scholarly journals Transbrachioradialis Approach to the Radial Tunnel: An Anatomic Study of 5 Potential Compression Sites

Hand ◽  
2018 ◽  
Vol 14 (3) ◽  
pp. 329-332 ◽  
Author(s):  
Jason R. Ummel ◽  
John G. Coury ◽  
Zachary C. Lum ◽  
Marc A. Trzeciak
Keyword(s):  
Single Incision ◽  
Anatomic Study ◽  
Muscle Belly ◽  
Surgical Access ◽  
Distal Edge ◽  
Fresh Frozen ◽  
Utilitarian Approach ◽  
Arcade Of Frohse ◽  
Tunnel Syndrome ◽  
Single Approach

Background: Recent anatomic studies have failed to demonstrate a single utilitarian approach to intraoperative identification and surgical release of all 5 potential sites of posterior interosseous nerve (PIN) compression in the radial tunnel. This study examines if a single incision brachioradialis-splitting approach without the use of additional anatomic windows is capable of adequately exposing the entire length of the radial tunnel, including all 5 sites of PIN compression to allow for adequate release. Methods: Ten fresh frozen cadaver forearms (6 female, 4 male) were dissected utilizing a curvilinear 7 cm incision over the brachioradialis. The muscle belly was split via simple blunt retraction, exposing the radial tunnel. The PIN was identified and mobilized at 5 compression sites: radiocapitellar joint (RCJ), radial recurrent vessels (Leash of Henry), fibrous medioproximal edge of extensor carpe radialis brevis, arcade of Frohse, and distal edge of supinator. Results: The PIN was identified and effectively released in all specimens without difficulty from this single approach. All 5 sites of compression were visible and accessible through the brachioradialis-split approach. Specifically, there was no difficulty in identifying and releasing the PIN at the distal edge of supinator. Conclusions: Radial tunnel syndrome is defined as PIN compression within the radial tunnel spanning from the fibrous RCJ to the distal edge of the supinator. A single brachioradialis-splitting approach is adequate for complete visualization and release of all compression sites of the radial tunnel. Utilizing this technique allows for surgical access and ease as well as minimizing necessity for additional windows or multiple incisions.

The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction

2021 ◽  
pp. 107110072110272
Author(s):  
Kenneth M. Chin ◽  
Nicholas S. Richardson ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Matthew W. Christian ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Cadaveric Study ◽  
Anatomic Study ◽  
Orthopedic Surgeons ◽  
Popular Knowledge ◽  
Fresh Frozen ◽  
The Mean ◽  
Anatomic Relationship

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

scholarly journals Comparative Study of Flexor Hallicus Longus Tendon Length through Single Incision or Accessory Plantar Medial Incision: A Cadaver Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Caitlin Curtis Crocker ◽  
Eildar Abyar ◽  
Sean Young ◽  
Fatemah Razaghi ◽  
Gerald McGwin ◽  
...  
Keyword(s):  
Single Incision ◽  
Plantar Flexion ◽  
Cadaver Study ◽  
Tendon Graft ◽  
Interference Screw ◽  
Flexor Hallucis Longus ◽  
Tunnel Length ◽  
Exact Test ◽  
Fresh Frozen ◽  
The Mean

