The Accuracy of Common Hand Injections With and Without Ultrasound: An Anatomical Study

Background: The aim of the study is to determine the accuracy of hand injections with and without the aid of ultrasound (U/S) into the carpal tunnel, thumb carpometacarpal (CMC) joint, first dorsal compartment (DC) and the radiocarpal (RC) joint. Methods: Four participants of various level of experience injected the carpal tunnel, thumb CMC, first DC, and RC joint into 40 fresh frozen cadaver specimens with blue dye and radiographic contrast. Participants 1 and 2 were injected without U/S guidance, and participants 3 and 4 were injected with U/S guidance. A successful injection was determined by both fluoroscopy and dissection/direct observation. Additional information was recorded for each injection such as median nerve infiltration and evidence of thumb CMC arthrosis. Results: The overall accuracy for carpal tunnel, thumb CMC, first DC, and RC injections were 95%, 63%, 90%, and 90%, respectively. Success was compared with and without U/S guidance. Success rates were similar for each injection site, except the thumb CMC joint, where U/S participants had 25% higher accuracy. In the setting of thumb CMC arthrosis, the incidence of success was 38% for participants with no U/S aid and 72% for participants with U/S aid. There was a significant difference between participants who used U/S with the participant with more U/S experience being more successful. Conclusion: Carpal tunnel, first DC, and RC injections had an accuracy of greater than 90%. Thumb CMC injections have a lower accuracy (63%) and one can improve accuracy with U/S. The accuracy of U/S-guided injections is dependent on the user and their experience.

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The Effect of an Open Carpal Tunnel Release on Thumb CMC Biomechanics

Advances in Orthopedics ◽

10.1155/2012/151348 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Marc A. Tanner ◽

Bryan P. Conrad ◽

Paul C. Dell ◽

Thomas W. Wright

Keyword(s):

Carpal Tunnel ◽

Soft Tissues ◽

Carpal Tunnel Release ◽

Transverse Carpal Ligament ◽

Before And After ◽

Fresh Frozen ◽

Rigid Body Mechanics ◽

Thumb Carpometacarpal ◽

Open Carpal Tunnel Release ◽

Cmc Joint

Purpose. We have observed worsening thumb pain following carpal tunnel release (CTR) in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal (CMC) biomechanics.Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130 N. We measured 3D translation and rotation of the trapezium, radius, and first metacarpal, before and after open CTR. Motion between radius and first metacarpal, radius and trapezium, and first metacarpal and trapezium during loading was calculated using rigid body mechanics. Overall stiffness of each specimen was determined.Results. Total construct stiffness following CTR was reduced in all specimens but not significantly. No significant changes were found in adduction, pronation, or dorsiflexion of the trapezium with respect to radius after open CTR. Motion between radius and first metacarpal, between radius and trapezium, or between first metacarpal and trapezium after open CTR was not decreased significantly.Conclusion. From this data, we cannot determine if releasing the transverse carpal ligament alters kinematics of the CMC joint.

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Thumb Carpometacarpal Arthroplasty with Dynamic Suspension Sling Using Extensor Carpi Radialis Tendon

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500450 ◽

2019 ◽

Vol 24 (03) ◽

pp. 353-358

Author(s):

Takehiko Takagi ◽

Yuka Kobayashi ◽

Masahiko Watanabe

Keyword(s):

