The Radial Synergy Test: An Aid to Diagnose de Quervain's Tenosynovitis.

BACKGROUND: Diagnosis of de Quervain's tenosynovitis is made clinically. Finkelstein's and Eichoff's tests are commonly utilized examination maneuvers. Their specificity has been questioned due to a propensity to provoke pain in asymptomatic patients. Using the principle of synergism, the novel radial synergy test takes advantage of isometric contraction of the first dorsal compartment with resisted abduction of the small finger. METHODS: Electromyography was performed on 3 authors and the first dorsal compartment sampled during the maneuver. Sensitivity evaluation was performed via retrospective chart review for patients diagnosed with de Quervain's from 2013 to 2018. Inclusion criteria were documented radial synergy test, Eichoff's test, and ≥90% pain relief after lidocaine/corticosteroid injection. We enrolled 222 patients with 254 affected extremities. Specificity evaluation was performed via a prospective cohort of volunteers undergoing radial synergy and Eichoff's tests. Inclusion criterion was lack of preexisting wrist pain. Score > 0 on Visual Analog Scale was considered positive. We enrolled 48 volunteers with 93 tested extremities. RESULTS: Electromyography revealed positive recruitment of the first dorsal compartment. Sensitivity of the radial synergy test was inferior to Eichoff's test (97% vs 91%, relative risk [RR] = 0.93 [95% confidence interval [CI] = 0.89-0.97], P < .01). Specificity of the radial synergy test was superior to Eichoff's test (99% vs 74%, RR = 1.33 [95% CI = 1.18-1.51], P < .001). CONCLUSIONS: We describe and evaluate the radial synergy test, a novel examination maneuver to aid the diagnosis of de Quervain's. This serves as an adjunct for future diagnostic evaluations with its high specificity. LEVEL OF EVIDENCE: Level II, diagnostic study.

Erratum to "halo naevus or malignant melanoma: A case report" [JPRAS open volume 16, June 2018, pages 98-99].

[This corrects the article DOI: 10.1016/j.jpra.2018.03.003.].

Halo naevus or malignant melanoma: A case report.

This is a report describing the case of a 66-year-old male with development of halo naevi. A biopsy of one of these naevi revealed a malignant melanoma with extensive regression. The purpose of this report is to identify that development of halo naevi outside of childhood or adolescence should raise suspicion and may require biopsy.

The management of complications of small joint arthrodesis and arthroplasty.

Arthrodesis and arthroplasty are surgical options used for the management of pain, stiffness, deformity, and instability related to arthritis and traumatic injury of the small joints of the hand. Arthrodesis and arthroplasty come with a risk of postoperative infection. Superficial soft tissue infections can often be managed with oral antibiotics alone. Deep infections and osteomyelitis frequently require removal of hardware in addition to antibiotics and may require surgical revision once the infection is cleared. Selection of the most appropriate revision technique depends on the underlying cause of the initial failure, patients' functional and outcome needs, and surgeon preference.

Percutaneous Distraction Pinning for Metacarpophalangeal Joint Stabilization After Blast or Crush Injuries of the Hand.

BACKGROUND: Unstable, severely comminuted fractures of the metacarpophalangeal (MCP) joint are difficult to treat. Closed treatment and casting of these fractures often fail to maintain proper alignment and impede wound care where concomitant open injuries such as gunshot wounds are present. Conventional pinning or plating techniques are not feasible if extensive bone loss and comminution are present. A distraction pinning technique represents a potential alternative, but results with this approach, to our knowledge, have not been reported. QUESTIONS/PURPOSES: The purposes of this study were (1) to evaluate the effectiveness (defined as osseous union and joint stability) of distraction pinning for comminuted fractures involving MCP joints after gunshot or crush injuries; (2) to report the short-term results in terms of pain and function in a small group of patients who underwent MCP distraction pinning; and (3) to evaluate complications and return to work status of these patients in the short term. METHODS: We reviewed 10 patients with comminuted pilon-type fractures of the base of the proximal phalanx or metacarpal head treated with wire distraction fixation from 2005 and 2014. During that period, we used this technique to treat all patients whose fractures were deemed too comminuted for plating or pinning, and during that period, no other techniques (such as simple external fixation) were used for patients meeting those indications. The minimum followup was 6 months; eight of the 10 patients were accounted at a median of 10 months (range, 6-89 months). The median age was 47 years (range, 28-57 years), and seven of the eight were male. Kirschner wire fixation frames were removed 3.5 to 6 weeks after the index surgery when fracture consolidation was confirmed on radiography by the treating surgeon. Stability and range of motion of the MCP joint were assessed using physical examination, radiographs, and goniometer by the treating surgeon. Patients completed the Quick Disabilities of the Arm, Shoulder and Hand score at latest followup or by telephone, and complications were assessed by chart review. RESULTS: All fractures were healed with stable MCP joints. Eight patients reported having no pain or minimal pain of their injuries to the hand. The median finger and thumb MCP arc of motion were 80° (range, 70°-105°) and 30° (range, 0°-60°), respectively. The median Quick Disabilities of the Arm, Shoulder and Hand score was 3 (range, 0-41). One patient underwent a second surgical procedure for bone grafting and soft tissue coverage. Three patients developed pin site irritations and were treated with oral antibiotics. Six patients returned to their original job. CONCLUSIONS: The distraction pinning technique provides reliable osseous union and joint stability of comminuted pilon-type fractures of the base of the proximal phalanx or metacarpal head, even with associated open wounds. Future studies will need to evaluate these patients at longer term followup and compare this approach with other available techniques, because arthrosis, stiffness, and progressive loss of function seem likely to occur given the severity of these injuries. LEVEL OF EVIDENCE: Level IV, therapeutic study.