De Quervain's Disease Research Articles

Results of surgical treatment of De Quervain's tenosynovitis: 80 cases with a mean follow-up of 9.5 years.

Surgery is indicated in De Quervain's tenosynovitis only after failure of medical treatment, often due to individual anatomical variants. We use Le Viet's technique, to avoid tendon instability. The aim of the present study was to evaluate long-term results, with the hypothesis that this surgical technique is reliable, providing lasting results. All patients operated on between 1993 and 2015 were included, and results were assessed by telephone questionnaire at a minimum 1-year's follow-up. Surgical technique was systematically as described by Le Viet, with subcutaneous fixation of the retinaculum flap. Any anatomical variants were specified. In 26 cases, a concomitant pathology was treated in the same step. In addition to demographic data, the study looked for: pain on VAS, functional impairment, tendon dislocation, and satisfaction. There were no intra- or immediate postoperative complications. Of the 89 patients, 74 (80 wrists) were successfully recontacted: 68 women and 6 men, with a mean age of 48.5 years (range, 19-71 years). The 15 patients lost to follow-up showed initial progression comparable to the rest of the population. A supernumerary septum was found in 50 cases, and an abductor pollicis longus tendon with multiple slips in 35 cases. There were no recurrences. Functional impairment was absent in 68 wrists, moderate in 8 and significant in 4, including 3 with associated diseases. Mean VAS was 0.76 (range, 0-10). No patients reported tendon dislocation or neuroma. Patients were very satisfied in 72 cases, satisfied in 6 and dissatisfied in 2 cases with associated diseases. Results in the present series, with a mean follow-up of 9.5 years, were favorable, with total regression of functional impairment in 85% of cases and a satisfaction rate of 97.5%. There were no cases of tendon dislocation, neuroma, or recurrence. Residual problems were all related to associated diseases, whether pre-existing or with subsequent onset. Le Viet's technique gives reliable, lasting results without complications or recurrence. IV, retrospective study.

Anatomical variations in the first extensor compartment: a cadaver study.

Anatomical variations in the first extensor compartment are associated with the pathogenesis of de Quervain's disease. Here, we report two novel anatomical variations of the first extensor compartment. The wrists of two adult cadavers were dissected to reveal the anatomical variations in the first extensor compartment. In one of the cadavers, no septum was present in the first extensor compartment. However, the extensor pollicis brevis tendon and its proximal muscle belly were absent. The abductor pollicis longus (APL) tendon had multiple slips, and one of them inserted on the dorsal base of the proximal thumb phalanx. In another cadaver, a septum was present in the first extensor compartment. One of the multiple APL tendon slips ran into the septum alongside the extensor pollicis brevis tendon for 4 mm, which then exited the septum and inserted into the base of the first phalanx together with the APL tendon. Our findings may help to improve the awareness of the anatomical variations in the first extensor compartment.

Asociación entre los síntomas musculoesqueléticos, tendinitis de De Quervain y frecuencia de uso de Smartphone

Objetivo: medir la fuerza de asociación entre los síntomas músculo-esqueléticos, tendinitis de De Quervain y la tenencia del Smartphone. Materiales y métodos: estudio observacional transversal y analítico con muestra de 200 participantes de 13 a 35 años de edad del distrito de Los Olivos, Perú. Se recolectó información acerca de la tenencia, el tiempo de posesión, frecuencia de uso, características del Smartphone y factores sociodemográficos. Se utilizó el Cuestionario Nórdico para la detección y análisis de síntomas músculo-esqueléticos y estimar el nivel de riesgo de lesión. Para el diagnóstico de la Tendinitis de De Quervain se utilizó el test de Finkelstein. Resultados: se encontró fuerza de asociación entre la tendinitis de De Quervain con la frecuencia de uso del Smartphone a la semana (OR= 1.03; p=0.021) donde sí se aumenta una hora más la frecuencia de uso a la semana provocaría un aumento de 3 % de riesgo de lesión. En relación a las demás partes de la extremidad superior, no se encontró asociación significativa. Conclusión: no existe asociación entre los síntomas musculoesqueléticos, tendinitis de De Quervain con la tenencia del Smartphone. Pero si se evidencia que existe fuerza de asociación entre la tendinitis de De Quervain y molestias en cuello con la frecuencia de uso del Smartphone.

