bluuebunny/crossref_metadata_2025 huggingface dataset:
Uncommon Number and Distribution of the Pacinian Corpuscles in a Human Hand
Authors: ROSET-LLOBET J. , DOMENECH-MATEU J. M.
Published: June 2005

We describe some rare findings seen when dissecting the hands of a 65-year-old male cadaver. Very many lamellated (Pacinian) corpuscles were distributed all over the palms of both hands. They were normal in structure, but their size was greater (8 mms. in length and 5 mms. across) than the normal (2 mms. in length and 100–500 μms. across). Each lamellated corpuscle had only one nervous pedicle.
Controlled Study of the Use of Local Steroid Injection in the Treatment of Trigger Finger and Thumb
Authors: LAMBERT M. A. , MORTON R. J. , SLOAN J. P.
Published: June 2005

A controlled double-blind prospective study of injection of methylprednisolone acetate plus local anaesthetic against a control injection of a local anaesthetic in the treatment of trigger finger and thumb has shown a 60% success rate for the steroid injection against 16% for the control group (p < 0.05). This is the first controlled trial of local steroid therapy in this condition.
The Recovery of Sensation and Function after Cross-Finger Flaps for Fingertip Injury
Authors: NISHIKAWA H. , SMITH P. J.
Published: June 2005

Over a five-year period, 54 patients had cross-finger flaps at Mount Vernon Hospital for single fingertip injuries. A retrospective study was carried out to evaluate the recovery of sensation and function. 92% of the patients were satisfied with the result although 53% suffered cold sensitivity. All the cross-finger flaps tested had diminished sweating and a raised threshold for electrical stimulation. Despite the presence of protective sensation, dynamic sensory discrimination and the return of advanced Aβ fibre innervation, none of the cross-finger flaps was found to have recovered tactile gnosis.
Mixed Sclerosing Bone Dystrophy Presenting with upper Extremity Deformities
Authors: OSTROWSKI D. M. , GILULA L. A.
Published: June 2005

We present a detailed study of a 59-year-old white woman with mixed sclerosing bone dystrophy: the rare occurrence of two or more sclerosing bone dysplasias in a single subject. She exhibited features of osteopoikilosis, osteopathia striata and melorheostosis. The symptoms were primarily the result of the melorheostosis lesions which were distributed within the C 6 sclerotome. This is an unusual case of mixed sclerosing bone dystrophy in that the upper extremity was the main site of involvement, instead of the usual symmetrical involvement of all limbs. The patient developed a recalcitrant lateral epicondylitis in the un-involved contralateral elbow that required surgical treatment.
The Sauvé-Kapandji Procedure for Chronic Dislocation of the Distal Radio-Ulnar Joint with Destruction of the Articular Surface
Authors: NAKAMURA R. , TSUNODA K. , WATANABE K. , HORII E. , MIURA T.
Published: June 2005

The Sauvé-Kapandji procedure has been performed in 15 non-rheumatoid patients with chronic distal radio-ulnar joint dislocation accompanied by joint damage or deformity. The clinical results were favourable; wrist pain improved in all patients, wrist flexion-extension was increased by more than 10° in nine patients, grip strength of at least 80% of the contralateral wrist was achieved in 11 patients, and forearm rotation was more than 150° in 12 patients. However, X-ray examination revealed an unstable proximal ulnar stump and radio-ulnar convergence in all patients similar to that associated with the Darrach procedure. Although the Sauvé-Kapandji procedure can preserve ulnar support of the wrist and is believed to yield more satisfactory results than the Darrach procedure, its extensive use is not recommended for non-rheumatoid distal radio-ulnar joint disorders, but it is recommended for chronic distal radio-ulnar joint dislocation with articular injury or deformity.
The Chauffeur’s Fracture: Simple or Complex?
Authors: HELM R. H. , TONKIN M. A.
Published: June 2005

14 chauffeur’s-type fractures were treated by open reduction and internal fixation, mainly with Herbert screws. At average follow-up of 18 months, all had good or excellent functional results. The presence of an associated carpal injury in four cases indicates that the mechanism of injury may not be one of simple “backfire” and that a radial styloid fracture may represent the first stage of a more complex pattern.
Ulnar Collateral Ligament Repair of the Metacarpo-Phalangeal Joint of the Thumb: A Study Comparing Two Methods of Repair
Authors: SAETTA J. P. , PHAIR I. C. , QUINTON D. N.
Published: June 2005

25 patients were assessed following repair of an acutely ruptured ulnar collateral ligament of the thumb metacarpo-phalangeal joint. The patients were divided into two groups, repaired by either a horizontal mattress suture using 4/0 polybutylate (nine patients), or a pre-fashioned steel wire (16 patients). Assessment included a physical examination and functional testing at a mean of 12.9 months (range 4–36 months) after the operation. Both techniques were equally effective, and the use of the more expensive steel wire, while technically satisfying and easy to perform, offers no clinical advantage over simple suture. This pre-fashioned steel wire is, however, recommended in those cases with an avulsion fracture or where distal avulsion of the ligament is associated, since the technique allows easy secure reduction.
Quantifying Interdigital Web Morphology
Authors: SHEWELL P. C. , NANCARROW J. D. , FATAH F.
Published: June 2005

A new method for the measurement of the interdigital webs of the hand is described and is shown to be reproducible. Measurements are taken from photographs and the method would be suitable for the comparison of post–operative appearances in the evaluation of “web creep” after surgery.
The Incidence of Gout in Patients with Dupuytren’s Disease
Authors: ADAM R. F. , LOYNES R. D.
Published: June 2005

