The Journal of hand surgery
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Socioeconomic pressures on medicine have redefined traditional relationships between physicians and patients, researchers and regulatory bodies, and consultants and device companies. Physicians are disheartened that the public perception of medicine, reinforced by the media, is often negative. ⋯ Although both groups have clear codes defining the ethical interaction between them, expediency and loose adherence to those guidelines has been problematic. In a climate of skepticism, the house of medicine needs to reverse and not feed that skepticism.
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Comparative Study
Comparison of needle position proximity to the median nerve in 2 carpal tunnel injection methods: a cadaveric study.
Steroid injections are commonly performed by hand surgeons for relief of symptoms associated with carpal tunnel syndrome. The purpose of this study is to examine the relationship of the needle to the median nerve within the carpal tunnel and to the palmar cutaneous branch, using 2 injection techniques. ⋯ Physicians must exercise caution when performing carpal tunnel injections to avoid intraneural injection. The needle was a statistically significant shorter distance to the median nerve with the traditional injection method; however, the alterative method risks injury to the palmar cutaneous branch of the median nerve.
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We investigated the effect of severity and form of mutilating hand injuries on functional recovery and return to work, and the usefulness of an injury-severity score in predicting these outcomes. ⋯ Given the current surgical care of patients with mutilated hand injuries, HISS determined at the time of injury can adequately predict functional outcome and return to work status. Larger studies will be necessary to validate these findings.
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Comparative Study
Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome.
To determine retrospectively whether the technique of ulnar nerve transposition (subcutaneous versus submuscular) is associated with clinical sensory and motor recovery in cubital tunnel syndrome, and whether recovery is influenced by prognostic factors such as preoperative McGowan stage, age, and duration of symptoms. ⋯ Sensory and motor recovery for patients with McGowan stages II and III of cubital tunnel syndrome were similar following submuscular and subcutaneous transposition techniques, and patients with symptoms lasting longer than 6 months had a worse prognosis regardless of surgical technique.
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Promethazine injections have led to necrosis and gangrene of the distal upper extremity when inadvertently injected into an artery. There have been few case reports of this alarming complication in the literature. We report on 2 cases of intra-arterial promethazine injection that led to amputation.