bluuebunny/crossref_metadata_2025 huggingface dataset:
Open and Closed Arthrodesis of the Rheumatoid Wrist Using a Modified (Stanley) Steinmann Pin
Authors: CHRISTODOULOU L. , PATWARDHAN M. S. , BURKE F. D.
Published: September 2002

In a series of 21 patients (22 wrists) with rheumatoid arthritis, arthrodesis of the wrist was done using a modified Steinmann pin (Stanley) either by an open or closed technique. The open technique, which included fragmenting the carpal bones (12 cases), was mainly used when additional procedures were needed simultaneously. The closed technique simply required insertion of the Stanley pin under fluoroscan control through a small incision over the metacarpal head. Nine out of 12 wrists treated with the open technique and nine out of ten of those treated by the closed technique were successfully fused. Complications were few. A single patient was dissatisfied due to continuing pain. Two out of the four pins that migrated (both involving the open technique) have been removed.
Fixation of Metacarpal Fractures Using Absorbable Hemi-Cerclage Sutures
Authors: BRÜSER P. , KREIN R. , LARKIN G.
Published: September 2002

We retrospectively reviewed the use of biodegradable hemi-cerclage sutures in the treatment of 79 metacarpal fractures in 66 patients. The polyglycolic acid hemi-cerclages achieved sufficient fracture fixation to permit early motion exercises, but fractures were also immobilized for a mean of 3.7 (range, 1.5–6) weeks postoperatively, during which time physiotherapy was given. Adequate bony stability was achieved after a mean of 4.5 (range, 3.5–7) weeks and fracture redisplacement occurred in only one case.
Congenital Aneurysm of the Ulnar Artery in the Palm
Authors: OFFER G. J. , SULLY L.
Published: September 2002

An aneurysm of the palmar ulnar artery is rare and usually follows penetrating or blunt trauma to the hypothenar eminence. We report a case in which there was no history of trauma and the aneurysm may have been of congenital origin.
Median Nerve Latency Measurement Agreement Between Portable and Conventional Methods
Authors: ATROSHI I. , GUMMESSON C. , JOHNSSON R. , ORNSTEIN E. , ROSÉN I.
Published: September 2002

A portable nerve conduction testing device was compared with a conventional method of measuring median nerve distal latencies. In a population-based study, a health questionnaire was mailed to a random sample of 3000 participants (aged 25 to 74 years). Two hundred and sixty-two responders with numbness and/or tingling in the median nerve distribution, and 125 asymptomatic responders underwent clinical examination as well as portable and conventional median nerve distal latency measurements. Motor latency measured with the portable device was on average 0.1 millisecond (ms) lower than motor latency measured with the conventional method (95% limits of agreement, −0.8–0.5 ms). Sensory latency (wrist-to-index finger) measured with the portable device was on average 0.3 ms lower than sensory latency (long finger-to-wrist) measured with the conventional method (95% limits of agreement, −0.7–0.1 ms). Strong correlations were found between the latencies measured by the portable and conventional methods (Pearson correlation coefficient, 0.90–0.93). The agreement between the portable and conventional methods in measuring median nerve distal latencies appears to be acceptable. The cut-of value for abnormal sensory latency needs to be lower for the portable than the conventional method if the present measurement techniques are used.
Variable Expression of Isolated Familial Long-Ring-Little Syndactyly
Authors: AL-QATTAN M. M.
Published: September 2002

A family with isolated long-ring-little syndactyly is reported to demonstrate that the responsible autosomal gene may cause either simple or complex syndactyly.
Dorsal Dislocation of the Capitate
Authors: WALKER R. W. , PRADHAN R.
Published: September 2002

We report a case of dorsal dislocation of the capitate and third metacarpal, and discuss the possible classification of this pattern of injury.
Validity and Reliability of Three Generic Outcome Measures for Hand Disorders
Authors: SHARMA R. , DIAS J. J.
Published: September 2002

This is an assessment of three different outcome measures for the hand: the Hand Clinic Questionnaire (HCQ); the Patient Evaluation Measure (PEM); and the Hand Outcome Survey Sheet (HOSS). Each measure has been tested for its reliability and validity. The results suggest that the PEM and the HCQ are comparably consistent but the PEM is more reproducible. Both the PEM and HOSS are valid questionnaires. The PEM is suitable for use in an outpatient clinic and as a postal questionnaire. The HOSS may be used for research or audit especially when the injury has been measured using the Hand Injury Severity Score.
Efficacy of Forearm versus Upper Arm Tourniquet for Local Anaesthetic Surgery of the Hand
Authors: EDWARDS S. A. , HARPER G. D. , GIDDINS G. E. B.
Published: September 2002

A prospective study was undertaken to compare the use of forearm and upper arm tourniquets for local anaesthetic procedures on the hand. One hundred consecutive patients with an upper arm tourniquet were compared with a further consecutive 100 patients in whom a forearm tourniquet was used. The tourniquet time was always less than 20 minutes and the scoring of perceived pain was not significantly different in the two groups. Use of a forearm tourniquet was well tolerated and was not associated with an increase in complications.
The First Toe-to-Hand Transfer: A Thirty-Year Follow-up
Authors: WHITWORTH I. H. , PICKFORD M. A.
Published: September 2002

In April 1968 the first successful free toe-to-hand transfer was performed by Mr. J. R. Cobbett at the Queen Victoria Hospital to reconstruct the thumb of a woodworker. Details of the case are discussed and the patient’s current level of sensation, power and function are presented over 30 years following reconstruction.
Carpal Tunnel Release Under Intravenous Regional or Local Infiltration Anaesthesia
Authors: TOMAINO M. M. , ULIZIO D. , VOGT M. T.
Published: September 2002