Category: Ankle; Hindfoot Introduction/Purpose: Flexor Hallucis Longus (FHL) tendon transfer to the calcaneus is a common adjuvant procedure in the treatment of Achilles pathology. The FHL tendon can be harvested using a posterior incision where the tendon is dissected along its course into the fibroosseous tunnel. Alternatively, the FHL may be harvested through a separate plantar medial incision as it crosses the flexor digitorium longus at the Knot of Henry. This study aims to quantify FHL tendon lengths achieved through the two common approaches utilizing pair matched cadavers. Methods: Seven pair matched fresh-frozen cadaver legs without signs of musculoskeletal abnormalities were used for this assessment. One leg in each pairing underwent a single incision harvest while the contralateral leg underwent an accessory medial plantar harvest. After dissecting the tendon, a calcaneus tunnel was prepared from dorsal to plantar in both calcanei in standard fashion. Two measurements were obtained. The first measurement was taken from the distal aspect of the muscle belly to the distal end of the tendon. The tendon was then pulled through the calcaneus, and the foot was held in tension at 20 degrees of plantar flexion. The second measurement was taken from site where tendon entered the calcaneous to the distal end of the tendon graft. The measurements were analyzed using Wilcoxon Signed Ranks Test and Fischer Exact Test. Results: Using a posterior incision, the mean tendon measurement from calcaneous tunnel to the distal end of the tendon was 4.0 cm. Using an accessory plantar medial incision, the mean tendon measurement from the calcaneous tunnel to the distal end of the tendon was 7.2 cm. The average tunnel length obtained using an accessory medial incision was significantly greater than the length obtained using the single incision approach (p= 0.0003, p=0.0022, and p=0.0016). The accessory plantar medial incision obtained an FHL tendon tunnel length that was an average of 2.9 cm greater than the posterior incision. Conclusion: The single incision approach provided sufficient length to safely anchor the FHL into the calcaneus which suggests that the accessory plantar medial approach is not necessary for routine FHL transfers to the calcaneus with interference screw fixation. However, if additional length is needed for other applications such as posterior tibialis tendon dysfunction or peritoneal tendon tears, the accessory incision does provide an average of 2.9 cm of additional length.

scholarly journals Fundamentals of the Currently Available Single Port Abdominal Laparoscopic Gynecologic Systems and Utility in Minor Gynecologic Surgery

2021 ◽  
Author(s):  
M. Luann Racher ◽  
Ann Marie Mercier
Keyword(s):  
Single Incision ◽  
Surgical Techniques ◽  
Gynecologic Surgery ◽  
Single Incision Laparoscopic Surgery ◽  
Single Incision Laparoscopy ◽  
Surgical Access ◽  
Single Incision Surgery ◽  
Added Benefit ◽  
Multiport Laparoscopy

Single incision laparoscopic surgery encompasses a plethora of techniques and styles. Single incision laparoscopy has demonstrated outcomes comparable to traditional multiport laparoscopy with the added benefit of improved cosmesis. This book chapter will review single incision surgery for minor gynecologic surgery, including adnexal surgical procedures and myomectomy. The chapter reviews available data in regard to outcomes in single incision laparoscopy. It also discusses the commercially available single incision surgical access systems, laparoscopes, and accessory instruments. Surgical techniques beneficial in single incision laparosocpy, including uterine manipulation, are also reviewed.

Trigger Wrist Associated with Carpal Tunnel Syndrome Caused by Flexor Digitorum Superficialis Muscle Belly Hypertrophy: A Case Report and Literature Review

2020 ◽  
Author(s):  
Behzad Enayati ◽  
Mahmoud Farzan ◽  
Shahram Akrami ◽  
Pouya Tabatabaei Irani ◽  
Alireza Moharrami
Keyword(s):  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Surgical Techniques ◽  
Muscle Belly ◽  
Painful Sensation ◽  
Tunnel Syndrome ◽  
Trigger Wrist ◽  
Flexor Digitorum

Background: Trigger wrist is a rare disease with few reported cases in the literature. This condition presents with painful sensation and a clicking sound during finger or wrist movements. Case Report: In this report, we present a 32-year-old man suffering from trigger wrist along with carpal tunnel syndrome caused by muscle belly hypertrophy and extension to the carpal tunnel. The diagnostic approach and surgical techniques are explained. Conclusion: In cases of trigger wrist associated with carpal tunnel syndrome (CTS), there may be an underlying cause covering both the trigger wrist and CTS at the volar side of the wrist. Therefore, a precise clinical examination is recommended to avoid unnecessary surgery, releasing of A1 pulley, or steroid injection.  

scholarly journals The Hallux Metatarsophalangeal Capsule: An Anatomic Study with Respect to Percutaneous Hallux Valgus Correction

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0001
Author(s):  
Kenneth M. Chin ◽  
Nicholas S. Richardson ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Matthew W. Christian ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Invasive Surgery ◽  
Metatarsal Head ◽  
Anatomic Study ◽  
Popular Knowledge ◽  
Fresh Frozen ◽  
The Mean ◽  
Anatomic Relationship

Category: Bunion Introduction/Purpose: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux MTP proximal capsular origin on the metatarsal neck is critical for surgeons in planning and executing extra-capsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, five female and five male. The mean distances from the central hallux metatarsal head to the MTP capsular origin was 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopaedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus.

