Tyson K Cobb

• MD
• Shoulder Elbow Wrist And Hand Center Of Excellence

Purpose Scapholunate advanced collapse (SLAC) wrist results from an untreated scapholunate dissociation and is the most common type of degenerative arthritis of the wrist. The most common surgical treatments for SLAC wrist are proximal row carpectomy and four-corner fusion with scaphoid excision. Arthroscopic surgical treatment for SLAC wrist has b...

Scapholunate dissociation when left untreated commonly leads to the most common type of degenerative arthritis of the wrist known as scapholunate advanced collapse (SLAC). When nonoperative treatment fails, surgical intervention is indicated. SLAC wrist is commonly treated with either a four-corner fusion with scaphoid excision or proximal row carp...

Motocross and off-roading motorcyclists are the most common subpopulation to suffer from chronic exertional compartment syndrome (CECS) of the forearm. While this condition is rare in the general population, it is very common among professional motocross riders. This is due to their repetitive muscular activity of the forearm and hand as motorcycli...

Through smaller, improved equipment and refined surgical techniques, hand surgeons are now able to address the entire spectrum of basilar joint arthritis arthroscopically. Specifically, arthroscopic resection arthroplasty for isolated carpometacarpal (CMC) or pantrapezial arthritis with interposition has been shown to provide excellent results and...

Cubital tunnel syndrome is a common compressive neuropathy of the upper limb. Surgical decompression is indicated for patients who failed conservative therapy. Decompression in situ has shown to achieve comparable outcomes as decompression with anterior transposition in idiopathic cubital tunnel syndrome. Endoscopic cubital tunnel decompression has...

Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb. Endoscopic cubital tunnel decompression has gained popularity in recent years as this enables surgeons to achieve decompression of the ulnar nerve along its course using a small incision. This article describes the technical peals in performing endoscopic cu...

Cubital tunnel syndrome is the 2nd most common compressive nerve entrapment in the upper limb. For patients who remained symptomatic after conservative therapy, surgical decompression of the ulnar nerve is indicated. In selected cases e.g. ulnar nerve hypermobility, concomitant anterior transposition of the ulnar nerve may be needed to warrant a go...

Cubital tunnel syndrome is the second most common nerve entrapment disorder in the upper extremity. Most cases of idiopathic cubital tunnel syndrome will resolve without surgical intervention. Those who remain symptomatic despite conservative treatment are offered surgery. There is no consensus for the best surgical approach; however, simple releas...

Chronic exertional compartment syndrome (CECS) of the forearm, while uncommon, can occur among elite and professional athletes, especially in the motocross and off-road motorcycle-riding community. Swelling in the forearm muscles occurs with repetitive and sustained hand and forearm muscle activity. This causes increased intra-compartmental pressur...

Background: Chronic exertional compartment syndrome (CECS) of the forearm is traditionally treated with open compartment release requiring large incisions that can result in less than optimal esthetic results. The purpose of this study is to describe a case report of 2 professional motocross patients with forearm CECS treated endoscopically using...

To report results on 144 cases following arthroscopic resection arthroplasty (ARA) with or without interposition for basal joint arthritis. Cases undergoing ARA for thumb carpometacarpal osteoarthritis between 2004 and 2011 were prospectively enrolled (n = 178). Data were collected before surgery and after surgery at 1, 3, 6, and 12 months and annu...

A self-retaining retractor and surgical method of retracting integument at a surgical site comprising a medial arm moveably connected to a first end of an extension arm. The extension arm is connected to a lateral arm. The connection may be made after the medial arm is in the surgical site. The extension arm may be moved from an undeployed position...

Through smaller, improved equipment and refined surgical techniques, hand surgeons are now able to address the entire spectrum of basilar joint arthritis arthroscopically. Specifically, arthroscopic resection arthroplasty for isolated carpometacarpal (CMC), or pantrapezial arthritis with interposition, has been shown to provide excellent results an...

