Risk Factors for Requiring Ulnar Superficialis Slip Resection During Trigger Finger Release.

PURPOSE: Ulnar superficialis slip resection (USSR) has been described to address persistent postoperative triggering following trigger finger release (TFR). The primary purpose of our study was to evaluate the results of simultaneous TFR and USSR under wide-awake local anesthesia no tourniquet (WALANT). The secondary purpose was to identify patient characteristics and risk factors associated with persistent triggering following A1 pulley release requiring USSR. METHOD: We retrospectively identified 1,005 patients who underwent TFR at one institution by a single fellowship-trained, hand surgeon under WALANT from 2015 to 2023. Nine hundred ninety-two patients were treated with TFR alone. Twelve patients (1.2%) underwent USSR because of persistent triggering that was identified in the operating room after release of the A1 pulley. An age-, sex-, and body mass index-matched cohort of 28 patients who underwent TFR alone was created. Medical records were reviewed for demographics and complications. RESULTS: A total of 12 patients (14 digits) underwent TFR with USSR. The long finger was the most commonly affected finger (6, 42%). Patients in the USSR group had more average lifetime trigger fingers compared with the control group (4 vs 1). Additionally, the percentage of patients who had previously undergone TFRs for other fingers was higher in the USSR group (100%) compared with the control group (36%). After surgery, 6 patients (4 USSR and 2 control) underwent formal hand therapy for postoperative stiffness with USSR patients receiving therapy more often than controls. CONCLUSIONS: Although uncommon, some patients (1.2%) who undergo TFR require USSR for persistent triggering following A1 pulley release. Patients who have had more lifetime trigger fingers and/or who have previously undergone TFR for other fingers are more likely to need USSR. No serious complications were incurred by patients who underwent USSR, but these patients may benefit from hand therapy compared to those undergoing isolated TFR. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Range of Motion Following Flexor Tendon Repair: Comparing Active Flexion and Extension With Passive Flexion Using Rubber Bands Followed by Active Extension.

PURPOSE: This study aimed to compare the outcome in terms of range of motion between early active flexion and extension (early active motion, [EAM]) and passive flexion using rubber bands followed by active extension (sometimes referred to as a Kleinert regimen) after flexor tendon repair in zones 1 and 2. METHODS: Data were collected from the Swedish national health care registry for hand surgery (HAKIR). Rehabilitation regimens were decided by the preference of each caregiver. At 3 months, 828 digits (656 EAM and 172 passive flexion) and at 12 months, 448 digits (373 EAM and 75 passive flexion) were available for analysis. Thumbs were analyzed separately. RESULTS: No notable difference in total active motion was found between the groups at 12 months of follow-up. CONCLUSIONS: This large registry study supports the hypothesis that EAM rehabilitation may not lead to better range of motion long-term than passive motion protocols. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Potential financial loss and risk factors for hamstring muscle injuries in elite male Brazilian soccer players: a season-long prospective cohort pilot study.

Purpose: The aim of this pilot study was to analyze the potential financial loss and a range of potential risk factors for hamstring muscle injuries in elite Brazilian soccer. Methods: Thirty-four male players (age: 25 ± 6 years; stature: 180 ± 8 cm; body mass: 78 ± 9 kg; minutes played in matches: 2243 ± 1423 min) from an elite professional soccer club were monitored during a 12-month season. Muscle injury was identified by magnetic resonance imaging and the severity was defined according to the number of days away: minimal (1-3 days), mild (4-7 days), moderate (8-28 days), severe (>28 days). Potential financial loss due to the team's under achievements was determined. Dorsiflexion range of motion, eccentric knee flexor strength and isokinetic tests were performed during the pre-season. Association between dependent variables and the occurrence of injury was evaluated. Results: Nine hamstring muscle injuries with moderate severity were found in 8 athletes. Recovery time was 22 days off the field on average. Potential financial loss was $-43.2 million USD and earnings on merit money was 21%. Previous injury, increased flexor deficit 60°â€…/sec and increased flexor fatigue index 300°/sec were all associated with a greater chance of hamstring muscle injury. Ankle dorsiflexion range of motion was significantly lower in the injured group (35.6 ± 3° vs. 39.1 ± 4.9°; p = 0.017, effect size = -0.74). Conclusion: High financial burden was found in elite Brazilian soccer during one full season. Injured athletes had high hamstring fatigue index, knee flexor strength deficit, ankle range of motion restriction and previous hamstring muscle injury when compared to non-injured athletes. Therefore, preventive approaches in professional soccer players with previous hamstring injuries should be a priority.

