Open Release Research Articles

Sonographically-navigated frozen shoulder release (S-FSR): A modified technique for sonographically-navigated, in-office hydrodilatation of adhesive capsulitis

We describe a new technique for hydrodilatation of the frozen shoulder, which we coined ‘Sonographically-Navigated Frozen Shoulder Release (S-FSR)’ or ‘Dr Gonzalez's technique.’ Traditional treatments include a combination of conservative and surgical modalities, such as non-steroidal anti-inflammatories, physical therapy, and open capsular release. We describe a modification to hydrodilatation of the frozen shoulder. Our technique describes the gradual dilation of the glenohumeral (GH) capsule with the goal of seeing a gentle release of the frozen shoulder. Furthermore, we outline our protocol for patient preparation with preprocedural diazepam 5 mg and Hydrocodone 5 mg-Acetaminophen 325 mg, one tablet each. During the procedure, we inject a solution of 10 mL lidocaine mixed with 2 mL of 40 mg/mL triamcinolone acetonide injection (80 mg total) through an anterior approach at the level of the rotator interval for pain control. Following this injection, we proceed to fenestrate the superior glenohumeral ligament (SGHL) in the process. We conclude the procedure with hydrodilatation of the GH joint (GHJ) through the posterior approach with approximately 50 mL of 0.9% normal saline, or until an expansion and release of the GH joint is visualized under ultrasound visualization. A full instruction video can be found at: https://www.youtube.com/watch?v = ZNB0R0hkeok&ab_channel = DrJorgeA.Gonzalez

Arthroscopic Release of the First Metatarsophalangeal Joint: The 3-Portal Approach

Arthrofibrosis of the first metatarsophalangeal joint may cause significant limitation of sport and daily activities. Surgical release is indicated if conservative management fails. Open release may have a high recurrence rate of joint stiffness because the surgical trauma will induce fibrous tissue formation and the presence of lengthy surgical wounds may hinder early joint mobilization. Arthroscopic release of the first metatarsophalangeal joint is a minimally invasive approach that may be the treatment of choice for arthrofibrosis of the joint. The purpose of this Technical Note is to describe the details of the 3-portal approach of arthroscopic release of the first metatarsophalangeal joint.

Elucidating Dynamics of Adenylate Kinase from Enzyme Opening to Ligand Release.

This study explores ligand-driven conformational changes in adenylate kinase (AK), which is known for its open-to-close conformational transitions upon ligand binding and release. By utilizing string free energy simulations, we determine the free energy profiles for both enzyme opening and ligand release and compare them with profiles from the apoenzyme. Results reveal a three-step ligand release process, which initiates with the opening of the adenosine triphosphate-binding subdomain (ATP lid), followed by ligand release and concomitant opening of the adenosine monophosphate-binding subdomain (AMP lid). The ligands then transition to nonspecific positions before complete dissociation. In these processes, the first step is energetically driven by ATP lid opening, whereas the second step is driven by ATP release. In contrast, the AMP lid opening and its ligand release make minor contributions to the total free energy for enzyme opening. Regarding the ligand binding mechanism, our results suggest that AMP lid closure occurs via an induced-fit mechanism triggered by AMP binding, whereas ATP lid closure follows conformational selection. This difference in the closure mechanisms provides an explanation with implications for the debate on ligand-driven conformational changes of AK. Additionally, we determine an X-ray structure of an AK variant that exhibits significant rearrangements in the stacking of catalytic arginines, explaining its reduced catalytic activity. In the context of apoenzyme opening, the sequence of events is different. Here, the AMP lid opens first while the ATP lid remains closed, and the free energy associated with ATP lid opening varies with orientation, aligning with the reported AK opening and closing rate heterogeneity. Finally, this study, in conjunction with our previous research, provides a comprehensive view of the intricate interplay between various structural elements, ligands, and catalytic residues that collectively contribute to the robust catalytic power of the enzyme.

Is weight trajectory a better marker of wound complication risk than BMI in hernia patients with obesity?

