Flexor Carpi Radialis Tendon Research Articles

Radiopalmar ganglion cysts: prevalence, morphology, and clinical significance in wrist MRI.

To assess radiopalmar ganglion cysts' (RPG) prevalence, morphology, and clinical significance in consecutive patients. In this retrospective single-center study, two radiologists assessed the presence of RPG and morphologic features on wrist MRI. Radiopalmar complaints and scapholunate ligament (SLL) tears were evaluated. A total of 1053 wrists in 909 patients (mean age 43.4 ± 15.5 years, 602 females) were evaluated. All 308 RPG (Group 1; 308 patients, 29.2%) originated from the palmar capsule; 49 were unilocular, 95 oligolocular, and 164 multilocular; 745 wrists had no RPG (Group 2; 601 patients). One hundred and twenty-six RPG showed internal debris. The mean diameter was 8.5 ± 5.6 mm (cranio-caudal) (1.0-32.9 mm), 8.0 ± 4.1 mm (medio-lateral) (1.0-31.9 mm), and 3.7 ± 2.3 mm (dorso-palmar) (0.4-16.0 mm). 168 RPG showed direct contact with the radial vascular bundle, 24 with the flexor carpi radialis tendon, and 123 with the flexor pollicis longus tendon. In Group 1, significantly more patients showed partial (82/308) [group 2: 45/745, p < 0.001] or complete SLL tears (22/308) [group 2: 20/745, p < 0.001]. Of the patients with RPG, 15.3% presented with radiopalmar complaints. Only the dorso-palmar RPG diameter was positively correlated with radiopalmar complaints (for readers 1 and 2: rs = 0.66/0.61, p < 0.001, respectively), and the best dorso-palmar diameter cut-off value for the probability of having radiopalmar complaints was defined at 3 mm (area under the curve (AUC) 0.74). Other morphologic features were not eligible to discriminate symptomatic patients (AUC range 0.53-0.61). This study found RPG in 29% of patients, most of them asymptomatic. However, a dorso-palmar cyst diameter > 3 mm may be clinically significant. Radiopalmar ganglion cysts, observed in 29% of wrist MR examinations, are mostly asymptomatic, but those with a larger dorso-palmar diameter may be associated with radiopalmar complaints. Radiopalmar ganglion cysts are found in 29% of patients undergoing wrist MRI. Most patients with evidence of radiopalmar ganglion cysts do not show radiopalmar symptoms (85%). A dorso-palmar cyst diameter > 3 mm may be associated with radiopalmar complaints.

De Quervain’s tendinitis after trapeziometacarpal arthroplasty

ObjectivesDe Quervain’s tendinitis is frequently observed after placement of a trapeziometacarpal prosthesis. The aim of this study was to investigate the relationship between De Quervain’s tendinitis, osteoarthritis of the thumb and placement of a trapeziometacarpal prosthesis. The second aim was a critical analysis of the literature in search of a cause for this postoperative event after arthroplasty or trapeziectomy. MethodsWe reviewed a series of 331 trapeziometacarpal prostheses. ResultsThere were no differences in thumb column length, gender, type of neck (straight or angled), or surgical approach between patients who developed De Quervain’s tendinitis and those who did not. However, the frequency of De Quervain’s tendinitis was much higher after arthroplasty than trapeziectomy. ConclusionsWe believe that the preoperative frequency of De Quervain’s tendinitis in trapeziometacarpal osteoarthritis is underestimated, being part of a more general pain symptomatology. More precise and specific examination is needed for a better preoperative diagnosis.Trapeziometacarpal osteoarthritis should be considered within a more global framework of peri-trapeziometacarpal pathology, including the trapeziometacarpal and triscaphoid levels, the articular ligaments and the abductor pollicis longus, extensor pollicis brevis, flexor pollicis longus, and flexor carpi radialis tendons.

