ifssh

www.ifssh.info VOLUME 2 ISSUE 2 MAY 2012

ezine

MEMBERS NEWS• Paul R Manske Award winner announced• An update from the Secretary General

CONNECTING OUR GLOBAL HAND SURGERY FAMILY

Lessons from Julius Casserius:
Discoveries and innovations
by 17th Century hand surgeon
PAIN GUIDED HAND THERAPY FOR HAND
FRACTURES: THE SAINT JOHN PROTOCOLANATOMY AND FUNCTION OF
THE THENAR MUSCLES

12th Triennial Congress of the IFSSH&

9th Triennial Congress of the IFSHT
See you in New Delhi 4th – 8th March 2013
Congress Chairman
Dr. S. Raja Sabapathy

Websitewww.ifssh-ifsht2013.com

May 2012

Contents
4 Editorial

By Professor Ulrich Mennen, editor of the IFSSH ezine

5 Members news

Paul R Manske Award for the best upper extremity
congenital research manuscript
An update from the Secretary General

8 Hand Surgery focus

Lessons from Julius Casserius, the most prominent
hand surgeon of the 17th Century

14 IFSHT

Pain Guided Hand Therapy for Hand Fractures: theSaint John Protocol

Front cover image: Anatomical drawing of Interosseus and Lumbricalis
Muscles of the Hand by Julius Casserius (1552-1616) Italian anatomist andhand surgeon. Reproduced by kind permission of Marciana Library, Venice.

20 Research Roundup

Rheumatoid hand surgery
Anatomy and function of the thenar muscles
Anatomy and function of lumbrical muscles

23 Journal Highlights

Tables of Contents from leading journals such as The
Journal of Wrist Surgery, The American Journal ofHand Surgery, Journal of Hand 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 surgeons

18 Pioneer Profiles

Professors Erik Moberg and Johan Landsmeer

IFSSH ezine MAY 20123

editorial

No pain, nore gain
Nobody wants the curse of pain. The feeling is sore,
obnoxious, depressing and incapacitating. It negatively
affects our emotions, logic and attitude. On the other hand,the ability to feel pain is a blessing; it is essential for ourwellbeing, for life itself. People without this ability, this ‘gift’ tosense pain (e.g. familial pain insensitivity, leprosy) mutilatethemselves, have fractures and severe infections without
the slightest discomfort. But PAIN is the alarm bell that starts
ringing. It tells us that something is wrong, that damage isbeing caused. Pain ‘screams’, it begs to stop whatever activity
causes the hurting. Pain even has various characteristics.
It comes in various forms. Colic-type pain indicates anobstruction of a hollow organ e.g. stone blocking an ureter.
Deep burning, constant-agony pain, points to ischaemia
of a muscle. Throbbing pain indicates vasodilatation e.g.
migraine or inflammation. Nerve pain is not alleviated bypainkillers, whereas pain due to inflammatory irritation (e.g.
osteoarthritis) responds to anti-inflammatory drugs.
Inflammation is a normal response by our bodies toany kind of trauma e.g. mechanical, infection, metabolic,thermal, chemical, etc. It is an essential reaction by thetissues to the effect of the trauma. It is essential for thehealing process. Inflammation is an essential part of living.
Without it we would all die, because without it infection
cannot be fought and tissue damage cannot be healed.
The classic signs of inflammation are throbbing pain,
swelling, redness, tenderness and function loss.
As therapists we have to address the cause of these signs,
i.e. vasodilatation and extravasations of fluid. This causes

the pain, swelling, redness and function loss. Oedema fluid
is protein rich and is foreign to the interstitial tissue where
it lies. It irritates the tissue because of its protein content,
and therefore causes MORE inflammation. A vicious cycle
begins. We can counter the inflammatory process by getting
rid of the oedema fluid. Elevation, massage and pressure
garments are mechanical means of reducing oedema. Antiinflammatory drugs do it chemically.
This brings us back to our alarm system, pain sensation.
Therapy which causes pain causes tissue damage, causes
inflammation, causes more tissue reaction. It counters all
the logical healing efforts. It is anti-therapy. Any person(and I do not want to call them therapists) who subscribe
to the irresponsible dictum: ’no pain no gain’ should beexcommunicated from the health profession.
These quacks do not have the slightest knowledgeof physiology, pathology and the healing process. They
have a sadistic nature, which causes their patients and thetherapy profession much harm.
All therapy should be done gently, within the limitsof pain. This approach will encourage wellbeing and gain
the confidence of your patient. After all, we want to rid
our patient of inflammation, promotefunction and make them pain free. Then,I believe we have succeeded in our
mission. No pain, is more gain!
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

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members news

Paul R Manske Awardfor the best upper extremity
congenital research manuscript
In honour of the late Paul R Manske (please see
obituary in the IFSSHezine of May 2011) theUSA based Pediatric Hand Study Group has
established an annual Paul R Manske Award(which includes a monetary honorarium) forthe best upper extremity congenital researchmanuscript.
The four member panel (Charles A.
Goldfarb, MD, Ann Van Heest, MD, Michelle
James, MD, H. Relton McCarroll, MD ), recently
selected the paper by GB Andersson, C
Gillberg, E Fernell, M Johansson and A
Nachemson, entitled: “Children with surgicallycorrected hand deformities and upper limb
deficiencies: self-concept and psychologicalwell-being”, in the Journal of Hand Surgery(European) 2011.36: 795-801, as the 2011
winner.
The winner was chosen after careful
review of the scientific manuscripts in 6
journals including the Journal of Hand Surgery(American and European), the Journal Bone
Joint Surgery (American and British), theJournal Pediatric Orthopedics (American),and the Journal of Plastic and Reconstructive
Surgery. They felt that this manuscript was themost impactful and relevant for the field ofchildren’s hand surgery and the care of patientswith congenital hand anomalies.
The manuscript describes a study about
the self-concept and psychological well-being
IFSSH ezine MAY 2012

in 92 children with either mild or severe handdeformities and upper limb deficiencies.
Testing for self-esteem and wellbeing
showed ‘good’ overall self-concept, equal
to a comparative group of healthy children.
Interestingly, those with severe deformities had
higher (better) self-concept than those withmild deformities.
This study provides new information for
those who care for children with congenital
anomalies. It will help to improve care as it willallow more informed discussions with families.
The IFSSH congratulates the winners on theircontribution to the profession.

The inaugural Paul R
Manske 2011 Award waspresented by Dr. Claire
Manske, (daughter ofPaul, who is presently an
Orthopaedic Resident at
the Washington University
in St. Louis, USA) to Dr. Ann
Nachemson (Sweden), oneof the authors, at the 10th
World Congenital Hand
Anomalies Congress which
was held in March 2012 in
Dallas, Texas, USA.

5

members news

Secretary General’sReport2012 DELEGATES’COUNCIL MEETINGThe 2012 IFSSH Delegates’ Council
meeting will be held on Friday 22ndJune, 2012 10:15am-12:00pm. This willtake place in Antwerp, in conjunction
with the FESSH annual congress.
We look forward to welcoming thedelegates from all IFSSH member
nations and discussing the activities
and plans of our Federation. An
agenda and relevant documentation
will be forwarded to all delegatesin the near future. If your society
has updated its contact details or
appointed a new delegate, please
ensure the IFSSH secretariat has been
notified (email: administration@
ifssh.info). If your delegate is unable
to attend could you nominate analternative member to represent yoursociety.
Further information regarding the2012 FESSH Congress is available via
the website: www.fessh2012.org.

