bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Results of Denervation of the Wrist Joint for Chronic Wrist Pain
Authors: ISHIDA O. , TSAI T-M. , ATASOY E.
Published: June 2005

The results have been evaluated of 29 patients who had wrist denervation for chronic wrist pain between 1979 and 1987. Follow-up ranged from 22 to 86 months (mean 51 months). 17 patients had denervation without a concurrent procedure. Of these, 12% became pain-free and 71% had pain with all activities or had additional surgery; 24% said they were satisfied with their treatment. The results were worse in those who had partial denervation than those who had total denervation. 12 patients had denervation performed concurrently with another pain-relieving procedure. Denervation alone was not reliable in resolving chronic wrist pain.
Long-Term Follow-Up of Swanson’s Silastic Arthroplasty of the Metacarpophalangeal Joints in Rheumatoid Arthritis
Authors: WILSON Y. G. , SYKES P. J. , NIRANJAN N. S.
Published: June 2005

77 patients with rheumatoid arthritis, 62 female and 15 male, underwent metacarpophalangeal joint arthroplasty on 375 joints using the Swanson design silicone rubber spacer between 1976 and 1985. Retrospectively, 48 of these patients were evaluated by postal questionnaire and 35 of them also underwent objective assessment at intervals ranging from five to 14 years post-operatively. Objective variables recorded included range of active motion, recurrence of ulnar drift and radiographic appearances.

Both in the early and late stages, the vast majority of patients were satisfied with the outcome, with abolition of pain, correction of deformity and improved range of motion. There was some loss of mobility with time. However, functional improvement was maintained in the majority. Complication rates compare favourably with other reported series and no case of silicone synovitis was diagnosed.

We agree with previous studies that the procedure is useful for lasting relief of pain and enhancement of a patient’s sense of well-being and is associated with few complications.
Arthroscopic Synovectomy of the Rheumatoid Wrist
Authors: ADOLFSSON L. , NYLANDER G.
Published: June 2005

18 wrists in 16 patients with synovitis due to rheumatoid arthritis were treated with arthroscopic synovectomy. The surgical procedure and the results after surgery are described. Range of motion, grip strength, subjective experience of pain and level of activity were registered pre-and post-operatively. The operations were found to give good pain relief, increased grip strength, no post-operative stiffness and a short period of rehabilitation.
Post-Traumatic Neuralgia in the Upper Extremity Treated with Extraneural Scar Excision and Flap Cover
Authors: HOLMBERG J. , EKEROT L.
Published: June 2005

19 patients with neuralgia in the upper limb after surgical or non-surgical trauma to peripheral nerves were treated by excision of the extraneural scar and surrounding hypersensitive skin and application of free or pedicle flaps. The subcutaneous fat of the flaps was wrapped around the affected nerves. After a mean follow-up time of 5.8 years the patients were sent a questionnaire. Only one patient considered herself cured, six were almost cured and seven improved. Two patients were unchanged and three worse. The results after three to four months appeared stable.
Hand Infections: An Audit of 160 Infections Treated in an Accident and Emergency Department
Authors: STEVENSON J. , ANDERSON I. W. R.
Published: June 2005

160 consecutive hand infections presented to an Accident and Emergency department over a four-month period. All but one were treated solely on an out-patient basis. The mean delay to presentation was three days, the mean duration of treatment was six days. Follow-up to complete resolution was achieved in 89% of cases. No patients were treated with parenteral antibiotics. The need for careful assessment, early aggressive surgery, and meticulous attention to the principles of wound care by experienced clinicians is emphasized.
Metacarpophalangeal Joint Arthroplasty Based on the Osseointegration Concept
Authors: LUNDBORG G. , BRÅNEMARK P.-I. , CARLSSON I.
Published: June 2005

The osseointegration concept has been used for fixation of 68 MP joint endoprostheses in 31 patients operated on at the Department of Hand Surgery, Malmö General Hospital during the period 1988–1992. The indications were rheumatoid arthritis (50 joints), primary osteoarthrosis (three joints), post-traumatic osteoarthrosis (three joints), post-traumatic osteoarthrosis (five joints), post-infectious osteoarthrosis (seven joints) and joint deformities secondary to spastic conditions (three joints). The average follow-up time was 2.5 years (6–54 months). The surgical procedure included resection of the joint followed by introduction of screw-shaped titanium fixtures into the bone marrow cavities of the metacarpal and the phalangeal base. Rheumatoid cases usually required grafting of cancellous bone and marrow from the iliac crest. At the same time a flexible constrained silicone spacer was connected to the titanium fixtures in such a way as to allow later replacement of the spacer if accessory. The average active range of motion (ROM) was 57° in the rheumatoid cases and 50° in all cases. Radiological and clinical osseointegration occurred in every case, and there were no clinical signs of loosening. In four cases (6%) there was a fracture of the joint mechanism. Patient satisfaction was high, with pain relief, increased range of motion, improved hand function and good cosmetic appearance.
The Range of Motion of the MP Joint of the Thumb Following Operative Repair of the Ulnar Collateral Ligament
Authors: BOSTOCK S. , MORRIS M. A.
Published: June 2005

The range of motion of the MP joint of the thumb following repair of the ulnar collateral ligament has been compared with the range of motion of the uninjured thumb. By making this comparison we conclude that there is no good evidence that joint stiffness is a common post-operative complication.
The Isolated Scapho-Trapezio-Trapezoid Ligament Injury
Authors: MASQUELET A. C. , STRUBE F. , NORDIN J. Y.
Published: June 2005

Isolated injuries of the scapho-trapezial ligament complex are not well recognized. The ligament complex comprises the stout scapho-trapezial ligament, the floor of the flexor carpi radialis (FCR) tendon sheath and the scapho-capitate ligament.

