Subsequent bilateral acute carpal tunnel syndrome due to tophaceous infiltration: A case report.

BACKGROUND: Acute carpal tunnel syndrome (ACTS) is commonly caused by repetitive strain, trauma, or inflammatory conditions. However, ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported. This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications. CASE SUMMARY: A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout. Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo, the patient underwent emergency decompression surgery for both wrists at different time points. Postoperatively, he exhibited complete recovery of sensory and motor functions, with no recurrence at long-term follow-up. Favorable outcomes were achieved through immediate decompression surgery, anti-inflammatory medications, postoperative active and passive range-of-motion exercises, and intermittent wrist splinting. Prompt diagnosis and surgical intervention, when necessary, are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS. An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes. CONCLUSION: Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.

Arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor in acute and subacute scapholunate dissociation.

PURPOSE: The objective of this study was to investigate the potential of arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor as a treatment option for patients experiencing symptomatic acute and subacute (< 3 months) scapholunate instability. METHODS: From Jan. 2017 to Jan 2020, 19 wrists with acute or subacute tears of the SL ligament with symptomatic instability were treated with arthroscopic SL repair and dorsal capsulodesis with a suture anchor. The average time from injury to operation was 8.8 weeks (range, 4-11 weeks) and the regular follow-up mean duration at our clinic was 26.5 months (range, 24-32 months). The pain score according to the visual analog scale, wrist range of motion, grip strength, radiographic outcomes and functional outcomes according to the Modified Mayo Wrist Score (MMWS) were evaluated preoperatively and postoperatively during the follow-up period. RESULTS: All 19 patients had rupture and dissociation of the SL ligament in the radiocarpal joint. The total arc of wrist motion in the flexion-extension plane loss averaged 5.1° (P > .01).The Wilcoxon signed-rank test was used to compare the results: grip force improved significantly with 14.7% improvement of that on the normal side (P < .01); the postoperative MMWS was significantly better than the preoperative scores (P < .01). Of 19 patients of the series, 18 patients (94.7%) achieved good or excellent results according to the MMWS and 16 patients (84.2%) resumed their previous activities. Only one patient (5.3%) had residual laxity of the scapholunate ligament joint at 15 months of follow-up. CONCLUSIONS: At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results. LEVEL OF EVIDENCE: Level IV, case series.

Arthroscopic treatment of stable nonunion, unstable nonunion, or nonunion of the scaphoid with early degenerative radioscaphoid arthritis.

BACKGROUND: This study was designed to analyze the clinical follow-up results (minimum of 2 years) in patients with stable nonunion, unstable nonunion, or nonunion of the scaphoid with early degenerative radioscaphoid arthritis (Lichtman classification stage I-III) treated with arthroscopic osteosynthesis with autogenous bone graft. METHODS: We retrospectively recruited 44 consecutive patients with scaphoid fracture nonunion treated with arthroscopy-assisted percutaneous internal fixation with autogenous bone grafts from January 2010 to November 2019. We recorded union and return to activity and analyzed data with regular clinical follow-up at a mean duration of 33 months (range 24-46 months). Clinical (i.e., visual analog scale pain score, grip strength, and range of motion), radiographic, and functional (Mayo Modified Wrist Score (MMWS)) outcomes at the final follow-up were compared with the preoperative assessments and analyzed in patients with different stages. RESULTS: We confirmed union in 39 of the 44 patients (88.6%) after a mean 15.4 weeks post-operatively according to clinical examinations and standard radiography. All clinical parameters improved significantly. For the MMWS, there were 25 excellent and 14 good results. Of the 44 patients, 40 (90.9%) returned to work or sports activities at their preinjury levels. Comparisons of the outcomes between patients in different stages of scaphoid nonunion revealed no significant difference in the aspect of union rate, VAS pain score, and functional score improvement. CONCLUSIONS: Arthroscopic osteosynthesis with autogenous bone grafts is a reliable and minimally invasive method for achieving nonunion healing and improving clinical outcomes in stage I-III scaphoid nonunion. LEVEL OF EVIDENCE: Level IV, case series.

