Infiltración comisural dorsal en el tratamiento del pulgar y los dedos en resorte. Estudio de una cohorte prospectiva / Out-of-sheath corticosteroid injections through the dorsal webspace for trigger finger and trigger thumb. A prospective cohort study

Antecedentes y objetivo: Las infiltraciones de corticoides son efectivas en el tratamiento de los dedos en gatillo pero el dolor percibido por el paciente durante la inyección es un efecto acompañante siempre presente. El objetivo de este estudio fue evaluar la efectividad y el dolor percibido durante una infiltración corticoidea depositada fuera de la vaina tendinosa utilizando la técnica comisural dorsal. Material y método: Se incluyeron 126 pacientes consecutivos. Se realizó una infiltración esteroidea subcutánea (fuera de la vaina) a través de la comisura dorsal. En los casos en que los signos o síntomas persistieron, se ofreció una segunda infiltración. Se registró el dolor percibido durante la infiltración mediante la escala visual analógica, el cuestionario DASH antes del tratamiento y al final de seguimiento, la tasa de éxito y las complicaciones. Resultados: Fueron 86 mujeres y 40 hombres con una edad media de 61 años. La puntuación media del dolor durante la infiltración fue de 3,8. Doce pacientes se perdieron durante el seguimiento. El éxito global fue del 68% y el éxito tras una única inyección fue del 54%. El mejor resultado se obtuvo en el dedo anular. Los pacientes que no habían sido operados previamente del síndrome del túnel carpiano respondieron mejor. No se objetivaron complicaciones. Conclusiones: La infiltración esteroidea fuera de la vaina tendinosa y utilizando la técnica comisural dorsal es efectiva y segura en el tratamiento de los dedos en resorte. Parece ser menos dolorosa que los resultados publicados para la técnica palmar sobre la línea media, aunque esto debe evaluarse en un estudio diseñado para ello.(AU)

Background and objective: Steroid injections are effective in the treatment of trigger digits but the pain during the injection is an always-present accompanying effect. The aim of this study was to assess the effectiveness and perceived pain during an out-of-sheath corticosteroid injection through the dorsal webspace in the treatment of trigger digits. Material and method: A total of 126 consecutive patients were included. A subcutaneous (out-of-sheath) corticosteroid injection was performed through the dorsal webspace in all digits. In cases where signs or symptoms persisted, a second injection was offered. Visual analog scale for pain during the injection, DASH questionnaire, success rate and complications were collected. Results: There were 86 women and 40 men with a mean age of 61 years. The mean visual analog scale for pain during the injection was 3.8. Twelve patients were lost to follow-up. The overall success was 68% and success after a single injection was 54%. The best result was achieved on the ring finger. Patients who were not previously operated on carpal tunnel syndrome responded better. No complications were noted. Conclusions: The extra-sheath corticosteroid injection through the dorsal webspace is effective and safe. It seems to be less painful than the reported scores for the palmar midline technique although it should be assessed in a comparative study.(AU)

Out-of-sheath corticosteroid injections through the dorsal webspace for trigger finger and trigger thumb. A prospective cohort study / Infiltración comisural dorsal en el tratamiento del pulgar y los dedos en resorte. Estudio de una cohorte prospectiva

Background and objective: Steroid injections are effective in the treatment of trigger digits but the pain during the injection is an always-present accompanying effect. The aim of this study was to assess the effectiveness and perceived pain during an out-of-sheath corticosteroid injection through the dorsal webspace in the treatment of trigger digits. Material and method: A total of 126 consecutive patients were included. A subcutaneous (out-of-sheath) corticosteroid injection was performed through the dorsal webspace in all digits. In cases where signs or symptoms persisted, a second injection was offered. Visual analog scale for pain during the injection, DASH questionnaire, success rate and complications were collected. Results: There were 86 women and 40 men with a mean age of 61 years. The mean visual analog scale for pain during the injection was 3.8. Twelve patients were lost to follow-up. The overall success was 68% and success after a single injection was 54%. The best result was achieved on the ring finger. Patients who were not previously operated on carpal tunnel syndrome responded better. No complications were noted. Conclusions: The extra-sheath corticosteroid injection through the dorsal webspace is effective and safe. It seems to be less painful than the reported scores for the palmar midline technique although it should be assessed in a comparative study.(AU)