BURSARIES AND GRANTS
As discussed at the 2011 Delegates’
Council Meeting, one of the goalsof the IFSSH is to support worthy
hand surgery proposals withfinancial assistance. Examples ofprevious projects/recipients haveincluded the Baragwanath Hospital

6

Hand Fellowship, production of
the Terminology for Hand Surgery
publication in five languages, andan educational DVD on Pollicization.
To increase the profile of thisprogramme, the IFSSH Executive andDelegates have initiated the ‘IFSSH
Special Committee on Educational
Sponsorship’, chaired by Marc GarciaElias (IFSSH Secretary-Elect). The fulldetails of this committee and theprocess for applications are detailedon the IFSSH website (www.ifssh.info).
If you have a relevant project, pleaseconsider applying for an IFSSH grant.

TRIENNIAL CONGRESS:INDIA 2013
With only one year remaining until
India hosts the 2013 triennial IFSSH
Congress, Zsolt Szabo (IFSSH Secretary
General) and Lynne Feehan (IFSHT
President) visited Delhi last monthto perform the site inspection anddiscuss the conference plans andprogress with the Indian Society’s
Organising Committee.
Dr Raja Sabapthy, Organising
Chairman, and his committee have
prepared an informative scientificprogramme, accompanied bymemorable social events and we lookforward to joining the Indian Society
for the triennial IFSSH Congress –March 4-8, 2013. Further information isavailable via www.ifssh-ifsht2013.com.

REGIONAL EDUCATIONPROGRAMME: EASTERNEUROPE, 2012
At the 2011 meeting, the Delegates’
Council approved a new education
programme which will start thisyear. The IFSSH will financially assist(up to US$20,000) a hand surgery
teaching programme in economicallyhandicapped regions. This is to beorganised on an annual rotation basis(through Europe, America, Asia andAfrica). The IFSSH also hopes to assist
by providing the experience andknowledge of its members to thefaculty of these courses.
The format will entail a 2-3 daycourse with a number of young
hand surgeons (under 45 years) fromthe region participating for free.
These surgeons will be selected bytheir own national societies within
the geographical region of thatyear’s course. The number of freeparticipation possibilities will be
influenced by the budget, but will
be announced at least four months
prior to the event. Beyond this, thecourse will be open for registrations
from hand surgeons within theregion for a reduced fee. The course
IFSSH ezine MAY 2012

members news

organisers should attract sponsors,other educational grants and support
in order to significantly reduce the costof participation, accommodation andcatering. The scientific programme of
the course must be approved by the
IFSSH ExCo. The Delegates’ Council
will consider the region/host society
options for the following year at eachannual Council meeting.
This Regional Education
Programme will commence in 2012
with the Eastern European Course,
sponsored and endorsed by the
IFSSH and FESSH. This course will
be organised in Debrecen, Hungary,close to the Romanian border,
allowing participants from all Eastern
European countries to come by car
or train. Each national society from
Eastern Europe will have the option
to nominate four delegates for free(registration, accommodation andcatering). In this way, a total of 50
participants may attend for free andanother 50 will have the chance toregister for a reduced fee of 300 Euro(all inclusive). The course will have
two days of theoretical educationon ‘highlights in hand surgery’and one cadaveric workshop day
involving ten internationally wellknown experienced hand surgeons
presenting their favourite operations
IFSSH ezine MAY 2012

to small groups the ‘masters at work’.
The Eastern European course aims
to provide the possibility to see andlearn from the best. The complete
course programme will be available
on the IFSSH website and presented
during the Antwerp Delegates’ Council
meeting.

NEW HORIZONSThe IFSSH ExCo launched a
programme to involve societies, handsurgeons from all around the word
who still now were not part of ourgreat family. One of the first societies,
with a tradition, knowledge andsignificant history, to be included inthis project was the Russian Society
for Surgery of the Hand. As a first step
the President and Secretary Generalof IFSSH were invited to discuss thepossibility of collaboration in the futurewith the Russian Society members.
On 14-16 September 2011 an
Instructional Course was held entitled‘Topical issues of Hand Surgery’ at the
St. Petersburg Orthopaedic Institute(1200 beds) under the Directorshipof Professor J Kocsis. Professor Igor
Golobev, President of the RussianSociety for Surgery of the Hand,
was responsible for organising thecourse and the IFSSH was invited toparticipate in this event. President

Ulrich Mennen and Secretary-General
Zsolt Szabo presented some of thelectures and demonstrated surgicalprocedures in the very well-equipped
Department of Anatomy. A group of
150 hand surgeons from around Russia
attended this course.
A great interest was shown
from both parties to develop a
collaboration, and everybody agreed
that such events should be continued.

FUTURE MEETINGS
A detailed list of national and regional
hand surgery meetings is available on
the IFSSH website. The triennial IFSSH
Congresses are as follows:■ XIIth IFSSH - IXth IFSHT Congress New Delhi, India.
■ 4th - 8th March, 2013
XIIIth IFSSH – Xth IFSHT Congress –Buenos Aires, Argentina
2016
Zsolt Szabo
Secretary General,
IFSSH
Email: secretary@
ifssh.info7

Lessons from
Julius Casserius:

Discoveries and innovations
by 17th Century hand surgeon
Authors: A. Landi, L. Garagnani, M. Mancini
A logo with a history
The Italian Society for Surgery of theHand (Società Italiana di Chirurgiadella Mano, SICM) was founded in
December 1962. The origin of the logo
of SICM has been a subject of muchdebate. Prof. Augusto Bonola, fatherof the Modena Hand Surgery school,
became the first President of SICM.
Neither Prof. Bonola, nor Prof. Ezio
Morelli, who was honoured with thetitle of ‘Pioneer of Hand Surgery’ by the
IFSSH, recall who commissioned the
SICM logo and how it was accepted.
Also no records can be found in thearchives of the SICM.
We reviewed the proceedings ofthe first meetings of our Society’s
council in the ‘Brown Book’ that is
kept in the secretariat headquarters in
Florence, where the Secretary, Prof. P
Bedeschi (who is also honoured as an

8

IFSSH ‘Pioneer of Hand Surgery), always
accurately recorded the activities of
the SICM. Even he makes no mentionof the origin of the logo.
The concept of the SICM logo wasmost likely influenced by Prof. Bonola’s
environment: the Ospedale Civile (Civil
Hospital) Sant’Agostino in Modena,
especially by its gate, through which

Logo of the Italian Society for Surgeryof the Hand (SICM).

he used to enter every morning toreach his clinic (Figure 1).
The SICM logo, which has a simple
and graceful geometry, is a copy ofthe logo on this gate. Underneath thislogo is a quotation by Julius Casserius:“Rimatur manus apta manum: menserue mentem”
This gate, in the entrance hallof the Ospedale Civile di Modena,(Figures 1 and 2) was handcrafted by
the blacksmith Giambattista Malagoli
of Modena, distinguished craftsmanof the 18th century. The logo on thisgate was chosen by Prof. Bonola,
and he copied it in black on a whitebackground, as the logo for the SICM
(Figures 2 and 3)
Julius Casserius, at the age of 39
years, is depicted on the cover pageof his first publication, dissecting
a hand (Figure 4). The meaning of
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hand surgery focus

Lumbrical muscles by Casserius.
Reproduced by kind permission of
Padua University library.
IFSSH ezine MAY 20129

Top left: The Malagoli gate,
main entrance of ex-HospitalSant’Agostino, Modena.
Bottom left: The coping of
the gate by Giambattista
Malagoli.
Right: Front page of “Devocis auditusque organi
historia anatomica” by Julius
Casserius with the portraitof the Author at the age of
39, in the act of performing ahand dissection. The famous
sentence “Rimatur manus
apta manum: mens eruementem” can be found below
the portrait.

the sentence which accompanies
the image of Casserius is somewhat
unclear: “De vocis auditusque organi
historia anatomica”. Prof. Bonola, in
1960, sought the help from Domenico
Melli, Professor of Literature and Latin
at LA Muratori Lyceum in Modena,
who was an eminent Latinist andliterature scholar, (especially on
subjects related to Dante, which still
remain memorable). He interpreted thesentence as follows: “The skillful handof the surgeon dissects the hand; themind supports its comprehension”1.

