The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Jun 2004
Mechanical evaluation of the Pronator Teres rerouting tendon transfer.
We simulated pronator teres rerouting using a three-dimensional biomechanical model of the arm. Simulations comprised the evaluation of changes in muscle length and the moment arm of pronator teres with changes in forearm axial rotation and elbow flexion. The rerouting of Pronator Teres was simulated by defining a path for it through the interosseous membrane with re-attachment to its original insertion. ⋯ The effect on total internal rotation and external rotation capacity was determined by calculating the potential moments for pronator teres, supinator, pronator quadratus, biceps brachii and brachioradialis. Pronator teres was found to be a weak internal rotator in extreme pronation, but a strong internal rotator in neutral rotation and in supination. After rerouting pronator teres was only a strong external rotator in full pronation and not at other forearm positions, where the effect of rerouting was comparable to a release procedure.
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We reviewed 22 patients who had undergone either carpal tunnel decompression or release of Dupuytren's contractures while anticoagulated with warfarin. All patients continued with their usual anticoagulant regime over the period of operation, provided that the international normalized ratio (INR) was 3 or less. There was no abnormal intraoperative or postoperative bleeding in any patient. Journal of Hand Surgery (British and European volume, 2004).
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A case of high-temperature, high-pressure injection injury of the hand is reported. The injury is particularly severe in that it involves both a high-temperature thermal insult and a pressure effect, either of which, alone, can result in major disability. It is evident that the high temperature of the injected material considerably reduced the pressure required for penetration of the tissues.
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J Hand Surg Eur Vol · Feb 2004
Randomized Controlled Trial Comparative Study Clinical TrialRandomized trial of buffered versus plain lidocaine for local anaesthesia in open carpal tunnel decompression.
We performed a randomized double-blind case-control study in 64 consecutive patients undergoing open carpal tunnel decompression under local anaesthetic to assess the pain experienced on injection of plain lidocaine (pH 6.4) compared with lidocaine buffered with sodium bicarbonate (pH 7.4). The results showed no statistical difference in the pain scores reported by patients. The mean pain scores for all patients were low, and most patients reported that they were "not at all anxious" about receiving a similar injection in the future.