Nonsurgical Treatment of De Quervain Tenosynovitis: A Prospective Randomized Trial.

Background: De Quervain tenosynovitis is commonly seen in patients who perform repetitive wrist ulnar deviation with thumb abduction and extension. Previous studies comparing nonsurgical options have contributed to a lack of consensus about ideal management. This study's purpose was to analyze results in prospectively randomized patients treated with either corticosteroid injection (CSI) alone versus CSI with immobilization. Methods: Radial sided wrist pain, first dorsal compartment tenderness, and positive Finkelstein test were used to define De Quervain. Pain score of 4 or higher on a visual analog scale (VAS) was utilized for inclusion. Following exclusion criteria, patients underwent randomization into groups: (1) CSI alone; or (2) CSI with 3 weeks of immobilization. We followed at 3 weeks and 6 months for further evaluation, where resolution of symptoms and improvements in VAS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed to evaluate treatment success. Results: Nine patients with CSI alone and 11 patients with CSI and immobilization were followed. At 6 months in both groups, patients experienced significant improvement in VAS and DASH scores, while 88% of patients with CSI alone and 73% of patients with CSI and immobilization experienced complete resolution of at least 2 out of 3 of their pretreatment symptoms. Between groups, outcomes were comparable except for resolution of radial-sided wrist pain, which was superior in patients with CSI alone (100% vs 64%). Conclusions: Immobilization following injection increases costs, may hinder activities of daily living, and did not contribute to improved patient outcomes in this study. Further prospective studies are warranted.

Open versus Endoscopic Release of Carpal Tunnel Syndrome

A total of 90 hands belonging to 80 patients were included in the study. They were mostly female (70) and the rest were male (10). There were 30 endoscopic releases, 60 open releases, and 2 endoscopic converted to open release. There were 15 hands complications in 90 hands. The overall complica­tion rate was 12.2%. Complications noted were pillar pain, open tendonitis presenting as De Quervain disease or trigger finger (1 endoscopic surgeries, 1 open surgeries), infection (1 endo­scopic surgeries, 3 open surgeries), wound adhesion (3 open surger­ies), nerve injury (2 open surgery, 1 endoscopic), complex regional pain syndrome (4 open surgery), and scheduled re­turns to the operating room (OR) for recurrent, ongoing, or wors­ening symptoms (1 endoscopic surgeries, 5 open surgeries). In carpal tunnel syndrome, endoscopic surgery was associated with less postoperative pain than open surgery, but the small size of the benefit and similarity in other outcomes make its cost effectiveness uncertain. There were 12 patients (out of 90) in the surgery group had painful or hypertrophic scar or pillar pain. Wound adhesion and pillar pain was the only statistically significant complica­tion found in the study when comparing open with endoscopic carpal tunnel release. This can potentially be pre­vented in future patients by delaying the removal of sutures and prolong­ing the use of a protective dressing in patients who undergo open release. There was not a statistically signifi­cant increase in overall complications when using the minimally invasive method of release, which is consis­tent with existing literature.

The effect of new articulated splint in pinch strength in De Quervain syndrome: A comparative study

For patients with De Quervain syndrome using thumb spica orthosis prescribing in acute stage of syndrome, is restricting. Many patients are dissatisfied with using the static hard design and find it difficult to perform their daily activities. The aim of this study is to compare the effect of modified articulated and conventional static orthoses on pinch power and functional abilities of hand in De Quervain syndrome. In this quasi-experimental study, palmar and lateral pinch strength of the thumb, pain and functional abilities of hand, patient's satisfaction of orthoses, were evaluated after using modified articulated and conventional static orthosis in two groups. Twenty-four women between 18 and 60 years with De Quervain syndrome were randomly allocated in two groups of treatment. The first group used conventional static orthoses and the second one utilized modified articulated design. During the period of treatment, patients were encouraged to do their daily activities just like before. Both orthoses improved palmar and lateral pinch strength of the thumb, pain level and functional abilities. In comparison of mentioned variables, there was no significant difference between two groups regarding to pain recovery and abilities improvement ( P > 0.05). However, the satisfaction level of the patients who had used the articulated orthosis was higher ( P < 0.05). It seems, adding a joint to the static thumb spica leads to patient's relief and consequently to their satisfaction. This study shows that static and modified articulated thumb spica orthoses were similar regarding to the effect on pain and functional abilities of the patients with De Quervain syndrome. However, according to the higher rate of satisfaction of the patients utilizing articulated orthosis, the use of new articulated design of orthosis is recommended instead of the conventional static model.