Girolamo Fabrici D’Acquapendente,
who was lecturer of Anatomy andSurgery at Padua University. Fabrici
used to partially dissect the cadavers
before the official demonstrations in
the lecture theatre. Casserius, who used
to assist him, soon became as skilful as
his master. Fabrici supported his young
servant’s aptitude and helped him
become a university student.
Casserius graduated at Padua
University around 1580 after studying
Latin and Greek: the knowledge ofthese subjects constituted a necessary
requirement to obtain a degree
A keen student
in Medicine. Casserius started his
A rare booklet by Dr Giuseppe
postgraduate career in Padua, and,Sterzi, Professor at Padua Instituteunlike Fabrici who was a public manof Anatomy, contains one of thewho did not like to expose himself tomost comprehensive and interestingrisks, he was able to create a network forhistorical researches on Julius Casserius procuring bodies with the connivance(1552-1616). As a young man, Casserius of clergymen and gravediggers. The
moved from Piacenza to Padua,cadavers were stolen from churches
probably as a servant for a medical
before burial, or just after burial. It is
student from Piacenza1,2. In his newtrue that the judicial authority used tocity he worked as a house servant for
supply the university with bodies, but it10

also holds true that two students wereselected by the Rector and the Council
members of the ‘Nations’ (national
corporations of university students) andgiven a special mandate to find othercadavers. These students were called‘Massari dell’anatomia’ (literally, thefarmers of anatomy!).
Casserius managed to dissect alarge number of bodies in his own
house. He gained respect and was heldin high regard by the students andtheir lobbies, in particular the mostpowerful one: the Natio Germanica(German Nation). Fabrici had not beenable to keep good relationships withthis Nation due to the conclusion
which he drew following his
comparative anatomy studies that theGerman students would never be able
to pronounce Italian well because ofanatomical differences!

Inspired lecturer
Due to ill health, Fabrici‘s productivity
slowed, but, in the beginning of
IFSSH ezine MAY 2012

hand surgery focus

Left: Palmar and plantar cutaneous innervation and aponeuroses according to
Casserius. Reproduced by kind permission, private collection.
Above: Neck musculature and levator scapulae according to Casserius.
Reproduced by kind permission of Padua University library.

the academic year of 1608-9, hemanaged to dissect the bodies of
two hanged men. Casserius had
inevitably gained the support of theacademic environment. This became
more obvious when the ‘Collegio
dei Riformatori’ (Reformers Council)
on 25/08/1609 decided to split theteachings of anatomy, which was thenallocated to Fabrici, and surgery, which
was assigned to Casserius.
Julius Casserius had now becomea public lecturer at Padua University.
What was still missing was an up
to date textbook of anatomy. The
university students were forced to
study the treatise by Mondino, which
was almost three hundred years old.
Casserius hired the Swiss German
painter, Joseph Murer, who stayedat his home, and later also Edoardo
Fialetti, a painter from Bologna, tocreate large anatomical drawings.
These were engraved by Francesco
Valleri, from Veneto. Casserius
published three pieces of work: De
IFSSH ezine MAY 2012

“Julius Casserius’s
contribution as
an anatomist andsurgeon rates
him amongst thegreatest personsof hand surgery,belonging to
the scientificcommunity of thehand surgeons of
all continents.”
Reproduced by kind permission ofMarciana Library, Venicevocis auditusque organis historia
anatomica, Pentaestheion, hoc est, De
quinque sensibus liber, and Tabulae
anatomicae. Even to present day
hand surgeons, these works are full ofinteresting information.
Casserius in his Pentaestheion,
discusses the key role that is played by
the skin and, against the common belief
in his times, locates the sense of touchin the dermis instead of the epidermis.
Palmar and plantar aponeuroses
are wonderfully represented in two
drawings2 (Figure 5).
Casserius claims that touch is tobe considered the fundamental sensefrom which all others derive, and that all
sensations converge to the brain, in linewith the statement on the front page.
The main edition of Tabulae
anatomicae was printed in Venice in
1627. Sterzi’s research on Casserius not
only found his last will in the archives ofPadua in 1910, but also 51 anatomical
charts, some with annotations written
by Casserius himself. The eminent

11Morgagni owned these charts for sometime. They are now kept and preservedin the university library of Padua, where
we were able to review them andreproduce the anatomical charts. They
most certainly contribute to redefining

About the authors• Landi, Head of the Hand
Surgery and Microsurgery
Unit, Azienda OspedalieroUniversitaria Policlinico,Modena, Italy, e-mail: landi.
antonio@policlinico.mo.it• L. Garagnani, Hand Surgeon,
Hand Surgery and Microsurgery
Unit, Azienda OspedalieroUniversitaria Policlinico,Modena, Italy• M. Mancini, Manager ofthe Hand Surgery digitalarchive, Azienda OspedalieroUniversitaria, Policlinico,Modena, Italy

12

the history of upper limb anatomy.
These Tabulae represent a magnificent
piece of work that has been quoted
and discussed by several experts in thehistory of medicine.

which many of us know as ‘perforatorof Casserius’ (Figure 8), was in fact
already known to Vesalius andColombo. Casserius was the first to
provide an accuarate representationof the extensor carpi radialis longus
A pioneer in understanding anatomy (ECRL) and brevis (ECRB) muscles.
The muscles of the back have also been Canano3 in his treatise makes anthoroughly described by Casserius,
imprecise description of these two
but despite this, their exact anatomy
muscles. Canano is the author of aremained largely unknown during the rare ‘notomia’ (notomia meant an
17th century. The rhomboid muscles,
accurate and detailed anatomicallevator scapulae, serratus, splenius
description) book4. Among the manythings that have been found in the ex
capitis, and latissimus dorsi are clearly
Libreria Contabile in Ferrara, there is a
reproduced here (Figures 6 and 7).
The levator scapulae was named the rare copy of his famous book entitledMusculorum umani corporis picturata‘patience’ muscle in the 17th century.
dissectio by Joannis Baptista Cananum
It is interesting to try and understandFerrariensis med, with 27 anatomical
the reason behind this nickname: thischarts by Girolamo di Carpi. Anotheris most probably because the act of
copy of this book was brought back tolifting the shoulders was considered
Italy by Vittorio Putti, in 1927. We havealike asking the other person to be
been able to review it at the Rizzoli
patient! The levator was also named
Orthopedic Institute library, with kindafter Spigelius, but it is now clear that
permission of the Putti Foundation.
Casserius described it first.
This allowed us to better define and
The musculocutaneous nerve,
IFSSH ezine MAY 2012

Hand surgery focus

Far left: Shoulder musculature according to Casserius. Reproduced by kindpermission of Padua University library.
Left: Musculocutaneous nerve (perforator of Casserius). Reproduced by kindpermission of Padua University library.
Above: ECRL and ECRB: anatomical description by the Anatomists of the XVI-XVII
century. Anatomic drawing by Canano (left) reproduced by kind permission of
Fondazione V. Putti and Rizzoli Orthopedic Institute library, Bologna (Dr P. Picci, Dr
A. Viganò, P. Tomba).
Right: Lumbrical muscles by Casserius. Reproduced by kind permission of Padua
University library.

