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Background: Elevation of carpal tunnel pressure is known to be associated with carpal tunnel syndrome. This study aimed to correlate the shear wave elastography in the transverse carpal ligament (TCL) with carpal tunnel pressures using a cadaveric model. Methods: Eight human cadaveric hands were dissected to evacuate the tunnels. A medical balloon was inserted into each tunnel and connected to a pressure regulator to simulate tunnel pressure in the range of 0-210 mmHg with an increment of 30 mmHg. Shear wave velocity and modulus was measure in the middle of TCL. Results: SWV and SWE were significantly dependent on the pressure levels (p < 0.001), and positively correlated to the tunnel pressure (SWV: R = 0.997, p < 0.001; SWE: R = 0.996, p < 0.001). Regression analyses showed linear relationship SWV and pressure (SWV = 4.359 + 0.0263 * Pressure, R2 = 0.994) and between SWE and pressure (SWE = 48.927 + 1.248 * Pressure, R2 = 0.996). Conclusion: The study indicated that SWV and SWE in the TCL increased linearly as the tunnel pressure increased within the current pressure range. The findings suggested that SWV/SWE in the TCL has the potential for prediction of tunnel pressure and diagnosis of carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

Although the important roles of proprioception and neuromuscular control in carpal instabilities under laboratory conditions have been recognized, only a few studies have translated this knowledge into a routine clinical practice. This study aimed to evaluate the results of a personalized rehabilitation in patients with carpal instability on functionality and pain intensity. This was a case series study. This case series included 39 adults (mean age: 38.2 ± 14.0 years; 16/23 females/males) diagnosed with carpal instability (radial or ulnar) with indication for orthopedic treatment. The disabilities of the arm, shoulder, and hand questionnaire was used to assess upper limb functionality. Pain perception was assessed using a visual analog scale. Exercise-based physiotherapy interventions were performed according to the clinical needs of the patients for at least 6 weeks (2-3 sessions per week). For the treatment of radial instability (n = 13), strengthening exercises of the abductor pollicis longus, extensor carpi radialis longus, flexor carpi radialis, and pronator quadratus muscles were prescribed. For the treatment of ulnar instability (n = 24), extensor carpi ulnaris and pronator quadratus were trained. All patients underwent proprioceptive training in open kinetic chain and closed kinetic chain, as well as strengthening of the unaffected hand. Changes before and after treatment were compared using the nonparametric Wilcoxon signed rank test. A significant improvement with a large effect size in disabilities of the arm, shoulder, and hand (P <.001; d = 2.9) and visual analog scale (P <.001; d = 3.2) scores were obtained after treatment. Moreover, the changes were greater than the minimal clinically important difference of 10.8 and 1.4, respectively. Similar results were found when patients with radial instability and ulnar instability were analyzed separately. Personalized training with specific proprioception and strengthening exercises produces improvements in functionality and pain perception in our cohort of people with carpal instability. These results highlight the importance of multicomponent exercise in the treatment of wrist instability. Future randomized clinical trials should further investigate the effectiveness of this protocol. • The protocol included strength training exercises combined with proprioceptive and cross-education training. • The combined exercise program showed benefits for function and pain in patients with carpal instability. • This protocol could be a valid alternative as a nonsurgical treatment for carpal instabilities. [ABSTRACT FROM AUTHOR]

Describing the outcomes of an exercise program on wrist and hand function for patients with midcarpal instability (MCI). This study has a prospective cohort design. Two hundred and thirteen patients with MCI were included. The intervention was a 3-month exercise program consisting of hand therapy and home exercises. The primary outcome was perceived wrist and hand function evaluated with the Patient-Rated Wrist/Hand Evaluation (PRWHE) three months after treatment onset. Secondary outcomes were conversion to surgery, pain, and satisfaction with treatment results. PRWHE total scores improved from 51 ± 19 (mean ± SD) to 33 ± 24 at 3 months (95% CI: 36–30, p < 0.001). All visual analog scales for pain demonstrated clinically relevant improvements at 6 weeks and 3 months (p < 0.001). At 3 months, 81% of the participants would undergo the treatment again. After a median follow-up of 2.8 years, 46 patients (22%) converted to surgery. We found clinically relevant improvements in hand and wrist function and pain. Most participants would undergo treatment again and 78% of the participants did not convert to surgery. Hence, non-invasive treatment should be the primary treatment choice for patients with MCI. Midcarpal instability (MCI) is a disabling condition and treatment options are limited. Patients with MCI can benefit from an exercise program aiming to improve the strength and coordination of the wrist muscles. Participants improved in hand/wrist function and 78% did not convert to surgery. Non-invasive treatment should be the primary treatment choice for these patients. [ABSTRACT FROM AUTHOR]