Extracorporeal shockwave therapy for pain reduction of musculoskeletal diseases: Predictors and responders

Musculoskeletal disorders are a continuous challenge for the search for practical and viable treatment solutions that generate analgesia and well-being. To discover the predictors of the outcome of radial extracorporeal shockwave therapy (rESWT) on pain reduction of patients with musculoskeletal diseases and to identify the best responders of this therapy. Short-term retrospective before-after trial. Outpatient facility of a Physical Medicine and Rehabilitation Service. Nine hundred medical records of patients with musculoskeletal disorders (rotator cuff syndrome, De Quervain syndrome, trigger finger, lateral epicondylitis, pseudarthrosis, trochanteric bursitis, anserine syndrome, knee osteochondritisdissecans, patellofemoral syndrome, plantar fasciitis, Achilles tendinitis) who undertook rESWT for pain reduction. Patients younger than 18 years of age, with ongoing treatment at the time of the medical record selection, with other associated diseases, and whose information was unclear or incomplete in the medical records were not included. Radial extracorporeal shockwave therapy, applied once a week for two weeks. Pain, assessed before and one week after the end of the intervention is the main outcome and was measured by Visual Analogue Scale (VAS). The participants’ pathology, demographic data and pain at baseline were approached via multiple regression for the predictors and odds ratio for the responders. Pain was reduced in 63.4% (VAS = 2.90, 95% CI: 2.72–3.08). Higher levels of pain at baseline, higher frequencies of rESWT application, and knee diseases were the predictors of the treatment outcome (β = −0.21, P ≤ 0.001, β = −0.88, P ≤ 0.001, and β = 1.10, P = 0.001, respectively). Patients with shoulder diseases were the best responders to the rESWT (OR = 1.91, 95% CI: 1.21–3.02). There is strong evidence that rESWT is effective for reducing pain of patients with severe pain treated with higher application frequencies. Patients with knee diseases tend benefit less from rESWT, whereas those with shoulder diseases are the best responders this treatment.

Building an Effective Right-Hand Guitar Technique Around Injury Prevention Methods

The right-hand technique of guitarists needs to move forward when it comes to injury prevention. Guitarists are often diagnosed with median neuritis, carpal tunnel syndrome, lateral epicondylitis, medial epicondylitis, intersection syndrome, digital flexor tenosynovitis, stenosing tenosynovitis, and De Quervain's syndrome as a result of faulty right-hand technique. The causes generally converge to the lack of warm-ups, compression of the forearm muscles, excessive wrist flexion, extension, or sideways deviations, and repetitive movements with simultaneous muscle tension or strained positions. Based on evidence, this article provides technical suggestions that reduces tension and theoretically decreases the chances of playing-related injuries.

Ultrasound-guided steroid injection for the treatment of de Quervain's disease: an anatomy-based approach.

To suggest different ultrasound-guided steroid injection (USI) techniques based on anatomical variations of the first extensor compartment (FEC), and to evaluate the usefulness of it, in patients with de Quervain's disease. Twenty-eight patients who underwent USI for de Quervain's disease were included. Anatomical variations were classified into complete sub-compartmentalization (n = 11), distal incomplete sub-compartmentalization (n = 5), and no sub-compartmentalization (n = 12) on ultrasound. Involved sub-compartments were recorded in patients with complete sub-compartmentalization. USIs were performed based on the anatomical variations: in both sub-compartments (n = 2) or only in the affected sub-compartment (n = 9) depending on the location of tenosynovitis involvement, in patients with complete sub-compartmentalization; in proximal FEC in patients with distal incomplete sub-compartmentalization (n = 5); in the common compartment in patients with no sub-compartmentalization (n = 12). Medical charts were retrospectively reviewed for evaluation of clinical outcome at follow-up visits. Twenty-three out of 28 patients were followed up with a mean period of 31.2days after injection (6~87days). Mean VAS was 7.96 before injection (range: 4 to 10), which was significantly reduced to 0.65 at rest and 1.57 during activity at follow-up visits (p < 0.05). Twenty-two out of 23 patients were satisfied with the results. The mean proportion of subjective pain reduction was 82.0% (median 95%). Ultrasound-guided steroid injections using different injection techniques based on the anatomical variations of the FEC have shown to be beneficial in the management of de Quervain's disease.

