Evaluation of Factors Associated with Night Pain in Women Undergoing Carpal Tunnel Release.

BACKGROUND: Night pain has important diagnostic and prognostic values in patients with carpal tunnel syndrome (CTS). We aimed to determine whether night pain is associated with certain patient characteristics in female patients undergoing carpal tunnel release. METHODS: We recruited 75 women with the mean age of 54 years who were scheduled for carpal tunnel release. Diagnosis of CTS was made based on both the clinical symptoms and the results of electrophysiologic studies. Patient characteristics investigated as factors potentially associated with night pain were: age, body mass index (BMI), symptom duration, comorbidities such as diabetes mellitus (DM) and thyroid disease, electrophysiologic severity of CTS, and sleep position. We conducted a logistic regression analysis to examine the relationships between the presence of night pain and the different patients' demographic and clinical variables. RESULTS: Absence of night pain was associated with increased age (odds ratio (OR), 0.918, 95% confidence interval (CI), 0.851 to 0.99) and presence of DM (OR, 0.196; 95% CI, 0.046 to 0.835). The other variables assessed were not found to be associated with presence or absence of night pain. CONCLUSIONS: This study found that in women undergoing carpal tunnel release, older patients or those having DM are slightly less likely to have night pain. As night pain is an important prognostic factor for CTS, further studies are warranted to determine whether the absence of night pain could affect outcome assessment of CTS in the elderly or patients with DM.

Radial collateral ligament injury of the little finger proximal interphalangeal joint in young pianists.

PURPOSE: To report the features of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players. METHODS: Between 2005 and 2012, we treated 6 cases of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players at a single referral center. We conducted a retrospective review of charts and radiographs and telephone-interviewed all patients at a mean follow-up of 33 months (range, 12-66 mo) to evaluate features of this injury. RESULTS: All patients were girls with a mean age of 10 years (range, 8-12 y), and all had injuries in their right hands. Patients had been playing piano for a mean 3.8 years (range, 3-5 y) and practicing for a mean 1.8 hours per day (range, 1-3 h). Pain was commonly aggravated when they played octaves or advanced pieces requiring extensive finger movements. All patients were playing on standard-size piano keyboards and had generalized hypermobility with a mean Beighton and Horan score of 6.3 (range, 5-9). Two patients had an ulnar deviation deformity of 10° and 15° each at the proximal interphalangeal joint whereas the others had no fixed joint deformity. Five patients showed improvement with conservative treatment, but 1 patient underwent surgery. CONCLUSIONS: In our practice, all piano-related radial collateral ligament injuries were in female preadolescents with evidence of generalized hypermobility; patients had been playing piano extensively, suggesting that the injury could have resulted from stress on the joint during piano playing. Future studies should further evaluate the efficacy of modifying keyboard size, techniques, and repertoires for piano lessons and of patient education for this type of injury. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Early results of anterior elbow release with and without biceps lengthening in patients with cerebral palsy.

PURPOSE: To investigate the effect of partial biceps lengthening on elbow flexion posture and active elbow flexion and extension in patients with cerebral palsy. METHODS: We retrospectively reviewed 29 patients with cerebral palsy who underwent anterior elbow release as part of multilevel upper extremity surgery. The early series of the patients (N = 14; group 1) had lacertus fibrosus division, brachialis fractional lengthening, and denuding of the pretendinous adventitia off the biceps tendon. The later series of patients (N = 15; group 2) had partial biceps tendon lengthening in addition to the procedures in group 1. We compared the 2 sets of patients for elbow flexion posture, active elbow flexion and extension, forearm rotation, and House scores, with mean follow-ups of 72 months for group 1 and 31 months for group 2. RESULTS: The 2 groups were comparable in terms of mean age, number of procedures, and preoperative House scores. Group 2 patients had more improvement in flexion posture (53° vs. 44°) and active extension (23° vs. 15°) than group 1 postoperatively. However, group 2 had a mean decrease of 7° in active elbow flexion, whereas group 1 had no changes. There was no difference in forearm supination or in the improvement of House scores between groups. CONCLUSIONS: Early results of partial lengthening of the biceps tendon showed that it may improve elbow flexion posture and active elbow extension in patients with flexion deformity in cerebral palsy. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Vitamin D levels in post-menopausal Korean women with a distal radius fracture.

INTRODUCTION: The purpose of this study was to investigate serum levels of vitamin D in post-menopausal Korean women with a distal radius fracture (DRF) and to determine if there is any association between vitamin D levels and bone-related variables such as bone mineral densities (BMDs), serum parathyroid hormone (PTH) levels and several bone turnover markers. MATERIALS AND METHODS: The data of 104 postmenopausal women surgically treated for a distal radius fracture (DRF group) and 107 age-matched control patients without a fracture (control group) were compared. Serum vitamin D levels (25-hydroxycholecalciferol, 25(OH)D(3)) were compared between the groups with consideration of age and seasonal variations. BMDs, serum PTH and several bone turnover markers, including serum osteocalcin, C-telopeptide and urine N-telopeptide, were measured and analysed to find any association with vitamin D levels. RESULTS: The mean 25(OH)D(3) level was significantly lower in the DRF group compared to the control group (p < 0.001). In particular, patients in their sixth and seventh deciles in the DRF group had significantly lower 25(OH)D(3) levels than patients in the control group (p = 0.001 and 0.013, respectively). When seasonal variation was considered, significant differences of 25(OH)D(3) levels were found between the groups in autumn and winter. Hip BMDs were significantly lower in the DRF group than in the control group, and there was a positive correlation between serum 25(OH)D(3) levels and hip BMDs. Bone turnover markers were not significantly different between the two groups, although serum PTH levels were marginally higher in the DRF group (p = 0.08). CONCLUSIONS: Post-menopausal Korean women with a DRF were found to have significantly lower serum vitamin D levels than the control group, and vitamin D levels were particularly lower in women in their sixth and seventh deciles who may be a good target group for prevention of future fractures. Future investigation should focus on determining whether vitamin D supplementation can be helpful in preventing future fractures in patients with a DRF.

