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Purpose: To compare short- and midterm functional and subjective outcomes of arthroscopically repaired Palmer 1B tears., Methods: At 2 time points, we evaluated 49 patients with Palmer 1B tears who underwent arthroscopic repair. We examined 46 patients (23 males and 23 females) in the short-term at an average of 11 months (range, 6-23 mo) postoperatively. In a second midterm follow-up, we examined 40 patients (20 males and 20 females) an average of 4.8 years (range, 4.2-5.9 y) after repair. Between short- and midterm follow-ups, 6 patients underwent an ulnar-shortening osteotomy to alleviate persistent ulnar-sided symptoms. Objective and subjective evaluation included the determination of range of motion, grip strength, pain, and wrist scores (modified Mayo wrist score and Disabilities of Arm, Shoulder, and Hand score)., Results: Compared with short-term repair results, midterm outcomes showed a further improvement in pain, wrist scores, grip strength, and motion. Neither static nor dynamic ulnar variance was correlated to preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand scores, short-term modified Mayo wrist scores, or need for ulnar-shortening osteotomy. Five patients improved only after having received an ulnar shortening osteotomy., Conclusions: After repair of Palmer 1B lesions, patients continued to improve in function and comfort at least into the second year, although some needed to have the ulna shortened to achieve this result., (Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: In clinical day-to-day life, grip strength, key pinch, and range of motion (ROM) serve to objectively evaluate treatment outcomes on wrist interventions. The goals of this study were to generate normative values of wrist function including the parameters of grip strength, key pinch, wrist ROM, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores in a healthy, working population, and to investigate the influence of age, sex, body weight and height, handedness, and work strain., Methods: We clinically examined 750 volunteer working subjects (363 women and 387 men, all white). We divided subjects into 2 groups depending on whether their labor involved high or low manual strain. We recorded participants' height, weight, grip strength, pinch strength, and wrist ROM. Each participant filled out a DASH questionnaire., Results: Grip strength and pinch strength showed a maximum at between 30 and 49 years of age. In men, body mass index, body height, and weight all correlated with grip strength and pinch grip. Whereas women exhibited greater grip strength on the right side, men showed nonsignificant greater grip strength on the left side. Wrist ROM was greatest for ages ranging between 18 and 29 years. The average DASH value for all male subjects was significantly less than that of female subjects. In a healthy working population, the DASH score increased yearly by an average of 0.2 points in men and 0.3 points in women., Conclusions: This study showed that in a healthy working population, people 30 to 49 years of age had the highest grip strength and pinch strength. Age positively correlated with the DASH score and inversely related to wrist ROM. Persons employed in jobs with high manual strain presented with lower wrist ROM and higher DASH scores., Clinical Relevance: These data help to objectively evaluate wrist function and the effectiveness of therapeutic interventions., (Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: To analyze functional and subjective outcomes of patients with posttraumatic dorsal instability of the distal radioulnar joint (DRUJ) treated by a dorsal capsular imbrication., Methods: We reviewed 11 patients (7 men and 4 women) with posttraumatic instability of the DRUJ who were treated by a capsular imbrication. The patients ranged in age from 18 to 48 years (average, 33 y). The duration of symptoms before surgery ranged from 3 weeks to 6 months (average, 5 mo). We evaluated subjective outcome measurements such as the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, questions regarding symptoms of pain and instability, and overall satisfaction. Objective outcome measurements were physical examination, standard radiographs, and a review of any surgical complications. Patients were asked whether they experienced wrist tenderness with applied pressure, swelling, scar sensitivity, or pain. We determined functional outcome using the Modified Mayo Wrist Score including range of motion and grip strength. The score was used to evaluate the surgical technique and enable comparison with other surgical methods used to treat instability of the DRUJ., Results: After surgery, the total mean DASH score was 15 points. Range of motion, grip strength, pain, and overall function resulted in a mean Modified Mayo Wrist Score of 88 points, and therefore a good functional outcome. Three patients were noted to have persistent mild DRUJ instability on the stress test but did not have symptoms. The only intraoperative or postoperative complications observed were transient paresthesias on the ulnar side of the hand., Conclusions: Capsular imbrication for posttraumatic instability of the DRUJ is a highly effective procedure with few complications and good functional and subjective results even in cases with concomitant healed fractures of the radius or ulnar styloid., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: Traumatic and degenerative disc lesions cause ulnar-sided wrist pain. To date, anatomical investigations of cadaver triangular fibrocartilage discs examining the innervation of the triangular fibrocartilage complex have found no evidence of nerve fibers in the healthy disc. In this study, we immunohistologically investigated biopsies from patients with either central traumatic or degenerative disc lesions, to determine the existence of nerve fibers. We hypothesized that an ingrowth of nerve fibers causes ulnar-sided wrist pain associated with traumatic and degenerative disc lesions., Methods: We included 32 patients with a traumatic Palmer 1A lesion and 17 patients with a degenerative Palmer 2C lesion in the study. We obtained a biopsy of each patient and stained the specimen with protein gene product 9.5 for nerve fiber detection., Results: There were no nerve fibers in either traumatic or degenerative disc lesions. In addition, the marginal areas of the biopsies showed no evidence of nerve fibers., Conclusions: Traumatic and degenerative disc lesions show no ingrowth of nerve fibers., (Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)