bluuebunny/crossref_metadata_2025 huggingface dataset:
Dislocation of the Trapezio-Metacarpal Joint
Authors: WATT N. , HOOPER G.
Published: December 2021

Acute traumatic dislocation of the trapezio-metacarpal joint is not invariably associated with instability of the joint after reduction and the injury should not be considered simply as a “Bennett’s fracture without a fracture”.
Dislocation of the Carpometacarpal Joint of the Thumb
Authors: CHEN V. T.
Published: December 2021

A case is reported of traumatic dislocation to the carpometacarpal joint of the left thumb, treated by ligament reconstruction.
The Optimal Position for Arthrodesis of the Metacarpophalangeal Joint of the Thumb: A Clinical Study
Authors: SALDANA M. J. , CLARK E. N. , AULICINO P. L.
Published: December 2021

Arthrodesis of the metacarpophalangeal joint of the thumb is a well-accepted procedure. Recommendations for position of fusion have varied from 0 to 30° of flexion. Two hundred of these joints in normal subjects were measured in thirteen positions of function for different tasks. The mean of all thirteen measured positions was considered to be the “optimal functional position”. Based on this study, we recommend the metacarpophalangeal joint of males be fused in approximately 25° of flexion and females in 20° of flexion.
Transcutaneous Electrical Nerve Stimulation in Acute Hand Infections
Authors: QUINTON D. N. , SLOAN J. P. , THEAKSTONE JULIE
Published: December 2021

Twenty-six patients with severe hand infections requiring operative drainage and admission to hospital were entered into a prospective, randomised, placebo-controlled trial. This was to test the use of a functioning transcutaneous electrical nerve stimulator and a non-functioning transcutaneous electrical nerve stimulator for pain relief in the first three postoperative days. Those patients with a functioning transcutaneous electrical nerve stimulator required significantly less analgesia. They also demonstrated highly significant improvement in their range of total active movement over those patients with a non-functioning transcutaneous electrical nerve stimulator.

We recommend the use of transcutaneous electrical nerve stimulator after operation to reduce pain and improve mobility.
First Dorsal Interosseous Compartment Syndrome
Authors: ABDUL-HAMID A. K.
Published: December 2021

Compartment syndromes of the interosseous muscles in the hand are difficult to diagnose because of their atypical presentation, and are often not recognised, especially when the syndrome presents as a chronic affliction. Such a syndrome affecting the first dorsal interosseous muscle in a dominant hand, and undiagnosed for nearly eight years, is described. Simple fasciotomy proved to be the only definitive treatment necessary.
A New Treatment of Painful Amputation Neuroma: A Preliminary Report
Authors: TADA K. , NAKASHIMA H. , YOSHIDA T. , KITANO K.
Published: December 2021

Two cases of painful amputation neuroma treated by a new method are described. A vascularized island transfer from a less important finger was used, but the accompanying nerve was divided and its distal end sutured to the proximal end of the nerve in the recipient finger, after excision of the neuroma. Four years and two years later, no clinical evidence of neuroma was present at either amputation stump or donor site.
Skeletal Involvement in Sarcoidosis: A Case Report
Authors: SCHUIND F. , QUINTIN J. , SCHILS J. , KETELBANT P. , APPELBOOM T.
Published: December 2021

A patient is described in whom sarcoidosis caused a pathological fracture of the middle phalanx of the little finger. A bone scan showed increased uptake. She was treated by resection of the diseased area and bone grafting, which led to bone healing. The bony manifestations of sarcoidosis are reviewed.
Tendon Transfer in Partially Anaesthetic Hands
Authors: CITRON N. , TAYLOR JANE
Published: December 2021

Stereognosis and sensory localisation were studied in hands of patients with partial anaesthesia due to peripheral nerve injury both before and after tendon transfer to impart movement to the anaesthetic part. One patient showed a marked improvement in stereognosis and localisation, but in general little was gained in terms of improved sensation. Function was improved more in the dominant than in the non-dominant hand. Earlier tendon transfer in cases of peripheral nerve injury might decrease cortical exclusion.
Experimental Studies of the Effect of Bupivacaine on Peripheral Nerves
Authors: HELM R. H. , LEE Y. S. , PHO R. W. H.
Published: December 2021

0.5% Bupivacaine was administered around the sciatic nerve of rabbits by means of a catheter, over a period of ten days. Twenty nerves showed no histological changes, but in three there were areas of demyelination and axonal degeneration, especially near the surface of the nerve. However, similar changes occurred in two out of six nerves to which normal saline was administered instead, and it is suggested that the damage may have been caused by mechanical trauma from movement of the catheter.
Fractures of the Phalanges: Results of Internal Fixation Using 1.5mm and 2mm A. O. Screws
Authors: FORD D. J. , EL-HADIDI S. , LUNN P. G. , BURKE F. D.
Published: December 2021

Thirty-six patients were treated for 38 phalangeal fractures using 1.5 mm and 2 mm A. O. screws. Plates were not used in the fingers. Oblique fractures of the condyles, shafts or bases of the proximal or middle phalanges were treated by internal fixation because of instability, displacement or rotation. 40% of fractures had associated skin wounds, were comminuted or had damage to the extensor mechanism. The mean duration of post-operative immobilization was 9 days and the mean time off work was 6 weeks. Total active movement in the involved ray was 220 degrees or greater in 24 cases, 180 degrees to 215 degrees in eight cases, and less than 180 degrees in two patients at follow up. The patients were reviewed between three and 54 months after treatment and the mean duration of follow up was 24 months. The most frequent complication was 10 degrees to 30 degrees of flexion deformity of the proximal interphalangeal joint after internal fixation of condylar fractures. Results were satisfactory in 90% of cases.
Dorsal Locking of the Metacarpophalangeal Joint
Authors: QUINTON D. N.
Published: December 2021

