Ulnar Side Research Articles

Irreducible Dislocation of Thumb Interphalangeal Joint: A Case Report

Closed dislocation of thumb Interphalangeal (IP) joint is rare, due to the inherent stability of the thumb IP joint. The interposition of the volar plate, flexor pollicis longus, sesamoids, and digital nerves can treat the joint closed reduction. In this study, we report a case of three-week-old irreducible closed dislocation of thumb IP joint in a 33-year-old woman. We planned to perform open reduction surgery using a dorsal approach on the IP joint and the ulnar side opening. The volar plate was interposed in the joint. Seven months after surgery, the patient achieved 0-45 degrees of IP range of motion. No sign of degenerative joint changes on the x-ray images was observed in the final visit. This study suggests the high probability of open reduction for these injuries and recommends the use of dorsal approach, excluding the complications of volar approach.

Occupational ergonomic assessment of hand pain symptoms among Bagh hand block print artisans of the handicraft textile industry in Madhya Pradesh, India

Objectives. Hand block printing is a highly repetitive and precision job involving tasks such as hitting the wooden hand block with the hands as a hammer, causing chronic mechanical trauma to the ulnar side of the palm. This study aimed to determine the prevalence of work-related hand symptoms, to identify ergonomic risks and musculoskeletal disorders (MSDs) and evidence of mechanical trauma among artisans working in Bagh print of Madhya Pradesh. Methods. Occupational risk involved in the artisan’s wrist area was identified using the modified Dutch musculoskeletal questionnaire (MDMQ) and modified Boston hand evaluation questionnaire. The Boston hand evaluation questionnaire helps in the measurement of the severity of the symptoms. A direct observation study was performed to identify the chronic effects of mechanical trauma (CEMT) on artisan’s hands. Results. Symptoms like pain, weakness, numbness and tingling were highly prevalent among the artisans, those with experience <3 years were more likely to report pain during working hours (p < 0.001) and those with experience >13 years were more likely to report numbness (p < 0.001) and tingling (p < 0.001). Conclusion. This study supports the evidence that the new artisans are at higher risks of reporting pain and CEMT, including fever and body pain, ultimately causing job loss.

Ulnar-sided wrist pain: a prospective analysis of diagnostic clinical tests.

Identifying the cause of pain on the ulnar side of the wrist can be challenging. The outcome and recovery following surgery can be unpredictable. The aim of this study was to document and analyse the clinical tests used to evaluate the cause of ulnar-sided wrist pain and determine their diagnostic relevance. This is a prospective evaluation of 110 patients who presented with pain on the ulnar side of the wrist. The clinical evaluation and results from radiological investigations were documented and analysed. There were 17 different diagnoses. Eighty-five percent of the diagnoses were triangular fibrocartilage complex (TFCC) injuries, ulnocarpal abutment syndrome (UCAS), pisotriquetral arthritis (PTA), triquetral fracture or non-union, distal radioulnar joint arthritis (DRUJ OA) and extensor carpi ulnaris (ECU) pathology. The ulnocarpal stress test and ulnar foveal sign were positive in several diagnoses. The ulnar foveal sign had a sensitivity and specificity of 89% and 48% for TFCC injuries, and 85% and 37% for UCAS, respectively. The sensitivity and specificity of pisotriquetral shear test for PTA was 100% and 92%, respectively. Patients with PTA or ECU pathology localised their pain better on the patient's pain localisation chart. Diagnosis of TFCC injuries, UCAS, DRUJ OA and ECU injuries are challenging as the clinical symptoms and signs for the four diagnoses were similar and required either magnetic resonance imaging or computed tomography for diagnostic confirmation after clinical examination. The ulnocarpal stress test and the ulnar foveal sign were not sufficiently specific.

Arthroscopic Triangular Fibrocartilage Complex Reconstruction Using a Palmaris Longus Tendon Graft.

