The Journal of hand surgery
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Twenty-two patients with carpal tunnel syndrome scheduled to have a carpal tunnel release, and six volunteer control subjects had carpal tunnel pressures measured with their wrist in neutral position, maximum flexion, and maximum extension. The wrist was then repetitively flexed and extended to maximum position at a rate of 30 full cycles per minute for 1 minute. ⋯ The pressures were found to be significantly elevated in the immediate post-exercise period in the patients with carpal tunnel syndrome, and they demonstrated a prolonged recovery time to reach the resting pressure when compared with the normal control subjects. This property of prolonged recovery time in patients with carpal tunnel syndrome suggests a possible cause for carpal tunnel syndrome in the occupational setting.
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Randomized Controlled Trial Comparative Study Clinical Trial
Bupivacaine: a safe local anesthetic for wrist blocks.
Seventy-one patients having minor hand surgical procedures under wrist block anesthesia were studied, with the goal of identifying a possible neurotoxic potential of bupivacaine when used according to standard clinical practice. This drug was compared with lidocaine at equipotent analgesic concentrations (bupivacaine: 5 mg/ml; lidocaine: 20 mg/ml) by use of a double-blind randomized protocol. ⋯ In the remaining patient, anesthesia was induced with lidocaine, and no cause could be identified. It was concluded that bupivacaine, when used in clinical concentrations, is not associated with an increased incidence of neural complications.
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An injury to the dorsal aspect of the metacarpophalangeal joint of a finger usually damages the sagittal fibers of the extensor tendon mechanism. Rupture of the underlying joint capsule, a far more serious injury, has received scant attention in the medical literature. ⋯ Eight dorsal capsular ruptures are described in six patients who had closed direct trauma to either the knuckle of their index or long fingers. Most of the injuries occurred in professional boxers.
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In standard anatomy textbooks the course and distribution of the medial antebrachial cutaneous nerve and its branches are glossed over in a vague fashion as if they are of little importance. There are, however, clinical circumstances in which a knowledge of the anatomy of this nerve is invaluable. ⋯ The medial antebrachial cutaneous nerve is also frequently used in nerve grafting, especially in brachial plexus reconstruction, in which it is beneficial to know the available length and size of donor nerve. Fifty fresh cadaveric arms were dissected to define the course, distribution, size, and branches of the nerve.