Many causes for metacarpophalangeal joint locking have been documented. However nearly all are from volar entrapment of periarticular structures. The following case, unlike those previously reported in the literature, was one with locking caused by dorsal entrapment. The differences in presentation and its importance to subsequent treatment are highlighted.
Cold Sensitivity After Replantation in Relation to Arterial Circulation and Vasoregulation
Authors: NYLANDER G. , NYLANDER E. , LASSVIK C.
Published: December 2021

Cold intolerance is a common problem after injuries to the band. To elucidate the mechanism of this cold sensitivity, eight patients with successful replantations of amputations of the thumb or index finger were studied one and half years later.

In six patients the Doppler signal from the anastomosed arteries was normal and in two patients signs of mild stenosis were found. All patients had normal or slightly reduced basal finger systolic pressure in the replanted finger. Six had signs of marked vasospasm.

Alpha-receptor blockade had no effect on the cold-induced decrease in finger systolic pressure in the replanted finger.

It is concluded that cold intolerance after hand injuries results from a defect in vasoregulation and is not caused by organic insufficiency of the circulation.
The Allen Test — an Investigation of its Accuracy by Fluorescein Angiography
Authors: McGREGOR A. D.
Published: December 2021

Six consecutive patients whose clinical Allen test suggested a non-patent radial artery have been investigated by intra-arterial fluorescein angiography.

Cannulation of the radial artery and injection of fluorescein typically perfused only the thumb and thenar eminence. Occlusion of the ulnar artery, leaving the radial artery as the dominant supply, resulted in fluorescein perfusion of the entire hand. It is concluded that the Allen test is of no clinical value.
One Stage Reconstruction of Intercalated Defect of the Thumb Using the Osteocutaneous Radial Forearm Flap
Authors: CHACHA B. , SOIN K. , TAN K. C.
Published: December 2021

A radial forearm flap including a segment of the cortex of the radius, based on the distal pedicle of the radial vessels and the cephalic vein, was used to reconstruct an intercalated defect of the thumb in two cases. In one case it was used as an ipsilateral pedicle flap while in the other case it was used as a free microvascular flap. In both cases, the skin flap as well as the segment of bone survived in toto without any evidence of creeping substitution. The functional result was good in both cases. This flap provides thin skin of good texture together with bone for a one-stage reconstruction.
An Unusual Role of the Vinculum after Complete Laceration of the Flexor Tendons
Authors: SASAKI Y. , NOMURA S.
Published: December 2021

Two cases are described with full flexion of the proximal interphalangeal joint produced by an intact short vinculum after complete laceration of both superficialis and profundus tendons. To establish the clinical diagnosis of complete flexor digitorum superficialis division, the necessity of examining the flexion strength of an injured finger is emphasized.
Multiple Flexor Tendon Ruptures Following Colles’ Fracture: A Case Report
Authors: DIAMOND J. P. , NEWMAN J. H.
Published: December 2021

Flexor tendon ruptures are a very rare complication of Colles’ fracture. Only ten cases have been previously reported in the literature. We describe a case of multiple sequential flexor tendon rupture as a delayed consequence of a malunited Colles’ fracture.
Digital Volar Amelanotic Malignant Melanoma in a Child
Authors: CHAPMAN P. , BANERJEE A. , ANDERSON J. R. , LAMBERTY B. G. H.
Published: December 2021

Malignant melanoma in childhood is rare. An unusual case of amelanotic melanoma of the volar thumb in a fourteen-year-old boy which posed problems of recognition and management is presented.
Eccrine Tumours of the Hand: Two Cases
Authors: FAHY A. M. , PETERS E. E.
Published: December 2021

Two cases of eccrine tumour of sweat gland origin found in the hand are presented. They were on-tender rounded masses of eight months to two years duration, beneath and adherent to the pidermis but movable on underlying tissue. The pre-operative diagnosis in each case was that of sebaceous cyst. Histology revealed one to be an eccrine spiradenoma and the other a chondroid syringoma. The lesions were considered unusual in that such tumours usually occur on the trunk, head and back and are rarely found in the hand.
An Unusual Case of Diaphyseal Aclasis Arising in Fingers
Authors: SHANKAR N. S. , PUSEY. R. J.
Published: December 2021

Diaphyseal aclasis (multiple hereditary exostoses) occurs in the bones developed in cartilage and gives rise to cartilage-capped exostoses. It usually affects the ends of the diaphyses of long bones of extremities (McKusick, 1972). Although the phalanges of the fingers may be shorter than normal, no record could be found of significant deformity. A case of digital deformity is described below.
Dislocation of Extensor Tendons of the Hand Caused by Focal Myoclonic Epilepsy.
Authors: OVESEN O. C. , JENSEN E. KROGH , BERTHEUSSEN K. J.
Published: December 2021

A case of dislocation of the extensor tendons of the hand caused by focal myoclonic epilepsy is presented. This particular aetiology, which has not previously been reported, is discussed. The tendons were repositioned and there was no sign of recurrence one year later.
Acute Osteomyelitis of Index Finger Caused by Dog Bite.
Authors: HOLMS W. , ALI M. A.
Published: December 2021

A forty-seven-year-old man was bitten by a dog on his left index finger. Despite initial antibiotic treatment, he developed acute osteomyelitis of the middle phalanx over the next three weeks. Pasteurella multocida and Bacteroides were isolated from the necrotic bone. Subsequently the infection was successfully treated by debridement and Tetracycline.
A Review of Repaired Flexor Tendons
Authors: GAULT D. T.
Published: December 2021

67 patients with 176 repaired flexor tendons have been reviewed after a mean interval of 26.4 months. 160 tendons to 100 fingers, and 16 flexor pollicis longus tendons were repaired. When evaluated by Buck-Gramcko criteria, the functional results in 92% of the fingers and 69% of the thumbs were graded as excellent or good.