Complex ventral hernias are frequently repaired via an open transversus abdominis release (TAR). Obesity, particularly a BMI > 40, is a strong predictor of wound morbidity following this procedure. We aimed to determine if preoperative weight loss may still be beneficial in patients with persistently elevated BMIs. A retrospective chart review of patients with obesity (BMI ≥ 30) who underwent open TAR at a tertiary academic medical center from January 2018 to December 2021 was completed. Demographics, medical history, operative details, and postoperative data were analyzed. Weight and BMI were recorded at three time points: > 6months prior to initial surgical consultation, surgical consultation, and day of surgery. In total, 182 patients with obesity underwent an open TAR. Twenty-seven patients (14.8%) underwent surgery with a BMI > 40; they did not have any significant differences in surgical site occurrences (SSO, 48.1% vs 32.9%, p = 0.13) or surgical site infections (SSI, 25.9% vs 23.2%, p = 0.76) compared to those with a BMI ≤ 40.The average timeframe analyzed for preoperative weight loss was 592days. Patients who had at least a 3% weight loss (n = 49, 26.9%) had decreased rates of SSI compared to those who did not have this weight loss (12.2% vs 27.8%, p = 0.03), despite the groups having similar BMIs at the time of surgery (36.4 vs 36.0, p = 0.50). Patients who only had a 1% weight loss did not see a decrease in SSI rate compared to those who did not (20.6% vs 25.4%, p = 0.45). Weight loss may be a better indicator of a patient's risk for wound morbidity following TAR than BMI alone, as weight loss of at least 3% resulted in fewer SSIs despite similar BMIs at time of surgery. Further research into optimal timing and amount of weight loss, as well as effects on long-term outcomes, is needed to confirm these findings.

Trigger Finger Hand, Pathophisiology and Management

Trigger finger hand is a stenosing tenosynovitis that occurs in the flexor sheaths of the finger and thumb due to repetitive use. Narrowing of the flexor sheath combined with hypertrophy and inflammation between tendons and sheaths causes trigger finger stenosing tenosynovitis leading to tendon restriction. The purpose of this literature review to provide an update regarding the pathophysiology and management of trigger finger. This literature study using search engines including Pubmed, ScienceDirect, NCBI, and Google Schoolar. In total, 10 sources were used which were obtained from various existing databases. In the treatment of trigger finger, there are non-surgical treatments such as conservative management and conventional management, and surgical management, namely Open release pulley A-1 which is the first line of treatment before medical rehabilitation, medical rehabilitation.

Comparative analysis of open versus endoscopic carpal tunnel release in a comprehensive national database

PurposeCarpal tunnel syndrome is the most common compressive neuropathy. There is limited evidence to support endoscopic compared to open carpal tunnel release according to the 2016 American Academy of Orthopaedic Surgeons Clinical Practice Guideline on carpal tunnel syndrome. The purpose of the present study was to assess differences between the two procedures by comparing 30- and 90-day complications and mean hospital costs in a large patient population. MethodsUsing the national Mariner15 Database by PearlDiver Technologies, we retrospectively studied 27,192 carpal tunnel syndrome patients who received carpal tunnel release using an endoscopic or open surgical approach from 2010 to 2019. Patients who met the inclusion criteria were grouped and case-matched at a 1:1 ratio through the corresponding International Classification of Diseases codes (n = 13,596) and assessed for 30- and 90-day complications such as median nerve injury, superficial palmar arch injury, and revision carpal tunnel release surgery. Univariate analysis was used to compare outcomes and a multivariate regression was performed to identify risk factors associated with each outcome. ResultsEndoscopic carpal tunnel release was associated with a higher rate of median nerve injury than open release at 30 days (0.3% vs. 0.1% odds ratio, 2.21; 95% confidence interval, 1.29–3.81; p < 0.05) and 90 days (0.4% vs. 0.3%; odds ratio, 1.77; 95% confidence interval, 1.16–2.70; p < 0.05). Endoscopic release was also associated with a higher rate of superficial palmar arch injury (0.1% vs. 0%; odds ratio, 25.02; 95% confidence interval, 1.48–423.0; p < 0.05). ConclusionsIn the present study, risk of median nerve injury and vascular injury was higher after endoscopic than open carpal tunnel release. At 90 days, all-cause revision rates were similar between techniques. Surgeons should understand these differences, to optimize surgical decision-making. Level of evidenceTherapeutic, IIIa.

