Corticoid injection as a predictive factor of results of carpal tunnel release

OBJECTIVE: To evaluate whether the symptoms relief after local corticoid injection correlate with better results of surgical treatment in carpal tunnel syndrome. METHODS: Between February 2011 and June 2013, 100 wrists of 88 patients were included in the study. All patients were subjected to corticoid injections in the carpal tunnel and evaluated before and after infiltration and surgery. The following parameters were evaluated: visual analog scale (VAS) for pain, Boston questionnaire, sensitivity and strength. RESULTS: Only 28 out of 100 wrists subjected to injection were symptom-free after six months follow up. Sixty out of the 72 patients who did not present relief or relapse symptoms were treated surgically. Surgical results were better regarding VAS, Boston questionnaire and sensitivity in a specific group of patients, which had a longer relief of symptoms after the corticoid injection, with statistical significance. CONCLUSION: Longer relief of symptoms after corticoid injection correlated with better results of surgical treatment. Level of Evidence II, Prognostic Study.

Calcifying Aponeurotic Fibroma: Case Report with Radiographic and MR Features

Calcifying aponeurotic fibroma is a rare, benign fibroblastic tumor. The lesion has a propensity for local invasion and a high recurrent rate. Therefore, accurate preoperative diagnosis and complete excision are important to prevent the recurrence of the tumor after surgical removal. However, radiographic and magnetic resonance imaging findings of calcifying aponeurotic fibroma have been extremely rarely described in the radiology literature. Thus, we report a rare case of calcifying aponeurotic fibroma affecting the dorsal wrist in a 67-year-old man, describe radiographic and MR findings, and discuss the differential diagnosis of the tumor.

Osteomielite de punho em paciente com paracoccidioidomicose disseminada: uma rara apresentação / Osteomyelitis of the wrist in a patient with disseminated paracoccidioidomycosis: a rare presentation

Paracoccidioidomicose é a micose sistêmica endêmica mais frequente no Brasil. No início, o paciente não desenvolve sintomas. Com a progressão da doença, o indivíduo pode apresentar envolvimento disseminado, sendo que o acometimento ósseo é extremamente raro. O objetivo deste artigo é avaliar as alterações ósseas encontradas em estudos de imagem em um paciente com osteomielite de punho decorrente de paracoccidioidomicose disseminada.

Paraccocidioidomycosis is the most frequently found endemic systemic mycosis in Brazil. No symptoms are observed in the early phases of the disease. As the disease progresses, the patient may present disseminated involvement, but bone involvement is extremely rare. The present report is aimed at evaluating bone changes found on imaging studies in a patient with osteomyelitis of the wrist as a result of disseminated paracoccidioidomycosis.

La ultrasonografía en el estudio de la patología regional de la mano y la muñeca: [revisión] / Ultrasound in the evaluation of hand and wrist disorders: [review]

La mano y la muñeca son frecuentemente implicadas en síndromes de dolor regional, inflamatorios y degenerativos. La ultrasonografía ha demostrado ser más sensible que los exámenes clínicos y de radiología convencional para la detección de sinovitis y erosiones. También ha podido revelar una participación subclínica en pacientes con artritis crónica. Las indicaciones de la ultrasonografía a nivel de la mano y la muñeca son amplias e incluyen el diagnóstico de la afección articular y el tendón, la patología de poleas, los cambios morfoestructurales a nivel del nervio mediano en el túnel carpiano; puede servir como guía para las infiltraciones, así como para la valoración del tratamiento en pacientes con artritis crónica. El objetivo de esta revisión es mostrar el resultado de las alteraciones más frecuentes en las que la ultrasonografía ha demostrado ser útil.

The hand and wrist are frequently involved by regional pain syndromes, inflammatory and degenerative conditions. Ultrasonography had demonstrated to be more sensitive than both clinical examination and conventional radiology for the detection of synovitis and erosions. It has also able to reveal a subclinical involvement in patients with chronic arthritis. The indications of ultrasonography at hand and wrist level is wide and include: diagnosis of joint and tendon involvement, pulleys pathology, morphostructural changes at median nerve level into to carpal tunnel, guidance for infiltrations into and treatment monitoring in patients with chronic arthritis. The aim of this review is to show the most frequent alterations in which ultrasound has proven useful.

