Bilateral STT Arthrodesis in a Young Patient with Occult Proximal Row Coalition

2021 ◽  
Author(s):  
Rupert M.H. Wharton ◽  
David Ahearne
Keyword(s):  
Literature Review ◽  
Clinical Relevance ◽  
Degenerative Change ◽  
Case Description ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
African Populations ◽  
Carpal Coalition ◽  
Clinical Problems ◽  
Stt Arthrodesis

Abstract Background Carpal coalitions have an incidence of 0.1 to 1% in Caucasians and up to 8 to 9% in African populations. They rarely cause clinical problems requiring investigation or treatment, but are commonly identified on imaging obtained for other indications. Case Description We report a case of a 35-year-old male with progressive degenerative change of incomplete coalitions of the scaphotrapeziotrapezoid joint (STT) in the presence of bilateral complete osseous lunate–triquetral coalitions (Minnaar type 4). He was successfully treated with staged bilateral arthrodesis with excellent symptom resolution and preservation of function. Literature Review In patients with isolated STT coalition six reports of surgery exist, two of which were for arthrodesis. This is the first described case of STT arthrodesis in a patient with coexistent lunate–triquetral coalition. Clinical Relevance The STT arthrodesis remains a safe and effective treatment for STT pain even in cases of occult carpal coalition. Functional range of movement was well preserved. Level of evidence This is a Level V study.

scholarly journals The Suction Test: A Novel Technique to Identify and Verify Successful Repair of Peripheral Triangular Fibrocartilage Complex Tears

2017 ◽  
Vol 06 (04) ◽  
pp. 334-335 ◽  
Author(s):  
Ryan Greene ◽  
Sanjeev Kakar
Keyword(s):  
Literature Review ◽  
Clinical Relevance ◽  
Triangular Fibrocartilage Complex ◽  
Case Description ◽  
Arthroscopic Technique ◽  
Novel Technique ◽  
Triangular Fibrocartilage ◽  
The Subject ◽  
Successful Repair

Background The diagnoses of peripheral triangular fibrocartilage complex (TFCC) tears continue to be the subject of numerous investigations. Case Description We describe a novel arthroscopic technique that may be used as an adjunct with other arthroscopic maneuvers to diagnose and confirm repair of peripheral sided TFCC injuries. Literature Review The hook and trampoline tests are intraoperative techniques to diagnose TFCC tears. Clinical Relevance The suction test provides a means to detect peripheral tears and to confirm restoration of its tension post repair.

scholarly journals Flexor Pollicis Longus Rupture in a Scaphoid Nonunion: A Case Report

2020 ◽  
Vol 09 (04) ◽  
pp. 357-361
Author(s):  
Bruno E. Crepaldi ◽  
Courtney Andrijich ◽  
Jeff Ecker
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Surgical Management ◽  
Clinical Relevance ◽  
Tendon Rupture ◽  
Rare Complication ◽  
Case Description ◽  
Scaphoid Nonunion ◽  
Flexor Pollicis Longus ◽  
Capsule Repair

Abstract Background Flexor pollicis longus (FPL) tendon rupture is a rare complication of scaphoid nonunion. Case Description A fit active 70-year-old woman ruptured her FPL when it abraded on a painless 50-year-old scaphoid nonunion. She had asymptomatic scaphoid nonunion advanced collapse (SNAC) arthritis. At surgery, the sharp mobile volar scaphoid osteophytes were excised and the volar wrist capsule was repaired. A vascularized fat flap based on a perforator of the radial artery was used to augment the volar wrist capsule repair and to create a smooth gliding surface for the FPL. The ruptured FPL tendon was reconstructed with a palmaris longus graft. Literature Review Complete rupture of the FPL tendon secondary to scaphoid nonunion is a rare complication. It can be easily misdiagnosed because the original injury may be unrecognized or forgotten. A consensus regarding the optimal surgical management has not been reached. Clinical Relevance The objective of surgery in this case was to restore FPL function and prevent a recurrent rupture. The asymptomatic SNAC arthritis was not treated. No further wrist surgery was required. The patient was asymptomatic with a functioning FPL tendon 4 years after surgery.

scholarly journals Arthroscopic Resection of Wrist Scaphotrapeziotrapezoidal (STT) Joint Ganglia

2020 ◽  
Vol 09 (05) ◽  
pp. 440-445
Author(s):  
Ho Lam Chai ◽  
Cabello Álvaro Pérez ◽  
Wai Ping Fiona Yu ◽  
Pak Cheong Ho
Keyword(s):  
Literature Review ◽  
Local Anesthesia ◽  
Gold Standard ◽  
Clinical Relevance ◽  
Case Description ◽  
Portal Site ◽  
The Past

Abstract Background Volar wrist ganglion is the second most common wrist mass and accounts for 20% of all cases. Surgery is the gold standard for persistent and symptomatic ganglia. Arthroscopic resection has gained popularity in the past two decades. Application of this technique to ganglia in less accessible locations, such as the scaphotrapeziotrapezoidal (STT) joint, however, remains controversial. Case Description To date, no literature has described using the STT -ulnar (STT-u) and STT -radial (STT-r) joint portals for ganglionic resection. Literature Review In this report, two cases of arthroscopic ganglionic resection utilizing the STT-u and STT-r joint portals at our institution were described. Clinical Relevance Arthroscopic resection of STT joint ganglion under portal site local anesthesia is a technically feasible, safe, and effective approach. There was no recurrence observed for both cases at 50 months of follow-up.