Surgical outcome of open carpal tunnel release: A 2-year case series study at Zliten Teaching Hospital, Libya

Carpal tunnel syndrome (CTS) is the most commonly diagnosed peripheral neuropathy, with a prevalence of 1 &amp;ndash; 16% within the general population. If left untreated, it can lead to permanent dysfunctionality and disability. This study aimed to determine the outcomes and complications associated with open carpal tunnel release surgery (OCTR), compare the presentation of CTS symptoms before and after the operation, and investigate the factors contributing to post-operative complications. To achieve these objectives, a case series design was employed, and the study was conducted at the Department of Orthopedics and Traumatology in Zliten Teaching Hospital, Libya, from January 2016 to December 2018. A total of 256 patients who had opted to undergo OCTR of the transverse carpal ligament during the preoperative stage were enrolled and prospectively followed up for 2 years. The post-operative follow-up analysis revealed a statistically significant reduction in symptoms such as dull aching discomfort in the hand and forearm, as well as paresthesia and numbness when compared to the pre-operative period (10.2% vs. 90.5%; P &lt; 0.0001). However, there were no significant differences in clumsiness (18.8% vs. 25.8%; P = 0.256) or thenar muscle atrophy (1.6% vs. 5.0%; P = 0.194). The majority of the patients (90.6%) expressed high levels of satisfaction with the procedure, reporting no recurrence of symptoms. In contrast, only 9.4% of patients experienced post-operative complications. The study findings revealed no significant correlation between post-operative complications and body mass index (P = 0.194). Nonetheless, a statistically significant association was observed between the severity of nerve conduction and post-operative complications (P = 0.011). In summary, the open release of the transverse carpal ligament resulted in positive surgical outcomes.

Endoscopic Versus Open In Situ Decompression for the Management of Cubital Tunnel Syndrome.

This study compared the results of endoscopic cubital tunnel release (eCuTR) with those of open cubital tunnel release (oCuTR) for the management of cubital tunnel syndrome (CuTS). In this retrospective study, 35 patients underwent eCuTR or oCuTR. Group I and group II consisted of 16 patients undergoing eCuTR and 19 patients undergoing oCuTR, respectively. Patients were asked to report paresthesia and pain, and electromyography was performed. The Dellon and Bishop classifications were used. The Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS) pain scores were recorded, as well as the key pinch strength and two-point discrimination. The incision length and operation duration were noted. The mean follow-up was 39 months. The mean operating time was longer in the endoscopy group (43 vs 22 minutes). Overall, 34.3% (n=12) of the cases were classified as Dellon grade II and 65.7% (n=23) were classified as Dellon grade III. According to the Bishop score, excellent or good results were obtained for 75% of the patients in the eCuTR group and 78.9% of the patients in the oCuTR group. In the eCuTR and oCuTR groups, all outcome measures improved after surgery: DASH score (preoperative, 37.7 vs 30.7; postoperative, 15.4 vs 20), VAS score (preoperative, 7.8 vs 7.3; postoperative, 4.3 vs 4.1), pinch strength (preoperative, 74 vs 66; postoperative, 93 vs 84), and two-point discrimination (preoperative, 5.6 vs 6.6; postoperative, 4.9 vs 4.5). No significant difference was apparent between the two techniques in outcomes. However, the endoscopic release had a higher reoperation rate and took twice as long to perform despite having a shorter incision. [Orthopedics. 2024;47(3):e119-e124.].

Patient-Reported Outcome Measures After Endoscopic Cubital Tunnel Release With At Least 1-Year Postoperative Follow-up.

The primary objective of this study was to investigate midterm outcomes following endoscopic cubital tunnel release (ECuTR) with the Seg-Way system using patient-reported outcome measures (PROMs). A secondary aim was to evaluate symptom resolution as assessed through Dellon's stage, McGowan's grade, and Messina's criteria and recurrence following ECuTR. Functional outcomes were assessed in 38 patients who underwent 43 surgeries. Details on baseline characteristics as well as preoperative and postoperative symptoms were collected. Patient-reported outcome measures were administered with at least 1-year follow-up in all patients. Mean age of patients was 50.2 ± 16.1 years, with 20 men (52.6%) and 18 women (47.4%). Postoperatively, pain completely resolved in 21 (72.4%), while sensory and motor deficits improved completely in 22 (56.4%) and 11 (64.7%) patients, respectively. Mean time interval between ECuTR and PROMs was 26.3 (13-63) months. Median Michigan Hand Outcomes Questionnaire score was 73.2 (48-91). Median Disabilities of the Arm, Shoulder and Hand (DASH) and Numerical Rating Scale (NRS) scores were 12.9 (7-35) and 2.5 (0-5), respectively. Most of the patients were satisfied postoperatively with a median satisfaction score of 4 (3-5). There was a significant difference in median DASH and NRS scores between patients with and without concomitant proximal nerve disease. Endoscopic cubital tunnel release is a safe and effective option for surgical management of primary cubital tunnel syndrome. The presence of other proximal nerve disease is associated with poorer outcomes, less symptom resolution, and higher recurrence rates. One-year postoperative PROMs show equivalence to those reported in other studies following open cubital tunnel release.