In a retrospective study we found that the incidence of gout in patients with Dupuytren’s disease is 3.5%. The mean serum uric acid was 330 umol/l. (5.5 mg./100 ml.) in men and 240 umol./l. (4.0 mg./ 100 ml.) in women. The rate of hyperuricaemia was 7%. These are not significantly higher than the expected figures in Britain.
The Sequelae of Osteomyelitis of the Proximal Ulna Occurring in Early Childhood
Authors: HELM R. H. , PHO R. W. H. , TONKIN M. A.
Published: June 2005

Three patients presented with upper limb problems caused by the loss of the proximal ulnar shaft due to osteomyelitis which occurred in early childhood. The three patients had several features in common: instability of the elbow, dislocation of the radial head and shortness and bowing of the forearm, but hand and wrist function were largely unaffected. One patient had evidence of impaired function of the posterior interosseous nerve, presumably a traction injury. The treatment of these problems is discussed. In one patient, a child who had a functioning ulno-humeral joint, successful reconstruction of the ulna using a vascularised fibular graft was possible.
Osteoid Osteoma of the Radial Styloid Mimicking Stenosing Tenosynovitis
Authors: FROMM B. , MARTINI A. , SCHMIDT E.
Published: June 2005

An osteoid osteoma of the styloid process of the radius mimicking de Quervain’s tenovaginitis in a 28-year-old man is reported. As the clinical presentation and X-rays of the wrist were not typical of an osteoid osteoma, only the histological examination led to the correct diagnosis.
Specificity of Muscle Reinnervation following Repair of the Transected Sciatic Nerve
Authors: ZHAO Q. , DAHLIN L. B. , KANJE M. , LUNDBORG G.
Published: June 2005

Specificity of muscle reinnervation and the recovery of muscle contractility were studied after repair of the transected rat sciatic nerve. Six different techniques were compared: epineurial suture, perineural suture, whole nerve graft, interfascicular grafts, skeletal muscle bridge and tubulization. Muscle tetanic force and specificity of reinnervation were evaluated 12 weeks after nerve repair. Recovery of tetanic force was superior after repair with epineurial sutures. There was no statistical significance between the other methods in respect of tetanic force. The specificity of muscle reinnervation was best after tubulization, repair with interfascicular grafts and perineurial suture.
Variation of Holding Strength of Synthetic Absorbable Flexor Tendon Sutures with Time
Authors: MASHADI Z. B. , AMIS A. A.
Published: June 2005

This study examined the potential use of absorbable polytrimethylene carbonate (Maxon) sutures for tendon surgery. Flexor tendons of the third toe of 48 chickens were transected and sutured, then evaluated both mechanically and histologically at 0, five, 15 and 45 days after operation. Mechanical testing showed that the suture kept its strength long enough to unite tendon ends. However, high tissue reactivity of polytrimethylene carbonate during its dissolution caused adhesions.
Pisiformectomy in Young Patients
Authors: TRAIL I. A. , LINSCHEID R. L.
Published: June 2005

Pisotriquetral arthrosis in young patients is considered rare and the diagnosis may be difficult to distinguish from other ulno-carpal problems. 12 patients under 40 years of age (15 cases) who underwent pisiformectomy were reviewed at a mean of 41 months. Patients with a good history of trauma and a positive response to intra-articular local anaesthetic injection did well. Others with an indefinite history and bilateral symptoms did not do so well. Trispiral tomography is the radiological investigation of choice.
Congenital Palmar Nail Syndrome
Authors: RIDER M. A.
Published: June 2005

Two patients are described who have a congenital ectopic nail on the little finger associated with absent flexion in this finger. One patient was treated by surgical excision of the nail.
Opponensplasty by Extensor Indicis and Flexor Digitorum Superficialis Tendon Transfer
Authors: ANDERSON G. A. , LEE V. , SUNDARARAJ G. D.
Published: June 2005

From 1977 to 1988, 166 patients with median nerve paralysis of varied aetiology underwent opponensplasty. In 50 of these the extensor indicis was used, and in 116 the flexor digitorum superficialis of the ring finger. An analysis of these hands showed that the EI opponensplasty was best in supple hands and FDS opponensplasty was more suitable for less pliable hands. There were fewer complications seen after FDS opponensplasty if the detachment of the donor tendon was done through a volar oblique incision rather than the conventional lateral incision.
Flexor Digitorum Superficialis Tendon Transfer for Intrinsic Replacement
Authors: BRANDSMA J. W. , OTTENHOFF-DE JONGE M. W.
Published: June 2005

This study is a review of 127 hands in 100 patients in whom one or two FDS tendons were used to correct claw-hand deformity and/or loss of opposition of the thumb. In lumbrical replacement the results were graded as excellent in 16 hands (21%) and good in 43 hands (57%). For opponensplasty the results were excellent in 26 hands (32%) and good in 42 hands (51%). Possible defects that can develop in the donor finger are: swan-neck deformity, flexion posture of the DIP joint, not as part of the swan-neck deformity, check-rein deformity or flexion contracture, and insufficient finger flexion. Of the 158 fingers swan-neck deformity was seen in 15%, DIP flexion in 29%, check-rein deformity in 26% and insufficient finger flexion in 18%. The latter occurred with another defect. In 48 fingers (30%) no defects were observed.
Long-Standing Extended Dynamic Splintage and Release of an Abnormal Restraining Structure in Camptodactyly
Authors: MIURA T. , NAKAMURA R. , TAMURA Y.
Published: June 2005

