The Journal of hand surgery
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Case Reports Clinical Trial
Limited surgical treatment of de Quervain's disease: decompression of only the extensor pollicis brevis subcompartment.
A septum between the abductor pollicis longus tendon and the extensor pollicis brevis (EPB) tendon in the first extensor compartment is frequently encountered during surgical treatment of de Quervain's disease. It was hypothesized that de Quervain's disease was secondary to EPB entrapment and the decision was made to decompress only the EPB subcompartment. Twenty-two patients were treated with this method. ⋯ The results of Finkelstein's test were negative in all cases. We conclude that de Quervain's disease is secondary to EPB entrapment. In those cases with a septum, it is sufficient to decompress only the EPB subcompartment.
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In this study, psychometric principles were used to develop an outcomes questionnaire capable of measuring health state domains important to patients with hand disorders. These domains were hypothesized to include (1) overall hand function, (2) activities of daily living (ADL), (3) pain, (4) work performance, (5) aesthetics, and (6) patient satisfaction with hand function. An initial pool of 100 questions was pilot-tested for clarity in 20 patients; following factor analysis, the number of questions was reduced to a 37-item Michigan Hand Outcomes Questionnaire (MHQ). ⋯ The MHQ is a reliable and valid instrument for measuring hand outcomes. It can be used in a clinic setting with minimal burden to patients. The questions in the MHQ have undergone rigorous psychometric testing, and the MHQ is a promising instrument for evaluation of outcomes following hand surgery.
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Carpal kinematics during a wrist flexion/extension motion using high-speed videodata acquisition was investigated. A cadaver forearm was stabilized, allowing unconstrained excursion of the wrist for passive range of motion (ROM). The extensor and flexor pairs of the wrist were looped together and a 1-lb weight was attached to each pair, simulating synergistic muscle tension. ⋯ It shows that during wrist flexion/extension, normal carpal kinematics does not have an ISA fixed in or limited to the capitate. In addition, the ISA data provide evidence that translational motion is a real and measurable component of normal carpal motion. These findings alter the understanding of carpal kinematics obtained from the results of previous studies which suggested that the center of rotation was fixed in the capitate.
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Multicenter Study
Wide excision of the distal ulna: a multicenter case study.
Excision of the distal ulna to treat degenerative disease or instability has fallen into disfavor following reports of radioulnar impingement, carpal instability, and distal ulnar instability. Alternative procedures for reconstruction of the painful distal ulna have been developed to address these problems; the results have been generally favorable. When faced with distal ulnar reconstruction that has failed after multiple surgical procedures, or a distal ulnar neoplasm, the surgeon is left with few treatment options. ⋯ Grip strength was restored to 75% of the normal side and range of motion was restored to 86% of the normal side. Wide excision of the distal ulna without soft tissue reconstruction is a simple and durable treatment of neoplasms of the distal ulna or salvage of the failed reconstruction of the distal radioulnar joint. We do not recommend its use in patients with incompetency or disruption of the interosseous membrane.
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Case Reports
Pathologic fracture of the scaphoid due to enchondroma: treatment with vascularized bone grafting. report of a case.
Enchondroma of the scaphoid has been rarely reported. A young male manual worker presented with a pathologic fracture on the lesion. It was successfully managed with a vascularized bone graft from the dorsum of the distal radius.