Between August 1991 and May 1992, we diagnosed and treated four cases of partial chronic post-traumatic lesions of this ligament complex. There was chronic pain at the base of the thenar eminence and instability of the thumb-index-middle finger pinch. Standard X-rays were normal. The diagnosis of ligament rupture was confirmed by mid-carpal arthrography showing filling of the sheath of FCR tendon. Surgical exploration showed complete rupture of the tendon sheath of FCR in two cases, associated in the other two cases with complete rupture of the scapho-trapezial ligament. Direct repair of the ligamentous elements was performed in all cases. The tendon of FCR was sutured to the tubercle of scaphoid to protect and to reinforce the ligament repair.

The patients have been followed-up for between 6 and 12 months. All four patients recovered normal pinch strength to the middle finger. One patient suffered from chronic pain at work.
Aneurysmal Bone Cysts in the Hand Treated by Free Non-Vascular Transfer of Metatarsal or Proximal Phalanx from the Foot
Authors: RAO G. S. , KEOGH P. , WEBSTER H. , LUNN P. G. , BURKE F. D.
Published: June 2005

Two cases of aneurysmal bone cyst in the hand are reported. In one case the entire first metacarpal was resected and grafted using the fourth metatarsal. In the second case diaphysectomy of the middle phalanx of the index digit was performed, and the proximal phalanx of the second toe was used as graft. Satisfactory length and function were maintained, the grafts remained viable and there was no donor site morbidity. Transplant of a metatarsal or toe phalanx to the hand, as a free non-vascularized graft, is a relatively straight forward operation, requires minimal refashioning of the graft, provides articular surfaces for joint reconstruction and leaves little donor site morbidity.
Unilateral Carpal Tunnel Syndrome and Space-Occupying Lesions
Authors: NAKAMICHI K. , TACHIBANA S.
Published: June 2005

To assess the association between unilateral carpal tunnel syndrome and space-occupying lesions, 128 patients have been reviewed. They were divided into bilateral, subclinical (unilateral signs and symptoms, and bilateral slowing in the median nerve conduction) and unilateral carpal tunnel syndrome. Space-occupying lesions were investigated on the basis of physical examination and wrist imaging using plain radiographs and ultrasonograms. Of 20 patients with unilateral carpal tunnel syndrome, space-occupying lesions were found in seven (occult ganglion in five and occult calcified mass in two). In contrast, none of 89 patients with bilateral carpal tunnel syndrome and 19 with subclinical carpal tunnel syndrome had space-occupying lesions. We conclude that careful examination and wrist imaging on suspicion of local pathology, especially a space-occupying lesion, are needed when the condition is unilateral and the aetiology is not clear from the history and on physical examination.
Cross Thumb Transfer
Authors: REIGSTAD A. , HETLAND K. R.
Published: June 2005

Thumb reconstruction following amputation was accomplished by microvascular transfer of the thumb from the contralateral paralyzed hand in two cases. The appearance and function of the transferred thumbs were excellent and no problem was seen in the donor hand.
The Hoffmann-Tinel Sign
Authors: BUCK-GRAMCKO D. , LUBAHN J. D.
Published: June 2005

The aim of this article is to show that the well-known Tinel sign is realiy a Hoffmann-Tinel sign. The translation of the two papers of Hoffmann, published in the same year that Tinel wrote his article (1915), is completed by a short biography of Paul Hoffmann.
Bilateral Median Nerve Bifurcation with an Accessory Compartment within the Carpal Tunnel
Authors: SZABO R.M. , PETTEY J.
Published: June 2005

A case is reported in which the median nerves bifurcated bilaterally, with the radial segment of each nerve passing through an accessory ligamentons compartment within the carpal tunnel.
A New Fibrin Seal in Primary Repair of Peripheral Nerves
Authors: POVLSEN B.
Published: June 2005

Fibrin sealing, with or without sutures, has become a commonly used technique in human nerve grafting with clinically good results, but is seldom used in primary repair of peripheral nerves. A prospective study was designed to evaluate the incidence of dehiscence in the traditional (Tisseel Kit) and a new “ready-to-use” fibrin seal preparation (Tisseel Duo), and the outcome following fibrin sealing was compared with microsurgical repair of peripheral nerves in rats. No dehiscence was seen in the Tisseel Duo group compared with 20% in the Tisseel Kit group. The electron micrographic evaluation following regeneration showed no significant difference from the microsuture group. Tisseel Duo should therefore be used instead of the traditional fibrin seal preparation when no sutures are used, and may prove to be an alternative to microsuture of peripheral nerves.
Identification of Elastic Fibres in the Peripheral Nerve
Authors: TASSLER P. L. , DELLON A. L. , CANOUN C.
Published: June 2005

Traditional histological staining techniques, as well as elastin-specific antibodies and electron microscopy, have been used to assess the distribution of elastin within the peripheral nerve. The location of the elastin identified by the VerHoeff-VanGiesen or Weigert stains has been shown to coincide with the unambiguous identilication of elastin by immunospecific stains and electron microscopy. Elastin is located in all three connective layers of the peripheral nerve. Thick elastic fibres, consisting of amorphous elastiu protein and microfibrils, are located consistently in the perineurium and, to a lesser extent, in the epineurium. The endoneurium contains small collections of elastic fibres widely distributed between the axons. Compared with collagen, the overall content of elastin, however, is small, suggesting that the visco-elastic properties of peripheral nerve may be due primarily to collagen.
Electrophysiological Changes after Severance of the C7 Nerve Root
Authors: GU Y-D. , SHEN L-Y.
Published: June 2005