Incidence of Carpal Tunnel Syndrome Requiring Surgery May Increase in Patients Treated with Trigger Finger Release: A Retrospective Cohort Study.

Purpose: The correlation between carpal tunnel syndrome (CTS) surgery and trigger finger (TF) surgery is unclear; we conducted this nationwide population-based study to assess the development of severe CTS requiring surgery after TF surgery. Patients and Methods: This retrospective cohort study used the data of patients diagnosed as having TF between January 1, 2001, and December 31, 2017, and they were divided into two comparative groups. Patients who underwent surgical release within 1 year of diagnosis were included in the TF-OP group, and those who did not undergo TF release during the same period were included in the TF-NOP group. The primary outcome was the new incidence of CTS release (CTR), and data on the related risk factors were collected for analysis. Results: A total of 8232 patients each were enrolled into the TF-OP and TF-NOP groups and were 1:1 propensity score matched (mean patient age, 54.7 ± 10.1 years; mean follow-up duration, 6.58 years). The incidence rate of CTR was 1.1 per 1000 person-years in the TF-OP group and 0.7 per 1000 person-years in the TF-NOP group. The adjusted hazard ratio of TF surgery was 1.51. The factors significantly correlated with an increased incidence of CTR were age, female sex, diabetes mellitus, and chronic renal failure. In subgroup analysis, patients aged >65 years and female patients in the TF-OP group were still at significantly higher risks of CTR than were their counterparts in the TF-NOP subgroups. The cumulative incidence of CTR after TF surgery linearly increased with time in both groups. Conclusion: Patients undergoing TF release may have a higher incidence of CTR 1 year later, especially women and patients aged >65 years. Diabetes mellitus and chronic renal failure may be risk factors.

Arthroscopic foveal repair with suture anchors for traumatic tears of the triangular fibrocartilage complex.

BACKGROUND: Foveal tears of the traumatic triangular fibrocartilage complex (TFCC) are the most commonly neglected high-energy injuries of the wrist joint, and the patients with such tears often experience unrecovered ulnar-sided wrist pain and poor wrist function. This study investigated the functional outcomes of patients who underwent arthroscopic repair of foveal TFCC tears with suture anchors and adjuvant platelet-rich plasma (PRP) injections after the surgery. METHODS: From September 2014 to August 2018, 156 men and 45 women with diagnoses of foveal TFCC tears without wrist fractures underwent arthroscopic repair by using the outside-in method with 1.3-mm suture anchors and subsequent PRP injection. After surgery, splinting was applied for 6 weeks, and the patients underwent rehabilitation, re-examination, and follow-up at our clinic. The patients' wrist functional scores and grip strength data were retrospectively collected. RESULTS: The mean follow-up period was 32.6 months, and the mean age was 26.7 years. The mean modified Mayo wrist score improved from 48.5 ± 2.6 to 82.4 ± 2.5, whereas the mean Disabilities of the Arm, Shoulder and Hand (DASH) score decreased from 39.2 ± 6.7 to 10.6 ± 7.5. Overall, the wrist functions of 186 (92.5%) of the patients were satisfactory according to their modified Mayo wrist scores, and the patients with satisfactory scores returned to sports or work activities. These patients retained normal ranges of motion, and their average grip strength in the affected hand was restored to at least 85% of that of the other hand. CONCLUSIONS: According to the postoperative 25-36 months surgical results of our study, arthroscopic repair with adjuvant PRP injections is a satisfactory method of repairing early foveal tears of the TFCC and can enhance wrist function by relieving pain and increasing tolerance for work or sports.

Arthroscopic triangular fibrocartilage complex reconstruction with free tendon graft for chronic distal radioulnar joint instability.

