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ABSTRACT: As carpal tunnel syndrome is more common in women, particularly around the menopause, female-related risk factors are suspected to play a role in its pathogenesis. We have assessed whether female hormone-related symptoms are associated with upper extremity disabilities in women undergoing carpal tunnel release. A total of 92 women with a mean age of 53 years scheduled for surgery for carpal tunnel syndrome were assessed preoperatively for female hormone-related symptoms using the menopausal rating scale and other female-related factors such as menopausal status, pregnancy number and serum female hormone levels. Upper extremity disability was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. DASH scores had a moderate correlation with total menopausal rating scale scores, but not with other female-related factors assessed. This study suggests that female hormone-related symptoms are associated with subjective upper extremity disabilities in women with carpal tunnel syndrome. This information may be helpful in addressing patients' complex symptoms or interpretation of outcomes in women with carpal tunnel syndrome.
The Journal of hand surgery, European volume. 04/2013;
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ABSTRACT: The purpose of this study was to evaluate the risk of late displacement after the treatment of distal radial fractures with a locking volar plate, and to investigate the clinical and radiological factors that might correlate with re-displacement. From March 2007 to October 2009, 120 of an original cohort of 132 female patients with unstable fractures of the distal radius were treated with a volar locking plate, and were studied over a follow-up period of six months. In the immediate post-operative and final follow-up radiographs, late displacement was evaluated as judged by ulnar variance, radial inclination, and dorsal angulation. We also analysed the correlation of a variety of clinical and radiological factors with re-displacement. Ulnar variance was significantly overcorrected (p < 0.001) while radial inclination and dorsal angulation were undercorrected when compared statistically (p < 0.001) with the unaffected side in the immediate post-operative stage. During follow-up, radial shortening and dorsal angulation progressed statistically, but none had a value beyond the acceptable range. Bone mineral density measured at the proximal femur and the position of the screws in the subchondral region, correlated with slight progressive radial shortening, which was not clinically relevant. Volar locking plating of distal radial fractures is a reliable form of treatment without substantial late displacement. Cite this article: Bone Joint J 2013;95-B:396-400.
The bone & joint journal. 03/2013; 95-B(3):396-400.
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ABSTRACT: We reviewed retrospectively seven patients with Apert acrosyndactyly and measured the size of the capitate ossification centre relative to that of the hamate and determined the relative position of the middle finger metacarpal relative to the ring finger metacarpal. We then compared those parameters in 197 normal children. In all patients, the middle finger metacarpal bone had migrated proximally relative to the ring finger metacarpal and the size of the capitate ossification centre was smaller than that of the hamate. After surgical release of the middle finger, relative proximal migration of the middle finger metacarpal was partially relieved and catch-up growth of the capitate was observed within several months. As fusion of the distal phalanges creates a diamond-shaped configuration, bone growth is markedly impaired in the middle finger ray. Therefore, early separation of the middle finger may be as important as early separation of the border digits.
The Journal of hand surgery, European volume. 10/2012;
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ABSTRACT: We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.
The Journal of hand surgery, European volume. 05/2012;
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ABSTRACT: The outcome of surgery in patients with medial epicondylitis of the elbow is less favourable in those with co-existent symptoms from the ulnar nerve. We wanted to know whether we could successfully treat such patients by using musculofascial lengthening of the flexor-pronator origin with simultaneous deep transposition of the ulnar nerve. We retrospectively reviewed 19 patients who were treated in this way. Seven had grade I and 12 had grade IIa ulnar neuropathy. At a mean follow-up of 38 months (24 to 48), the mean visual analogue scale pain scores improved from 3.7 to 0.3 at rest, from 6.6 to 2.1 with activities of daily living, and from 7.9 to 2.3 at work or sports, and the mean disabilities of the arm, shoulder and hand scores improved from 42.2 to 23.5. These results suggest that this technique can be effective in treating patients with medial epicondylitis and coexistent ulnar nerve symptoms.
Journal of Bone and Joint Surgery - British Volume 06/2010; 92(6):823-7. · 2.83 Impact Factor
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ABSTRACT: Advanced osteoarthritis of the wrist or the distal articulation of the lunate with the capitate has traditionally been treated surgically by arthrodesis. In order to maintain movement, we performed proximal row carpectomy with capsular interposition arthroplasty as an alternative to arthrodesis in eight patients with advanced arthritis and retrospectively reviewed their clinical and radiographic outcomes after a mean follow-up of 41 months (13 to 53). The visual analogue scale (VAS) for pain at its worst and at rest, and the patient-rated wrist evaluation score improved significantly after surgery, whereas ranges of movement and grip strength were maintained at the pre-operative levels. Progression of arthritis in the radiocapitate joint was observed in three patients, but their outcomes were not significantly different from those without progression of arthritis. Proximal row carpectomy with capsular interposition arthroplasty is a reasonable option for the treatment of patients with advanced arthritis of the wrist.
