STUDY OF UPPER LIMB PERIPHERAL NERVE PATHOLOGIES WITH SPECIAL EMPHASIS ON QUICK DASH SCORE AND SELECTED ELECTROMYOGRAPHIC PARAMETERS

Introduction Trigger finger is a common and functionally limiting disorder. Finger immobilization using an orthotic device is one of the conservative treatment options for treating this condition. The most common orthosis previously described for trigger finger is metacarpophalangeal joint immobilization. There are limited studies describing the effectiveness of proximal interphalangeal joint orthosis for treatment of trigger finger. Methods This study was a single group pretest-posttest design. Adult patients with single digit idiopathic trigger finger were recruited and asked to wear a full-time orthoses for 6 weeks. The pre- and post-outcome measures included Quick-DASH score, the Stages of Stenosing Tenosynovitis (SST), the Visual Analogue Scale (VAS) for pain, the number of triggering events in ten active fists, and participant satisfaction with symptom improvement. Orthotic devices were made with thermoplastic material fabricated with adjustable Velcro tape at dorsal side. All participants were given written handouts on this disease, orthotic care and gliding exercises. Paired t-tests were used to determine changes in outcome measures before and after wearing the orthosis. Results There were 30 participants included in this study. Evaluation after the use of PIP joint orthosis at 6 weeks revealed that there were statistically significant improvements in Quick-DASH score from enrolment (mean difference −29.0 (95%CI −34.5 to −23.4); p < 0.001), SST (mean difference −1.4 (95%CI −1.8 to −1.0); p < 0.001) and VAS (mean difference −3.4 (95%CI −4.3 to −2.5); p < 0.001). There were no serious adverse events and patient satisfaction with the treatment was high. Conclusions Despite our small study size, the use of proximal interphalangeal joint orthosis for 6 weeks resulted in statistically significant improvements in function, pain and triggering, and also high rates of acceptance in patients with isolated idiopathic trigger finger.

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A study on the outcome of displaced midshaft non-comminuted clavicle fractures treated with anatomical locking plate versus titanium elastic nail

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720975189 ◽

2020 ◽

pp. 221049172097518

Author(s):

Vineet Thomas Abraham ◽

Chandrasekaran Marimuthu

Keyword(s):

Functional Outcome ◽

Locking Plate ◽

Plate Versus ◽

Dash Score ◽

Titanium Elastic Nail ◽

Constant Murley Score ◽

Elastic Nail ◽

Clavicle Fractures ◽

The Mean ◽

Quick Dash

Purpose: Fixation of displaced midshaft clavicle is well known to decrease nonunion, malunion and shoulder disability as compared to nonoperative treatment. This study was done to compare the clinical and functional outcome of group 1 clavicle fractures treated with anatomic locking plates (ALP) versus Titanium elastic nail (TEN). Methods: We studied patients presenting with displaced midshaft clavicle fractures treated with ALP or TEN. The study period was from Jan 2013 to Dec 2016. Patients were reviewed and at each visit clinical and radiological progress of union was noted, complications if any were noted, functional assessment was done using the quick Dash score and Constant Murley score. Results: A total of 116 patients met our inclusion criteria. 62 patients were treated with TEN and 54 with ALP. Bony union was achieved at an average of 11.8 weeks in the TENS group and 12.8 weeks in the ALP group post operatively and this was found to be significant. The mean postoperative Constant Murley score in the ALP and the TEN groups were 92.8 (range 80–97), and 93.7 (82–97) respectively. The mean postoperative quick dash score in the ALP and TEN groups were 2.48(range from 0 to 6.8) and 2.1 (range 0–9.1) respectively. Conclusion: Both Anatomical locking plate and TEN are good options for the treatment of non-comminuted mid clavicular fractures as they have a similar functional outcome. TEN nail insertion has the advantage of being minimally invasive, having a faster union time and may be recommended in midshaft clavicle fractures without comminution.

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Peripheral nerve compression syndromes of the upper limb

Surgery (Oxford) ◽

10.1016/j.mpsur.2019.02.011 ◽

2019 ◽

Vol 37 (5) ◽

pp. 288-293 ◽

Cited By ~ 2

Author(s):

Kate Nicholls ◽

Nicholas D. Furness

Keyword(s):

Peripheral Nerve ◽

Upper Limb ◽

Nerve Compression ◽

Nerve Compression Syndromes ◽

Compression Syndromes

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Compression neuropathies of the forearm: anatomy, clinical features and management

British Journal of Hospital Medicine ◽

10.12968/hmed.2021.0187 ◽

2021 ◽

pp. 1-10

Author(s):

Alexander Scarborough ◽

Robert J MacFarlane ◽

Michail Klontzas ◽

Rui Zhou ◽

Mohammad Waseem

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Upper Limb ◽

Peripheral Nerves ◽

Clinical Presentation ◽

Permanent Damage ◽

Peripheral Nerve Lesions ◽

Clinical Presentations ◽

Wide Range ◽

Prompt Diagnosis

The upper limb consists of four major parts: a girdle formed by the clavicle and scapula, the arm, the forearm and the hand. Peripheral nerve lesions of the upper limb are divided into lesions of the brachial plexus or the nerves arising from it. Lesions of the nerves arising from the brachial plexus are further divided into upper (proximal) or lower (distal) lesions based on their location. Peripheral nerves in the forearm can be compressed in various locations and by a wide range of pathologies. A thorough understanding of the anatomy and clinical presentations of these compression neuropathies can lead to prompt diagnosis and management, preventing possible permanent damage. This article discusses the aetiology, anatomy, clinical presentation and surgical management of compressive neuropathies of the upper limb.