Pannexin-1 opening in neuronal edema causes cell death but also leads to protection via increased microglia contacts

Neuronal swelling during cytotoxic edema is triggered by Na+ and Cl- entry and is Ca2+ independent. However, the causes of neuronal death during swelling are unknown. Here, we investigate the role of large-conductance Pannexin-1 (Panx1) channels in neuronal death during cytotoxic edema. Panx1 channel inhibitors reduce and delay neuronal death in swelling triggered by voltage-gated Na+ entry with veratridine. Neuronal swelling causes downstream production of reactive oxygen species (ROS) that opens Panx1 channels. We confirm that ROS activates Panx1 currents with whole-cell electrophysiology and find scavenging ROS is neuroprotective. Panx1 opening and subsequent ATP release attract microglial processes to contact swelling neurons. Depleting microglia using the CSF1 receptor antagonist PLX3397 or blocking P2Y12 receptors exacerbates neuronal death, suggesting that the Panx1-ATP-dependent microglia contacts are neuroprotective. We conclude that cytotoxic edema triggers oxidative stress in neurons that opens Panx1 to trigger death but also initiates neuroprotective feedback mediated by microglia contacts.

Single-Incision Endoscopic Trigger Finger Release.

Trigger finger surgery is a commonly performed open procedure with known potential complications of infection, stiffness, pain, nerve injury, bowstringing, and incomplete release of the A1 pulley. We present a novel single-incision endoscopic trigger finger release technique that moves the incision from the palm to the palmar-digital crease, leading to less pain, scarring, and stiffness. We believe that this technique is technically simple, fast, and may decrease the risk of complications commonly encountered with open trigger finger release. Level of Evidence: Therapeutic IV.

The Effect of Body Mass Index on Open Carpal Tunnel Release Recovery

The purpose of this study was to determine whether a relationship exists between body mass index (BMI), specifically obesity, and surgical outcomes for open carpal tunnel release. Obesity is correlated with increased incidence of carpal tunnel syndrome; however, the effect of obesity on after release recovery has not been examined. This study used a retrospective review of patient charts (n= 142). BMI was calculated based on height and weight measurements, and patients were grouped based on their BMI into the following categories: healthy BMI (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity class one (30-34.9 kg/m2) (OB1), obesity class (2 35-39.9 kg/m2) (OB2), or obesity class three (40+ kg/m2) (OB3). Data were then complied on surgical outcomes by assessing preoperative pain, postoperative pain at 2 and 6 weeks, postoperative joint stiffness, wound healing time, and infection status. Data were analyzed using chi-square analyses and multivariable logistic regression to assess the differences in treatment outcomes while controlling for possible confounding variables. Age at the time of release was found to be inversely correlated with BMI. Healthy BMI patients (n= 19) underwent release at an average age of 59.1 years, whereas OB3 (n= 30) underwent release at an average age of 46.9 years. The odds of improvement in pain were significantly lower in all three obesity groups when compared with healthy BMI at both 2 and 6 weeks after operation. Our results indicate that obesity may be positively correlated with earlier incidence of carpal tunnel syndrome requiring surgical intervention. These data also indicate the increased rates of postoperative complications in obese patients, particularly patients with OB3. Patients with OB3 need to understand these risks before undergoing open release. Further study should examine the impact of type 2 diabetes on carpal tunnel release recovery. The information included in this study may be used to guide surgeons and patients when considering the effect and potential improvement in outcomes that may come from addressing patient BMI before open carpal tunnel surgery.

Ultrasound-guided rotator interval or subacromial corticosteroid injection in primary adhesive capsulitis of the shoulder: Does it make a difference?