Ultrasonographic Evaluation of the Needle Insertion Site for the Flexor Pollicis Longus Using the Flexor Carpi Radialis Tendon

Objective: In needle electromyography (EMG), the flexor pollicis longus (FPL) muscle is important for diagnosing anterior interosseous nerve syndrome and proximal median neuropathy. However, different methods have been proposed for needle EMG placement in the FPL. This study aimed to determine the optimal needle insertion position for the examination of the FPL via needle EMG under ultrasound guidance.Methods: This study included 15 men (30 upper limbs) and 13 women (26 upper limbs). At the mid-forearm level, the angles between the vertical line descending from the radial side of the flexor carpi radialis (FCR) tendon and radial artery (angle A), flexor digitorum profundus 1 (angle B), and median nerve (MN) (angle C) were measured. Angle D was defined as the average of angles A and B.Results: The median value of angle D was –19.8°. The probability of radial artery injury at an angle D of 10° was 10.7%. The likelihood of MN injury was 7.1%.Conclusion: Needle insertion through the FCR tendon is relatively safe, although the risk of neurovascular injury remains. Therefore, an ultrasound examination could be considered as an assistive method.

Acupressure Versus Ondansetron Usage for Postoperative Nausea and Vomiting After Gynecologic Surgeries.

Introduction Anti-emetic interventions include pharmacologic and non-pharmacologic strategies. Acupressure is a non-pharmacologic and non-invasive therapeutic method that involves applying physical pressure to acupuncture points with fingers or devices. The pericardium (PC6) acupoint is located on the palm side of the wrist between the palmaris longus and flexor carpi radialis tendons, three fingers across the wrist starting at the wrist crease. Our first aim was to assess the effect of PC6 point acupressure on PONV after gynecological surgeries compared to intravenous (IV) ondansetron. Secondly, we aimed to assess the factors associated with the firstand second hours (early) postoperative nausea scores. Methods This was a prospective, randomized, and single-centered intervention study conducted between November 1, 2022, and December 31, 2022, in a tertiary care hospital. Sancaktepe Martyr Prof. Dr. Ilhan Varank Education and Research Hospital Ethical Committee provided ethical approval for this study on October 14, 2022 (No: E-46059653-020). Randomization was done using the lottery method.Patients, who were over the age of 18with an American Society of Anesthesiologists (ASA) physical score of I, II, or III status and had undergone gynecologic surgery under general anesthesia, were included. Patients, who were ASAIV, under continuous use of opioids or corticoids, underwent surgery with regional anesthesia, or declined to participate in the study, were excluded.There were two comparisons in this study. First, we divided patients into two groups according to anti-emetic prevention. Patients, who received IV 4 mg ondansetron (Group O), and patients, who placed acupressure bands at the P6 points on both forearms (Group B). The second comparison was done to assess the factors associated with early postoperative nausea. Patients were divided into two groups according to the mean early postoperative nausea scores as low (< 4, Group 1) and high/moderate (≥ 4, Group 2).PONV and pain scores were collected at five-time points: the first, second, sixth, twelfth, and twenty-fourth hours after surgery. Results Of 102 patients, 50were in Group O and 52were in Group B. There was no significant difference in postoperative pain, nausea, and vomiting scores. Fifty patients (50%), including 24 patients (48%) in Group O and 26 patients (52%) in Group B, experienced early moderate/high postoperative nausea in our study. According to the second comparison, 52 patients were in Group 1, and 50 patients were in Group 2. Operation time; first and second-hour pain scores; first, second, sixth, twelfth, and twenty-fourth-hourscores; and first and second-hour vomiting scores were all significantly different across groups. Conclusion The effect of PC6 point acupressure on early PONV compared to IV ondansetron was similar after gynecological surgeries. However, using only one anti-emetic treatment did not adequately relieve early PONV. Of all patients, 11(10%) required an extra anti-emetic medication at the ward. 50% of patients experienced early moderate/high postoperative nausea in our study. Motion sickness history, operation time, and early postoperative pain scores were associated with early PONV.

The Hand Hug: A Novel Test for Linburg-Comstock Syndrome and Wide-awake Correction of the Anomaly.