Background The objective was to evaluate recovery characteristics of patients undergoing endoscopic cubital tunnel release (ECuTR) by determining the following: (1) return to work (RTW) times following ECuTR compared with RTW times of patients that underwent anterior transposition of the ulnar nerve (ATUN), (2) satisfaction rates and factors affect...

Background Symptomatic advanced scapholunate advanced collapse (SLAC) wrists are typically treated with extensive open procedures, including but not limited to scaphoidectomy plus four-corner fusion (4CF) and proximal row carpectomy (PRC). Although a minimally invasive arthroscopic option would be desirable, no convincing reports exist in the liter...

Background The purpose of this study was to provide prospective independently analyzed evidence on how patients feel about a carpal tunnel release (CTR) performed under local anesthesia only (no sedation or tourniquet) versus with local anesthesia, intravenous (IV) sedation, and a tourniquet. Methods This prospective cohort study compared 100 cons...

Wrong site surgery is estimated to occur 40 times per week in hospitals and clinics in USA. The universal protocol was implemented by the joint commission board of commissioners to address wrong site, wrong procedure, and wrong person surgery. The universal protocol has three principal components: preoperative verification, marking of the operative...

This article covers new and emerging techniques in small joint arthroscopy in the hand. Recent improvement in the quality of small joint scopes and advancement in techniques have allowed for many new small joint arthroscopic procedures in the hand. The arthroscopic classification for thumb carpometacarpal (CMC) arthritis as well as treatment of eac...

Arthroscopy of the carpometacarpal (CMC) and scaphotrapeziotrapezoid (STT) joints has been described for the purpose of diagnosing, staging, and treating CMC and STT pathology. This study evaluates the short-term outcome of arthroscopic resection arthroplasty (ARA) for pantrapezial arthritis. Thirty-five cases of ARA of the CMC and STT joints were...

Purpose: Arthroscopy of the carpometacarpal (CMC) and scaphotrapeziotrapezoid (STT) joints have been described for the purpose of diagnosing, staging, and treating CMC and STT pathology. This study evaluates the short-term outcome of arthroscopic resection arthroplasty of the CMC and STT joint for CMC and STT (pantrapezial) arthrosis. Methods: Thir...

A minimally invasive endoscopic approach has been successfully applied to surgical treatment of cubital tunnel syndrome. This procedure allows for smaller incisions with faster recovery time. This article details relevant surgical anatomy, indications, contraindications, surgical technique, complications, and postoperative management.

Cubital tunnel syndrome is the second most common nerve entrapment in the upper extremity. There are no current publications concerning the recurrence rates after endoscopic cubital tunnel release. The purpose of this study is to evaluate the recurrence rate of endoscopic cubital tunnel release compared to published reports of recurrence following...

Arthrodesis using a headless screw has been shown to be an effective surgical treatment for pain, deformity, or instability arising at the distal interphalangeal joint of the fingers or interphalangeal joint of the thumb. Previous publications have documented the utility of this treatment using open techniques. Common indications include degenerati...

Fifty-three cases of symptomatic heterotopic ossification were evaluated after total hip arthroplasty for the specific purpose of determining the value of surgical excision without revision or other concurrent procedures. The mean followup was 3.5 years for range of motion and 7.8 years for radiographic evaluation. A statistically significant incre...

Elevated-rim acetabular liners recently were shown to be associated with improved stability of total hip prostheses in a large clinical series. However, the effect of this design on loosening remains unknown. To address this question, we reviewed the results of 5167 primary and revision total hip arthroplasties that had been performed at our instit...

An anatomic basis for carpal tunnel syndrome (CTS) has been proposed but not confirmed; both volumetric and area studies have been used to address this issue. The authors have demonstrated that the ratio of the carpal tunnel contents (CTC) to carpal tunnel volume (CTV) provides information regarding the relative free space in the carpal tunnel as c...

We retrospectively reviewed the results of primary total elbow arthroplasty for the treatment of an acute fracture of the distal aspect of the humerus in twenty consecutive patients (twenty-one elbows) who had a mean age of seventy-two years (range, forty-eight to ninety-two years) at the time of the injury. The patients were managed between Novemb...