Fifteen patients with bilateral carpal tunnel syndrome underwent surgery using intravenous regional anaesthesia (IVRA) on one hand and local infiltration anaesthesia (LA) on the other. All 30 carpal tunnel releases were performed without complication. Patient tolerance for IVRA and LA was similar. Six patients preferred the LA, eight preferred IVRA and one had no preference. Tourniquet time averaged 16 minutes when LA was used and 24 minutes with IVRA ( P< 0.05). Use of local anaesthesia allows more expeditious surgery and limits costs, but intravenous regional anaesthesia is recommended if epineurotomy, internal neurolysis or flexor tenosynovectomy are planned.
Ultrasound for Diagnosis of Scaphoid Fractures
Authors: MUNK B. , BOLVIG L. , KRØNER K. , CHRISTIANSEN T. , BORRIS L. , BOE S.
Published: September 2002

We investigated the diagnostic value of two different ultrasound scanning methods for the early diagnosis of acute scaphoid fractures. Fifty-seven patients with ten scaphoid fractures were assessed within a week of injury. The accuracy of the ultrasound assessment was 84% and its specificity was 91%. However, its sensitivity was only 50%. We conclude that ultrasound examination is unreliable for the diagnosis of acute scaphoid fractures.
Rapid Repeat Testing of Grip Strength for Detection of Faked Hand Weakness
Authors: TREDGETT M. W. , DAVIS T. R. C.
Published: September 2002

This study assessed the use of rapid, repeated measurement of grip strength to detect feigned hand weakness. Normal participants, performing with maximum effort or feigning hand weakness, and patients recovering from carpal tunnel surgery were asked to grip a Jamar dynamometer alternately with each hand on ten occasions.

The results showed that grip strength fatigued by an average of 23% during the test in the normal participants, 18% in participants faking weakness, and increased by 2% in the carpal tunnel decompression patients. An increase in grip strength after the first effort was found in 39% of normal participants, 52% of participants faking hand weakness and in 69% of the carpal tunnel decompression patients.

These results suggest that rapid, repeated measurement of grip strength is not a reliable discriminator of true and faked hand weakness.
Complications of Operative Treatment for Mallet Fractures of the Distal Phalanx
Authors: KANG H -J. , SHIN S -J. , KANG E -S.
Published: September 2002

Twenty-four of 59 (41%) surgically treated mallet fractures developed postoperative complications. The most common complication was marginal skin necrosis on the dorsal aspect of the distal phalanx, but recurrent extension lag, permanent nail deformities, transient infections along the Kirschner wires and pull-out steel wires and osteomyelitis were also observed.
The Mechanical Properties of Locking and Grasping Suture Loop Configurations in Four-Strand Core Suture Techniques
Authors: WADA A. , KUBOTA H. , HATANAKA H. , HOTOKEZAKA S. , MIURA H. , IWAMOTO Y.
Published: September 2002

We have compared the effect of locking and grasping suture loop configurations in four-strand core suture techniques for tendon repair. Forty canine flexor digitorum profundus tendons were repaired with one of four suture techniques (the grasping cruciate, the double-modified grasping Kessler, the locking cruciate and the double-modified locking Kessler) and tested to failure in a tensile testing machine. The mode of failure in all the locking suture specimens was breakage of the sutures in the locking loops or at suture knots. The sutures did not pull out of the tendon, as was seen in the grasping suture specimens. The greatest tensile strength was found with the double-modified locking Kessler technique which incorporated eight rectangular locking loop configurations.
Mri Versus Arthroscopy in the Diagnosis of Scapholunate Ligament Injury
Authors: SCHÄDEL-HÖPFNER M. , IWINSKA-ZELDER J. , BRAUS T. , BÖHRINGER G. , KLOSE K. J. , GOTZEN L.
Published: September 2002

In a prospective study 103 patients with clinically or radiologically suspected tears of the scapholunate interosseous ligament were investigated with magnetic resonance imaging (MRI) and wrist arthroscopy. MRI was performed with the conventional technique in 72 cases and after intravenous injection of contrast medium in the remaining 31 patients. The correct diagnosis was made by MRI in 75% of cases and its overall sensitivity and specificity were 63% and 86% respectively. There was no statistical difference in the accuracy of MRI for acute or chronic tears and the use of intravenous contrast medium did not improve its accuracy. In conclusion, MRI is not recommended for the diagnosis of scapholunate ligament injury.
Peripheral Nerve Motion Measurement with Spectral Doppler Sonography: A Reliability Study
Authors: HOUGH A. D. , MOORE A. P. , JONES M. P.
Published: September 2002

This study evaluates single operator test-retest reliability of spectral Doppler ultrasound measurement of median nerve excursion during wrist extension. Longitudinal motion of the median nerve was measured at the elbow on three occasions in both upper limbs of 16 healthy subjects using a standard colour Doppler ultrasound system. The mean of the three maximum velocity time integrals was calculated from the spectral Doppler sonogram of each test. Analysis of data with intraclass correlation coeffcient indicated a high degree of repeatability (0.92). Spectral Doppler ultrasound may provide a valuable method for measurement of peripheral nerve motion and may have a role in the clinical assessment of entrapment syndromes.
Ulnar Shortening for the Treatment of Early Post-Traumatic Osteoarthritis at the Distal Radioulnar Joint
Authors: SCHEKER L. R. , SEVERO A.
Published: September 2002