In 1979, Linburg and Comstock1 described an inability to flex the interphalangeal joint of the thumb without simultaneously flexing the distal interphalangeal joint of the index finger, caused by a congenital anomalous connection between the flexor pollicis longus tendon and the flexor digitorum profundus tendon to the index finger. The “hand hug test” is a novel clinical test for this condition. The palm of the affected hand of the patient is placed on the ipsilateral palm of the examiner’s hand with all the digits lined up in extension. The thumbs are abducted. The patient is asked to bend the thumb around the examiner’s hand while the examiner does the same action—as if the hands are “hugging.” Because the index finger of the patient and the small finger of the examiner are aligned and blocking each other in extension, the thumb of the patient with the Linburg-Comstock anomaly is not able to make a “hand hug.” We report the case of a 20-year-old, right-hand dominant carpentry student who had a complete inability to move his right thumb and right index finger independently. The patient did have the anomaly on the contralateral side, but it was far less pronounced. Specific activities affected by the anomaly were piano, typing, and rock climbing. The phenomenon had always been present but was progressively becoming more pronounced, with no clear history of an inciting traumatic event. We performed a point-of-care ultrasound examination and observed a pathologic band in both the coronal and sagittal view, which was 4 cm in length. We agree that magnetic resonance imaging or computed tomography scan can be helpful to characterize the anatomy, but high-frequency ultrasonography is sufficient to localize the congenital band.2 We performed wide-awake surgery with subcutaneous local anesthesia infiltration of 10 mL lidocaine 1% with 10 mg/mL of epinephrine with 20 mL saline buffered with 2 mL 8.3% bicarbonate [wide awake local anesthesia no tourniquet (WALANT) technique].3 The local anesthesia was allowed at least 45 minutes to take effect before the procedure. The patient was positioned supine with the affected limb on an arm board without a tourniquet. The surgical field was prepared and draped using field sterility. A linear incision was made along the radial aspect of the distal forearm over the flexor carpi radialis tendon, just proximal to the volar wrist crease. The anomalous connection was confirmed by the synkinesis of the tendons on both active and passive intraoperative testing. We observed the fibrous type anomalous connection, which is the most common type among the classification of Yurasakpong et al.4 We sharply divided the connection, which immediately corrected the anomaly. The thumb and index finger could now move independently, and the patient was able to make the “hand hug” with the surgeon [See Video (online), which displays the preoperative clinical and ultrasound examination, surgical procedure, and final result with the “hand hug test” for each step]. The patient was mobilized immediately, using principles of hand elevation, early cessation of postoperative analgesics, and “pain-guided healing.” Hand therapy was used to encourage independent tendon gliding. He made a complete recovery and was able to return to normal activities without restrictions. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"This video displays the preoperative clinical and ultrasound examination, surgical procedure and final result with the « hand hug test” for each step.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_pcsm1wze"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} PATIENT CONSENT The patient provided written consent for the use of his image.

Flexor Carpi Radialis Tendon Insertion Onto the Trapezial Ridge: An Anatomic Description

The flexor carpi radialis (FCR) tendon is often involved in surgical procedures of the hand and wrist. The FCR tendon may be mobilized from the trapezium during distal radius fracture fixation, for tendon transfer, and during carpometacarpal joint procedures. There is a paucity of literature describing the anatomy of the FCR insertion onto the trapezial ridge. We analyzed the insertional characteristics of the FCR onto the trapezium. Forty-two fresh-frozen cadaveric wrists were dissected using the extended FCR approach through the FCR tendon sheath. The length of the fibrous portion of the FCR insertion onto the trapezial ridge was measured from proximal to distal using a digital caliper. FCR insertion onto the trapezium was present in all specimens. The mean length of the FCR insertion was 11.8 ± 4.14 mm. The character of the tissue quality varied across specimens. These results demonstrate the commonality of the FCR fibers that insert onto the trapezium. The length and tissue quality of this insertion varied across specimens. Understanding the complex anatomy of the hand and wrist facilitates surgical planning and intraoperative techniques. The FCR tendon insertion onto the trapezium is an important component of exposure for the volar approach to the distal radius and surgical management of thumb carpometacarpal joint arthritis.

Pyrocarbon Disc Interposition Arthroplasty (PyroDisk) for the Treatment of Carpometacarpal Thumb Joint Osteoarthritis.

