Can the Boston Carpal Tunnel Syndrome Questionnaire Be Used as a Screening Tool Among a Potentially High-Risk Population in Singapore?

Introduction Carpal tunnel syndrome (CTS) causes significant morbidity with delayed diagnosis or management. The Boston Carpal Tunnel Questionnaire (BCTQ) is validated for monitoring CTS following diagnosis; however, it has not been trialed in a screening capacity. The study aimed to determine whether it can be utilized when screening a focused population in Singapore. Materials and Methods A single-center survey-based study was undertaken prospectively to identify whether positive symptoms could be identified among nursing and administrative staff. Results A total of 605 staff responded. Positive symptoms were identified in 317 (52.4%) of participants and 23 (3.8%) reported them to be severe. Functional limitations were detected in 157 (26.0%) of participants with 5 (0.8%) reporting these as severe. Positive symptoms (84.9%) and functional limitations (81.5%) were more prevalent among nursing staff. Cronbach's α scores (0.896 for symptoms and 0.84 for functional limitations) suggested good reliability in matching symptoms and functional limitations. Conclusion The BCTQ can potentially be implemented as a screening tool for CTS among those without a prior diagnosis. It has a greater depth of questioning with symptomatic and functional limitations considered, and in situations where a formal diagnosis is subsequently made, the same tool can be subsequently used for progression tracking pre- and post-treatment. Level of Evidence This is a Level II study.

Corrective Metacarpal Osteotomy With Intramedullary Screw Fixation: Technique and Case Report.

Metacarpal malunion with significant angulation leading to symptoms from bony prominence in the palm or dorsum and decreased grip strength occur rarely, but may lead to patients requiring surgical correction. Corrective osteotomy procedures with plate fixation are commonly performed for these patients. Localizing the correct site of osteotomy and the required amount of bone removal for precise correction is difficult even with adequate preoperative planning. After osteotomy, plate osteosynthesis is the most common fixation method to allow for early mobilization; however, plate osteosynthesis can lead to soft tissue irritation, which may necessitate secondary surgeries for tenolysis and implant removal. This case study highlights our use of an intramedullary wire as an additional guide to the ideal site of osteotomy and then the use of an intramedullary screw for stabilization of the osteotomy site.

Relation of Lateral Antebrachial Cutaneous Nerve to the Volar Approach to Distal Radius.

BACKGROUND: The anatomy of the lateral antebrachial cutaneous nerve (LABCN) in relation to volar approaches to the distal radius is not well visited. With the increasing popularity of distal radius fracture fixation with volar locking plates, it is prudent to study the innervation pattern of the LABCN to minimize the risk of nerve injury. METHODS: Ten cadaveric distal radial forearms were dissected to study the relationship between the LABCN, flexor carpi radialis (FCR), superficial branch of radial nerve (SBRN), and scaphoid tubercle (ST). RESULTS: The LABCN coursed closer to the FCR than the SBRN, with branches traversing the tendon in two specimens. The LABCN was also noted to be intimately related to the radial artery, with an average distance of the LABCN from the lateral border of FCR was 6.4mm distally and 9.6mm proximally. CONCLUSIONS: There is a sparsely innervated corridor between the radial border of the FCR and terminal branches of the LABCN that provides safe access for volar approach to the distal radius.

Use of a hand drill to remove particulate contamination within a traumatic bone tunnel.

We report a novel method of debridement for penetrating trauma to the hand involving bone using a sterile hand drill. This provides a means for adequate clearance of debris which may otherwise be left in-situ due to poor access to the contaminants when conventional techniques of debridement are used.