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Resumen El sindrome del martillo hipotenar es una infrecuente lesion de la arteria cubital a su paso por el canal de Guyon relacionada con los traumatismos repetitivos. Su diagnostico requiere un elevado indice de sospecha y una adecuada historia clinica. Su tratamiento no esta bien definido en la literatura, y va desde tratamiento medico hasta cirugia reconstructiva. Presentamos el caso de un varon de 52 anos con parestesias de los dedos cuarto y quinto tras un traumatismo en la eminencia hipotenar. En el test de Allen destaco la ausencia de vascularizacion por parte de la arteria cubital, por lo que se sospecho una trombosis de la arteria que se confirmo mediante angiorresonancia. Se realizo reseccion del fragmento trombosado y bypass con una vena antebraquial para reconstruir el flujo distal. Presento una evolucion satisfactoria a los 6 meses de seguimiento.

Hypothenar hammer syndrome is an uncommon injury of the ulnar artery in its passage through Guyon's canal, and has been associated with repetitive trauma. Its diagnosis requires of a high level of suspicion and a careful clinical interview. The appropriate treatment is not well defined in the literature, ranging widely from medical treatment to reconstructive surgery. A clinical case is presented of a 52 year-old healthy male, who presented with numbness of his fourth and fifth fingers after a trauma at the hypothenar eminence. The Allen test highlighted an absence of vascularisation from the ulnar artery, thus suspecting an ulnar artery thrombosis, which was later confirmed by angio-MRI. The thrombosed segment was resected and a by-pass with a forearm vein was performed to reconstruct the distal arterial flow, presenting with a good functional outcome at 6months follow-up.

Purpose To study the time to wound healing and recurrence rate achieved in the treatment of distal interphalangeal joint mucous cysts using the Zitelli modified bilobed flap. Methods We surgically treated 33 patients from January 2006 to June 2015. We assessed demographic data, comorbidities, location and size of the cyst, time to wound healing, and complications. Results The most affected finger was the right middle finger. All flaps survived and wounds healed in 14 days on average. The mucous cyst recurred in 1 of 33 cases. There were no major complications. Conclusions The Zitelli bilobed flap can provide good-quality skin coverage over the distal interphalangeal joint in a short period. Type of study/level of evidence Therapeutic IV.

Objectives The aim of this study is to analyse the outcomes of the surgical treatment of metacarpophalangeal stiffness by dorsal teno-arthrolysis in our centre, and present a review the literature. Material and methods This is a retrospective study of 21 cases of metacarpophalangeal stiffness treated surgically. Dorsal teno-arthrolysis was carried out on all patients. A rehabilitation programme was started ten days after surgery. An evaluation was performed on the aetiology, variation in pre- and post-operative active mobility, complications, DASH questionnaire, and a subjective satisfaction questionnaire. Results The mean age of the patients was 36.5 years and the mean follow-up was 6.5 years. Of the 21 cases, the most common cause was a metacarpal fracture (52.4%), followed by complex trauma of the forearm (19%). Improvement in active mobility was 30.5°, despite obtaining an intra-operative mobility 0–90° in 80% of cases. Mean DASH questionnaire score was 36.9 points. The outcome was described as excellent in 10% of our patients, good in 30%, poor in 40%, and bad in the remaining 20%. There was a complex regional pain syndrome in 9.5% of cases, and intrinsic muscle injury in 14.3%. Conclusion Because of its difficult management and poor outcomes, surgical treatment of metacarpophalangeal stiffness in extension is highly complex, with dorsal teno-arthrolysis being a reproducible technique according to our results, and the results reported in the literature.