Patients suffer from persistent ulnar wrist pain and distal radioulnar joint instability because of chronic triangular fibrocartilage complex (TFCC) foveal tear are treated with TFCC reconstruction. We performed an arthroscopic TFCC reconstruction using a palmaris longus tendon graft that provided a minimally invasive procedure. After confirming the TFCC foveal tear and stability between the TFCC remnant and radius, the bone tunnel was made in the ulna from the ulnar shaft to ulnar fovea. The position of the bone tunnel was checked by fluorography and arthroscopy. Curved bendable 18-gauge needles into which 3-0 nylon sutures were inserted in a loop shape were passed through the tunnel from the ulnar side, and both volar-side and dorsal-side TFCC remnants were penetrated. The nylon suture was extracted from the arthroscopic 4/5 portal, and the palmaris longus tendon graft was introduced into the joint. The graft was passed through the TFCC remnant and ulnar bone tunnel from the arthroscopic portal and fixed to the ulna using an interference screw. This procedure was indicated for TFCC foveal tears with intact radial-side TFCC remnants. If the radial-side tear and instability between the TFCC and radius coexist, this technique is contraindicated, and stabilization of both the radial and ulnar sides of the TFCC should be considered. This arthroscopic technique does not violate the distal radioulnar joint capsule, extensor carpi ulnaris tendon, or tendon sheath. In addition, it helps to stabilize the ulnar carpal complex.

Right Arm Dystonia In A Former Baseball Pitcher

HISTORY: A 58-year-old right-hand dominant former baseball pitcher presented with right forearm pain. It started 1 year ago after he fell down the stairs and caught himself with his right arm. It feels like “tightness”, is localized to the ulnar side of the wrist, and radiates up the forearm. Since the fall, he also reports repetitive involuntary movements of the right upper extremity provoked by rest and improved with external rotation of the shoulder. Denies numbness, tingling, or weakness. He has a history of depression treated with fluoxetine; he was took lurasidone for this in the past but developed tic-like movements in his hands, legs, and mouth due to this medication which resolved with stopping it. PHYSICAL EXAMINATION: He is in no acute distress. He repeatedly involuntarily elevates and internally rotates the right shoulder. Cervical spine, elbow, and wrist have full range of motion; shoulder has decreased internal and external rotation. Right levator scapulae is hypertrophic; other neck muscles have normal tone. Upper and lower extremity muscle groups have 5/5 strength bilaterally. Sensation is intact to light touch bilaterally. Reflexes are 2+ in the upper extremities and at the Achilles tendons and 3+ at the patellar tendons. Spurling's and Hoffman’s signs were negative and he had no clonus. DIFFERENTIAL DIAGNOSIS: 1. Cervical myelopathy 2. Tardive dyskinesia 3. Medication-induced dystonia 4. Cervical radiculopathy TEST AND RESULTS:Right shoulder x-rays: Moderate degenerative changes of the glenohumeral and acromioclavicular joints. Cervical spine x-rays: Multilevel degenerative changes of the cervical spine. MRI cervical spine: Multilevel degenerative changes with facet arthropathy, slight retrolisthesis from C3-C7, and loss of disc height from C4-C7. Moderate-to-severe right foraminal stenosis at C3-C4 and C4-C5. Spinal cord appears normal. FINAL WORKING DIAGNOSIS: Post-traumatic dystonia TREATMENT AND OUTCOMES: 1. No structural lesion was identified to explain the patient’s symptoms. 2. He was referred to neurology for possible medication-induced dystonia. 3. Neurology diagnosed him with post-traumatic dystonia based on his history of a fall down the stairs, dystonic movements in the affected limb, and right levator scapulae hypertrophy. 4. He was treated with botox injections.

Clinical observation of different surgical methods for metaphyseal sequelae of ulna