62 patients with camptodactyly of the little finger have been reviewed, and only five cases failed to respond to conservative treatment. These cases are reported. One patient could straighten the deformed PIP joint with snapping, and the other two were resistant to conservative treatment and were found to have a restraining structure requiring release. These findings are in keeping with an imbalance between flexion and extension forces due to long-standing malposition of the extensor lateral bands. Operative treatment should be reserved for cases of failed conservative treatment, which should be started as early as possible.
Acrylic Resin Finger Prosthesis
Authors: SCHMAMAN J. , CARR L.
Published: June 2005

A technique is described for the prosthetic replacement of two fingers using acrylic resin. Retention was obtained using finger rings. The stages of the technique are outlined. Advantages and disadvantages are briefly stated.
Rupture of Extensor Tendons due to Osteoarthritis of the Distal Radio-Ulnar Joint
Authors: CARR A. J. , BURGE P. D.
Published: June 2005

Extensor tendons ruptured in 12 patients as a result of osteoarthritis of the distal radio-ulnar joint. Rupture occurred without warning in ten cases and was sequential in five. Perforation of the dorsal capsule of the distal radio-ulnar joint, allowing contact between the roughened ulnar head and extensor tendons, was present in every case. The capsular performation was demonstrated by arthrography, which may be used to identify patients who are at risk of extensor tendon rupture. Loss of independent extension of the little finger is a valuable clinical sign because rupture of extensor digiti minimi may be masked by a powerful contribution from the extensor tendon of the ring finger.
Man’s Hand in Evolution
Authors: Harvey Kemble J. V.
Published: June 2005

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.
The Presence of Myofibroblasts in the Dermis of Patients with Dupuytren’s Contracture
Authors: McCANN B. G. , LOGAN A. , BELCHER H. , WARN A. , WARN R. M.
Published: June 2005

Samples of skin and underlying cord obtained at dermofasciectomy for Dupuytren’s contracture have been examined for the presence of smooth muscle α-actin (SM α-actin), a marker for myofibroblasts. 15 of the 20 samples stained positively for SM α-actin corresponding with areas of hypercellular Dupuytren’s tissue. In 12 of these 15 samples SM α-actin-positive hypercellular Dupuytren’s tissue extended into the dermis, in three cases reaching the epidermis. In eight samples, diffusely distributed cells positive for SM α-actin and resembling fibroblasts were seen in the dermis. These cells appeared to be separate from the Dupuytren’s foci. The presence of hypercellular foci and isolated fibroblasts positive for SM α-actin within the dermis may explain the high recurrence rate of Dupuytren’s disease after fasciectomy.
Aetiology of Kienböck’s Disease Based on a Study of the Condition among Patients with Cerebral Palsy
Authors: JOJI S. , MIZUSEKI T. , KATAYAMA S. , TSUGE K. , IKUTA Y.
Published: June 2005

Examination of 110 patients with cerebral palsy revealed a diagnosis of Kienböck’s disease in six wrists in five cases. All had cerebral palsy of the mixed type with athetosis and high muscle tone. It is considered that the increased prevalence of Kienböck’s disease in these cases was attributable to repeated minor trauma to the lunate from childhood due to high muscle tone across the wrist joint, together with negative ulnar variance. The high prevalence of Kienböck’s disease observed in patients with cerebral palsy strongly suggests that repeated minor trauma together with negative ulnar variance is also the cause of Kienböck’s disease in normal individuals.
Bilateral Anomalous Insertion of Flexor Pollicis Longus
Authors: NAKAMURA J. , KUBO E.
Published: June 2005

A case of bilateral insertion of flexor pollicis longus to the proximal as well as the distal phalanges is reported. Initially, this case was diagnosed as congenital absence of the flexor pollicis longus, but surgery revealed an intact tendon, with the abnormality only present in the site of insertion. A survey of the literature on congenital abnormalities of flexor pollicis longus failed to reveal any reports of similar abnormalities.
A New Technique for Mismatched Nerve Suture in Direct Intercostal Nerve Transfers
Authors: OCHIAI N. , MIKAMI Y. , YAMAMOTO S. , NAKAGAWA T. , NAGANO A.
Published: June 2005

We introduce a new suturing technique for intercostal nerve transfer in brachial plexus injuries. This method allows the anastomosis of nerves of unequal diameter.
Paronychia: a Mixed Infection
Authors: BROOK I.
Published: June 2005

Cultures of paronychia of the fingers have grown aerobic and anaerobic bacteria. Each was recovered individually in only about a quarter of the patients and a mixed aerobic/anaerobic flora was isolated in half of the patients. The predominant anaerobic organisms were Gram-positive anaerobic cocci, Bacteroides species and Fusobacterium species. The predominant aerobic organisms were Staphylococcus aureus, gamma-haemolytic streptococci, Eikenella corrodens, group A beta-hemolytic streptococci, alpha-hemolytic streptococci, and Klebsiella pneumoniae. Candida albicans was recovered in about 15% of the cases. The management of this infection is discussed.
Resection of a Periosteal Osteosarcoma and Reconstruction Using the Ilizarov Technique of Segmental Transport
Authors: STOFFELEN D. , LAMMENS J. , FABRY G.
Published: June 2005

The reconstruction of a large diaphyseal bone defect is a surgical challenge. Autologous bone grafts are usually insufficient to bridge the gap and allografts are prone to infection and may pose problems with internal fixation. Another solution is presented for the reconstruction of a large ulnar defect due to tumour resection, using the Ilizarov technique of segmental transport.
Arthroscopic Diagnosis of Scapho-Lunate Instability in the Absence of X-Ray Abnormalities
Authors: DAUTEL G. , GOUDOT B. , MERLE M.
Published: June 2005