Strain-based elastography assessment of patients with De Quervain tenosynovitis: A preliminary study

IntroductionThe development of the condition is occurs by repeated strain of the APL and EPB tendons as they pass under a thickened and swollen extensor retinaculum.De Quervain tenosynovitis prevalence is about 0.5% in males and 1.3% in females. In the recent years, De Quervain tenosynovitis incidence increases by virtue of modern life conditions such as excessive computer use and increased use of cellular phones. Materials and methodsThe final study population comprised 52 subjects; 30 diseased (patients) (group 1) and 22 healthy subjects (volunteers) (group 2).All participants were subject to; (1) history taking, (2) clinical examination to prove or eliminate the presence of tenosynovitis, (3) US, and (4) MRI. ResultsStrain-based elastography positive predictive value was 95%, negative predictive value was 90%, sensitivity 92%, and specificity 93%. ConclusionIn conclusion, we can postulate that strain-based elastography ratio can be used confidently and quantitatively to diagnose De Quervain tenosynovitis.

Variation of abductor pollicis longus tendons in cadavers

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; First extensor compartment of the wrist comprises of abductor pollicis longus and extensor pollicis brevis. It helps in movement and stabilization of thumb. Variations in the number of tendons of APL muscle may be asymptomatic and often incidental finding. Stenosing tenosynovitis of the first dorsal compartment of the wrist or de Quervains disease is a commonly encountered debilitating condition of the wrist.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cadaveric study was done on 40 forearms in 20 cadavers available in Department of anatomy and forensic medicine at our institute. The muscles of extensor compartments were dissected, extensor retinaculum split over first extensor compartment, tendons of APL exposed. Study period from February-2017 to February-2018.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 6 female and 14 male cadavers. The APL muscle was found with a single tendon in 2, double in 30, triple in 8. There were variations in the insertion of the APL tendon as well. In all hands, the APL tendon had insertion into the first metacarpal bone and in 20 hands (50%), it had second insertion into the trapezium.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Variation of APL muscle insertion in the Indian population and two or more tendinous slips attached commonly to the first metacarpal base and the trapezium may be the cause of treatment failure in DQT and cause of Trapeziometacarpal arthritis. Further studies needs to be done for further evaluation.&lt;/p&gt;

Soft Tissue Atrophy Related to Corticosteroid Injection: Review of the Literature and Implications for Hand Surgeons.

Corticosteroid injections (CIs) are frequently used by hand surgeons to treat a wide range of pathology including de Quervain tenosynovitis and lateral epicondylitis. Although generally viewed as a benign modality, and a way to potentially avoid or postpone surgical intervention, common complications from CI should be considered and discussed with patients before the procedure. One such complication is local soft tissue atrophy and hypopigmentation after injection. We discuss the incidence of soft tissue-related adverse effects from CI, the pathophysiology and influence of different steroid preparations on soft tissues, and potential treatment options once atrophy has occurred.

Finkelstein's Test Is Superior to Eichhoff's Test in the Investigation of de Quervain's Disease.

Introduction de Quervain's tenosynovitis is a common pathologic condition of the hand. Finkelstein's test has long been considered to be a pathognomonic sign of this diagnosis, yet most clinicians and instruction manuals erroneously describe what is in fact the Eichhoff's test, which is thought to produce similar pain by tendon stretching in a normal wrist. The purpose of this study was to compare Finkelstein's test with Eichhoff's test in asymptomatic individuals. Materials and Methods Thirty-six asymptomatic participants (72 wrists) were examined using both Finkelstein's and Eichhoff's tests with a minimum interval of 24 hours between the tests. Results The results showed that Finkelstein's test was more accurate than Eichhoff's test. It demonstrated higher specificity, produced significantly fewer numbers of false-positive results, and also caused significantly less discomfort to patients. Conclusion This study recommends Finkelstein's test as the clinical examination of choice for the diagnosis of de Quervain's disease.