To investigate the effect and safety of ulnar osteochondroma resection, ulnar minimally invasive osteotomy, external fixation and ulnar lengthening in the treatment of forearm deformity of metaphyseal extension of ulna. From August 2005 to December 2013, there were 20 cases of ulnar metaphyseal sequelae, including 15 males and 5 females, aged from 7 to 13(10.00±2.34) years, the course of disease ranged for 6 to 11(8.10±1.52) months. The clinical manifestations were shortening of the affected forearm and bending to the ulnar side. The postoperative evaluation included pain, activities of daily living, orthopedic effect and the range of motion of wrist, elbow and forearm. The radiological evaluation included ulnar length, radial joint inclination angle and wrist epiphysis growth. All patients healed without infection. The only operation related to complications was ulnar lengthening, including 1 case of nonunion, 2 cases of ulnar lengthening callus fracture and 1 case of temporary radial nerve palsy. All patients were followed up for 4 to 7.5 years, with an average of (6.03±1.33) years. There were statistically significant differences in changes of wrist radial deviation, ulnar deviation, forearm pronation and supination in all cases (P<0.05). Radiological evaluation parameters (ulnar variance, radial joint angle, wrist slip) were improved, and the differences were statistically significant(P<0.05). The modified Green and O'Brien wrist function scores at the last follow-up were significantly different from those before operation (P<0.05). The clinical effect of wrist joint was significantly different from that before operation (P<0.05). The Mayo elbow function scoreat the latest follow-up was significantly different from that before operation (P<0.05). The clinical effect of elbow joint was significantly different from that before operation (P<0.05). Ulnar lengthening is not beneficial to prevent the development of long-term deformity. Simple resection of osteochondroma of distal ulna is beneficial to prevent the development of deformity. Patients with limited rotation of wrist joint and forearm and strong demand for improvement of appearance can be actively treated.

Isolated Volar Distal Radioulnar Joint Dislocation, a Very Rare and Easily Missed Injury.

Background: Isolated distal radioulnar joint (DRUJ) dislocations without associated fracture are very rare entities. A few mechanisms of injury were reported in the literature with dorsal(posterior) dislocation being more common than the volar (palmar, anterior) dislocation.&#x0D; Case report: A 26-year-old male, manual laborer presented to our emergency department (ED) 24 hours post-self-inflected injury with right wrist pain, deformity, and decreased range of motion (ROM). The physical examination showed bruising over the dorsal ulnar side of the wrist, loss of the ulnar styloid bony prominence, abnormal volar fullness of the wrist, and gutter deformity on the dorsal aspect of the distal forearm and wrist. The diagnosis was confirmed by comparative radiographs which were followed by closed reduction and immobilization in the below-elbow cast in pronation for 4 weeks.&#x0D; Conclusion: Timely accurate diagnosis and conservative treatment with favorable outcome necessitate a proper history on the mechanism of injury with a thorough physical examination, accurate radiographic positioning, and true lateral view.

Preoperative ultrasonography and magnetic resonance imaging evaluation of the position of the neurovascular bundle for Dupuytren's disease of the fifth digit.

Dupuytren's contracture (DC) is a fibrosing disor-der that produces pathological subcutaneous nodules and cords in the normal fascia. The isolated occurrence of Dupuytren's disease of the fifth digit is uncommon. This study is aimed to describe the imaging features of an isolated digital cord of the small finger and its relationship with the neurovascular bundle. A total of 13 hands in 13 patients who were clinically diagnosed with an isolated occurrence of Dupuytren's disease of the small finger were included between October 2008 and October 2013. Two independent radiologists used ultrasound and magnetic reso-nance imaging (MRI) to record size, signal or echogenicity, contrast enhancement or hyperemia, calcification, and anatomical features of the cord and its relationship with the neurovascular bundle. We found that ultrasound and MRI were accurate for the detection of the cords and neurovascular bundles in the small finger. The intermodality agreement between MRI and ultrasound was 100% for the detection of 6 spiraling bundles containing 13 isolated cords (46.2%). Among the subjects examined, 100% of the hands had ab-ductor digiti minimi (ADM) area involvement, and the distal insertion of the cord was on the ulnar side of the base of the middle phalanx. On MRI, all of the cords showed predominantly low signal intensity on both T1- and T2-weighted images. On ultrasound, the ulnar cord showed a hyperechoic or isoechoic appearance in 69.3% of hands and a hypoechoic appearance in 30.7% of hands. The spiraling of the bundle in the isolated occurrence of Dupuytren's disease at the small finger is a frequent occurrence. MRI and ultrasound are good imaging modalities for the evaluation of the relationship between the neurovascular bundle and the isolated cord.