Dorsal Translocation of the Flexor Pollicis Longus Tendon Following Pediatric Both Bone Forearm Fracture.

Tendon entrapment is a rare complication of closed forearm fractures. A 16-year-old boy sustained a type 1 open both bone forearm fracture after falling from a skateboard. The injury was initially managed with irrigation, debridement, and flexible intramedullary nailing. Seven weeks after surgery, a flexion contracture of the ipsilateral thumb interphalangeal joint was noted. Subsequent hardware removal and hand therapy failed to improve thumb extension. The patient was taken to the operating room for planned tenolysis and possible tendon reconstruction. Intraoperatively, the flexor pollicis longus tendon was found to be wrapped around the radial shaft as an apparent complication of the initial procedure, which necessitated division and reconstruction of the tendon. To our knowledge, this is the first pediatric reported case of dorsal flexor pollicis longus tendon entrapment through the fracture site in a both bone forearm fracture requiring tendon reconstruction. This case highlights a unique surgical approach to a novel complication of pediatric both bone forearm fracture.

Ultrasound-guided needle knife release for stenosing tenosynovitis of the flexor pollicis longus: a prospective randomized controlled trial.

PURPOSE: This study aimed to evaluate the efficacy and safety of ultrasound-guided needle knife release in the treatment of stenosing tenosynovitis of the flexor pollicis longus. METHODS: In this prospective trial, 60 patients with clinically and ultrasonographically confirmed stenosing tenosynovitis of the flexor pollicis longus were randomly allocated to 1 of 3 groups: ultrasound-guided needle knife release (n = 20), traditional conservative treatment (n = 20), and open surgery (n = 20). The primary outcome measure was the Quinnell grade of triggering severity. Secondary outcomes comprised pain intensity (on visual analog scale), satisfaction (5-point Likert scale), and complications. Outcomes were evaluated at baseline, 1 week, 1 month and 3 months post-intervention by blinded assessors. RESULTS: At all follow-up time points, the needle knife release group demonstrated significantly lower Quinnell grades (p < 0.05) and pain scores (p < 0.001) than the conservative treatment group; satisfaction was greater in the needle knife release group compared to the conservative treatment group at 1 month (p = 0.002) and 3 months (p < 0.001). There were no significant differences in outcomes between the needle knife release group and the open surgery group. The overall complications rate was 5% in the needle knife release group, 10% in the conservative treatment group, and 15% in the open surgery group (p = 0.574). CONCLUSION: Ultrasound-guided needle knife release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus, with outcomes that are better than with traditional conservative treatment and similar to those of open surgery.

Accessory Ligament of the Deep Digital Flexor Tendon of the Horse Forelimb and Its Relationship with the Superficial Digital Flexor Tendon: A Plastination, Histological, and Morphometry Study.

The accessory ligament of the deep digital flexor tendon (AL-DDFT) plays a crucial role in the stay apparatus of the horse. This study aimed to investigate the anatomical relationship between the AL-DDFT, the superficial digital flexor tendon (SDFT), and other structures in the metacarpal region. Sixteen distal forelimbs from eight horses, aged 1 to 6 years, were evaluated through macroscopic, microscopic, and morphometric analyses, utilizing detailed dissection, E12 plastinated sections, and histological analysis. During lateral dissection, a connection was observed between the AL-DDFT and the SDFT. Histological evaluation revealed that this connection was a fibrous band (FB), extending the common synovial sheath (CSS) to the SDFT, along with associated collagen fibrils of the epiligament and peritenon. Additionally, two distinct forms of the AL-DDFT were identified, Type I and Type II, with Type II showing a greater cross-sectional area (CSA) than Type I. While numerous morphological and morphometric studies have explored the AL-DDFT and related structures, research incorporating plastination-based morphological and histological evaluations remains scarce. The findings provide valuable insights for both the morphological and clinical assessment of structures within the metacarpal region.

Five weeks of dynamic finger flexor strength training on bouldering performance and climbing-specific strength tests. A randomized controlled trial.

