RESUMEN
Ultrasound is becoming more prevalent as physicians gain comfort in its diagnostic and therapeutic uses. It allows for both static and dynamic evaluation of conditions and assists in therapeutic injections of joints and tendons. Proper technique is necessary for successful use of this modality. Appropriate coding for physician reimbursement is required. We discuss common wrist and hand pathology for which ultrasound may be useful as an adjunct to diagnosis and treatment and provide an overview of technique and reimbursement codes when using ultrasound in a variety of situations.
Asunto(s)
Atención Ambulatoria , Codificación Clínica , Reembolso de Seguro de Salud , Quirófanos , Ultrasonografía , Tornillos Óseos , Síndrome del Túnel Carpiano/diagnóstico por imagen , Ligamento Colateral Cubital/diagnóstico por imagen , Ligamento Colateral Cubital/lesiones , Enfermedad de De Quervain/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Mano/diagnóstico por imagen , Humanos , Inyecciones Intraarticulares , Cuidados Intraoperatorios , Muñeca/diagnóstico por imagenRESUMEN
One of the challenges of forearm-level hand transplantation surgery is the achievement of osseous union of the ulna given the substantial soft tissue dissection, the use of immune modulating medications, and the diaphyseal level of osseous coaptation. Modification of the conventional surgical technique for an elective ulnar shortening osteotomy provides the advantages of precise osteotomy alignment, a large contact surface oblique osteotomy, and lag screw and compression plating technique. A step-by-step description of the developed modification is provided with a case example.
Asunto(s)
Amputación Traumática/cirugía , Brazo/trasplante , Placas Óseas , Tornillos Óseos , Traumatismos del Antebrazo/cirugía , Traumatismos de la Mano/cirugía , Trasplante de Mano/métodos , Osteotomía/métodos , Curación de Fractura/fisiología , Humanos , Microcirugia/métodos , Modelos Anatómicos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Radiografía , Instrumentos Quirúrgicos , Cúbito/cirugíaRESUMEN
A significant number of patients infected with Mycobacterium marinum have been treated at the Curtis National Hand Center in Baltimore, Maryland. The purpose of this study was to review the authors' experience with M. marinum infections of the upper extremity. Twenty-nine patients were identified and their charts were reviewed for all factors related to diagnosis and treatment. The most common presenting symptoms were swelling (n = 25) and pain (n = 14). Only 69 percent of patients could correlate their injury with aquatic activities. The mean time from injury to diagnosis was 5.2 months. Acid-fast bacilli stains were positive in only 22 percent of specimens. The mean number of procedures was 1.75, with the majority being tenosynovectomy. The mean duration of antibiotic therapy was 6 months. Clinical history, pathological evaluation, and a high clinical suspicion can lead to early diagnosis and introduction of antibiotics. The authors' patients were successfully treated with 6 months of antibiotic therapy and early surgical intervention.