Correlation of clinical signs with nerve conduction tests in the diagnosis of carpal tunnel syndrome.

In order to establish the need for nerve conduction studies, a prospective study has been performed on 112 patients with symptoms of carpal tunnel syndrome (172 symptomatic hands), seeking correlation with 11 clinical criteria taken either singly or in combination. Even when the patient presents with a typical clinical presentation of carpal tunnel syndrome the diagnosis is only confirmed electrophysiologically in 61% of cases. Analysis of the sensitivity and specificity of various clinical tests and diagnostic manoeuvres has shown their mediocre reliability in establishing the diagnosis with a sensitivity of 58% and a specificity of 54% for Phalen's test.

The results of conservative management of trigger finger. A series of 169 patients.

The authors present the preliminary results of a series of 230 trigger fingers in 169 patients managed conservatively by injection of 1 ml of hydrocortisone into the flexor sheath as described by Curtis. 'Good' results were obtained after a single infiltration in 73% cases, after two infiltrations in 81.6% cases and in 83% cases after three infiltrations. Factors have been studied in order to identify variables with prognostic significance. The outcome was not influenced by the severity of symptoms, by the association with other disease, by sex or by the site of pathology. Outcome was affected by the duration of symptoms. Duration exceeding one year indicates surgical release as does failure of conservative treatment.

[Repair of the flexor digitorum profundus and the flexor pollicis longus by the "rope down" technique. Results in a series of 77 cases]. / Réparation du fléchisseur profond et du long fléchisseur du pouce par la "fixation en rappel". Résultats d'une série de soixante-dix-sept cas.

UNLABELLED: Seventy-seven flexor tendon lesions in zone I have been reinserted by the "rope down" technique using the Jennings barb-wire. They included 20 cases of repair of FPL. The patients were reviewed with an average follow-up of 4 years (minimum 3 months, maximum 10 years). By means of this technique, immediate active mobilisation was possible in 70 of the 77 cases. Mobility of the MCPJ and the PIPJ was maintained in all but one case. At DIPJ level active flexion was recovered at an average of 42.8 degrees with an average extension deficit of 5.5 degrees. This corresponds to a 1.3% (D1) and 2% (D2-D5) handicap as assessed by the International Federation of Hand Surgery. Complications were recorded in 12 of the 77 cases. Two cases required a secondary tenolysis. The factors which influence on the result were analysed. This analysis demonstrates the frequency with which the association of other lesions worsens an outcome which, traditionally, is otherwise good. The average time off work was 6.9 weeks (minimum 0, maximum 6 months). IN CONCLUSION: this simple, rapid technique achieves secure reinsertion allowing immediate active mobilisation. The use of barb-wire demands meticulous surgical technique and close post-operative surveillance. These requirements indicate why this method does not readily lend itself to the management of these lesions in infants.