Antecedentes y objetivo: Las infiltraciones de corticoides son efectivas en el tratamiento de los dedos en gatillo pero el dolor percibido por el paciente durante la inyección es un efecto acompañante siempre presente. El objetivo de este estudio fue evaluar la efectividad y el dolor percibido durante una infiltración corticoidea depositada fuera de la vaina tendinosa utilizando la técnica comisural dorsal. Material y método: Se incluyeron 126 pacientes consecutivos. Se realizó una infiltración esteroidea subcutánea (fuera de la vaina) a través de la comisura dorsal. En los casos en que los signos o síntomas persistieron, se ofreció una segunda infiltración. Se registró el dolor percibido durante la infiltración mediante la escala visual analógica, el cuestionario DASH antes del tratamiento y al final de seguimiento, la tasa de éxito y las complicaciones. Resultados: Fueron 86 mujeres y 40 hombres con una edad media de 61 años. La puntuación media del dolor durante la infiltración fue de 3,8. Doce pacientes se perdieron durante el seguimiento. El éxito global fue del 68% y el éxito tras una única inyección fue del 54%. El mejor resultado se obtuvo en el dedo anular. Los pacientes que no habían sido operados previamente del síndrome del túnel carpiano respondieron mejor. No se objetivaron complicaciones. Conclusiones: La infiltración esteroidea fuera de la vaina tendinosa y utilizando la técnica comisural dorsal es efectiva y segura en el tratamiento de los dedos en resorte. Parece ser menos dolorosa que los resultados publicados para la técnica palmar sobre la línea media, aunque esto debe evaluarse en un estudio diseñado para ello.(AU)

Out-of-sheath corticosteroid injections through the dorsal webspace for trigger finger and trigger thumb. A prospective cohort study. / Infiltración comisural dorsal en el tratamiento del pulgar y los dedos en resorte. Estudio de una cohorte prospectiva.

BACKGROUND AND OBJECTIVE: Steroid injections are effective in the treatment of trigger digits but the pain during the injection is an always-present accompanying effect. The aim of this study was to assess the effectiveness and perceived pain during an out-of-sheath corticosteroid injection through the dorsal webspace in the treatment of trigger digits. MATERIAL AND METHOD: A total of 126 consecutive patients were included. A subcutaneous (out-of-sheath) corticosteroid injection was performed through the dorsal webspace in all digits. In cases where signs or symptoms persisted, a second injection was offered. Visual analog scale for pain during the injection, DASH questionnaire, success rate and complications were collected. RESULTS: There were 86 women and 40 men with a mean age of 61 years. The mean visual analog scale for pain during the injection was 3.8. Twelve patients were lost to follow-up. The overall success was 68% and success after a single injection was 54%. The best result was achieved on the ring finger. Patients who were not previously operated on carpal tunnel syndrome responded better. No complications were noted. CONCLUSIONS: The extra-sheath corticosteroid injection through the dorsal webspace is effective and safe. It seems to be less painful than the reported scores for the palmar midline technique although it should be assessed in a comparative study.

Dorsal web injection technique in the treatment of trigger finger and trigger thumb. Anatomical study. / Infiltración comisural dorsal en el tratamiento del pulgar y los dedos en resorte. Estudio anatómico.

BACKGROUND AND OBJECTIVE: Corticosteroid injection is an effective treatment for trigger digits but the pain during the injection is an ever-present side effect. Since the palmar skin has a high density of sensitive receptors, injecting through dorsal skin could be less painful. Our aim was to assess whether a dorsal technique through the dorsal web is safe for extra-sheath injection of trigger fingers and thumb. MATERIAL AND METHOD: This is an anatomical study in sixteen cadaveric hands. An injection through the dorsal web was performed on each digit. After careful resection of the palmar skin, the distance between the needle and the main anatomical structures was measured. The risk of major injury was considered high when the mean distance from the needle to the neurovascular bundle was below 1mm. RESULTS: The mean distance from the needle to the neurovascular bundle was 1.77mm. Two neurovascular injuries in 112 injections were observed, one nerve and one artery. The safest digit was the thumb while the most dangerous was the index finger. At the ring finger, the technique was safer when it was carried out from the dorso-radial. CONCLUSIONS: A subcutaneous injection near the flexor tendon sheath can be carried out through the dorsal web with a low, but present, risk of neurovascular injury. It could be useful for injection in the treatment of trigger finger and trigger thumb but it should be assessed in a clinical study.

Inter-arm asymmetry in bone mineral content and bone area in postmenopausal recreational tennis players.