26 patients with at least one clinical symptom that could indicate a tear of the scapho-lunate interosseous ligament but normal static and dynamic radiographs were examined by arthroscopy. We found that a diagnosis of scapho-lunate instability could be established by dynamic manoeuvres during radio-carpal and mid-carpal arthroscopy. Five patients were found to have true scapho-lunate instability. Six tears of the interosseous ligament without instability were also detected but it was doubtful if the tear was the origin of the painful symptomatology. This experience suggests that dynamic manoeuvres during arthroscopy are superior to other methods in diagnosing scapho-lunate instabilities at the pre-radiographic stage.
Articular Fractures of the Digits: A Prospective Study
Authors: SHIBATA T. , O’FLANAGAN S. J. , IP F. K. , CHOW S. P.
Published: June 2005

We report a prospective study of 92 articular fractures of the digits. The treatment protocol was based on functional stability and acceptable alignment rather than on joint congruity. 54% of patients had good results, with 22% fair and 24% poor results being recorded. These results are similar to reports of treatment of finger fractures in general and suggest that for articular fractures of the digits, stability and alignment are more important factors than joint congruity in determining short-term outcome. Compound fractures and those associated with comminution, significant soft tissue damage and marked displacement at presentation have a worse prognosis.
Cutaneous Malignant Peripheral Nerve Sheath Tumour (Mpnst) of the Hand: A Review of Current Literature
Authors: COADY M. S. E. , POLACARZ S. , PAGE R. E.
Published: June 2005

Malignant peripheral nerve sheath tumours (MPNST) are spindle cell sarcomas normally situated in the deep soft tissues. Cutaneous MPNST is an uncommon variant, usually occurring in the head and neck. When it arises in the upper limb this tumour may pose a considerable diagnostic and therapeutic problem. We present a case of cutaneous MPNST arising in the hand. Tumour extension was exclusively perineural along three major nerve trunks from an interdigital origin. Current knowledge of the clinical behaviour of cutaneous MPNST is reviewed.
Skin Tumours of the Hand
Authors: CHAKRABARTI I. , WATSON J.D. , DORRANCE H.
Published: June 2005

A 10-year retrospective study was performed in order to determine the incidence, distribution, histological type and behaviour of skin tumours of the hand that were referred to a regional Plastic Surgery unit. 85 patients were studied and 98 malignant or pre-malignant lesions identified. The majority were squamous cell carcinomas in male manual workers. Recurrence after excision was seen only in lesions greater than 1.5 cm in diameter. The overall incidence of squamous cell carcinoma of the hand (requiring surgical excision) was seen to be five cases per million per year.

Other skin tumours were rare.
Demineralized Bone Powder
Authors: WHITEMAN D. , GROPPER P. T. , WIRTZ P. , MONK P.
Published: June 2005

The results of 20 consecutive cases of bone defects of the hand treated by curettage and implantation of demincralized bone powder compare well with a similarly matched retrospective group managed with autogenous grafts and curettage alone. Results revealed “excellent” (16 patients) or “good” bone healing (4 patients) in the bone powder group on independent radiographic evaluation. Bone bridging was noted at an average of 9.9 weeks. All defects healed without recurrence, resorption or refracture, with follow-up of 4 to 36 months. In the conventionally managed retrospective group there was a 25% failure rate necessitating re-operation. Demineralized bone powder provides a rapid, safe and effective method of management of bone defects of the hand.
Bennett’s Fracture Combined with Fracture of the Trapezium
Authors: GARCIA-ELIAS M. , HENRÍQUEZ-LLUCH A. , ROSSIGNANI P. , FERNANDEZ DE RETANA P. , DE ELÍZAGA J. OROVIO
Published: June 2005

Three cases are reported in which open reduction and internal fixation were required to stabilize an unstable first carpometacarpal joint with simultaneous fracture of the trapezium and Bennett’s fracture. The results were good in terms of range of movement and radiological appearance, all of them returning to normal activities, including heavy manual work.
Improved Results in Zone 2 Flexor Tendon Injuries with a Modified Technique of Immediate Controlled Mobilization
Authors: KARLANDER L-E. , BERGGREN M. , LARSSON M. , SÖDERBERG G. , NYLANDER G.
Published: June 2005

The results following primary and delayed primary repair in zone 2 flexor tendon injuries were evaluated in 85 fingers of 79 patients using immediate controlled mobilization post-operatively. In 31 patients a conventional Kleinert technique was used. In the remaining 48 patients a modified technique was used with rubber band traction to all fingers instead of only to the injured one. Also a shorter dorsal splint was used in order to secure extension of the PIP and DIP joints. The results were improved and the time of treatment was reduced.
Skyline View of the Metacarpal Head in the Assessment of Human Fight-Bite Injuries
Authors: EYRES K. S. , ALLEN T. R.
Published: June 2005

With the fingers extended, the severity of the bony injury from human fight-bite injuries can be underestimated or missed. We describe a “skyline view” of the metacarpal head to highlight the intra-articular damage that can occur.
Radiological Measurement of Radial Shortening in Colles’ Fracture
Authors: WARWICK D. , PROTHERO D. , FIELD J. , BANNISTER G.
Published: June 2005