Journal of Bone and Joint Surgery - British Volume 12/2009; 91(12):1601-6. · 2.83 Impact Factor
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ABSTRACT: We treated 32 displaced mallet finger fractures by a two extension block Kirschner-wire technique. The clinical and radiological outcomes were evaluated at a mean follow-up of 49 months (25 to 84). The mean joint surface involvement was 38.4% (33% to 50%) and 18 patients (56%) had accompanying joint subluxation. All 32 fractures united with a mean time to union of 6.2 weeks (5.1 to 8.2). Congruent joint surfaces and anatomical reduction were seen in all cases. The mean flexion of the distal interphalangeal joints was 83.1 degrees (75 degrees to 90 degrees ) and the mean extension loss was 0.9 degrees (0 degrees to 7 degrees ). No digit had a prominent dorsal bump or a recurrent mallet deformity. We believe that this technique, when properly applied, produces satisfactory results both clinically and radiologically.
Journal of Bone and Joint Surgery - British Volume 11/2009; 91(11):1478-81. · 2.83 Impact Factor
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ABSTRACT: Congruency of the distal radioulnar joint was assessed by computed tomography after gradual lengthening of the radius in patients with considerable ulnar positive variance of mean 12 (range 10-17) mm and chronic dislocation of the distal radioulnar joint. Six patients of mean age 25 years were treated by radial osteotomy and subsequent gradual lengthening using either a single-rod or a half-ring external fixator, which was applied for a mean of 81 days. The causes of deformity were distal radial epiphyseal injury in four, malunion of a radius shaft fracture in one and Madelung deformity in one. Computed tomography scans taken at 1 year postoperatively demonstrated that all patients had a congruent distal radioulnar joint. All patients achieved symptom and radiographic parameter improvements at a mean follow-up of 40 months. A disadvantage was unattractive scars on a cosmetically important surface of the forearm. Given a relatively intact bony contour of the distal radioulnar joint, congruent reduction of the distal radioulnar joint can be obtained by gradual lengthening of the radius.
The Journal of hand surgery, European volume. 07/2009; 34(3):391-6.
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ABSTRACT: An adjunctive technique of ray approximation after central ray amputation is presented. This procedure creates a "dorsal transverse intermetacarpal ligament" by using a free tendon graft from the amputee to help prevent scissoring of the fingers, without the need for bony transposition or dorsal dermodesis.
Journal of Hand Surgery (European Volume) 05/2008; 33(2):163-5. · 1.17 Impact Factor
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ABSTRACT: We have performed a form of lunate replacement arthroplasty, which included excision of the lunate and insertion of a vascularised radial bone flap wrapped in pronator quadratus, for stage IIIB or stage IV Kienböck's disease, in 41 patients who have been followed up for more than three years. All patients reported an improvement in their symptoms, and 20 of the 41 became free of pain after the operation. Extension and flexion of the wrist were increased by a mean of 9 degrees and 6 degrees , respectively (p < 0.05). The radioscaphoid angle and the carpal height ratio were not significantly changed and only minimal deterioration was observed due to degenerative change. The size, density or location of the inserted bone did not change with time. A vascularised radial bone flap wrapped in pronator quadratus can be a reliable treatment option for advanced Kienböck's disease, when the pedicled bone and muscle envelope acts as a stable spacer for the excised lunate.
Journal of Bone and Joint Surgery - British Volume 06/2006; 88(5):623-8. · 2.83 Impact Factor
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ABSTRACT: Two children with isolated ischaemic contractures of the mobile wad (extensor carpi radialis longus, extensor carpi radialis brevis and brachioradialis), which developed after treatment of a supracondylar fracture, are presented. Z-lengthening of the extensor carpi radialis longus and brevis tendons improved wrist flexion.