OBJECTIVE: To determine whether long-term recreational tennis participation is associated with increased bone and muscle mass in the dominant compared to the non-dominant arm, in postmenopausal tennis players. METHODS: Dual-energy X-ray whole body scans were performed in 10 postmenopausal tennis players (mean +/- S.D.; 59.7 +/- 4.8 years) and 12 postmenopausal non-active women (62.8 +/- 7.2 years) matched for age and height. Tennis players started in this sport at 31.4 +/- 8.8 years, and had been playing for 26.8 +/- 6.8 years, at least 3 h per week. In addition, shoulder isokinetic muscular strength was also evaluated. RESULTS: Tennis participation resulted in a lower whole mass and fat mass in both arms (P < 0.05). Dominant arm muscle mass and shoulder joint isokinetic strength were essentially similar in both groups, however, the tennis players showed 8% greater bone mineral content and 7% greater osseous area in the dominant than in the non-dominant arm (P < 0.05). No inter-arm differences were found in bone mineral density. A relationship was observed between the length of tennis participation and the degree of inter-arm asymmetry in bone mineral content (r = 0.81, P < 0.01) and bone area (r = 0.78, P < 0.01). However, the BMD of the arms was essentially similar in both groups. No differences were observed in femoral and lumbar bone mass and density between groups. CONCLUSIONS: Long-term tennis participation is associated with increased bone mass, but not BMD, in the dominant arm of postmenopausal tennis players. The magnitude of the inter-arm asymmetry of postmenopausal tennis players is proportional to the length of tennis participation.

Ondas de choque extracorpóreas: evidencias científicas de sus indicaciones en patología musculoesquelética / Extracorporeal shock wave therapy: scientific evidence of its indications in musculoeskeletal disorders

El tratamiento de lesiones músculoesqueléticas mediante ondas de choque extracorpóreas, ha suscitado el interés de la comunidad científica europea en los últimos veinte años. A nivel mundial ha despertado enorme interés desde que la F.D.A. (Federal Drug Administration) norteamericana aprobara su uso para el tratamiento conservador de la fascitis plantar en octubre de 2000. En la actualidad las ondas de choque extracorpóreas se presentan como una alternativa más en el arsenal de los métodos conservadores del tratamiento de las afecciones del aparato locomotor. Este artículo de revisión resume el estado actual de la evidencia científica de la indicación del uso de las ondas de choque extracorpóreas en patología músculoesquelética (AU)

Rehabilitación acelerada tras cirugía artroscópica del ligamento cruzado anterior / Accelerated rehabilitation after arthroscopic surgery of anterior cruciate ligament

La rehabilitación acelerada tras reconstrucción artroscópica del ligamento cruzado anterior ha ido adquiriendo cada vez más protagonismo dentro del arsenal terapéutico disponible para la insuficiencia de este ligamento. Teniendo como objetivo la reincorporación a la actividad competitiva deportiva del lesionado alrededor de los seis meses tras la intervención quirúrgica, está basada en la consecución de una extensión completa desde el principio y una flexión superior a los 120º dentro de las cuatro semanas siguientes. El apoyo precoz y la potenciación muscular mediante ejercicios en cadena cinética cerrada, junto con una especial dedicación a la recuperación propioceptiva, constituyen los fundamentos de su empleo. En este trabajo se expone el protocolo del Instituto Canario de Ortopedia y Traumatología basado en estos principios. (AU)

Uso de la isoestación B-200 y electromiografía de superficie en la valoración del dolor lumbar / Assessment of low back pain with the isostation B-200 lumbar dynamometer and surface electromyography

Objetivo: Estudiar la fuerza isométrica del tronco en los tres ejes del espacio y actividad eléctrica de la musculatura erectora del tronco y oblicuos abdominales en una población normal, otra con patología lumbar conocida y otra normal fingiendo lumbalgia. Método: La fuerza se midió con una isoestación B=200® y la actividad muscular con un electromiografo superficial ME3000P® de cuatro canales. La población normal estuvo formada por 36 individuos, la patológica por 39 pacientes y la de fingidores por 16 voluntarios. Resultados: El grupo de fingidores mostró significativamente menor fuerza que los otros dos grupos en todos los ejes (p < 0,001), mientras que el de patológicos sólo mostró una disminución significativa de fuerza con respecto al normal en flexión (p < 0,001). La actividad eléctrica de la musculatura erectora fue mayor en el lado contralateral alas rotaciones en el grupo de normales y fingidores, mientras fue mayor en el lado homolateral a las rotaciones en el grupo de patológicos. La actividad eléctrica de los oblicuos fue similar bilateralmente durante las rotaciones en los grupos normal y de fingidores, mientras que estuvo claramente disminuida en la musculatura contralateral al sentido de la rotación en el grupo de patológicos. Estos hallazgos pueden ser útiles para diferenciar pacientes con lumbalgia de aquellos que intentan fingir dolor (AU)

Early diagnosis of stress fracture of the lumbar spine in athletes.

Thirty-three athletes complaining of back pain of more than 1 months' duration and with normal radiography of the lower spine were all studied by scintigraphy and in 24 of them with single photon emission computerized tomography. A stress fracture was considered present if localized increased uptake was seen at a vertebral level. Scintigraphy showed increased uptake in 17 of 33 patients and single photon emission computerized tomography in 16 of 24 patients.

Longitudinal overgrowth of bone after osteotomy in young rats: influence of bone stability.