Preoperatively, review radiology images to confirm that the osteoarthritis is limited to the thumb CMC joint and that all appropriate tools for inserting the disc are available before beginning surgery. Next, the patient is placed with their arm on an arm rest. The CMC thumb joint is exposed via a dorsal longitudinal skin incision, sparing the dorsal radial nerve branches and the radial artery and accompanying venes. The capsule is opened with an H-incision. With 2 parallel cuts to the joint surface, the articular surfaces of the joint are removed. After resection of the articular joint surfaces, the residual width and height of the joint space after resection are measured. The central point in the joint surfaces is marked for the bone tunnels. With an awl, tunnels are created from the center of the joint surface to the proximal (trapezial bone) and distal (first metacarpal bone) and the dorsal side. The implant size is measured with the trial implants for correct size of the disc. A tendon strip of either APL (abductor pollicis longus) or FCR (flexor carpi radialis) tendon is harvested for use securing the disc. The disc is secured with the tendon strip from proximal through the trapezium, through the disc and distal through the first metacarpal, and is secured to itself at the trapezial bone. The position is checked under fluoroscopy. When the disc in the right position, the joint capsule and skin are closed and a plaster cast is applied with the thumb in abduction. Alternative treatments include hemitrapeziectomy without interposition; full trapeziectomy, with or without ligament reconstruction and/or tendon interposition; and joint resurfacing prostheses. The advantage of pyrocarbon disc interposition arthroplasty over other treatment options is the preservation of the STT joint1. Therefore, the procedure is minimally harming the surrounding anatomy despite open surgery and has a high success rate in reducing pain while preserving function and strength. The risk of complications is comparable with that of other CMC joint arthroplasty techniques. A relatively high survival rate has been reported at a mean follow-up of 7 years (range, 5 to 12 years). In cases of recurrent pain, all other surgical options remain possible ("no bridges are burned"). The main disadvantage is the cost of the disc. Our recent study of this technique showed good patient-reported outcomes, pain reduction, patient satisfaction, and preservation of strength and range of motion at a mean follow-up of 7 years1,2. The survival rate was 91%, with 3% failing as a result of disc dislocation. Other reasons of failure were STT osteoarthritis and pain without a specific cause. Preoperatively, make sure that only the CMC thumb joint has osteoarthritis and that the STT joint does not. In cases in which it is unclear whether the osteoarthritis is isolated to the CMC thumb joint, perform computed tomography to make certain10.Only a few millimeters of bone must be resected from the first metacarpal base and the distal trapezium. Both bone cuts must be made parallel to each other and perpendicular to the longitudinal axis of the first metacarpal bone.Bone tunnels must be exactly centered in the cut joint surfaces for proper implant positioning and to decrease the chance of subluxation.Size the implant properly and check movement and stability. OR = operating roomFCR = flexor carpi radialisAPL = abductor pollicis longusPRWHE = Patient-Rated Wrist and Hand EvaluationDASH = Disabilities of the Arm, Shoulder and Hand QuestionnaireMHQ = Michigan Hand QuestionnaireROM = range of motionFU = follow-upCRPS = complex regional pain syndromeLRTI = ligament reconstruction and tendon interpositionMRI = magnetic resonance imagingCT = computed tomography.

Thumb reconstruction after radical tumor resection using free osteocutaneous lateral arm flap with secondary humerus fracture—a case report

IntroductionMalignant diseases with infiltration of bony structures in the area of the phalanges or metacarpals require either amputation or complex reconstruction. The decision for reconstruction means to restore length, mobility, sensibility, stability as well as aesthetics.MethodsWe present a case of complex first ray reconstruction of the left hand using a free osteocutaneous lateral arm flap from the ipsilateral side. The reconstruction was performed after radical resection of an exulcerated squamous cell carcinoma, including the first metacarpal bone, trapezium, partial trapezoid and distal scaphoid as well as partial resection of the extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus and flexor carpi radialis tendons. The osteosynthetic restoration was achieved distally by a double wire cerclage and a proximally by temporary K-wire suspension. Moreover, to reconstruct the extensor pollicis longus tendon the ipsilateral palmaris longus tendon was harvested and used. Postoperatively, a secondary humerus fracture occurred, which was initially attended by plate osteosynthesis. The fracture showed delayed healing, which was treated by re-plating and autologous cancellous bone.Results12 months postoperatively, the patient showed an excellent outcome with length preservation and good range of motion, sensibility, stability and aesthetic of the thumb. Furthermore, the quarterly tumor aftercare showed no evidence of recurrence.ConclusionThis case report showed that the free osteocutaneous lateral arm flap is a reliable solution for the reconstruction of the first ray with a great functional and aesthetic outcome. To prevent a secondary humerus fracture, a preventive plate osteosynthesis simultaneous with the osteocutaneous flap elevation should be considered.

