Prospective Cohort Study Comparing Ligament Reconstruction with Tendon Interposition and Suture-Only Suspension Arthroplasty.

BACKGROUND: Basal joint arthritis is a common form of osteoarthritis. There is no consensus procedure for maintenance of trapezial height following trapeziectomy. Suture-only suspension arthroplasty (SSA) is a simple method for stabilizing the thumb metacarpal following trapeziectomy. METHODS: This single-institution, prospective, cohort study compares trapeziectomy followed by either ligament reconstruction with tendon interposition (LRTI) or SSA for the treatment of basal joint arthritis. Patients underwent LRTI or SSA from May of 2018 to December of 2019. Visual analogue scale pain scores; Disabilities of the Arm, Shoulder and Hand questionnaire functional scores; clinical thumb range of motion, pinch, and grip strength data; and patient-reported outcomes were recorded and analyzed preoperatively and at 6 weeks and 6 months postoperatively. RESULTS: Total number of study participants was 45 (LRTI, n = 26; SSA, n = 19). Mean ± SE age was 62.4 ± 1.5 years; 71% were female patients; and 51% underwent surgery on the dominant side. Visual analogue scale scores improved for LRTI and SSA ( P < 0.0001) over 6 months, with no differences between groups at any time point ( P > 0.3). Disabilities of the Arm, Shoulder and Hand questionnaire scores improved for LRTI and SSA over 6 months ( P < 0.0001), with no differences between groups at any time point ( P > 0.3). Following SSA, opposition improved ( P = 0.02), but not as well for LRTI ( P = 0.16). Grip and pinch strength decreased following LRTI and SSA at 6 weeks but recovered similarly for both groups over 6 months. Patient-reported outcomes were generally no different between groups at all time points. CONCLUSION: LRTI and SSA are similar procedures following trapeziectomy relative to pain, function, and strength recovery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Radiographic Thumb Metacarpal Subsidence Following Ligament Reconstruction With Tendon Interposition and Suture-Only Suspension Arthroplasty in the Treatment of Basal Joint Arthritis.

BACKGROUND: The thumb carpometacarpal (CMC) joint is a common source of osteoarthritis. Following trapeziectomy, ligament reconstruction with tendon interposition (LRTI) is considered a "gold standard" treatment, but suture-only suspension arthroplasty (SSA) has recently emerged as a simpler alternative. Currently, there is no objective radiographic study comparing subsidence following these 2 techniques. METHODS: This study is a retrospective review of 23 patients (10 LRTI, 13 SSA) that had at least 6 months of radiographic follow-up following thumb CMC arthroplasty. Posteroanterior radiographs at a preoperative timepoint, and at the 2-week and greater than 6-month postoperative timepoints were evaluated for actual trapezial height, as well as trapezial height normalized to capitate, thumb metacarpal, and proximal phalangeal heights. Normalized trapezial heights were calculated, and preoperative values were compared with greater than 6-month postoperative values. In addition, actual and normalized trapezial heights following LRTI and SSA were compared at each timepoint. RESULTS: Mean trapezial height decreased from approximately 12 to 5 mm (reduction of ~60%, P < .05) in both groups with no differences when comparing LRTI and SSA at each timepoint. All normalized trapezial heights revealed differences from preoperative to greater than 6-month postoperative timepoints, but no differences between LRTI and SSA. CONCLUSIONS: Ligament reconstruction with tendon interposition and SSA exhibit equivalent actual and normalized trapezial heights over a greater than 6-month postoperative time course.

Baseline Characteristics of the Median Nerve on Ultrasound Examination.

Background: Previous studies using ultrasound for diagnosis of carpal tunnel syndrome have reported on relatively small series of patients, leading to large standard deviations and/or confidence intervals for the mean cross-sectional area of the median nerve. The purpose of this study is to define the CSA of the median nerve in a large cohort of patients. Methods: Patients (n = 175) without history of carpal tunnel release were recruited. All participants were evaluated using the Carpal Tunnel Syndrome-6 questionnaire, a validated clinical diagnostic tool, with a score of 12 or greater considered positive for CTS. Ultrasound examination was performed on both wrists of all participants using a 13-6 MHz linear array transducer. Results: The mean median nerve CSA was significantly larger (P < .001) for patients with a positive (mean = 11.16, SD = 2.51) versus negative CTS-6 result (mean = 6.91, SD = 2.06). There was a significant correlation (.527, P < .001, n = 349) between CSA and CTS-6 score. Logistic regression analysis determined that a CSA of 10 mm2 optimized sensitivity and specificity at 80% and 88%, respectively. Accuracy was 87.9%. Conclusions: A significant difference in mean CSA was found between patients with and without CTS. Median nerve CSA showed a statistically significant positive correlation with CTS-6. Similar to prior studies, a CSA of 10 mm2 was determined to be the optimal cutoff. In this large series of patients, ultrasound was a sensitive, specific, and accurate test for confirmation of a clinical diagnosis of CTS.