100 consecutive patients with Colles’ fracture were assessed functionally three months after the injury, and the result correlated with initial shortening of the radius. Three methods were used to measure radial shortening; only the one that measured the distance from distal radial to distal ulnar surfaces correlated with functional outcome. It is concluded that this is the most valid method of measurement and the deficiencies of the other methods are discussed.
Anatomical Risk Factors for Keinböck’s Disease
Authors: TSUGE S. , NAKAMURA R.
Published: June 2005

Contralateral unaffected wrists from 41 males with Kienböck’s disease were compared with wrists from 66 normal males. From X-rays, various features of the lunate and radius were measured. In patients with Kienböck’s disease, the lunate tended to be smaller and inclined more radially than in normal subjects and the radial inclination was flatter. Discriminant analysis showed that 85% of the unaffected contralateral wrists in patients with Kienböck’s disease and 74% of the wrists in normal subjects were accurately discriminated to their respective groups. It may be possible to identify subjects who are at risk for Kienböck’s disease prior to onset using discriminant analysis.
Bilateral Pyoderma Gangrenosum of the Hand: Treatment with Dapsone
Authors: BROWN R. E. , LAY L. , GRAHAM D.
Published: June 2005

The first reported case of bilateral pyoderma gangrenosum of the hands is presented. One lesion was treated with wound care only, with spontaneous healing after two months. The contralateral lesion which occurred one month later was treated with wound care and oral dapsone. Healing occurred between four and six weeks after the start of dapsone. It is suggested that this acts by limiting the necrotizing process, thus allowing earlier epithelialization.

Pyoderma gangrenosum is rare, and treatment is non-surgical. It is important that it is recognized to avoid extension of the necrotizing process through ill-advised surgery.
Grip Strength and Hand Position of the Dynamometer in 204 Finnish Adults
Authors: HÄRKÖNEN R. , PIIRTOMAA M. , ALARANTA H.
Published: June 2005

A primary purpose of this study was to establish data on hand strength by Jamar dynamometer for normal Finnish adults aged 30 to 50 years. A second aim was to find out how five various breadths of grip affect the strength value. A sample of 103 male and 101 female adults, aged 19 to 62, from the southern part of Finland were tested using standardized positioning and instructions.

Male and female subjects reached the highest grip strength using the third handle breadth of dynamometer, except females over 50 years. Female grip strength was 60% to 70% less than male grip strength. There was no significant difference in strength between dominant and non-dominant hands.
Silastic Implants of the Scaphoid and Lunate
Authors: EGLOFF D. V. , VARADI G. , NARAKAS A. , SIMONETTA C. , CANTERO C.
Published: June 2005

39 implant replacement arthroplasties were reviewed with a mean follow-up of 13 years. The study includes nine cases of partial replacement of the proximal pole of the scaphoid, 16 cases of total replacement of the scaphoid and 14 cases of replacement of the lunate. In 33 cases the conventional silicone elastomer (CSE) was used and in six the high performance elastomer (HP). Subjective, clinical and radiological evaluations gave different results. Respectively the results were excellent in 41, 23 and 5%, satisfactory in 41, 49 and 39% and poor in 18, 28 and 56% of the cases. Lytic lesions in carpal and/or pericarpal bones were present in all except two cases. Study of the X-rays chronologically revealed that they increased in number and size. Six cases had their implant removed. All had histologically proven silicone synovitis. A major secondary operation has been performed or is foreseen in all cases except one. We do not recommend implant replacement arthroplasty for the scaphoid or the lunate bone.
Posterior Interosseous Nerve Paralysis Related To Focal Radial Nerve Constriction Secondary to Vasculitis
Authors: HASHIZUME H. , INOUE H. , NAGASHIMA K. , HAMAYA K.
Published: June 2005

A case of posterior interosseous nerve paralysis is reported with discussion of some characteristics that appear to distinguish it from entrapment neuropathy and neuralgic amyotrophy. The surgical implications are also discussed. More than ten similar cases have been reported, but the pathogenesis of this condition is still controversial. The patient presented with posterior interosseous nerve paralysis related to focal radial nerve constriction secondary to vasculitis in the perineurium. The constriction site was resected and the radial nerve was sutured. The patient recovered completely after 8 months.
The Corkscrew Sign in Hypothenar Hammer Syndrome
Authors: HAMMOND D. C. , MATLOUB H. S. , YOUSIF N. J. , SANGER J. R.
Published: June 2005

Arteriography of an adult manual labourer presenting with numbness and cold intolerance in the middle and ring fingers of the right hand demonstrated filling defects in the digital arteries of these two fingers associated with a corkscrew-like configuration of the ulnar artery in Guyon’s canal. This arterial segment was subsequently excised revealing intramural necrosis and fibrosis and non-occlusive intraluminal thrombosis. An arteriogram performed 2 years previously for an unrelated condition revealed a similar but less pronounced corkscrew configuration of the artery, suggesting that this finding could be a marker for arterial injury which may eventually lead to embolization or thrombosis with accompanying ischaemic symptoms.
Amputations in the Treatment of Dupuytren’s Disease
Authors: JENSEN C. M. , HAUGEGAARD M. , RASMUSSEN S. W.
Published: June 2005

23 finger amputations in 19 patients operated on for Dupuytren’s disease were reviewed 6 months to 8.5 years after operation (mean 4 years). The distribution of amputations were 17 little fingers and six ring fingers.

We found a recurrent lack of extension in nine out of 16 finger amputations distal to the MP joint and painful neuroma or phantom limb pain in five out of seven little finger amputations through or proximal to the MP joint.

When amputation in the little finger is necessary, disarticulation of the MP joint may be preferable to amputation at a more distal level.