understand the role and greatness of
Casserius in the ‘vesalian era’. According
to the biographer Brunet, this book was
printed in 1541, hence it would antecede Vesalius’s anatomical drawings5.
Canano describes extensor carpi radialis
longus and brevis as originating froma common muscle belly, with two
separate tendons (‘Musculus duplici
tendine carpu extendens’) (Figure 9).
The same description was given also by
Vesalius and Fabrizio D’Acquapendente6.
Casserius alone appears to be clear in his
mind that these muscles are separate,
and that in the case of an anatomical
anomaly, even three muscle bellies could
be found (Figure 9).
Nancy H. McKee described thestructure of these muscles in 20047.
Their different architecture wasthoroughly analysed: extensor carpi
radialis longus is composed by longer
fibres at a small angle that makes it
ideal for long excursion, while extensor
carpi radialis brevis is a wrist stabilizer
with a small excursion. Its anatomical
IFSSH ezine MAY 2012

and functional autonomy from its
neighbour is the reason why ECRL
transfer is the procedure of choice torestore digital flexion in eg. tetraplegia.
The lumbrical muscles have been
reproduced by Canano, but accuratecomparisons cannot be made withthe reproduction made by Fialetti in
his anatomical drawing for Casserius(Figure 10). It is interesting to note how
the style of the volar representation by
Casserius (Figure 10) and the dorsal one
by Fabrizio D’Acquapendente (Figure11) appears almost identical.
In the light of the above reflections
one can understand the great respect
Bonola had for Casserius and thereasons why he chose Casserius’s
inscription “Rimatur manus apta
manum: mens erue mentem” to be
included in the SICM logo. Julius
Casserius’s contribution as an anatomist
and surgeon rates him amongst thegreatest persons of hand surgery,belonging to the scientific communityof the hand surgeons of all continents.

REFERENCES:
1. Riva A., Orrù B, Pirino A, Testa Riva F. Iulius
Casserius. The self-made anatomistof Padua’s Golden age. The anatomical Record(new anat.) 2001; 265(4):168-175.
2. Sterzi G. Giulio Casseri: anatomico e chirurgo.
Istituto Veneto di Arti Grafiche ed.,Venezia, 1909.
3. Canano GB, Girolamo da Carpi. Musculorum
humani corporis picturata dissectio.
Lier ed., Firenze, 1925.
4. Società Medico Chirurgica di Bologna. Un libro
raro di notomia. Bollettino delle
Scienze Mediche 1857; Vol. IV(7):480.
5. Castiglioni A. Storia della medicina. Unitas ed.,Milano, 1927.
6. Rippa Bonati M. Manuum munus: per una
iconografia del toccar con mano. In
Olivieri A, Rinaldi M and Rippa Bonati M eds,
All’incrocio dei saperi:la mano,
CLEUP ed., Padova, 2004:325-336.
7. McKee N, et al. Extensor carpi radialis longus
and brevis: A 3-D study ofmusculotendinous architecture. American Society
for Peripheral Nerve Annual
Meeting, Rancho Mirage, CA, USA, January 17-18,
2004. Abstract published on J
Reconstr Microsurg, 2004; 20:340.

13

hand therapy

Pain guided hand therapy
for hand fractures:
the Saint John Protocol
Authors: D. Lalonde MD, FRCSC, A. Higgins BSc. OT
Dr D Lalonde (hand surgeon) andMs Amanda Higgins (hand therapist)
work at the St John Hospital in
New Brunswick, Canada. They havedeveloped an early protective motion
rehabilitation protocol for patients withfractures of the hand. This protocol
was developed to prevent longbouts of immobilisation and prevent
finger stiffness. The results have beenvery good. Amanda shares their
protocol with members of the handrehabilitation teamIntroduction
Early controlled mobilisation oftissues surrounding a healing fracture
has the potential to enhance thequality and rate of fracture healing
and therefore improve the functional
range of motion of the hand1. Early
mobilisation has certainly been
accepted as the treatment of choicefor flexor tendon repair. This is wellsupported by the Cochrane review
on this subject2.
The risk of tendon rupture has
not dampened the interest in early14

protected movement for flexor
tendon repair. This is because it is
widely accepted that early protectedmovement of the finger results inimproved mobility. Other protocols
did not give similar results and many
fingers became stiff when othertendon rehabilitation protocols wereused. All therapists know that a stiff
finger is a useless finger 3,4.
Although there is a risk of loss offinger fracture reduction with earlyprotected movement, it is generally
accepted that this is much easier torepair than a ruptured tendon.
The following protocol of earlyprotected movement for finger
fractures has been developed overmany years in our unit with goodsuccess. Success was measured basedon the following:● Patient’s functional range of motion● Patient satisfaction● Surgeon and therapist satisfaction.
Using this protocol, we have foundthat the patients’ fingers remain supple
and stiffness has been avoided. Loss offracture reduction has been minimal.

The protocol is based on two guiding
principles:
1. Early protected movement is just as
important in finger and metacarpal
fractures as it is in flexor tendon
repair. The reason is the same: stiff
fingers are not an acceptable goodresult. In our experience, the risk ofclinically significant loss of fracture
reduction with this protocolhas been lower than the risk of
tendon rupture in early protectedmovement with flexor tendon
repair.
2. The patients should be off all
analgesics, so that they are guided
by their pain. If it hurts, they may be
doing damage. This may result inthe loss of fracture reduction.
We tell our patients the following:“We did not spend two billion years
evolving pain because it is not goodfor us. It is nature’s only way for ourbodies to tell us: “Hey, don’t do that;I’m trying to heal in here!”. Get off of all
pain killers including acetaminophen
and ibuprophen as soon as possible,
and let your pain tell you what you can
IFSSH ezine MAY 2012

hand therapy

and cannot do. Your body is very cleverand it will let you know when you arepushing it. If you listen to your body,you will get better faster”
This concept is well understoodand accepted by all our patients.
Amanda Higgins has submitted
an extensive protocol, which covers
fractures of all the bones of the hand.
The principles are the same. The
following early protected motion
protocol has been worked out for
fractures of the proximal phalanx.
1. Proximal Phalanx Fracture● Can be unfixated or k-wire fixated.
If there is a K wire, determine
when k-wire needs to be removed
with surgeon. K wires are usually
removed when the fracture is nolonger tender to palpation and thepatient is off of analgesics.
● There is not much point in moving
fractures in the first 2-3 days after
injury, as collagen formation does
not start until day 3. Besides,
very early movement will cause
bleeding, which will generate morescar and callus.
IFSSH ezine MAY 201215

hand therapy● Treat oedema with Coban until thefinger is no longer swollen● Let the pain of the fracture be themain guide for allowing movement
during the healing phase, unless thepatient is unreliable. No movement
is allowed while the patient is on
analgesics .The hand is kept elevated.
Once the patient is completely off
analgesics, he is allowed to move thefinger, but he is not allowed to use
it. If he does something that hurts
significantly, he should not try thatagain for 2-3 days. When it no longer
hurts to move it, he can use it. The
rule is: Don’t baby it but don’t dowhat hurts.
● If the fracture is unstable or if
unsure when to start ROM, discusswith surgeon.
● If stable fracture with no K
wire, then buddy tape finger toneighbouring finger and start early
active ROM when patient is off
analgesics. He should just move it
but not use it stressfully in activities
of daily living. It should not hurt
him to move it. The pain guides the
movement. Buddy tape until nolonger sore to use the finger, which
is usually 2-3 weeks. Re-assess
the patient at 7 days to be surethere is no unacceptable rotation(scissoring) or angulation at thefracture site.
● If unstable fracture with no K wire,or fracture with a K wire, safest is
to elevate hand and splint MP in
flexion and PIP in extension until
the fracture is no longer hurtingwith gentle finger movementwith the patient off all analgesics(usually 3-10 days). If there are no
K wires across joints, actively move16