Recent research interest has grown in exploring the role of muscles, isometric contraction, proprioception, and neuromuscular control in addressing dynamic scapholunate and lunotriquetral joint instability, marking a shift in the understanding of wrist stability. To present a comprehensive review of the carpal ligaments anatomy and wrist biomechanics, with a particular focus on the role of proprioception in dynamic carpal stability and their role in managing scapholunate (SL) and lunotriquetral (LTq) dynamic instabilities. We conducted a systematic search of the literature and review of the most relevant papers published and indexed in pubmed, related to wrist biomechanics, proprioception and its contribution to carpal dynamic stability. The study involved a comprehensive review of neuromuscular mechanisms in dynamic stabilization of the carpus, based on cadaver studies. The 3D position of the scaphoid, triquetrum, and capitate was monitored before and after tendon loading. The extensor carpi ulnaris (ECU) and the flexor carpi radialis (FCR) are identified as the primary pronators of the midcarpal joint. The ECU's pronation effect can potentially strain the scapholunate ligament, while the supinator muscles, the abductor pollicis longus (APL), the extensor carpi radialis longus (ECRL), and the flexor carpi ulnaris (FCU), have a protective role, particularly in cases of scapholunate ligament dysfunctions. The FCR, despite being a pronator of the distal row, has a beneficial effect as it provokes supination of the scaphoid. Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics. Proprioception, encompassing joint position sensation and neuromuscular control, is pivotal for stability. Biomechanical research informs tailored muscle strengthening for specific carpal issues. Supinator muscles should be strengthened for SL injuries, and ECU-focused strengthening and proprioceptive training are key for dynamic LTq instabilities. Ongoing research should delve into the intricate relationship between carpal ligaments, muscles, and proprioception to enhance wrist stability. • Forearm muscles are categorized as carpal pronators or supinators based on their effect during traction in neutral rotation. • The carpal pronator muscles are the extensor carpi ulnaris and the flexor carpi radialis. • The carpal supinator muscles are the abductor pollicis longus, extensor carpi radialis longus, and flexor carpi ulnaris. • Scapholunate dysfunction may benefit from strengthening and proprioceptive training of the supinator muscles and flexor carpi radialis. • Lunotriquetral dysfuntions may benefit from strengthening and proprioceptive training of the extensor carpi ulnaris. [ABSTRACT FROM AUTHOR]

Chronic joint hypermobility has been attributed to repetitive ligamentous microtrauma, benign joint hypermobility syndrome (BJHS), or genetic connective tissue disorders that lead to pain and functional impairment, especially among females. Chronic wrist hypermobility (CWH) prevalence, etiology, and effects on proprioception, strength, and function have yet to be established. This pilot study aimed to determine the CWH prevalence among adults; its effects on proprioception, strength, and function; and whether these effects are gender based. This was a quasi-experimental cross-sectional study. Ninety wrists (55 participants, mean age 27.46 years) with no wrist range of motion (ROM) restrictions or previous trauma for ≥6 months were screened for CWH based on an exploratory set of diagnostic criteria. Fifty-eight wrists (34 adults) were allocated to a CWH group, and 32 wrists (21 adults) were allocated to a healthy control group. Twenty-five CWH and 25 healthy control matched (gender, age, and handedness) participants were compared. Assessment included the active wrist joint position sense test, hand-held dynamometry for wrist extension and grip strength, and the patient-rated wrist evaluation for function. Testers were blinded to group allocation. A 64.4% CWH prevalence existed among CWH participants, who were mostly asymptomatic females (74%). Frequent etiologic factors were midcarpal (96.5%) and scapholunate (39%) instabilities and BJHS (37%), which was higher among females (30%) than males (8%). Independent t -tests showed statistically significant (p < 0.05) group differences in wrist proprioception, wrist isometric extension, grip strength, and function with moderate-high (0.41-0.75) effect size. No significant gender differences existed in proprioception and function. CWH is very prevalent among functional independent young adults with atraumatic midcarpal and intercarpal ligamentous laxities and BJHS. CWH prevails among women and adversely affects wrist proprioception, strength, and function. The study's specific CWH diagnostic criteria may be useful for clinicians to identify and timely manage impacted individuals by CWH. • CWH is very prevalent in young adults, and it can be diagnosed via specific criteria. • CWH prevails among females with atraumatic midcarpal or intercarpal laxities, and BJHS. • CWH adversely affects wrist proprioception, wrist strength, grip-force, and function. [ABSTRACT FROM AUTHOR]