Primary adhesive capsulitis occurs spontaneously without any predisposing factors. Diabetes, diseases of thyroid, cerebrovascular accident, coronary artery diseases, autoimmune disease and Dupuytren’s contracture are some of the associated conditions. Various treatment methods for adhesive capsulitis of shoulder including physical therapy, intraarticular corticosteroid injections, manipulation under anaesthesia, and arthroscopic or open capsular release have been described. Intra-articular, subacromial, rotator interval and bicipital grove are the various sites for corticosteroid injection in adhesive capsulitis. Ultrasound has been used widely in shoulder joint injections to improve accuracy. There is limited data comparing these sites for their efficacy in adhesive capsulitis when injected under ultrasound guidance. In this study, we compared ultrasound-guided corticosteroid injection through rotator interval and subacromial route shoulder joint in adhesive capsulitis of shoulder.

Pancreaticoduodenal Artery Aneurysm Complicated by Median Arcuate Ligament Syndrome.

To highlight median arcuate ligament syndrome as a potential cause for celiac artery stenosis and pancreaticoduodenal artery aneurysm, and describe treatment options in this setting. A 63-year-old male presented with a pancreaticoduodenal artery aneurysm and concomitant celiac artery stenosis that was treated with celiac artery stenting and aneurysm coiling. He subsequently developed stent fracture and celiac artery occlusion secondary to previously unrecognized median arcuate ligament syndrome causing reperfusion of the aneurysm. This was treated with open median arcuate ligament release and aorta to common hepatic artery bypass with good clinical result and stable 20-month surveillance imaging. It is critical to recognize median arcuate ligament syndrome as a cause of celiac artery stenosis in the setting of pancreaticoduodenal artery aneurysm given the high risk of failure of endovascular stenting. Open aorto-hepatic artery bypass and endovascular aneurysm coiling should be the preferred approach in these patients.

Outcomes of Therapy and Ulnar Nerve Transposition for Elbow Stiffness After Pediatric Medial Epicondyle Fractures

Following medial epicondyle fractures, a subset of pediatric patients has persistent limitations in elbow motion. This study soughted to understand the patient characteristics of this group and to assess the effectiveness of intensive therapy and ulnar nerve transposition in improving elbow range of motion and patient-reported outcomes. A cohort of 31 pediatric patients with stiffness after elbow trauma was narrowed to 8 pediatric patients (7 female) ranging in age from 9 to 14 years, who were diagnosed with medial epicondyle fractures and underwent intensive therapy and ulnar nerve transposition with or without elbow joint release. We collected demographic and objective data as well as subjective data including Patient-Reported Outcome Measurement Information System (PROMIS) scores before and after ulnar nerve transposition. Following initial intensive therapy, elbow range of motion improved by an average of 56°, and 7 of the 8 patients reached a functional motion arc of 100°. Subsequently, following ulnar nerve surgery with or without elbow release, motion improved by an average of 22°, and 5 of the 8 patients demonstrated improvement from this intervention. Surgery led to improvements in subjective outcomes with an improvement in PROMIS mobility scores by an average of 9 points, pain interference by 6 points, and upper extremity scores by 3 points. Based on a previously determined minimally important difference of three points, these indicate significant clinical improvements. A subset of pediatric patients with persistent stiffness following medial epicondyle fractures may benefit from additional interventions, including intensive therapy, transposition of the ulnar nerve, and open capsular release. However, not all patients were improved after ulnar nerve surgery, and the identification and treatment of ulnar nerve irritability may not fully resolve preoperative symptoms in all patients. Therapeutic IV.

Incidence of Repeat Elbow Capsular Release After Arthroscopic Elbow Capsular Release.

Elbow capsular release can be performed arthroscopically or through an open method to improve range of motion (ROM). However, it is unclear how frequently patients require an open capsular release after unsatisfactory results from an arthroscopic release. The purpose of this study was to determine the percentage of patients who underwent an arthroscopic elbow release for loss of motion who then required a repeat elbow capsular release or other subsequent surgery on the same elbow. It was hypothesized that patients who underwent arthroscopic elbow release would rarely (<5%) require a subsequent elbow release. Case series; Level of evidence, 4. Patients who underwent arthroscopic elbow capsular release from January 1, 2010, to December 31, 2019, were identified by chart review and procedure code. Demographic parameters, pre- and postoperative ROM, and surgical history were collected by chart review. Follow-up data included patient satisfaction and the Timmerman-Andrews (TA) elbow score. Data were compared between patients who did and those who did not require subsequent elbow surgery. Overall, of 140 study patients (116 male, 24 female; mean age, 49.6 years), 18 (12.9%) required subsequent surgery, including 6 capsular releases (4.3%; 1 open and 5 arthroscopic). The most common follow-up procedure was ulnar nerve releases/transpositions (n = 7). Total arc of elbow motion (flexion to extension) improved by a mean of 51.4°. The mean TA score was 76.5 ± 20.4 at a mean of 5.25 years postoperatively. Mean satisfaction score was 77.6 ± 26.3. In this study, 82.4% of patients stated that their symptoms either improved or resolved completely. Patients who required subsequent surgery had a significantly lower preoperative total arc of elbow motion versus those who did not require subsequent surgery (P = .046). There was no difference between the groups in symptom resolution, satisfaction, ROM, or TA score (P ≥ .279 for all). After arthroscopic elbow release, <5% of patients required a repeat elbow capsular release, 12.9% required some form of follow-up elbow surgery, and 4.3% had a new injury of the elbow. Overall, patients saw improvement in elbow ROM, but many still had residual symptoms from their underlying disease after arthroscopic elbow capsular release.

