The Journal of hand surgery
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Entrapment of the sesamoids within the metacarpophalangeal joint can result in irreducible dislocations; however, dysfunction from trauma-induced, chronic sesamoiditis is unfamiliar. Twenty-five patients with intractable posttraumatic pain of the metacarpophalangeal joint of the thumb are reported. ⋯ Residual joint stiffness was present in 20% of patients, and 8% had significant residual pain. Traumatic microtears appear to produce pathologic findings in the perisesamoid tendon and/or sesamoid-metacarpal articulation.
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Arthrosis of the trapeziometacarpal joint of the thumb is a predictable sequelae of ligament laxity. A new technique of tendon interposition arthroplasty with ligament reconstruction using the flexor carpi radialis tendon for a painful arthritic trapeziometacarpal joint of the thumb is described. Twenty-one patients had 25 operative procedures; 14 were women and seven were men. ⋯ Follow-up averaged 37 1/2 months. After surgery, 91.7% of patients had good to excellent results, and 56% were completely pain free. Range of motion and grip and pinch strengths were equal on the operated and unoperated sides.
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Continuous regional anesthesia through a catheter placed in the axillary sheath has been an effective method of brachial plexus neural blockade. This article confirms this observation and demonstrates that continuous axillary block is useful in replantation surgery to provide anesthesia and analgesia in addition to sympathetic blockade for up to 7 days after operation. This anesthetic technique may allow extensive revascularization or replantation procedures to be performed for patients who could not safely tolerate prolonged application of general anesthesia.
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Pigmented villonodular synovitis of the wrist joint invading adjacent bones rarely occurs. A case in which synovitis invaded the carpal and metacarpal bones at the ulnar aspect of the wrist is described. The invasion of multiple bones by the tumor and its histologic hypercellularity in this case caused concern because of its aggressive behavior. However, review of the literature on pigmented villonodular synovitis arising at the wrist and invading adjacent bones and follow-up of our patient confirmed its benign character.
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Case Reports
Symptomatic palmar tendon subluxation after surgical release for de Quervain's disease: a case report.
Palmar subluxation of the abductor pollicis longus and extensor pollicis brevis tendons developed in a 50-year-old woman after total excision of the first dorsal compartment sheath for de Quervain's disease. Conservative therapy did not improve her symptoms and surgical reconstruction of the first dorsal compartment from a slip of extensor retinaculum was performed. The patient was asymptomatic 1 year after surgery, with no evidence of subluxation or recurrence of de Quervain's disease. This complication can be avoided by leaving a palmarly based flap of extensor retinaculum to prevent palmar subluxation of the tendons with wrist flexion.