Hand clinics
-
It is safe to say that in situ decompression of the ulnar nerve in cubital tunnel syndrome has been demonstrated to achieve equivalent functional results when compared with more elaborate techniques, such as decompression with nerve transposition. The evolution toward procedures associated with less patient morbidity is reflected by the introduction of endoscopic techniques for the treatment of cubital tunnel syndrome. ⋯ Although the skin incision can frequently be kept to a minimum (<2 cm), superior visualization associated with this approach allows for in situ decompression of the ulnar nerve along a distance of up to 30 cm. Despite the extent of decompression performed, operative morbidity is minimal, with return to full duty being the rule even in manual laborers within 10 to 14 days postoperatively.
-
Open surgery has been indicated as the surgical treatment for trigger finger for many years; however, minimally invasive techniques are replacing conventional methods. Minimally invasive techniques enable early recovery of the patient with minimal damage to soft tissues. The authors’ study showed that levels of effectiveness of open surgical and percutaneous methods were superior to those of the conservative method using corticosteroid based on the cure and reappearance rates of the trigger. Percutaneous pulley release for treating trigger finger is a safe, effective, and minimally invasive surgical alternative.
-
Bone healing is a complex process that can be influenced by both host and environmental factors. In this article, we review the biology involved in the regeneration of new bone after fracture, and factors influencing bone healing, including diabetes, smoking, NSAID use, and bisphosphonates.
-
Metacarpal fractures are common, and many can be managed nonoperatively with appropriate reduction and immobilization. As with any hand fracture, the primary goals are to achieve anatomic and stable reduction, bony union, and early mobilization to minimize disability. Appropriate treatment requires a keen understanding of the types of fractures, their inherent stability, and the available treatment options. Functional outcomes depend on appropriate treatment and early range of motion whenever possible.
-
Neuromas primarily arise from iatrogenic injury, trauma, or chronic irritation. Given the disabling symptoms of neuromas, an array of treatment strategies exist, with varied results. Successful treatment relies on accurate identification of the offending nerve, containment of the regenerating fascicles, and cessation of mechanical or other noxious stimuli over the regenerating nerve end. The choice of treatment depends in part on the nerve affected, whether it involves critical or noncritical sensation, and its location.