Variations of extensor pollicis brevis tendon in Indian population: A cadaveric study and review of literature

ObjectivesVariations of the tendons of the first dorsal compartment of the wrist may be one of reasons of treatment failure and recurrence in De Quervain's tenosynovitis (DQT). The present cadaveric study was designed to look into the variations of the Extensor pollicis brevis (EPB) tendon in Indian population. MethodsSeventy-seven formaldehyde-fixed cadaveric upper limbs of Indian origins were dissected to observe the number of EPB tendons and its variations. ResultsThe EPB muscle was found to be absent in one hand (1.3%). The EPB muscle was found with single tendon, two tendons and three tendons in 73 limbs (94.8%), 2 limbs (2.6%) and one limb (1.3%) respectively. The muscle originated from the posterior surface of the radius and the adjacent interosseous membrane. The EPB muscle with single tendon was found to be inserted into the distal part of dorsal surface of the proximal phalanx of the thumb in 44 limbs (57.1%). In limbs with bitendinous EPB, the tendon slips were inserted into the base of proximal phalanx and into the base of distal phalanx of the thumb. An Osseo-fibrous septum separating EPB from Abductor Pollicis Longus (APL) was observed in 45 limbs (58%). ConclusionEPB in first extensor compartment of Indians is usually monotendinous. It mostly inserts into the distal part of dorsal surface of proximal phalanx of thumb and into the base of distal phalanx. In majority of the wrists, one may find an osseofibrous ridge separating EPB from APL. These anatomical variations may be helpful to guide proper treatment in de Quervain’s tenosynovitis.

Analysing orthotic designs for de Quervain's disease based on in vivo gliding distance of extensor pollicis brevis tendon

Background/Aims: To reconsider orthotic designs used for de Quervain's disease based on in vivo information obtained from ultrasound images. Methods: The hands (n=40) of 20 healthy adult men and women participants with no history of thumb injury or deformation were examined. A two-dimensional tissue tracking system was used to quantitatively measure in vivo gliding distance in the extensor pollicis brevis tendon during thumb interphalangeal joint autonomic movement while wearing a thumb spica orthosis. Findings: Results revealed anatomical variations in the insertion of the extensor pollicis brevis tendon in 9 (22.5%) hands. A septum was noted in the first dorsal compartment of the extensor tendon in 23 (57.5%) hands. Multiple comparison testing of gliding distance across four groups, classified by the presence or absence of anatomical variations and/or septa using Tukey's test, revealed significant differences for gliding distance between groups with and without anatomical variations, regardless of whether septa were observed (p=0.01). Conclusions: It is necessary to evaluate physical characteristics such as septa and anatomical variations based on advanced screening with ultrasound examinations before considering thumb fixation range for patients in the acute inflammation phase or those exhibiting recurrence of de Quervain's disease.

Ultrasound assessment of extensor pollicis brevis tendon excursion in different wrist positions in healthy people

Study DesignCross-sectional, observational study. IntroductionThere is little reported on the in vivo mechanics and behavior of extensor pollicis brevis (EPB) in relation to wrist position. Wrist position is known to significantly influence tendon excursion and therefore function of the digits. Ultrasound imaging (USI) can be used to assess in vivo tendon behavior and excursion. An improved knowledge of the excursion of the EPB tendon is important in understanding normal tendon mechanics and potentially pathological tendon disorders such as de Quervains tenosynovitis. Purpose of the StudyTo assess the reliability of using USI to measure EPB tendon excursion and to quantify EPB tendon excursion in 3 wrist positions. MethodsUSI with speckle-tracking analysis were utilized to assess 49 normal EPB tendons (25 subjects). Tendon excursion was measured in wrist flexion (45°), wrist neutral and wrist extension (45°) on 2 different occasions. ResultsThe within- and between-session reliability of using USI to quantify EPB tendon excursion was “excellent” and “high,” respectively. Wrist position had a significant influence on EPB tendon excursion (P ≤ .05). EPB excursion in the neutral wrist position was statistically greater than the other 2 positions (P < .05). DiscussionEPB tendon excursion has been shown to be dependent on the wrist positions of flexion and extension. The measures are notably lower than those found in cadaver studies; however, they follow a similar pattern with greatest excursion occurring in the neutral wrist position and least in flexion. This information is useful for EPB tendon rehabilitation and in consideration of biomechanics and pathogenesis of disorders that affect EPB tendon. ConclusionIn vivo EPB tendon excursion measures have been quantified, and wrist position has been found to have an influence on excursion. USI with speckle-tracking analysis are considered to be reliable methods for measuring EPB tendon excursion.