The Role of the Flexor Carpi Radialis Groove in Trapeziometacarpal Osteoarthritis.

Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common condition. The contribution of surrounding ligaments and tendons to the stability of the CMC joint is likely altered in OA. The flexor carpi radialis (FCR) tendon runs in the trapezial FCR groove and is often noted to be frayed during CMC arthroplasty. We hypothesized that decreased integrity of the FCR tendon is related to FCR groove morphology and is associated with increased severity of CMC OA. We examined 3-dimensional surface models based on computed tomography (CT) scans of explanted trapezia from patients who underwent thumb CMC arthroplasty. Fraying of the FCR tendon was rated intraoperatively. Measurements were taken of the FCR groove to evaluate its morphology. Preoperative thumb CMC radiographs for each patient were scored using the modified Eaton classification system and the Thumb Osteoarthritis Index. Differences in the tendon groups were examined, and multivariable linear regression models were used to test the association between tendon group and FCR groove measurement. There were 136 patients who were categorized into 4 tendon groups: intact, minor fraying, fraying, and ruptured. There were no differences between the tendon groups on any measures. Our findings do not demonstrate a significant influence of FCR groove morphology on FCR tendon fraying in CMC arthroplasty patients. We also did not find a significant association between the FCR tendon state and degree of radiographic CMC OA. Further studies should investigate the in vivo FCR tendon to evaluate its tearing and inflammation in relation to basilar thumb pain.

Anatomy of the Palmar Region of the Carpus of the Dog.

Simple SummaryDespite dogs being one of the main species in the veterinary field and having been used as animal models for human musculoskeletal research, the anatomical information about the palmar region of the canine carpus found in the literature is inconsistent. After the dissection and evaluation of complementary histology of 86 carpi obtained from 43 dogs, we provide precise information about the location, extensions, and anatomic relations of the palmar carpal components, with special reference to the carpal canal. The results of this study show that the anatomy of the palmar region of the canine carpus is more similar to human wrists than was previously thought. Numerous similar studies about the carpal anatomy of other species have been published; however, to our knowledge, this is the first article to clarify and describe reference information about the anatomy of the palmar region of the canine carpus. The palmar region of the canine carpus is anatomically complex, and the information found in the literature about its anatomy is inconsistent. The aims of this prospective, descriptive, anatomic study were (1) the clarification and (2) the description of the precise anatomic composition of the palmar region of the canine carpus, with special reference to the canalis carpi. For this study, 92 cadaveric specimens were obtained from 46 dogs that had died for reasons unrelated to this study. Of these, 43 medium-to-large-breed dogs were randomly selected for the dissection of transverse slices of the carpus. Samples of the flexor retinaculum and flexor carpi radialis tendon and surrounding tissues were taken for complementary histology. For additional histology of the palmar structures in their anatomical position, three small breed dogs were randomly selected for obtaining transverse slices. The anatomic characteristics of the components of the palmar region of the canine carpus were qualitatively described, with special attention to the following structures: flexor retinaculum, flexor carpi radialis muscle, arteria and vena mediana, nervus medianus, interflexorius muscle, flexor digitorum profundus muscle, canalis carpi, and arteria and nervus ulnaris. The findings from this study provide reference information about the anatomy of the palmar region of the canine carpus.