This prospective study describes the outcome of ulnar shortening performed on 32 wrists with early osteoarthritis of the distal radiounlar joint (DRUJ) in an attempt to change the contact area between the ulnar head and the radial sigmoid notch. By changing the contact area, we attempted to relieve pain, while maintaining the function of the DRUJ. The mean age of the patients was 34 years, and the mean follow-up was three years and two months. The wrists were graded by the patients’ self-assessment of satisfaction and by a clinical wrist rating that assessed pain, functional status, range of motion, and grip strength. In terms of self-assessment, 16/32 patients were very satisfied, with complete pain relief. Of the 32 patients, 26 said that they would have surgery again if circumstances were similar. The postoperative wrist ratings were 7/32 excellent, 11/32 good, 9/32 fair, 5/32 poor. The most frequent postoperative complaint was plate irritation.
Metacarpal and Phalangeal Lengthening by Callus Distraction
Authors: HOUSHIAN S. , IPSEN T.
Published: September 2002

Twelve metacarpals and two phalanges in 14 patients (nine males and five females) were lengthened between August 1992 and March 1999 by the callus distraction technique using a small external fixator (Orthofix®). The indications were traumatic amputation (10 cases), aplasia (three cases) and hypoplasia owing to premature epiphyseal closure of the metacarpal (one case). All patients were reviewed with a median follow-up time of 39 (range, 9–88) months. The median age of the patients was 15 (range, 4–39) years. The median lengthening was 21 (range, 13–34) mm which was a median of 82% (range, 38–162) of the original bone length. The median times for callus distraction and consolidation were 4.5 and 7.5 weeks respectively. All except one patient tolerated the procedure well and were satisfied with the results. Functional improvement was seen in 13 out of 14 patients, but non-union was observed in one patient.
Open Reduction and Internal Fixation of Intra Articular and Unstable Fractures of the Distal Radius Using the AO Distal Radius Plate
Authors: CAMPBELL D. A.
Published: September 2002

This study reports the results of open reduction and internal fixation of 25 dorsally displaced distal radial fractures using a specifically designed plate for the distal radius, the AO pi plate (Synthes Ltd, Paoli, USA). Twenty-one of these fractures were complex and intra-articular (AO Type ‘C’). Measurement of range of motion of the affected wrist at an average follow-up of 16 months revealed a median return of 60° of wrist extension, 40° of wrist flexion, 90° of pronation and 90° of supination. Radiographic assessment revealed restoration of normal radial length, inclination and palmar tilt in all but six cases. The final outcome, as assessed by the Gartland and Werley scale, was excellent in four cases, good in 11, and fair in ten cases. Complications were seen in five patients.
Surgical Anatomy of Spinal Accessory Nerve: Is Trapezius Functional Deficit Inevitable after Division of the Nerve?
Authors: DAILIANA Z. H. , MEHDIAN H. , GILBERT A.
Published: September 2002

The course of spinal accessory nerve in the posterior triangle, the innervation of the sternocleidomastoid and trapezius muscles and the contributions from the cervical plexus were studied in 20 cadaveric dissections. The nerve was most vulnerable to iatrogenic injuries after leaving the sternocleidomastoid. Direct innervation of trapezius by cervical plexus branches was noted in five dissections, whereas connections between the cervical plexus and the spinal accessory nerve were observed in 19 dissections. These were usually under the sternocleidomastoid (proximal to the level of division of the nerve in nerve transfer procedures). Although the contribution from the cervical plexus to trapezius innervation is considered minimal, trapezius function can be protected in neurotization procedures by transecting the spinal accessory nerve distal to its branches to the upper position of trapezius.
Wrist Arthrodesis with Excision of the Proximal Carpal Bones Using the AO/ASIF Wrist Fusion Plate and Local Bone Graft
Authors: HARTIGAN B. J. , NAGLE D. J. , FOLEY M. J.
Published: September 2002

We present our series of 17 patients who underwent wrist arthrodesis with excision of the proximal row carpal bones using the AO wrist fusion plate and local bone graft obtained from the excised proximal carpal row. All patients were evaluated using a questionnaire to assess pain, function, ability to perform an occupation and satisfaction with the procedure. The mean follow-up was 17 months, at which time all the fusions had united. Clinical outcome scores showed that 14 and 15 of the 17 patients achieved good or excellent results with regard to their current condition and clinical improvement, respectively. Four patients required secondary surgery, two for fractures and two for instability of the distal radio-ulnar joint unrelated to the wrist fusion.
Interdigital Pilonidal Sinus in the Hand
Authors: ADAMS C. I. , PETRIE P. W. R. , HOOPER G.
Published: September 2002

We report three cases of interdigital pilonidal sinus including a case of a woman with this condition. Previous reports that surgical excision is curative in all cases are not supported by our experience.
TREATMENT OF CONGENITAL SWAN NECK DEFORMITY WITH DYNAMIC TENODESIS OF PROXIMAL INTERPHALANGEAL JOINT
Authors: SMRÈKA V. , DYLEVSKÝ I.
Published: September 2002

Congenital swan neck deformities in seven fingers of two patients were treated by transfer of the flexor digitorum superficialis tendon to a tendon graft which was attached the extensor aponeurosis over the middle phalanx. The tendon transfer is protected for at least 2 months by a modified Murphy splint.
PHALANGEAL NECK FRACTURES IN CHILDREN: CLASSIFICATION AND OUTCOME IN 66 CASES
Authors: AL-QATTAN M. M.
Published: September 2002