Extensor indicis proprius transfer for the abducted small finger.

PURPOSE: Persistent abduction of the small finger has usually been treated by transfer of the extensor digiti minimi muscle. However, anatomic variations of the extensor system may limit the potential for a successful extensor digiti minimi transfer. Therefore, we evaluated the outcomes of an alternative reconstruction method for the abducted small finger using an extensor indicis proprius (EIP) transfer. METHODS: We performed 8 EIP transfers in 8 patients with persistent, flexible abduction posturing of the small finger. The primary etiology of the deformity was incomplete motor reinnervation after surgeries for ulnar neuropathy in 6 patients, rupture of the third palmar interosseous musculotendinous unit in 1 patient, and intrinsic muscle fibrosis in 1 patient. The EIP was elongated by splitting the tendinous portion and was transferred to the distal and radial part of the extensor hood. Surgical outcomes were assessed by comparing preoperative and postoperative active adduction and abduction motion of the 2 ulnar digits. RESULTS: At the mean follow-up of 23 months, the average adduction angle improved from 19 degrees to 1 degrees postoperatively. In terms of active finger motion, 6 patients showed excellent results, 1 good, and 1 fair, without loss of flexion and extension. No patient had an extension lag or complained of functional deficits of the donor index finger. There was not adverse change to digital function or range of motion for the middle and ring fingers that are crossed by the EIP. CONCLUSIONS: Extensor indicis proprius transfer can be a reliable option for correction of abduction deformity of the small finger, maintaining active abduction and full flexion and extension. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Oblique closing wedge osteotomy and lateral plating for cubitus varus in adults.

UNLABELLED: Corrective osteotomy around the elbow can require longer recovery time in adults than in children because of the longer healing period and the propensity for stiffness. We hypothesized a lateral oblique closing wedge osteotomy with a larger contact area and fixation with a lag screw plus early motion would provide stable fixation and early motion recovery in adults with cubitus varus deformity. Twelve consecutive patients who needed surgery were treated using this procedure. They were allowed active motion exercises 1 week postoperatively. The age of the patients at the time of surgery averaged 39 years (range, 31-48 years). The minimum followup was 15 months. All patients achieved healing of the osteotomy, and regained preoperative arcs of elbow motion at a mean of 7.3 weeks (range, 2-12 weeks) postoperatively. The average humerus-elbow-wrist angle improved from -23.3 degrees to 8 degrees (p < 0.002) by a mean gain of 29.6 degrees . The mean lateral prominence index did not increase postoperatively. The final MEPI and DASH score averaged 95.4 points and 5.5 points. No patient experienced nerve palsy. Oblique osteotomy and fixation with a lag screw and lateral plating is a reasonable alternative technique for cubitus varus in adults, with early recovery of elbow motion and satisfactory deformity correction. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Extensor indicis proprius transfer for the abducted small finger

PURPOSE: Persistent abduction of the small finger has usually been treated by transfer of the extensor digiti minimi muscle. However, anatomic variations of the extensor system may limit the potential for a successful extensor digiti minimi transfer. Therefore, we evaluated the outcomes of an alternative reconstruction method for the abducted small finger using an extensor indicis proprius (EIP) transfer. METHODS: We performed 8 EIP transfers in 8 patients with persistent, flexible abduction posturing of the small finger. The primary etiology of the deformity was incomplete motor reinnervation after surgeries for ulnar neuropathy in 6 patients, rupture of the third palmar interosseous musculotendinous unit in 1 patient, and intrinsic muscle fibrosis in 1 patient. The EIP was elongated by splitting the tendinous portion and was transferred to the distal and radial part of the extensor hood. Surgical outcomes were assessed by comparing preoperative and postoperative active adduction and abduction motion of the 2 ulnar digits. RESULTS: At the mean follow-up of 23 months, the average adduction angle improved from 19 degrees to 1 degrees postoperatively. In terms of active finger motion, 6 patients showed excellent results, 1 good, and 1 fair, without loss of flexion and extension. No patient had an extension lag or complained of functional deficits of the donor index finger. There was not adverse change to digital function or range of motion for the middle and ring fingers that are crossed by the EIP. CONCLUSIONS: Extensor indicis proprius transfer can be a reliable option for correction of abduction deformity of the small finger, maintaining active abduction and full flexion and extension. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.