scholarly journals Arthroscopic Bone Grafting and Arthrodesis of Partial Lunotriquetral Coalition

2020 ◽  
Vol 9 (06) ◽  
pp. 523-527
Author(s):  
Brahman S. Sivakumar ◽  
Nicholas C. Smith
Keyword(s):  
Literature Review ◽  
Bone Graft ◽  
Bone Grafting ◽  
Degenerative Changes ◽  
Arthroscopic Debridement ◽  
Case Description ◽  
Prior Report ◽  
Fusion Site ◽  
Carpal Coalition

Abstract Background Lunotriquetal coalition is the most common carpal coalition that can be symptomatic if trauma disrupts the syndesmosis or synchondrosis or if degenerative changes develop between the abnormal articulating surfaces. Case Description A 15-year-old boy presented with a symptomatic lunotriquetral coalition after a fall 2 years prior. Following appropriate investigation, he was managed via arthroscopic debridement, bone grafting, and lunotriquetral arthrodesis. Literature Review The majority of symptomatic lunotriquetral coalitions have been managed with open arthrodesis. There is only one prior report of arthroscopic arthrodesis of this articulation that did not utilize bone graft. Relevance This report details the procedure to allow arthroscopic lunotriquetral arthrodesis with bone grafting, conveying osteogenic properties, and encouraging incorporation at the fusion site while maintaining the dorsal ligaments.

Features of redox homeostasis in patients with liver cirrhosis (literature review and clinical case description)

2020 ◽  
Vol 26 (1) ◽  
pp. 70-86
Author(s):  
M.O. Abrahamovych ◽  
◽  
O.O. Abrahamovych ◽  
O.P. Fayura ◽  
L.R. Fayura ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Literature Review ◽  
Clinical Case ◽  
Redox Homeostasis ◽  
Case Description

scholarly journals Morphological Changes of the Hip Commonly Associated With Femoroacetabular Impingement Are Not Correlated With Rotational Range of Hip Motion in Elite Soccer Athletes

2021 ◽  
pp. 194173812097366
Author(s):  
André Orlandi Bento ◽  
Guilherme Falótico ◽  
Keelan Enseki ◽  
Ronaldo Alves Cunha ◽  
Benno Ejnisman ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Lower Limb ◽  
Clinical Relevance ◽  
Morphological Changes ◽  
Alpha Angle ◽  
Soccer Players ◽  
Level Of Evidence ◽  
Rotational Movement ◽  
Professional Soccer ◽  
Significant Difference

Background: Morphological changes characteristic of femoroacetabular impingement (FAI) are common in soccer players. However, the clinical relevance of such anatomical variations is still not well-defined. Hypothesis: We hypothesized that high alpha angle values and/or acetabular retroversion index (ARI) are correlated with rotational range of motion (ROM) of the hip and that there are clinical-radiological diferences between the dominant lower limb (DLL) and nondominant lower limb (NDLL) in professional soccer players. Study Design: Cross-sectional. Level of Evidence: Level 3. Methods: A total of 59 male professional soccer players (average age 25.5 years, range 18-38 years) were evaluated in the preseason. As main outcome measures, we evaluated the alpha angle and the ARI and hip IR and ER ROM with radiographic analysis. Results: The measurements taken on DLL and NDLL were compared and a significant difference was found between the sides in the ER ( P = 0.027), where the DLL measures were 1.54° (95% CI, 0.18-2.89) greater than the NDLL. There were no significant differences between the sides in the measures of IR ( P > 0.99), total ROM ( P = 0.07), alpha angle ( P = 0.250), and ARI ( P = 0.079). The correlations between the rotation measurements and the alpha angle in each limb were evaluated and the coefficient values showed no correlation; so also between the ARI and rotation measures. Conclusion: Morphological changes of the femur or acetabulum are not correlated with hip IR and ER ROM in male professional soccer players. ER on the dominant side was greater than on the nondominant side. There was no significant difference in the other measurements between sides. Clinical Relevance: In clinical practice, it is common to attribute loss of hip rotational movement to the presence of FAI. This study shows that anatomical FAI may not have a very strong influence on available hip rotational movement in professional soccer athletes.

scholarly journals Bone Morphogenetic Protein in Scaphoid Nonunion: A Systematic Review

2021 ◽  
Author(s):  
Michael M. Polmear ◽  
Ashley B. Anderson ◽  
Paul J. Lanier ◽  
Justin D. Orr ◽  
Leon J. Nesti ◽  
...  
Keyword(s):  
Literature Review ◽  
Bone Morphogenetic Protein ◽  
Controlled Trial ◽  
Scaphoid Nonunion ◽  
Journal Articles ◽  
Level Of Evidence ◽  
Carpal Collapse ◽  
Morphogenetic Protein ◽  
Combination Of Methods

