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Background: Carpal tunnel syndrome is the most common focal neuropathy that results from pressure on a nerve. The goal of this study was to assess carpal tunnel syndrome and its associated factors such as occupation, sex, and accompanying complications in a teaching general hospital. Methods: This cross-sectional study investigated 362 patients with the diagnosis of carpal tunnel syndrome admitted in the orthopedic ward of Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences in Tehran, Iran during 2000-2010. Results: The difference in the mean age of men and women was statistically significant (P

Background: Syndactyly is the most common congenital malformation of the hand, with an incidence of 1 in 2000-2500 live births. In this study we evaluated the surgical outcomes and complications of patients with syndactyly.Methods : The surgical outcomes and complications of 42 patients, 27 male and 15, female, undergoing surgery for syndactyly were evaluated. The study took place in Imam Khomeini Hospital, in Tehran, Iran during 1996 to 2011. Having had the inclusion criteria, the patients were assessed for function, cosmetic outcome, sensation and occurrence of complications. The patients were followed-up for at least 3 years.Results : The mean age of patients was 4.4 years. There was a positive familial history for the disease in 8 patients. 71.4%, 90.4% and 73.8% of the participants had good results regarding cosmetic outcome, sensation and function, respectively.Conclusion: The overall results of surgery for syndactyly in this study were interpreted as good in 78.5%, moderate in 12.5% and fair in 8.4% of the patients. This study confirmed better surgical outcomes in patients older than 18 months.

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Nerve entrapment neuropathies are relatively frequent in the upper limb. Significant costs related to resultant disability and treatment, and also simultaneous occurrence of some of these syndromes can result in alteration in the treatment approach. The aim of this study was to evaluate the frequency of these syndromes, the rate of concurrence of carpal tunnel syndrome as the most prevalent syndrome with others, related risk factors, and accordance of clinical and electrophysiological findings."n"nMethods: In a retrospective study, data of the 170 affected patients to these syndromes operated during a period of 10 years in a referral center were searched using recorded documents. Information about patient's gender, age, occupation and associated co-morbidities, clinical and surgical findings and their accordance to the EMG-NCV findings, and also concurrence of these syndromes were assessed."n"nResults: Patients' range of age was 10-91 year (mean: 48.09 year) and 74.5% of them were female. In this study carpal tunnel and cubital tunnel syndrome were the most frequent (81.7% and 15.8% respectively). In 23.5% of patients with carpal tunnel syndrome, electrophysiological findings were negative but there was no false positive result. Concurrent carpal tunnel syndrome with other syndromes were found in three cases of cubital tunnel syndrome, two cases of thoracic outlet syndrome and one case of Guyon's canal syndrome."n"nConclusion: Constellation of symptoms, physical examination and electrophysiologic-al findings altogether should be considered for correct diagnosis of nerve entrapment syndromes in the upper extremity. Simultaneous entrapment in the other regions of the same nerve or other nerves in the same extremity is a probable condition

Background: Ulnar club hand (ulnar deficiency) is a rare congenital disorder of the upper extremity. In the Flatt series among 2758 congenital disorders of upper extremity only 28 cases of ulnar deficiency were reported. Due to its rarity and variations in presentation current data in the management of the deformity is very limited. Here we present our experience and results in comparing management of ulnar deficiency.Methods: We include all of the ulnar club hand patients (five boys and one girl with seven involved extremities) from 1993 to 2006. After recognizing the type of deformity the classic management approach was performed that was splinting in corrective position until six months of age and then anlage resection. Syndactyly release was done in appropriate age according to involved rays, other operations for restoration of apposition was done after 18 months of age. Two of our patients were neglected, the first one was a 12 years old boy without any ulnar deviation but with syndactyly of the remaining rays and the other was a 32 years old male with severe ulnar deviation and partial syndactyly who is a skillful worker. We determined the effect of anlage resection on ulnar deviation of the wrist and restoration of opposition and syndactyly release on function of the limb.Results: In short term follow up, anlage resection was effective in prevention and correction of ulnar deviation, however the deformity was partially recurred later. Surprisingly, the function of the limb was not significantly affected with the extent of the deformity. On the other hand, the operations used for opposition of the thumb like first metacarpal rotational osteotomies and tendon transfers for powerful opposition, were more effective in the hand and also limb function compared with anlage resection alone. Conclusions: Due to our observation of the neglected cases, the most important factor in the function of the hand is the function of the thumb, thus we believe that restoration of opposition and syndactyly release may be more effective than anlage resection on limb function in Ulnar Club Hand patients