Why We Should Care About the Sex of Specimens in Cadaveric, Animal, and Cell-Based Orthopaedic Research: Commentary on an article by Jessica Bryant, MD, et al.: "Potential Sex Bias Exists in Orthopaedic Basic Science and Translational Research".

Commentary As orthopaedic surgeons, we are well aware of the important role that sex plays in the epidemiology and treatment of many orthopaedic conditions. Some conditions have a strong bias toward men (such as Achilles tendon rupture)1 or women (such as de Quervain tenosynovitis)2, and surgical treatment plans can also be influenced by sex. Using the knee as an example, women at the time of anterior cruciate ligament (ACL) reconstruction are at a higher risk for an excessively small gracilis and semitendinosus combined autograft diameter3. Women also tend to have relatively narrower distal parts of the femora (in medial-lateral dimension) than men do, which, in part, led to the design of sex-specific implants for use in total knee arthroplasty4. Historically, women have been severely underrepresented in human clinical trials, which led to the Revitalization Act of 1993 and the requirement to include women in clinical research funded by the National Institutes of Health (NIH). Under this policy, enrollment rates of women in modern NIH-funded clinical trials are now higher than those of men5. However, little attention has been paid to sex bias among animals or cells utilized in basic science research. In 2014, the NIH leadership unveiled future plans to roll out policies that require balanced use of female and male animals and cells in basic science research6. The rationale for these proposed policies is that elimination of sex bias at the preclinical stage will lead to improved clinical study design and more reliable translation of results to clinical practice. This proposal has had mixed support in the basic science community. Routine use of male and female cell lines and animals as well as comparison of experimental results by sex may unnecessarily increase experimental costs and variability7; if there is no physiologic basis for sex to play a role in certain experiments, why should it be investigated? However, proponents of the proposal suggest that the extra cost and effort needed to equally include male and female specimens are justified by the downstream costs of failing to do so, namely, failed clinical trials, misdiagnosis and inappropriate therapies for women, and omission of fundamental biological principles8. In the current review, Bryant et al. investigated the potential for sex bias in orthopaedic basic science research. The authors identified all cadaveric, animal, and cell-based studies shown in 4 of our top journals in 2014 (Journal of Orthopaedic Research, Clinical Orthopaedics and Related Research, The Bone & Joint Journal, and The Journal of Bone & Joint Surgery) and determined that sex is not reported in more than one-third of the included studies. Among studies that did include sex, there was a predilection toward use of male specimens, and authors reported sex-specific results in only 13% of studies that included both sexes. The predilection for male specimens in animal studies, in particular, is based on the unfounded (and debunked)9 assumption that variability in results is intrinsically higher in females because of variability in estrogen cycles. Clearly, we need to do a better job of consistently reporting sex in basic science research within our field. The current review highlights an important topic and reminds us to, at a minimum, actively consider the sex of specimens when interpreting study results or designing a new basic science experiment. Standardized reporting of the sex of included specimens should be a requirement, as well as an explanation for use of samples from one sex if a balanced sample (of male and female specimens) is not used. This has the potential to increase discovery of previously obscured sex-specific relationships and to improve the clinical applicability of basic science studies within our field.