any or all of the MP, PIP and DIP
joints as much as possible whilestabilising the proximal and/or
middle phalanges with the fingersof the other hand. A splint may
be used to stabilise the proximal
phalanx. The patient is allowed to
do this movement frequently (up tohourly) as long as
he is off all analgesics,
he is just moving it but notusing it stressfully with activities
of daily living,
it does not hurt him to move it.
The pain guides the movement.
Splint the MP and/or PIP joints during
possible stress activities of daily living
and during sleep. Re-assess the patient
at 7 days to be sure there is still nounacceptable rotation (scissoring) or
angulation of the fracture. A splint is
no longer required when it does not
hurt to use the finger, which is usually
2-4 weeks post injury or reduction. It
may be that the intermittent splinting
described above will only need toimmobilise one of the MP or PIP joints(and not both joints). Be guided by thepatient’s pain. The DIP should always
be kept actively moving from day 2-3
onward. This will help to keep the flexor
digitorum profundus gliding. Continue
with active ROM exercises, 10 reps every
waking hour. If joint mobility does not
improve with active ROM, add passive
ROM exercises at 4 weeks.
● Subluxed intra-articular fracturesof the MP or PIP are all treatedindividually and will require
surgeon guidance. These may
require a Schenk, Banjo, or other
distraction splint. The surgeon will
let you know. He will insert a Kwire, which will pass through thehead of the middle phalanx distal
to the fracture site. You will haveto fabricate banjo splint to hookonto this k-wire. The patient willusually wear this splint full time forsix weeks. Bring back to clinic for 6
week follow up (if not seen earlier).
● When the fracture is solidly healed,usually at 6-10 weeks, forceful veryfrequent active movement (several
times per hour with sustained
holding and the patient counting
to 10), to get the last few degrees ofROM, can be initiated. At this point,
pain is allowed as it is no longer thepain of fracture fragments moving,
but it is the pain of stretching
shortened ligaments. If frequent
forceful active movement is not
improving joint mobility after
4 weeks, passive forces may be
applied.
The full protocol, covering fractures ofthe distal and middle phalanxes andmetacarpals, is available from Amanda
Higgins at grashay@nb.sympatico.ca

References
1. Feehan, L. Early controlled mobilization ofpotentially unstable extra-articular handfracture. Journal of Hand Therapy Volume 16,
Issue 2, Pages 161-170.
2. Thien TB, Becker JH, Theis JC. Rehabilitation
after surgery for flexor tendon injuries in thehand.Cochrane Database Syst Rev. 2004 Oct18;(4)
3. Higgins, A, Lalonde, DH, Bell, M, McKee, D,
Lalonde, J. Avoiding flexor tendon repair
rupture with intraoperative total active
movement examination. Plast Reconstr Surg
2010. 126(3):941-945
4. Tang JB. Indications, methods, postoperative
motion and outcome evaluation of primary
flexor tendon repairs in Zone 2. J Hand Surg
(European Volume) 2007; 32E : 2 :118-129.
IFSSH ezine MAY 2012

ifsshezine

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remembering our pioneers

Pioneers in Hand Surgery
IFSSH Pioneer profile:

Professor Erik Moberg
Professor Moberg’s work and observations, particularly
his studies on sensitivity in the hand and its importancefor function, have been recognised and honored formany years. The objective methods that he developed todetermine the functional value of sensitivity in the hand areused everywhere by Hand Surgeons and have stimulated

18

continuing research for improved methods of nerve
repair. His concise and accurate descriptions of diseases
and injuries of the hand are classical. He trained many
Hand Surgeons in Sweden and worldwide through his
participation in numerous international symposia.
Professor Moberg was born in Lund, Sweden. He
received his Medical Doctorate and his PhD degreefrom the University of Lund where he became AssistantProfessor of Experimental Pathology. He was later appointed
Assistant Professor of General Surgery at the University of
Göteborg (1945). In 1946, Professor Moberg created thefirst Department of Hand Surgery in Scandinavia at the
University of Göteborg. He further studied Hand Surgery
in the United States under the aegis of Drs. Sterling
Bunnell, Sumner L. Koch, Allen Kanavel, Michael L. Mason,and Harvey S. Allen in 1947. He was appointed Professorof Orthopaedic and Hand Surgery at the University of
Göteborg in 1958.
Professor Moberg had the honor to deliver the first
Sterling Bunnell Memorial Lecture in San Francisco in 1962.
He was President of the Swedish Surgical Society in 1968.
He was a founding member of the Scandinavian Society for
Surgery of the Hand and of the International Federation ofSocieties for Surgery of the Hand which he served as first
President in 1968-1969. Professor Moberg was a Visiting
Professor at the University of California (Irvine) and arranged
International Conferences on the Surgical Rehabilitationof the Upper Limb in Tetraplegia in Edinburgh (1978) and
Giens, France (1984).
Professor Moberg was honorary or corresponding
member of 15 medical societies abroad and in Sweden.
He published many books and articles in the field of Hand
Surgery and Medicine.
Professor Moberg loved the sea and was an avid sailor.
He and his wife Marta resided in Göteborg, Sweden.
IFSSH ezine MAY 2012

remembering our pioneers

IFSSH Pioneer profile:

Professor Johan
MF Landsmeer
Professor Johan Matthijs (Hans)
Landsmeer dedicated his career to
Basic Sciences and especially to theAnatomy or Human Morphology
as applied to Hand Surgery. He
made enormous contributions tothe understanding of the functionof the hand, its deformities, andthe biomechanical and anatomicalbasis for its action. His thoroughinvestigations on the precise
anatomical basis for movement
have made his work recognised andappreciated worldwide.
Professor Landsmeer was a nativeof Rotterdam, Holland and obtained
his Doctorate in Medicine in 1947. In
1960, he was appointed Professor
at the Department of Anatomy andEmbryology of the University of
Leiden. He was appointed Consultant
in Hand Anatomy on the project of theAmpersand Research Group (Charles
Long, Director, Cleveland, Ohio), andalso at the Hospital for Joint Diseases,
New York. Professor Landsmeer gave
the Founders Lecture at the annual
meeting of the American Society for
Surgery of the Hand in 1965. In 1976
his work as anatomist was published
in: Landsmeer’s Atlas of Anatomy
IFSSH ezine MAY 2012of the Hand. Professor Landsmeer
was Chairman of the International
Committee of the “International
Conference on Biomechanics andClinical Kinesiology of Hand and Foot”
held in Madras, India in 1985. He was
the Guest Professor Anatomy at the
Kasturba Medical College, Manipal,
India (1986).
Professor Landsmeer was anhonorary member of the American,

British, and Dutch Societies for Surgeryof the Hand. He was a member of
the French and of the ArgentinianSocieties for Surgery of the Hand
and of the Anatomical Society ofGreat Britain and Ireland. Professor
Landsmeer was the author of many
scientific publications.
He and his wife Annelies resided in
Oegstgeest, The Netherlands.