Insertion Site ◽

Dorsal Side ◽

Pinch Strength ◽

Reconstruction Method ◽

Dash Score ◽

Post Surgery ◽

Significant Difference ◽

Thumb Carpometacarpal ◽

Extensor Carpi Radialis ◽

Cmc Joint

Background: Despite various treatment methods, complications are reported with ligament reconstruction for thumb carpometacarpal (CMC) arthropathy, such as proximal migration, dorsal subluxation of the first metacarpal base, and hyperextension of the first CMC joint. The flexor carpi radialis (FCR) tendon is, in some cases, too thin to maintain suspension on the first metacarpophalangeal (MCP) joint. We used one-half of the extensor carpi radialis longus (ECRL) tendon instead of the FCR tendon, and compared this method with conventional reconstruction using the FCR tendon. Methods: The procedures were performed during 12 thumb CMC arthropathies. One-half of the ECRL tendon was passed and then wrapped around the intact FCR tendon several times for 6 cases (ECRL group). One-half of the FCR tendon was passed for 6 cases (FCR group). On radiography, we compared the thumb to index finger metacarpal angle (M1M2) and the first MCP angle (P1M1) between groups. Grip strength, pinch strength, and DASH score were also evaluated up to 2 years post-surgery. Results: In the ECRL group, M1M2 and P1M1 1 year post-surgery showed significant improvements compared to those before surgery; they showed no significant difference in the FCR group, although they achieved a peak at 3 months post-surgery in both groups. Both groups showed improvements in other parameters from 3 months to 1 year post-surgery. Conclusions: Postoperative progression of hyperextension of the first CMC joint was significantly reduced in the ECRL group. The ECRL tendon is thicker than the FCR tendon. In addition, the insertion site of the ECRL tendon is at the dorsal side of the second metacarpal, and the tendon can extend from the dorsal side to the volar side to stabilize the first metacarpal. Thumb CMC arthroplasty using one-half of the ECRL tendon is a useful reconstruction method.

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Proprioceptive Neuromuscular Facilitation Protocol for Thumb Osteoarthritis: A Pilot Study

Hand ◽

10.1177/1558944721990785 ◽

2021 ◽

pp. 155894472199078

Author(s):

Raquel Cantero-Tellez ◽

Nancy Naughton ◽

Lori A. Algar ◽

Ivan Medina-Porqueres ◽

Leire Cruz-Gambero ◽

...

Keyword(s):

Training Program ◽

Effect Size ◽

Standard Treatment ◽

Pinch Strength ◽

Control Group ◽

Significant Difference ◽

Proprioceptive Training ◽

Thumb Carpometacarpal ◽

Experimental Group ◽

Cmc Joint

Background Osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint often presents with joint instability and proprioceptive deficits. Proprioception has been found to play an important role in the rehabilitative process. The purpose of this study was to evaluate the effectiveness of a proprioceptive training program on pain and function in individuals with early-stage thumb Carpometacarpal joint OA. Methods A double-blind experimental trial using a 2-group pretest/posttest design was used in this pilot study. Participants had a diagnosis of grade I and II thumb CMC joint OA in their dominant hand and a pain rating of >4/10 on Visual Analogue Scale. Participants received either standard treatment (control group) or standard treatment plus a proprioceptive training program (experimental group). Outcome measures were lateral pinch strength, pain intensity during activities, and proprioceptive response via joint position sense (JPS) testing. Results Twelve individuals (average age of 66.25 years) participated. Both groups had a statistically significant decrease in pain and increase in lateral pinch strength, all occurring with a large effect size but no statistically significant difference between groups. The experimental group experienced a large effect size for JPS testing, whereas the control group experienced a trivial effect size, and there was a statistically significant difference between groups for JPS testing. Conclusions Individuals who completed the proprioceptive training program in this study had an improvement in proprioceptive functioning. This program shows potential for routine inclusion in hand therapy for thumb CMC joint OA; however, additional high-level studies with larger sample sizes are required.

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AN ANATOMICAL STUDY ON HILAR VARIATIONS AND MORPHOMETRIC DIMENSIONS OF HUMAN KIDNEYS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i9.543 ◽

2019 ◽

Vol 3 (9) ◽

Author(s):

Dr. Deepa Devadas ◽

Dr. Urmila Sinha ◽

Dr. G N Trivedi

Keyword(s):

