1/38. Communicating defects of the triangular fibrocartilage complex without disruption of the triangular fibrocartilage: a report of two cases.Perforations or communicating defects of the triangular fibrocartilage complex have been more commonly identified after Palmer published his classification system (J hand Surg 1989;14A:594-606). To his variants of class 1B (traumatic) ulnar avulsion with or without distal ulnar fracture, a third category may be added: defects of the ulnar collateral ligament without any associated disruption of the triangular fibrocartilage. The ulnar collateral ligament can be defined as an ulnar capsular structure between the more discrete elements of the triangular fibrocartilage and the ulnar ligaments, with the defect or perforation being distal to the intact triangular fibrocartilage and exiting into the floor of the extensor carpi ulnaris sheath. We present 2 cases that illustrate the diagnosis, the use of both magnetic resonance imaging and arthrography to confirm the diagnosis, the associated dorsal ulnar cutaneous nerve pain distribution, and the open direct and retinacular flap repair.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/38. Complete avulsion of the distal posterior interosseous nerve during wrist arthroscopy: a possible cause of persistent pain after arthroscopy.A case of avulsion of the distal posterior interosseous nerve during wrist arthroscopy is presented. Surgeons unaware of this entity may attribute persistent middorsal wrist pain to the underlying disease rather than to iatrogenic damage to the distal posterior interosseous nerve.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
3/38. Superficial radial neuropathy following venepuncture.A 42-year-old female suffered excruciating pain and paraesthesia on venepuncture of the cephalic vein in her left wrist. The left superficial radial nerve was injured. A flexed wrist during venepuncture renders the superficial radial nerve immobile and vulnerable to being punctured by the needle. To reduce the risk of nerve injury during venepuncture, the phlebotomist should choose a large and visible vein and insert the needle at a 5-15 degrees angle with the skin. The wrist should be selected only if the veins in the antecubital area are deemed unsuitable. The feeling of an electric shock along the distribution of the nerve, or rupture of the vein during venepuncture, should alert the phlebotomist to the possibility of nerve injury and the procedure should be stopped immediately.- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
4/38. Ulnar bursa distention following volar subluxation of the distal radioulnar joint after distal radial fracture: a rare cause of carpal tunnel syndrome.This report describes an eighty-four-year-old woman with persistent carpal tunnel syndrome attributable to an ulnar bursa distention associated with the subluxation of the distal radioulnar joint after distal radial fracture. During surgery, when the forearm was placed in supination, the ulna head with a sharp osteophyte was found to be displaced into the carpal tunnel through a defect of the ruptured capsule of the wrist joint. This volar subluxation of the ulnar head had caused distention of the ulnar bursa, causing compression of the median nerve, which resulted in carpal tunnel syndrome. In addition to reduce displaced fractured segment to obtain anatomic articular surface, original radial length and tilt, the anatomic restoration of the distal radioulnar joint is essential to maintain better long-term function after fracture of the distal radius.- - - - - - - - - - ranking = 272.83356699649keywords = median nerve, median, nerve (Clic here for more details about this article) |
5/38. Primary and secondary microvascular reconstruction of the upper extremity.Tissue defects of the upper extremity may result from trauma, tumor resection, infection, and congenital malformation. Restoration of anatomy and functional integrity may require microsurgical free flap transfer for coverage of bones, nerves, blood vessels, or tendons. Microsurgical tissue transfer also may be required prior to secondary reconstruction, such as tendon transfers or nerve or bone grafts. This article addresses indications for upper extremity reconstruction using microsurgical tissue transfer flap selection and strategies including primary and secondary reconstruction.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