This study aimed to quantify the long-term progression of blunt and sharp cartilage defects and their effect on joint homeostasis and function of the equine carpus. In nine adult Shetland ponies, the cartilage in the radiocarpal and middle carpal joint of one front limb was grooved (blunt or sharp randomized). The ponies were subjected to an 8-week exercise protocol and euthanized at 39 weeks. Structural and compositional alterations in joint tissues were evaluated in vivo using serial radiographs, synovial biopsies, and synovial fluid samples. Joint function was monitored by quantitative gait analysis. Macroscopic, microscopic, and biomechanical evaluation of the cartilage and assessment of subchondral bone parameters were performed ex vivo. Grooved cartilage showed higher OARSI microscopy scores than the contra-lateral sham-operated controls (p

Purpose: The objective of this study was to investigate the potential of arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor as a treatment option for patients experiencing symptomatic acute and subacute (< 3 months) scapholunate instability. Methods: From Jan. 2017 to Jan 2020, 19 wrists with acute or subacute tears of the SL ligament with symptomatic instability were treated with arthroscopic SL repair and dorsal capsulodesis with a suture anchor. The average time from injury to operation was 8.8 weeks (range, 4–11 weeks) and the regular follow-up mean duration at our clinic was 26.5 months (range, 24–32 months). The pain score according to the visual analog scale, wrist range of motion, grip strength, radiographic outcomes and functional outcomes according to the Modified Mayo Wrist Score (MMWS) were evaluated preoperatively and postoperatively during the follow-up period. Results: All 19 patients had rupture and dissociation of the SL ligament in the radiocarpal joint. The total arc of wrist motion in the flexion–extension plane loss averaged 5.1° (P >.01).The Wilcoxon signed-rank test was used to compare the results: grip force improved significantly with 14.7% improvement of that on the normal side (P <.01); the postoperative MMWS was significantly better than the preoperative scores (P <.01). Of 19 patients of the series, 18 patients (94.7%) achieved good or excellent results according to the MMWS and 16 patients (84.2%) resumed their previous activities. Only one patient (5.3%) had residual laxity of the scapholunate ligament joint at 15 months of follow-up. Conclusions: At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Purpose. Carpal tunnel syndrome (CTS) is a common entrapment neuropathy with an incidence rate of 6%. The significance of carpal tunnel shape and dimensions in idiopathic carpal tunnel syndrome has long been debated. Recent studies have examined the accuracy of previous morphometric studies, as the reported dimensions have conflicting results. The purpose of this study was to use cadavers to determine the dimensions and shape of the carpal tunnel using a three-dimensional digitization approach. Methods. The carpal tunnels of 35 cadavers were evacuated, and 210 silicon molds were created from 70 hands by inserting them into the soft tissue-carpeted tunnel. The mold was then scanned by a Structured Light Scanner from Steinbichler 3D scanner to obtain a three-dimensional image of the carpal tunnel, from which various carpal tunnel measures were calculated. Results. The width, height, and cross-sectional area (CSA) of the carpal tunnel decreased significantly from proximal to distal, with a narrow CSA at the distal end. Furthermore, the ulnar side of the tunnel was observed to be significantly deeper than the radial side. Conclusions. In this study our measured dimensions render a truncated elliptical coneshaped carpal tunnel tapering distally. Based on our analysis, the CSA of the distal carpal tunnel may be estimated by knowledge of the proximal tunnel CSA by using the formula (DistalCSA = 22.137 + 0.734 (Proximal CSA). Knowledge of the tunnel's structural architecture is important in determining the aetiology of carpal tunnel syndrome associated with variant anatomy. [ABSTRACT FROM AUTHOR]