A series of 66 children with 67 phalangeal neck fractures in the hand is presented. Young children (1–3 years of age) made up 44% of the series. The mechanism of injury was entrapment of the digit in a closing door or a swing in almost all cases. Type I fractures (n=13) were undisplaced and treatment with a splint resulted in excellent results in almost all cases. Type II fractures were defined as displaced fractures with some bone-to-bone contact. There were 47 Type II fractures and the outcome was significantly affected by the method of initial management. Fractures treated without K-wire fixation had a significantly worse outcome than those who underwent K-wire fixation. Type III fractures (n=7) were displaced with no bone-to-bone contact. If inadequately treated, these fractures did not unite.
The Use of Split Thickness Skin Grafts in the Correction of Apert’s Syndactyly
Authors: AL-QATTAN M. M.
Published: September 2002

Stiffness of the interphalangeal joints of the fingers is a constant feature of Apert’s syndrome. Because of this stiffness, the author has used split-thickness skin grafts when correcting Apert’s syndactyly, thinking that contraction of such grafts post-operatively would not cause any joint contracture or finger deviation. This paper reports the results of eight patients whose average age at first surgery was 6 months. Separation of all digits was accomplished before the age of 2 years. A dorsal rectangular flap and interposing triangular digital flaps were utilised to create the web space and partially cover the skin defects in the fingers. The remaining digital defects were covered with thin split-thickness skin grafts which took fully in all cases. At final follow-up (1–6 years), the areas covered by skin grafts have reduced in size significantly because of skin graft contraction. However, this did not result joint contracture or digital deviation.
The Sequelae of Reflex Sympathetic Dystrophy
Authors: ZYLUK A.
Published: September 2002

This paper presents the results of a retrospective analysis of 94 patients who were assessed at a mean of 11 months after successful treatment of reflex sympathetic dystrophy (RSD) of the hand. Fifty-four percent still complained of pain related to the weather, and many complained of cold intolerance (44%), slight pain after use (34%), nail and hair growth changes (34%), sensory disturbances (34%) and stiffness of fingers in the morning (28%). There were also complaints of reduced finger extension, pain and loss of movement in the shoulder joint and hand swelling after use, and 78% of patients had significantly reduced grip strength. These results suggest that, in spite of resolution of the acute RSD problem, significant long term sequelae of RSD continue to impair function of the hand in a proportion of patients.
Should Anatomic Reduction be Pursued in Distal Radial Fractures?
Authors: FERNANDEZ D. L.
Published: September 2002

Two articles on distal radial fractures in young adults are published in this issue of the journal. One reports the results of open reduction and internal fixation with the π-plate in a group of patients in which the majority of fractures were complex and intraarticular. The other retrospectively assessed 169 fractures with an average follow-up of 4.9 years, based on the radiographic evaluation of the patient’s X-rays until discharge and on the answers provided by a patient-based subjective outcome questionnaire. My task has been to comment, criticise and analyse the findings and results reported in both articles, in order to highlight areas of uncertainty and controversy regarding the current management of fractures of the distal radius in the younger age group.
HAND BLOOD SUPPLY IN RADIAL FOREARM FLAP DONOR EXTREMITIES: A QUALITATIVE ANALYSIS USING DOPPLER EXAMINATION
Authors: CIRIA-LLORÉNS G. , GÓMEZ-CIA T.
Published: September 2002

This retrospective study evaluated the contribution of the forearm arteries to the blood supply of the hand after radial forearm flap surgery. Doppler ultrasound examinations of the radial, ulnar, anterior interosseous and posterior interosseous arteries were performed in the distal forearm using a continuous emission directional Doppler and a modified Allen test. Twenty-seven patients were included in this investigation which demonstrated a significant contribution of the anterior interosseous artery to hand vascularity after radial forearm flap surgery.
Carpal Tunnel Syndrome Due to an Intraneural Perineurioma in a 2-Year-Old Child
Authors: ALFONSO D. T. , SOTREL A. , Grossman J. A. I.
Published: September 2002

We report a 2-year-old girl with carpal tunnel syndrome due to a large intraneural perineurioma that required resection and nerve reconstruction.
Temporary Ischaemia of the Scaphoid in a Child
Authors: GALLIE P. , CHAMBERLAIN S. , STABLER D.
Published: September 2002

We describe a case of a 12-year-old boy who developed acute ischaemia of the entire scaphoid following simple trauma to the wrist. No fracture was evident; however, MRI and bone scintigraphy at the time of the injury revealed complete ischaemia of the scaphoid. A repeat MRI at 6 months showed evidence of incomplete revascularisation of the scaphoid.
The Histochemical Structure of the Deep Fascia and Its Structural Response to Surgery
Authors: McCOMBE D. , BROWN T. , SLAVIN J. , MORRISON W. A.
Published: September 2002

The histochemical structure of the deep fascia and its interface with the underlying muscle was examined in ten pigs. This structure was also evaluated after it had been raised as a fascial flap and in another site after the underlying muscle surface had been disrupted. The deep fascial is a simple structure of densely-packed collagen bundles and elastin fibres, and has hyaluronic acid concentrated on its inner surface, which is in contact with the underlying muscle. There is no specialised lining of this surface of the fascia to account for its gliding properties. The post-surgical specimens demonstrated preservation of the structure of the interface between fascia and muscle, including the retention of the hyaluronic acid lining, if the epimysium was intact. However, if the epimysium was disrupted, the structure of the interface was obliterated.
Comparison of Postoperative Early Active Mobilization and Immobilization in Vivo Utilising a Four-Strand Flexor Tendon Repair
Authors: WADA A. , KUBOTA H. , MIYANISHI K. , HATANAKA H. , MIURA H. , IWAMOTO Y.
Published: September 2002