BACKGROUND: Tears in the triangular fibrocartilage complex (TFCC) often manifest as ulnar wrist pain and limited wrist function. In chronic cases, the treatment of large tears with irreparable TFCC degeneration combined with distal radioulnar joint (DRUJ) instability is difficult. In the current report, we describe the outcomes of a minimally invasive technique for TFCC reconstruction using the free palmaris longus (PL) tendon via arthroscopy. METHODS: We examined the cases of 67 adult patients [54 men and 13 women; age range, 19-34 years (mean age, 26.4 years)] treated for chronic and irreparable TFCC tears from 2001 to 2019. We used the arthroscopic TFCC reconstruction method with the free PL tendon for all chronic and irreparable TFCC injuries with DRUJ instability in our clinic. Thereafter, the patients underwent the rehabilitation program, which included wrist motion and occupational therapy. The mean time period from the event causing the tear to the operation was 22.6 months. RESULTS: The function results of these patients significantly improved, and the ulnar wrist pain significantly decreased at postoperative follow-up. Of the 67 patients, 38 rated their wrists as "excellent," 26 as "good," and 3 as "fair." None of the patients developed wound infections or complications. CONCLUSIONS: The results of this study suggest that arthroscopic TFCC reconstruction using the free PL tendon is an effective method for treating chronic and irreparable TFCC tears with DRUJ instability.

Arthroscopic-assisted reduction, bone grafting and screw fixation across the scapholunate joint for proximal pole scaphoid nonunion.

BACKGROUND: There are some difficulties in treating proximal scaphoid nonunion, mainly including poor vascularity of the proximal scaphoid fragment and limited space for a stable fixation in the proximal scaphoid fragment. This study reports the outcomes of treating proximal scaphoid nonunion with arthroscopic assist for reduction, bone grafting and screw fixation across the scapholunate (SL) joint. METHODS: Between 2008 and 2017, 21 patients were enrolled. Fracture healing and change in the lateral SL angle and SL gap were evaluated. Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, wrist range of motion, grip strength, and the Visual Analog Scale (VAS) for pain. RESULTS: Nineteen patients achieved fracture healing and their mean follow-up duration was 31.3 months (24-120 months). The average fracture healing time was 16.3 weeks (10 to 28 weeks). From the preoperative to the postoperative final evaluation, there was some significant improvement in wrist function, including wrist flexion from 54.5o to 67.4o, wrist extension from 62.3o to 71.7o, DASH scores from 52.4 to 21.4, VAS during activity from 4.6 to 2.1, and grip strength from 9.6 kg to 24.7 kg. The lateral SL angle also improved significantly, from 82o to 66o. Seventeen patients requested screw removal after fracture healing because of their cultural belief in not leaving hardware in the body. No significant SL gap widening was noted after screw removal in the sequential follow-ups. CONCLUSIONS: Using arthroscopic-assisted reduction, bone grafting and screw fixation across the SL joint in proximal scaphoid nonunion treatment, satisfactory functional and radiographic outcomes can be achieved.

Functional Results after Intramuscular Ulnar Nerve Anterior Transposition for Young Adults Patients.

Background: This study investigated the functional outcomes of intramuscular ulnar nerve transposition (IMUNT) in young adults with cubital tunnel syndrome (CuTS). Methods: This retrospective study enrolled 37 military soldiers on active duty diagnosed with and treated for CuTS to determine the compression sites, complication rate, and postoperative results. Patient outcomes were analyzed using the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Bishop-Kleinman rating scales. Results: Patient outcomes were analyzed after a mean follow-up duration of 26.1 (22-29) months for 37 extremities. DASH scores improved from 38.7 (range, 13-63 points) preoperatively to 5.8 (range, 0-18 points) postoperatively. Patient improvement was statistically significant (p < 0.05). Based on the 12-point Bishop-Kleinman rating system, 30 (82.1%) patients were graded as excellent; five (13.5%) as good, and two (5.4%) as failed outcomes. Statistically significant improvements in both key pinch and grip strength were noted. Complications included one case of transient neuroparaxias of the medial antebrachial cutaneous nerve and one case of hematoma formation. Conclusions: We consider intramuscular ulnar nerve transposition to be a satisfactory procedure for CuTS. The procedure enhances upper limb function, thus allowing the patients to resume their physically demanding work with minimal complications.