Is it really safe to evaluate symptomatic extensor carpi ulnaris tendon instability by magnetic resonance imaging (MRI)?

The extensor carpi ulnaris (ECU) tendon is in the sixth extensor compartment of the wrist and is isolated from other tendons by a different sheath. Extensor carpi ulnaris pathologies are characterized by pain locally localized to the wrist ulnar side. Outpatient records and wrist MRI (magnetic resonance imaging) tests were retrospectively scanned between January 2018 and July 2019. By examining the anamnesis and examination notes of the patients in the outpatient clinic records, patients with wrist ulnar side pain, pain or sensitivity on the ulnar styloid and provocation test (synergy) were assigned to the first study group (Group 1).The second study group was composed of patients who underwent wrist MR for the diagnosis or differential diagnosis of a synovial cyst around the wrist, without ulnar side pain (Group 2).While evaluating MR images in the axial plane, the depth and width of the ulnar groove, thickness of the ECU tendon were measured. The position of the ECU tendon relative to the ulnar groove and the forearm rotation during the shooting were recorded.105 cases evaluated, there were 41 cases in the symptomatic subgroup and 64 cases in the asymptomatic subgroup. Among all patients, the mean patient age was 38.05.In the evaluation according to whether cases were symptomatic or not, there was no significant relationship between being symptomatic and the degree of instability and MR withdrawal position. Our study suggests that ECU instability in MR is not a specific condition, and detection of MR in instability may not be associated with a patient's symptoms.

Methods and effects of high-frequency color Doppler ultrasound assisted reverse island flap of dorsal digital artery of ulnar thumb for repairing skin and soft tissue defects in the distal end of the same finger

Objective: To explore the methods and effects of high-frequency color Doppler ultrasound assisted reverse island flap of dorsal digital artery of ulnar thumb for repairing skin and soft tissue defects in the distal end of the same finger. Methods: The retrospective cohort study method was applied. From March 2014 to January 2020, 43 patients with skin and soft tissue defects in the distal end of thumb were hospitalized in the Department of Hand and Foot Surgery of Yidu Central Hospital of Weifang, including 28 males and 15 females, aged 19-58 years. The time from injury to operation was 4 to 10 hours, and the area of wound defect was 1.5 cm×1.0 cm-5.0 cm×3.0 cm. The type and course of dorsal digital artery of ulnar thumb were detected by high-frequency color Doppler ultrasound before operation, based on which the reverse transfer of the island flap of dorsal digital artery of ulnar thumb was designed to repair the skin and soft tissue defects in the distal end of the same finger. The patients with absence of the dorsal digital artery of ulnar thumb were repaired by the greater fish reverse island flap pedicled with the radial palmar artery. The area of the flap was 2.0 cm×1.5 cm-5.5 cm×3.5 cm. The donor site wound was directly closed by suturing or covered with split-thickness skin graft from the inner side of the upper arm in the same arm. The status of dorsal digital artery of ulnar thumb detected by high frequency color Doppler ultrasound before operation was recorded. The type, course, and distribution of the dorsal digital artery of ulnar thumb detected before operation were compared with those observed during the operation. The survival of the flap was observed after operation. During the last follow-up, the appearance of the donor and recipient area of flaps was observed, the thumb function was evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association, and the sensory function of the area transplanted with flap was evaluated with the sensory function evaluation standard. Results: The results of high-frequency color Doppler ultrasound showed that the dorsal digital artery of ulnar thumb was absent in 2 patients, while 41 patients had the dorsal digital artery of ulnar thumb, among which 20 cases were type 1 that started from the first dorsal metacarpal artery and ran on the surface of the first interosseous dorsal muscle; 16 cases were type 2 that started from the deep branch of the radial artery or the main artery of thumb and ran in the deep surface of the first interosseous dorsal muscle, including 10 cases of type 2a with the starting point in the basal region of the first metacarpal bone and 6 cases of type 2b with the starting point in the first metacarpal bone region; 5 cases were type 3 that started from the confluence of the first dorsal metacarpal artery and the main thumb artery in the region of the first metacarpophalangeal joint. The outer diameter of the vessel at the beginning of the dorsal digital artery of ulnar thumb was (1.12±0.31) mm, and the outer diameter of the vessel at the beginning of the accompany vein was (0.63±0.21) mm. The dorsal digital artery of ulnar thumb was concentrated in the ulnar side of the first metacarpophalangeal joint and snuff box region. The type, course, and distribution range of the dorsal digital artery of ulnar thumb observed during the operation were consistent with the results detected by high-frequency color Doppler ultrasound before operation. After the operation, the flaps survived in 43 patients. The patients were followed up for 6 months to 1 year. During the last follow-up, only linear scars were left in the donor area; there were no obvious pigmentation in the area transplanted with reverse island flap of dorsal digital artery of ulnar thumb, with good texture and elasticity, and beautiful appearance; the thumb function was evaluated as excellent in 23 cases, good in 17 cases, and fair in 3 cases; the sensory function of the area transplanted with flap was evaluated as S4 level in 16 cases, S3 level in 22 cases, and S2 level in 5 cases. Conclusions: The reverse island flap of dorsal digital artery of ulnar thumb is one of the ideal methods to repair the skin and soft tissue defect in the distal end of the same finger, especially that beyond the distal interphalangeal joint. Preoperative detection with high-frequency color Doppler ultrasound can identify the type and distribution of dorsal digital artery of ulnar thumb, so as to design a personalized operation plan, resulting in good appearance of the donor and recipient area and thumb function after operation.

