A prospective comparative study of surgical release of carpal tunnel syndrome with and without flexor tenosynovectomy

Background: Carpal tunnel syndrome (CTS) is a common condition causing hand pain and numbness. The rationale of tenosynovectomy is to remove the flexor tenosynovium that is contributing to increased volume within the carpal canal, thus removal of this tenosynovium should give more space for the median nerve and there by relief from symptoms. Aims and Objectives: The main objective of our study was to assess the role of routine flexor tenosynovectomy in the treatment of CTS. Materials and Methods: Eighty-six hands with CTS were randomized into two groups, either to carpal tunnel release with or without flexor tenosynovectomy. All patients were requested to fill up the self-administered questionnaire for the assessment of symptom severity and functional status, examined for 2-point discrimination, grip and pinch strength, scar tenderness and patient satisfaction score preoperatively, 2 weeks, 1 month, and 6 months follow-up. Results: After the surgical release, both groups improved significantly with respect to symptom severity and functional status, 2-point discrimination, grip and pinch strength, scar tenderness and patient satisfaction score but there was no significant difference between the two groups. There were two cases of post-operative wound infection and one case of mild reflex sympathetic dystrophy. Conclusion: We conclude that routine flexor tenosynovectomy during surgical release of carpal tunnel in patients with CTS does not provide any added benefit nor does it increase any morbidity.

Preoperative Classification System Used to Determine Release Performed during Endoscopic Brow Lift

The techniques presented in article will allow the facial plastic specialist to use the anatomy of each individual patient as a guide for the surgical release of the brow performed during endoscopic brow lift. The author presents his 15 years of experience in which he developed this approach. Five different surgical releases of the brow will be demonstrated and discussed in terms of which patients would best benefit from which release. Adopting this approach has made the predictability of the authors brow lift results much better and therefore improved patient satisfaction. This concept has not been described in the literature and the author firmly believes using a preoperative anatomical approach is a better way to approach endoscopic brow lift surgery.

Presentation and aetiology of paediatric trigger finger: a systematic review

Paediatric trigger finger is a rare condition distinct from paediatric trigger thumb and adult trigger digits. We performed a systematic review of paediatric trigger finger presentation and aetiology in order to guide workup and management. Fifty-one studies with 193 patients and 398 trigger fingers were included. Most patients had a single, unilateral trigger finger (54%). Fifty-five patients (29%) had an underlying condition, such as mucopolysaccharidosis; these cases appeared to be associated with multiple or bilateral trigger fingers or with carpal tunnel syndrome. All patients with mucopolysaccharidosis were treated surgically. Conservative management was reported in 33% of all patients, and two-thirds of these did not need further intervention. Patients undergoing surgical release infrequently had recurrence of triggering (6%). We propose an algorithmic approach for patients presenting with paediatric trigger finger. Presence of bilateral or multiple trigger digits or concomitant carpal tunnel syndrome should raise suspicion for an atypical underlying pathology.

Structures contributing to the shoulder contracture in brachial plexus birth palsy. An intraoperative biomechanical study

Internal rotation contracture of the shoulder is a common sequel of the brachial plexus birth palsy. The purpose of this study is to describe the surgical method used in our centre and to measure the effect of sequentially releasing several anatomical structures that have been ascribed as the cause of the contracture. Twenty-four consecutive patients were operated on with an open release. We documented the increase in passive external rotation after each surgical step. We found small gains in passive external rotation when performing coracoidectomy and division of the upper part of the subscapularis tendon; 4° (95% confidence interval [CI] 2°–6° p < 0.01) and 6° (95% CI 4°–8° p < 0.01), respectively. A substantial gain in external rotation occurred when dividing the entire subscapularis tendon, 43° (95% CI 38°–48°, p < 0.01). Our findings indicate that a clinically relevant surgical release of the contracture requires lengthening of the entire subscapularis musculo-tendinous unit. Level of evidence: IV

