Hand (New York, N.Y.)
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Hand (New York, N.Y.) · May 2020
Prospective Randomized Study Examining Preoperative Opioid Counseling on Postoperative Opioid Consumption after Upper Extremity Surgery.
Background: Rates of opioid addiction and overdose continue to climb in the United States, increasing pressure on prescribers to identify solutions to decrease postoperative opioid consumption. Hand and upper extremity surgeries are high-volume surgeries with a predilection for inadvertent overprescribing. Recent investigations have shown that preoperative opioid counseling may decrease postoperative opioid consumption. ⋯ Conclusion: Patients receiving preoperative counseling consumed significantly fewer opioids postoperatively. Inadvertant overprescribing remains high. Routine use of preoperative counseling should be implemented along with prescribing fewer opioids overall to prevent overprescribing.
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Hand (New York, N.Y.) · May 2020
Steroid Injection and Open Trigger Finger Release Outcomes: A Retrospective Review of 999 Digits.
Background: Open surgical release of the A1 pulley is the definitive treatment for the common hand condition of trigger finger, or inflammatory stenosing tenosynovitis. Anecdotal evidence among hand surgeons has questioned whether or not recent steroid injection may be related to complications following open trigger finger release, particularly wound infection, but no studies have primarily studied this connection to date. We aimed to determine whether recent steroid injection was associated with postoperative surgical infections. ⋯ Conclusions: Steroid injection, smoking, increasing age, lesser number of days between steroid injection and surgery, and use of lidocaine with epinephrine are risk factors for postoperative trigger surgical infections. We recommend careful preoperative counseling regarding higher wound healing risks for smokers, avoidance of steroid injections immediately prior to an operative date, and scheduling operative dates that tend to be greater than 80 days from the date of last steroid injection. We also recommend avoidance of epinephrine in the local anesthetic solution, as this may minimize surgical site infection risks.
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Hand (New York, N.Y.) · Mar 2020
Randomized Controlled TrialNonsurgical Treatment of De Quervain Tenosynovitis: A Prospective Randomized Trial.
Background: De Quervain tenosynovitis is commonly seen in patients who perform repetitive wrist ulnar deviation with thumb abduction and extension. Previous studies comparing nonsurgical options have contributed to a lack of consensus about ideal management. This study's purpose was to analyze results in prospectively randomized patients treated with either corticosteroid injection (CSI) alone versus CSI with immobilization. ⋯ Between groups, outcomes were comparable except for resolution of radial-sided wrist pain, which was superior in patients with CSI alone (100% vs 64%). Conclusions: Immobilization following injection increases costs, may hinder activities of daily living, and did not contribute to improved patient outcomes in this study. Further prospective studies are warranted.
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Hand (New York, N.Y.) · Mar 2020
Patients With Triangular Fibrocartilage Complex Injuries and Distal Radioulnar Joint Instability Gain Improved Forearm Peak Pronation and Supination Torque After Reinsertion.
Background: Forearm peak pronation and supination torque measurements are reduced up to 30% in patients with triangular fibrocartilage complex (TFCC) 1B injuries with concomitant distal radioulnar joint (DRUJ) instability. The aim of our study was to evaluate whether patients with TFCC 1B injuries, with concomitant DRUJ instability, improve in forearm peak pronation and supination torque following TFCC reinsertion surgery where postoperative DRUJ stability was achieved. Methods: We report a retrospective case series with short-term follow-up (20 months) of the postoperative forearm peak torque in pronation and supination in 11 patients (9 women/2 men, average age at surgery 32 years) operated on by TFCC reinsertion. ⋯ Functional postoperative improvement was noted in all patients, with reduced pain, good satisfaction, and acceptance of the surgery and the final result. Conclusion: We conclude that patients with TFCC injuries and DRUJ instability gain improved forearm peak pronation and supination torque after reinsertion. We also conclude that forearm peak pronation and supination torque is a valuable tool in the preoperative diagnostics of TFCC injuries with DRUJ instability as well as in the postoperative follow-up.
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Hand (New York, N.Y.) · Mar 2020
Performance of Pediatric PROMIS CATs in Children With Upper Extremity Fractures.
Background: This study was designed to quantify the performance of the pediatric Patient-Reported Outcome Measurement Information System (PROMIS) when delivered as part of routine care to children with upper extremity (UE) fractures. Methods: This cross-sectional study analyzed 964 new pediatric patients presenting with an UE fracture. All patients completed PROMIS computer adaptive tests for pain interference, peer relationships, UE function, and mobility domains at clinic registration. ⋯ After grouping by fracture type, parent-proxy completion estimated worse UE function, more pain interference, and worse peer relationship. Conclusions: Pediatric PROMIS UE function scores capture impairment from UE fractures but do have a strong positive correlation with pediatric PROMIS Mobility, which assesses lower extremity function. Among children with UE fractures, parent-proxy completion of pediatric PROMIS appears associated with worse scores on most PROMIS domains.