Widespread Mechanic's Hands in Antisynthetase Syndrome With Anti-OJ Antibody.

Mechanic's hand is a representative manifestation of antisynthetase syndrome (AS) but is observed in other forms of dermatomyositis1 This is a nonpruritic, hyperkeratotic, and scaly eruption on the ulnar side of the thumb and radial side of other fingers; occasionally the palms, fingertips, and feet are involved. However, a widespread type affecting the whole palm and fingers is extremely rare in anti-OJ antibody.

Long-term outcome of a “short” anterograde homodigital neurovascular island flap with a simple or double V-Y plasty

IntroductionAnterograde homodigital neurovascular island flaps are very useful for reconstructing proximal fingertip amputations with exposed bone but have the disadvantage of bringing about proximal interphalangeal joint (PIPJ) stiffness. The addition of a single or double V-Y plasty increases mobility without having to extend the dissection beyond the PIPJ. The purpose of this study was to examine the long-term functional outcome of patients who received a “short” anterograde homodigital neurovascular island flap with a single or double V-Y plasty. Our primary hypothesis was that this flap did not induce PIPJ stiffness and our secondary hypothesis was that it preserved good fingertip sensation. Materials and methodsThis was a retrospective study of patients operated between August 2017 and February 2019. The inclusion criteria were the following: a fingertip amputation caused by either a crush or laceration injury with exposed bone, treated during the acute phase of the injury or for secondary necrosis (attempted replantation or subtotal amputation) and classified as type II oblique palmar, type III or type IV amputations according to the Allen classification system. The assessment criteria were: joint mobility, sensory evaluation with the two-point discrimination and Semmes–Weinstein monofilament tests, time to healing, postoperative complications, postoperative splinting, duration of work stoppage, perioperative smoking, cold intolerance, touch hypersensitivity, nail deformity and excluded finger. ResultsNine patients (mean age 53.9 years [32–67]) were operated, of which eight long fingers and one thumb. One procedure was complicated by skin flap necrosis. At the mean follow-up of 22.4 months [16–31], the mean mobility for the metacarpophalangeal joint (MCPJ), proximal interphalangeal joint and distal interphalangeal joint (DIPJ) were 92-0-0°, 97.8-1.5-0° and 60.3-6.8-0°, respectively. In comparison to the contralateral side, a significant difference was only detected in the DIPJs. The mean two-point discrimination in the proximal portion of the flaps were 7.1mm on the ulnar side (p<0.05) and 7.6mm on the radial side (p<0.01), while in the distal portion they were 7.3mm (p<0.01) and 7.8mm (p<0.01). The Semmes–Weinstein monofilament test also detected significantly reduced sensation. ConclusionThe combination of a “short” anterograde homodigital neurovascular island flap with a single or double V-Y plasty seems to avoid PIPJ stiffening while preserving good fingertip sensation. Level of evidenceIV; retrospective study.