19research roundup

Differing approaches to rheumatoid
hand surgery in the United Kingdom
United Kingdom

A recent study, led by Professor FrankBurke from the Pulvertaft Hand Centre
at the Derbyshire Royal Infirmary in
Derby, aimed to assess the differencesin perception about rheumatoid handsurgery between rheumatologists,
hand surgeons and hand therapists
in the UK. The team used a postal
questionnaire to assess commonly
performed rheumatoid handoperations and for each procedure,
respondents rated the most important
indication for surgery and scoredeffectiveness at reducing pain,
improving function and aesthetics, andpreventing deformity.
“The reason we undertook the
study was to see if there was aconsistent view on the outcomesof eight surgicalprocedures for therheumatoid handamongst surgeons,rheumatologists
and hand therapists.

20

Studies in America showedrheumatologists and hand surgeons
had fairly widely differing views on
the outcome of these procedures.
This inevitably leads to significantly
differing advice on specific procedures,
depending on the speciality of thedoctor offering the advice,” Professor
Burke explained.
Statistically significant differenceswere found between all three groups
with regards to expected outcome andmain indications for surgery.
“Attitudes between specialities
in the UK was less polarised than in
the USA with the therapists by andlarge holding opinions between thetwo medical groups. To some extent
that situation was more reassuring
for patients, but it is clear that
more work needs to bedone in terms of better
outcome assessment
for these procedures
and sharing thoseresults withhealthcare
workers who
advise rheumatoid
patients,” Burke
concluded.

“more work needs
to be done in termsof better outcome
assessment forthese procedures
and sharing
those resultswith healthcare
workers who
advise rheumatoid
patients”

JOURNAL REFERENCE
Rheumatoid hand surgery: differing
perceptions amongst surgeons,rheumatologists and therapists
in the UK (J Hand Surg Eur Vol
October 2011vol. 36 no. 8 632-641)

IFSSH ezine MAY 2012

research roundup

Anatomy and function of
lumbrical muscles
IsraelIn a recent paper in Hand Clinics, Dr
Mordechai Vigler from the Departmentof Orthopaedic Surgery at the Rabin
Medical Center in Israel, conducteda study to better understand therelationship between the lumbricalmuscle anatomy and the significant
impact on hand and digit function.
“The lumbrical muscles are uniquehaving both origin and insertion on
tendon. No other muscle in the humanbody shares the same characteristic,” Dr
Vigler explains.
For Vigler, the most important
observations of the study from ananatomical point of view, are thehighly specialised architecturalproperties including small physiologic
cross-sectional area but long fibre
length, which indicate that the
lumbricals are important in fast,
alternating movements and finetuning motion. “Modern society habits
today, involve chronic repetitive digit
motion such as prolonged typing. The
lumbricals play an important role insuch activitity. Better understanding of
their anatomy and function may assist
patients having difficulty performing
prolonged, repetitive tasks,” he Vigler
added.

IFSSH ezine MAY 2012

He believes it is essential for
hand surgeons to understand how
the lumbricals assist in metacarpophalangeal joint flexion and contributeto interphalangeal joint extension.
Secondly, from a functional pointof-view, the role of the lumbricals
in performing fast, alternating
movements and fine-tuning motion.
Future research will involve
understanding better the relationshipbetween the lumbricals and theinterossei muscles in regard to theunique functional ability of the human
hand and digits.

“Betterunderstandingof their anatomy
and function may
assist patients
having difficulty
performing
prolonged,
repetitive tasks”

JOURNAL REFERENCE
Anatomy and function of lumbricalmuscles, Ram Palti, MD, Mordechai
Vigler, MD. Hand Clinics: February
2012 (Volume 28, Issue 1)

21

research roundup

Anatomy and function of thethenar muscles
USA

Dr Salil Gupta, from the Departmentof Orthopedic Surgery at the NYUHospital for Joint Diseases in New York,
recently wrote the paper to provide a
review of the anatomy and function of
the thenar muscles for hand surgeons
and training surgeons.
The four thenar muscles make up
the intrinsic muscles of the thumb.
They include the abductor pollicis,
adductor pollicis, opponens pollicis,
and flexor pollicis brevis. Thumbmotion is facilitated through thecoordination of these intrinsic muscles.
The thumb musculature dynamicallyallows for precision pinching ad power
gripping.
“I was surprised to learn of thegreat variability in the innervationof the thumb intrinsic muscles aswell as the vast number of anatomic
variations present in the thenar region.
In addition, I was impressed by the
intrinsic muscle contribution to theinterphalangeal joint extension,” Dr
Gupta explained.

Gupta believes it is importantto understand the anatomy as it
pertains to muscle position within
the hand as well as to function. In
addition, it is critical to understandthe relationship to the neurovascular
structures. “The mobility of thethumb is critical to hand function. To
understand the physiological anatomy
only helps further our understandingof hand function. In order to treat
pathology and consider reconstructive
procedures, we must first have a firm
grasp of anatomy and function, as it is
the foundation of our knowledge,” heconcluded.

“To understandthe physiologicalanatomy only
helps further our
understanding ofhand function”

JOURNAL REFERENCE
Anatomy and Function of the
Thenar Muscles, Salil Gupta, MD,
Heidi Michelsen-Jost, MD in Hand
Clinics: February 2012 (Volume 28,
Issue 1)22

IFSSH ezine MAY 2012

journal highlights

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 Clinics

Latest issue is: Volume 28 • Issue 1 February 2012
■ Anatomy and Function of the Thenar
Muscles Salil Gupta, Heidi Michelsen-Jost■ Restoration of Pinch in Intrinsic Musclesof the Hand Steve K. Lee, Jamie R. Wisser■ The Interosseous Muscles: The Foundationof Hand Function Frederic E. Liss

■ Correction of the Claw Hand Anthony
Sapienza, Steven Green■ Anatomy and Function of Lumbrical
Muscles Ram Palti, Mordechai Vigler■ Intrinsic Contractures of the Thumb Jack
Choueka, Susan Craig Scott■ Anatomy and Function of the
Hypothenar Muscles John A. Pasquella,
Pam Levine■ Intrinsic Contractures of the Hand Nader
Paksima , Basil R. Besh

■ Restoration of Opposition Martin A.
Posner, Deepak Kapila■ Hand Therapy for Dysfunction of theIntrinsic Muscles Monica Seu, Michele
Pasqualetto

Coming soon

Journal ofWrist Surgery
Editor in Chief: Dr David Slutsky,
MD, Assistant Clinical Professor,
Department of Orthopaedic
Surgery, UCLA School of
Medicine, Los Angeles, CA

CLICK HERE TO
FIND OUT MORE

Hand

Volume 7 / 2012
■ Epithelioid hemangioendotheliomaof the pisiform Isidre A. Gracia, Ignacio R.
Proubasta, Ana I. Peiró, Laura T. Trullols andJaume Llauger, et al.
■ Early versus delayed imaginal exposurefor the treatment of posttraumatic stressdisorder following accidental upper
extremity injury Jo M. Weis, Brad K. Grunertand Heidi Fowell Christianson■ Re: End-of-skin grafts in syndactyly
release: description of a new flap for web
space resurfacing and primary closure offinger defects Kresimir Bulic■ Spindle cell hemangioma reoccurrencein the hand: case report Sylvia S. Gray,
Mahmoud A. Eltorky, Roy F. Riascos andRichard D. Montilla
IFSSH ezine MAY 2012