Since 1986, contralateral C7 root transfer has been used to treat brachial plexus root avulsions in our hospital. We performed post-operative electrophysiological examinations of the healthy-side limb in the first 27 patients. Electromyography and nerve conduction studies on the healthy side demonstrated mild abnormalities only of individual limb muscles in a few cases. These changes mostly recovered during the follow-up period. In the measurement of radial nerve motor conduction, median nerve sensory conduction and somato-sensory evoked potentials, we found that the amplitude of the median nerve sensory conduction alone was slightly lower than that of the control group ( p < 0.05). The results showed that severance of C7 caused no permanent functional damage to the upper limb.
Flexor Tendon Repair in Zone 2C
Authors: TANG J. B.
Published: June 2005

A randomized prospective clinical study was carried out in 33 patients (37 lingers) with lacerations of both FDS and FDP tendons in the area covered by the A2 pulley, that is, zone 2C in Tang’s subdivision of no man’s land. Both lacerated tendons were repaired in 19 fingers and repair of only FDP with regional excision of FDS were performed in 18 fingers. Follow-up of average 12 months revealed that there was no significant difference in the end results evaluated according to the TAM system. The average TAM was 204° in the fingers with suture of FDP only and 187° in those with suture of both tendons. The fingers with suture of both tendons showed a higher rate of re-operation due to adhesions or rupture of repair. This study suggests that it is better to repair only FDP with regional excision of FDS when both tendons are injured in zone 2C.
Dorsal V-Y Advancement Flaps in Digital Reconstruction
Authors: YII N. W. , ELLIOT D.
Published: June 2005

A series of 29 patients is presented in which 40 dorsal full-thickness defects of the reconstructed using homodigital flaps advanced distally with V-Y closure of the donor defect.
Digital Lengthening in Congenital Hand Deformities
Authors: OGINO T. , KATO H. , ISHII S. , USUI M.
Published: June 2005

12 hands with congenital short finger in 11 patients were treated with various types of metacarpal bone lengthening. These included three patients with brachydactyly, seven with transverse deficiency, and one with constriction ring syndrome. All cases involved metacarpal lengthening and surgery was performed 16 times in 15 digits. Single-stage lengthening was performed in seven cases, on-top plasty in three cases, and distraction lengthening in six cases. The length gained ranged from 2 to 10 mm in single-stage lengthening, 3 to 17 mm in on-top plasty, and 12 to 30 mm in distraction lengthening. Delayed union and malunion occurred in single-stage lengthening or on-top plasty. After metacarpal lengthening, pinch function was improved in seven out of eight patients with either transverse deficiency or constriction band syndrome, and aesthetic improvement was achieved in three patients with brachydactyly.
Acute Carpal Tunnel Syndrome in Hansen’s Disease
Authors: GAUR S. C. , KULSHRESHTHA K. , SWARUP S.
Published: June 2005

Two cases of acute carpal tunnel syndrome due to median nerve abscess as a consequence of Hansen’s disease are reported. Nerve abscess as a cause of acute carpal tunnel syndrome is rare.
Non-Hodgkin’s Lymphoma Presenting as Median Nerve Compression in the Arm
Authors: DESTA K. , O’SHAUGHNESSY M. , MILLING M. A. P.
Published: June 2005

A 70-year-old woman presented with median nerve compression secondary to enlarged supratrochlear lymph nodes infiltrated with malignant non-Hodgkin’s lymphoma. Peripheral nerve compression is rarely seen in this condition. The management and prognosis are discussed.
Laser Doppler Imaging of Finger Skin Blood Flow in Patients after Microvascular Repair of the Ulnar Artery at the Wrist
Authors: BORNMYR S. , ARNER M. , SVENSSON H.
Published: June 2005

Laser Doppler imaging is a new, non-invasive technique allowing the spatial distribution and the temporal variation of the skin blood flow to be monitored. A mean blood flow value over an area, such as the finger-tip in the present study, can also be calculated. Recordings from 12 patients with a sutured ulnar artery following trauma did not significantly differ from those obtained in 14 controls. Four patients with a ligated ulnar artery, however, showed a slower restitution of blood flow values after cold provocation. All sutured ulnar arteries were found to be patent, which confirms that microvascular reconstruction of an injury to the ulnar artery at the wrist is worthwhile.
The Posteromedial Arm Flap for Posterior Elbow Defects
Authors: TIMMONS M. J. , NISHIKAWA H.
Published: June 2005

A sensate, fasciocutaneous flap for cover of posterior elbow defects is described. The flap is innervated by the lower lateral cutaneous nerve of the arm. The flap is simple to raise and can be rotated and advanced over the posterior elbow region with direct closure of the proximal donor site. A case is presented.
Radiological Evaluation of the Long-Term Effects of Resection of the Distal Ulna in Rheumatoid Arthritis
Authors: VAN GEMERT A. M. L. , SPAUWEN P. H. M.
Published: June 2005