Arthroscopic partial trapeziectomy and tendon interposition for thumb carpometacarpal arthritis.

BACKGROUND: The purpose of this study was to introduce arthroscopic partial trapeziectomy and tendon interposition for the treatment of symptomatic thumb carpometacarpal arthritis of Eaton stage II or III. METHODS: From August 2001 to April 2009, 23 patients with thumb carpometacarpal arthritis were treated using this technique. Pain score, range of motion, and pinch strength were clinically evaluated and compared with the preoperative values after a minimum follow-up duration of 24 months. RESULTS: Significant reduction in pain score and increases in range of motion and pinch strength were found (all p < 0.001) after a 2-year follow-up. The mean ± SD (median) postoperative pain score was 1.0 ± 0.7 (1.0) at rest and 1.3 ± 0.9 (1.0) during daily activities. The postoperative range of motion was 19.1° ± 4.2° (20°) for extension and 35.7° ± 7.1° (35.0°) for flexion, and the postoperative pinch strength was 86.5 % ± 19.9 % (90.0 %). No complications were observed in our patient series. CONCLUSIONS: Arthroscopic partial trapeziectomy and soft tissue interposition could be an alternative treatment method for patients with symptomatic thumb carpometacarpal arthritis of Eaton stage II or III.

Arthroscopically assisted use of injectable bone graft substitutes for management of scaphoid nonunions.

PURPOSE: The purpose of this study was to analyze the clinical follow-up results (minimum, 2 years) in patients with nonunions of the scaphoid with minimal sclerosis treated with arthroscopically assisted percutaneous internal fixation augmented by injection of a bone graft substitute. METHODS: From January 2006 through November 2007, a consecutive series of 15 patients with fibrous union or nonunion of a carpal scaphoid fracture with minimal sclerosis or resorption at the nonunion site were treated with arthroscopically assisted percutaneous internal fixation combined with the use of injectable bone graft substitute. Preoperative and postoperative evaluations included measurement of clinical (grip strength and range of motion), radiographic, and functional (Mayo Modified Wrist Score) parameters, as well as satisfaction. The sample included 13 men and 2 women with a mean age of 31 years (range, 20 to 45 years). We recorded union and return to activity and analyzed data with regular clinical follow-up at a mean of 33 months (range, 24 to 46 months). RESULTS: We confirmed union in 14 of 15 patients (93%) at a mean of 15.4 weeks according to clinical examinations and standard radiography. For the Mayo Modified Wrist Score, there were 10 excellent and 4 good results. A total of 14 of 15 patients (93%) returned to work or sports activities at their preinjury level. CONCLUSIONS: Arthroscopically assisted treatment with percutaneous internal fixation with injectable bone graft substitute is a reliable and minimally invasive method to achieve union and scaphoid healing. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Electrothermal treatment of thumb basal joint instability.

PURPOSE: This study examined whether radiofrequency electrothermal treatment of thumb basal joint instability could produce clinical improvement and result in successful functional outcomes for patients. METHODS: From August 2001 to April 2006, we treated 17 thumbs with symptomatic thumb basal joint instability using arthroscopic electrothermal shrinkage of the volar ligaments and joint capsule with a monopolar radiofrequency probe. The sample included 11 men and 6 women with a mean age of 35.3 years (range, 20 to 60 years). All patients underwent regular clinical follow-up at a mean of 41 months (range, 24 to 80 months). RESULTS: Pain improved in all thumbs after surgery. Thumb pinch strength significantly improved in all thumbs after surgery (P < .01). All patients were satisfied with the results and returned to their preinjury activities. CONCLUSIONS: By use of the described method of arthroscopic electrothermal shrinkage of the volar ligaments and joint capsule in patients with symptomatic thumb basal joint instability, most patients had good subjective results and the pinch strength improved significantly in most patients. Of 17 thumbs, 16 had satisfactory subjective and functional stability at a minimum 2 years' follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Stabilization of the proximal ulnar stump after the Darrach or Sauvé-Kapandji procedure by using the extensor carpi ulnaris tendon.