Patients with partially divided tendons fared no better than those whose tendons were completely divided. The results of repair in the little finger were less satisfactory than in other fingers.
Metacarpo-Phalangeal Joint Replacement with a New Prosthesis: Description and Preliminary Results of Treatment with the Helal Flap Joint
Authors: LEVACK B. , STEWART H.D. , FLIERENGA HANSKA , HELAL. B.
Published: December 2021

A new prosthesis for the metcarpo-phalangeal joint is presented. Its advantageous design features and the early results following its use suggest that it is of value in treating the painful, stiff and ulnar deviated metacarpo-phalangeal joint in the rheumatoid hand.
Osteoid Osteoma of the Distal Phalanx: A Report of Four Cases and Review of the Literature
Authors: FOUCHER G. , LEMARECHAL P. , CITRON N. , MERLE M.
Published: December 2021

Four cases of osteoid osteoma of the distal phalanx are described. The difficulty of diagnosis is stressed. Complete removal of the nidus is essential for surgical cure. Other modes of treatment are discussed and our series compared to other similar cases described in the literature.
Osteoid Osteoma of the Distal Phalanx: A Case Report
Authors: McCARTEN G. M. , DIXON P. L. , MARSHALL D. R.
Published: December 2021

A sixteen-year-old male presented with pain and swelling of the distal phalanx of his right middle finger. X-ray examination demonstrated an osteolytic lesion which at operation was found to be an osteoid osteoma.
Skeletal Changes in the Hand in the Ehlers-Danlos Syndrome
Authors: WATT N. A. R. , HOOPER G.
Published: December 2021

We report a woman patient with Ehlers-Danlos Syndrome who presented with trapeziometacarpal subluxation and whose hands exhibited several other skeletal features of Ehlers-Danlos Syndrome, including acro-osteolysis.
Man’s Hand in Evolution
Authors: HARVEY KEMBLE J. V.
Published: December 2021

In developmental terms, the human hand is at the same time both specialised and primitive. Its manipulative ability, though somewhat better than that of the apes and monkeys, has lost strength compared with hands of recently extinct species of Man, and shows some evolutionary characteristics seen in reptiles of 250 million years ago. Its evolution, as presently understood, is described.
Wrist Pain in the Madelung’s Deformity of Dyschondrosteosis
Authors: FAGG P. S.
Published: December 2021

Madelung’s deformity is the most recognizable clinical manifestation of dyschondrosteosis. The natural history of the painful wrist in this condition has not been well documented and a study of nineteen patients is reported, with a review of the literature on the surgical treatment.
Carpal Tunnel Syndrome in Madelung’s Deformity
Authors: LUCHETTI R. , MINGIONE A. , MONTELEONE M. , CRISTIANI G.
Published: December 2021

The authors describe a case of carpal tunnel syndrome due to Madelung’s deformity. They discuss the pathophysiological causes of median nerve entrapment to explain the compression which occurs in this disease and its clinical implications. They take also into consideration the surgical approach to the carpal tunnel in this particular condition.
The History of Carpal Tunnel Syndrome
Authors: PFEFFER G. B. , GELBERMAN R. H. , BOYES J. H. , RYDEVIK B.
Published: December 2021

Carpal tunnel syndrome is the most frequently diagnosed, best understood and most easily treated entrapment neuropathy. During the first half of the 20th century, however, most patients with carpal tunnel syndrome were diagnosed as having compression of either the brachial plexus or thenar nerve motor branch of the median nerve. As late as 1950, only twelve patients with operative release of the transverse carpal ligament for idiopathic carpal tunnel syndrome had been reported. The delay in accurate anatomical localization of this compressive neuropathy can be attributed both to the confusion caused by the diverse manifestations of median nerve compression in the carpal tunnel, and to some interesting developments that altered early investigations in this area.
A Diagnostic Test for Carpal Tunnel Syndrome using Ultrasound
Authors: MOLITOR P. J. A.
Published: December 2021

The paper describes the details of an ultrasound test for carpal tunnel syndrome and compares the results of this with E.M.G. studies in a series of 19 patients.

The equipment used was a standard therapeutic ultrasound unit and the tests were performed by a physiotherapist.

The results were encouraging, with a 90% correlation with E.M.G. results.
Fulminating Carpal Tunnel Syndrome Due to Gout
Authors: OGILVIÉ C. , KAY N. R. M.
Published: December 2021

Severe, fulminating carpal tunnel compression due to gout has not previously been described. We report such a case.
Micro – Arterial Anastomosis Using Only Two Sutures and an Autogenous Cuff
Authors: KANAUJIA R. R.
Published: December 2021

Microvascular anastomosis using only two sutures and an autogenous cuff was carried out in an experimental model of Wistar albino rats. 40 femoral and 40 epigastric arteries were used for this cuff technique and compared with conventional technique in the same number of vessels. The cuff technique is simple, quick, causes less trauma to the vessel wall and gives a good patency rate. Anastomosis of an artery 0.5mm in diameter is very easy with the cuff technique (98% patency) which remains difficult using conventional technique (0% patency).