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Distal interphalangeal Joint Arthrodesis using only Kirschner Wires in small distal Phalanges

Handchirurgie · Mikrochirurgie · Plastische Chirurgie ◽

10.1055/a-1559-2684 ◽

2021 ◽

Vol 53 (05) ◽

pp. 462-466

Author(s):

Jun-Ku Lee ◽

Soonchul Lee ◽

SeongJu Choi ◽

Dong Hun Han ◽

Jongbeom Oh ◽

...

Keyword(s):

Distal Phalanx ◽

Bony Union ◽

Dash Score ◽

Medical Database ◽

X Ray ◽

Wire Fixation ◽

Distal Interphalangeal ◽

K Wires ◽

Quick Dash

Abstract Purpose To report the clinical and radiographic results of arthrodesis of relatively small-sized distal interphalangeal joints (DIPJs) using only K-wire fixation. Patients and methods Between January 2000 and December 2018 28 arthrodesis in 21 patients (9 males and 12 females with an average age of 52.1 years) with relatively small-sized DIPJs were performed using only K-wires. Data on patient’s characteristics, such as age, sex, affected finger, and the number and size of the used k-wires were collected from the medical database. The narrowest diameter of the cortex and medulla of the distal phalanx was measured on preoperative plain radiographs. The time to union and the arthrodesis angle was determined using serial X-ray radiography follow-up. Preoperatively and at the latest follow-up examination, pain using the visual analogue scale (VAS) and the quick DASH score was registered. In addition, complications were investigated. Results Average follow-up period was 11.4 months. The small finger was mostly affected (n = 12; 42.9 %). The narrowest diameters of the distal phalanx cortex and the medulla measured on preoperative X-ray images were 2.8 mm (SD 0.5) and 1.2 mm (SD 0.4), respectively. Seven fusions were done with use of 1 K-wire, 20 with 2 (71.4 %), and 1 with 3 K-wires. The most common K-wire sizes were 1.1-inch (24 K-wires = 48 %), and 0.9 inch (21 K-wires = 42 %) The preoperative VAS score and quick DASH score improved from 6.1 (range: 0–9) and 25.8 (range: 2–38) to 0.4 (range: 0–2) and 3.4 (range: 0–10.2), respectively. 25 (89.3 %) out of 28 fingers achieved bony union in an average of 96.1 days (range: 58–114) with three non-union. Conclusion Arthrodesis of small DIPJs with K-wire fixation has a high success rate. Therefore, we suggest K-wire fixation as an acceptable alternative for patients with a small phalanx which may be at risk of mismatch with bigger implants. However, concerns remain in terms of fusion delay with K-wire only fixation.

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Examination of the Peripheral Nerve Function in the Upper Limb

Examination of the Hand and Wrist ◽

10.1201/b14643-5 ◽

1998 ◽

pp. 261-369

Keyword(s):

Peripheral Nerve ◽

Upper Limb ◽

Nerve Function ◽

Peripheral Nerve Function

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Ultrasound guided interscalene brachial plexus block via lower approach for upper limb surgeries

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20183913 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1304

Author(s):

Roopal R. Garaniya ◽

Sheetal Shah ◽

Noopur Prajapati

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Ulnar Nerve ◽

Upper Limb ◽

Brachial Plexus Block ◽

Interscalene Block ◽

Ultrasound Guided ◽

Peripheral Nerve Stimulator ◽

Interscalene Brachial Plexus Block ◽

Plexus Block

Background: Brachial plexus block via interscalene approach is an excellent option for upper limb surgeries, but due to sparing of ulnar nerve (lower trunk, C8-T1) and its’ complications, it is not so popular. To overcome this problem, interscalene block via lower approach has been tried which has more advantage in view of ulnar nerve blockage and also less complications. In addition, ultrasound provides reliability, ease, rapidity and also patient comfort during block procedure. This prospective study was performed to evaluate the anaesthetic effect of lower approach interscalene block with the help of ultrasound and peripheral nerve stimulator.Methods: Ultrasound guided interscalene brachial plexus block via lower approach was given in randomly selected 30 patients, undergoing upper limb orthopaedic surgeries. After localisation of brachial plexus with ultrasound, the nerve roots were confirmed with the help of peripheral nerve stimulator, before injecting drug. At 5 and 15 min after block, all patients were assessed for the effect. Postoperatively they were assessed for any complication and also for their satisfaction level by Likert’s scale.Results: In territories of ulnar, radial and musculocutaneous nerve there was 100% effect while in median nerve territory 92.8% motor block was there. There was no need of analgesics during intra operative period in any patient and there were no major complications with this approach.Conclusions: Ultrasound guided interscalene block via lower approach is an excellent alternative for upper limb surgeries over classical approach in view of ulnar nerve blockage without any major complication.

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Elective amputation of the upper limb is an option in the treatment of traumatic injuries of the brachial plexus?

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170096 ◽

2017 ◽

Vol 75 (9) ◽

pp. 667-670 ◽

Cited By ~ 3

Author(s):

Mário Gilberto Siqueira ◽

Roberto Sérgio Martins ◽

Carlos Otto Heise ◽

Luciano Foroni

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Upper Limb ◽

Limb Amputation ◽

Brachial Plexus Palsy ◽

Traumatic Injuries ◽

Upper Limb Amputation ◽

Pros And Cons ◽

Post Traumatic ◽

Active Patients

ABSTRACT The treatment of complete post-traumatic brachial plexus palsy resulting in a flail shoulder and upper extremity remains a challenge to peripheral nerve surgeons. The option of upper limb amputation is controversial and scarcely discussed in the literature. We believe that elective amputation still has a role in the treatment of select cases. The pros and cons of the procedure should be intensely discussed with the patient by a multidisciplinary team. Better outcomes are usually achieved in active patients who strongly advocate for the procedure.

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