The aim of the study was to examine the effects of a 5-week dynamic finger flexor strength training program on bouldering performance and climbing-specific strength tests. Advanced to elite level boulderers (n = 31) were randomized to a dynamic finger strength training group (DFS) or a control group (CON). The DFS training program consisted of 3 weekly sessions (3-5 sets, 4-10 repetitions per session). Both groups continued bouldering training as usual throughout the intervention period. Pre- and post-intervention measures included bouldering performance, maximal dynamic finger strength, isometric finger strength (peak and average force), and rate of force development (RFD). The DFS demonstrated greater improvement in dynamic finger strength (11.5%, 3.9 kg) than the CON (5.3%, 1.7 kg; p = 0.075, ES = 0.90), but there were no differences between the groups in 1RM (p = 0.075, ES = 0.67), bouldering performance (p = 0.39, ES = 0.35), isometric finger strength (p = 0.42-0.56, ES = 0.20-0.22) or RFD (p = 0.30, ES = 0.46). The DFS improved dynamic (p < 0.01, ES = 1.83) and isometric peak and average (p < 0.01, ES = 0.98, and p < 0.01, ES = 0.75, respectively) finger strength, while the CON only increased dynamic finger strength (p < 0.05, ES = 0.58). None of groups improved bouldering performance or RFD (p = 0.07-0.58). In conclusion, 5 weeks of DFS training improving dynamic strength to a greater extent than bouldering alone in addition to improving isometric finger strength among advanced boulderers. Isolated bouldering improved dynamic finger flexor strength, but importantly, increased finger strength (dynamic or isometric) did not improve bouldering performance.

A 7-Year Retrospective Review of Flexor Sheath Infections.

Background: Flexor sheath infections require prompt diagnosis, and management with intravenous antibiotics and/or surgical washout followed by hand therapy. Complication rates as high as 38% have been reported. Our unit takes a relatively conservative approach to the management of flexor sheath infections and select patients are managed non-surgically via our outpatient antibiotic service where they are clinically reviewed and receive a once daily dose of intravenous antibiotics. The aim of this study is to determine if outpatient management of flexor sheath infections was associated with an increased risk of complications compared to those admitted as an inpatient. Methods: A retrospective review was carried out with all patients clinically diagnosed with flexor sheath infection who were seen at our unit between January 2014 and December 2020. Age, gender, co-morbidities, cause of infection, management and subsequent complications were recorded. Results: A total of 128 patients with flexor sheath infections were treated. And 68% were male. Mean age was 50.4 years. A trend towards fewer presentations each year with animal bites, foreign bodies and penetrating trauma as the main cause of infection was noted. And 89% (n = 114) required admission with the other 11% (n = 14) treated as an outpatient. And 77% (n = 98) underwent surgical washout. And 6% (n = 8) suffered a complication. Conclusions: While flexor sheath washout continues to be standard practice, 23% of patients were safely managed with intravenous antibiotics and 11% purely via an outpatient service. Level of Evidence: Level IV (Therapeutic).

Acute Calcific Tendinitis of the Flexor Hallucis Brevis Associated With Muay Thai.

Calcific tendinitis manifesting in the foot and toes is a rare condition that often goes unnoticed, even by podiatric specialists and healthcare practitioners. Characterized by an acute onset, this condition presents with pronounced local inflammatory indicators accompanied by pain, often complicating its differentiation from other conditions. We document our experience with a 27-year-old female patient presenting with calcific tendinitis in the flexor hallucis brevis (FHB), along with a review of the relevant literature.

Flexor Digitorum Profundus Avulsion With Distal Interphalangeal Joint Dorsal Dislocation: A Case Report.

An irreducible closed dorsal dislocation of the distal interphalangeal (DIP) joint of the finger is a rare injury, often caused by factors such as the interposition of the volar plate, entrapment of the flexor digitorum profundus (FDP) tendon behind the head of the middle phalanx, or the buttonholing of the middle phalanx head through the volar plate or flexor tendon. This case report presents a rare instance of FDP avulsion combined with dorsal dislocation of the DIP joint in a 42-year-old male who sustained trauma to his right middle finger during a workplace accident. Clinical examination and imaging confirmed FDP avulsion along with dorsal dislocation of the DIP joint. Urgent surgical intervention was performed, successfully reducing and repairing the FDP tendon and stabilizing the DIP joint. Subsequent follow-up showed satisfactory functional outcomes. This case highlights the importance of prompt diagnosis and appropriate surgical management in treating complex finger injuries.