Surgical Technique for Complex Syndactyly in Apert Syndrome : A Serial Case

Complex syndactyly in Apert syndrome, especially complicated with synonychia and synostosis, is a surgical challenge. The incidence of Apert Syndrome is reported to be approximately 1 per 100.000 to 160.000 live births and its incidence in Indonesia is not yet known. It is practically symmetrical causing significant dysfunction and infection if not treated properly. The goals in the treatment are separation of independent digits without disturbing function and growth, creation of a lined commissure, provision of skin cover for the denuded nail edge and exposed bone, and to create aesthetically pleasing individual fingertips with proper nails, nail folds and adequate pulp fullness. Many variations of surgical release of the first web space and of the remaining syndactyly have been described. Various approaches to the bony deformity of the thumb have also been described. All previously described techniques advocate releasing a single side of a digit at any given surgery to maintain the vascularity of that digit. This is due to the unreliability of the vascular branching pattern to the digits. In this serial case, we reported 5 cases of Apert syndrome. We described the clinical findings, incision design, immediate and post-surgery follow ups. The results were uneventful, with satisfying function and aesthetic appearance.

Point Blank: A Retrospective Review of Self-inflicted Gunshot Wounds to the Hand

Background A paucity of literature exists specifically examining self-inflicted (SI) gunshot wounds (GSWs) to the hand and wrist, which impart greater energy and have a higher risk of adverse events than non–self-inflicted (NSI) GSWs. Methods We retrospectively reviewed records of patients who presented to our plastic surgery service after sustaining acute GSWs involving the hand and wrist between 2016 and 2018. Results We identified 60 patients who sustained GSWs involving the hand and wrist; 17 (28%) were SI, and 43 (72%) were NSI. Within the SI group, 100% of patients were Caucasian, with an average age of 54 years. Within the NSI cohort, 77% of patients were Black, 19% were Caucasian, and 4% identified as other. While not statistically significant, we noted a substantial increase in patients requiring operative intervention in the SI cohort (65% SI vs 37% NSI, P = .08). There was a statistically significant increase in patients requiring more than 1 operation in SI patients (24% SI vs 5% NSI, P = .04). Patients who sustained SI injuries were also more likely to present with acute carpal tunnel syndrome requiring urgent surgical release and to develop wound infections (12% vs 0%, P = .08). Conclusions Self-inflicted GSWs involving the hand and wrist are associated with greater morbidity than their low-energy NSI counterparts. Individuals presenting with SI GSWs are more likely to be older, to require multiple operations, to develop infections, and to present with acute carpal tunnel syndrome requiring urgent surgical decompression.

Snapping thumb: a rare case of stenosing tenosynovitis of the extensor pollicis longus tendon

Tenosynovitis of the extensor pollicis longus (EPL) is rarely reported in patients without rheumatoid arthritis but may lead to thumb snapping as a consequence of EPL stenosing tenosynovitis.This case presents painful thumb snapping that developed after a wrist trauma and repetitive loading. Ultrasound and MRI were used as diagnostic tools, before surgical release of the EPL in the third extensor compartment was performed. Neither EPL tenosynovitis nor thumb snapping were found at follow-up.

Exercise Program in Post-Surgical Release of Knee Flexion Contracture in Patient with Osteochondroma: A Case Report

Introduction: Knee flexion contracture is caused by adaptive shortening of the muscles which is marked by the incapability of the knee to fully extend. This condition is associated with long periods of immobilization, pain, and muscle weakness that are caused by various pathological conditions. Post-surgical rehabilitation program is mainly aimed to recover basic lower limb functions through an exercise program. Case description: A 16-year-old male patient with a history of left-sided knee pain and fixed flexion contracture was undergone a surgical release procedure and diagnosed with osteochondroma. Post-surgical evaluation by physical therapist found muscle atrophy, limited range of motion, and pain on the operated limb. The patient was instructed to do muscle strengthening and active exercise on both legs. Exercise program post-surgery aimed to improve muscle strength, range of motion, functional limb ability and activities of daily living. Improvement in the range of motion of the left knee joint was observed after three sessions of physical therapy intervention. Conclusion: Exercise program could reduce the muscle contracture and improve the knee joint range of motion in patients with osteochondroma following surgical release procedure.