Hand (New York, N.Y.)
-
Magnetic resonance arthrography (MRA) has become the preferred modality for imaging patients with internal derangement of the wrist. However, several aspects of MRA use need to be clarified before a standardized approach to the imaging of internal derangement of the wrist can be developed. The objective of the study is to evaluate the efficiency of different magnetic resonance (MR) sequences in the detection of lesions of the triangular fibrocartilage complex (TFCC) and scapholunate and lunotriquetral ligaments on direct MRA. ⋯ Noncommunicating defects of the ulnar attachments of the triangular fibrocartilage (TFC), tears of the dorsal segment of the SLL, and defects at the lunate attachment of the SLL have a higher likelihood of being symptomatic and caused by trauma rather than by degenerative perforation. Although no consensus exists, it would appear that most arthrographies should be started with a radiocarpal injection. Injection into the distal radioulnar joint should be added if no communicational defects are visualized following radiocarpal injection in patients with ulnar-sided wrist pain.
-
Hand (New York, N.Y.) · Mar 2009
Ultrasound-assisted percutaneous trigger finger release: is it safe?
Trigger fingers can be treated by open or percutaneous division of the A1 pulley. The open approach allows for visualization of the pulley, the tendon, and the adjacent neurovascular bundles. The percutaneous trigger finger release (PTFR) lacks an incision and is thought to lead to a quicker recovery, but the safety and efficacy of this blind procedure are often questioned. ⋯ The subsequent dissection revealed three out of 18 tendons with visible lacerations and 15 out of 18 A1 pulleys with incomplete division. We concluded that ultrasound-guided PTFR can be complicated by flexor tendon lacerations, potential injury to neurovascular bundles, and incomplete division of the A1 pulleys. While the clinical significance of these findings is unclear to us, it does raise questions regarding the safety and efficacy of percutaneous trigger finger release, even when adding ultrasound guidance.
-
Hand (New York, N.Y.) · Mar 2009
Motor nerve transfers to restore extrinsic median nerve function: case report.
Active pronation is important for many activities of daily living. Loss of median nerve function including pronation is a rare sequela of humerus fracture. Tendon transfers to restore pronation are reserved for the obstetrical brachial plexus palsy patient. ⋯ Clinically evident motor function was seen at 4 months postoperatively and continued to improve for the following 18 months. The patient has 4+/5 pronator teres, 4+/5 flexor pollicis longus, and 4-/5 index finger flexor digitorum profundus function. The transfer of the extensor carpi radialis brevis branch of the radial nerve to the pronator teres and supinator branch of the radial nerve to the anterior interosseous nerve is a novel, previously unreported method to restore extrinsic median nerve function.