■ Patient-reported outcomes after acutecarpal tunnel release in patients with distal
radius open reduction internal fixation
Aakash Chauhan, Timothy C. Bowlin,
Alexander D. Mih and Gregory A. Merrell■ Moberg Modification using the first web
space: thumb reconstruction following
distal amputation Stéphanie Thibaudeau,
Dominique M. Tremblay, Michèle Tardif andAndré Chollet■ Management of digital tendon avulsion
at the musculotendinous junction of
the forearm: a systematic review Jessica
Collins, Yoshihiro Ishihara and Achilleas
Thoma■ Psychological factors predict
unexpected diagnoses Ana-Maria
Vranceanu and David Ring

■ Nonsurgical treatment of Dupuytren’scontracture: 1-year US post-marketing
safety data for collagenase clostridium
histolyticum C. A. Peimer, C. A. McGoldrick
and G. J. Fiore■ The free lateral arm flap – a reliableoption for reconstruction of the forearmand head M. Sauerbier, G. Germann, G. A.
Giessler, M. Sedigh Salakdeh and M. Döll
■ High impact articles in hand surgery
Kyle R. Eberlin, Brian I. Labow, Joseph
Upton and Amir H. Taghinia■ Wrong site surgery – where are we andwhat is the next step Tyson K. Cobb

23

journal highlights

Hand surgery: Asia PacificVolume 17, Issue 1 2012
■ Simultaneous Gradual Lengtheningof Proximal and Distal Nerve Stumps for
Repair of Chronic Peripheral Nerve Defectin Rats. Yoshiko Nakajima, Yasumasa
Nishiura, Yuki Hara, Sharula and Naoyuki
Ochiai■ Role of the Hyaluronan-Producing
Tenosynovium in Preventing Adhesion
Formation During Healing of Flexor
Tendon Injuries Masaharu Yagi, Yasuhiro
Mitsui, Masafumi Gotoh, Naoto Sato, Kenji
Yoshida and Kensei Nagata■ Alteration of the End-Plane Angle in
Press-Fit Cylndrical Stem Radial Head
Prosthesis: An In Vitro Study - Suriya
Luenam, Piti Chalongviriyalert, Arkaphat
Kosiyatrakul and Chusak Thanawattano■ Prevention of Instability of the Proximal
End of the Radius after Radial Head
Resection Using an Anconeus Muscle Flap
Kinya Nishida, Norimasa Iwasaki, Tadanao
Funakoshi, Makoto Motomiya and Akio
Minami■ Radial Head Dislocation as a Rare
Complication of Obsteteric Brachial Plexus
Palsy: Literature Review and Five Case
Series – Cecilia W. Huo■ Open Extensor Tendon Injuries: An
Epidemiologic Study – Dominic Patillo andGhazi M. Rayan■ Extensor Tendo Rupture in Rheumatoid
Arthritis: A Survey of Patients Between
2005 and 2010 at Five Korean Hospitals Hyun Sik Gong, Joon Oh Lee, Goo Hyun

Journal of Hand Surgery: American volume
Volume 37, Issue 4, April 2012
■ Opioid Consumption Following
Outpatient Upper Extremity Surgery Jeffrey
Rodgers, M.D, Kimberly Cunningham, Keely
Fitzgerald, Edward Finnerty

Alexander Y. Shin

Subluxation, Contact Area, and Contact
Pressure Tahseen Cheema, MD, Christina
Salas, MS, Nathan Morrell, MD, Letitia
Lansing, MD, Mahmoud M. Reda Taha, PhD,
Deana Mercer, MD■ Results of Needle Aponeurotomy for
Dupuytren Contracture in over 1,000
Fingers Gary M. Pess, Rebecca M. Pess,
Rachel A. Pess

■ Simultaneous Intercostal Nerve
Transfers to Deltoid and Triceps Muscle
Through the Posterior Approach Kanchai Malungpaishrope, Somsak
Leechavengvongs, Kiat Witoonchart,
Chairoj Uerpairojkit, Artit Boonyalapa,
Disorn Janesaksrisakul■ Surgical and Nonsurgical Treatment of
Cubital Tunnel Syndrome in Pediatric andAdolescent Patients Christopher M. Stutz,
Ryan P. Calfee, Jennifer A. Steffen, Charles
A. Goldfarb■ Functional Outcome of Glenohumeral
Fusion in Brachial Plexus Palsy: A Report of
54 Cases Franck Atlan, Sébastien Durand,
Michael Fox, Pierre Levy, Zoubir Belkheyar,
Christophe Oberlin■ Percutaneous Screw and Axial Kirschner
Wire Fixation for Acute Transscaphoid
Perilunate Fracture Dislocation Ying-Chao
Chou, MD, Yung-Heng Hsu, MD, Chun-Ying
Cheng, MD, Chi-Chuan Wu, MD■ Arthroscopic Ulnar Nerve
Decompression in the Setting of Elbow
Osteoarthritis – Rudy Kovachevich, M.D.,
Scott P. Steinmann, MD■ Carpal Tunnel Release Using the MANOSCTR System: Preliminary Results in 52
Patients Bruce McCormack, William Bowen,
Stephen Gunther, Jonathan Linthicum,
Michael Kaplan, Edward Eyster■ The Mechanism of Ulnar-sided
Perilunate Instability of the Wrist: A
Cadaveric Study and 6 Clinical Cases Peter
M. Murray, MD, Christopher G. Palmer, MD,
Alexander Y. Shin, MD■ Palmaris Profundus Tendon Prohibiting
Endoscopic Carpal Tunnel Release: Case
Report - Walter B. McClelland Jr, Kenneth
R. Means Jr Walter B Mc Clleland Jr, MD,
Kenneth R. Means Jr■ Ulnar Variance: Its Relationship to
Ulnar Foveal Morphology and Forearm
Kinematics - Toshiyuki Kataoka, MD, Hisao
Moritomo, MD, PhD, Shohei Omokawa,
MD, PhD, Akio Iida, MD,Tsuyoshi Murase,
MD, PhD, Kazuomi Sugamoto, MD, PhD■ Radial Nerve Injury During Double
Plating of a Displaced Intercondylar
Fracture - Rebecca Lim, Shian Chao Tay,
Andrew Yam■ Lateral Antebrachial Cutaneous
Neuropathy Following the Long Head of
the Biceps Rupture – David M. Brogan,
Allen T. Bishop, Robert J. Spinner,24■ Early Trapeziometacarpal Osteoarthritis:
A Biomechanical Investigation of Radial■ Innervation Patterns of Thumb
Trapeziometacarpal Joint Ligaments
Elisabet Hagert, MD, PhD■ Use of Standard and Anatomic-Tilt

IFSSH ezine MAY 2012

journal highlights

Baek, Byung Sung Kim, Jin Young Kim, Jae
Seong Lee and Choel Ho Song■ The Carpal Stretch Test at the
Rheumatoid Wrist - Hiroyuki Shimizu,
Moroe Beppu, Kazuhiko Matsusita, Takeshi
Arai and Noriyuki Yoshida■ The Current Practice of the Managementof Little Finger Metacarpal Fractures – A
Review of the Literature and Results of a
Survey Conducted Among Upper Limb
Surgeons in the United Kingdom - A. Sahu,
S. S. Gujral, S. Batra, S. P. Mills and M. S.