Alternatives to finger amputation should be sought in difficult cases of Dupuytren’s disease.
The Ulnar Neurovascular Bundle at the Wrist
Authors: COBB T. K. , CARMICHAEL S. W. , COONEY W. P.
Published: June 2005

The boundaries of Guyon’s canal have recently been redefined by a series of anatomical dissections. These showed that the confines of this space do not extend from the pisiform to the hook of the hamate, as currently accepted. The fascial roof extends radial to the hook of the hamate, which allows the ulnar neurovascular bundle to course radial to the hamate hook. The position of the ulnar nerve and artery is of particular significance for endoscopic carpal tunnel release. Most endoscopic devices are designed to divide the flexor retinaculum just to the radial aspect of the hamate hook. Utilizing cross-sectional analysis of nine cadaver specimens, we found the ulnar artery to course radial to the hamate hook in five and palmar to it in four. Therefore, the ulnar artery may be at greater risk of injury during endoscopic procedures than previously recognized.
Serial Overnight Recordings of Intracarpal Canal Pressure in Carpal Tunnel Syndrome Patients with and without Wrist Splinting
Authors: LUCHETTI R. , SCHOENHUBER R. , ALFARANO M. , DELUCA S. , DE CICCO G. , LANDI A.
Published: June 2005

In 15 carpal tunnel syndrome patients pressure was measured during the day and at 2-hourly intervals from midnight to 6 a.m., via a catheter introduced into the carpal canal, using the constant infusion technique. Intracarpal tunnel pressure of the patients always exceeded the critical pressure of 30 mmHg and the highest values were found at 6 a.m. Slightly lower pressures were found when the wrist was splinted, but the difference was not significant, nor were critical pressure levels prevented by splinting.
Distribution of the Sensory Endings of the C7 Nerve Root and Its Clinic Significance
Authors: GU Y-D.
Published: June 2005

50 patients with root avulsion of the brachial plexus have been treated with contralateral C7 root neurotization. Abnormal cutaneous sensation was found on the index finger in 37 cases (74%), on the middle finger in 29 cases (58%), on the thumb in 19 cases (38%), on the ring finger in ten cases (20%), and on the little finger in one case (2%). Seven patients had no abnormal cutaneous sensation. It is suggested that the area of skin innervated by C7 is centred on the index finger together with the thumb and middle fingers.
The Role of Ultrasound in the Management of Zone 1 Flexor Tendon Injuries
Authors: CORDUFF N. , JONES R. , BALL J.
Published: June 2005

We have reviewed 22 flexor tendon repairs in zone 1 undertaken in Hobart, Tasmania, during the period 1986 to 1991. The repairs were assessed using both ultrasound and Strickland’s clinical criteria. The results are presented, and the two methods of assessment compared. A new method of grading results is proposed based on the ultrasound findings.

We have demonstrated that ultrasound has an important role to play in assessing tendon repairs, both in the on-going management and as an objective method of measuring the results of repair.
The Central Slip Tenodesis Test for Early Diagnosis of Potential Boutonnière Deformities
Authors: SMITH P. J. , ROSS D. A.
Published: June 2005

Disruption of the central slip is the primary defect leading to boutonnière deformity. In the closed injury early diagnosis of this lesion is rarely achieved due to the limitations of current methods and difficulties encountered in assessing a painful finger. We describe a simple, non-invasive method of diagnosis which can be carried out on all patients and with minimal discomfort. This test is also beneficial in monitoring the progress of conservative management of central slip disruption.
Tubular Repair of the Median Nerve in the Human Forearm
Authors: LUNDBORG G. , ROSÉN B. , ABRAHAMSON S. O. , DAHLIN L. , DANIELSEN N.
Published: June 2005

Transected median nerves in the forearm of two male patients, 12 and 21 years of age, were treated with a chamber technique leaving a 3 to 5 mm gap between the nerve ends. The nerve ends were enclosed in a silicone tube of such a dimension that would not cause compression of the nerve. Post-operative examination including sensory evaluation and assessment of muscle contraction force was carried out after 3 years. In both cases there was excellent motor recovery of the thenar muscles. Outgrowth of sensory fibres was remarkably fast, resulting ultimately in functional sensibility allowing almost normal hand function. 2PD was ⩽ 6 mm (12year-old patient) and 8 to 10 mm (21-year-old patient) respectively. In one case the silicone tube was re-explored because of minor local discomfort 2 years after the repair. The former gap was bridged by a smooth continuous nerve-like structure of the same diameter as the adjacent nerve trunk and with no signs of nenroma formation or compression of the nerve.
Significance of Incomplete Release of The Distal Portion of The Flexor Retinaculum
Authors: COBB T.K. , COONEY W.P.
Published: June 2005

Endoscopic carpal tunnel release has been shown in recent studies to result in a significant number of incomplete releases of the distal aspect of the flexor retinaculum. The significance of this complication is unknown. To address this question, we measured the amount of carpal arch widening after incomplete and complete release. The mean amount of change in carpal arch width in five cadaveric hands after partial release (all but the distal 4 mm) was 0.74 mm, which was statistically significant. The mean additional change after release of the remaining 4 mm of the flexor retinaculum was 0.12 mm, which was not significant. Incomplete release of the distal 4 mm of the distal aspect of the flexor retinaculum allows carpal arch widening that is no different from that of complete sectioning of the flexor retinaculum in the cadaver limb.
The Effect of Caffeine on Digital Haemodynamics
Authors: BARTON B. , KLEINERT J. M.
Published: June 2005

Caffeine has been shown to increase mean blood pressure, but studies documenting the effect of caffeine on digits are lacking. We evaluated the effect of caffeine on digital blood pressure and pulse volume in normal volunteers.