Renal Artery ◽

Renal Vein ◽

Anatomical Study ◽

Modern Medicine ◽

Mean Values ◽

Surgical Interventions ◽

Additional Information ◽

Significant Difference ◽

The Mean ◽

Anterior Division

Variations in renal hilar arrangement patterns and morphometric dimensions are clinically relevant in this age of advancing modern medicine and minimally invasive surgery. The purpose of the present study is to record variations in renal hilar arrangement patterns and assess renal dimensions of length, width and thickness respectively. Hilar regions of fifty isolated embalmed kidneys were carefully dissected and variations observed were photographed and documented. Renal dimensions were measured with digital calipers and values obtained were tabulated and analysed. Normal anteroposterior hilar arrangement pattern was observed in 72% cases. Anterior and posterior divisions of renal artery were observed in 24% cases with anterior division being the most anteriorly placed structure in 14% cases. The renal pelvis was situated between the divisions of the renal artery in 8% cases. Prehilar segmental branches anterior to renal vein were observed in 4% cases. Other variations seen included extrahilar branches (4%), superior polar artery arising from anterior division of renal artery, prehilar tributaries of renal vein and an additional renal artery in 1 case each. The mean renal length was 9.35+/- 0.98 cm for right and 9.25 +/- 1.25 cm for left kidneys, mean renal width 4.93 +/- 0.65 cm for right and 4.95 +/- 0.5 cm for left kidneys and mean renal thickness 3.77 +/- 0.7 cm for right and 3.86 +/- 0.53 cm for left kidneys respectively. No statistically significant difference was observed in the mean values between right and left sides. The clinical implications of these findings have been discussed. The findings of this study may enhance the existing literature and contribute additional information for improving treatment outcomes during clinical and surgical interventions. Keywords: Variation, Hilum, Kidneys, Morphometry, Arrangement pattern, dimensions

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Intraoperative Detection of Efferent Lymphatic Vessels Emerging from Lymph Node during Lymphatic Microsurgery

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1677039 ◽

2019 ◽

Vol 35 (05) ◽

pp. 372-378

Author(s):

Shinsuke Akita ◽

Yoshihisa Yamaji ◽

Motone Kuriyama ◽

Hideki Tokumoto ◽

Tatsuya Ishigaki ◽

...

Keyword(s):

Early Stage ◽

Lymphatic Vessels ◽

Stage I ◽

Blue Dye ◽

Success Rates ◽

Optimal Method ◽

Patent Blue ◽

Intraoperative Detection ◽

Significant Difference ◽

Patent Blue Dye

Background Although the usefulness of efferent lymphaticovenular anastomosis (ELVA) in lymphatic microsurgery has been reported, the optimal method to distinguish efferent from afferent lymphatics is not yet established. We propose a novel technique to detect efferent lymphatics appropriate for anastomosis. Methods In total, 62 groin lymph nodes (LNs) of 46 limbs were divided into four groups based on the findings of indocyanine green lymphography: n = 15 in normal, 15 in dermal backflow stage 0, 18 in stage I, and 14 in stage II groups. The target LN and afferent lymphatic connecting it were preoperatively detected using ultrasonography. Intraoperatively, 0.05 mL patent blue dye was slowly manually injected from the afferent lymphatic; the lymphatic(s) subsequently stained was diagnosed as the efferent lymphatic(s) emerging from the node. The success rates of efferent lymphatic detection, sizes of LN, and diameter of efferent lymphatics were compared among the groups. Results Both LN size and diameter of efferent lymphatic were significantly larger in the stage 0 and I groups than the other groups (p < 0.01). Efferent lymphatic could be stained in 13, 13, 18, and 9 LNs in the normal and stage 0, I, and II groups, respectively. A significant difference was observed between the stage I and II groups regarding the success rate of efferent lymphatic detection (p = 0.04). Conclusion Efferent lymphatics could be detected using patent blue dye in 85.5% of the cases. The patients in early-stage lymphostasis might be the most appropriate candidates for ELVA.

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Effects of Previous Surgery on the Detection of Sentinel Nodes in Women With Vulvar Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31822dbe3c ◽

2011 ◽

Vol 21 (9) ◽

pp. 1679-1683 ◽

Cited By ~ 10

Author(s):

Tessa A. Ennik ◽

David G. Allen ◽

Ruud L.M. Bekkers ◽

Simon E. Hyde ◽

Peter T. Grant

Keyword(s):