The Darrach and Sauvé-Kapandji procedures are considered to be useful treatment options for distal radioulnar joint disorders. Postoperative instability of the proximal ulnar stump and radioulnar convergence, however, may cause further symptoms. From October 1999 to May 2002, a total of 19 wrists in 15 men and four women, with an average age of 48.3 years, were treated by stabilizing the proximal ulnar stump with a half-slip of the extensor carpi ulnaris tendon using modified Darrach and Sauvé-Kapandji procedures. The average follow-up period was 77 months (range, 62 to 91 months). No patient complained of symptoms due to instability of the proximal ulnar stump. Grip strength improved in all wrists after surgery. Postoperative X-rays, including loading X-rays, showed improved alignment in both coronal and lateral planes. We concluded that stabilization of the proximal ulnar stump with ECU tenodesis is an effective procedure for treating distal radioulnar joint disorder after the Darrach and Sauvé-Kapandji procedures.

Surgical outcome of volar plate arthroplasty of the proximal interphalangeal joint using the Mitek micro GII suture anchor.

BACKGROUND: The mechanism of injury in dorsal dislocation is usually a hyperextensive stress simultaneous with some degree of longitudinal compression. Operative treatment is indicated for those unstable and reduction is not achieved. We report the surgical outcome of volar plate arthroplasty of the proximal interphalangeal (PIP) joint using the Mitek Micro GII suture anchor. METHODS: We reviewed the medical records of 20 patients with acute or chronic dorsal dislocation or subluxation of the PIP joint who were managed using the Mitek Micro GII suture anchor over the past 5 years by the same surgeon (J.T.S.). Fourteen patients had acute injuries (<4 weeks before surgery) and six patients had chronic injuries (average interval of 4.1 week from injury to surgery; range, 1-8 weeks). The patients had persistent pain and loss of range of motion after trauma, and the reductions were still unstable. RESULTS: All patients were evaluated an average of 25 months postoperatively (range, 12-30 months). The average arc of motion of the PIP joints of the fingers was 82 degrees . There were no obvious perioperative complications, and no patient reported pain at rest or with activity. CONCLUSION: Volar plate arthroplasty using the Mitek Micro GII suture anchor is an effective treatment choice for acute or chronic PIP joint dorsal dislocation or subluxation.

Extensor-tendons reconstruction using autogenous palmaris longus tendon grafting for rheumatoid arthritis patients.

BACKGROUND: The purpose of the study is to retrospectively review the clinical outcome of our study population of middle-aged RA patients who had suffered extensor-tendon rupture. We reported the outcome of autogenous palmaris tendon grafting of multiple extensor tendons at wrist level in 14 middle-aged rheumatoid patients. METHODS: Between Feb. 2000 to Feb. 2004, thirty-six ruptured wrist level extensor tendons were reconstructed in fourteen rheumatoid patients (11 women and three men) using autogenous palmaris longus tendon as a free interposition graft. In each case, the evaluation was based on both subjective and objective criteria, including the range of MCP joint flexion after surgery, the extension lag at the metacarpophalangeal joint before and after surgery, and the ability of the patient to work. RESULTS AND DISCUSSION: The average of follow-up was 54.1 months (range, 40 to 72 months). The average range of MCP joint flexion after reconstruction was 66 degrees . The extension lag at the metacarpophalangeal joint significantly improved from a preoperative mean of 38 degrees (range, 25 degrees -60 degrees ) to a postoperative mean of 16 degrees (range, 0 degrees -30 degrees ). Subjectively all patients were satisfied with the clinical results, and achieved a return to their level of ability before tendon rupture. We found good functional results in our series of interposition grafting using palmaris longus to reconstruct extensor tendon defects in the rheumatoid patients. CONCLUSION: Reconstruction for multiple tendon ruptures is a salvage procedure that is often associated with extensor lag and impairment of overall function. Early aggressive treatment of extensor tendon reconstruction using autogenous palmaris longus tendon as a free interposition graft in the rheumatoid wrist is another viable option to achieve good clinical functional result.

