The distance between the distal margin of the flexor retinaculum and the radiocarpal joint as a landmark in CTS surgery: A cadaver study.

BACKGROUND: The most frequent peripheral entrapment neuropathy is compression of the median nerve in the carpal tunnel, known as carpal tunnel syndrome. The most effective treatment is surgery, where the flexor retinaculum (FR) is divided. Nevertheless, after this operation, a significant number of patients suffer from persistent symptoms due to incomplete FR distal release. It may be difficult to identify the distal boundary of the FR due to the minimal skin incision. We aimed to identify an anatomical landmark to avoid incomplete distal FR release. The radiocarpal (RC) joint can be palpated, and lies in close proximity to the boundaries of the FR. Thus, the distance between the RC joint space and the distal FR margin - the RC-FR distance - could be a reliable and individual morphologic measurement from easily acquired regional anthropological measurements. METHODS: During this study, 39 radiocarpal regions of 23 embalmed cadavers were dissected, and measurements were taken. Linear regression corresponding to the ulnar length and the RC-FR distance was established. RESULTS: The mean RC-FR distance from the RC joint space to the distal FR margin was 3.8 cm (95 % CI 3.5-4.0), and the range was 2.3-5.1 cm. This distance was 1.1 cm (95 % CI 0.8-1.4) longer in males than in females (p < 0.00001), and there were no side-specific differences. The individual projection of the distal FR margin in centimeters can be calculated by measurement of the ipsilateral ulnar length divided by 4 and reduced by 2.9, p < 0.005. CONCLUSIONS: The side-equal and sex-specific position of the distal flexor retinaculum margin could be calculated from the palpable radiocarpal joint space based on the ipsilateral ulnar length.

Human health in peril: The need to upgrade medical education in light of COVID-19.

While we might leave the COVID-19 pandemic behind, future health professionals are still confronted with another global phenomenon: the increasing pandemic of non-communicable diseases (NCDs). Both issues are strongly interwoven, yet current medical education fails to address their syndemic nature accordingly. There is scientific consensus that (i) most emerging infectious diseases are zoonotic, (ii) the overexploitation of earth's resources for animal protein production (i.e., tropical deforestation) rapidly escalates human contact with unknown pathogens, and (iii) people following a healthy plant-based diet present fewer rates of NCDs as well as severe illness and mortality from COVID-19. A shift toward whole food plant-based nutrition in the general population thus holds the potential to tackle both public health threats. We are convinced that it is every physician's responsibility to care for individual, public, and global health issues; however, future health professionals are not trained and educated regarding the health potential of plants and plant-based diets. The COVID-19 pandemic has demonstrated the urgent need for a "prevention first" approach. Therefore, in order to upgrade medical education worldwide and protect current and future human health properly, greater medical professional awareness of evidence on plant-based diets is urgently needed in classes, universities, and hospitals.