The Outcomes of 2,154 Endoscopic Trigger Finger Releases.

BACKGROUND: Trigger finger is one of the most frequent causes of hand pain and disability. Recently, an endoscopic trigger finger release technique was developed, but outcomes have rarely been reported. Here, we present the outcomes of 2154 endoscopic trigger finger release procedures in a single center. METHODS: In this retrospective study, 2154 endoscopic trigger finger release procedures were performed on 2034 patients. Outcome assessment at 90 days after surgery was classified as excellent, good, fair or poor according to a combination of patient satisfaction with the scar and pain at rest or under load on a numeric rating scale. RESULTS: The therapeutic outcomes were: 1027 excellent, 607 good, 400 fair, and none poor. No major surgical complications were observed. Minor complications occurred in 231 fingers (10.7%). CONCLUSIONS: All patients were satisfied with their outcome after endoscopic trigger finger release. Endoscopic release can be an effective and efficient therapeutic method for the treatment of trigger finger.

Flexor Tenosynovial Fistula as a Complication after Endoscopic Trigger Finger Release: A Case Report.

OBJECTIVE: We report a rare case of flexor tenosynovial fistula secondary to endoscopic release of the A1 pulley for treatment of trigger finger. CASE PRESENTATION: A 72-year-old woman underwent endoscopic release of the A1 pulleys of her left ring and right middle fingers. Nine days after surgery, the wound at the base of the proximal phalanx of the ring finger (distal portal) remained open and a clear liquid discharge was seen. The volume of discharge increased with active finger motion. However, there was no evidence of infection. The patient was diagnosed with tenosynovial fistula as a complication of endoscopic release of the A1 pulley. At day 30, the fistula and drainage persisted and the condition was managed by surgical excision of the fistula and primary closure. The wound then healed completely. CONCLUSION: Our report alerts hand surgeons to the potential development of flexor tenosynovial fistula as a very rare complication following endoscopic release of the A1 pulley for the treatment of trigger finger.

A case report of multi-compartmental lipoma of the hand.

This report shows a multi-compartmental lipoma that occupied a vast area of the hand volar compartment, the distal aspect of the Parona's space and infiltrated the dorsal compartment between the IV and V metacarpal bones. The mass was entirely removed through a dorsal approach, minimizing risks of neurovascular and tendinous lesions.

Arthroscopic Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis.

Scaphoid-trapezium-trapezoid (STT) joint arthritis is a common condition consisting of pain on the radial side of the wrist and base of the thumb, swelling, and tenderness over the STT joint. Common symptoms are loss of grip strength and thumb function. There are several treatments, from symptomatic conservative treatment to surgical solutions, such as arthrodesis, arthroplasties, and prosthesis implant. The role of arthroscopy has grown and is probably the best treatment of this condition. Advantages of arthroscopic management of STT arthritis are faster recovery, better view of the joint during surgery, and possibility of creating less damage to the capsular and ligamentous structures.

The New Smartphone Application for Wrist Rehabilitation.

BACKGROUND: The rehabilitation after wrist surgery is extremely important. An instructed therapy in hospital is widely practiced. However, a dependent aging society and rush life style in younger generation have precluded patients to access to the frequent formal therapy. With the advancement in telecommunication technology, we have invented an application for smartphone for home-based wrist motion rehabilitation. METHODS: Twenty participants were included in four-week wrist motion rehabilitation programme after wrist surgery. Participants were instructed to use the application by physical therapist and informed details of home-based wrist rehabilitation. The feasibility of application was evaluated by satisfaction level in various aspects and the adherence to the therapy was monitored by function provided in the application. The degrees of motion were compared at the end of prescribed programme. RESULTS: Patient satisfaction was consistently high in every aspects. Also, the adherence to the therapy was high (90.42%). Ranges of motion significantly gained in every plane of wrist motion ([Formula: see text]). CONCLUSIONS: This novel smartphone application seems to be a promising and convenient alternative for patients who need to gain wrist motion without formal rehabilitation in the hospital. Adherence to the therapy is also easily traced with this application.

Minimally invasive procedure for the stabilization of the painful "prearthritic" carpometacarpal joint of the thumb.

The painful thumb carpometacarpal joint without arthritic changes with joint laxity is a common condition mainly affecting the female population in their early decades. Despite this, there is a lack of literature on the available treatment options. In the existing literature ligament reconstruction and extension osteotomy have both been described. In these methods the surgical trauma is quite extensive. In this paper, the authors document and present a new minimally invasive procedure for the treatment of this condition. Patients with painful and lax thumb carpometacarpal joint who did not benefit from conservative treatment underwent surgical treatment. The integrity of the cartilage was checked arthroscopically and it was considered an absolute indication to perform the technique consisting of stabilizing the space between the first and second metacarpal base with a suture button device. A standard postoperative protocol followed. No major complications occurred. According to preliminary experience and short-term follow-up results this technique is a comparatively safer, less invasive, and less aggressive procedure.

Single portal endoscopic treatment for chronic exertional compartment syndrome of the forearm.

Chronic exertional compartment syndrome of the forearm is an unusual disease not commonly found in the daily practice of a hand surgeon. This condition is quite rare in the general population but occurs more frequently among musicians and athletes, with the highest incidence found in professional motorcycle drivers. It is mainly because of a critical augmentation of the extracellular pressure of the forearm compartments. The diagnosis is mainly clinical, based on stress dynamic tests and intracompartmental pressure measurements. Traditionally, the treatment of this disease has revolved around trigger activity suspension. In the case of professional athletes, this solution cannot be considered and thus the standard surgical treatment consists of an open forearm fasciotomy. This procedure usually requires a lengthy operation period and has a long recovery time before patients can resume their regular activity. Different surgical endoscopic solutions with mini-open techniques have been proposed to shorten this time and reduce the incision size. The aim of this study was to present a new technique for endoscopic-assisted fasciotomy of the forearm in chronic exertional compartment syndrome using a single mini-incision. Four surgical procedures were performed in 3 patients. They were all treated at our center for this condition, and in one case the disease was found on both sides.

Arthroscopic-assisted arthrodesis of the trapeziometacarpal joint.

Arthroscopic-assisted surgery of the trapeziometacarpal (TMC) joint has been described before for the treatment of TMC joint arthritis including, debridement, partial or total trapezectomy, and interpositional arthroplasty, but its use for fusion is not reported. TMC joint arthroscopy is a novel technique for arthrodesis which aims to maintain joint stability and strength. We have successfully used this technique to perform fusion of the TMC joint. We think that this would offer the possibility of expanding the indications for TMC joint arthroscopy.

Endoscopic carpal tunnel release: our experience with 12,702 cases.

Carpal tunnel syndrome (CTS) is still today the most common nerve entrapment syndrome at the level of the upper extremity. When surgery is indicated, the surgical treatment of choice is the opening of the retinaculum. The authors describe their experience on 12,702 carpal tunnel decompressions, by the endoscopic procedure in a period of 14 years, outlining the indications, post-operative treatment, complications and results.

Long-term follow-up of a malunited, isolated fracture of the capitate in a 6-year-old boy.

A 6-year-old boy with an isolated fracture of the capitate was presented. First radiograghs at our clinic revealed an oblique fracture with a displacement of 5 mm on the lateral view, which we successfully treated with immobilization. When complete union was recognized in the radiographs, the capitate had a deformity consisting of a large prominence on the palmar aspect. During follow-up, the capitate showed marked remodeling and at four and a half years after injury it had regained an almost normal shape. Eleven years after injury, there were no radiographic changes such as malalignment or arthrosis in the carpal bones.