28 patients have been studied after distal ulnar resection on one side. The operated hand has been compared with the hand on which no operation has been performed, using X-rays which had been taken pre-operatively and 4 to 8 years post-operatively. Only patients with no difference or a difference of only one degree between the two wrists, according to the Larsen classification, were admitted to the investigation. The mean ulnar translation was 5.3 mm in the operated wrists, compared to 3.7 mm in unoperated wrists. Radialization of the ulna following distal ulnar resection amounted to about 12 mm. Wrist dislocation is more due to the rheumatoid process itself than to the distal ulnar resection.
An Association between Scapho-Trapezio-Trapezoid Osteoarthritis and Static Dorsal Intercalated Segment Instability
Authors: FERRIS B. D. , DUNNETT W. , LAVELLE J. R.
Published: June 2005

A relationship between scapho-trapezio-trapezoid (STT) osteoarthritis and static dorsal intercalated segment instability (DISI) was suspected. The radiographs of 697 wrists in patients over 50 years were surveyed. In 63 wrists STT osteoarthritis was found in isolation, and isolated DISI was found in four wrists. A combination was found in 16 wrists. This was statistically significant (0.02< P<0.05). It is likely that the static DISI occurs as a consequence the STT osteoarthritis.
The “Mini-Bier’s Block”: A New Technique for Prevention of Tourniquet Pain During Axillary Brachial Plexus Anaesthesia
Authors: JAMES N. K. , KHOO C. T. K. , FELL R. H.
Published: June 2005

Tourniquet cuff pain is a significant cause of morbidity following regional anaesthesia of the upper limb. We describe a simple new technique for effectively anaesthetizing the area under a pneumatic tourniquet (the “mini-Bier’s block”), which permits comfortable surgery under axillary block anaesthesia even if the local block is incomplete.

We report a controlled study of 40 patients in whom statistically significant tourniquet cuff pain relief was obtained in patients receiving an additional low-dose intravenous injection of local anaesthetic localized beneath the cuff. This technique ensures that the safe axillary approach to the brachial plexus can always be used with avoidance of pain from the pressure of the tourniquet cuff.
The Position of Symbrachydactyly in the Classification of Congenital Hand Anomalies
Authors: MIURA T. , NAKAMURA R. , HORII E.
Published: June 2005

The clinical features of 53 cases of intercalated hypoplasia and 113 cases of distal aplasia are reviewed and compared with each other and with 129 cases of syndactyly.

Tri-, di-and mono-phalangeal symbrachydactyly, and adactyly with nubbin digits are consecutive anomalies. Transverse deficiency may result if the mesenchyme is damaged severely, and if damage is mild and formation has continued, intercalated transverse deficiency may occur. Webbing in symbrachydactyly may result from failure of the apical ectodermal ridge under the influence of damaged mesenchyme.
Duplication of the Thumb
Authors: NAASAN A. , PAGE R. E.
Published: June 2005

Thumb duplication is a common congenital abnormality accounting for 6.6% of all hand deformities. The object of the primary surgery is to achieve a thumb with aligned joint surfaces and epiphyses perpendicular to the long axis, central flexor and extensor tendons, and adequate collateral ligaments. Experienced surgeons with an understanding of the abnormal anatomy and knowledge of the numerous refinements in technique cannot guarantee a flawless result.

Of 43 cases treated in this Unit during the period 1970–1989 49% were noted to have secondary deformities. Angulation at the IP and/or MP joints were the most commonly observed problems. Unsatisfactory results were seen with a greater frequency following correction of the more complex deformities.
Tensile Strength of the End-Weave Flexor Tendon Repair
Authors: GABUZDA G. M. , LOVALLO J. L. , NOWAK M. D.
Published: June 2005

A study was designed to investigate the tensile strength of the end-weave method of tendon repair. Flexor tendons were removed from 13 fresh-frozen human cadavers, transected and repaired with the end-weave technique varying from one to five weaves, with two suture techniques, the commonly used horizontal mattress suture and a new method we have termed the cross stitch. The repairs were then tested in tension to failure on a Materials Test System (MTS) biomechanical testing device. Comparisons were also made to tensile strengths of intact whole tendons, tendon-bone insertions, and distal reinsertion techniques.

Tensile strength increased linearly with the number of weaves for both suture methods. The cross stitch was found to have significantly greater strength per weave compared to the horizontal mattress suture ( P < 0.05). Three out of five trials of five weaves done with the cross stitch actually failed at the tendon itself first, rather than through the repair, which was the failure mode for all other trials. The results from this in vitro model suggest that active rehabilitative exercises might safely be performed in the immediate post-operative period after procedures that involve tendon weaving.
The Endoscopic Diagnosis and Possible Treatment of Nerve Root Avulsions in the Management of Brachial Plexus Injuries
Authors: MONSIVAIS J. J. , NARAKAS A. O. , TURKOF E. , SUN Y.
Published: June 2005

The spinal cord, dorsal rootlets, and ventral rootlets at the cervical level were visualized by endoscopy in ten goats. It is currently possible to visualize and document avulsed rootlets. With refinement in techniques and instruments, it will be possible to perform repairs, transfers or implantation of avulsed rootlets in the brachial plexus.
A Burn Caused by the Operating Microscope Light during Brachial Plexus Reconstruction
Authors: AL-QATTAN M. M. , CLARKE H. M.
Published: June 2005

A case of an accidental burn caused by the operating microscope light during brachial plexus reconstruction is reported along with the various factors which could lead to such an injury.
Initial Treatment of Closed Metacarpal Fractures
Authors: McMAHON P. J. , WOODS D. A. , BURGE P. D.
Published: June 2005

A prospective clinical trial compared two forms of initial management for closed stable fractures of the shaft of the finger metacarpals. Patients were randomized to treatment with a compression glove and early mobilization (21 patients) or to immobilization in a plaster splint (21 patients).