Background: Pigmented villonodular synovitis is a tumor that arises from the synovial membrane of the joint or tendon sheaths. Two main forms include a diffuse form that involves the whole synovial lining of a joint, bursa, or tendon sheath, and a less common localized form. The diffuse form typically involves the large joints, while the localized one typically occurs around the small joints of the hands and feet. Usually involving the knee joint, the occurrence of pigmented villonodular synovitis in the foot, especially in the metatarsophalangeal joint of the great toe, is very rare, and is therefore often mistaken for other foot pathologies. Although it seems histopathologically benign, it has a known tendency to recur after surgery.Case report: Here, we report a 42 year old woman who had experienced pain in the right great toe for 1.5 years. She was treated conservatively with shoe modification and NonSteroidal Anti-Inflammatory Drugs, and two injections of Corticosteroid.Results: The failure of long-term conservative therapy and the bony erosion revealed in her radiograph led us to surgically excise the lesion of the first metatarsophalangeal joint. Histopathological examination revealed the diagnosis of pigmented villonodular synovitis. For the 18 months following surgery, she had no complaint except minimal pain in her toe after activity. No sign of recurrence was observed either clinically or radiologically.Conclusion: We conclude that pigmented villonodular synovitis should be noted in the differential diagnosis of chronic monoarticular synovitis in order to provide an earlier diagnosis and more effective treatment.

Background: In this study we evaluated the treatment of giant cell tumor (GCT) of long bones using cryosurgery combined with curettage and polymethylmetacrylate (PMMA) cementing. Material and methods: From January 1999 to December 2004, twenty patients (mean age at the time of surgery 29.2 years); 13 females and 7 males; were included in the study. Cortical disruption were presented in 7 patients; 4 with soft tissue extension, but none of them had intra-articular extension of tumor, 3 patients presented with pathologic fracture of distal femoral lesions. These tumors were located in distal femur in 6 patients, proximal tibia in 7, distal radius in 3, proximal femur in 2, and each of proximal humerus and distal ulna in one patient. In each case diagnostic biopsy was done and surgical procedure performed including curettage, power burr of the wall, cryosurgery with liquid nitrogen and finally filling the space with PMMA cementing. The mean follow-up was 34 months (7 to 61 ). Results: During follow-up, we observed one recurrence of GCT of proximal tibia. Secondary Aneurysmal bone cyst was reported at the site of one primary distal femoral lesion, without any finding in favor of a recurrence. Neurapraxia of the proneal nerve was occurred in one patient with proximal tibia tumor improved after 8 months. Conclusion: Cryosurgery combined with power burr and PMMA cementing in the treatment of GCT could be an effective approach in tumor eradication. This method obviates the need for extensive resections and reconstructive procedure.

Conclusion: Despite the long history of surgical treatment in syndactyly repair, this reconstructive operation has still special complexities. Materials and Methods: In order to evaluation of results of our surgical reconstructions, we studied 77 patients (40 boys and 37 girls) with hand syndactyly (mean age at operation: 5.8±4.3 years) in Imam Khomeini Hospital from 1994 to 2003. All of these patients had been operated by standard surgical methods. Post-operative complications and functional, sensational, and cosmetic results have been assessed by patient records and physical examination after an average follow-up of 4.6±2.1 years. Results: Syndactylies were simple in 71 patients (92.2%), complex in 2 (2.6%), and mixed in 4 (5.2%). In 45 patients (58.4%), surgical repair had been performed without graft. The overall results of operations were good in 81.8%, moderate in 13%, and poor in 5.2%. The most common complications were: web migration in 9.1%, scar contracture in 7.8%, infection in 5.2%, necrosis in 3.9%, and angular deformity in 2.6%. Conclusion: In this study we shown that the standard methods in our center for correction of syndactyly, at least in recent 10 years, have been efficient and with good results.

The majority of osseous tumors of the hand are benign. The surgeon who evaluates and treats osseous tumors of the hand has to be familiar with limb anatomy, tumor biology, various presentations of the tumors and the range of treatment possibilities and their limitations. Lesions in the hand more often present earlier in their course than those at other sites, just because they are more likely to superficial and easily noticed. A review of all cases of osseous tumors of the hand, seen by a hand surgeon over the last 10 years, at Imam Khomeini hospital was performed. Among 55 cases with osseous tumors of hand, 48 primary benign bone tumors, 3 primary malignant bone tumors, and 4 metastatic bone tumors were found. Enchondroma was the most common benign bone tumor followed by osteoid osteoma, osteoblastoma, aneurismal bone cyst, giant cell tumor, epidermoid cyst, and osteochondroma. There were two chondrosarcoma and one Ewing’s sarcoma as primary malignant bone tumors. Metastasis to the hand from colon, esophagus, and breast were also found. There were also two cases with Brown tumor secondary to hyperparathyroidism, we conclude that a variety of osseous tumors could occur in the hand, and usually they are benign. Although malignant neoplasms in the hand that arise from tissues other than the skin are very rare, the hand may be the site of distant breast, lung, kidney, esophagus, or colon adenocarcinoma metastases, most of which have a predilection for the distal phalanges.