Hand surgeon - to be or not to be? That is the question. Compulsory health service experience of hand surgery in Turkey

Objectives: Hand surgery has been a major theme throughout the education of orthopedics and traumatology (OT) along with plastic, reconstructive, and aesthetic (PRA) surgery residents. However, to work as a hand surgeon during compulsory health service (CHS) is a new topic for Turkey. We aimed to share the elective surgical experience of six hand surgeons during CHS in different centers of Turkey. Methods: The hand surgeons who have already finished their CHS or were up to finish their CHS was requested to fill operation records (OR) form for elective procedures performed in the surgeon's usual daily practice. The records from all six surgeons were integrated. Results: Five OT and one PRA originated hand surgeons were available for this study. Tendon procedures were the most commonly performed procedure (14.3%), followed by phalanx (10.6%), and then by nerve (10.4%) procedures. A small percentage (2.7%) of operations performed were beyond the scope of hand surgery. Simple procedures (trigger finger release, carpal tunnel release, foreign material extraction, ganglion cysts excision, de Quervain's tenosynovitis release) were comprising 20.9% of all the operations performed. Conclusion: Hand surgery comprises a broad spectrum of disorders and requires a distinct fellowship period. Hand surgeons bear an important mission about basic hand surgery education of OT and PRA residents and encourage them to perform simple procedures. The possibility of team-work will definitely increase the interest for hand surgery and result in better outcomes for patients. Finally, we honestly declare that we feel satisfied with our special work and invite residents to walk together in this endless hand surgery road.

Seasonal Variation in the Prevalence of Common Orthopaedic Upper Extremity Conditions

Introduction Seasonal variation in disease processes and injuries have been reported, but it is unclear if this variation exists in upper extremity disorders. The goal of this study is to characterize seasonal and weather variations in common upper extremity orthopaedic conditions. Methods This cross-sectional study reviewed 68,943 consecutive, new patient visits from January 2010 to September 2015 for carpal tunnel syndrome (CTS), trigger finger (TF), DeQuervain's tenosynovitis (DeQ), lateral epicondylitis (LE), hand arthritis (OA), and distal radius fractures (DRF). Presentation rates for each condition were compared across month, season, and various weather parameters. Results DRF, OA, and LE had a higher rate of presentation in the winter compared with all other seasons ( p < 0.001). TF and DeQ showed no statistically significant seasonal differences. Higher barometric pressures were associated with higher rates of all of the diagnoses. Higher humidity was associated with lower rates of CTS, TF, DeQ, LE, and DRF ( p < 0.001). There was no significant association between temperature levels or amount of precipitation. Discussion Although the precise mechanism remains unclear, there does appear to be an impact of winter, increased barometric pressure, and higher humidity on presentation rates. Further studies are needed to determine more conclusively why this occurs. Level of Evidence Level IV, cross-sectional study.

Maintaining anticoagulant treatment in hand surgery – a review of 63 procedures

Interruption and resumption of anticoagulant is at risk of high morbidity (thrombosis, hematoma) during or after hand surgery. Local anesthesia including epinephrin enables good hemostasis during and after surgery. Authors argue anticoagulant may be taken as usual, without interruption, if the surgery is performed using a local anesthesia with epinephrin. Authors described their experience of hand procedures without interruption of anticoagulant or strong antiaggregant treatment (clopidogrel) in a continuous series of 63 procedures. Over a period of 2.5 years, 63 continuous procedures (43 patients) were included. All procedures were operated on with a chronic treatment of anticoagulant (41), a strong antiaggregant treatment clopidogrel (19) or both (3). Concerning procedures under anticoagulant, 8 procedures were performed with a strong anticoagulant treatment (INR 3–4.5). Among 63 procedures, there were 28 carpal tunnel, 18 trigger fingers, 12 Dupuytren's contracture, 1 de Quervain tendinitis, 3 digital tumors. Fasting was forbidden. The surgery was performed under local anesthesia using epinephrine 1%, following the WALANT procedure. Mean duration between anesthesia and surgery was 17 minutes (12–40). All procedures were performed with percutaneous ultrasound guidance, excepted for digital tumors. We evaluated 2 criteria-excessive bleeding during the surgery and postoperative hematoma. The 3 cases of open surgeries (digital tumors) necessitated basic gestures of haemostasis. All ultrasound-assisted surgeries were performed without hemostasis gestures. None hematoma was observed or reported after surgery. This is a short series but we did not report specific bleeding or hematoma during or after surgery, either for anticoagulant or strong antiaggregant treated patients Local anesthesia with epinephrin is a relevant way to avoid interruption of anticoagulant treatment and preventing bleeding complications.