Comparison of two radiographic landmarks for centering the trapezial component in total trapeziometacarpal arthroplasty

We performed a retrospective review of standard anteroposterior and lateral radiographs of the thumb in 80 patients, to compare two radiographic landmarks, in terms of mediolateral bone support, for centering the trapezial component in total joint arthroplasty. On anteroposterior view, we identified the distal articular surface of the trapezium and trapezium width, and defined the two midpoints as radiographic landmarks for positioning a 9-mm trapezial cup. Mean trapezium width was significantly greater than the distal articular surface of the trapezium, and the midpoints did not match. Thus, after positioning simulated 9-mm prosthetic cups centered on each landmark, the residual radial bone distance was significantly greater using the landmark based on trapezium width. The mean value was 33% greater with this landmark, and the minimum value was 2.1 mm, compared to 0.2 mm using the landmark based on the distal articular surface. Our study thus suggested that the midpoint of the trapezium width is the more relevant radiographic landmark for centering the trapezial prosthetic cup in total joint arthroplasty, by preserving better bone stock on the radial side without depleting the ulnar side. On an intraoperative anteroposterior fluoroscopic view, this landmark could be used to check cup positioning.

Electrodiagnostic, Sonographic, and Clinical Features of Carpal Tunnel Syndrome with Bifid Median Nerve.

PurposeA bifid median nerve (BMN) is not a rare variant. This study aimed to investigate the features of carpal tunnel syndrome (CTS) accompanied by BMN.Patients and MethodsIn this retrospective study, we defined a BMN group as CTS with BMN and a non-bifid median nerve (NMN) group as CTS without BMN. All hands were assigned to four severity grades according to the findings of electrodiagnosis (EDx): very mild, mild, moderate, and severe. The cross-sectional area (CSA) of the median nerve, palmar bowing of the flexor retinaculum, and persistent median artery (PMA) were assessed by ultrasonography. Numerical pain rating scale (NRS) and symptom duration were assessed as clinical variables.ResultsSixty-four hands (57 patients) and 442 hands (341 patients) were enrolled in the BMN and the NMN groups, respectively. BMN was prevalent in 12.6% of all CTS hands. The distribution of EDx severity grade was milder in the BMN group than in the NMN group (P<0.001). The CSA of the BMN group was 16.2±4.1 mm2, slightly larger than 15.1±4.2 mm2 in the NMN group (P=0.056). The BMN group showed higher NRS than the NMN group (5.5±1.5 and 4.4±1.7, respectively; P<0.001). In the subgroup analysis, NRS was significantly higher in the BMN group than in the NMN group at all EDx severity grades. In the BMN group, the PMA group showed greater EDx severity (P=0.037) and higher NRS (6.0 and 5.0, respectively; P=0.012) than the non-PMA group. The radial side branch’s CSA was larger than that of the ulnar side branch (10.0 mm2 and 6.0 mm2, respectively; P<0.001).ConclusionCTS with BMN presented more severe symptoms and relatively milder EDx severity. When assessing the severity of CTS with BMN, the clinical symptoms should primarily be considered, as well as we should complementarily evaluate the EDx and ultrasonography.

\u201cSnapping\u201d of the extensor carpi ulnaris tendon in asymptomatic population