Vulvar Cancer ◽

False Negative ◽

False Negative Rate ◽

Blue Dye ◽

Previous Surgery ◽

Detection Rates ◽

Reliable Technique ◽

Appearance Time ◽

Negative Rate ◽

Significant Difference

BackgroundThere is a growing interest to apply the sentinel node (SN) procedure in the treatment of vulvar cancer. Previous vulvar surgery might disrupt lymphatic patterns and thereby decrease SN detection rates, lengthen scintigraphic appearance time (SAT), and increase SN false-negative rate. The aims of this study were to evaluate the SN detection rates at the Mercy Hospital for Women in Melbourne and to investigate whether previous vulvar surgery affects SN detection rates, SAT, and SN false-negative rate.MethodsData on all patients with vulvar cancer who underwent an SN procedure (blue dye, technetium, or combined technique) from November 2000 to July 2010 were retrospectively collected.ResultsSixty-five SN procedures were performed. Overall detection rate was 94% per person and 80% per groin. Detection rates in the group of patients who underwent previous excision of the primary tumor were not lower compared with the group without previous surgery or with just an incisional biopsy. There was no statistical significant difference in SAT between the previous excision group and the other patients. None of the patients with a false-negative SN had undergone previous excision.ConclusionsResults indicate that previous excision of a primary vulvar malignancy does not decrease SN detection rates or increase SN false-negative rate. Therefore, the SN procedure appears to be a reliable technique in patients who have previously undergone vulvar surgery. Previous excision did not significantly lengthen SAT, but the sample size in this subgroup analysis was small.

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Analysing Touchscreen Gestures: A Study Based on Individuals with Down Syndrome Centred on Design for All

Sensors ◽

10.3390/s21041328 ◽

2021 ◽

Vol 21 (4) ◽

pp. 1328

Author(s):

Jorge Martin-Gutierrez ◽

Marta Sylvia Del Rio Guerra

Keyword(s):

Socioeconomic Status ◽

Down Syndrome ◽

Cognitive Impairments ◽

Pairwise Comparison ◽

Success Rates ◽

Touch Gestures ◽

Design For All ◽

Significant Difference ◽

Collateral Effect ◽

Completion Times

There has been a conscious shift towards developing increasingly inclusive applications. However, despite this fact, most research has focused on supporting those with visual or hearing impairments and less attention has been paid to cognitive impairments. The purpose of this study is to analyse touch gestures used for touchscreens and identify which gestures are suitable for individuals living with Down syndrome (DS) or other forms of physical or cognitive impairments. With this information, app developers can satisfy Design for All (DfA) requirements by selecting adequate gestures from existing lists of gesture sets. Twenty touch gestures were defined for this study and a sample group containing eighteen individuals with Down syndrome was used. A tool was developed to measure the performance of touch gestures and participants were asked to perform simple tasks that involved the repeated use of these twenty gestures. Three variables are analysed to establish whether they influence the success rates or completion times of gestures, as they could have a collateral effect on the skill with which gestures are performed. These variables are Gender, Type of Down syndrome, and Socioeconomic Status. Analysis reveals that significant difference is present when a pairwise comparison is performed, meaning individuals with DS cannot perform all gestures with the same ease. The variables Gender and Socioeconomic Status do not influence success rates or completion times, but Type of DS does.

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First Lumbrical Muscle Flap for Recurrence of Carpal Tunnel Syndrome: Anatomical Study and Surgical Technique

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1730391 ◽

2021 ◽

Vol 49 (01) ◽

pp. 079-087

Author(s):

Esther Fernández Tormos ◽

Fernando Corella Montoya ◽

Blanca Del Campo Cereceda ◽

Montserrat Ocampos Hernández ◽

Teresa Vázquez Osorio ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Revision Surgery ◽

Muscle Flap ◽

Anatomical Study ◽

Physical Barrier ◽

Adjacent Structures ◽

Tunnel Syndrome ◽

Lumbrical Muscle

AbstractRecurrence of carpal tunnel syndrome implies the reappearance of symptoms after release surgery. If the cause of recurrence is not an incomplete release, but a traction neuritis, the tendency is to add to the revision surgery of the carpal tunnel the use of flaps to cover the median nerve. These flaps establish a physical barrier between the nerve and the rest of the adjacent structures, preventing adhesions, and providing neovascularization and better nerve sliding.In the present work, we detail a revision surgery in which the first lumbrical muscle is used as a covering flap. This flap has two benefits. Firstly, it acts as a vascularized coverage for the median nerve (avoiding the formation of fibrosis and favoring its sliding); secondly, a structure that takes up space is removed from the carpal tunnel, thus reducing the pressure within it.Along with the explanation of the technique, the present article provides a detailed description of the anatomical variability of the first lumbrical muscle and its vascularization, as well as the results of a cadaveric study on the location of the vascular pedicle of the first lumbrical muscle.

