Arthroscopic resection of the dorsal ganglia of the wrist.

Arthroscopic ganglion resection provides a means by which dorsal wrist ganglia may be safely resected while avoiding the requisite scar accompanying open resection. Use of the arthroscope provides a much more complete examination of the wrist, allowing assessment of the cause of the ganglion as well as associated intra-articular problems. In a previous pilot study, 50% of patients demonstrated visible intra-articular abnormalities, including SL ligament laxity and perforations, TFCC tears, or chondral degeneration at the radial and triquetral-hamate joints. Use of the shaver within the joint allows the surgeon to directly address the ganglion's site of capsular origin, ensuring that the "one-way valve" mechanism is resected. The authors' initial experience was that the recurrence rate after arthroscopic resection was equal to or lower than after open resection. There is now some suggestion that resection of only the ganglion stalk, without removal of the sac, is feasible, but may yield slightly higher recurrence rates than formal open resection of the sac and stalk. This may be attributed to cases in which the capsular attachment to the SL ligament is debrided without identification and removal of a true stalk. The recurrence rate of a ganglion that has previously recurred also appears to be higher than that of primary resection. The authors look forward to publishing their completed results of an on-going follow-up study comparing open, arthroscopic, and recurrent ganglion resections.

Extensor tendon lacerations in a preterm neonate.

A fetus of 30-weeks' gestation sustained 2 extensor tendon lacerations as an intraoperative complication of an emergency Cesarean section. This report describes treatment of the tendon lacerations in the preterm neonate using 2 different repair techniques which both yielded an excellent clinical outcome.

Evaluation of suture caliber in flexor tendon repair.

This biomechanical study investigated the effect of suture caliber variation on tensile strength in 3 types of 2-strand flexor tendon repairs. Each type of repair was constructed with 5-0, 4-0, 3-0, and 2-0 braided polyester suture. Linear distraction was performed on 120 repaired human cadaveric flexor digitorum profundus tendons until tensile failure occurred. Ten trials of each repair construct were tested. Analysis of variance revealed significant main effects of caliber and technique. Mean repair strength increased as suture caliber increased. A 4-0 suture was 66% stronger than a 5-0 suture, a 3-0 suture was 52% stronger than a 4-0 suture, and a 2-0 suture was 51% stronger than a 3-0 suture. The technique effected repair strength only with the larger 2-0 and 3-0 suture calibers, which tested the technique's capacity to hold the tendon.

Corticosteroid injections for trigger digits: is intrasheath injection necessary?

Ninety-five patients with 107 trigger digits were divided into 2 groups and studied prospectively to evaluate steroid injection placement and efficacy. In 1 group, an attempt was made to deliver 1 injection into the tendon sheath at the A1 pulley. In the other group, 1 injection infiltrated the subcutaneous tissues overlying the A1 pulley. Radiopaque dye provided contrast to the injection medium, and postinjection x-rays identified the true delivery site of the steroid solution. Of the 52 digits into which intrasheath injection was attempted, 19 digits (37%) received all the injection within the sheath, 24 (46%) received medication into both the sheath and the subcutaneous tissues, and 9 (17%) received no medication within the tendon sheath. The results were analyzed to determine whether injection placement influences the efficacy of steroid injection. The confirmed all-sheath injection group exhibited a 47% good response, the mixed sheath and subcutaneous group had a 50% good response, and the all-subcutaneous group had a 70% good response. The results of this study suggest that true intrasheath injection offers no apparent advantage over subcutaneous injection in the treatment of trigger digits.