BackgroundExtensor carpi ulnaris tendinopathy (ECU) can be one cause of ulnar side wrist pain and it is more prominent in pronation-supination movements against resistance. In supination, flexion, and ulnar deviation within the ulnar groove, the tendon is tense and becomes predisposed to subluxation or dislocation. Snapping occurs during this dislocation and relocation. As a result of this friction between the tendon sheath and ulnar groove, tendinopathy and pain occur. ECU tendon is an important structure that contributes to the dynamic stability of wrist therefore resulting degeneration contributes disruption of distal radioulnar joint and causes wrist instability.MethodsParticipants without active wrist complaints who presented to the outpatient clinic between 2019 and 2020 were included. Provocation test was performed and participants with snapping were evaluated with ultrasound to determine subluxation or dislocation. Participants asked to indicate approximately how much time they spent daily on the phone, computer and game console. The distribution of data was evaluated with the Kolmogorov-Smirnov test. Quantitative data that were not normally distributed were evaluated using the Mann-Whitney U test, and Student’s t-test was used for normally distributed data. The Chi-square test was used to compare categorical variables. For all tests, p < 0.05 was considered statistically significant.ResultsFour hundred and fifteen women and 340 men were included in the study. Fifty of the 755 participants (6.6 %) had snapping. 22 of the 755 participants (2.9 %) had dislocation or subluxation on ultrasound. Three (13.6 %) participants had dislocation and 19 (%86.4) participants had subluxation on ultrasound. All 50 of the participants with snapping had significant repetitive trauma and sports activities. It was determined that 21 of the 22 participants who were found to have subluxation or dislocation by ultrasound had more than two hours of hobby activity and significantly more participants had more than two hours of activity compared to the group without subluxation or dislocation.ConclusionsThis study with a large number of participants will contribute to the literature in terms of evaluating the contribution of technological devices, such as computers, smartphones, and consoles to chronic wrist pain and the prevalence of ECU snapping in the asymptomatic population.Trial registrationDate of Approval; 19.02.2019, Approval Number; 19-KAEK-045.

Palpation of the lateral bands of the extensor apparatus of the fingers. Anatomy of a neglected clinical finding.

This study aimed to determine by ultrasonography, and cadaveric dissection, whether the firm cords felt by palpation at the sides of the proximal phalanx (PP), actively flexing, and extending the proximal interphalangeal (PIP) joint while keeping the metacarpophalangeal (MCP) joint extended are the lateral bands (LBs) of the extensor apparatus. If so, palpation of the LBs could help evaluate hand conditions that impact the digits' intrinsic muscles. To this end, the PP of the middle and ring fingers of the dominant hand of seven subjects were studied by palpation on both sides. Ultrasonography (US) was performed with a hockey-stick transducer placed on the ulnar side. Five cadaveric hands were dissected, exposing the dorsal extensor apparatus. On palpation, a firm cord was consistently felt at the PP's sides in all subjects. These cords moved widely forward on PIP flexion and backward with PIP extension. By US scanning, the cords corresponded to the LBs. However, the forward movement had only a median of 1.8mm (range 0.7-3mm) in the middle finger and a median of 1.1mm (range 0.3-2.7mm) in the ring finger compared with an estimated 5-10mm upon palpation. Cadaveric dissection confirmed the forward movement of the LBs in PIP flexion. We concluded that the firm cords felt at the PP sides are the LBs of the extensor apparatus. We confirmed their movement with the active flexion/extension of the PIP joint. Comparing the wide palpatory and the meager US motion, a haptic illusion of motion may be present.

Clinical outcomes of a unique ulnar collateral ligament reconstruction hybrid technique with ulnar-sided suspensory fixation.

Ulnar collateral ligament reconstruction (UCLR) is the gold standard for treating ulnar collateral ligament injuries in throwing athletes who have failed conservative treatment. There are several described techniques that produce successful and reproducible outcomes. In addition, there is biomechanical evidence that supports hybrid fixation of the graft with a docking technique on the humeral side and suspensory fixation on the ulnar side. However, as of this writing there are no clinical studies that have reported results. This retrospective case series is the first of its kind to report on clinical outcomes following UCLR with hybrid suspensory fixation. Fifty throwing athletes who underwent ULCR with hybrid suspensory fixation from 2010-2017 by one of 5 surgeons at a single institution were available at a median follow-up of 7 years. Return to sport, level of sport, and postoperative complications were recorded at final follow-up. A total of 50 patients were included in final analysis. Nearly all were able to return to sport at the same level or higher (48/50, 96%). One of these 50 athletes (2%) played professionally, 27 (54%) played collegiately, and 21 (42%) played at the high school level. Seven patients (14%) underwent reoperation following the index procedure. The median (interquartile range) Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score was 0.098 (0-4.5) at final follow-up. Hybrid suspensory fixation is a safe and effective technique for UCLR in the throwing athlete. Throwers can expect to return to sport at a very high rate with low risks for postoperative complications.