Resumen Objetivo Analizar los resultados obtenidos en el tratamiento quirurgico de la rigidez metacarpofalangica en extension mediante tenoartrolisis dorsal en nuestro centro y revisar la literatura al respecto. Material y metodo Estudio retrospectivo de 21 rigideces metacarpofalangicas intervenidas. En todos los pacientes se realizo tenoartrolisis dorsal de forma ambulatoria, comenzando la rehabilitacion a los diez dias postoperatorios. Se registro etiologia, variacion de la movilidad activa tras la cirugia, complicaciones, cuestionario DASH y una encuesta de satisfaccion con el resultado. Resultados El seguimiento medio fue de 6,5 anos y la edad media de 36,5 anos. La causa mas frecuente fue la fractura de un metacarpiano (52,4%) seguida de los traumatismos complejos de antebrazo (19%). A final del seguimiento la mejoria en la movilidad activa fue de 30,5° pese a obtener una movilidad intraoperatoria de 0-90° en mas del 80% de los casos. En el cuestionario DASH la puntuacion media fue de 36,9, calificando el resultado como excelente el 10% de nuestros pacientes, bueno el 30%, regular el 40% y malo el 20% restante. En el 9,5% de los casos se produjo un sindrome de dolor regional complejo y en el 14,3% lesion de la musculatura intrinseca. Conclusion Por su dificil abordaje y pobres resultados, el tratamiento quirurgico de la rigidez metacarpofalangica en extension es de gran dificultad mostrandose la tenoartrolisis dorsal como una tecnica reproducible en relacion con nuestros resultados y a los resultados publicados en la literatura.

Purpose To assess the clinical and functional outcomes of proximal interphalangeal (PIP) joint denervation using a volar approach in the treatment of PIP joint osteoarthritis. Methods We retrospectively reviewed 11 cases treated from June 2007 to June 2016. The patients were identified and outcomes collected through a single institution’s registry, collecting demographic data, comorbidities, preoperative and postoperative visual analog scale (VAS) for pain, and Disorders of the Arm, Shoulder, and Hand (DASH) questionnaire. Results The ring finger was the most commonly treated. The VAS for pain improved from 7.8 to 1.4, and the DASH questionnaire improved from 43.6 to 8.7. The PIP joint active range of motion also improved from 52° to 79°. Two patients reported postoperative digital paresthesia that resolved spontaneously. There were no major complications. Conclusions Proximal interphalangeal joint denervation is a safe technique. It achieves good clinical results and, in case of failure, a more traditional and aggressive operation remains possible. Type of study/level of evidence Therapeutic IV.

Resumen Introduccion y objetivo La epicondilitis es una lesion muy frecuente en la poblacion. La mayoria de los pacientes mejoran con el tratamiento conservador, pero en un pequeno porcentaje sera necesaria la cirugia. Nuestro objetivo es analizar los resultados clinicos obtenidos mediante una intervencion consistente en «4 gestos quirurgicos». Material y metodo Estudio retrospectivo de 35 codos intervenidos con un seguimiento medio de 5,3 anos. En todos los casos se realizo denervacion epicondilea, extirpacion del nucleo de degeneracion angiofibroblastica, epicondilectomia y liberacion del nervio interoseo posterior. Se recogieron los resultados mediante Broberg and Morrey Rating System (BMRS), Mayo Elbow Performance Score (MEPS), Escala Visual Analogica (EVA), cuestionario DASH y una encuesta de valoracion subjetiva por parte del paciente. Resultados La puntuacion media del BMRS fue de 97,2 puntos, MEPS de 95,71 puntos. La reduccion media en la EVA fue de 8,12 puntos y la puntuacion media en el DASH fue de 1,68 puntos. El 94,3% de los pacientes valoraron el resultado como excelente o muy bueno. Se produjo una recidiva que se solvento con una nueva cirugia y una neuroapraxia del nervio interoseo posterior en 2 casos, recuperados integramente en 10 semanas. Conclusiones Con esta intervencion basada en 4 gestos, se ha conseguido la resolucion clinica en el 97,1% de los casos en la primera cirugia, por ello, consideramos esta tecnica efectiva, reproducible y con una aceptable tasa de complicaciones en el tratamiento quirurgico de la epicondilitis resistente a tratamiento conservador.

Pacinian corpuscles are rapidly adapting mechanoreceptors distributed in the dermis of the fingers and palm of the hand. A neuroma of the pacinian corpuscle is rare and extremely painful, with only a few cases reported in the literature. A 71-year-old man with pain and swelling on his left index finger, initially diagnosed as tenosynovitis resistant to nonsurgical treatment, was referred to our center. During surgery, a cluster of spherical, gray lesions close to the digital nerve was found and excised. The pathological diagnosis was neuroma of the pacinian corpuscles. Two years later, he reported the same clinical findings on his right index finger with no improvement after nonsurgical treatment. During surgery, the same lesions were found and also identified as pacinian corpuscle neuromas.