Wide Decompression May Render the Ulnar Nerve Unstable: A Cadaveric Study.

The purpose of this study was to evaluate for ulnar nerve instability following incrementally widened in situ decompression. A standard release of the ulnar nerve was performed in 16 cadaveric elbows, extending from 7cm distal to the medial epicondyle, and then released proximally for a total of 10 cm in 2-cm increments. Eight of the 16 elbows (50%) displayed subluxation of the ulnar nerve following complete in situ decompression. The rate of subluxation was found to increase with increasing length of proximal decompression. The greatest increase in rate of subluxation was seen beyond 4 cm proximal to the medial epicondyle. Cubital tunnel release should be limited to decompression of only the cubital tunnel if clinical and electrodiagnostic studies indicate that the cubital tunnel is the source of compression.

Treatment of advanced carpometacarpal joint disease: trapeziectomy and hematoma arthroplasty.

Some surgical treatment options of painful basal joint arthritis do not require complex arthroplasty or suspensionplasty techniques. Simple trapeziectomy with temporary pinning of a slightly overdistracted thumb metacarpal can provide reliable pain relief, good motion, and functional stability. Recent literature supports alternative options when compared with formal ligament reconstruction or suspensionplasty procedures. Simple trapeziectomy is associated with less morbidity due to shorter operative times and the lack of need for graft harvest and ligament reconstruction.

Gout affecting the hand and wrist.

Tophaceous gout in the hand and wrist often presents de novo as the first sign of the disease process in the elderly. Tophaceous material may present in a liquid, pasty, or chalky/granular state. Treatment may be as simple as aspirating the liquid or squeezing out pasty tophaceous material. Other nonsurgical treatment options include lifestyle and dietary modifications and drug therapy. Surgery is often indicated for the patient with significant tendon and joint compromise as well as skin breakdown and for decompression of compressive peripheral neuropathy.

Delayed flexor digitorum superficialis and profundus ruptures in a trigger finger after a steroid injection: a case report.

We report a case of delayed rupture of the flexor digitorum superficialis and profundus tendons after the use of local corticosteroid injections for trigger finger. The treatment involved the exploration, debridement, and placement of a silicone rod for planned flexor digitorum profundus staged reconstruction.

Functional outcomes in young, active duty, military personnel after submuscular ulnar nerve transposition.

PURPOSE: The purpose of this study was to report on the results of submuscular ulnar nerve transposition (SMUNT) for treatment of cubital tunnel syndrome in a young, active duty, military population. METHODS: Twenty patients (20 extremities) were evaluated retrospectively a minimum of 12 months after surgery. Outcome analyses were performed using the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Bishop-Kleinman rating scales, physical examination, return-to-work analysis, evaluation of complication rate, and overall patient satisfaction. RESULTS: At an average follow-up evaluation of 24 months (range, 12-38 mo), 19 patients had returned to full military active duty work status. The average duration of limited work capacity after surgery was 4.8 months (range, 3-7 mo). The DASH scores improved from an average of 32.5 points before surgery to 6.2 points after surgery. In 19 patients the functional outcome evaluated with the Bishop-Kleinman rating system was excellent. There were no poor outcomes using this rating score. Statistically significant improvements in both key pinch and grip strength were noted. Complications included one permanent and 2 transient neuropraxias of the medial antebrachial cutaneous nerve. Overall 19 of 20 patients were satisfied with the procedure and would have the surgery again if required. CONCLUSIONS: Submuscular ulnar nerve transposition for cubital tunnel syndrome provides a reliable rate of return to full active duty work in military personnel with good patient satisfaction and minimal complications.

Fixed subtalar subluxation in a pediatric patient: an unusual entity.

Atraumatic, fixed subluxation of the subtalar joint in the pediatric population has not been described. This report describes such a case in a skeletally immature boy.

The use of thermal capsulorrhaphy in the treatment of multidirectional instability.

The purpose of this study is to report on our experience with thermal capsulorrhaphy in the treatment of multidirectional instability of the shoulder. Thirty-three consecutive patients (33 shoulders) with multidirectional instability were treated with arthroscopic thermal capsulorrhaphy. Twelve patients had a history of traumatic dislocation. Three patients had been previously treated with open inferior capsular shift procedures. At a mean follow-up of 36 months (range, 24-40 months), results were available for 30 patients. On the basis of the UCLA rating scale, out of a possible 35 points, the mean preoperative score was 16.7 points and postoperatively it was 30.1 points, with 3 excellent, 20 good, and 7 poor results. Twenty-three patients (76%) were returned to full activity. In our experience the majority of patients with multidirectional instability were able to return to their previous occupations in the armed forces following thermal capsulorrhaphy. More information further defining the biomechanical pathology of capsular laxity and the specific role of electrothermal shrinkage in treating shoulder instability is needed.