The Journal of Hand Surgery British & European Volume 11/2004; 29(5):508-9. · 0.04 Impact Factor
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ABSTRACT: We performed nine metatarsal and three proximal phalangeal lengthenings in five patients with congenital brachymetatarsia of the first and one or two other metatarsal bones, by a one-stage combined shortening and lengthening procedure using intercalcary autogenous bone grafts from adjacent shortened metatarsal bones. Instead of the isolated lengthening of the first and the other metatarsal bones, we shortened the adjacent normal metatarsal and used the excised bone to lengthen the short toes, except for the great toe, to restore the normal parabola. One skin incision was used. All the operations were performed bilaterally and the patients were followed up for a mean period of 69.5 months (29 to 107). They all regained a nearly normal parabola and were satisfied with the cosmetic results. Our technique is straightforward and produces good cosmetic results. Satisfactory, bony union is achieved, morbidity is low, and no additional surgery is required for the removal of metal implants.
Journal of Bone and Joint Surgery - British Volume 10/2004; 86(7):1013-5. · 2.83 Impact Factor
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ABSTRACT: In this retrospective study, we analysed the clinical features of neurilemoma when it is located in muscle. Twelve patients had an intramuscular neurilemoma as shown on magnetic resonance (MR) scans and confirmed at operation. In six it was located in the upper limb, in five in the lower limb, and in one in the back. The mean age of the patients was 41 years (12 to 58). Nine complained only of a palpable mass and the other three of a mass with slight tenderness. None had neurological symptoms or signs, such as radicular pain, a positive Tinel sign, or motor weakness. There were no postoperative complications or recurrence of the tumour after a mean follow-up of two years (1 to 10).
Journal of Bone and Joint Surgery - British Volume 08/2003; 85(5):723-5. · 2.83 Impact Factor
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ABSTRACT: We studied radiographs of the wrists of 120 healthy volunteers in order to determine the normal range of ulnar variance. They had been taken in various positions under both unloaded (static) and loaded (dynamic) conditions. Pronation posteroanterior, supination anteroposterior and neutral posteroanterior views were taken of each wrist before and during a maximum grip under identical conditions. The mean normal ulnar variance in neutral rotation was +0.74+/-1.46 mm, a value which was significantly lower in males than in females. We found negative variance in 26% of cases. We measured maximum ulnar variance (UVmax +1.52+/-1.56 mm) when gripping in pronation and minimum ulnar variance (UVmin +0.19+/-1.43 mm) when relaxed in supination. We subtracted UVmin from UVmax to calculate a mean maximum dynamic change in ulnar variance of 1.34+/-0.53 mm. We consider this database of normal values to be useful for both the diagnosis and treatment of conditions related to discrepancy in radio-ulnar length and for clinical research.
Journal of Bone and Joint Surgery - British Volume 10/2001; 83(7):1029-33. · 2.83 Impact Factor
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ABSTRACT: In a previous study the prevalence of Raynaud's phenomenon (RP) in patients with idiopathic carpal tunnel syndrome (CTS) was found to be 60% which is much higher than that in the general population. We undertook a further study of the same cohort of patients have both CTS and RP and who had an open release of the carpal tunnel, to observe the effects of the operation on RP. We observed whether the symptoms of RP improved, and repeated the cold provocation tests to see if the arterial pulse which was decreased before operation would recover. We rated the outcome as good when the patients showed both an improvement of the symptoms of RP and a normal pulse amplitude after exposure to cold, fair when the pulse amplitude recovered to more than two-thirds of that before exposure, and poor when cold hypersensitivity was persistent or showed the same degree of decreased pulse amplitude as observed before operation. Of the 18 patients with both conditions, ten (56%) had good and four (22%) fair results, with a mean recovery time of 4.2 months (6 weeks to 1 year) after operation. If the vasospasm seen in RP is an expression of vasomotor irritation in the carpal tunnel, these findings suggest that local compression of vasomotor fibres in the carpal tunnel can also be relieved by the release of this structure. Careful consideration, however, is still required in treating patients with both conditions since in some cases. RP may be superimposed or it may have other origins.
Journal of Bone and Joint Surgery - British Volume 09/2000; 82(6):818-9. · 2.83 Impact Factor
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ABSTRACT: Both idiopathic carpal tunnel syndrome (CTS) and Raynaud's phenomenon (RP) are common, and may have similar clinical symptoms. The degree of their coexistence is uncertain. We have examined 30 patients, who were diagnosed clinically and electromyographically as having idiopathic CTS, for the presence of RP using a cold provocation test with photoplethysmography. The patients' hands were exposed in water at 10 degrees C for five minutes. A total of 18 patients (60%) was found to have RP; this is much greater than would be expected from the prevalence in the general population. Raynaud's phenomenon should be considered when treating patients with CTS because of the possibility of coexistence and the similar symptoms of these two disorders.