In the first part of the study, 24 subjects were given water containing either 200 mg of caffeine or placebo. Bilateral brachial and middle finger digital pressures were measured at room temperature before ingestion and at 30 and 60 minutes after ingestion. In the second part of the study, pulse volume recordings (PVRs) were obtained in 24 subjects at the level of the distal phalanx of the middle finger of one hand immediately prior to beverage ingestion and at 10 minute intervals for 90 minutes. Differences in mean digital systolic pressure, digital/brachial index, or PVR amplitude between the control and caffeine groups were not statistically significant. The administration of caffeine was found not to alter the haemodynamics of digital blood flow or digital pressure in this population.
Traction Radiographs in the Diagnosis of Chronic Wrist Pain
Authors: FORTEMS Y. , MAWHINNEY I. , LAWRENCE T. , STANLEY J. K.
Published: June 2005

A sensitive non-invasive diagnostic test for intrinsic ligament rupture in patients with chronic wrist pain has still to be found. Differential displacement of the scaphoid, lunate and triquetrum can in some instances be seen during arthroscopy of acute wrist injuries and also on overdistraction of distal radial fractures with an external fixator.

We performed a prospective study on 20 patients with chronic wrist pain using 2 kg and 5 kg traction radiographs without and with the addition of an ischaemic block, to assess differential displacement as a diagnostic criterion for intrinsic ligament rupture.

Arthroscopy was used as arbiter of diagnosis. The sensitivity ranged from 14% to 57% and the specificity ranged from 53.7% to 100% according to the amount of traction and ischaemic block. In view of these poor results we conclude the stretch test has no additional value in the preoperative assessment of chronic wrist pain.
Avascular Necrosis of the Hamate
Authors: TELFER J. R. C. , EVANS D. M. , BINGHAM J. B.
Published: June 2005

Avascular necrosis of the hamate is a rare condition, only one case having been reported in the literature (Van Demark and Parke, 1992). This reflects the relative rarity of fractures of the body of the hamate and the arrangement of the intraosseous vascular anatomy. A case is presented, which was diagnosed by MR Imaging and treated surgically.
Rolling Belt Injuries in Children
Authors: ADA S. , BORA A. , ÖZERKAN F. , KAPLAN I. , ARIKAN G.
Published: June 2005

The rolling belts on argicultural machinery attract children who unconsciously grab them. The injuries produced include friction burns, injuries to flexor tendons, digital nerves and arteries, skin in Zone 2 and fractures. Subtotal or total amputation may occur.

We present the results of such injuries to 44 fingers in 16 children aged 1 to 9. The functional results are not satisfactory. In order to grade the results we have devised a classification to this injury. The survival rate for all fingers was 71%, but in the fingers with circulatory problems the survival rate was 50%. On functional assessment seven patients had a good result, seven moderate, and two fair.
Soft Tissue Calcification in Children with Terminal Transverse Defects of the Upper Limb—Is it Tumoral Calcinosis?
Authors: ITOGA H. , JONES J. M. , HOOPER G.
Published: June 2005

We report five children with tranverse defects of the upper limb who developed calcified deposits at the distal end of the limb. The lesions were excised from two children and had the typical histological appearance of tumoral calcinosis but on clinical grounds it is unlikely that this is the same condition as that previously described as tumoral calcinosis.
Tumoral Calcinosis Associated with Congenital Malformations of the Hand
Authors: EVANS D. M. , LEWIS J. S.
Published: June 2005

Two cases of tumoral calcinosis are reported in children with congenital hand malformations. After excision of large calcific masses, reconstruction was performed using a free phalangeal graft in one case and a free toe transfer in the other.
A Medieval Casebook: Hand Cures Documented in the Icelandic Sagas of Bishops
Authors: WHALEY D. C. , ELLIOT D.
Published: June 2005

The Sagas of Icelandic bishops composed in and around the 13th century reveal something of the incidence and treatment of various hand conditions in the medieval period. A selection from the relevant material is translated and discussed.
A Homodigital Reverse Pedicle Island Flap in Soft Tissue Reconstruction of the Finger and the Thumb
Authors: NIRANJAN N. S. , ARMSTRONG J. R.
Published: June 2005

A single stage homodigital reverse pedicle island flap is described for the repair of volar or dorsal tissue loss on the finger or thumb. Donor site morbidity is minimal, and the length of the digit is preserved. Satisfactory function results in 25 patients are presented.
Handedness and Hand Injuries
Authors: BEATON A. A. , WILLIAMS L. , MOSELEY L. G.
Published: June 2005

Data are reported from a study of 1,003 patients attending with hand injuries at an Accident and Emergency Department. Among both left- and right-handers, injuries to the right hand were more common than to the left hand, except for accidents to right-handers at work. For this group there were more injuries to the left hand. Male and female patients differ in the frequency with which they present for medical attention but show similar types of injury.
Migration of Silicone Rods
Authors: WILSON G. R. , WATSON J. S.
Published: June 2005

Two cases of migration of silastic rods into the forearm after the first stage of flexor tendon grafting are reported. A CT scan shows the rods well if they are not visible on a plain X-ray. Possible factors involved in distal detachment of the rods are the composition of the tendon spacer, method of distal fixation, method of proximal fixation and the time between the stages of reconstruction.
The A1 Pulley in Rheumatoid Flexor Tenosynovectomy
Authors: de JAGER L. T. , JAFFE R. , LEARMONTH I. D. , HEYWOOD A. W. B.
Published: June 2005