Lateral X-rays to Determine Distal Radius
Volar Angulation - Ju Won Yi, MD, Rag Gyu
Kim, MD, Jin Ha Choi, MD, Jae Kwang Kim,
MD, PhD■ Comparison of 2 Forearm
Reconstructions for LongitudinalRadioulnar Disassociation: A Cadaver Study- Christopher M. Jones, MD, , Check C. Kam,
MD, E. Anne Ouellette, MD,MBA, Edward
L. Milne, BSc, David Kaimrajh, MS, Loren L.
Latta, PhD■ Radiocapitellar Cartilage Injuries
Associated With Tennis Elbow Syndrome- Koichi Sasaki, MD, Kazunori Onda, MD,
Gosuke Ohki, MD, Tomoko Sonoda, DDS,
Toshihiko Yamashita, MD, Takuro Wada, MD

Srinivasan■ Curettage and Calcium Phosphate Bone
Cement Injection for the Treatment ofEnchondroma of the Finger - Jae Kwang
Kim and Nam Ki Kim■ Negative Pressure Therapy with
Irrigation for Digits and Hands: PressureManagement and Clinical Application Yuki Matsushita, Masao Fujiwara, Takeshi
Nagata, Tatsuya Noda and Hidekazu
Fukamizu

Watanabe, MD, Jun Eto, MD■ Long-term Donor Site Morbidity AfterFree Nonvascularized Toe Phalangeal
Transfer - Lorenzo Garagnani, MD, Marc
Gibson, MBBSc, Paul J. Smith, MBBS, Gillian
D. Smith, MBBCh■ Radiation Therapy for Infiltrative
Giant Cell Tumor of the Tendon Sheath- Christopher J. Coroneos, MD, BrianO’Sullivan, MD, Peter C. Ferguson, MD,
Peter W. Chung, MD, Dimitri J. Anastakis,
MD■ Recurrence of a Giant Cell Tumor of theHand After 42 Years: Case Report - Keith
Jackson, MD,, Charles Key, MD, Michelle
Fontaine, MD, Richard Pope, MD■ Radiographic Arthrosis After Elbow
Trauma: Interobserver Reliability Anneluuk Lindenhovius, MD, PhD, PaulJack Karanicolas, MD, PhD, Mohit Bhandari,MD, MSc, David Ring, MD, PhD■ Cutaneous Mucormycosis of the Upper
Extremity in an Immunocompetent Host:
Case Report - Kyle D. Lineberry, BS, Adam
K. Boettcher, MD, Andrew L. Blount, MD,
Scott D. Burgess, MD■ Metacarpal Hypoplasia Associated With
Congenital Constriction Band Syndrome Hiroshi Satake, MD, PhD, Toshihiko Ogino,
MD, PhD, Kousuke Iba, MD, PhD, Tadayoshi■ Multiple Neurilemmomas in Birt-HoggDubé Syndrome: Case Report Kevin J.
Renfree, MD, Kara L. Lawless, BS

IFSSH ezine MAY 2012

■ Preventing Postoperative Congestion in
Reverse Pedicle Digital Island Flaps When
Reconstructing Composite Tissue Defects
in the Fingertip: A Patient Series - Hironori
Matsuzaki, Hisao Kouda and Haruyoshi
Yamashita

Blood Flow in Rats: A Potential Mechanism
for Treatment of Raynaud Phenomenon- Austin V. Stone, MD, L. Andrew Koman,
MD, Michael F. Callahan, PhD, Delrae M.
Eckman, PhD, Beth P. Smith, PhD, Johannes
F. Plate, MD, Thomas L. Smith, PhD■ Nonoperative Management of
Scleroderma of the Hand With Tadalafil andSubatmospheric Pressure Wound Therapy:
Case Report - Ronak M. Patel, MD,Daniel J.
Nagle, MD■ Conservative Management of Dieterich
Disease: Case Report Malin D. Wijeratna,
MBBS, BSc, James A. Hopkinson-Woolley,
MBBS, MSc
■ Magnetic Resonance Imaging in
Evaluating Workers’ Compensation Patients– Daniel Babbel, Ghazi Rayan■ The Effect of Botulinum Neurotoxin-A on

25

journal highlights

Journal of Hand Surgery (European Volume)
May 2012 J Hand Surg Eur Vol 37, Issue 4■ Joint replacement in 131 painful
osteoarthritic and post-traumatic distalinterphalangeal joint Sierakowski, C.
Zwiefel, M., Sirotakova, S. Sauerland and D.
Elliot■ Simultaneous powering of forearm
pronation and key pinch in tetraplegia
using a single muscle-tendon unit J.
Fridén, C. Reinholdt, A. Gohritz, W.J. Peace,
S.R. Ward and R.L. Lieber■ A randomised controlled trial ofabsorbable versus non-absorbable sutures
for skin closure after open carpal tunnel
release C. Theopold, S. Potter, M. Dempsey,and M. O’Shaughnessy■ Relative contribution of tissue oedema
and the presence of an A2 pulley toresistance to flexor tendon movement: anin vitro and in vivo study Y.F. Wu, Y.L. Zhou
and J.B. Tang

■ Finger replantations after ring avulsion
amputations K. Özaksar, T. Toros, T.S. Sügün,M. Kayalar, I. Kaplan, and S. Ada■ The effect of radial osteotomy on theposition of the posterior interosseous
nerve J.M. Itamura, S.A. Papadakis, E. Ziv, S.
Vaishnav, N. Roidis■ The effect of core suture flexor tendon
repair techniques on gliding resistanceduring static cycle motion and load to
failure: a human cadaver study T. Moriya,
M.C Larson, C. Zhao, K.-N. An, and P.C.
Amadio■ Trabecular microstructure of the human
lunate in Kienböck’s disease K.-J. Han, J. Y.
Kim, N.-S. Chung, H. R. Lee, and Y. S. Lee■ Experience of using the bioresorbablecopolyester poly(DL-lactide-εcaprolactone) nerve conduit guide
Neurolac™ for nerve repair in peripheral
nerve defects: Report on a series of 28
lesions S. Chiriac, S. Facca, M. Diaconu, S.
Gouzou, P. Liverneaux

Journal of Hand Therapy
Volume 25, Issue 2, April 2012

■ Understanding the Biomechanical Nature of Musculoskeletal
Tissue - Andrew R. Karduna■ Specialized Connective Tissue: Bone, the Structural Frameworkof the Upper Extremity – Alyssa M. Weatherholt, Robyn K. Fuchs,
Stuart J. Warden■ Tendon Biomechanics and Mechanobiology – A mini review of
Basic Concepts and Recent Advancements - James H-C Wang
■ Target-focused Exercise Regime: A Motivational Strategy to
Improve Patient’s Adherence to Treatment of a Stiff Thumb
Interphalangeal Joint - G. Sudhagar, Monique LeBlanc■ Using the “Visual Target Grip Test” to Identify Sincerity of Effort
during Grip Strength Testing – Orit Schechtman, PhD OTR/L,
Bhagwant S. Sindu, PhD OTR/L, Paul W. Davenport, PhD

26

IFSSH ezine MAY 2012

upcoming events

Upcoming events
22nd ETRS Meetingby the European Tissue Repair Society (ETRS)
Date: October 4th -5th, 2012
Venue: Royal Olympic Hotel (Across the Ancient Temple of Zeus)
Host city: Athens
The meeting will be hosted in Athens, a city of great importance since ancient times for
culture, philosophy and scientific thinking. Strolling through Athens, the visitor discovers thisrich history as Ancient, Roman, Byzantine and modern monuments abound. Take advantage ofthis unique feature and enjoy a trip into the course of history.
Host country: Greece
The country is considered to be the birthplace of modern western culture and democracy. In
addition to rich historical offerings, Greece has gorgeous coastlines and mountains.
www.etrs2012.org

12th Triennial Congress of the IFSSH and 9th
Triennial Congress of the IFSHT
Date: 4th – 8th March 2013
Location: New Delhi, India

IFSSH ezine MAY 201227

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