6/38. Current treatment of ganglion of the wrist.Ganglion of the wrist is one of the the most common lesions of the hand. The cause of pain in an occult dorsal wrist ganglion has been linked to compression of the posterior interosseous nerve at the wrist. A case is presented in this paper and the pathoanatomy discussed. Ultrasound-guided aspiration after hyaluronidase instillation provided a useful alternative to surgery with a high success rate. Arthroscopic decompression for dorsal and palmar wrist ganglia offered the patient the benefit of smaller surgical scars and a high success rate. A description of the surgical techniques, pathoanatomy, and early results of the authors and a review of the literature is presented.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/38. Electrophysiologic findings in two patients with digital neuropathy of the thumb.Repetitive trauma to a finger can result in compressive neuropathy of one or more digital nerves. The thumb is commonly affected in bowlers, hence the term "bowler's thumb". However, this condition can involve other fingers and non-bowlers. To our knowledge, none of the cases reported had undergone neurophysiologic testing. We describe the neurophysiologic findings in two patients who had a history consistent with digital neuropathy of the thumb.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
8/38. Wrist arthroscopy through a volar radial portal.PURPOSE: To quantitatively describe the neurovascular relationships of a volar radial wrist arthroscopy portal and to evaluate whether volar wrist arthroscopy identified additional pathology of the dorsal capsular structures and the palmar region of the scapholunate interosseous ligament that was not seen through the dorsal portals. TYPE OF STUDY: This study was an anatomic study and retrospective chart review. methods: cadaver dissections established the neurovascular anatomy of the volar radial portal. Measurements were taken from the portal to the radial artery and its superficial palmar branch; the superficial radial nerve, the median nerve, and its palmar cutaneous branch; and the pronator quadratus. A dorsal capsulotomy was performed to assess the ligamentous interval. A chart review of 30 patients in whom a volar radial portal was used was performed. Intraoperative pathology identified through volar wrist arthroscopy that was not visible through a dorsal portal was recorded. Postoperative neurovascular complications were noted. RESULTS: There was a greater than 3 mm safe zone surrounding the portal that was free of any neurovascular structures. There were no complications from the use of the portal. Additional pathology that was not visible from a dorsal portal was identified in 10 cases. This included 1 case of hypertrophic synovitis of the dorsal capsule, 1 patient with an avulsion of the radioscapholunate ligament, 1 patient with a tear restricted to the palmar region of the scapholunate interosseous ligament, and 7 patients with tears of the dorsal radiocarpal ligament. CONCLUSIONS: This study provides a safe, standardized approach to the volar radial aspects of the radiocarpal and midcarpal joints. Volar wrist arthroscopy identified additional pathology of the palmar scapholunate interosseous ligament and dorsal capsular structures in 30% of the patients. The volar radial portal should be considered for inclusion in the arthroscopic examination of any patient with radial-sided wrist pain.- - - - - - - - - - ranking = 273.83356699649keywords = median nerve, median, nerve (Clic here for more details about this article) |
9/38. Recurrent neuroma formation after lateral arm free flap coverage with neurorraphy to the posteroantebrachial nerve.We report a patient with previous wrist trauma and development of a symptomatic neuroma of the palmar cutaneous branch of the median nerve. The patient had previously been successfully treated with lateral arm free flap coverage with neurorrhaphy to a segment of the posteroantebrachial cutaneous nerve carried with the flap. Two years following this procedure the patient experienced re-onset of symptoms prompting surgical exploration of the area. At the time of operation a recurrent neuroma was found at the free distal terminus of the transferred posteroantebrachial cutaneous nerve. The neuroma was repositioned into the distal radius via a burr hole with relief of symptoms.- - - - - - - - - - ranking = 278.83356699649keywords = median nerve, median, nerve (Clic here for more details about this article) |
10/38. Dorsal wrist syndrome repair.Dorsal wrist pain with or without a palpable dorsal wrist ganglion is a common complaint. Watson developed the concept of the dorsal wrist syndrome (DWS) which is an entity encompassing pre-dynamic rotary subluxation of the scaphoid and the overloaded wrist. We reviewed 20 cases of DWS treated surgically. There were nine males (11 wrists) and nine females (nine wrists). Post-operative follow-up ranged from five to 67 months (mean, 37 months). At operation, we observed SLL tears in eight wrists and dorsal ganglia in 12 cases. Following surgery, 12 cases reported being pain free, five had mild pain, two moderate pain and one case reported severe pain. Post-operative extension/flexion was 73/70 average. Post-operative grip strength was 28 kg average. We believe that excision of the posterior interosseous nerve and the dorsal capsule including the ganglion, if present, provides pain relief in DWS.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
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