We evaluated a technique of four-strand double-modified locking Kessler flexor tendon repair in healing tendons. Seventy-two canine flexor digitorum profundus tendons in Zone 2 were repaired and evaluated following either active mobilization or immobilization at 0, 7, 14, 28 and 42 days after surgery. Fifty-six tendons were examined for gap and ultimate strength using a tensile testing machine and 16 were evaluated with standard hematoxylin and eosin, and Masson’s trichrome staining. All tendons healed without rupture or gap formation of more than 1 mm, thus demonstrating that this repair technique has enough tensile strength to withstand early active mobilization. The gap and ultimate strength of actively mobilized tendons did not decrease significantly during the first 7 days, and were significantly greater than those of immobilized tendons throughout the 42-day study period. Actively mobilized tendons healed without the extrinsic adhesions and large tendon calluses that were found in immobilized tendons.
Free Vascularized Toe Joint Transfer to the Hand. A Technique for Simultaneous Reconstruction of the Soft Tissue
Authors: KIMORI K. , IKUTA Y. , ISHIDA O. , ICHIKAWA M. , SUZUKI O.
Published: September 2002

Twelve patients underwent reconstruction of injured finger joints using our technique of a vascularized transfer of the second toe proximal interphalangeal joint. The age of the patients at operation ranged from 7 to 47 years and the postoperative follow-up was 9 to 48 months. All the joint transfers survived and united with resolution of the preoperative joint pain, deformity and instability. The average range of motion of the reconstructed joints was 59° in the proximal interphalangeal and 54° in the metacarpophalangeal joints. No patient complained of pain or functional deficits in the donor foot.
Inhibition of Tendon Cell Proliferation and Matrix Glycosaminoglycan Synthesis by Non-Steroidal Anti-Inflammatory Drugs in vitro
Authors: RILEY G. P. , COX M. , HARRALL R. L. , CLEMENTS S. , HAZLEMAN B. L
Published: September 2002

The purpose of this study was to investigate the effects of some commonly used non-steroidal anti-inflammatory drugs (NSAIDs) on human tendon. Explants of human digital flexor and patella tendons were cultured in medium containing pharmacological concentrations of NSAIDs. Cell proliferation was measured by incorporation of 3H-thymidine and glycosaminoglycan synthesis was measured by incorporation of 35S-Sulphate. Diclofenac and aceclofenac had no significant effect either on tendon cell proliferation or glycosaminoglycan synthesis. Indomethacin and naproxen inhibited cell proliferation in patella tendons and inhibited glycosaminoglycan synthesis in both digital flexor and patella tendons. If applicable to the in vivo situation, these NSAIDs should be used with caution in the treatment of pain after tendon injury and surgery.
Localized Amyloid Deposition in Trigger Finger
Authors: CORDINER-LAWRIE S. , DIAZ J. , BURGE P. , ATHANASOU N. A.
Published: September 2002

Trigger finger is due to degeneration and thickening of the proximal portion (A1 pulley) of the flexor tendon sheath, which causes constriction of the flexor tendon. This study reports the presence of localized amyloid deposition in the tendon sheath of 11 of 47 cases (23%) of idiopathic primary trigger finger. Amyloid deposits were only found in patients aged over 46 years old and were present around cells and at sites of mucinous and fibrinoid degeneration which contained highly sulphated glycosaminoglycans. The pathogenic significance of these deposits is uncertain but their small size and presence only in middle-aged and elderly adults suggests that they represent a form of age-associated amyloid deposition.
A Comparison of Metacarpophalangeal Joint Silastic Arthroplasty with or Without Crossed Intrinsic Transfer
Authors: PEREIRA J. A. , BELCHER H. J. C. R.
Published: September 2002

Forty-three hands in 36 adults undergoing Silastic interposition arthroplasty of the index, middle, ring and little finger metacarpophalangeal joints for rheumatoid arthritis were randomly allocated to undergo replacement with or without crossed intrinsic transfer. The patients were reviewed at a median of 17 (range, 7–50) months after surgery. The demographic characteristics and pre-operative clinical measurements of the two groups were indistinguishable. Both groups showed improvement in ulnar drift and an altered arc, but no change in total range of motion at the metacarpophalangeal joints. Grip strength and pulp to pulp pinch were significantly and comparably improved in both groups. There was no difference in pain scores or perceived function between the treatment groups. It is concluded that crossed intrinsic transfer does not significantly affect the outcome of Silastic interposition arthroplasty of the metacarpophalangeal joints in rheumatoid patients.
Diagnostic Arthroscopy: Indications and Interpretation of Findings
Authors: SENNWALD G.
Published: September 2002

Many authors recommend arthroscopy for diagnostic or therapeutic purposes. Arthroscopy is a sophisticated investigation, which can cause damage requiring wrist fusion. It allows visualization of findings, but these are subtle and difficult, if not impossible to interpret, since the contralateral wrist cannot be used as a standard for comparison. Furthermore, not all intracarpal ligaments are directly and reliably visible through the arthroscope: for example the scaphoid-trapezial ligament which is essential for the stabilization of the distal part of the scaphoid. Therefore, it is questionable whether we can define arthroscopy as a gold standard of diagnosis just because it permits direct vision, as if what cannot be seen does not exist! Traction, mandatory for examination, induces particular stresses that may distort intracarpal motion and so-called dynamic evaluation. Each author tends to present a specific classification, rendering comprehension even more difficult. Accordingly, teaching and learning become a real challenge. Arthroscopy may be important in particular cases, but it remains only one component of a complex clinical assessment.
The Use of Ultrasound Imaging to Demonstrate Reduced Movement of the Median Nerve during Wrist Flexion in Patients with Non-Specific Arm Pain
Authors: GREENING J. , LYNN B. , LEARY R. , WARREN L. , O’HIGGINS P. , HALL-CRAGGS M.
Published: September 2002