The mean loss of total active flexion (MP+PIP+DIP) in the second week after injury was 56° in the glove group and 84° in the splint group ( P=0.0036). In the third week, the mean loss of flexion was 23° and 46° respectively ( P=0.0010).

Hand volume and PIP joint circumference were significantly smaller in the glove group in the second week but not in the third and fourth weeks. Within each group, however, there was no correlation between range of motion and swelling, suggesting that these were independent variables in this study.

The support of the glove helped to relieve pain. Use of a compression glove avoided the loss of function imposed by splintage and was associated with a greater range of movement during the second and third weeks.
Sellotape Ischaemic Injury to the Fingertip
Authors: GIDDINS G. E. B.
Published: June 2005

A case is reported of significant ischaemic damage to a fingertip from the use of Sellotape. The elasticity of Sellotape has been tested and compared with that of Elastoplast, illustrating the stiffness of Sellotape and thus emphasizing its unsuitability. The general public needs to be aware of the dangers of using non-proprietary dressings and the medical profession must remain vigilant about the elasticity of dressings.
The Rupture Rate of Acute Flexor Tendon Repairs Mobilized by the Controlled Active Motion Regimen
Authors: ELLIOT D. , MOIEMEN N. S. , FLEMMING A. F. S. , HARRIS S. B. , FOSTER A. J.
Published: June 2005

A series of 233 patients with complete divisions of flexor tendons in zones 1 and 2 underwent operation following emergency admission over a period of 3.5 years. These included 203 patients with 317 divided tendons in 224 fingers injuries in zones 1 and 2 and 30 patients with 30 complete divisions of the flexor pollicis longus tendon in zones 1 and 2. All of these patients were mobilized post-operatively in a controlled active motion regimen. 13 (5.8%) fingers and five (16.6%) thumbs suffered tendon rupture during the post-operative period. Patients treated during the last year of the study were followed prospectively for a minimum period of 3 months; ten of the 16 (62.5%) fingers with zone 1 repairs, 50 of the 63 (79.4%) fingers with zone 2 repairs, all three (100%) FPL divisions in zone 1 and three of four (75%) FPL divisions in zone 2 had good and excellent results on assessment by the original Strickland criteria (Strickland and Glogovac, 1980).

These results confirm the safety of this regimen as an alternative to other regimens of post-operative flexor tendon repair mobilization in zone 1 and 2 finger injuries. However, in the unmodified form used in this series, this regimen has too high a rupture rate for FPL mobilization.
Bifid Median Nerve Compression due to a Musculotendinous Anomaly of FDS to the Middle Finger
Authors: FERNANDEZ-GARCIA S. , PI-FOLGUERA J. , ESTALLO-MATINO F.
Published: June 2005

A case is presented of a bifid median nerve whose longest portion had a normal course while the other portion passed through a hole in the FDS tendon of the middle finger, at its musculotendinous junction. This caused nerve compression during muscle contraction, producing pain and dysaesthesia in the middle finger suggesting carpal tunnel syndrome.
Outcome of Carpal Tunnel Release in Diabetic Patients
Authors: AL-QATTAN M. M. , MANKTELOW R. T. , BOWEN C. V. A.
Published: June 2005

A retrospective study of 15 diabetic patients (20 hands), who underwent carpal tunnel release, was performed to determine the outcome. All patients had a minimum of 18 months of follow-up. Outcome was considered excellent if there was complete resolution of symptoms and this occurred in 35% of the treated hands. Eight hands (40%) had a good outcome with significant improvement of pre-operative symptoms. Outcome was considered poor when symptoms were minimally improved, unchanged, or worse after surgery and this occurred in 25% of treated hands. All hands with a poor final result had either no electrodiagnostic evidence of localized compression or only mild compression in pre-operative nerve conduction studies. It was postulated that the contribution of localized compression to pre-operative hand symptoms was less than the contribution of peripheral neuropathy in these hands.
Cubital Tunnel Syndrome in a Patient in Long-Term Haemodialysis
Authors: KONISHIIKE T. , HASHIZUME H. , NISHIDA K. , INOUE H. , MORIWAKI K.
Published: June 2005

The onset mechanism of cubital tunnel syndrome and carpal tunnel syndrome may be similar in haemodialysis patients. Carpal tunnel syndrome is well recognized as a consequence of dialysis-associated amyloidosis. This case report documents the development of cubital tunnel syndrome in a patient on haemodialysis treatment for 10 years. Proliferating granulation tissue at the elbow had entrapped and displaced the ulnar nerve. This was corrected surgically, and the patient experienced immediate relief of the numbness and the “tingling”, but the muscular atrophy had not improved after 8 months.
Abductor Digiti Minimi Transfer for the Restoration of Opposition in Children
Authors: LATIMER J. , SHAH M. , KAY S.
Published: June 2005

Abductor digiti minimi transfer was used to restore opposition in 20 patients, the majority suffering from congenital anomalies of the hand. The transfer was shown to be effective in restoring abduction, but less effective in restoring the rotational component of opposition in these cases. The donor site was critically reviewed and found to be acceptable. The surgical techniques and benefits of this transfer are reviewed.
Myoelectric Prostheses in the Management of Poland’s Syndrome
Authors: DATTA D. , KINGSTON J. E.
Published: June 2005