The Learning Curves of Adelaide- and Gan-Modified Lim-Tsai Flexor Tendon Repair Techniques.

PURPOSE: Surgical performance that improves with experience is often depicted as representing a "learning curve." Although numerous studies examine the tensile properties of various flexor tendon repairs, few compare the associated learning curves. This study aims to address this gap by comparing the learning curves of Adelaide- and Gan-modified Lim-Tsai repairs. Emphasizing the difference in learning curves is crucial because it highlights the tension between achieving biomechanically superior repairs, which may be challenging to many surgeons, and opting for possibly incrementally less strong but more feasible techniques. METHODS: We organized a workshop attended by 20 medical students whose experience in surgery was limited to a few suturing exercises. Each participant repaired five porcine tendons in situ either with Adelaide- or Gan-modified Lim-Tsai, followed by a peripheral suture. We tested all tendons with linear static testing to measure ultimate and yield loads. In addition, repair times were recorded for each repair. We used a linear mixed model to compare learning between the techniques. RESULTS: Ultimate loads increased with experience and were higher in Adelaide technique during the first two repairs, compared with Gan-modified Lim-Tsai (80 N vs 63 N and 79 N vs 66 N, respectively). Yield loads also increased with experience but did not differ between the repair techniques at any time point. Mean repair times decreased from 44 to 28 minutes and from 46 to 25 minutes with Adelaide- and Gan-modified Lim-Tsai repairs, respectively. CONCLUSIONS: The Adelaide core suture had a higher initial ultimate load capacity despite fewer suture strands, possibly indicating better tension consistency. The ultimate load of the Gan-modified Lim-Tsai repair increased between the first and fifth repair, and repeats were needed to achieve comparable results with the Adelaide repair. CLINICAL RELEVANCE: The results of this study suggest that both repair methods are suitable for novice surgeons, but Adelaide tends to result in higher strength from the first repair. Generalizability to other repairs should be made with caution.

Passive Mobilization With Place-and-Hold Versus Active Mobilization Therapy After Flexor Tendon Repair: 5-Year Minimum Follow-Up of a Randomized Controlled Trial.

PURPOSE: There is no consensus on the optimal postoperative rehabilitation program following flexor tendon repair. Some studies suggest a faster recovery after active mobilization, whereas other studies have failed to find any differences between active and passive mobilization at 12 months. To our knowledge, no prior randomized controlled trial has compared the long-term effects of these two approaches. This randomized controlled trial compared the long-term outcomes of active mobilization with those of passive mobilization in combination with place-and-hold. METHODS: Sixty-four patients with a flexor tendon injury in zones I or II were included in the study. After surgery, patients were randomized to either active mobilization or passive mobilization with place-and-hold. Forty-seven patients were available for the 5-year minimum follow-up. Assessments included range of motion, grip strength, key pinch, as well as the Disabilities of the Arm, Shoulder, and Hand (DASH) and ABILHAND questionnaires. RESULTS: At the 5-year minimum follow-up, range of motion was significantly better in the group treated with passive mobilization with place-and-hold compared with the active mobilization group. Furthermore, there was a significant deterioration in the range of motion and an increased flexion contracture in the active mobilization group compared with 1 year after surgery. Grip strength deteriorated significantly in both groups from the 1-year to the 5-year minimum follow-up, but key pinch did not change. In both groups, DASH and ABILHAND scores improved from the 1-year to the 5-year minimum follow-up. CONCLUSIONS: Passive mobilization with place-and-hold following flexor tendon repair results in superior long-term outcomes compared with active mobilization. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

Comparing the efficacy of multiple quantitative and qualitative ultrasound parameters for the diagnosis of carpal tunnel syndrome.