Following clinical screening, we examined movement of the median nerve at the wrist using high-resolution (10–22 MHz) ultrasound in 16 controls and 12 patients with non-specific arm pain (also referred to as repetitive strain injury). Imaging was performed just proximal to the carpal tunnel with the wrist in neutral, 30 degrees of extension and 30 degrees of flexion. In control subjects the position of the median nerve was 4.8 (SE=0.4) mm more radial with the wrist flexed than with the wrist extended. In the twelve arm pain patients the average change was only 1.2 (SE=0.5) mm. It appears that ultrasound imaging may be helpful in diagnosing non-specific arm pain, a condition for which there are no well-defined diagnostic tests at present. The reduced nerve movement seen with ultrasound imaging confirms previous work with magnetic resonance imaging.
Risk of Neurovascular Injury with Limited-Open Carpal Tunnel Release: Defining the “Safe-Zone”
Authors: ATIK T. L. , SMITH B. , BARATZ M. E.
Published: September 2002

Limited-open carpal tunnel release was performed in ten cadaver arms using the “Safeguard” system. The “Safeguard” guide was intentionally placed off of the longitudinal middle/ring finger axis, either in 15° of radial deviation or 15° of ulnar deviation. Despite the errant placement, carpal tunnel release was performed without damage to any neurovascular structure. The proximity of neurovascular structures to the middle/ring finger axis was measured in all ten cadaver specimens. From this, a “safe-zone” was defined for endoscopic or limited-open carpal tunnel release. The “safe-zone” expands when surgery is performed from distal to proximal. The area of the “safe-zone” is greatest when a protective guide is placed between the bursal sac of the carpal canal and the flexor retinaculum.
Restoration of Tetraplegic Hand Function by Use of the Neurocontrol Freehand System
Authors: HOBBY J. , TAYLOR P. N. , ESNOUF J.
Published: September 2002

Nine tetraplegic patients with C5 or C6 level spinal cord lesions had the Freehand System, an eight channel Functional Electrical Stimulation device, implanted to allow of hand opening and grasp. This paper describes the surgical implementation of the system and the challenges encountered. Seven of the subjects are currently daily users of the device. One subject is unable to use the system due to disruption of bowel function when the system is used. A second subject suffered a lesion of the posterior interosseous nerve, but this was not thought to be related to system use. Additionally, one subject exhibited symptoms of autonomic dysreflexia, which were alleviated by reduction of the strength of the stimulus. Despite such problems, the Freehand system can significantly improve the functional ability of C5 and C6 lesion tetraplegics.
Nerve Regeneration Enhancement by Tourniquet
Authors: WIDERBERG A. , LUNDBORG G. , DAHLIN L. B.
Published: September 2002

The use of tourniquet compression as a non-invasive method to enhance axonal regeneration was assessed in the rat sciatic nerve. One hind limb of the rat was subjected to compression by a tourniquet set at 300 mmHg for 30 or 120 min followed by bilateral test crush lesions performed either directly or after a conditioning interval of 3 or 6 days, with the non-compressed side serving as a control. Axonal regeneration distances were evaluated after 3 days by the pinch reflex test. We found that compression caused an increased outgrowth length of sensory axons compared to the controls. The effect was most obvious after 120 min of compression with a conditioning interval of 6 days. Tourniquet compression has a conditioning lesion effect on peripheral nerve and may enhance nerve regeneration.
Surgery for Cerebral Palsy Part 3: Classification and Operative Procedures for Thumb Deformity
Authors: TONKIN M. A. , HATRICK N. C. , ECKERSLEY J. R. T. , COUZENS G.
Published: September 2002

Spastic thumb deformity is the result of imbalance between intrinsic and extrinsic forces acting across unstable joints. This paper presents a classification of spastic thumb deformity based on the accurate assessment of the deforming forces, outlines methods for their correction and reviews the results of our surgery. Thumb reconstruction procedures were performed in 32 patients with 33 spastic thumb deformities. All patients were assessed pre- and postoperatively using the same functional assessment system which was performed by the same team. The thumb was maintained out of the palm in 29 patients and lateral pinch was established in 26 patients.
Validity of Pulp-to-Palm Distance as a Measure of Finger Flexion
Authors: MACDERMID J. C. , FOX E. , RICHARDS R. S. , ROTH J. H.
Published: September 2002

This study investigated the validity of pulp-to-palm distance measures as clinical indicators of finger flexion capacity. Pulp-to-palm distance and goniometry of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints were measured by a single tester in 50 patients with abnormal digital flexion using a computerized hand assessment system. The correlation between pulp-to-palm distance measurements and total finger flexion measures obtained by goniometry, was moderate ( r = −0.46 and −0.51). This indicates that the measures are not interchangeable. The relationship between an upper extremity disability score (DASH) and restricted motion was stronger for the goniometric measurements ( r = 0.45, P<0.01) than for the pulp-to-palm distance measurements ( r<0.30, P>0.01). Both types of range of motion measurements were able to discriminate between minimal and substantial upper extremity disability. Further methodological evaluation is required to support the use of pulp-to-palm distance measures as an outcome indicator.
Flexor Tendon Anomalies in a Patient with Carpal Tunnel Syndrome
Authors: SLATER R. R.
Published: September 2002