The disadvantage of this technique may be leakage of blood just after releasing the clamps due to restoration of blood flow, but this is easily controlled within few minutes by mild compression.
Articular Fractures of the Distal Scaphoid
Authors: PROSSER A. J. , BRENKEL I. J. , IRVINE G. B.
Published: December 2021

We propose an anatomical classification of fractures involving the distal articular surface of the scaphoid. The predominant patterns, in the 37 patients reviewed, were avulsion fractures from the radio-volar tip of the tuberosity and impaction fractures of the radial half of the articular surface. The possible mechanisms of injury are discussed.
Piso – Triquetral Arthrosis as a Cause of Rupture of the Profundus Tendon of the Little Finger
Authors: LUTZ R. A. , MONSIVAIS J. J.
Published: December 2021

This case report describes a previously unreported cause of profundus rupture of the little finger due to arthrosis of the piso-triquetral joint. With heightened awareness of this entity, it is hoped that delays in diagnosis will be avoided.
A Simple Inexpensive Post-Operative Management Regime Following Surgery for Dupuytren’s Contracture
Authors: JAIN A. S. , MITCHELL C. , CARUS D. A.
Published: December 2021

A simple regime has been devised for the post-operative management of patients following surgery for Dupuytren’s contracture; this includes splintage of the hand for two weeks and active and passive mobilisation by the patient according to precise instructions. Selective help was provided by minimal occupational therapy in 5 of 50 patients. The results of the method were assessed prospectively by subjective criteria and objective assessment by measuring the deformity of the finger joints, lateral and tip pinch and grasp and shear forces.
Elbow Flexion Contractures: Treatment by Anterior Release and Continuous Passive Motion
Authors: BREEN T. F. , GELBERMAN R. H. , ACKERMAN G. N.
Published: December 2021

We treated three elbows with post-traumatic flexion contractures (mean contracture: 41°) by operative release and post-operative continuous passive motion rehabilitation.

Each elbow had been resistant to at least six weeks of conservative therapy. All patients complained of the residual deformity and some functional deficit. All patients, after failure of non-operative therapy, desired operative treatment.

At follow-up (mean 12 months), there was a mean post-operative contracture of 5°. Continuous passive motion is recommended as an adjunct to anterior release in patients with resistant elbow flexion contractures.
Measurement of Forearm Rotation: An Evaluation of Two Techniques
Authors: McGARRY G. , GARDNER E. , MUIRHEAD A.
Published: December 2021

In order to assess the reproducibility of two standard techniques of measuring forearm rotational movements, three trained observers used each method on twenty healthy volunteers. Analysis of the result obtained revealed no statistical difference between either method but both were subject to wide variation between observers, amounting to plus or minus 15° for total forearm rotation. Comparison of individual values in forearm rotation should take account of observer error.
Rupture of Flexor Tendons to the Little Finger Due to Bony Irregularities in the Carpal Tunnel
Authors: STEVENSON T. R. , LOUIS D. S. , ZUCKER S. E.
Published: December 2021

Rupture of a finger flexor tendon occurs most commonly in the patient with rheumatoid arthritis. We have treated two patients who suffered rupture of the flexor tendons to the little finger due to bony irregularities in the carpal tunnel unrelated to rheumatoid disease. Each irregularity was removed and the rough surface covered with a portion of the flexor retinaculum. This resurfacing affords protection against recurrent abrasion and rupture. Tendon function was restored by suturing the ruptured profundus tendon to the adjacent intact profundus tendon of the ring finger. Satisfactory function of the little finger was achieved in both patients. Neither patient has experienced recurrent rupture.
Ulnar Fasciocutaneous Flap of the Wrist
Authors: ELLIOT D. , BAINBRIDGE L. C.
Published: December 2021

An ulnar fasciocutaneous flap has been developed to provide skin cover of the donor defect after elevating radial forearm flaps and used for that purpose in 55 patients. A case is reported in which the same type of flap was used to cover a traumatic skin defect on the front of the wrist.
Radially Deviated Type of Thumb Polydactyly
Authors: OGINO T. , ISHII S. , MINAMI M.
Published: December 2021

In duplication of the thumb there is sometimes radial deviation of one or both components. Eight such hands have been studied. The findings are described and treatment discussed.
Intra-Articular Fracture of the Metacarpal Head of the Locked Index Finger due to Forced Passive Extension
Authors: INOUE G. , NAKAMURA R. , MIURA T.
Published: December 2021

Two cases of locked index finger causing an intra-articular fracture of the metacarpal head due to forced passive extension are described. We suggest that any manipulation should be gentle and if this is unsuccessful, surgical exploration is necessary.
Locking of a Metacarpo-Phalangeal Joint Caused by a Haemangioma of the Volar Plate
Authors: FERNANDEZ G. N.
Published: December 2021

A case of locking of a metacarpo-phalangeal joint in a 47-year-old woman is reported, Full movement of the joint was restored after excision of a haemangioma which had arisen from the volar plate. Other causes of locking are described and recommendations for treatment are made.
Medico-Economic Implications of Industrial Hand Injuries in India
Authors: MATHUR N. , SHARMA K. K. R.
Published: December 2021