Sixty-four consecutive biaxial total wrist arthroplasties performed in 52 patients between March 1983 and June 1988 were reviewed. Fifty-seven cases involving 45 patients were followed for a minimum of 5 years or until failure. Of the remaining 7 patients, 6 had died and 1 was lost to follow-up study. For the 46 intact implants in living patients,...

Revision total-wrist arthroplasty has a high incidence of complications. Loosening is a significant problem for the distal implant. Because of the high failure rate of single-pronged distal implants after revision total-wrist arthroplasty, a custom multipronged distal component (biaxial total-wrist implant) was designed for use in patients with def...

The boundaries of the space through which the ulnar neurovascular bundle crosses the wrist have been reinvestigated. Using gross dissections, transverse and sagittal sections, and histologic study, we determined that the roof of Guyon's canal, the "carpal ulnar neurovascular space," does not directly connect to the hamate bone, as is currently acce...

Although primary carpal tunnel release is usually successful, reoperation is needed in up to 3% of patients. Common indications of reoperation are previous incomplete surgery and postoperative fibrosis. Although most patients improve after reoperation, persistent systems are likely and failure is more frequent than after primary carpal tunnel surge...

One hundred thirty-one patients with reoperation for carpal tunnel syndrome were followed for a mean of 11 years. Reoperation failed in 15 patients, necessitating a third operation. Satisfaction, symptom severity, and functional status scores were assessed with a standardized questionnaire in the other 116 patients. Patients with normal findings on...

Arthrodesis is a reliable and predictable method of treating patients with symptomatic radiocarpal joint destructionand should be recommended in most cases. However, some patients are not able to compensate for the lack of wrist mobility associated with wrist fusion because of multiple joint arthroses as are commonly seen in patients with rheumatoi...

A cadaveric study was undertaken to investigate the effect of tool size and lumbrical muscle incursion on carpal tunnel pressure during active grip. Active grip was simulated by securing the specimens on an apparatus and loading each of the eight finger flexor tendons with 1 kg each. Carpal tunnel pressures were measured with and without 1- and 2-i...

Although an acetabular component with an elevated rim is thought to improve the postoperative stability of a total hip prosthesis, the actual clinical value has not yet been demonstrated. To address this question, we reviewed the results of 5167 total hip arthroplasties that had been performed at our institution from April 1, 1985, through December...

Although an acetabular component with an elevated rim is thought to improve the postoperative stability of a total hip prosthesis, the actual clinical value has not yet been demonstrated. To address this question, we reviewed the results of 5167 total hip arthroplasties that had been performed at our institution from April 1, 1985, through December...

A modified approach to endoscopic carpal tunnel release has been developed and tested in 60 cadaveric specimens by three surgeons using the Agee endoscopic carpal tunnel release system. The modified approach, which includes specific localization of the hook of the hamate, flexor retinaculum, and the superficial palmar arch utilizing topographical l...

Change in carpal tunnel pressures that result from externally applied forces to the palm of the hand were assessed in five cadaveric specimens. MIKRO-TIP transducers were percutaneously placed into the carpal tunnel at the level of the hook of the hamate. A 1 kg force was applied to the palm of the hand in 16 separate locations. Significant elevati...

Lumbrical muscle incursion within the carpal tunnel has been implicated as a possible cause of carpal tunnel syndrome. During finger flexion, surgeons have observed the presence of lumbrical muscles in the carpal tunnel. However, the significance of this incursion has not been evaluated. To evaluate the effect of lumbrical muscle incursion within t...

Although carpal tunnel pressures have been observed to increase as a result of repetitive flexion and extension of the wrist, and forearm compartment pressures have been shown to rise during and after muscle activity, the relationship between those two observations has not been studied. The flexor compartments of five cadavers were perfused with sa...

Patients with persistent instability after experiencing posterior dislocation of the ulnohumeral joint associated with large unstable fractures of the coronoid process of the ulna can be challenging to manage. To date, no reports have documented an effective treatment program for this injury. Joint stiffness or persistent instability results in mos...