Ultrasound Measurements of the First Extensor Compartment: Determining the Transection Limits for Ultra-minimally Invasive Release of De Quervain Tenosynovitis

Hand ◽  
2019 ◽  
pp. 155894471987343
Author(s):  
Logan McCool ◽  
Brionn Tonkin ◽  
Danqing Guo ◽  
Danzhu Guo ◽  
Alexander Senk
Keyword(s):  
Average Length ◽  
Short Axis ◽  
Anatomical Dissection ◽  
Compressive Neuropathy ◽  
First Extensor Compartment ◽  
Fresh Frozen ◽  
De Quervain ◽  
Tunnel Syndrome ◽  
Extensor Compartment ◽  
Guo Technique

Background: De Quervain syndrome is the second most common compressive tendinopathy. Although the length of the first extensor compartment (FEC) has been studied previously, there is no documented reported comparison study of short-axis and long-axis sonographic measurements. The thread technique, or Guo Technique, has been applied to carpal tunnel syndrome, trigger finger, and superficial peroneal compressive neuropathy. To perform this procedure, it is critically important to accurately identify the boundaries for transection. Methods: Twenty-one fresh frozen cadaver upper extremities were examined under ultrasound to determine the length of the extensor retinaculum (ER) over the FEC. Using the sonographic landmarks, the ERs were measured in short axis and long axis over their proximal to distal margins and from the distal margins to the distal edges of the radial styloids. These sonographic measurements were then compared with gross anatomical measurements. Results: The short-axis sonographic measurement of the ER on average was 22.53 mm (95% confidence interval [CI] = 20.79-24.05 mm). The long-axis sonographic measurement of the ER on average was 15.65 mm (95% CI = 13.70-17.78 mm). The average length of the ER by gross anatomical dissection was 22.40 mm (95% CI = 21.15-23.51 mm). Conclusions: The short axis is not significantly different from the gross anatomical measurement; however, the long axis is significantly lower than the gross anatomical measurement. The results support the idea that the short axis is more accurate than the long axis.

Anatomic Study of Arthroscopic Portal Sites of the Ankle

Foot & Ankle ◽  
1993 ◽  
Vol 14 (3) ◽  
pp. 142-147 ◽  
Author(s):  
Lawrence A. Feiwell ◽  
Carol Frey
Keyword(s):  
At Risk ◽  
Ankle Joint ◽  
Standard Technique ◽  
Joint Capsule ◽  
Anatomic Study ◽  
Fresh Cadaver ◽  
Relative Safety ◽  
Fresh Frozen ◽  
Neurovascular Structures ◽  
Portal Placement

Numerous anatomic structures are at risk when performing ankle arthroscopy through the more commonly utilized portals. The purpose of this paper was to demonstrate the relative safety of each of the arthroscopic portal and Acufex external ankle distractor pin sites by measuring their proximity to the neurovascular structures surrounding the ankle joint. Six fresh cadaver specimens and 12 fresh-frozen, be-low-knee amputations were utilized for this study. An Acufex ankle distractor was applied using the standard technique. Anteromedial, anterolateral, anterocentral, posterolateral, and posteromedial portals were placed using an 11-blade scalpel to make 5-mm longitudinal incisions. The joint capsule was penetrated and a 3-mm arthroscope was placed into the ankle joint. The skin surrounding each of the portals was carefully removed and the proximity of any nerves or vessels was measured with respect to the arthroscope. At least one incidence of contact or penetration of a nerve or vessel was noted for each site. The anterocentral portal was at greatest risk for nerve or vessel damage. The anterolateral, anteromedial, and posterolateral portals were the safest areas for portal placement, with no penetration of neurovascular structures in any case.

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