The Journal of hand surgery
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To evaluate the efficacy of arthroscopic repair of the triangular fibrocartilage complex (TFCC) tears treated within 4 months after injury, functional outcome after repair was determined following arthroscopic repair in 24 patients. The patients' average age was 31 years (range, 22-38 years); the average follow-up period was 34 months (range, 26-48 months). All patients had wrist pain limiting their participation in work prior to surgery. ⋯ Postoperatively, there was a significant relief of pain (p < .01). Postoperative range of motion averaged 89% +/- 9% SD of the contralateral side, and grip strength averaged 85% +/- 20% SD of the contralateral side. Thirteen of the 19 patients returning to work did so in their original jobs.
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Comparative Study
Injection versus surgery in the treatment of trigger finger.
One hundred nine trigger fingers in 102 patients were reviewed with respect to management plan and response to treatment. Thirty-four digits eventually underwent surgical release of the A1 pulley, while the other 75 digits were treated with local steroid injection only. All patients were evaluated with respect to clinical resolution of symptoms, dollar cost of treatment, and general satisfaction as measured with a post-treatment questionnaire. ⋯ Although surgical release of the A1 pulley cost our Medicare patients $250.00 more than a second injection, this additional cost may be offset by the benefit conferred through permanency of relief. Subjective data from the patient questionnaire responses also support surgery as a reasonable choice after one injection failure. The information from this study better delineates differences between injection and surgery as treatment choices and may aid the patient and physician in choosing an individually optimal care plan.
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Case Reports
Superficial radial nerve compression following flexor digitorum superficialis opposition transfer: a case report.
A patient is reported with a lesion of the radial branch of the superficial radial nerve following opposition transfer. The ring finger flexor digitorum superficialis slip was responsible for the neural compression near its thumb insertion.
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An anatomic study was performed to better delineate the extensor tendons of the index finger. Seventy-two cadaver hands were dissected. Classically, a single slip of the extensor digitorum communis (EDC) and a single slip of the extensor indicis proprius (EIP) are said to run to the index finger. ⋯ Thirteen hands (19%) showed anatomic variants of the EIP and EDC tendons at the level of the metacarpal head, differing from the classic description. Additionally, two hands showed aberrant tendons. A knowledge of these variants when performing tendon repair or EIP transfer is necessary.
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Thirteen consecutive transmetacarpal replantations and revascularizations in 12 patients were reviewed retrospectively. Ten patients (11 hands) sustained crush injuries, 1 withstood an explosive blast, and 1 suffered a guillotine amputation. Nine revascularizations (1 thumb and 31 fingers) and 4 replantations (1 thumb and 16 fingers), including bilateral procedures in 1 patient, were performed. ⋯ Only 1 patient resumed his prior occupation (as supervisor); 2 were permanently disabled, 3 pursued new and unrelated occupations, 2 were still in therapy, and 4 were lost to late follow-up evaluation. None of the manual laborers (11 patients) were able to return to their preinjury livelihood. Despite these discouragingly poor results, all patients were satisfied with the surgery.