Hand & Wrist Reconstruction Journal Scan

ACCME Accreditation Statement

The American Academy of Orthopaedic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American Academy of Orthopaedic Surgeons designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Posting date: October 26, 2015
Next review date: October 26, 2018

BACKGROUND: Corticosteroid injections are commonly used in the treatment of carpal tunnel syndrome in adults. This study sought to determine success rates early on and at one year postoperatively of a single corticosteroid injection while identifying prognostic indicators for symptom recurrence and repeat intervention.

METHODS: Fifty-four consecutive wrists in forty-nine patients with carpal tunnel syndrome treated with a single corticosteroid injection were prospectively enrolled. Demographic data and information on comorbidities were identified with a study-specific questionnaire. The Boston Carpal Tunnel Questionnaire was administered prior to injection. Patients returned to clinic at six weeks and were contacted at three, six, nine, and twelve months post-injection to determine symptom and intervention status.

The Journal of the American Academy of Orthopaedic Surgeons (JAAOS) is the #1 clinical review journal of musculoskeletal education in the world. The peer-reviewed articles presented each month in JAAOS critically evaluate and synthesize current information regarding the diagnosis and management of musculoskeletal conditions and document the current state of orthopaedic practice.

The editorial board of JAAOS represents every subspecialty within orthopaedic medicine: Sports Medicine, Trauma, Pediatric Orthopaedics, Hip and Knee, Spine, Shoulder and Elbow, Hand and Wrist, Foot and Ankle, and Musculoskeletal Oncology, as well as areas of general orthopaedic interest. This diversity of topics is reflected in every issue of the Journal.

Editor's Pick

The Effect of Timing on the Treatment and Outcome of Combined Fourth and Fifth Carpometacarpal Fracture Dislocations.

Zhang C, Wang H, Liang C, Yu W, Li Y, Shang R, Huang C, Huang C.

J Hand Surg Am. 2015 Sep 9. pii: S0363-5023(15)00953-3. doi: 10.1016/j.jhsa.2015.07.017. [Epub ahead of print]

BACKGROUND:

Some Internet sites have programs that attempt to help patients find their diagnosis based on symptoms. This study tested the null hypothesis that there are no factors associated with correspondence between online diagnosis and the hand surgeon's diagnosis in an outpatient hand and upper extremity surgeons' office.

METHODS:

Eighty-six outpatients were prospectively enrolled and used WebMD® symptom checker to guess their diagnosis. We collected demographic information, hours spent on the Internet per week, and the following questionnaires: Pain Catastrophizing Scale (PCS) and Center of Epidemiologic Studies Depression scale (C-ESD).

RESULTS:

Thirty-three percent of online diagnoses matched the final diagnosis of the hand surgeon.

BACKGROUND:

The most common compressive neuropathy affects the median nerve in the carpal tunnel; it is typically chronic and progressive. Acute carpal tunnel syndrome (ACTS), on the other hand, is a less frequently encountered surgical emergency that usually occurs in the setting of trauma, such as a displaced fracture of the distal radius or carpal dislocation. To our knowledge, there are only two cases of acute carpal tunnel secondary to gout reported in the literature, with both being outside of the USA and the last case being over 20 years ago. We reviewed the literature describing acute carpal tunnel syndrome (ACTS) caused by gout and present a recent case of atraumatic ACTS caused, in part, by a tophaceous gouty mass.

BACKGROUND:

Collagenase clostridium histolyticum (CCH) injection for Dupuytren contracture was approved in the USA in 2010. Current FDA guidelines stipulate that finger manipulation occurs the day following injection. To investigate the safety and efficacy of delaying manipulation to 2 or 4 days following CCH injection, we conducted a prospective, randomized trial at two sites.

METHODS:

Patients with Dupuytren contracture involving the metacarpophalangeal (MCP) joint ≥20° caused by a palpable cord participated. All patients received one dose of CCH (0.58 mg/0.25 ml) and were followed for 90 days. The primary end point was the percent of patients maintaining clinical success (reduction of contracture to 0°-5°) at 90 days post-injection.

Madelung deformity of the wrist is more common in females and is often associated with Leri Weill dyschondrosteosis, a mesomelic form of dwarfism. Patients with Madelung deformity often report wrist deformity resulting from the prominence of the relatively long ulna. The typical Madelung deformity is associated with a Vickers ligament that creates a tether across the volar-ulnar radial physis that restricts growth across this segment. The distal radius deforms in the coronal (increasing radial inclination) and the sagittal (increasing volar tilt) planes. There is lunate subsidence and the proximal carpal row adapts to the deformity by forming an upside-down pyramid shape or triangle.