Abstract Background Scaphoid nonunion can lead to carpal collapse and osteoarthritis, a painfully debilitating problem. Bone morphogenetic protein (BMP) has been successfully implemented to augment bone healing in other circumstances, but its use in scaphoid nonunion has yielded conflicting results. Case Description The purpose of this study is to assess the outcomes and complications of scaphoid nonunion treated surgically with BMP. Literature Review A literature review of all available journal articles citing the use of BMP in scaphoid nonunion surgery from 2002 to 2019 was conducted. We included studies that used BMP as an adjunct to surgical treatment for scaphoid nonunions in both the primary and revision settings with computed tomography determination of union. Demographic information, dose of BMP, tobacco use, outcomes, and complications were recorded. A total of 21 cases were included from four different studies meeting inclusion criteria. Clinical Relevance The union rates were 90.5% overall, 100% for primary surgeries, and 77.8% for revision surgeries. Five patients (24%) experienced 11 complications, including four cases (19%) of heterotrophic ossification. Use of BMP in scaphoid nonunion surgery resulted in a 90.5% overall union rate but was also associated with complications such as heterotopic ossification. All included studies used BMP to augment bone graft, screw or wire fixation, or a combination of methods. The efficacy of BMP in scaphoid nonunion is unclear, and a sufficiently powered, randomized controlled trial is needed to determine optimal fixation methods, dosing, and morbidity of the use of BMP. Level of Evidence This is a Level IC, therapeutic interventional study.

scholarly journals Digital Storytelling in Older Adults With Typical Aging, and With Mild Cognitive Impairment or Dementia: A Systematic Literature Review

2021 ◽  
pp. 073346482110154
Author(s):  
Adriana Maria Rios Rincon ◽  
Antonio Miguel Cruz ◽  
Christine Daum ◽  
Noelannah Neubauer ◽  
Aidan Comeau ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Digital Storytelling ◽  
Level Of Evidence ◽  
Form Of Life ◽  
Self Confidence ◽  
Care Partners

The rates of dementia are on the rise as populations age. Storytelling is commonly used in therapies for persons living with dementia and can be in the form of life review, and reminiscence therapy. A systematic literature review was conducted to examine the range and extent of the use of digital technologies for facilitating storytelling in older adults and their care partners, and to identify the processes and methods, the technologies used and their readiness levels, the evidence, and the associated outcomes. Eight electronic databases were searched: Medline, EMBASE, PsycINFO, CINAHL, Abstracts in Social Gerontology, ERIC, Web of Science, and Scopus. We included 34 studies. Mild cognitive impairment or dementia represented over half of medical conditions reported in the studies. Overall, our findings indicate that the most common use of digital storytelling was to support older adults’ memory, reminiscence, identity, and self-confidence; however, the level of evidence of its effectiveness was low.

The non-operative management of bony mallet injuries

2021 ◽  
pp. 175319342199298
Author(s):  
Ryan W. Trickett ◽  
James Brock ◽  
David J. Shewring
Keyword(s):  
Fragment Size ◽  
Visual Analogue Score ◽  
Operative Management ◽  
Clinical Results ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Custom Made ◽  
Evaluation Measure ◽  
Non Operative Management ◽  
Extensor Lag

Over a 4-year period, 218 mallet fractures in 211 adult patients were treated using a custom-made thermoplastic splint. Clinical results were collected prospectively, including the visual analogue score for pain, the range of motion and extensor lag, and the Patient Evaluation Measure (PEM). The joints were congruent in 168 and subluxed in 50. There were no differences in range of movement, extensor lag or PEM associated with articular subluxation or the size of the articular fragment. Pre-existing joint degeneration did not influence outcome. Non-surgical treatment demonstrates predictably good outcomes regardless of fragment size or subluxation in most patients and should be considered when discussing treatment for patients with bony mallet fractures. Level of evidence: III

scholarly journals Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review

2018 ◽  
Vol 53 (4) ◽  
pp. 251-262 ◽  
Author(s):  
Dimitris Challoumas ◽  
Paul D Kirwan ◽  
Dmytro Borysov ◽  
Christopher Clifford ◽  
Michael McLean ◽  
...  
Keyword(s):  
Systematic Review ◽  
Glyceryl Trinitrate ◽  
Strong Evidence ◽  
Evidence Synthesis ◽  
Clinical Effects ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Moderate Evidence ◽  
Best Evidence Synthesis ◽  
Topical Glyceryl Trinitrate

ObjectiveTo produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies.DesignA systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy.Data sourcesMEDLINE, Embase, Scopus and CINAHL from database inception to January 2018.MethodsWe examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulderet al.ResultsA total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. For all tendinopathies, improvements in pain were significant when comparing GTN versus placebo in the short term (<8 weeks; poor evidence). Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following: patient satisfaction (strong evidence); chances of being asymptomatic with activities of daily living (strong evidence); range of movement (moderate evidence); strength (moderate evidence); pain (at night and with activity; poor evidence) and local tenderness (poor evidence). Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo (moderate evidence).Conclusions and relevanceTreatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions.

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