625 five consecutive cases of industrial hand injuries attending the Employee’s State Insurance Hospital, Jaipur, have been studied from 1983 to October 1986. The incidence of injuries was 361 per 10,000 workers per year. 47% were due to entrapment of the hand in active machines, 25% occurred during lifting and transportation of heavy objects and 12% while handling tools. The injuries resulted in residual deficit in 55% of cases and were serious enough to require absence from work of more than four weeks in 48% of cases. On an average 35 days were lost per injure worker. The average economic loss per injured worker was Rs. 6900 (approximately £275) for workers in the wage-range of Rs. 5400 to 19,200 (£216 to £768) per annum.
Hand Infections with Mycobacterium Chelonei: A Case Report and Review of the Literature
Authors: ANOUCHI Y. S. , FROIMSON I.
Published: December 2021

A case is reported of soft-tissue infection in the hand due to Mycobacterium chelonei, presenting as a chronic painful swelling of a finger.
Septic Arthritis of the Hand due to Mycobacterium Marinum
Authors: JONES M. W. , WAHID I. A. , MATTHEWS J. P.
Published: December 2021

Mycobacterium marinum infections of the hand are very rare in the United Kingdom and we found only one case of involvement of deep structures (tenosynovitis) in the British literature. We report a case of septic arthritis due to the organism.
The Lateral Arm Free Flap in Releasing Severe Contracture of the First Web Space
Authors: SCHEKER L. R. , LISTER G. D. , WOLFF T. W.
Published: December 2021

To permanently release severe contracture of the first web space, suitable additional skin must be provided. Local skin is often insufficient and is unable to fill the depths of the space. Pedicle flaps are bulky, require a second operation for division, and frequently demand further procedures for revision. A precisely tailored lateral arm free flap allows unparalleled correction to be achieved with one surgical intervention. The operation can be performed under regional anaesthesia with morbidity restricted to one extremity.
Mallet Finger: Comparison Between Operative and Conservative Management in Those Cases Failing to be cured by Splintage
Authors: WARREN R. A. , KAY N. R. M. , FERGUSON D. G.
Published: December 2021

Sixty-nine patients with mallet finger who failed to be cured by a period of splintage were offered either tenodermodesis or Kirschner wire fixation of the DIP joint. Eleven (16%) accepted the offer and eight of these were significantly improved. Of those patients declining surgery, 30 were available for review after a minimum period of six months; of these 13 (43%) had undergone a significant spontaneous improvement.
The Microvascular Anatomy of the Distal Digital Extensor Tendon
Authors: WARREN R. A. , KAY N. R. M. , NORRIS S. H.
Published: December 2021

The circulation of six hands from four human cadavers was washed out, the hand then being injected with contrast material to provide 24 fingers for analysis under the dissecting and light microscopes. The microvascular anatomy of the distal part of the extensor tendon was outlined and is described, with particular emphasis on the fine vessels within the tendon and on the tendon surface. An area of deficient blood supply was shown within the tendon which may have implications in the aetiology and treatment of mallet finger.
The Arteriovenous Pattern of the Distal Digital Segment
Authors: CHAUDAKSHETRIN P. , KUMAR V. P. , SATKU K. , PHO R. W. H.
Published: December 2021

By injection of eosin dye with latex into 45 cadaveric fingers we were able to demonstrate: (1) a distinct digital pulp arch formed by the ulnar and radial digital arteries over the mid-point of the terminal phalanx in 93% of digits; (2) variations in size of the proper digital arteries to each digit; (3) numerous branches from the pulp arch to the tip of each digit and (4) a constant pattern of dorsal veins over the terminal segment in 89% of digits.
The Dorsal Occult Ganglion of the Wrist and Ultrasonography
Authors: OGINO T. , MINAMI A. , FUKADA K. , SAKUMA T. , KATO H.
Published: December 2021

In five cases of suspected occult ganglion on the back of the wrist, an ultrasonographic examination was performed. This revealed a small hypoechogenic area on the dorsal aspect between the scaphoid and the lunate or just dorsal to the lunate. Exploration of this area in three cases confirmed the presence of an occult ganglion. In the other two cases, further aspiration revealed traces of mucinous jelly at the tip of the needle.
The Treatment of Dorsal Wrist Ganglia by Radical Excision
Authors: CLAY N. R. , CLEMENT D. A.
Published: December 2021

The dorsal wrist ganglion is the commonest benign soft-tissue tumour of the hand. Its treatment has been the subject of discussion for centuries, many methods being accompanied by an unacceptably high recurrence rate. Surgical extirpation gives the most reliable results and success has been said to depend on the identification of an unvarying deep attachment of the ganglion to the scapholunate ligament. A previous study has suggested that if this is excised, there will be no recurrences and no residual symptoms. Our experience of 62 dorsal ganglia confirms that although a scapholunate origin is usual, ganglia may also arise from a variety of additional sites over the dorsal wrist capsule, particularly in the region of the capitate. Two ganglia have recurred and clinical review of 52 (84%) of the cases has shown that persistent discomfort following excision is not uncommon. One patient appears to have developed scapholunate instability.
Brachial Plexus Anaesthesia for Upper Limb Surgery: A Review of Eight Years’ Experience
Authors: THOMPSON A. M. , NEWMAN R. J. , SEMPLE J. C.
Published: December 2021

1248 supraclavicular brachial plexus blocks and 665 axillary plexus blocks were administered to 1913 patients undergoing upper limb surgery. Plexus block alone was successful in 83.5%. In a further 11.4% of cases, adequate anaesthesia was obtained following augmentation by other regional or local techniques. This resulted in an overall success rate of 94.9% and general anaesthesia was required in only 5.1%. The two percutaneous approaches to the brachial plexus did not differ in their success-rates but clinically apparent pneumothorax occurred in 0.8% of supraclavicular blocks.