A case of an anomalous interconnection between the tendons of the flexor pollicis longus and the flexor digitorum profundi to both the index and middle fingers at the wrist of a patient presenting with carpal tunnel syndrome is described. The contents of the carpal tunnel should be inspected carefully at the time of median nerve decompression in cases where preoperative clinical examination suggests associated pathologies.
Carpal Tunnel Syndrome: The Correlation between Outcome, Symptoms and Nerve Conduction Study Findings
Authors: LONGSTAFF L. , MILNER R. H. , O’SULLIVAN S. , FAWCETT P.
Published: September 2002

A retrospective study was performed on 62 patients who had undergone carpal tunnel decompression surgery. Each patient was assessed in clinic, their case notes were reviewed and their electrophysiological results were analysed and graded according to severity. The median preoperative duration of symptoms was 2 years. No relationship was found between the nature or duration of pre-operative symptoms and the severity of the electrophysiological impairment. Furthermore, no relationship could be identified between pre-operative nerve conduction impairment and either successful outcome of surgery (defined as complete symptom relief) or time to resolution of symptoms after surgery.
Vibration Damage to the Hand: Clinical Presentation, Prognosis and Length and Severity of Vibration Required
Authors: FRIDÉN J.
Published: September 2002

Exposure to vibrating hand-held tools can cause a variety of vascular and neuromuscular symptoms collectively named Hand–Arm Vibration Syndrome (HAVS). The clinical presentation of this syndrome includes paraesthesiae or tingling in digits, pain or tenderness in the wrist and hand, digital blanching, cold intolerance, weakness of the finger flexors or intrinsic muscles and discolouration and trophic skin lesions of the fingers. HAVS can be reversible, at least in the earlier stages, but resolution of symptoms is unusual in more severe cases, and continued use of vibrating tools in such cases is unwise. The duration of exposure needed to produce HAVS cannot be readily defined. This is due not only to different individual susceptibilities to vibration, but also to the different physical characteristics of the vibration exposure. There is a cumulative effect of vibration on both the vascular and sensorineural components of HAVS and these components appear to occur and progress independently of each other.
Congenital Isolated Upper Limb Hypertrophy with Hand Abnormality—A Report of 2 Cases
Authors: TEOH L. C. , YONG F. C. , GUO C. M.
Published: September 2002

Two cases of congenital isolated hypertrophy of the left upper limb with different hand deformities are described. A 4-year-old girl had splayed fingers and an abducted thumb due to anomalous muscles. Excision of these muscles corrected the deformity. The other, an 8-year-old boy, had severe ulnar drift of the fingers (windblown-like hand). He had corrective osteotomies of the second and third metarcarpals and reconstruction of the collateral ligaments. The deformity was corrected and at the latest follow up there was with no recurrence of the deviation. Both cases regained good hand function.
The Prespinal Route in Contralateral C7 Nerve Root Transfer for Brachial Plexus Avulsion Injuries
Authors: MCGUINESS C.N. , KAY S.P.J.
Published: September 2002

Contralateral C7 nerve root transfer for brachial plexus injury is described, passing the nerve through a subcutaneous tunnel on the anterior surface of the neck and chest. We recommend passing the nerve graft through the retropharyngeal space. This route has the benefits of a simpler dissection, a shorter distance and protected placement of the graft. It has been used in one clinical case.
Lateral Digital Photography with Computeraided Goniometry versus Standard Goniometry for Recording Finger Joint Angles
Authors: GEORGEU G. A. , MAYFIELD S. , LOGAN A. M.
Published: September 2002

This study compares the accuracy of computer-aided goniometry with standard goniometry. 109 finger joint angles at the extremes of flexion and extension were measured by a senior hand therapist using standard goniometry. Lateral digital photographs were then taken of the hands and the same angles were read from these by computer. There was good correlation ( r2=0.975) between the results. Computer goniometry averaged 1°(95%Cl=0°–+2°) more than the standard goniometry. We feel that computer goniometry of finger joints is accurate and compares well with standard goniometry.
Reconstruction of Finger Tip Amputations with Advancement Flap and Free Nail Bed Graft
Authors: SABAPATHY S. RAJA , VENKATRAMANI H. , BHARATHI R. , JAYACHANDRAN S.
Published: September 2002

Fifteen finger tip amputations through the proximal half of the nail bed were reconstructed with palmar V–Y advancement flaps and full thickness nail bed grafts. The undersurface of the V–Y flap was sutured to the nail bed remnant and the raw area was covered with full thickness nail bed grafts from the amputated part. They were followed for a minimum period of one year and the nail bed grafts took fully in all patients. The results were best in the thumb and least favourable in the little finger but all the patients were happy with the cosmetic result and the functional outcome. This technique results in an average gain of 5mm of extra length to the nail. This is a useful technique when replantation of a distal fingertip amputation is not possible.
An Anomalous Flexor Carpi Ulnaris
Authors: LEMON M. , BELCHER H. J. C. R.
Published: September 2002

We report a muscle with features suggesting an anomalous conjoined palmaris longus and flexor carpi ulnaris. To our knowledge this has not been described previously. In light of improved imaging techniques we question the previously published view that surgery is indicated for swellings suspected as forearm muscle anomalies that are clinically benign and otherwise asymptomatic.
A New Loop Suture Tie-Over Technique for Skin Graft Dressings
Authors: MISRA A. , BELCHER H. J. C. R.
Published: September 2002