Two cases of Poland’s syndrome are reported in whom myoelectric prostheses have been used. The rare congenital sporadic disorder of Poland’s syndrome characterized by absence of pectoralis major and varying degrees of ipsilateral upper limb deficiency has been reported by various authors (Rasjad and Sutiaksa, 1991, Gausewitz et al, 1984; David, 1982; Ireland et al, 1976). Management of the upper limb deficiency depends on the degree of functional and cosmetic disability. We report two cases of Poland’s syndrome where myoelectric prostheses have been successfully used. We have been unable to find any published report of the use of a myoelectric prosthesis in Poland’s syndrome.
Compartment Syndrome of the Arm
Authors: RIDINGS P. , GAULT D.
Published: June 2005

Compartment syndrome in the upper arm is uncommon, but early recognition and treatment is as essential as it is in other sites. A case of compartment syndrome in the upper arm is reported.
Analysis of 100 Upper Limb Injuries Using the Merseyside Accident Information Model
Authors: RALSTON D. R. , HALL P. N. , DAVIES J. C. , MANNING D. P.
Published: June 2005

More than 2 million upper limb injuries occur each year in Britain. Information about the precise sequence of events leading up to an accident may help prevention of similar injuries by alteration of the work environment or through safety education. The first impression of the cause of an accident may not identify the key event triggering it. The Merseyside Accident Information Model (MAIM; Manning, 1987) provides a structured questionnaire, based on a menu-led computer programme. This not only allows the first unforeseen event to be identified from the history, but is also the basis of a database. Pooled data can then be analyzed. We present an analysis of 100 consecutive cases presenting to one Plastic Surgery Unit.
Spot Weld Injuries of the Hand
Authors: GIDDINS G. E. B. , WILSON-MACDONALD J.
Published: June 2005

Spot weld burns of the hand result in damage to structures deep to the skin by dissipation of heat locally causing extensive necrosis. This must be appreciated to optimize treatment.
Phalangeal Fractures of the Hand
Authors: DE JONGE J. J. , KINGMA J. , VAN DER LEI B. , KLASEN H. J.
Published: June 2005

The incidence and aetiology of 6,857 phalangeal fractures of the hand have been reviewed in a series of 235,427 patients, looking for an age-specific vulnerability to fracture. We found sports to be the main cause of fracture in the 10–29 years age groups and accidental falls to be the leading cause in those aged 70 years or older. We made a new observation that the highest incidence occurs in the male 40–69 age group and machinery was the dominant cause of fracture in this group. Recognition of the frequency of industrial trauma is needed, and public expenditure should be invested in its prevention and treatment.
An Isolated Complex Dorsal Dislocation of the MP Joint of the Ring Finger
Authors: AL-QATTAN M. M. , MURRAY K. A.
Published: June 2005

A rare case of isolated complex dorsal dislocation of the MP joint of the ring finger is described. Differences in the pathological findings between dislocations of the ring finger and other digits are discussed.
Arthroscopic Treatment of Metacarpophalangeal Arthropathy in Haemochromatosis
Authors: DECLERCQ G. , SCHMITGEN G. , VERSTREKEN J.
Published: June 2005

A 37-year-old sports teacher suffering from idiopathic haemochromatosis with arthropathy of the MP joints has been treated and followed-up by us for 4 years. Three out of four affected MP joints were treated with arthroscopic operations; one of these had been treated elsewhere previously by arthrotomy. This article presents a brief review of the condition and its treatment by arthroscopic surgery with detailed technique. We believe that MP joint arthroscopy in certain cases is an alternative to open surgery and gives excellent results. No specific instruments are needed apart from a standard small joint arthroscopy set.
Wrist Arthrodesis Using a Sliding Radial Graft and Plate Fixation
Authors: SORIAL R. , TONKIN M. A. , GSCHWIND C.
Published: June 2005

In a retrospective study, the results of 18 wrist fusions with a radial sliding graft and a dynamic compression plate are reviewed. All 18 fusions united, with an average position of 16° of extension and 7° of ulnar deviation. Wrist strength and stability and diminished pain allowed improved function. However, decreased manoeuvrability impaired function for some activities.
Tuberculosis of the Hand
Authors: AL-QATTAN M. M. , BOWEN V. , MANKTELOW R. T.
Published: June 2005

Three cases of tuberculosis of the hand are presented. There was a significant delay between the onset of symptoms and the correct diagnosis. Several observations are made to increase the awareness of this condition.
A New Fibrin Seal: Functional Evaluation of Sensory Regeneration Following Primary Repair of Peripheral Nerves
Authors: POVLSEN B.
Published: June 2005

A new fibrin seal has recently been evaluated in terms of axonal regeneration; however morphological examination of the fibre composition of regenerated nerves may not necessarily provide functionally relevant information. This study therefore aims to evaluate the functional regenerated sensation, following peripheral nerve transection treated with fibrin seal (Tisseel-Duo, Immuno; Austria). The sural nerve-innervated skin of the rat hindfoot served as the target organ. Previously published results from animals following transection and suture served as controls. Ten 3-month-old female Sprague-Dawley rats were used. The sciatic nerve was divided and rejoined with fibrin seal. The rats were allowed unrestricted movement directly after surgery and allowed to survive for 3 months. Our observations show that the functional results of regenerated polymodal nociceptors and low-threshold mecanoreceptors show no statistical difference when compared with microsuture. This strengthens the early positive morphological impression of this new product. Further prospective studies in man are anticipated.
An Approach to Soft Tissue Sarcomas of the Hand and Upper Limb
Authors: FLEEGLER E. J.
Published: June 2005

Referral letters and histories of patients seen for sarcomas involving their hands repeatedly describe a serious tumour found during or after shelling out a “lump”. Many times these apparently unexpected encounters are followed by an incomplete excision which is, in turn, followed by one or more local recurrences. Repeat operations are often amputations of increasing magnitude, and are not infrequently followed by the death of the patient. The hand is a site in which a patient usually presents for evaluation of a swelling when it is quite small. For the patient with a sarcoma, initial adequate surgery offers the best hope of cure.