Brachial plexus block anaesthesia is recommended as a safe and satisfactory alternative to general anaesthesia for upper limb surgery.
Traumatic Dislocation of the Fourth and Fifth Carpo–Metacarpal Joints: A Case Report
Authors: STORM J. O.
Published: December 2021

A case of traumatic dislocation of the fourth and fifth carpo-metacarpal joints and fracture of the base of the third metacarpal is presented. It is recommended that lateral X-rays of the hand be taken if dislocation is suspected at this level, as the injury may be missed on standard X-rays.
Avulsion Fracture of the Index Metacarpal Base: Three Case Report
Authors: CRICHLOW T. P. K. R. , HOSKINSON J.
Published: December 2021

Three cases of an avulsion fracture of the base of the index metacarpal by the tendon of Extensor Carpi Radialis Longus are reported. There are two previous reports of this injury which were both treated operatively. These cases were treated conservatively with satisfactory results. The relevant anatomy, mechanism of injury and incidence are discussed.
A Cryptic Cause of Monarthritis in the Hand: The Juxta-Articular Osteoid Osteoma
Authors: MARCK K. W. , DHAR B. K. , SPAUWEN P. H. M.
Published: December 2021

Three patients with an isolated arthritis in the hand are described. All three had long-term complaints and had undergone surgery before presenting in our clinic. The cause of arthritis, in all three patients, was a juxta-articular osteoid osteoma. In one patient the diagnosis was established by a plain X-ray. Additional radiological studies were necessary to arrive at the diagnosis in another patient, while in the third no preoperative diagnosis could be made, despite extensive investigations. Treatment consisted of curetting the nidus.
Boutonniere Deformity in Dupuytren’s Disease
Authors: KUHLMANN J. N. , BOABIGHI A. , GUERO S. , MIMOUN M. , BAUX S.
Published: December 2021

The boutonnière deformity in Dupuytren’s disease has been found to be due to fibrous contraction of the transverse retinacular ligament which anteriorly displaces the fibres of the extensor apparatus.

Complete ablation of this ligament and liberation of the extensor apparatus arrows easy extension of the finger when operating on severe cases of Dupuytren’s contracture.
Phalen’s Test in the Diagnosis of Carpal Tunnel Syndrome
Authors: SEROR P.
Published: December 2021

The wrist flexion test of Phalen has been studied in 127 patients with carpal tunnel syndrome and 20 control subjects, all of whom also had nerve conduction studies. There was a statistically significant relationship between the severity of electrical changes and the probability of a positive Phalen’s test. However 34% of patients had a negative test and 20% of control subjects a positive one.
Assessment of Sensory Nerve Conduction in Carpal Tunnel Syndrome before, during and after Operation
Authors: LUCHETTI R. , SCHOENHUBER R. , LANDI A.
Published: December 2021

Sensory conduction velocities of the median nerve before, during and after operation were compared in nine patients with carpal tunnel syndrome and four controls, in order to evaluate the prognostic value of the pre-operative and intra-operative findings.

Sensory conduction velocity was higher after operation than before in all patients (mean difference 31.33%), but not in control subjects. One patient showed a dramatic increase of 157% immediately after decompression.

Comparing the intra-operative with the post-operative findings all patients but one showed an increase of antidromic sensory conduction velocity (mean 44.37%), while in control subjects again minimal changes were found (mean –4.25%).

The study confirms the high diagnostic value of the pre-operative antidromic sensory conduction velocity findings. However, the prognostic value of both pre-operative and intra-operative ASCV findings is low.
Prediction of Outcome of Decompression for Carpal Tunnel Syndrome
Authors: NAU H.-E. , LANGE B. , LANGE S.
Published: December 2021

45 patients (55 hands) with carpal tunnel syndrome treated surgically have been studie Painful nocturnal paraesthesiae occurred in patients with short histories and was a good prognostic feature. Electromyography proved of value in assessing motor lesions and the degree of the process. The first sign of muscle involvement was fibrillation potential. In longer histories an increased amount of polyphasic potentials and reduced voluntary pattern was seen. The reduced pattern is reversible in cases of short duration and the absence of muscle wasting. In cases with marked alteration and signs of chronic muscle degeneration, the prognosis for pain is good, but not so for the neurological deficit. The nerve conduction velocity improve quickly after decompression of the median nerve in accordance with the complaints of the patient Electrophysiological methods proved their value in staging and follow-up.
Surgical Release of the Median Nerve under Local Anaesthesia for Carpal Tunnel Syndrome
Authors: ALTISSIMI M. , MANCINI G. B.
Published: December 2021

Carpal tunnel release was performed under local anaesthesia in 124 wrists of 108 patients. The local anaesthetic was injected into the carpal tunnel and into the subcutaneous tissue under the line of the skin incision. A tourniquet was used in all cases. Analgesia was complete in all but six patients. Only one patient had real difficulty in tolerating the tourniquet.