Journal of Bone and Joint Surgery - British Volume 11/1999; 81(6):1017-9. · 2.83 Impact Factor
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ABSTRACT: The objective of this study was to provide quantitative data on the insertion sites of the cruciate ligaments. In the first part of the study, we determined the shapes and sizes of the insertions of the anterior and posterior cruciate ligaments (ACL and PCL), and further compared these data with the midsubstance cross-sectional areas of the ligaments. The cross-sectional area of the ACL and PCL midsubstance of 5 human knees was measured using a laser micrometer system. The insertion sites of each ligament were then digitized and the 2-dimensional insertion site areas were determined. Relative to the ligament midsubstance, the PCL tibial and femoral insertions were approximately 3 times larger, whereas those of the ACL were over 3.5 times larger. In the second part of the study, the ACLs and PCLs of 10 knees were each divided into their 2 components and the areas of each insertion were determined. Each component was approximately 50% of the total ligament insertion area and no significant difference between the 2 could be shown.
Arthroscopy The Journal of Arthroscopic and Related Surgery 11/1999; 15(7):741-9. · 3.02 Impact Factor
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ABSTRACT: For the restoration of thumb opposition many types of tendon transfer techniques have been described. The flexor digitorum superficialis (FDS) of the ring finger is commonly selected as a motor. On occasion, however, the quality of the flexor muscles of the fingers or wrist is not good enough for tendon transfer and another available muscle must be selected. In this situation, we have preferred to use an extensor carpi radialis longus (ECRL) or brevis (ECRB) transfer to restore opposition of the thumb. Follow-up examination, at an average 5 years and 10 months after operation, showed that the results of ten of 11 transfers were excellent and the other was good.
The Journal of Hand Surgery British & European Volume 03/1999; 24(1):50-3. · 0.04 Impact Factor
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ABSTRACT: The ultrastructural anatomy of collagen fibril diameters in the cruciate and meniscofemoral ligaments, from four young human cadaver knees (mean age, 20 years, range, 17-22 years) was studied using transmission electron microscopy. Samples were harvested from the proximal, middle, and distal regions of the anterior and posterior cruciate ligaments, and the meniscofemoral ligament. Photomicrographs were taken and assessed quantitatively using image analysis software to determine the collagen fibril diameters and eccentricities, and the percentage of total cross sectional area occupied by collagen. The collagen fibril diameter for the anterior cruciate ligament was found to be largest in the distal region but it decreased as it moved proximally. The posterior cruciate ligament had an opposite trend because it decreased from the proximal to the distal region. For the meniscofemoral ligament, the fibrils of the middle region were larger than those of the proximal and distal regions. The percentage of total cross sectional area occupied by collagen, however, did not vary significantly between regions. Fibril eccentricity also varied little between ligament or location. The variability observed in fibril diameters may account for the different mechanical properties of the ligaments.
Clinical Orthopaedics and Related Research 01/1999; · 2.53 Impact Factor
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ABSTRACT: Experimental findings have suggested that the metabolic activities of articular cartilage can be influenced by mechanical stimuli. Our mathematical analysis predicted that cyclic compressive loading may create periods of intermittent sub-ambient hydrostatic pressure within the cartilage extracellular matrix. Based on this mathematical analysis, the present study was aimed to investigate whether the intermittent sub-ambient hydrostatic pressure, created in the cartilage extracellular matrix during cyclic compression, has a stimulative effect on the biosynthesis of chondrocytes.
In order to test this hypothesis, the present study developed a custom-designed sub-ambient pressure generator to subject a monolayer culture of chondrocytes to an intermittent sub-ambient pressure. Using this pressure generator, the monolayer chondrocyte culture system was analyzed for 35S-sulfate and 3H-proline incorporation rates for biosynthesis of proteoglycan and collagenous/noncollagenous protein molecules, respectively. Northern analyses for aggrecan and type II collagen mRNAs were also performed.
It was found that the intermittent sub-ambient pressure produced a 40% increase in proteoglycan and a 17% increase in non-collagenous protein synthesis during the pressurization period (P < 0.05). The collagenous protein synthesis was not affected by the intermittent sub-ambient pressure regimen used in this study. After the intermittent sub-ambient pressurization, the metabolic activities of the chondrocytes returned to normal (control level). The intermittent sub-ambient pressure also produced an increase in the mRNA signals for aggrecan. Therefore, we conclude that intermittent sub-ambient pressure may be one of the potential mechanical stimulators of chondrocytes in articular cartilage during dynamic compression.
Osteoarthritis and Cartilage 01/1999; 7(1):71-80. · 3.90 Impact Factor