Indicações de artroplastia radiocubital distal: relato de três casos clínicos / Indications for distal radio-ulnar arthroplasty: report on three clinical cases

A artroplastia radiocubital distal é uma solução atrativa no tratamento de diferentes patologias da articulação radiocubital distal, pois permite restaurar a estabilidade, a transmissão de cargas e a função. As principais indicações são: o impingement radiocubital após ressecção parcial ou completa do cúbito distal e a artrite degenerativa, inflamatória ou pós-traumática da articulação radiocubital distal. Os autores apresentam três casos clínicos de patologia radiocubital distal: dois pacientes com sequelas pós-traumáticas e um caso de impingement radiocubital distal após operação de Sauvé-Kapandji. Os três casos foram tratados cirurgicamente com prótese metálica de substituição do cúbito distal tipo First Choice - Ascencion®. Os dois primeiros foram tratados com prótese tipo resurfacing e o último com prótese tipo modular. Em todos os pacientes obteve-se diminuição da dor e aumento da amplitude da RCD ao fim de um ano de seguimento pós-cirúrgico.

Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up.

Tuberculosis de la muñeca y de la mano / Tuberculosis of the hand and wrist

Introducción: La tuberculosis osteoarticular se observa en la columna, la rodilla y la cadera y, menos a menudo,en las vainas tenosinoviales, y en los huesos de la mano y la muñeca. El objetivo del presente trabajo es analizar esta patología y su tratamiento, y valorar la técnica de reconstrucción simultánea a largo plazo. Materiales y métodos: El estudio abarca a 19 pacientes tratados en 45 años, correspondientes a: 3 espinas ventosas, 10 tenosinovitis de flexores, 4 tenosinovitis de extensores y 2 artritis de muñeca. Empleamos una metodología diagnóstica moderna y el estudio retrospectivo de los pacientes, sus tratamientos y resultados. Resultados: El tratamiento farmacológico correcto es eficaz en 99 por ciento de los casos para la infección tuberculosa. El quirúrgico acelera la curación y consiste en la resección de los tejidos necróticos y la reconstrucción funcional, primaria o secundaria. La curación de la infección se logra siempre; la recuperación funcional estará en relación con el tipo, la. gravedad y la extensión de la lesión. Conclusiones: Se demuestra la frecuencia de estas patologías en los trabajadores de la carne o que están en contacto diario con hacienda. Se destacan los procedimientos modernos de diagnóstico. Se enfatiza en un tratamiento médico completo en calidad, duración y tipo de fármacos. Se destacan las bondades de los tratamientos quirúrgicos y de la reconstrucción funcional simultánea que propusimos en 1965.

Resección artroscópica de gangliones dorsales: técnica quirúrgica / Arthroscopic resection of dorsal ganglia: surgical technique

El ganglión dorsal es la tumoración benigna más frecuente de la muñeca y su origen es habitualmente constante a nivel de la confluencia de la cápsula dorsal con el ligamento escafolunar. El diagnóstico se realiza con ecografía o resonancia magnética siendo las radiografías estándares normales. La técnica quirúrgica artroscópica se realiza con tracción de la muñeca introduciendo el artroscopio por el portal 6R y el shaver por el 3-4, realizando sinovectomía y capsulectomía de 1 cm² de la zona de implante del pedículo del ganglión, en la cápsula dorsal, hasta la visualización del 2º radial externo. La complicación más frecuente es la recidiva. Desde el punto de vista estético el resultado es más satisfactorio que la cirugía a cielo abierto.

Os efeitos da mobilização neural como abordagem fisioterapêutica na síndrome do túnel do carpo / The effects of neural mobilization as physical therapy approach in carpal tunnel syndrome

A síndrome do túnel do carpo é uma neuropatia compressiva periférica que consiste na compressão do nervo mediano no canal do carpo. Apresenta maior incidência no sexo feminino e está associada ao esforço repetitivo. Os sinais e sintomas mais freqüentes são fraqueza, hipotrofia dos músculos tenares e dos dois primeiros lumbricais, retração do adutor do polegar e dos músculos flexores profundos e superficiais dos dedos, perda da mobilidade no deslizamento longitudinal e transversal do nervo mediano. Esses estão associados a edema, inflamação e retração do tecido conjuntivo neural. O objetivo deste estudo foi mostrar a aplicação da técnica de mobilização neural, como tratamento para a síndrome do túnel do carpo. Tal técnica tem como principal objetivo restaurar o movimento e a elasticidade tecidual do nervo periférico.