Surgical Management of the Trapezium Canal Syndrome: An Uncommon Presentation of Tenosynovitis of Flexor Carpi Radialis

Flexor carpi radialis (FCR) tenosynovitis is a condition characterized by pain over the volar radial wrist caused by inflammation of the FCR tendon sheath. It is an uncommon and often unrecognized pathology that could be misleading from a diagnostic and therapeutic point of view. Treatment usually involves immobilization, nonsteroidal anti-inflammatory drugs, and injections. In refractory cases, operative release of the FCR tendon sheath may be indicated. In this article, we report our experience in treating FCR tenosynovitis by surgically decompressing the trapezium canal, through which the tendon runs, at the wrist. In our experience, this surgical technique allows a good functional recovery with the resolution of painful symptoms without notable complications.

Variation of the palmar cutaneous branch of the median nerve identified within the tendon sheath of the flexor carpal radialis

Purpose: During volar plate fixation of distal radius fractures, we have encountered patients with an anomalous course of the palmar cutaneous branch (PCB) of the median nerve within the sheath of the flexor carpi radialis (FCR) tendon. The purpose of this study was to assess the frequency and location of variations of the PCB within the sheath of the FCR tendon.Methods: This retrospective study enrolled 83 patients who underwent volar locking plate fixations through a modified Henry approach for distal radius fractures from July 2018 to April 2020. When we encountered an anomalous PCB within the sheath of the FCR tendon, we documented the specific finding and location where the PCB entered the sheath of the FCR tendon.Results: There were nine patients (10.8%) who had an anomalous course of PCB penetrating the sheath of the FCR tendon. The average entering point of PCB into the sheath of the FCR tendon was 3.07 cm from the distal wrist crease (range, 2.5–3.6 cm).Conclusion: An anomalous course of the PCB entering the sheath of the FCR tendon was observed at a high frequency (10.8%). Care must be taken not to injure the PCB during a dissecting of the FCR sheath during a modified Henry approach for a distal radius fracture.

Radial nerve palsy corrected by brand’s procedure: A case report

The radial nerve is one of the three important nerves of the upper limb which causes the wrist, fingers and thumb extension. Loss of radial nerve function in the hand creates a significant disability with difficulty in grasp and power grip. Injuries to the radial nerve can occur at any point along its anatomical route and the etiology could be either post-traumatic or post-surgical. After irreparable radial nerve injury, the only treatment available is tendon transfer other than arthrodesis. Tendon transfer is a treatment option to compensate for the loss of function of the wrist, fingers and thumb extensions of which the flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU) are the most common used donor tendons. FCR tendon transfer provides better functional results than FCU tendon transfer. There is no standard procedure but the surgeon must tailor the tendon transfer procedure according to the patients needs.

Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study

Background/aimCarpal tunnel is an important anatomical passage that carries the flexor tendons into the hand. As there is still no consensus about its contents among the anatomy textbooks, the main purpose of this study was to identify the relations of the flexor carpi radialis tendon in the carpal tunnel.Materials and methodsThis retrospective study was completed in April 2018 at authors’ university’s hospital. Seventy-four female and 44 male patients’ wrists without any pathology were examined by using magnetic resonance images. The series of axial sections where the pisiform exist were evaluated by using T1 sequence and the structures in the carpal tunnel were identified.ResultsResults of this study showed that the tendon of the flexor carpi radialis was found above the flexor retinaculum within its own septal compartment in all patients.ConclusionAccording to the results, tendon of flexor carpi radialis crosses the wrist region superficial to the carpal tunnel. Thus, tendon of flexor carpi radialis doesn’t have any effect on the carpal tunnel syndrome. Further cadaveric studies would be useful for identifying the contents of the carpal tunnel and morphological organization of the wrist.

The Flexor Carpi Radialis Portal for Arthroscopy-Assisted Reduction of the Dorsal Ulnar Fragment in Distal Radius Fractures.