Combined extraforaminal and intradiscal cement leakage following percutaneous vertebroplasty.

STUDY DESIGN: A case report and review of the literature are presented. OBJECTIVE: To describe an extremely rare case of combined extraforaminal and intradiscal cement leakage in different vertebral levels following percutaneous vertebroplasty. SUMMARY OF BACKGROUND DATA: Cement leaks in vertebroplasty are relatively common but generally not clinically significant. To our knowledge, this is the first report of extraforaminal cement leakage inducing radiculopathy combined with intradiscal cement leakage evoking acute adjacent compression fracture. METHODS: A 78-year-old woman with L2 and L5 osteoporotic compression fractures received vertebroplasty. Two weeks after surgery, the patient presented severe low back pain radiating to the right thigh, with associated weakness and numbness in the right thigh and lower leg. Roentgenographic images revealed cement leakage into the right extraforamen of L2-L3 as well as leakage into L4-L5 disc with acute adjacent compression fracture of L4. RESULTS: Surgical intervention was required to relieve discomfort. One-stage posterior approach was performed: right L2-L3 intertransverse process approach with removal of extraforaminal leaked cement and posterior instrumentation from L3-L5 and posterior fusion. The severe low back pain, leg pain, and neurologic deficit associated weakness all improved after surgery. CONCLUSION: Although considered a minimally invasive procedure, percutaneous vertebroplasty with polymethylmethacrylate is not risk free. Intractable neurologic complications can occur if it is not performed by experienced physicians under appropriate indications and cautionary safeguards.

Monopolar radiofrequency electrothermal shrinkage of the scapholunate ligament.

PURPOSE: This study examined whether radiofrequency electrothermal shrinkage has a role in the treatment of patients with symptomatic dynamic and predynamic scapholunate (SL) instability without advanced degenerative changes. METHODS: From January 1999 to July 2001, 19 wrists with laxity of the SL ligament, but with symptomatic instability, were treated with arthroscopic electrothermal shrinkage of the SL ligament using a monopolar radiofrequency probe. Before surgery, all patients underwent wrist arthroscopy to confirm the diagnosis and exclude arthritis. The sample included 16 men and 3 women with an average age of 23.3 years (range, 18 to 27 years). The average time from injury to operation was 17.2 months (range, 14 to 28 months). All patients underwent follow-up at our clinic regularly for an average of 28.1 months (range, 24 to 34 months). RESULTS: All 19 patients had attenuation or laxity of the continuity SL ligament in the radiocarpal joint. Modified Mayo wrist scores revealed the following functionality: the total arc of wrist motion in the flexion-extension plane loss averaged 5.1 degrees (P > .01). Grip force improved significantly, with 14.7% improvement of that on the normal side (P < .01). The Wilcoxon signed-rank test was used to compare the results: the postoperative scores were significantly better than the preoperative scores (P < .01). Fifteen patients (79%) were fully satisfied with the results and returned to their preinjury activity. Four patients (21%) had recurrent laxity of the SL joint. CONCLUSIONS: Electrothermal shrinkage of the SL ligament in patients with symptomatic, predynamic and dynamic SL instability had a 79% success rate at a minimum of 2 years' follow-up. LEVEL OF EVIDENCE: Level IV, case series.

Results of arthroscopic reduction and percutaneous fixation for acute displaced scaphoid fractures.