The carpal tunnel syndrome is a peripheral compressive neuropathy that consists in median nerve compression in the carpal tunnel. It occurs more often in females and is associated with repetitive strain. The more frequent signals and symptoms are weakness, hypertrophy of the tenhar and the first two lumbrical muscles, retraction of adductor of thumb and the deep and superficial flexor finger muscles, loss of mobility in the longitudinal and transverse sliding of the median nerve. These signals and symptoms are associated with swell, inflammation and retraction of the conjunctive neural tissue. The objective of the study aimed to show the use of neural mobilization technique as treatment for the carpal tunnel syndrome. Such technique has as main objective to restore range of motion and elasticity of the peripheral nerve tissue.

Carpal Tunnel Syndrome Caused by Space Occupying Lesions

PURPOSE: To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesions (SOL). MATERIALS AND METHODS: Eleven patients and 12 cases that underwent surgery for CTS due to SOL were studied retrospectively. We excluded SOL caused by bony lesions, such as malunion of distal radius fracture, volar lunate dislocation, etc. The average age was 51 years. There were 3 men and 8 women. Follow-up period was 12 to 40 months with an average of 18 months. The diagnosis of CTS was made clinically and electrophysiologically. In patients with swelling or tenderness on the area of wrist flexion creases, magnetic resonance imaging (MRI) and/or computed tomogram (CT) were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL. RESULTS: The types of lesion confirmed by pathologic examination were; tuberculosis tenosynovitis in 3 cases, nonspecific tenosynovitis in 2 cases, and gout in one case. Other SOLs were tumorous condition in five cases, and abnormal palmaris longus hypertrophy in 1 case. Tumorous conditions were due to calcifying mass in 4 cases and ganglion in 1 case. Following surgery, all cases showed alleviation of symptom without recurrence or complications. CONCLUSION: In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and MRI and/or CT should be supplemented in order to rule out SOLs around the carpal tunnel, if necessary.

[Epithelioid hemangioendothelioma of the wrist and the hand a case report]

The primitive epitheliod hemangio-endothelioma of bone is a rare vascular tumor recently described. A case of epitheliod hemangio-endothelioma of the distal phalanx and the ulna of the left band in a 15 years old young man is reported. In the same side soft tissue tumors of the hand and the forearm have been simultaneously diagnosed. In the same time radical excision with bone grafting was performed. The histologic and immunohistochemical study confirm the diagnosis. At the 8 years follow-up there was no clinical evidence of recurrence or metastasis. In the literature the outcome is not well defined. However no death was reported in the bone localization. Surgical resection with bone grafting to prevent pathologic fracture is suggested as a treatment, althongh it's not well codified in this rare lesion

Use of seton on ganglion of the wrist

To find out the role of Seton on ganglion of the wrist. Interventional study. Surgical unit II, Sindh Government Lyari General Hospital, Karachi. Number of patient selected for this study were 105. They were having swelling of wrist weather on the dorsal or ventral surface. All patients were treated with the ligature of silk no 1 on needle. This silk ligature on needle passed through the ganglion. After suturing the ganglion jelly like material was aspirated by applying a pressure of thumb and index over the ganglion and triamcinolone injected. The ligature was left for ten days. There were 80 females and 25 male patients. Most of the ganglions were present on the dorsum of the wrist. Highest number of patients were in their third decade. Rcurrence was noticed in 13.6%. This procedure found to be simple, economic can be carried out in out patient department procedure and leaves no scar

Cystic swellings on hands and wrist common pitfalls

To determine the etiopathological causes of simple cystic swellings of Hand and wrist. Prospective / retrospective descriptive study. Orthopaedic Department of Sindh Government Lyari General hospital, Dow University of Health Sciences Karachi and Remedial Centre Hospital Karachi from January 2005 to April 2006. A total of 87 patients, who had cyctic swellings in hand and wrist were operated. Apart from simple ganglian, other pathological lesions were found. In 87 patients who had surgery, 63 [72.4%]had wrist swelling while 24 [27.6%] had hand swelling. In 71 [81.6%] patients the cystic swelling was ganglion while 16 [18.4%] had other pathology. Out of that 10 were giant cell tumors of tendon sheath, 1 was spindle cell carcinoma, 1 was fibroma, 3 cases were tuberculosis and 1 case of lipoma. All cystic swellings in hand and wrist are not ganglion, they could be, from infection to malignancy