Background: Osteoid osteoma is a well-known benign tumor of bone. It occurs in children and young adults and is rarely seen above the age of 40. It is uncommon in hand and wrist. If it occurs in hand and wrist, its diagnosis is difficult because of its unusual presentations both clinically and radiologically. Materials and Methods: We encountered ten patients with osteoid osteoma of hand during the last ten years in orthopedic department of Emam university hospital from 1970 to 1979. Results: The average age of ten patients with osteoid osteoma of the hand and wrist that were treated in Imam hospital from 1369 to 1378, was 22.9 years (range, 14 to 33 years). Five lesions were in proximal phalanx, one in middle phalanx, and one in distal phalanx. In the wrist, one lesion was in the capitate, one in the lunate, and one in the hamate. The average time from onset of symptoms to successful treatment was 20 months (range, 4 months to 60 months). Three of ten patients had had treatment elsewhere, all of them had had unsuccessful operative procedures related to incorrect diagnosis. All patients had a minimum follow-up of 6 months (range, 6 months to 9 years, mean: 4.6 years). The operative treatment were successful in all ten patients without any signs or symptoms of recurrence. Only limitation of proximal interphalangeal joint range of motion was remained in one patient due to 60 months delay in diagnosis and treatment. Conclusion: High index of suspicion is necessary for diagnosis of osteoid osteoma of hand because of unusual presentation of it. The most important factors for successful treatment of osteoid osteoma of hand are accurate diagnosis and exact preoperative planning.

During the last 10 years, we have had 11 cases of radioulnar (RU) synostosis, a very rare congenital amomaly of the upper extremity. Only 3 of them required surgical intervention. So we evaluated these three cases of proximal radioulnar synostosis corrected by proximal derotational osteotomy. The indication for surgery was severe pronation deformity that caused functional problem. Mean age at the time of surgery was 4.5 years (3-6 years) and mean postoperative follow up was 3.5 years(1-5 years). Forearm position after surgery was 15 supination. Anesthetic and functional results in all patients were good. In only one patient it was complicated by impending compartment syndrome that was treated by conservative measures. We recommend derotational osteotomay for correcting RU synostosis in earlier age.

Cleft hand deformity is a rare congenital anomaly of the hand with an incidence rate about 1/90,000. It has two clinical types; Typical and Atypical. In this paper we are representing ten cases of this anomaly admitted during seven years from 1992 in Emam Khomeini Hospital. Some of the patients especially those with typical cleft hand deformity achieved good functional results after surgical correction of the deformity. In the younger age group we observed better functional results.

Isolated scaphoid dislocation is a rare injury of the wrist. To our knowledger, only 22 cases of isolated scaphoid dislocation have been reported in Enghish-language literature and we could find only one case with pure radial dislocation. We present a 34-year-old man with isolated pure radial scaphoid dislocation that was treated by open reduction and repair of the scapholunate ligament and pin fixation. Because of the rarity of the injury and as few orthopedic surgeons seem to have encountered it, we present this case along with literature review stressing on treatment options and results.

Variation of recurred branch of median nerve in relation to the median and flexor retinaculum are significant for both hand surgeons and specialists always. In this study, 64 cadaver hands (32 men) have been dissected. The median nerve was identified at the proximal edge of the flexor retinaculum, and in order to expose carpal tunnel the ligament was divided, and the above subjects were studied. The results are: 1) The relation of recurrent nerve to the flexor retinaculum was classified into 4 types: A) In (53.1%) of subjects, this branch arises from the median after the flexor retinaculum. B) In (31.3%) of subjects, it arises from the median in the carpal tunnel and the moves around the lower edge of flexor retinaculum and enters the thenar region. C) In (14.1%) of subjects, it arises from the median in the carpal tunnel and pierces the flexor retinaculum. D) In (1.56%) of subjects it arises, in the carpal tunnel and it divides into two subbranches here. One follows pattern A and the other pattern C. 2) In this step, the relation of the recurrent branch to the median nerve was studied. The results show that inspite of this image even though most often the recurrent branch arises from the lateral side of median, in (68.75%) of subjects it arises from it's anterior surface. The MC Nemar test reveals that there is no relation between manifestation of mentioned patterns with right or left hands.