Background The importance of the dorsal ulnar fragment (DUF) for stability and articular congruence of the radius is widely recognized, and standard surgical techniques often fail to ensure its reduction. Description of Technique We describe a modification of volar wrist portals for arthroscopic management of the DUF of the distal radius. It is made in an outside-in fashion in line with the flexor carpi radialis (FCR) approach for the distal radius. Through this volar portal, we achieve wide and direct visualization of the DUF, with the advantage of protecting important anatomic structures such as the FCR tendon, the radial artery, and the median nerve; all protected with the previously made volar approach for the distal radius. In addition, easy manipulation and reduction of the DUF is obtained with instrumentation through standard dorsal portals. Patients and Methods We performed this procedure in 23 patients with distal radius fractures (DRF) with displaced DUF. Results Early and late postoperative evaluation demonstrated intraoperative reduction maintenance and adequate range of motion, compatible with the usual findings of standard volar plating, with the benefit of anatomic reduction of the DUF. Conclusion With our technique, volar plating associated with arthroscopy-assisted dorsal fragment specific fixation with dorsal standard and the FCR portals permits optimal surgical treatment of most DRFs.

Trapeziectomy and Ligament Reconstruction Tendon Interposition Technique Experience for the First Carpometacarpal Joint Arthrosis

Osteoarthritis of the hand is rare; however, the most retained joint after the distal interphalangeal joint is the first carpometacarpal (1. CMC) joint. Pain in the rest and increased pain with opposition is the most serious symptom, which significantly decreases the quality of life. The aim of these patients is to obtain a painless and stable thumb. Experience of trapeziectomy and ligament reconstruction tendon interposition technique for a Stage III patient was shared and diagnosis and treatment were discussed through the relevant literature. A 53-year-old female patient was admitted with complaints of pain in the right hand thumb root and unable to open the jar lid. In direct radiography, narrowing in the 1. CMC joint space and osteophytes were detected. After the trapeziectomy, 1st and 2nd metacarpals were fixed with K wire. Flexor carpi radialis tendon was passed from the first metacarpal base to the second metacarpal base in the form of a distal-based tendon flap to mimic the beak ligament. There was no pain at the postoperative 6th month, and the Kapandji opposition score was 10. When diagnosing 1. CMC osteoarthritis, pain during opposition and circumduction movements that is not relieved with analgesics and rest is the most important symptom for a clinician to look for. Many treatment principles have been defined according to the staging for the postdiagnosis period, despite the diagnosis is a challenging process.

Partial trapeziectomy for Eaton stage III thumb carpometacarpal arthritis: ligament reconstruction with tendon interposition using the entire flexor carpi radialis and interference screw fixation.

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is currently the most popular technique for treating primary osteoarthritis of the thumb carpometacarpal joint. However, reduced trapezial height has sometimes been reported after LRTI. Longer immobilization and delayed rehabilitation times are also problematic. In this study, we evaluated the clinical and radiological outcomes of patients who underwent our modified LRTI procedure. Retrospective study included 26 thumbs in 24 cases with advanced stages. Our modified Burton's procedure was as follows: (1) trapeziectomy was limited to distal-half, (2) the entire flexor carpi radialis (FCR) was harvested from the forearm, and (3) half-slip of the FCR tendon was stabilized by interference screw in the first metacarpal bone tunnel. Pain on the visual analogue scale (VAS), the quick Disabilities of the Arm Shoulder and Hand score, tip pinch strength significantly improved postoperatively. The preoperative height of the trapezial space was well-maintained at final follow-up. Magnetic resonance imaging at the one-year follow-up showed the existence of FCR tendon ball in 15 cases. Eighteen housewives resumed their daily activities after a mean period of 10days postoperative, while another 6 patients returned to their original jobs after 3weeks. Our modified LRTI method involves distal-half trapeziectomy and entire FCR interposition. A sewn FCR tendon ball always provide enough volume to fill the trapeziectomy space, which helps to prevent sinking of the metacarpal bone. Our technique produced sufficient ligamentoplasty and allowed early mobilization after surgery.