PURPOSE: Carpal tunnel syndrome (CTS) is a compression neuropathy causing significant morbidity. Over the years, ultrasound has been evaluated as an alternative to nerve conduction study (NCS) for diagnosing CTS, however, there is no consensus as to which ultrasound parameter is the best. Our study aimed to determine and compare the efficacy of various ultrasound-based variables for diagnosis of CTS. METHODS: 80 patients with clinical suspicion of CTS underwent ultrasound examination with calculation of cross-sectional area (CSA), delta CSA, wrist forearm ratio (WFR), palmer bowing (PB), flattening ratio (FR), flexor retinaculum thickness (FT), and evaluation of echogenicity and vascularity of median nerve. NCS was taken as the gold standard and the diagnostic efficacy of all these variables was compared, followed by receiver operator curve (ROC) analysis. RESULTS: Delta CSA had the highest accuracy (91.25%), followed by CSAc (80%), WFR (78.75%), and PB (73.75%). Youden's index and sensitivity were highest for delta CSA (0.783 and 96.15% respectively), while specificity was highest for FT (89.29%). The highest area under the curve was noted for delta CSA (97.1%), followed by WFR (AUC = 87.4%) and CSAc (AUC = 86.0%). CONCLUSION: Delta CSA was found to be the best ultrasound parameter for diagnosis of CTS, followed by CSAc, WFR, and PB, and can be used as an alternative to NCS. Using ROC analysis this study also predicted the best cut-off values for these parameters which could improve their diagnostic accuracy and further research is needed to confirm these findings.

The Effect of Forearm Shortening on Finger Flexion: A Biomechanical Study.

PURPOSE: Surgeons may shorten the forearm for many indications. We quantified the impact of shortening on finger flexion with a cadaver model. METHODS: Ten fresh cadaver proximal forearms were pinned to a static block. We pinned each distal forearm/hand to a block that could unlock, slide, and relock on a mounting track. This block allowed wrist-neutral or 30-degree extension. With the sliding block locked, we removed the central 10 cm of the radius/ulna. We placed sutures in the proximal end of each flexor digitorum profundus (FDP). After pretensioning, we simulated near-maximum baseline FDP muscle-generating force by applying 100 N via a load cell at the proximal sutures. We then anchored the load cell system proximally to set the initial length-tension relationship for simulating near-maximum baseline muscle-generating force. We called subsequent load cell readings the simulated muscle force (SMF) and pressure sensor readings between fingertips and the palm the tip-to-palm force (TPF). We shortened the forearm in 1 cm increments with the distal sliding-locking block. At each increment, we recorded SMF and TPF in the wrist-neutral position. Once a specimen lost measurable TPF, we applied 30 degrees wrist extension until again losing TPF. RESULTS: Incremental forearm shortening was associated with exponential decreases in each FDP's SMF and TPF. In wrist-neutral, 3 cm mean shortening had a loss of 99% and 98% SMF and TPF, respectively. Wrist extension marginally improved SMF and TPF up to 4 cm mean shortening, where both lost 99%. Loss of any fingertip touchdown occurred after a mean shortening of 4.9 cm in wrist-neutral and 5.3 cm in 30 degrees wrist extension. CONCLUSIONS: Mean forearm shortening of 3 or 4 cm had a near-complete loss of FDP SMF and TPF in wrist-neutral/wrist extension, respectively. With ∼5 cm shortening, there was a complete loss of fingertip touchdown. CLINICAL RELEVANCE: Surgeons should consider the influence of forearm shortening on the FDPs and contemplate flexor tendon shortening or alternative reconstructions as indicated.

Ultrasonographic Evaluation of Flexor Pollicis Longus Tendon Location in Various Functional Hand Positions.

Background: Flexor pollicis longus (FPL) tendon injury is a significant complication following distal radius fractures treated with volar locking plate fixation. We were unable to find any studies investigating the FPL tendon in relation to the distal radius in various functional hand positions. The aim of this study is to comprehensively evaluate FPL tendon location in essential functional hand positions commonly encountered in daily life, including pulp pinch, key pinch, chuck grip, power grip, cylindrical grasp and spherical grasp. Methods: We assess the position of the FPL tendon and finger flexor tendons concerning the radius in various functional hand positions. Sixty-two wrists in 31 healthy volunteers were examined using transverse ultrasonography at the watershed area of the radius in six different functional hand positions, including pulp pinch, key pinch, chuck grip, power grip, cylindrical grasp and spherical grasp. Results: The shortest distance between the FPL tendon and radius was observed in the key pinch position with a mean of 3.37 mm, while the cylindrical grasp position showed the farthest distance with a mean of 4.21 mm. Conclusions: The location of the FPL tendon and finger flexor tendons varies across different functional hand positions. Our study shows that these tendons are closest to the radius when the hand is in the key pinch position. Level of Evidence: Level IV (Diagnostic).

Biomechanical Comparison of Three Modified Kessler Techniques for Flexor Tendon Repair: Implications in Surgical Practice and Early Active Mobilization.