Osteoid osteoma is a unique benign primary bone tumor that may present in the metaphyseal diaphyseal areas of the short tubular bones and has also been reported in the carpal bones. It occurs in the first two decades of life. The classic history is bone pain, often relieved by aspirin. The clinical appearance is local swelling and tenderness. The typical radiographic appearance is very characteristic: an eccentric area of cortical sclerosis, frequently with a radiolucent nidus. The lesion does not exceed 1 cm in diameter. The use of a bone scan may be helpful diagnostically, as are the CAT scan and tomography. Doyle et al described seven cases of osteoid osteoma with a prolonged delay in diagnosis, but reported an excellent cure rate following excision. The carpus is not unusual as a site for this tumor, especially the scaphoid. Treatment is windowing with curettage of the tumor nidus. The use of a dental drill to window the phalanx and expose the nidus is very helpful. Removal of the entire nidus is permanently curative, but if a portion of the tumor is missed, prompt recurrence of the symptoms is the rule.

Cysts in bone are seen occasionally at or near its end and are filled with mucoid, glaird fluid. Typically, they have a thick fibrous wall similar to that of a "ganglion" of tendon sheath, are associated with no significant degenerative changes in the nearly near by joint, and seem appropriately considered to be collections in synovial spaces in unusual locations. Although they are rare and usually an incidental radiographic finding, intraosseous ganglions are being increasingly recognized as a source of wrist pain. Surgical treatment is best delayed, however, until all other possible etiologic factors for the patient's discomfort have been excluded. When indicated, curettage and bone grafting will adequately treat the condition. A careful exploration of the joint at the time of surgery helps rule out other undiagnosed causes for the patient's symptoms. Communications between the joint cavity and the intraosseous cyst are inconsistently demonstrated. The histologic features of intraosseous ganglions are identical to their soft tissue counterparts

The primary carcinoma may secondarily invade bone tissue through direct extensions, blood circulation or lymphatic transportation particulary when it is arising from breast, prostate, kidney, thyroid and lung. Metastatics tumors of bone are more common than primary tumor of bone. The most common tumor, which metastasizes into bone, is the breast adenocarcinoma. Some metastatic tumors of bone including the breast cancer, may appear only as a destructive lesion, while prostatic carcinoma is osteoblastoma. The metastasis is mostly appeared in skull, vertebrae, pelvic, femur and humerus bones. The first metastatic syndrome is usually the affected bone pain and pathologic fractures are commonly caused by osteometastasis

This deformity is often reffered to as thumbclutched hand, but a better term is the congenital clasped thumb. The congenital clasped thumb is associated with several well-de-fined syndromes, although it may also present as an isolated abnormality. Weckesser, Reac, and Heiple called it a syndrome and divided the syndrome in to four groups. In group I, the thumb is deficient in extention only. In group II, flexion contractur combine with deficient extention. In group III, the thumb is hypoplastic, and tendons and muscles are deficient. Group IV consists of the few remaining cases that so not fit into the first three groups. Group I cases are found three times as frequently as group II cases, while group III and IV cases are five times less frequet than group II cases. The congenital clasped thumb is twice as common in males as in females and is nearly always bilateral. During the early weeks of life, an infant frequently clutches the thumb and releases it intermittently for spontaneous motion. However, by the third or fourth month of life, the normal child ceases to clasp his thumb under his fingers. If the clasping persists and normal independent action of the thumb dose not develop, the syndrome of congenital clasped thumb is present

Dislocation of the thumb carpometacarpal joint is a rare injury, and only 38 cases have been definitively described in the English-speaking literature. All the reported dislocations have been dorsal. We present a volar form of the thumb carpometacarpal dislocation which was managed surgically after three months from the injury with open reduction and volar ligament reconstrction, with satisfactory outcome.

The appropriate time for performing transfers in radial nerve palsy is somewhat a controversial matter. Brown suggested that it would be advisable to proceed early with the full component of tandon transfers when there is a questionable or poor prognosis for the nerve repair. For example, when there is a nerve gap of greater than 4 cm or when there is a large wound or extensive scarring or skin loss over the nerve. He recommended ignoring the nerve and proceeding directly to tandon transfer