Carpal tunnel syndrome is one of the many so-called cumulative trauma disorders thought by some to be related to the performance of repetitive tasks in the work-place. The cause of this disorder is unknown. We have observed lumbrical muscle incursion into the carpal tunnel during finger flexion. This study was conducted to determine the amount of t...

We treated three patients with malunion after comminuted intercondylar fractures of the humerus by intra-articular derotational opening-wedge osteotomy and the insertion of a tricortical iliac bone graft. Two patients required additional operations, including interposition arthroplasty and hardware removal. A mean arc of increased motion of 65 degr...

Endoscopic carpal tunnel release has been shown in recent studies to result in a significant number of incomplete releases of the distal aspect of the flexor retinaculum. The significance of this complication is unknown. To address this question, we measured the amount of carpal arch widening after incomplete and complete release. The mean amount o...

The boundaries of Guyon's canal have recently been redefined by a series of anatomical dissections. These showed that the confines of this space do not extend from the pisiform to the hook of the hamate, as currently accepted. The fascial roof extends radial to the hook of the hamate, which allows the ulnar neurovascular bundle to course radial to...

The relative risk of nonunion in smokers versus nonsmokers after ankle arthrodesis was determined in a case control study. Twenty-two patients were matched to 22 controls by age, sex, surgeon, surgical technique, and preoperative diagnosis. Information on duration, amount, and past history of smoking was obtained for these 44 patients. Ten of the p...

For an accurate definition of the anatomic limits of the carpal tunnel, 26 cadaver upper extremities were studied by gross (10), histologic (3), and radiographic (13) methods. The mean proximal limit of the central portion of the flexor retinaculum was 11 mm distal to the capitate-lunate joint, and the mean distal limit of the distal portion was 10...

The relationship of topographical landmarks to the deep structures of the wrist and hand has not been clearly defined and would be of benefit to surgeons performing endoscopic carpal tunnel surgery. To this end, 10 fresh cadaveric wrist specimens had radiopaque markers placed adjacent to key anatomic structures within the wrist and hand. A new tech...

Magnetic resonance imaging (MRI) was used to determine cross-sectional areas and volumes of carpal canals and carpal canal contents in five cadaver specimens in an assessment of the reliability of MRI for establishing contents/canal ratios. Volumes of the carpal canals and their contents were accurately calculated from MRI with a previously describ...

Previously, patients with carpal tunnel syndrome have exhibited an elevated carpal tunnel pressure compared with that of control subjects. The etiology and maintenance of this pressure remains controversial, however. Both the open- and closed-compartment theories have their own advocates, although the closed-compartment theory has no apparent anato...

This article introduces a technique of tendon repair using large-gauge dacron core sutures placed by a suture-assist device. Tensile strengths of the repair on preserved human tendons averaged 44.1 Newtons, compared with 29.8 Newtons for repairs with a modified Kessler technique. The technique shows promise as an alternative method for flexor tendo...

An 80-year-old man had acute pancreatitis during the fourth week of antibiotic therapy for enterococcal endocarditis and 12 days after initiation of ketoprofen therapy for osteoarthritis of the hip. Pancreatitis resolved after discontinuance of ketoprofen therapy and while continuing antibiotic therapy for endocarditis. Common causes of pancreatiti...

Dietary advice based on saturated versus unsaturated fatty acids for the purpose of controlling the plasma cholesterol level has for many years plagued the American public with unpalatable diets that are difficult to adhere to. Stearic acid, an 18-carbon saturated fatty acid, does not share the hypercholesterolemic effect of other saturated fatty a...

This paper describes a unique procedure utilized on seven occasions to restore thumb function in amputation at or near the level of the interphalangeal joint. Consisting of two phases, the procedure adds approximately 2.5 cm of functional length to the thumb. The metacarpal bone is lengthened approximately 1.5 cm by a bone-lengthening device, and a...

Includes copies of 8 publications. Thesis (M.S.) -- Biomedical Sciences--Orthopedics -- Mayo Graduate School, 1996. Includes bibliographical references (leaves 30-35).