Patologia tendinea, vascular y tumoral de la mano: hallazgos ultrasonograficos / Tendons, vascular and tumoral pathology of the hand: sonographical findings

El desarrollo de transductores de alta resolución (10-15 MHz), permite ahora evaluar con certeza, en forma rápida y a bajo costo, lesiones inflamatorias, traumáticas y tumorales de las manos. Esta presentación analiza los hallazgos ultrasonográficos de las patologías más frecuentes de la mano. Esto incluye tenosinovitis, roturas tendíneas, lesiones vasculares y tumorales.

Quiste oseo yuxtaarticular: estudio clinicopatologico / Juxta-articular bone cyst: clinical and pathologic study

El quiste oseo yuxtaarticular es una lesion quistica benigna localizada en el hueso subcondral adyacentea una articulacion, no relacionada con enfermedades articulares inflamatorias o degenerativas. Entre los años 1986 y 2000 se realizo un estudio retrospectivo de 116 pacientes con el diagnostico de dicha patologia obtenido por puncion o biopsia. Se utilizaron 2 parametros para ser evaluados: el clinicorradiologico y la investigacion anatomopatologica. Se detecto un predominio en el sexo femenino y en la cuarta decada de la vida. Las localizaciones mas frecuentes fueron las articulaciones de la cadera, la rodilla, el tobillo y la muñeca. En la mayoria de los casos los quistes fueron detectados por hallazgo. El dolor fue el sintoma predominante. La medicion quistica arrojo valores entre 1 y 2 cm.; algunos alcanzaron 4 cm. La anatomia patologica evidencio su naturaleza multiocular observandose una pared fibrosa de espesor variable con areas de degeneracion mixoide y formacion de quistes mas pequeños rodeada por escaso tejido oseo maduro escleroso. El tratamiento fue el curetaje; en los casos en que el tamaño era importante se utilizo el agregado de injerto oseo. El objetivo del presente trabajo es actualizar el tema mediante el analisis casuistico

Técnica Punho Tornozelo

Método de tratamento pelo punho-tornozelo. Localização e técnica de inserção de agulhas. Técnica Punho-tornozelo - posições dos pontos do punho. Técnica Punho-tornozelo - posições dos pontos do tornozelo. Indicação do método Punho-tornozelo. Aplicação clínica do método punho-tornozelo. Estudo de casos

Técnica punho tornozelo / Technical ankle cuff

Método de tratamento pelo punho-tornozelo. Localização e técnica de inserção de agulhas. Técnica Punho-tornozelo - posições dos pontos do punho. Técnica Punho-tornozelo - posições dos pontos do tornozelo. Indicação do método Punho-tornozelo. Aplicação clínica do método punho-tornozelo. Estudo de casos

Linfangiohemangiona del músculo pronador cuadrado: presentación de un caso clinicopatológico / Lymphangi-hemangioma of the quadratus pronator muscle: a clinico pathological case

Los linfangiomas son tumores poco frecuentes de los tejidos blandos, piel y órganos internos; son neoplasias generalmente benignas, los raros casos malignos están asociados a radioterapia o aplicaciones de soluciones esclerosantes. Las manifestaciones clínicas de los linfangiomas son tardías y dependen de las dimensiones del tumor y la región anatómica afectada. Se presenta el caso clínico-patológico de una paciente de 43 años de edad, con un linfangiohemangioma que afectó el músculo pronador cuadrado en antebrazo derecho, en quien no se estableció el diagnóstico y la evolución fue tórpida hasta que se logró la resección total de la neoplasia, seguida de rehabilitación y se dio de alta por curación. La importancia de este caso radica en las dificultades diagnósticas presentes en la paciente.

Calcinose tumoral na mäo e punho / Tumoral calcinosis in hand and wrist

Calcinose tumoral, descrita inicialmente por Inclan, é uma patologia rara de etiologia indeterminada, caracterizada pela formaçäo de grande massas calcificadas em regiöes justarticulares, geralmente em pontos de pressäo. Os aspectos radiográfico e histológico säo bastante característicos. Os autores relatam quatro casos de calcinose tumoral localizados em punhos e mäos.