Trigger Finger or De Quervain Tenosynovitis after Surgical Treatment for Carpal Tunnel Syndrome.

Objective To evaluate the open surgical treatment for carpal tunnel syndrome as a risk factor for the development of stenosing tenosynovitis that results in trigger finger and De Quervain disease. Materials and Methods A retrospective study analyzing the medical records of patients submitted to open surgical release of carpal tunnel syndrome between 2010 and 2021 in a secondary- and tertiary-level hospital. The following data were collected: pathological history, duration of the follow-up after the surgical treatment for carpal tunnel syndrome, development of trigger finger or De Quervain tenosynovitis, affected fingers, and the interval between the end of surgery and symptom onset. Results We evaluated 802 patients of both genders and with a mean age of 50.1 (±12.6) years. The mean follow-up was of 13 (±16.4) months. The mean time until the development of trigger finger was of 61.4 months, and of 73.7 months for De Quervain disease. The incidence of development of De Quervain disease was of 4.12%, and for trigger finger it was of 10.2%. The most affected digits were the thumb (47.6%), the middle (24.4%), and the ring finger (8.54%). Age was the only factor that showed an association with the risk of developing trigger finger, with an increase of 2% for each increase in age of 1 year. Conclusion The incidence rates for the development of De Quervain disease (4.12%) and trigger finger (10.2%) after the surgical treatment for carpal tunnel syndrome were like those described in the literature. Only age was a factor that influenced the development of trigger finger.

Not Just Another Trigger Finger.

Open A1 pulley release for trigger finger has generally been considered a minor procedure with infrequent complications. Most reported complications are minor, including scar pain and tenderness, mild extension lag, and recurrence of triggering. Rates of major complications, such as bowstringing, neurovascular bundle injury, and infection requiring reoperation, are less than 1% to 4%. We aimed to describe the potentially devastating sequelae of these major complications and the subsequent consequences. Three patients underwent open trigger finger release, which were all complicated by severe postoperative surgical site infection requiring multiple subsequent procedures. We review our initial management, subsequent reconstructive options, and outcomes with up to 19 years follow-up. All 3 adult patients who underwent open A1 pulley release for trigger finger developed a surgical site infection, leading to flexor tenosynovitis requiring urgent operative debridement and multiple subsequent procedures. Two patients were poorly controlled diabetics, and the third patient was otherwise healthy. Each patient ultimately developed distinct consequences from their postoperative course-finger stiffness and contracture, disabling bowstringing requiring the use of a pulley ring, and flexor tendon rupture requiring staged tendon reconstruction, respectively. All 3 patients at final follow-up had a permanent functional deficit. Major complications after trigger finger release are infrequent. However, if left untreated, particularly in diabetic patients, there can be disastrous consequences, resulting in permanent loss of function. This case series highlights the importance of accurate diagnosis of postoperative infections and expedient treatment thereafter.