Copyright of Harran University Journal of the Faculty of Veterinary Medicine / Harran Üniversitesi Veteriner Fakültesi Dergisi is the property of Harran University, Faculty of Veterinary Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The distal radius is the most common location for giant cell tumors (GCT) in the upper extremity. Treatment should balance the goals of maximizing function and minimizing recurrence and other complications. Given the complexity in surgical treatment, various techniques have been described without clear standards of treatment. The purpose of this review is to provide an overview of evaluation of patients presenting with GCT of the distal radius, discuss management, and provide an updated summary on outcomes of treatment options. Surgical treatment should consider tumor Grade, involvement of the articular surface, and patient-specific factors. Options include intralesional curettage and en bloc resection with reconstruction. Within reconstruction techniques, radiocarpal joint preserving and sparing procedures can be considered. Campanacci Grade 1 tumors can be successfully treated with joint preserving procedures, whereas for Campanacci Grade 3 tumors consideration should be given to joint resection to prevent recurrence. Treatment of Campanacci Grade 2 tumors is debated in the literature. Intralesional curettage and adjuvants can successfully treat cases where the articular surface can be preserved, while en-bloc resection should be used in cases where the articular surface cannot undergo aggressive curettage. A variety of reconstructive techniques are used for cases needing resection, with no clear gold standard. Joint sparing procedures preserve motion at the wrist joint, whereas joint sacrificing procedures preserve grip strength. Choice of reconstructive procedure should be made based on patient-specific factors, considering relative functional outcomes, complications, and recurrence rates. [ABSTRACT FROM AUTHOR]

BackgroundCarpal instability is defined as a condition where wrist motion and/or loading creates mechanical dysfunction, resulting in weakness, pain and decreased function. When conventional methods do not identify the instability patterns, yet clinical signs of instability exist, the diagnosis of dynamic instability is often suggested to describe carpal derangement manifested only during the wrist's active motion or stress. We addressed the question: can advanced MRI techniques provide quantitative means to evaluate dynamic carpal instability and supplement standard static MRI acquisition? Our objectives were to (i) develop a real-time, three-dimensional MRI method to image the carpal joints during their active, uninterrupted motion; and (ii) demonstrate feasibility of the method for assessing metrics relevant to dynamic carpal instability, thus overcoming limitations of standard MRI.MethodsTwenty wrists (bilateral wrists of ten healthy participants) were scanned during radial-ulnar deviation and clenched-fist maneuvers. Images resulting from two real-time MRI pulse sequences, four sparse data-acquisition schemes, and three constrained image reconstruction techniques were compared. Image quality was assessed via blinded scoring by three radiologists and quantitative imaging metrics.ResultsReal-time MRI data-acquisition employing sparse radial sampling with a gradient-recalled-echo acquisition and constrained iterative reconstruction appeared to provide a practical tradeoff between imaging speed (temporal resolution up to 135 ms per slice) and image quality. The method effectively reduced streaking artifacts arising from data undersampling and enabled the derivation of quantitative measures pertinent to evaluating dynamic carpal instability.ConclusionThis study demonstrates that real-time, three-dimensional MRI of the moving wrist is feasible and may be useful for the evaluation of dynamic carpal instability.

The article describes the case of a 78-year-old woman presented to the clinic with one-week history of fever, shortness of breath, carpal and interphalangeal arthritis and skin lesions. Topics discussed include medical history of the patient, findings on laboratory analysis, and confirmation of the diagnosis with anti-melanoma differentiation-associated protein 5 (MDA5) antibody-positive dermatomyositis through antibody testing.