In 18 cases the median nerve, when exposed at operation, showed evidence of some damage caused by the needle or by injection of local anaesthetic but, at follow-up, no symptoms or signs related to this damage were found.
The Possible Role of Vascular Congestion in Carpal Tunnel Syndrome
Authors: THURSTON A. J. , KRAUSE B. L.
Published: December 2021

A study of interstitial pressures within the carpal tunnel using a slit catheter found that, in some patients, an initial rise in pressure is recorded when the wrist is passively extended a this continues to rise to a plateau if the position is maintained. A rise above a critical pressure brought about by congestion would explain the clinical picture of predominantly nocturnal symptoms and no electro-physiological evidence with the wrist in a neutral (resting) position. The results also bring into doubt published results of the pressure within the carpal tunnel wit the wrist flexed or extended, since the pressure can be changed at will, depending on the flexion or extension force used.
Acute Carpal Tunnel Syndrome: A Case Report
Authors: JONES W. A. , SCHEKER L. R.
Published: December 2021

We describe the development of acute carpal tunnel syndrome in a 53-year-old female following intensive repetitive use of the left wrist for two consecutive days.
Amyloidosis as a Cause of Carpal Tunnel Syndrome in Haemodialysis Patients
Authors: SPENCER J. D.
Published: December 2021

Over a five-year period (1981–1985), nine patients on haemodialysis developed carpal tunnel syndrome. Five patients, following biopsy of synovium in the carpal tunnel or biopsy of thickened epineurium of the median nerve, were found to have amyloid deposits in the soft tissues. The relationship between this condition, dialysis arthropathy and long-term haemodialysis is reviewed. In addition, in this small group of patients no relationship to the side of the fistula has been demonstrated and two patients developed recurrent problems despite initial open decompression of the carpal tunnel.
Anatomical Basis of Dorsal Forearm Flap
Authors: BAYON P. , PHO R. W. H.
Published: December 2021

Injection studies on 35 upper limbs with neoprene latex were carried out and the limbs carefully dissected to observe the vascular contribution of the posterior interosseous branches of the dorsal forearm, the transverse anastomosis between anterior and posterior interosseous vessels and the calibre of the vessel. The findings indicated that a fascia-cutaneous flap based on septocutaneous branches of the posterior interosseous artery can be raised as a reversed forearm for resurfacing after skin loss in the hand.
Late Rupture of the Extensor Pollicis Longus Tendon: The Case against Attrition
Authors: JENKINS N. H. , MACKIE I. G.
Published: December 2021

The authors report the case of a 23-year-old man who sustained ipsilateral volar Barton’s and scaphoid fractures which were complicated by a late rupture of the extensor pollicis longus tendon. The anatomy of the injury precluded attrition as the cause of the tendon rupture and the alternative theory of ischaemic rupture is examined. Clinicians should be aware that injuries other than the Colles’ fracture may be complicated by rupture of extensor pollicis longus.
The Essex-Lopresti Injury: A Variation
Authors: HARGADON E. J. , PORTER M. L.
Published: December 2021

The Essex-Lopresti fracture-dislocation consists of a radial head fracture associated with dislocation of the inferior radio-ulnar joint. We report a variation of this injury in which there was an additional fracture through the scaphoid.
Scaphoid Fractures Treated by Herbert Screw Fixation
Authors: MORAN R. , CURTIN J.
Published: December 2021

Forty-one scaphoid fractures had Herbert screw fixation. There were three acutely displace fractures (Type B), nine delayed unions (Type C), and 29 non-unions (Type D). All procedures were carried out by the senior author between December 1983 and May 1987. The average time from injury to surgery was 19 months. All Type D fractures were bone-grafted.

Six of the 29 Type D fractures failed to unite radiologically following surgery. Incorrect screw placement was a factor in two cases. The average time from injury to surgery in three of the others was seven years. Radiological evidence of screw loosening was present within two months of mobilising these cases. We feel that Herbert screw fixation may not be adequate when dealing with longstanding scaphoid non-unions, and stronger fixation or prolonged cast immobilisation may be necessary.
Classification of Fresh Fractures of the Lunate
Authors: TEISEN H. , HJARBAEK J.
Published: December 2021

The X-rays of 17 patients with fresh fractures of the lunate bone have been reviewed. The fractures were classified according to their radiological appearances and according to the vascular anatomy of the lunate. A long term X-ray follow-up examination was performed.
Complex Dislocation of the Metacarpo-Phalangeal Joint of the Index Finger: A Comparison of the Surgical Approaches
Authors: BARRY K. , McGEE H. , CURTIN J.
Published: December 2021

Complex dislocation of the index metacarpo-phalangeal joint almost always requires surgical intervention. Controversy exists as to the most suitable surgical approach to reduction: palmar or dorsal.

We reviewed four cases and carried out dissections in eight cadaver hands to compare the surgical approaches. The interposed volar plate was found to be the most important obstacle to reduction. Both approaches were successful in obtaining reduction. The dorsal approach was simple and safe, hut necessitated longitudinal division of the volar plate and may carry a theoretical risk of late instability. The palmar approach allows restoration of normal anatomy but the radial neurovascular bundle is always vulnerable.
Limitation of Thumb Flexion Due to an Unusual Insertion of the Flexor Pollicis Longus
Authors: HAGAN H. J. , IDLER R. S.
Published: December 2021

A case is described in which an anomalous insertion of the flexor pollicis longus tendon into the region of the carpal tunnel caused limited active flexion of the thumb in a child. This is the first reported case of this anomaly in which an apparent familial relationship has been noted, and the first reported case in the Caucasian race. Two similar cases in Japanese have been described. Abnormal insertion of a portion of the flexor pollicis longus must be included in the differential diagnosis of inadequate thumb flexion.
Flexor Tendon Pulley Reconstructions—A Histological and Ultrastructural Study in Non-Human Primates
Authors: DUNLAP JANET , McCARTHY J. A. , MANSKE P. R.
Published: December 2021