Trapeziectomy and suspension arthroplasty with the flexor carpi radialis tendon for treatment of trapeziometacarpal osteoarthritis

Excision of the trapezium is the common step in most arthroplasties for treating trapeziometacarpal arthritis. Trapeziectomy can be supplemented by several techniques intended to stabilize the first metacarpal but none of these has been proven superior. The aim of this study was to verify if a simplified suspension arthroplasty with the flexor carpi radialis (FCR) tendon, requiring only a single short surgical incision, no intraosseous tunnels and no interposition of prosthetic material, yields equal clinical outcomes to more complex techniques and if the clinical outcomes remain stable over the long term. A cohort of 299 patients was reviewed retrospectively at a follow-up ranging from 3 to 12 years (mean follow-up time 6 years) following total trapeziectomy and suspension arthroplasty using a half-tendon strip of FCR. At this long-term follow-up, the mean DASH score improved from 52 preoperatively to 20 postoperatively. Pain at follow-up was subjectively rated by patients as absent or improved in 92% cases. Thumb opposition assessed on the Kapandji scale was rated 9 or 10 in 144 (76%) hands, 7 or 8 in 30 (16%) hands and <7 in 15 hands (8%). Mean palmar flexion and radial abduction were 45° and 42°, respectively. Mean key pinch and grip strength were 4.7 Kg and 23.5 kg, respectively. When treating trapeziometacarpal osteoarthritis, surgical techniques that do not require complex procedures, bone tunnels, K wire stabilization or interposition of prosthetic materials can be considered and maybe preferred. Our technique of trapeziectomy and suspension arthroplasty with the FCR tendon produces good long-term results.

Simplified abductor pollicis longus suspension interposition arthroplasty for thumb carpometacarpal joint osteoarthritis

PurposeThe primary treatment goals for advanced-stage thumb carpometacarpal (CMC) joint osteoarthritis are complete pain relief and restoration of thumb strength. The purpose of the present study was to introduce a variation of the abductor pollicis longus (APL) suspension arthroplasty using a single looping of a radial slip from the APL tendon around the flexor carpi radialis (FCR) tendon combined with RegJoint™ interposition and to determine its efficacy in the treatment of thumb CMC joint osteoarthritis.MethodsBetween 2015 and 2017, 21 patients were included. The average age was 60.8 years (range 48–79). The mean follow-up was 27.7 months (range 8–50). Evaluation included pain, radial and palmar abduction, tip pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsPain averaged 0.3 (range 0–4) at rest and 1.4 (range 0–4) on exertion. The radial and palmar abduction were 97% and 99% compared to the contralateral side. The tip pinch and grip strength were 4.1 kg (range 3–6.5) and 22 kg (range 13.3–40), respectively. The DASH score accounted for 18.5 (range 0.8–41.7).ConclusionThe modified APL suspension interposition arthroplasty was an efficient and simplified option for the treatment of thumb CMC joint osteoarthritis, with results comparable or better than other published procedures. The APL suspension technique was easy to perform avoiding difficult bone tunneling and incision of the FCR tendon. The RegJoint™ interposition as spacer prevented impingement of the first metacarpal base on the second metacarpal base or the trapezoid bone.

Fungating malignant peripheral nerve sheath tumor arising from a slow-growing mass in the forearm: a case report and review of the\xa0literature

BackgroundMalignant peripheral nerve sheath tumor is a rare and aggressive form of sarcoma that arises from a peripheral nerve, mostly in association with neurofibromatosis type 1. Half of the cases were reported in the extremities, with the lungs being the most common site of metastasis. We report a rare case of successful limb salvage surgery performed for a large exophytic malignant peripheral nerve sheath tumor of the right forearm with wide surgical margins followed by split-thickness skin graft and later a flexor carpi radialis tendon transfer to extensor digitorum communis tendon.Case presentationA 51-year-old Bedouin Arabic man presented to our institution with an incompletely excised, large, fungating, malignant peripheral nerve sheath tumor occupying most of his right forearm. Staging imaging showed multiple lung nodules. He underwent wide local excision followed by skin graft and tendon transfer as a palliative measure to preserve the function of his dominant limb. The operation was performed without any complications, and the patient had an excellent postoperative result. Afterward, he was started on multiple lines of chemotherapy that failed because of disease progression, and the patient died 7 months after the operation.ConclusionClinicians must consider the possibility of soft tissue sarcoma even in a patient with a small, slow-growing, superficial mass. Furthermore, a wrong open biopsy or nononcological surgical procedure may lead to possible contamination and ultimately a more radical procedure than would have originally been necessary, where this can be prevented by an early referral to a highly specialized sarcoma center.