A 25-day-old goat kid was presented for the treatment of lameness in the right forelimb. During the clinical examination, swelling, pain, and valgus were detected in the carpal joint. Radiography demonstrated a 14° carpal valgus centered around the radiocarpal joint. Surgical treatment was chosen as valgus was moderate. A transphyseal staple was placed in the medial distal radius. After 3 months, the implant was removed with the valgus corrected; later, no complications were seen. [ABSTRACT FROM AUTHOR]

In this dynamic protocol, ultrasound evaluation of the wrist and hand is described using various maneuvers for relevant conditions. Scanning videos are coupled with real-time patient examination videos. The authors believe that this practical guide—prepared by the international consensus of several experts—will help musculoskeletal physicians perform a better and uniform/standard examination approach. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess the influence of a 50% distal ulnectomy on mediolateral carpal stability in the dog.Study designCanine cadaveric study.Sample populationSeven canine thoracic limbs METHODS: Thoracic limbs were placed in a jig to mimic weight bearing with a load representing 30% of body weight. Carpal extension angle was standardized at 190° ± 5°. Frontal plane carpal angles were measured with the limb loaded on craniocaudal radiographs before and after ulnectomy. Valgus and varus stress radiographs with the limb loaded were acquired before and after ulnectomy. The limbs were palpated and were subjectively graded for valgus or varus instability by 2 investigators before and after ulnectomy.ResultsMean (±SD) valgus angulation increased after ulnectomy (2.1° ± 1.7°; P = .017; CI95  = 0.5°-3.7°) when the limb was loaded without valgus or varus stress applied. Mean valgus angulation increased after ulnectomy (2.7° ± 2.8°; P = .032; CI95  = -0.2°-5.5°) when valgus stress was applied to the loaded limb. Varus angulation was unchanged after ulnectomy (0.6° ± 4.6°; P = .383; CI95  = -4.2°-5.3°) when varus stress was applied to the loaded limb. Palpation detected increased valgus score after ulnectomy.ConclusionDistal ulnectomy with excision of the lateral styloid process induces a slight increase in valgus in canine cadaver carpi. The clinical consequences of that valgus on carpal function and health should be assessed in clinical patients.

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Injuries to the wrist are, due to its small size and complex anatomical structures, difficult to assess by MR, and surgical interventions such as diagnostic arthroscopy are often necessary. Therefore, improved visualization using non-invasive methods could be of clinical value. As a first step of improvement, the purpose of this study was to evaluate visualization of anatomical structures at 7T compared with 3T MR. Methods: Eighteen healthy volunteers (three males and three females from each age decade between 20 and 49 years) were examined with 7T and 3T MR. Four musculoskeletal radiologists graded 2D and 3D images on a five-level grading scale for visibility of ligaments, cartilage, nerves, trabecular bone, and tendons, as well as overall image quality (i.e., edge sharpness, perceived tissue contrast, and presence of artefacts). Statistical analysis was done using a visual grading characteristics (VGC) analysis. Results: Visibility of cartilage, trabecular bone, tendons, nerves, and ligaments was graded significantly higher at 7T with an area under the curve (AUCVGC) of 0.62–0.88 (95% confidence interval [CI] 0.50–0.97, p = < 0.0001–0.03) using either 2D or 3D imaging. Imaging with 3T was not graded as superior to 7T for any structure. Image quality was also significantly superior at 7T, except for artefacts, where no significant differences were found. Conclusions: Tendons, trabecular bone, nerves, and ligaments were all significantly better visualized at 7T compared to 3T. Key Points: • MRI of the wrist at 7T with a commercially available wrist coil is feasible at similar acquisition times as for 3T MRI. • The current study showed 7T to be superior to 3T in the visualization of anatomical structures of the wrist, including ligaments, tendons, nerves, and trabecular bone. • Image quality was significantly superior at 7T, except for artefacts, where no significant differences were found. [ABSTRACT FROM AUTHOR]

Carpal instability is a complex subject and the theories behind the pathoanatomy and management continue to evolve in the literature. The consequences of carpal instability for the patient can be significant and lead to functional impairment and long-term pain. We outline the normal anatomy of the carpus and relate the complex interactions between the ligamentous and bony structures to the patterns of injury both acute and chronic. We then go on to review current opinion on the classification, assessment and management of patients with carpal instability. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Wrist/hand pain is a prevalent musculoskeletal condition with a great spectrum of etiologies (varying from overuse injuries to soft tissue tumors). Although most of the anatomical structures are quite superficial and easily evaluated during physical examination, for several reasons, the use of ultrasound imaging and guidance has gained an intriguing and paramount concern in the prompt management of relevant patients. In this aspect, the present review aims to illustrate detailed cadaveric wrist/hand anatomy to shed light into better understanding the corresponding ultrasonographic examinations/interventions in carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, rhizarthrosis, and the radiocarpal joint arthritis. In addition, evidence from the literature supporting the rationale why ultrasound guidance is henceforth unconditional in musculoskeletal practice is also exemplified. [ABSTRACT FROM AUTHOR]

