MR imaging of the wrist: effect on clinical diagnosis and patient care.

PURPOSE: To evaluate the effect of magnetic resonance (MR) imaging of the wrist on clinicians' diagnoses, diagnostic certainty, and patient care. MATERIALS AND METHODS: A controlled observational study was performed. Referring clinicians completed questionnaires about diagnosis and intended management before and after wrist MR imaging. One hundred eighteen consecutive patients referred for MR imaging of the wrist were recruited from the MR imaging units at a regional teaching hospital and a large district general hospital. The main measures were changes in the clinicians' leading and subsidiary diagnoses after MR imaging, their certainty in these diagnoses, and changes in intended patient care. RESULTS: Questionnaires were incorrectly completed for five patients, questionnaires were not returned for three, appointments were canceled for 10, and two could not tolerate the MR examination. Complete follow-up data were available for 98 patients. The clinical diagnosis changed in 55 of 98 patients; in the remaining 43 patients, diagnostic certainty increased in 23. Clinicians reported that MR imaging had substantially improved their understanding of the disease in 67 of 98 patients. The care plan changed in 45 of 98 patients, with a shift away from surgical treatment. Twenty-eight patients were discharged without further investigation. MR imaging was similarly effective in the regional teaching center and the district general hospital. CONCLUSION: MR imaging of the wrist influences clinicians' diagnoses and management plans.

The histopathology of de Quervain's disease.

The histopathological appearances of the tendon sheath and synovium from 23 patients treated surgically for de Quervain's disease are described and compared with 24 controls. The condition was not characterized by inflammation, but by thickening of the tendon sheath and most notably by the accumulation of mucopolysaccharide, an indicator of myxoid degeneration. These changes are pathognomonic of the condition and are not seen in control tendon sheaths. The term 'stenosing tenovaginitis' is a misnomer and we believe that de Quervain's disease is a result of intrinsic, degenerative mechanisms rather than extrinsic, inflammatory ones.

Injuries to the hand in rugby union football.

Hand injuries are a common consequence of playing rugby. A prospective study of all rugby injuries referred to a hand clinic over the course of one season was carried out. 72 patients with such injuries were seen. There were 46 fractures and 26 soft tissue injuries. A substantial number were caused deliberately by opponents. One-third of the injuries were thought to be preventable.

The Herbert screw for delayed and non-union of scaphoid fractures: a review of fifty cases.

The results of treatment using the Herbert screw in 50 consecutive patients with delayed or established non-union of the scaphoid are reported. 14% of these fractures failed to unite after operation and a further 20% required prolonged protection, uniting within six months. There were significant technical problems in 28% of operations. A bone graft was only used when there was significant collapse of the scaphoid (52%) and the cases without graft did just as well. Overall, the results do not support the view that this method of treatment is a significant advance over Russe grafting in terms of union rates, but confirm that it produces similar results without the need for prolonged immobilisation and without the need for bone grafting in almost half the cases, although there can be significant technical problems with the procedure.

Hypoplastic scaphoid--an unusual cause of carpal tunnel syndrome.

A case of median nerve compression within the carpal tunnel, secondary to hypoplasia of the carpal scaphoid and dysplasia of the distal radius, is described in a 15-year-old boy with Spondylo-epiphyseal dysplasia tarda. Hypoplastic carpal bones and a dysplastic distal radius may be a feature of Spondylo-epiphyseal dysplasias, but carpal tunnel syndrome has not been previously reported either in this condition or in association with hypoplasia of the scaphoid.

Habitual anterior subluxation of the head of the ulna treated by Baldwin's operation. A case report.

A case of habitual anterior subluxation of the ulna at the inferior radio-ulnar joint is reported. The subluxation presented with signs and symptoms of both ulnar amd median neuritis. There was no past history of trauma. Baldwin's procedure was carried out, stabilising the distal radio-ulnar joint and relieving all symptoms of nerve compression. The use of Baldwin's procedure to correct this condition has not previously been described.

Osteochondral fractures of the lateral femoral condyle: a result of indirect violence to the knee.

Twenty patients with an average age of eighteen and a half years sustained osteochondral fractures of the lateral femoral condyle as the result of a sudden twist and valgus strain to the straight or almost straight knee. All the patients felt sudden pain at the moment of injury, all had a haemarthrosis, and yet the fracture escaped early diagnosis in one-third of the cases. Internal fixation of the fragment with early mobilisation is recommended if the diagnosis is made within two weeks of injury, and excision of the fragment if it is only later identified.