Surgical Options in Chronic Extensor Tendon Subluxation

Ulnar subluxation of the extensor tendons at the metacarpophalangeal joint level after damage to the sagittal bands is a rare problem in nonrheumatoid patients. It is aimed to discuss the treatment options for the extensor tendon subluxation and present a rare chronic case. A 25-year-old male patient presented with the complaint of stucking and snapping feeling in the middle finger when moving it after falling as a child. Type 2 sagittal band injury was detected in which the extensor tendon was subluxated to the ulnar side, and the sagittal band was strengthened with a junctura tendinum flap harvested from the adjacent finger. The patient returned to his daily life, and no recurrence was detected. Extensor tendon subluxation is the instability that occurs in the tendon as a result of damage to the sagittal bands. Many techniques have been described since the ideal technique is not available yet. Techniques that provide realignment by centralizing the extensor tendon are successful ones that can be preferred in chronic sagittal band ruptures and in professional athletes in whom primary repair is not possible.

Four Unusual Cases of Congenital Forelimb Malformations in Dogs.

Simple SummaryCongenital limb defects are sporadically encountered in dogs during normal clinical practice. Literature concerning their diagnosis and management in canine species is poor. Sometimes, the diagnosis and description of congenital limb abnormalities are complicated by the concurrent presence of different malformations in the same limb and the lack of widely accepted classification schemes. In order to improve the knowledge about congenital limb anomalies in dogs, this report describes the clinical and radiographic findings in four dogs affected by unusual congenital forelimb defects, underlying also the importance of reviewing current terminology.Four dogs were presented with thoracic limb deformity. After clinical and radiographic examinations, a diagnosis of congenital malformations was performed for each of them. In one case, a deformity involving both the radial and ulnar side of the distal limb was observed. Based on clinical and radiological evaluations, a diagnosis of postaxial terminal longitudinal ulnar hemimelia was performed. The term ectrodactyly was used to refer different malformations characterized by skin and soft tissue separation of the distal forelimb observed in two dogs. Simple complete uncomplicated syndactyly of the right forelimb, and complex incomplete uncomplicated syndactyly of the left forelimb were diagnosed in the fourth case. To the authors’ knowledge, ectrodactyly and simple complete uncomplicated syndactyly are very uncommon anomalies in companion animals and have been rarely documented. Moreover, postaxial terminal longitudinal ulnar hemimelia has still not been reported in dogs.

Assessing the innervation of the dorsal wrist capsule using modified Sihler's staining.

The aim of this study was to assess the innervation of the dorsal articular capsule of the wrist using modified Sihler's staining. Thirty dorsal wrist capsules were collected from 15 donors (both sides) within 12 hours of death. All the capsules were collected in the same manner - using the dorsal incision. The specimens were stained according to the protocol of the modified Sihler's staining technique. The preserved capsules were analysed under 8-16× magnification of an optical microscope for the presence of major nerve trunks, their major and minor branches, and nerve connections. The range of innervation visualised was that the posterior interosseous nerve innervated approximately 60% of the central part; the remaining area was innervated by the dorsal sensory branch of the radial nerve and medial antebrachial cutaneous nerve. The constant findings were the branches departing from the ulnar side of the posterior interosseous nerve and from the radial side, with an exception seen in 2 cases. A communicans branch between the posterior interosseous nerve and medial antebrachial cutaneous nerve was seen in all the specimens. The posterior interosseous nerve innervation extended beyond the level of the carpometacarpal joints II-V. The modified Sihler's staining technique allows for transparent visibility of the nerves that innervate the dorsal wrist capsule. However, it does not allow as accurate assessment as does histological examination, especially regarding the evaluation of nerve endings. Nevertheless, this method provides a significantly larger area of nerve observation than is provided by histological examination.