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The effect of displacement of the esophagus by transoesophageal echocardiography probe in cryoablation of atiral fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0573 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Sun ◽

X.M Yin ◽

L.J Gao ◽

X.J Xiao ◽

X.H Yu ◽

...

Keyword(s):

Lower Risk ◽

Transoesophageal Echocardiography ◽

The Other ◽

Esophageal Injury ◽

Funding Source ◽

Success Rates ◽

Procedure Time ◽

Mechanical Displacement ◽

Significant Difference

Abstract Background Esophageal injury caused by cryoballoon-based PVI is common. Cryoablation guided by transoesophageal echocardiography (TEE) for occlusion of the pulmonary vein (PV) is safe and effective. Objective To investigate the protective effect of mechanical displacement of the esophagus by TEE probe in cryoablation of atiral fibrillation. Methods Fifty patients with paroxysmal AF (PAF) were enrolled in the present study. 25 patients underwent cryoablation without TEE (non-TEE group) and the other 25 underwent with TEE (TEE group) for PV occlusion guidance and displacement of the esophagus. In the TEE group during the procedure, TEE was used to guide the movement of the balloon to achieve PV occlusion. And before freezing, the probe of the TEE was moved to displace the esophagus away from the PV being freezed in order to reduce the risk of cryoinjury. All patients underwent esophagogastroscopy within 2 days of the procedure. The patients were followed up in our center at regularly scheduled visits every 2 months. Results There was no significant difference between the TEE group and non-TEE group in regard to the procedure time. The fluoroscopy time in the TEE group was less compared to the non-TEE group (4.1±3.3 min vs. 16.6±6.9 min, P<0.05), and the amount of contrast agent in the TEE group was less than the non-TEE group (4.7±5.7ml vs. 17.9±3.4 ml, P<0.05). The incidence of esophageal injury was significantly lower in TEE group compared with non-TEE group (0 vs. 20%, P<0.05). At a mean of 14.0 months follow-up, success rates were similar between the TEE group and non-TEE group (80.0% vs. 84.0%, P=0.80). Conclusion Cryoablation of AF with TEE for protecting the esophagus from cryoinjury is safe and effective. Lower risk of esophageal injury can be achieved with the help of TEE probe movement for mechanical displacement of the esophagus during freezing. Funding Acknowledgement Type of funding source: None

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CLINICAL OUTCOME AND COST COMPARISON OF CARPAL TUNNEL WOUND CLOSURE WITH MONOCRYL® AND ETHILON®: A PROSPECTIVE STUDY

Hand Surgery ◽

10.1142/s0218810413500226 ◽

2013 ◽

Vol 18 (02) ◽

pp. 189-192 ◽

Cited By ~ 1

Author(s):

Anis Dosani ◽

Sameer K. Khan ◽

Sheila Gray ◽

Steve Joseph ◽

Ian A. Whittaker

Keyword(s):

Carpal Tunnel ◽

Wound Closure ◽

Unit Cost ◽

Cost Effective ◽

Cost Comparison ◽

Absorbable Suture ◽

Significant Difference ◽

Group A ◽

Group B ◽

A Prospective Study

This prospective non-randomised two-cohort study compares the use of an absorbable suture (Poliglecrapone [Monocryl]: Group A) and a non-absorbable suture (Polyamide [Ethilon]: Group B) in wound closure after elective carpal tunnel decompression. The primary outcome was scar cosmesis as assessed by the Stonybrook Scar Evaluation Scale (SBSES); the financial cost of wound closure was compared as a secondary outocome. All fifty patients completed follow-up. At six weeks, there was no significant difference in the two groups regarding scar tenderness (p = 0.5), although residual swelling was more evident in the absorbable group (p = 0.2). The mean SBSES score at six weeks was 4.72 in Group A, and 4.8 in Group B (p = 0.3). The unit cost per closed wound of Monocryl was three times than Ethilon (p < 0.05). Ethilon is thus cost-effective without compromising the cosmetic outcome, and we recommend using this as the preferred suture for closure of carpal tunnel wounds.

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