We report a detailed comparative evaluation of flexor tenosynovectomy in 55 fingers in which the A1 pulley was divided and 45 fingers in which the A1 pulley was retained. The metacarpophalangeal joint subluxed volarly in 49% when the A1 pulley was divided, compared to 11% when the pulley was preserved. Bowstringing occurred in 7% and only when the A1 pulley was divided. Ulnar deviation was 7° worse when the pulley was divided. Active range of movement was limited in both groups. It was 11° less when the A1 pulley was divided.
Complications of the Use of the Harrison–Nicolle Intramedullary Peg in Digital Arthrodesis
Authors: TAYLOR M. F. S. , SPENCER J. D.
Published: June 2005

The Harrison–Nicolle Intramedullary Peg is used for the arthrodesis of digital joints. We report our experience of complications found using this peg in a series of 16 arthrodeses. At review after an average of 2.9 years, three cases had been revised. Only five of the remaining 13 cases showed a bony fusion and in only two of these five was the fusion in an acceptable position. In nine cases the joint became straight or extended; the preset angle of the peg did not determine the final angle of the arthrodesis. In five cases the tips of the peg appeared to be eroding through bone.
The Histopathology of Fibrous Flexor Sheath Ganglia
Authors: LAWSON G. M. , SALTER D. M. , HOOPER G.
Published: June 2005

In order to determine if fibrous flexor sheath ganglia had any histological features that could distinguish them from other ganglia, we reviewed 50 consecutive ganglia treated by surgical excision. Of these, eight were fibrous flexor sheath ganglia. They did not have any specific features to distinguish them from the other ganglia. Furthermore, an absence of true synovial lining in them refutes the theory that they may result from synovial herniation around the A1 pulley.
The Use of Patterned Neuromuscular Stimulation to Improve Hand Function Following Surgery for Ulnar Neuropathy
Authors: PETTERSON T. , SMITH G. P. , OLDHAM J. A. , HOWE T. E. , TALLIS R. C.
Published: June 2005

A 60-year-old man with wasting and weakness of the right hand following ulnar nerve entrapment at the elbow was referred for electrotherapy. An ulnar nerve transposition had been performed 2 years previously. This had produced some improvement in nerve conduction without significantly improving hand muscle function.

The right first dorsal interosseous muscle (FDI) was stimulated for 4 hours per day over a 6-week period with a stimulus pattern replicating the discharge of a single motor unit from a healthy, fatigued FDI (patterned neuromuscular stimulation or PNMS). The response was assessed using a single case design. Significant improvements in the strength and fatigue resistance of the FDI were observed, associated with improvements in general hand function.

PNMS may be useful in restoring hand function in patients with muscle atrophy following entrapment neuropathy.
Kienböck’s Disease, Early Stage 3––Height Reconstruction and Core Revascularization of the Lunate
Authors: BOCHUD R. C. , BÜCHLER U.
Published: June 2005

Early stage 3 Kienböck’s disease has been treated by inner débridement, recontouring, height reconstruction, bone grafting and core revascularization of the lunate; additional procedures included temporary external fixation of the wrist and/or shortening osteotomy of the radius in selected cases.

26 patients, representing an uninterrupted series of 28 procedures, were followed-up for an average of 6.7 years (range 2.5–9.3 years) with periodic clinical and radiographic evaluations until they reached the final comprehensive assessment that included trispiral tomography and MRI.

Every patient was subjectively improved, pleased with the result and able to resume his previous job. Pain intensity, rated on a zero to five scale, improved from 2.5 points pre-operatively to a final score of 0.8 points. Wrist motion gained slightly. Grip strength improved significantly. Lunate reconstruction proved successful in 37% of the cases; in an additional 23%, the disease process was stabilized. Carpal height decreased 4.7%; ulnar translation was not substantially altered. Arthrosis increased postoperatively in 55%, remained unchanged in 36% and progressed in 9%.

Overall, 43% good and excellent, 43% fair and 14% poor results were observed.
Congenital Unilateral Muscle Hyperplasia of the Hand with Ulnar Deviation of the Fingers
Authors: LANZ U. , HAHN P. , VARELA C.
Published: June 2005

Three cases of congenital unilateral muscular hyperplasia of the hand combined with ulnar deviation of the fingers are presented. In all three patients the deformity was confined to the right upper extremity, and there were no other associated congenital malformations. All patients displayed anomalous or hyperplastic musculature acting on the proximal phalanges of the fingers, contributing to the associated ulnar drift of the hand. This condition is previously unreported, and is a different entity from the previously described “windblown hand”.
Clinical Signs in Scaphoid Fractures
Authors: WAIZENEGGER M. , BARTON N. J. , DAVIS T. R. C. , WASTIE M. L.
Published: June 2005

In a prospective study we investigated 12 clinical features for scaphoid fractures in 52 patients: 23 in whom a fracture of the scaphoid was diagnosed radiologically and 29 patients in whom a fracture was clinically suspected but could not be confirmed by radiography or scintigraphy. The signs were tested within a few days of injury and again 2 weeks later. None was reliable in diagnosing a scaphoid fracture.
Acute Compression Fracture of the Scaphoid
Authors: GIDDINS G. E. B. , WILSON-MACDONALD J.
Published: June 2005

A previously unreported radiological sign of a sclerotic margin to an acute displaced scaphoid fracture due to bone compression is reported. This should to be recognized because of the implied bone loss and hence risks of both mal-union and non-union, and because of the implication that volar compression fractures of the scaphoid, may occur.