The Journal of hand surgery, European volume
-
The feasibility of hand transplantation has been demonstrated, both surgically and immunologically. Levels of immunosuppression comparable to regimens used in solid organ transplantation are proving sufficient to prevent graft loss. Many patients have achieved discriminative sensibility and recovery of intrinsic muscle function. ⋯ The recipient's pre-operative psychological status, his motivation and his compliance with the intense rehabilitation programme are key issues. While the induction of graft specific tolerance represents a hope for the future, immunosuppression currently remains necessary and carries significant risks. Hand transplantation should, therefore, only be considered a therapeutic option for a carefully selected group of patients.
-
J Hand Surg Eur Vol · Dec 2006
Randomized Controlled Trial Comparative StudyLocal anaesthesia for carpal tunnel decompression: a comparison of two techniques.
Carpal tunnel decompression is mostly performed as a day case procedure using local anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The intention of this study was to compare the efficacy of anaesthesia using these two techniques. ⋯ Pain was evaluated using the numerical rating pain scale (0-10). Six patients experienced intraoperative pain with the Gale technique, while none had pain with the Altissimi and Mancini technique (P = 0.02). The postoperative pain was not significantly different between the two groups, although the patients anaesthetised by the Altissimi and Mancini technique required significantly lower numbers of analgesic tablets.
-
J Hand Surg Eur Vol · Dec 2006
The clinical significance of the palmaris longus tendon in the pathophysiology of carpal tunnel syndrome.
Carpal tunnel syndrome is associated with increased intracarpal canal pressure. The effect of tendon loading on intracarpal canal pressures is documented in biomechanical studies. Palmaris longus loading in wrist extension induces the greatest absolute increase in intracarpal canal pressure. ⋯ Each subject was clinically examined for the presence of the palmaris longus tendon. The prevalence of palmaris longus agenesis was significantly lower in the carpal tunnel group. The palmaris longus tendon is a strong independent risk factor for carpal tunnel syndrome.
-
J Hand Surg Eur Vol · Oct 2006
Review Randomized Controlled Trial Meta AnalysisA comparison of traditional digital blocks and single subcutaneous palmar injection blocks at the base of the finger and a meta-analysis of the digital block trials.
A randomised, double-blinded, controlled trial was performed to compare traditional digital blocks with single subcutaneous palmar injection blocks at the base of the finger. A search for randomised controlled trials of digital blocks through MEDLINE, EMBASE, Cochrane Controlled Trials Register and CBM was conducted and a meta-analysis including the current trial was performed. ⋯ The meta-analysis suggests that traditional digital blocks and single subcutaneous palmar injection blocks are similar with regard to injection pain and are less painful than the transthecal digital block. The palmar techniques, including single subcutaneous palmar block and transthecal block, carry a risk of not anaesthetising the dorsum of the digit adequately, particularly the dorsum of the thumb and the proximal phalanx of the fingers.