The feasibility of A2 pulley reconstructions using expanded polytetrafluoroethylene (PTFE), woven nylon, and fascia lata was assessed in a non-human primate model and evaluated by light and scanning electron microscopy 18 weeks after implantation. No adhesions were found between reconstructed pulleys and flexor tendons. All types of pulley were intact and incorporated by host tissues, without evidence of a foreign body reaction. The inner surfaces of the fascial and PTFE pulleys, apposed to the gliding flexor tendons, were smooth and covered by a fibrous layer of tissue on microscopic and ultrastructural examination. The apposed visceral synovial surfaces of the F.D.P. tendon were indistinguishable from those from unoperated digits. The FDP tenosynovium apposed to woven nylon pulleys was more fibrillar and granular. Based on the results of the present study and on previous biomechanical data, expanded PTFE should be considered as a material for pulley reconstruction; it is incorporated by host tissues, elicits no foreign body reaction and causes no adhesions or traumatic changes to underlying flexor tendons. It is not yet known whether it has sufficient breaking strength to meet the functional demands of human pulleys.
Biomechanical Analysis of Finger Flexor Pulley Reconstruction
Authors: LIN G.-T. , AMADIO P. C. , AN K.-N. , COONEY W. P. , CHAO E. Y. S.
Published: December 2021

Fifty cadaver digits were used to study the mechanical properties of five different methods of pulley reconstruction and the effectiveness of three different pulley reconstructive arrangements in restoring a normal relationship between tendon excursion and joint motion. All reconstructed pulleys showed less stiffness and more displacement before failure than normal intact pulleys. Although reconstruction using a length of another tendon woven through the remaining fibrous rim of the pulley and both double and triple tendon graft loops around bone absorbed more energy to failure than a normal pulley, only the triple loop around bone could withstand as much load before failure as a normal pulley. No reconstruction restored a normal tendon excursion/joint motion relationship, but reconstruction of the A2 and A4 pulleys restored a more normal relationship than either the “belt loop” reconstruction or a combination belt loop, A2 and A4 reconstruction.
Stabilisation of the Wrist in Rheumatoid Disease
Authors: KOKA R. , D’ARCY J. C.
Published: December 2021

Internal splintage was undertaken of fifteen wrists for pain and instability, using an intramedullary Rush nail. The patients were examined at an average of thirty-three months after operation. Spontaneous fusion in a useful position had occurred in all but one. The operation is simple and external immobilisation is unnecessary.
Rehabilitation of Atrophied Muscle in the Rheumatoid Arthritic Hand: A Comparison of Two Methods of Electrical Stimulation
Authors: OLDHAM J. A. , STANLEY J. K.
Published: December 2021

This study compares the effectiveness of two therapeutic electrotherapies which result in plastic adaptation in the atrophied muscle of rheumatoid arthritic hands. The natural discharge pattern of a fatigue-resistant motor unit (eutrophic electrotherapy) was more effective than a uniform 10 Hz electrotherapy. It was concluded that uniform 10 Hz electrotherapy ignored the information carried in the motor unit action potential spike train, which was the signal inducing rapid and behaviourally effective plastic adaptation.
Documentation of the First Web Space Angle
Authors: BHATTACHARYA S. , PANDEY S. D. , CHANDRA R. , SINGH G. K.
Published: December 2021

We describe a new method of measuring adduction contractures of the thumb by using stent mould casts of the first web, which are sectioned sagittally to give an accurate clinical angle at their cut section. This can be recorded from ink impressions. This method has been used successfully in 65 cases and appears more accurate than other methods.
Primary Nerve Repair: Strength of Repair with Different Gauges of Nylon Suture Material
Authors: GIDDINS G. E. B. , WADE P. J. F. , AMIS A. A.
Published: December 2021

Cadaveric median nerves were divided and repaired with interrupted epineural sutures, as in normal clinical practice, using three different gauges of nylon monofilament material. Tensile testing of the nerve repairs showed that, of these three gauges, 9/0 (0.3 metric) sutures were preferable: gap formation at the repair site occurred at the highest force. Finer gauge (10/0) sutures snapped at a lower force, while thicker (8/0) sutures were less consistent and pulled out of the nerve tissue.
The Social and Economic Consequences of Failure to Replant Amputated Thumbs
Authors: HOVGAARD C. , DALSGAARD S. , GEBUHR P.
Published: December 2021

Thirty-two patients with amputated thumbs were admitted to hospital. In none was replantation considered to be feasible because of the serious damage to the soft tissues and the bone damage. The social and economic consequences are discussed.
Allograft Bone for Arthrodesis and Repair of Skeletal Hand Problems
Authors: ANDERSON W. J.
Published: December 2021

Banked freeze-dried allograft bone was used in 16 patients who underwent three types of wrist operation. Subjective, objective, roentgenographic and economic end-result evaluations were satisfactory. The mean time to union was 12.4 weeks, and the complication rate was low. Allograft bone compares favourably with autografts and avoids donor site morbidity, as well as the need for general anaesthesia.
Aseptic Necrosis of the Capitate Secondary to Gaucher’s Disease: A Case Report
Authors: WOUNLUND J. , LOHMANN M.
Published: December 2021

We report a case with aseptic necrosis of the capitate in a young patient with Gaucher’s disease and no fracture of the carpus. The value of technetium bone scintigraphy and computer tomographic scanning are discussed.
Bilateral Giant Cell Tumour of the Distal Radius: A Case Report
Authors: BOTTKE C. A. , HANKIN F. M.
Published: December 2021

A case of bilateral distal radius giant cell tumour of bone is reported. Each lesion appears to have arisen de novo rather than as a metastasis.