Skin grafting is a well established technique for reconstructing areas of skin loss or excision in the hand. Traditional tie-over sutures often require operator assistance, do not allow adequate control when knotting and may cause unnecessary trauma to the graft when removed. We describe a new looped suture tie-over technique to secure and fix the graft dressings that is simple, quick, allows better knot-tying control and can be removed atraumatically.
Functional Outcome Following Excision of Tumours of the Distal Radius and Reconstruction by Autologous Non-Vascularized Osteoarticular Fibula Grafting
Authors: MARUTHAINAR N. , ZAMBAKIDIS C. , HARPER G. , CALDER D. , CANNON S.R. , BRIGGS T.W.R.
Published: September 2002

The distal radius and its articulations clearly have a vital role in the functional abilities of the hand and wrist. The treatment of tumours of the radius, therefore, needs to achieve satisfactory clearance of the lesions while also preserving as much wrist function as possible. We have employed osteoarticular autologous fibula grafts to reconstitute the distal radius after tumour excision. Since 1992, 13 patients have been treated by this technique for tumours of the distal radius. The group comprised patients with primary and recurrent giant cell tumours of bone, osteosarcoma, chondrosarcoma and Ewing’s tumour. This technique achieves a satisfactory functional result without compromise of the prognosis for the tumour.
Beware of the Ulno-Palmar Distal Radial Fragment
Authors: APERGIS E. , DARMANIS S. , THEODORATOS G. , MARIS J.
Published: September 2002

Five patients sustained isolated fractures of the ulnopalmar rim of the distal radius. In three cases the fragment was small and was classed as an avulsion fracture of the short radiolunate ligament. Palmar wrist subluxation occurred in all cases, four during treatment in a cast or splint. The ulnopalmar rim of the distal radius contributes to the stability of the radiocarpal joint and fractures in this region merit particular attention.
Compartment Reconstruction for De Quervain’s Disease
Authors: LITTLER J. W. , FREEDMAN D. M. , MALERICH M. M.
Published: September 2002

A new surgical treatment for De Quervain’s disease is presented, in which the anatomy and function of the first dorsal compartment is preserved. Our findings in 11 wrists in ten patients revealed complete relief of the pre-operative symptoms in all instances. The advantages of this technique are its ease, its restoration of normal anatomy, and the prevention of tendon prolapse.
MRI Susceptibility Artefacts Related to Scaphoid Screws: the Effect of Screw Type, Screw Orientation and Imaging Parameters
Authors: GANAPATHI M. , JOSEPH G. , SAVAGE R. , JONES A. R. , TIMMS B. , LYONS K.
Published: September 2002

Metal implants produce susceptibility artefacts in magnetic resonance imaging. We have explored the effects of scaphoid screw characteristics and orientation on MR susceptibility artefact. Titanium alloy, smallness and longitudinal alignment with the z-axis of the main magnetic field reduce the size of the susceptibility artefact.
Arthroscopy of the Proximal Interphalangeal Joints of the Finger
Authors: THOMSEN N. O. B. , NIELSEN N. S. , JØRGENSEN U. , BOJSEN–MØLLER F.
Published: September 2002

Cadaveric studies were carried out to evaluate the technique, portals and possible indications for arthroscopy of the proximal interphalangeal joints of the finger. We suggest horizontal placement of the hand instead of using a traction tower, as it is important to be able to flex the joint freely. The recommended arthroscopic portals are either between the central slip and the lateral bands of the extensor mechanism or between the lateral band and the collateral ligament. A blunt technique of introduction is used to avoid iatrogenic cartilage damage and possible digital nerve injury.
Glomus Tumour of the Hand
Authors: BHASKARANAND K. , NAVADGI B. C.
Published: September 2002

We report a series of 18 patients with pain in the thumb or finger tips who were diagnosed as having glomus tumour. Fourteen patients were found to have histopathologically proven glomus tumours, one had a neuroma and three had haemangioma. The duration of symptoms before treatment averaged 1.9 years. Cold-sensitivity and Hildreth’s tests have sensitivities of 100% and 77.4% respectively and specificity of 100%. Love’s pin test had a sensitivity of 100%. Love’s and Hildreth’s tests showed 78% accuracy, whereas the cold-sensitivity test was 100% accurate. We used a double-tourniquet technique during dissection and excision of the tumour. None of our patients experienced recurrence of symptoms during the post-operative follow up.
Metacarpal Descent, Definition and Normal Range
Authors: TUCKER S. C. , TITLEY O. G.
Published: September 2002

Metacarpal descent, an indication of carpometacarpal (CMC) joint mobility, was measured in 90 normal subjects by assessing the alignment of the metacarpal heads with the hand in a relaxed posture and when making a tight fist. Metacarpal descent was greater in women. Hand dominance was associated with an increase in positional angles but not metacarpal descent.
Assessment of Outcome of Carpal Tunnel Syndrome: A Comparison of Electrophysiological Findings and a Self-Administered Boston Questionnaire
Authors: HEYBELI N. , KUTLUHAN S. , DEMIRCI S. , KERMAN M. , MUMCU E. F.
Published: September 2002

The relationship between nerve conduction studies and the self-administered Boston Questionnaire that measures the severity of symptoms and functional status in carpal tunnel syndrome was assessed in 44 patients with idiopathic carpal tunnel syndrome. The patients were examined preoperatively and 3 and 6 months postoperatively. Although both the clinical outcome and electrophysiological findings improved significantly after surgery, we observed no correlation between improvements in nerve conduction and the questionnaire scores.