Objective: Managing flexor tendon injuries surgically remains challenging due to the ongoing debate over the most effective suture technique and materials. An optimal repair must be technically feasible while providing enough strength to allow for early active mobilization during the post-operative phase. This study aimed to assess the biomechanical properties of three modified Kessler repair techniques using two different suture materials: a conventional two-strand and a modified four-strand Kirchmayr-Kessler repair using 3-0 Prolene® (2s-KK-P and 4s-KK-P respectively), and a four-strand Kessler-Tsuge repair using 4-0 FiberLoop® (4s-KT-FL). Methods: Human flexor digitorum profundus (FDP) tendons were retrieved from Thiel-embalmed prosections. For each tendon, a full-thickness cross-sectional incision was created, and the ends were reattached using either a 2s-KK-P (n = 30), a 4s-KK-P (n = 30), or a 4s-KT-FL repair (n = 30). The repaired tendons were tested using either a quasi-static (n = 45) or cyclic testing protocol (n = 45). Maximum force (Fmax), 2 mm gap force (F2mm), and primary failure modes were recorded. Results: In both quasi-static and cyclic testing groups, tendons repaired using the 4s-KT-FL approach exhibited higher Fmax and F2mm values compared to the 2s-KK-P or 4s-KK-P repairs. Fmax was significantly higher with a 4s-KK-P versus 2s-KK-P repair, but there was no significant difference in F2mm. Suture pull-out was the main failure mode for the 4s-KT-FL repair, while suture breakage was the primary failure mode in 2s- and 4s-KK-P repairs. Conclusions: FDP tendons repaired using the 4s-KT-FL approach demonstrated superior biomechanical performance compared to 2s- and 4s-KK-P repairs, suggesting that the 4s-KT-FL tendon repair could potentially reduce the risk of gapping or re-rupture during early active mobilization.

Streptococcus pyogenes flexor tenosynovitis.

We describe a case of Group A streptococcal infection originally presenting as flexor tenosynovitis. Group A Streptococcus outbreaks have been recently described in developed countries, which constitutes an epidemiological shift that hand surgeons should be aware of.

Which is more effective? Porcine tendon or 3D- printed flexor tendon? A study of model realism and educational utility in a flexor tendon repair workshop.

Introduction: Animal models in orthopaedic surgical training have raised concerns about ethics and availability, prompting the search for non-animal alternatives. The 3D-printed silicone tendon model has emerged as a potential alternative due to its hygiene and reusability. This study aimed to compare the effectiveness of the two models for flexor tendon repair training. Materials and methods: A survey involved 25 postgraduate trainees with no prior experience in flexor tendon repair. Porcine tendon models and 3D-printed models were used, with participants evaluating accuracy, understanding of pulley systems, joint flexion, tissue feel, and model realism. Repairs were evaluated by experienced surgeons, and participants completed a survey. Results: Both models demonstrated satisfactory accuracy and realistic joint flexion. The porcine model scored higher in anatomical accuracy, while the 3D-printed model excelled in understanding pulley systems. The porcine model provided realistic tissue feel, while the 3D-printed model facilitated anatomy teaching. No significant difference was found in educational utility. The 3D-model was perceived as hygienic and odourless, whereas the porcine model offered better tendon handling. The 3D-model improved visualization of suture placement. Both models were equally accepted and recommended for training. Conclusion: The 3D-printed silicone tendon model is a cost-effective and reproducible alternative to porcine models in flexor tendon repair training. Although the 3D-printed model has limitations in mimicking human tendons, it was equally effective in teaching suturing techniques and improving repair skills. Combining the porcine model and 3D-printed model provides a comprehensive approach to flexor tendon repair training, addressing the limitations of each model and enhancing the educational experience.

Endoscopic carpal tunnel release with opponensplasty using ring finger flexor digitorum superficialis under WALANT with ultrasound assistance.

In patients with severe, long-standing carpal tunnel syndrome and thenar muscle atrophy, nerve decompression alone is unlikely to restore thumb opposition. A multitude of tendon transfer techniques have been described to restore thumb opposition. We describe the technique of an endoscopic carpal tunnel release with opponensplasty using ring finger flexor digitorum superficialis (FDS) tendon under Wide Awake Local Anaesthesia No Tourniquet (WALANT) and ultrasound assistance.