The Journal of hand surgery
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Randomized Controlled Trial
Standard open decompression in carpal tunnel syndrome compared with a modified open technique preserving the superficial skin nerves: a prospective randomized study.
A common surgical treatment for carpal tunnel syndrome is open carpal tunnel decompression. This involves skin incision followed by sharp dissection straight down through fat and palmar fascia to the transverse carpal ligament, which is then divided. The incidence of scar discomfort ranges from 19% to 61%, and its cause is not fully understood. We conducted a prospective randomized controlled trial to investigate whether preservation of superficial nerve branches crossing the incision site reduces the incidence and severity of postoperative scar pain after open carpal tunnel release. ⋯ Scar pain scores in this series of open carpal tunnel decompressions were similar, whether or not an attempt was made to identify and preserve superficial nerve branches crossing the wound.
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The ulnar nerve passes posterior to the medial epicondyle and experiences longitudinal strain when subjected to elbow flexion. Furthermore, Osborne's ligament and the arcade of fibers between the 2 heads of the flexor carpi ulnaris (Osborne's fascia) compress the nerve during elbow flexion with narrowing of the cubital tunnel passageway. Some patients experience the added element of nerve subluxation over the posterior edge of the epicondyle. ⋯ Transposition has been the most widely used method of treatment with the final position of the nerve lying subcutaneous, intramuscular, or submuscular. Each of the transposition methods has proponents with a variety of arguments made in favor of specific aspects of the surgery. This article presents a form of anterior transposition that seeks to draw the best elements from previously reported techniques with the goal of optimizing results.
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Surgical intervention may be necessary to treat unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint of the hand. One method of stabilization is open reduction and internal fixation (ORIF). The purpose of this study was to assess the outcomes of ORIF for unstable dorsal fracture-dislocations of the PIP joint using mini-screws via a volar approach. ⋯ Therapeutic IV.
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To present the results of various treatment modalities based on injury grade of radial collateral ligament (RCL) injuries to the index metacarpophalangeal (MP) joint. ⋯ The significance of this injury remains underestimated and requires a high index of suspicion. Stable injuries seen early should be treated with prompt immobilization. Casting may be more effective than a removable splint. Grade III injuries seen early could possibly be treated with cast immobilization though close follow up is mandatory as surgical repair may be necessary in the high demand hand. All Grade III injuries treated late yielded fair to poor results requiring tendon reconstruction or fusion with significant alteration in hand function.
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Clinical Trial
Revision of incompletely released trigger fingers by percutaneous release: results and complications.
Percutaneous trigger digit release has been reported as a safe, effective, and quick procedure, but most surgeons convert to an open method for residual triggering after percutaneous release. This study evaluates the safety and efficacy of repeated percutaneous release for patients who had residual triggering after the initial percutaneous release. ⋯ Therapeutic IV.