Poster 176: Distal Mononeuropathy and Nerve Release after Arthroscopic Shoulder Surgery: A Matched Cohort Analysis

Objectives: Following arthroscopic shoulder procedures such as total shoulder arthroplasties, reverse total shoulder arthroplasties, and rotator cuff repairs, select patients have presented with symptomatic distal mononeuropathy (DMN) that require follow-up nerve release procedure(s). This occurrence may be secondary to operative complications such as limb traction, surgical dissection, hematoma formation, or interscalene block placement. Separately, many patients presenting for impending shoulder procedures have been found to have preexisting DMN that similarly require nerve release for management. This retrospective cohort study aims to compare the clinical outcomes of a cohort of patients who underwent peripheral nerve release (cubital/carpal tunnel) for DMN following recent shoulder surgery to a cohort with no prior history of a shoulder procedure before DMN presentation. Methods: From 2010 to 2020, CPT codes were used to identify a cohort of patients over the age of 18 who underwent a shoulder procedure (rotator cuff repair, total shoulder arthroplasty, reverse total shoulder arthroplasty, and shoulder stabilization) and had an ensuing nerve release procedure for DMN (open or endoscopic cubital or carpal tunnel release) within 2 years of that surgery. A second cohort of patients who underwent a nerve release procedure for DMN presentation (open or endoscopic cubital or carpal tunnel release) with no prior history of shoulder surgery were identified using CPT codes and subsequently matched to the first cohort by age, sex, and BMI in a 3:1 (control: case) ratio. Following this, chart review and Redcap surveys were used to collect: demographics, surgical history, electromyography/nerve conduction velocity (EMG/NCV) results, post-operative symptoms (numbness, weakness, pain), and patient-reported outcomes (ASES, SANE, DASH). EMG/NCV results were categorized as Mild/Moderate/Severe based on standard practices. T-tests and Mann-Whitney tests were used for statistical analysis between the two groups with significance set at P &lt; .05. Results: 120 patients are included in this analysis (28 case, 92 control). There was no statistical difference between the groups for mean age at surgery, sex, or BMI . Patients with prior shoulder surgery before DMN presentation had a nerve release at an average of 0.81 ± 0.61 years after shoulder surgery. Mean follow-up time after nerve release for all patients in both cohorts was 4.91 ± 2.11 years. The most common nerve release for DMN across both cohorts was open carpal tunnel release (n=86), followed by endoscopic carpal tunnel release (n=22), open cubital tunnel release (n=16), and endoscopic cubital tunnel release (n=2). There was no statistical difference in preoperative EMG/NCV results between patients in the case group (39.3% mild, 32.1% moderate, 28.6% severe) compared to patients in the control group (29.3% mild, 47.8% moderate, 22.8% Severe) (P=0.125). There was no difference between groups for preoperative ASES, SANE, and DASH (P≥0.188), or for postoperative ASES, SANE, and DASH (P≥0.170). Following nerve release, patients in the case group were found to have significantly more post-operative numbness/tingling (42.9%) than patients in the control group (18.5%) (P=0.017). There was no difference between groups in postoperative pain (P=0.075) or weakness (P=0.156) [Figure 1]. Residual post-operative numbness following nerve release, was more likely to occur in the forearm for patients in the case group (21.4%) than patients in the control group (6.52% of patients) (P=0.032) [Figure 2]. Although not significant, 65.2% of patients in the case group reported complete resolution of symptoms following nerve release procedure compared to 50% of patients in the control group (P=.219). Conclusions: Patients with a history of shoulder surgery prior to presentation of DMN are more likely to experience persistent numbness or tingling after nerve release surgery than patients without a history of shoulder surgery. These patients are also more likely to experience symptoms located in the forearm. However, patient-reported outcomes between patients undergoing nerve release surgery with a history of shoulder surgery and those without are similar. Surgeons should be aware of these findings for improved patient education regarding post-operative prognosis.

Ultrasound-Guided Percutaneous Release of Pulley in Trigger Finger: A Curved Needle Technique

Thickened A1 pulley is the most common cause of trigger finger. The patient complains of snapping and locking of finger like a trigger as the gliding of the flexor tendon become harder through the thickened pulley during flexion and superadded development of nodule on the surface of the tendon proximal to pulley. In severe cases or failed conservative/steroid injection cases, real-time percutaneous release of pulley under ultrasound (US) guidance can be considered. The percutaneous pulley release is a minimally invasive procedure compared to open surgical release and more accurate than blind percutaneous release with overall minimal complications. The US-guided percutaneous A1 pulley release has been described in the literature and done by knife, straight needles, and acutely bent needles with variable results. We describe the curved needle technique of percutaneous pulley release. The curved needle technique for US-guided A1 pulley release is novel and has the advantage of easy maneuverability over acutely bent needle and minimal chances of complications. The cutting edge of the curved needle scores through the thickened pulley with effective release and easy maneuverability.