PURPOSE: This study used percutaneous techniques augmented by simultaneous wrist arthroscopy to visualize the fracture and thus confirm the fracture alignment and reduction and also to assesses the concurrent associated ligament injuries. TYPE OF STUDY: Retrospective study. METHODS: Arthroscopy was used to help to reduce scaphoid fractures and assess soft-tissue injuries in 15 acute cases (13 male and 2 female patients). The fractures were treated by reduction under arthroscopic control and percutaneous fixation with the cannulated interosseous compression screw. Soft-tissue lesions were also treated at the same time using debridement, suture repair, or K-wire transfixation. The average age of the patients was 29.2 years (range, 19 to 48 years). RESULTS: Two patients (13.3%) had scapholunate (SL) ligament injuries, and both exhibited partial tear of the SL ligament. Four patients (26.7%) suffered lunotriquetral (LT) ligament injuries and received ligament debridement, K-wire fixation of the LT joint, and splinting. Six patients (40%) had chondral fractures. Additionally, the triangular fibrocartilage complex (TFCC) was torn in 5 patients (33%). Finally, 5 patients (33%) suffered radioscaphocapitate ligament or long radiolunate ligament injuries. All fractures healed without malunion or nonunion and, at follow-up of 24 to 28 months, 11 patients had excellent results and 4 had good results based on Mayo Modified Wrist Scores. CONCLUSIONS: We believe that arthroscopic reduction may be considered for scaphoid fractures because this approach can use a single procedure to achieve acceptable restoration of fractures as well as assessment and management of soft-tissue lesions. LEVEL OF EVIDENCE: Level IV Therapeutic Study, case series with no, or historical, control group.

Functional results post-triangular fibrocartilage complex reconstruction with extensor carpi ulnaris with or without ulnar shortening in chronic distal radioulnar joint instability.

From September 1996 to September 2001, 37 adult patients were diagnosed with chronic triangular fibrocartilage complex (TFCC) tears with distal radioulnar joint (DRUJ) instability in our clinic. They had all received the procedure of TFCC reconstruction with partial extensor carpi ulnaris (ECU) combined with or without ulnar shortening. There were 36 males and one female in the study with a mean age of 22.4 years. The follow-up period ranged from 25 to 48 months with a mean of 36.2 months. All patients received the rehabilitation programme and were re-examined at our outpatient department. The results were graded according to the Mayo Modified Wrist Score. Eleven of the 37 patients rated their wrists "excellent", 22 rated "good", and four rated "fair". Overall, a total of 33 patients (89%) rated satisfactorily and returned to work or sport activities. Therefore, TFCC reconstruction with partial ECU tendon combined with or without ulnar shortening procedure is an effective method for post-traumatic chronic TFCC tears with DRUJ instability suggested by this study.

Evaluation of shoulder proprioception following muscle fatigue.

OBJECTIVE: To investigate the effect of shoulder muscle fatigue on glenohumeral proprioception. DESIGN: A repeated proprioception test was performed. BACKGROUND: The role of conditioning and fatigue in sport injuries remains controversial. It has been hypothesized that proprioceptive information plays an important role in joint stabilization and that muscle fatigue may alter proprioceptive ability. However, the effect of shoulder muscle fatigue on glenohumeral proprioception is still controversial. METHODS: Eleven normal subjects (mean age 27.3 years) participated in this study. Proprioception tests (on the dominant shoulder) were performed in which proprioception of the active reproduced and passive reproduced shoulder position was measured using an isokinetic dynamometer and a proprioception testing apparatus, respectively. The speed of active repositioning was at 2 deg/s and passive repositioning was at 0.5 deg/s. The mean value of maximum voluntary contraction and the number of repetitions for muscle fatigue were recorded. Post-fatigue proprioception test was started within 3 min after muscle fatigue. RESULTS: There was no significant difference of shoulder proprioception between pre- and post-fatigue determinations of passive repositioning in shoulder internal rotation, passive repositioning in external rotation and active repositioning in internal rotation. There was a significant difference between pre- and post-fatigue determination of active repositioning in external shoulder rotation (mean degrees: 2.57 (SD 1.02) vs. 4.96 (SD 1.73), P<0.05). CONCLUSION: Shoulder proprioception in active repositioning in external rotation was major affected by muscle mechanoreceptors in the presence of muscle fatigue. RELEVANCE: This study revealed that the shoulder proprioception after muscle fatigue in active repositioning in shoulder external rotation was affected more sensitively by the muscle mechanoreceptors than the joint mechanoreceptors. Increasing resistance of muscle fatigue would increase the shoulder proprioceptive ability.