The entrapment of the ulnar nerve in Guyon's canal (GC) is a well-known wrist canalicular syndrome which is usually followed by a gradual combination of both sensitive and motor symptomatology. However, GC nerve compression could also cause a pure hand motor dysfunction. This condition, less frequent than the classic Guyon's syndrome, can be difficult to diagnose. Authors report a case series of eight patients affected by isolated compression of the ulnar nerve motor branch, due to piso-triquetrum or triquetro-hamate joint ganglia. Surgical technique and postoperative outcomes are discussed in this paper. The isolated compression of the ulnar nerve motor branch is a very rare clinical condition which is often linked to several causes. The rarity of the pathology is probably due to lack of knowledge and therefore to the difficulty in formulating a correct diagnosis. Surgical treatment appears to be decisive in most cases, although late diagnosis often leads to incomplete functional recovery. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate a series of intra-articular distal radius fractures (DRFs) to determine whether patients without radiographic evidence of scapholunate (SL) ligament injury have a difference in outcomes in comparison with patients with radiographic evidence of SL ligament injury and no ligament repair or reconstruction. Our hypothesis is that there are no significant differences in outcomes between patients after treatment of their intra-articular DRF. A retrospective analysis of patients from a single institution who sustained an intra-articular DRF from January 2006 through January 2019 with minimum 12-month (n = 192) and 24-month (n = 100) follow-up was performed. Patient demographic, clinical, and outcome variables were compared between SL angles less than 70° (cohort 1) and SL angles 70° or greater (cohort 2). Radiographic parameters were measured and recorded at 3 time points: baseline in the contralateral wrist, following closed reduction but prior to surgical intervention, and at final follow-up. Outcomes collected included Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Modified Global Assessment of Function (mGAF), and a visual analog scale (VAS) for pain. One hundred ninety-two patients were included. Of these 192 patients, cohort 1 (n = 110) was observed to have median (range) SL angles of 58° (42°–68°) and cohort 2 (n = 82) median (range) SL angles of 74.5° (70°–87°) after closed reduction. Cohort 2 had statistically significant increases in median SL angles from closed reduction to final follow-up (74.5° [range, 70°–87°) to 78.5° (range, 71°–107°). There were no statistically significant differences in Quick DASH disability scores, mGAF scores, and VAS pain scores between the cohorts at initial and final follow-ups. Patient-reported outcomes at 12 and 24 months do not differ between patients without radiographically apparent SL ligament injury (SL angles < 70°) and patients with radiographically apparent SL ligament injury(SL angles ≥ 70°) who do not undergo ligament repair or reconstruction following treatment of their intra-articular DRF. Therapeutic IV. [ABSTRACT FROM AUTHOR]

Objective To realize the automated bone age assessment by applying deep learning to digital radiography （DR） image recognition of left wrist joint in Uyghur teenagers, and explore its practical application value in forensic medicine bone age assessment. Methods The X-ray films of left wrist joint after pretreatment, which were taken from 245 male and 227 female Uyghur nationality teenagers in Uygur Autonomous Region aged from 13.0 to 19.0 years old, were chosen as subjects. And AlexNet was as a regression model of image recognition. From the total samples above, 60％ of male and female DR images of left wrist joint were selected as net train set, and 10％ of samples were selected as validation set. As test set, the rest 30％ were used to obtain the image recognition accuracy with an error range in ±1.0 and ±0.7 age respectively, compared to the real age. Results The modelling results of deep learning algorithm showed that when the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the net train set was 81.4% and 75.6% in male, and 80.5% and 74.8% in female, respectively. When the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the test set was 79.5% and 71.2% in male, and 79.4% and 66.2% in female, respectively. Conclusion The combination of bone age research on teenagers’ left wrist joint and deep learning, which has high accuracy and good feasibility, can be the research basis of bone age automatic assessment system for the rest joints of body.

Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome worldwide. There are limited studies on the effectiveness of carpal ligament stretching on symptomatic and electrophysiologic outcomes. The purpose of this study was to evaluate the effect of self-myofascial stretching of the carpal ligament on symptom outcomes and nerve conduction findings in persons with CTS. This is a prospective, double-blinded, randomized, placebo-controlled trial. Eighty-three participants diagnosed with median mononeuropathy across the wrist by nerve conduction study were randomized 1:1 to sham treatment or self-carpal ligament stretching. Participants were instructed to perform the self-treatment four times a day for six weeks. Seventeen participants in the sham treatment group and 19 participants in the carpal ligament stretching group completed the study. Pre- and post-treatment outcome measures included subjective complaints, strength, nerve conduction findings, and functional scores. Groups were balanced on age, sex, hand dominance, symptom duration, length of treatment, presence of nocturnal symptoms, and compliance with treatment. Even though the ANOVA analyses were inconclusive about group differences, explorative post hoc analyses revealed significant improvements in numbness (P =.011, Cohen's d =.53), tingling (P =.007, Cohen's d =.60), pinch strength (P =.007, Cohen's d = −.58), and symptom severity scale (P =.007, Cohen's d =.69) for the treatment group only. The myofascial stretching of the carpal ligament showed statistically significant symptom improvement in persons with CTS. Larger comparative studies that include other modalities such as splinting should be performed to confirm the effectiveness of this treatment option. • Self-Stretching of Carpal Ligament for Carpal Tunnel Syndrome. • Self-Stretching shows improvement symptom severity and pinch strength. • Providing self-care technique may help alleviate the need for skilled therapy. [ABSTRACT FROM AUTHOR]

The volar divergent dislocation of the second to fifth carpometacarpal joints and involving fracture of carpal is an extremely rare injury. We reported a case of 55-year-old man, victim of a motorbike, who was struck by a car, admitted at the emergency department unable to move his left hand with severe swelling. X-rays and CT scan showed a volar divergent dislocation of second to fifth carpometacarpal joints and involving fracture of carpal. Patient underwent closed reduction and plaster fixation right way, after one week, he received open reduction internal fixation with K-wire and plaster. Functional exercise was started progressively once K-wire and plaster were removed after six weeks. At six months follow-up, results were excellent and patient has regained all of his range of motion and hand activities. [ABSTRACT FROM AUTHOR]

Objectives: This research examines whether the distribution of trabecular bone in the proximal capitates of extant hominids, as well as several fossil hominin taxa, is associated with the oblique path of the midcarpal joint known as the dart-thrower's motion (DTM)., Materials and Methods: We analyzed proximal capitates from extant (Pongo n = 12; Gorilla n = 11; Pan n = 10; fossil and recent Homo sapiens n = 29) and extinct (Australopithecus sediba n = 2; Homo naledi n = 1; Homo floresiensis n = 2; Neandertals n = 3) hominids using a new canonical holistic morphometric analysis, which quantifies and visualizes the distribution of trabecular bone using relative bone volume as a fraction of total volume (rBV/TV)., Results: Homo sapiens and Neandertals had a continuous band of high rBV/TV that extended across the scaphoid, lunate, and hamate subarticular regions, but other fossil hominins and extant great apes did not. A. sediba expressed a distinct combination of human-like and Pan-like rBV/TV distribution. Both H. floresiensis and H. naledi had high rBV/TV on the ulnar-side of the capitate but low rBV/TV on the radial-side., Conclusion: The proximal capitates of H. sapiens and Neandertals share a distinctive distribution of trabecular bone that suggests that these two species of Homo regularly load(ed) their midcarpal joints along the full extent of the oblique path of the DTM. The observed pattern in A. sediba suggests that human-like stress at the capito-scaphoid articular surface was combined with Pan-like wrist postures, whereas the patterns in H. floresiensis and H. naledi suggest their midcarpal joints were loaded differently from that of H. sapiens and Neandertals., (© 2023 The Authors. American Journal of Biological Anthropology published by Wiley Periodicals LLC.)