Why are these relatively uncommon tumours of such interest and importance? They frequently afflict young, productive patients. When treated late or inadequately, they can result in tremendous suffering.

In recent years there has been considerable progress made in the treatment of sarcomas. Early and effective treatment often allows local control of the tumour without amputation. In order to accomplish this, the approach to these patients must be cautious and precise.
Trauma-Related Thoracic Outlet Syndrome
Authors: ELLISON D. W. , WOOD V. E.
Published: June 2005

181 patients treated for thoracic outlet syndrome by first rib resection were reviewed. 88 (49%) indicated a single traumatic event which precipitated the thoracic outlet syndrome. 79% of patients with a history of a single traumatic episode had good to excellent results after first rib resection. A separate group of 18 patients developed work-related thoracic outlet syndrome due to repetitive activities. Ratings of good to excellent results were lower (66%) among workmen’s compensation cases.
Entrapment and Compartment Syndromes of the Upper Limb in Haemophilia
Authors: DUMONTIER C. , SAUTET A. , MAN M. , BENNANI M. , APOIL A.
Published: June 2005

17 patients with haemophilia have been treated for a neurological deficit of the upper limb. Four of the five entrapment neuropathies have been operated upon, and only two patients recovered completely. Only two of the 12 patients with a compartment syndrome have been operated upon, and only two had sequelae. Clotting factor replacement is always indicated as primary treatment. Surgical release is indicated if the condition fails to improve. Late treatment was responsible for incomplete recovery, whatever the cause of the nerve compression.
Arterial Grafting with the Telescoping Anastomotic Technique for Arterial Defects
Authors: SAITOH S. , NAKATSUCHI Y.
Published: June 2005

An arterial graft was taken from the left femoral artery of the rat and grafted into the right femoral artery using the telescoping anastomotic technique at both the proximal and distal anastomoses to compare the patency rate with that of the vein grafts interposed into the arterial defect with the same telescoping technique. The time required for each anastomosis was about 10 minutes and all of the 31 grafts remained patent without application of xylocaine, yielding a higher patency rate than the vein grafts interposed in an arterial defect. The telescoping technique proved to be so dependable that it could be used at least twice in an artery. Inserting one vessel stump into another using the telescoping technique may not itself be responsible for the failure of vein grafts interposed in an arterial defect, but distortion of the slack venous wall of the graft by high arterial blood pressure is.
Silicone Synovitis
Authors: LANZETTA M. , HERBERT T. J. , CONOLLY W. B.
Published: June 2005

Silicone implant arthroplasty is, arguably, the most effective treatment for the majority of patients with symptomatic arthritis in the hand and wrist. In 1985 the problem of silicone synovitis was first brought to our attention. Since that time there have been numerous reports on this condition leading to a worldwide trend against the use of silicone implants. However, the true incidence and effects of silicone synovitis have not been clearly defined. For this reason, we have undertaken a survey of all patients who have undergone silicone implant arthroplasty in the wrist and hand in our Unit between 1975 and 1990.

Patients with rheumatoid arthritis and those undergoing MP or IP joint arthroplasty were excluded. Of the 289 implant arthroplasties remaining, we have been able to review personally 229 implants with a mean follow-up of 3.8 years (range 1–15). Although 40% of cases showed significant radiological changes, only 11 patients (4.8%) developed symptoms requiring treatment. Of these, two were managed conservatively whilst the rest underwent revision surgery, all with entirely satisfactory results.

We conclude that silicone implant arthroplasty remains the treatment of choice for patients with painful joint disease in the hand and wrist.
Arthroscopic Diagnosis of Ligament Lesions of the Wrist
Authors: ADOLFSSON L.
Published: June 2005

144 patients with post-traumatic wrist pain hut normal standard radiographs were examined by wrist arthroscopy. Ligamentous lesions were observed in 75 patients. TFCC lesions, classified according to the Palmer classification and including lunato-triquetral interosseous ligament lesions, were seen in 61, and scapho-lunate interosseous ligament lesions in 14 patients. Degenerative TFCC changes were equally common in patients younger than 40 years of age but significantly more common with more than 2 years duration of symptoms.

Varying degrees of instability were noted in patients with scapho-lunate interosseous ligament lesions but no associated ligament lesions were observed. Because of the variety of pathological changes arthroscopy is recommended in the management of patients with post-traumatic wrist pain.
A Comparison of Post-Operative Mobilization of Flexor Tendon Repairs with “Passive Flexion–Active Extension” and “Controlled Active Motion” Techniques
Authors: BAINBRIDGE L. C. , ROBERTSON C. , GILLIES D. , ELLIOT D.
Published: June 2005

We report a comparative study of the outcome of flexor tendon repairs mobilized by either a “passive flexion-active extension” or a “controlled active motion” regimen. We show that the controlled active motion regimen conferred significant benefits on the final range of motion and extensor lag. The rupture rate was raised with “controlled active motion” but this was not greater than levels reported by other authors using “passive flexion-active extension” regimens.
The Palmar Fascia after Treatment by the Continuous Extension Technique for Dupuytren’s Contracture
Authors: BRANDES G. , MESSINA A. , REALE E.
Published: June 2005

After complete elongation using the continuous extension technique the palmar fascia of four patients with Dupuytren’s contracture was examined by light and electron microscopy and compared with non-elongated samples from 20 patients at the same clinical stage of the disease. Nodules and cords were no longer clinically recognizable after extension. The tissue contained collagen fibrils of uniform diameter (about 50 nm), densely packed in fibres parallel to the stretching force. Fine filaments (presumably proteoglycans) formed a network which was intermingled with and periodically bound to the collagen fibrils. Fibroblasts and myofibroblasts with an high biosynthetic activity and oxytalan-like microfibrils were aligned along the collagen fibres.

