Cubital Tunnel Syndrome: Does a Consensus Exist for Diagnosis?

PURPOSE: Cubital tunnel syndrome (CuTS) is the second most common compressive neuropathy of the upper extremity. We aimed to determine a consensus among experts using the Delphi method for clinical criteria that could be validated further for the diagnosis of CuTS. METHODS: The Delphi method was used for establishing a consensus among a group of expert panelists, comprising 12 hand and upper-extremity surgeons, who ranked the diagnostic clinical importance of 55 items related to CuTS on a scale from 1 (least important) to 10 (most important). The average and SDs of each item were calculated, and Cronbach α was used to assess homogeneity among the panelist-ranked items. RESULTS: All panelists answered the 55-item questionnaire. A Cronbach α value of 0.963 was obtained on the first iteration. The top criteria that were considered most clinically relevant to the diagnosis of CuTS among the group were determined based on the most highly ranked and correlated items among the expert panelist group. The criteria based on which there was agreement were as follows: (1) paresthesias in ulnar nerve distribution, (2) symptoms precipitated by increased elbow flexion/positive elbow flexion tests, (3) positive Tinel sign at the medial elbow, (4) atrophy/weakness/ late findings (eg, claw hand of the ring/small finger and Wartenberg or Froment sign) of ulnar nerve-innervated muscles of the hand, (5) loss of two-point discrimination in ulnar nerve distribution, and (6) similar symptoms on the involved side after successful treatment on the contralateral side. CONCLUSIONS: Our study demonstrated a consensus among an expert panelist group of hand and upper-extremity surgeons on potential diagnostic criteria for CuTS. This consensus on diagnostic criteria may help clinicians readily diagnose CuTS in a standardized form; however, further weighting and validation are necessary prior to the development of a formal diagnostic scale. CLINICAL RELEVANCE: This study is the first step in producing a consensus on how to diagnose CuTS.

Outcomes of Thumb Metacarpophalangeal Joint Arthrodesis Using the XMCP Intramedullary Interlocking Device.

Purpose: The intramedullary interlocking device for metacarpophalangeal (MCP) joint arthrodesis (XMCP, Extremity Medical, Parsippany, NJ) has been shown to promote union at a precise angle, provide strong fixation without the need for prolonged immobilization, and lower the incidence of hardware irritation and revision surgery. In this study, we evaluated the clinical outcomes of patients undergoing MCP joint arthrodesis with the XMCP system using a retrospective chart review, patient reported outcomes, and radiographic analysis. Methods: A retrospective chart review and phone survey was conducted on 57 patients (58 cases) from a single institution between 2017 and 2022. The primary outcome was patient satisfaction, including pre- and postoperative Numeric Rating Scale (NRS) pain scores, Disabilities of Arm Shoulder and Hand (QuickDASH) outcomes, perceived grip strength, and willingness to undergo the procedure again. Secondary outcomes included the need for revision procedures, successful fusion of arthrodesis, and postoperative complications. Results: Of the 57 patients who underwent MCP joint arthrodesis of the thumb using the XMCP fusion device, a total of 43 (75%) completed the phone survey. The average age of patients was 67 years with an average clinical follow-up of 9 months (range 1-65 months). Patients who participated in the phone survey questionnaire had an average QuickDASH score of 24.7 ± 20.5. Average perceived NRS scores were 6.2 ± 3.5 and 1.2 ± 2.1 before and after surgery, respectively. Average perceived grip strength of patients was 3 ± 1.3 out of 5. When evaluating for concurrent procedures, there was no statistically significant difference in pre- or postoperative NRS scores. In total, 38 (88%) patients were satisfied with the procedure, and 39 (91%) patients would undergo the procedure again. Conclusion: Metacarpophalangeal joint arthrodesis of the thumb with the intramedullary fusion device is reproducible, allows for immediate use without immobilization, has a low number of complications, and provides improved function and pain relief. Level of Evidence: Therapeutic III.

Successful Surgical Repair of Acute Quadriceps Tendon Rupture Utilizing Cortical Button Fixation: A Case Report.

BACKGROUND Timely diagnosis and surgical treatment are often needed to restore function of the extensor mechanism after rupture of the quadriceps tendon. Several techniques for quadriceps tendon repair have been reported, including suture anchors and bone tunnels. Cortical button fixation, or the use of an adjustable cortical fixation device, is a local and biomechanically strong internal brace technique used to treat ligament and tendon injuries. This report is of a 69-year-old man who experienced a quadriceps tendon rupture while golfing and underwent a successful surgical repair using cortical button fixation. CASE REPORT A 69-year-old man sustained an injury after slipping while golfing. He had immediate left knee pain and inability to bear weight. Radiographs demonstrated patella baja with an acute superior pole avulsion fracture of the patella, consistent with rupture of the quadriceps tendon. Surgical repair was discussed. Technique: After soft tissue debridement, the quadriceps tendon was debrided from the frayed and edematous edges. Two Krackow-type stitches were placed with #2 Fibertape and passed through 2 cortical buttons. Two bone tunnels were drilled from the superior to the inferior poles of the patella, bicortically. The cortical button was passed and appropriately tensioned. CONCLUSIONS Although acute quadriceps tendon rupture is commonly treated with transosseous suture repair and suture anchor repair, this report demonstrates that cortical button fixation was a successful procedure with strong biomechanical properties, resulting in the early return of function and range of motion.

The Use a Prophylactic Intramedullary Tibial Nail for a Stress Fracture in a High-Level Athlete.

INTRODUCTION: Mid-diaphyseal anterior tibial stress fractures can be debilitating injuries. They have been described occurring in athletes due to repetitive lower extremity trauma. The purpose of our study was to highlight a case of an athlete sustaining a tibial stress fracture with multiple cortical defects. CASE REPORT: We present an 18-year-old collegiate bound athlete who sustained a tibial stress fracture with multiple cortical defects. The clinical decision, after failure of conservative treatment, was made to treat the patient with tibial intramedullary nailing. She was able to return to full unrestricted activities, including high-level sports participation. Our case report specifically describes a case of a high-level athlete with multiple anterior tibial linear cortical defects from a chronic stress fracture. CONCLUSION: When conservative management for mid-diaphyseal anterior stress fractures fails, the utilization of prophylactic tibial nailing is a viable option. The decision for surgical intervention is dependent on many factors including patient's activity level and characteristics, failure of conservative management, and radiographic evidence of non-healing stress fractures.

Fulminant Septicemia from Aeromonas hydrophilia in a Nonmobile Diabetic Patient.

We report an unusual case of Aeromonas hydrophilia septicemia in a nonmobile diabetic patient secondary to contaminated well water used for bathing with a portal of entry through chronic forefoot and heel ulcers. To date, there are no documented cases similar to this patient's presentation. Aeromonas hydrophilia is commonly distributed among aquatic environments and tends to be found during warmer months. It is a rare cause of disease but can be life threatening and deadly, as in our case, in immunocompromised individuals. As podiatric physicians, we must remain diligent and have a high index of suspicion to identify patients at risk for this rare but serious infection and administer treatment aggressively to limit morbidity and mortality.