Unstable dorsal proximal interphalangeal joint fracture-dislocations treated with extension-block pinning.

Unstable proximal interphalangeal (PIP) joint fracture-dislocations, which can cause significant disability, can be treated with multiple techniques. Extension-block pinning (EBP) allows for early motion and is less technically demanding than alternative surgical treatments. In the study reported here, 12 patients with unstable dorsal PIP fracture-dislocations were treated with closed reduction of the PIP joint followed by percutaneous insertion of a Kirschner wire (K-wire) into the distal aspect of the proximal phalanx. For these patients, extent of articular surface involvement averaged 43% (range, 25%-75%). Active motion was initiated early after surgery, and the K-wire was removed a mean of 25 days after pinning. Radiographic reduction of joint dislocation was achieved and maintained for 11 of the 12 patients at a mean follow-up of 35.5 months. At follow-up, mean visual analog scale (VAS) score was 0.64 (scale, 0-10). Mean score on the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire was 5.7, suggesting minimal functional impairment. Mean PIP active motion was 84° (range, 50°-110°). Grip strength was equal between operative and contralateral hands. Patient satisfaction most closely correlated with low VAS and QuickDASH scores. One patient developed a malunion, which was treated with corrective osteotomy. EBP is a simple, safe, and reproducible technique for unstable PIP fracture-dislocations. This technique yields outcomes similar to those reported for more complex surgical procedures.

Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard.

BACKGROUND: Ultrasound examination is both accurate and cost-effective for the confirmation of a clinical diagnosis of carpal tunnel syndrome. Previous studies have shown electrodiagnostic testing and ultrasound to be similar with regard to sensitivity and specificity. The purpose of this study was to compare the sensitivity and specificity of ultrasound and electrodiagnostic testing by using a validated clinical diagnostic tool as the reference standard. METHODS: All consecutive patients referred to an upper-extremity practice for electrodiagnostic testing for any reason over a three-month period were recruited to participate in this study. All patients were evaluated with the use of the Carpal Tunnel Syndrome 6 (CTS-6) clinical diagnostic tool, and a score of ≥12 was considered positive for carpal tunnel syndrome. A positive finding on ultrasound was considered to be a cross-sectional area of the median nerve, measured just proximal to the level of the pisiform, of ≥10 mm(2). A positive finding on electrodiagnostic testing was a distal motor latency of ≥4.2 ms and/or a distal sensory latency of ≥3.2 ms. Sensitivity, specificity, and accuracy were calculated for ultrasound and electrodiagnostic testing with use of the CTS-6 as the reference standard. RESULTS: With use of the CTS-6 as the reference standard, ultrasound had a sensitivity of 89% and a specificity of 90% in our series of eighty-five patients. Electrodiagnostic testing had a sensitivity of 89% and a specificity of 80%. The positive predictive value of ultrasound was 94% compared with 89% for electrodiagnostic testing. The negative predictive value of ultrasound was 82% compared with 80% for electrodiagnostic testing. Ultrasound was accurate in seventy-six (89%) of the eighty-five cases whereas electrodiagnostic testing was accurate in seventy-three (86%) of the eighty-five cases (p = 0.5). CONCLUSIONS: While ultrasound will not replace electrodiagnostic testing in complicated or unclear cases, in a select group of patients with a positive CTS-6, ultrasound can be used to confirm the diagnosis of carpal tunnel syndrome with better specificity and equal sensitivity as compared with those of electrodiagnostic testing. LEVEL OF EVIDENCE: Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Outcome of surgery for lateral epicondylitis (tennis elbow): effect of worker's compensation.

We retrospectively compared the results of extensor origin release for lateral epicondylitis (tennis elbow) against worker's compensation (WC) status. All patients (N = 57) underwent extensor origin release between October 1989 and June 1998. For the 33 patients (37 elbows) who received WC, mean follow-up was 55 months; for the 25 patients (26 elbows) who did not receive WC, mean follow-up was 45 months. Pain relief, symptom recurrence, satisfaction with procedure outcome, and ability to return to work (same or similar job) were evaluated. Pain relief was reliably achieved in the WC and non-WC groups (36/37 and 24/26 elbows, respectively). Symptom recurrence was intermittent in both groups, and few patients sought medical intervention for recurrent symptoms. Patient satisfaction was high in the WC and non-WC groups (35/37 and 26/26 elbows, respectively). A majority of patients in both groups returned to work, but a significantly higher percentage of patients in the WC group changed jobs because of persistent symptoms.