The results show that in Dupuytren’s disease the contracted palmar fascia reacts to external forces with neoformation and reorientation of all tissue components by myofibroblasts.
The Use of Skeletal Traction to Correct the Flexed PIP Joint in Dupuytren’s Disease
Authors: HODGKINSON P. D.
Published: June 2005

The flexed PIP joint presents a particular problem in the treatment of advanced Dupuytren’s disease. Following reports of the use of skeletal traction in the treatment of this condition, a simple device, the “Pipster” was developed to extend the PIP joint by skeletal traction before surgery. In seven fingers in five patients with severe contractures, there was a pre-operative improvement of at least 45° in the flexion angle (measured as maximum achievable passive extension). The technique was effective in primary and recurrent disease. Subsequent surgery was facilitated and amputation avoided in five tigers. The optimum distraction technique was identified. The study continues with more patients.
Median Nerve Compression within the Humeral Head of Pronator Teres
Authors: TULWA N. , LIMB D. , BROWN R. F.
Published: June 2005

We describe a case of the pronator syndrome caused by compression of the median nerve by a fibrous band as the nerve passed through the humeral head of origin of pronator teres. This rare anatomical arrangement resulted in displacement of the median nerve to the anterior aspect of the medial humeral epicondyle and, as far as we are aware, has not previously been described as a site of compression neuropathy.
Sensitivity of the Various Tests for the Diagnosis of Carpal Tunnel Syndrome
Authors: SEROR P.
Published: June 2005

The electrophysiological results of a prospective study of 150 successive cases of carpal tunnel syndrome in 96 patients are reported to evaluate the sensitivity of nine different electrophysiological tests and thresholds for the diagnosis of carpal tunnel syndrome.

The distal motor latency was >5 ms in 35% of cases and ⩾4 ms in 55% of cases. The distal sensory latency from the PIP joint of the middle finger was up to 3.4 ms in 61% of cases. The middle finger orthodromic conduction velocity (14 cm) was ⩽45 m/s in 66% of cases and the orthodromic conduction velocity after palmar stimulation (8 cm) was ⩽45 m/s in 76%. The remaining 24% of cases were assessed by special tests such as specific median-ulnar latency difference (21%), and the centimetric test was altered in all.

Highly sensitive tests are required to assess or exclude the diagnosis in one quarter of cases of carpal tunnel syndrome. Although the specific median-ulnar latency difference is the easiest test to perform, the centimetric test is the most valuable for the assessment of the mildest forms of carpal tunnel syndrome.
Prediction of Secondary Displacement in Colles’ Fracture
Authors: HOVE L. M. , SOLHEIM E. , SKJEIE R. , SÖRENSEN F. K.
Published: June 2005

In a prospective study, 645 consecutive Colles’ fractures treated conservatively were followed until union. The fractures subsequently lost some of their manipulated position during the immobilization period. However, the anatomical end result was significantly improved compared with the initial deformity. The mean shortening of the radius during plaster-cast treatment was 3 mm, and the mean increase of dorsal angulation was 7°. Multiple regression analyses showed that initial dorsal angulation, age, and Older type were important predictor variables for the end result of dorsal angulation. Initial radial length, age and initial dorsal angulation were of importance for the end result of radial length. The strongest linear relationship was found between the end result of radial length and the initial radial length (r = 0.67). This may indicate that the patients who will malunite with radial shortening are those with significant radial axial shortening at the initial presentation. Thus, these patients should be treated with a more stable fixation device.
Scintigraphy in the Evaluation of the “Clinical” Scaphoid Fracture
Authors: WAIZENEGGER M. , WASTIE M. L. , BARTON N. J. , DAVIS T. R. C.
Published: June 2005

In a prospective study we performed bone scans on 84 patients who had sustained a wrist injury and in whom a scaphoid fracture was clinically suspected but could not be confirmed on the original set of five routine “scaphoid view” radiographs. In 40 patients the bone scan was normal and in 25 there was increased uptake in areas other than the scaphoid. In 19 there was localized increased uptake in the scaphoid bone. In seven of these a scaphoid fracture was subsequently demonstrated on repeat radiographs (five cases) or a CT scan (two cases). In the remaining 12 no fracture could be demonstrated.
The Early History of Arthroplasty of the Wrist
Authors: RITT M. J. P. F. , STUART P. R. , NAGGAR L. , BECKENBAUGH R. D.
Published: June 2005

During the past 3 decades implant arthroplasty of the destroyed wrist has become a reliable and satisfying procedure. However, the first total wrist replacement was performed in Berlin as early as 1890. This paper describes the history of resection and interposition arthroplasty of the wrist leading to the first total wrist implant arthroplasty performed by Themistocles Gluck. An overview of recent designs is given, and the relevant historical cases are reported.