One hundred and five 5-week-old male rats were used to study the influence of the stability of an osteotomy on longitudinal overgrowth of the bone. In 45 rats (Group 1) a transverse diaphyseal osteotomy of the right tibia was made; the left tibia was left untreated. In the second 45 rats (Group 2) the right tibia was osteotomized after applying an external fixator; the left tibia underwent a sham operation without osteotomy. Fifteen further rats (Group 3) were used as a nonoperated control group. After being measured at different periods up to 20 weeks, the osteotomized tibiae of the Group 1 (unstable) were 16-25% longer than those of their nontreated limbs (P < 0.001). The osteotomized tibiae of the Group 2 (stable) were 6-11% longer than those of the sham-operated opposite limbs (P < 0.001). The osteotomized and unstable tibiae were 9-17% longer than the osteotomized and stable tibiae (P < 0. 001) throughout the whole study. Although several factors have been considered to be responsible for longitudinal bone overgrowth after fracture in young animals, this work suggests that bone's stability plays a decisive role in the final outcome.

Surgical stabilization of spondylolisthesis in a wrestler.

Sporting activity in wrestlers operated on for spondylolisthesis is not well documented in the literature. We present the case of a wrestler with a grade I L5-S1 spondylolisthesis who was L4-S1 arthrodesed due to pain not relieved by conservative methods. One year after surgery he had returned to full wrestling activity, including competitions. Two years later, he continues to wrestle at the same level of competition.

Stress radiography in the diagnosis of anterior cruciate ligament deficiency.

A prospective study was carried out to test the sensitivity and specificity of stress radiography in detecting anterior cruciate ligament deficiency in both knees of 116 patients using the Telos device. In 47 of these a total or partial rupture of the anterior cruciate ligament was diagnosed by arthroscopy, while the ligament was intact in the remaining 69 patients. The mean difference in radiological translation between the injured and the normal knee was greater than 5 mm (p < 0.001) in those with anterior cruciate deficiency, and less than 3 mm in the others. A differential displacement of up to 3 mm was considered normal. The sensitivity of the method was less than 67% and the specificity was 100%. Clinical diagnosis had a sensitivity of 70.2% and a specificity of 98.5%. Our findings suggest that, although a differential translation of more than 3 mm can be diagnostic, smaller differences do not rule out anterior cruciate deficiency.

Growth-plate modifications after drilling.

Thirty 5-week-old male rats were used to discern the local modifications of the growth plate after drilling. A 1-mm wide drill hole was made on the right femur from the intercondylar notch to the diaphysis crossing the growth plate, with the left femur acting as a sham-operated control. Animals were killed in four five-unit groups at 1, 2, 8, and 16 weeks, respectively, after the surgical procedure. Soft tissues were removed and bone length measured. Distal growth plates of both femora were histologically, histomorphometrically, and histochemically studied. There were no significant differences in length or growth-plate height between drilled bones and their controls. Drill holes were filled by bony trabeculi formed progressively from metaphyses and adjacent cartilage metaplasia. This bone bridge grew wider as time passed after the surgical procedure. These experimental findings suggest that caution should be taken when pinning fractures through the growth plate. Failed attempts can produce permanent epiphysiodesis bridges.

Bone growth after periosteal stripping in rats.

The effect on bone growth after stripping of the periosteum of the middle third of the femur was investigated in 70 rats. Seventy further animals were used as controls. The animals were serially killed at 1, 2, 4, 8, 12, 16 and 20 weeks after operation. The femoral length, intertrochanteric diameter, diameter of the distal epiphysis of the femur, diameter of the femoral diaphysis and the tibial length were measured. Significant lengthening of the femur was noted only after 4 weeks, when it was 1.5% longer than the opposite side (p 0.001), but this was not maintained. The diameter of the distal epiphysis and the tibial length were not significantly affected. The intertrochanteric diameter was significantly shorter on the stripped side at the 2nd week and significantly longer at the 12th. The diaphyseal diameter of the stripped bones was progressively more narrow than the contralateral from the 2nd week. Differences remained significant at all stages of this study. Periosteal stripping yields only a temporary slight increase in bone length with a definite decrease in diaphyseal diameter.

Longitudinal bone growth after sciatic denervation in rats.

The right sciatic nerve of 50 one-month-old male rats was cut under general anaesthesia. Groups of animals were sacrificed at intervals of up to 12 weeks after operation and the length of the femora, tibiae and first and fifth metatarsals were measured with a caliper accurate to 0.05 mm. From the first week, both metatarsals were between 3% and 5% shorter on the denervated side, but there was no further increase of the discrepancy. The femora were less than 1% longer in the denervated limb at the second and eighth week. No difference was found between the lengths of the tibiae. The various factors which could possibly be responsible for these findings are discussed.