, C. J. Yeo, S. J.
Sebastin, T. C. Tan and A. Y. T. Lim■ Wrist denervation in isolation: aprospective outcome study with patient
selection by wrist blockade - P. A. Storey,
T. Lindau, V. Jansen, S. Woodbridge, L. C.
Bainbridge and F. D. Burke■ Accurate radiographic measurementof the distal radial tilt - Benjamin Rajabi,
Oyvind Roed, Kristian Roed, Paal Sandoe
Alm-Paulsen, Harald Russwurm andVilhjalmur Finsen
IFSSH ezine FEBRUARY 2012

■ Clinical outcomes of excisionarthroplasty for Kienbock’s disease Tomoya Matsuhashi, Norimasa Iwasaki,
Hiroyuki Kato, Michio Minami and Akio
Minami■ Macromastia: a risk factor for carpal
tunnel syndrome? - Ana Silva Guerra,
Carlos Marques Correia, José ManuelVideira e Castro and Maria Angélica
Almeida■ Outcomes of silastic trapezium
replacements - D. P. A. Jewell, M. B. S.
Brewster and M. A. Arafa■ Hand infection in diabetic patients Amir Jalil, Philip Ian Barlaan, Boris Kwok
Keung Fung and Josephine Wing-Yuk Ip■ Proximal phalanx injection for trigger
finger: randomized controlled trial - K.
Pataradool and T. Buranapuntaruk

25

journal highlights

Journal of Hand Surgery: American volume
Volume 37, Issue 2, February 2012
■ Cellular Apoptosis and Proliferation in
the Middle and Late Intrasynovial Tendon
Healing Periods Ya Fang Wu, You Lang
Zhou, Wei Feng Mao, Bella Avanessian, Paul
Y. Liu, Jin Bo Tang
■ An Analysis of the Pull-Out Strength of
6 Suture Loop Configurations in Flexor
Tendons
T. Karjalainen, M. He, A.K.S. Chong, A.Y.T.
Lim, J. Ryhane■ Surgical Repair of Multiple Pulley
Injuries—Evaluation of a New Combined
Pulley Repair
V. Schöffl, T. Küpper, J. Hartmann, I. Schöffl■ The Effect of the Number of CrossStitches on the Biomechanical Propertiesof the Modified Becker Extensor Tendon
Repair Kyung-Chil Chung, Bong Jae Jun,
Michelle H. McGarry, Thay Q. Lee■ Predictors of Pain During and the Day
After Corticosteroid Injection for Idiopathic
Trigger Finger Abhishek Julka, Ana-Maria
Vranceanu, Apurva S. Shah, Frank Peters,
David Ring
■ Trigger Finger Treatment: A Comparisonof 2 Splint Designs Kauser Tarbhai, Susan
Hannah, Herbert P. von Schroeder■ Interobserver Reliability of Computed
Tomography to Diagnose Scaphoid Waist
Fracture Union Geert A. Buijze, Mathieu
M.E. Wijffels, Thierry G. Guitton, Ruby
Grewal, C. Niek van Dijk, David Ring, The
Science of Variation Group■ The Fixation Strength of Scaphoid BoneScrews: An In Vitro Investigation Using
Polyurethane Foam Louise A. Crawford, Eric
S. Powell, Ian A. Trail■ Single Versus Double End-to-Side
Nerve Grafts in Rats Nahoko Iwakura, Seiji
Ohtori, Tomonori Kenmoku, Takane Suzuki,
Kazuhisa Takahashi, Kazuki Kuniyoshi

26■ Minimum 4-Year Follow-Up on
Contralateral C7 Nerve Transfers for
Brachial Plexus Injuries David Chwei-Chin
Chuang, Catherine Hernon■ Role of Wrist Arthrodesis in Patients
Receiving Double Free Muscle Transfers
for Reconstruction Following Complete
Brachial Plexus Paralysis Ahmad Addosooki,
Kazuteru Doi, Yasunori Hattori, Abhijeet
Wahegaonkar■ Predicting the Outcome of Revision
Carpal Tunnel Release John D. Beck, Justin
G. Brothers, Patrick J. Maloney, John H.
Deegan, Xiaoqin Tang, Joel C. Klena■ Meta-analysis of Imaging Techniques
for the Diagnosis of Complex Regional
Pain Syndrome Type I Zachary J. Cappello,
Morton L. Kasdan, Dean S. Louis■ Community-Acquired MethicillinResistant Staphylococcus aureus Hand
Infections in the Pediatric Population
Michael Thomas Chung, Patrick Wilson,
Brian Rinker■ Objective Structured Assessment ofTechnical Skill in Upper Extremity Surgery
Ann VanHeest, Bradley Kuzel, Julie Agel,
Matthew Putnam, Loree Kalliainen, James
Fletcher■ Arthroscopic Knotless Peripheral
Triangular Fibrocartilage Repair William B.
Geissler■ Intrafocal Pin Plate Fixation of Distal Ulna
Fractures Associated With Distal Radius
Fractures Brian J. Foster, Randy R. Bindra■ Ability of Near Infrared Spectroscopy to
Measure Oxygenation in Isolated Upper
Extremity Muscle Compartments Ashley
L. Cole, Richard A. Herman Jr, Jonathan B.
Heimlich, Sahir Ahsan, Brett A. Freedman,
Michael S. Shuler■ Reconstruction of Distally Degloved
Fingers With a Cross-Finger Flap and a
Composite-Free Flap From the Dorsumof the Second Toe Bin Wang, Xu Zhang,Wenping Jiang, Tiepeng Ma, Hao Li, Hui
Wang■ Reconstruction of an Entire Metacarpal
and Metacarpophalangeal Joint Usinga Fibular Osteocutaneous Free Flap andSilicone Arthroplasty Neil F. Jones, Brian P.
Dickinson, Scott L. Hansen■ Exaggerated Inflammatory Response
and Bony Resorption From BMP-2 Use ina Pediatric Forearm Nonunion Andrew W.
Ritting, Elizabeth W. Weber, Mark C. Lee■ Long-Term Results of Forearm
Shortening and Volar Radiocarpal
Capsulotomy for Wrist Flexion Deformity
in Children With Amyoplasia Ronald C.
Burgess, Rudy Robbe

IFSSH ezine FEBRUARY 2012

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Upcoming events
SociedadeBrasileira deCirurgia da Mao(Brazilian Hand Surgery Society)32nd National Meeting
April 28-30, 2012
Sao Paulo, Brazil
Chairman: Ivan Chakkour
www.mao2012.com.br
e: atendimento@cirurgiadamao.org.br

14th Congreso
Sudamericano de
Cirugia de la Mano
(14th South American Hand
Surgery Meeting)
In conjunction with the33rd National
Meeting of theBrazilian Hand
Surgery Society
April 25-27, 2013
Rio de Janeiro, Brazil
Chairmen: Luiz Carlos Sobania(South America) and Anderson
Vieira Monteiro (Brazil)
e: atendimento@cirurgiadamao.org.br

IFSSH ezine FEBRUARY 201227

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August 2012
Millennium Hotel,
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