The role of midcarpal arthroscopy in the diagnosis of disorders of the wrist.

The findings of midcarpal versus radiocarpal arthroscopic examinations were compared in the diagnosis of a variety of wrist pathology in 89 patients. During 15 months 89 midcarpal arthroscopic examinations were performed in conjunction with radiocarpal arthroscopic examinations. Eighty-one wrists underwent arthroscopy for acute or chronic intracarpal instability. Eight wrists underwent arthroscopy for arthroscopy-assisted intra-articular distal radius fracture reduction. In the acute wrist instability group midcarpal arthroscopy added to the radiocarpal diagnosis in 21 of 26 (82%) of the wrists. In the chronic wrist instability group midcarpal arthroscopy added to the radiocarpal diagnosis in 46 of 55 (84%) of the wrists. In the distal radius group 5 of 8 wrists had additional pathology on the midcarpal arthroscopy examination, leading to additional surgical intervention. These results demonstrate that midcarpal arthroscopy added statistically significant information to the radiocarpal examination compared with wrist arthroscopy performed without a midcarpal examination.

Dynamic axial carpal instability: a case report.

The concept of distal carpal row dissociation is not new. It has occurred secondary to high-energy crush or blast injuries, with resultant axial dislocations of both carpal rows and metacarpals. Axial carpal sprains without disruption or dynamic axial carpal instability have not been previously described. The evaluation of this new type of carpal instability with radiographs, tomography, arthrography, and magnetic resonance imaging failed to demonstrate its etiology. Arthroscopic evaluation of the midcarpal and radiocarpal joints demonstrated a dynamic axial carpal instability with incompetence of the capitohamate and scapholunate ligaments. Stabilization of the axial instability by capitohamate arthrodesis relieved the chronic wrist pain.

Anterior intramuscular transposition of the ulnar nerve for cubital tunnel syndrome.

Forty-five sequential cubital tunnel releases with anterior transposition of the ulnar nerve in an intramuscular fashion were performed over a 4-year period. All patients had a positive Tinel's sign at the cubital tunnel and reported numbness and tingling in the ring and small finger of the affected arm. Thirty-three cases had preoperative electrodiagnostic studies performed. Twenty-three cases had positive electromyographic and nerve conduction velocity findings for cubital tunnel syndrome, whereas 10 cases had normal electromyographic and nerve conduction velocity studies. Twenty-four cases were covered by Workers' Compensation insurance. The average age of the patients was 40 years, with an average duration of symptoms of 22 weeks. Average follow-up examination was 15 months, with all patients being reexamined and completing a symptom outcome questionnaire. No significant differences between preoperative electrodiagnostic status could be demonstrated with regard to final symptom outcome. Patients with improved results from a symptom status were younger and had cubital tunnel syndrome of shorter duration. A trend toward poor results in patients with Workers' Compensation was noted, although this was not statistically significant. Overall, 87% of the patients had resolved or improved symptoms after cubital tunnel release with the anterior intramuscular transposition technique.

Disorders of the distal radioulnar joint.

Disorders of the distal radioulnar joint can be classified into functional abnormalities based on instability, incongruity of the joint surface, impaction, and isolated triangular fibrocartilage complex tears. Knowledge of the type of lesion aids in selecting the treatment option best suited to correcting each problem. This review begins by summarizing the anatomy of the distal radioulnar joint. It then examines the various clinical problems that may arise in this complicated anatomic area and outlines the different surgical and nonsurgical options available to treat these disorders. The most important aspect in treatment of disorders of the distal radioulnar joint is early recognition, followed by prompt appropriate surgical or nonsurgical management.

Arthroscopic debridement alone for intercarpal ligament tears.

This study examined the role of arthroscopic debridement alone for complete and incomplete intercarpal ligament tears of the wrist. Forty-three wrists underwent arthroscopic evaluation for persistent wrist pain and were identified as having isolated scapholunate or lunotriquetral ligament tears treated by arthroscopic debridement alone of the torn ligament edges. At follow-up examination at an average of 27 months, 29 (66%) wrists having a complete scapholunate ligament tear and 36 (85%) wrists having a limited scapholunate ligament tear had either complete symptom resolution or improved symptomatology. Thirty-three (78%) wrists with a complete lunotriquetral ligament tear and 43 (100%) wrists having a limited lunotriquetral ligament tear had complete symptom resolution or improvement. No wrists were noted to have static intercarpal instability pattern changes on follow-up radiographs. Grip strength improved 23% postoperatively. These findings suggest that intercarpal ligament tears, in a majority of patients, may be treated from a symptomatic standpoint by debridement alone for at least several years. The long-term ability of this approach to maintain a pain-free wrist has yet to be determined. No statistically significant difference was noted in the symptomatic improvement rate of scapholunate compared to lunotriquetral ligament debridement.

Distal radius fractures: concepts and complications.

Distal radius fractures are one of the most common types of injuries treated by an orthopedic surgeon. The overall results may not be as favorable as once thought. As a distinct subgroup, the young adult deserves special consideration. Management of distal radius fractures in these patients is difficult due to the higher energy involved, amount of comminution, and associated soft tissue damage. Functional outcome has been best when an anatomical reduction has been achieved. Many surgical options are available: external fixation, percutaneous pin fixation and open reduction are the mainstays. The complications may be minimized with careful attention to and knowledge of the techniques used and early intervention when closed treatment fails.

Electrodiagnostic testing and carpal tunnel release outcome.

This study examined the correlation of electrodiagnostic test results and symptom outcome after carpal tunnel release. After meeting specific inclusion and exclusion criteria and failing conservative management, 167 patients (227 hands) underwent an open carpal tunnel release. Of 99 hands with a positive electromyographic/nerve conduction velocity study, 93 (93%) had resolved or improved symptoms. This finding compares with a 93% resolution or improvement rate in 27 hands with a negative electromyographic/nerve conduction velocity study and a 93% resolution or improvement in postoperative symptoms in 101 hands on which no electromyographic/nerve conduction velocity study had been performed. Statistical analysis demonstrated no significant differences in final symptom status after carpal tunnel release when comparing patients who had positive, negative, or no electrodiagnostic preoperative testing. Given specific clinical criteria for establishing the diagnosis of carpal tunnel syndrome, electrodiagnostic testing does not appear to correlate with improved final symptomatic outcome after carpal tunnel release.

Giant cell tumors of tendon sheath.

Giant cell tumor of tendon sheath represents a common disorder that can present a surgical challenge. This article discusses the clinical, histologic, and treatment options for this lesion and the technique of excision.

Serum fractions and related agonists with calcium-mobilizing activity in the bovine growth plate chondrocyte.

Longitudinal growth of bone involves a complex sequence of cellular events in the cartilaginous epiphysis. Whole blood serum has been shown previously to be a potent stimulus to the cells of the growth plate, as demonstrated by its ability to activate the inositol phosphate-calcium second messenger system, resulting in a rise in intracellular Ca2+. By manipulating the preparation of serum to functionally separate it into its constituent parts, we have shown that the processes of platelet lysis and activation of the clotting cascade are responsible for the generation of factors that stimulate this signaling mechanism in isolated bovine growth plate chondrocytes. Through a subsequent trial of bioactive agents generated in these processes, we identified and partially characterized several novel agonists of growth plate chondrocytes:adenosine triphosphate and adenosine diphosphate, the purine energy substrates, and bradykinin, the bioactive peptide generated in a side reaction of the clotting cascade, each induces a rise in intracellular Ca2+ via release from intracellular ion stores. Additionally, the three distinct isoforms of platelet-derived growth factor (AA, AB, and BB), also released on platelet lysis, were compared with respect to their ability to stimulate the inositol phosphate-calcium second messenger system in growth plate chondrocytes.

[Approach to cases of acute acoustic traumas in our own materials]. / Postepowanie w przypadkach ostrych urazów akustycznych w materiale wlasnym.

The authors showed the proceeding in cases of acute acoustic traumas on the bases of own materials. The clinic prefers pharmacological treatment.