Background: The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain. Materials and Methods: Thirty three patients with chronic wrist pain suspected to have ligament injuries of the wrist were prospectively recruited. They underwent MRA examinations followed by wrist arthroscopy. Arthroscopic findings were compared with radiological findings focusing on three important structures – triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL). Results: For the 17 patients with TFCC tears/perforations on arthroscopy, MRA gave a sensitivity (SEN) = 88%, specificity (SPE) = 87.5%, positive predictive value (PPV) = 88%, and negative predictive value (NPV) = 87.5%. For the 13 patients with SLL tears on arthroscopy, MRA gave SEN = 77%, SPE = 100%, PPV = 100%, and NPV = 87%. For the 7 patients with LTL tears on arthroscopy, MRA gave SEN = 29%, SPE = 100%, PPV = 100%, and NPV = 84%. A composite correlation between findings on MRA and wrist arthroscopy revealed an overall SEN = 73%, SPE = 96%, PPV = 93%, and NPV = 85% for MRA, with overall accuracy = 88%. Conclusions: The presented diagnostic results of MRA are superior to those of magnetic resonance imaging quoted in literature. MRA is a potent tool for evaluating chronic wrist pain but tends to miss lesions of intrinsic carpal ligaments (SLL and LTL) more than TFCC. Wrist arthroscopy may be recommended when the clinical suspicion is strong. [ABSTRACT FROM AUTHOR]

Background: Isolated injuries of the scapholunate interosseous ligament (SLIL) are insufficient to produce dorsal intercalated segment instability. There is no consensus about which additional ligamentous stabilizers are critical determinants of dorsal intercalated segment instability. The aim of this study was to evaluate the role of the long radiolunate (LRL), scaphotrapeziotrapezoid (STT), and dorsal intercarpal (DIC) ligaments in preventing dorsal intercalated segment instability.Methods: Thirty fresh-frozen forearms were randomized to 5 ligament section sequences to study the SLIL, LRL, STT, and DIC ligaments. The DIC-lunate insertion (DIC) and scaphoid insertion (DIC) were studied separately; the DIC insertions on the trapezium and triquetrum were left intact. Loaded posteroanterior and lateral fluoroscopic images were obtained at baseline and repeated after each ligament was sectioned. After each sequence, the wrists were loaded cyclically (71 N). The radiolunate angle was measured with load. Dorsal intercalated segment instability was defined as an increase of >15° in the radiolunate angle compared with baseline.Results: Division of the SLIL did not increase the radiolunate angle. Section of the SLIL+LRL or SLIL+DIC significantly increased the radiolunate angle but did not produce dorsal intercalated segment instability. Section of the SLIL+STT or SLIL+DIC+DIC produced dorsal intercalated segment instability.Conclusions: In order to produce dorsal intercalated segment instability, complete scapholunate injuries require the disruption of at least 1 critical ligament stabilizer of the scaphoid or lunate (the STT or DIC+DIC).Clinical Relevance: When treating SLIL tears with dorsal intercalated segment instability, techniques to evaluate the volar and dorsal critical stabilizers of the proximal carpal row should be considered. [ABSTRACT FROM AUTHOR]

Objectives: Peritrapezial osteoarthritis (OA) includes scaphotrapezial and trapeziometacarpal OA. In clinical practice, scaphotrapezial OA seems better tolerated than trapeziometacarpal OA, with fewer complaints and better tolerance. The difference in pain could be linked to a difference in joint capsule innervation, perhaps with fewer nerve fibers in the scaphotrapezial than the trapeziometacarpal joint., Materials and Methods: We performed a histologic evaluation of these two joints to compare their respective innervation in 17 cadaveric specimens with peritrapezial OA. Radiographic scoring confirmed the presence of peritrapezial OA. Mean Kellgren-Lawrence score was 2.2 ± 1.1 in the trapeziometacarpal joint and 1.5 ± 0.7 in the scaphotrapezial joint (p = 0.08)., Results: There was no difference between scaphotrapezial and trapeziometacarpal joints in number of neurofilaments: 5.2 ± 3.9 and 4.4 ± 4.5, respectively (p = 0.20). A significant difference was found in S100 staining (myelinated structures), with a higher rate in the scaphotrapezial joint: 11.8 ± 7.5 vs 6.6 ± 5.2 (p = 0.005)., Conclusion: The present study suggests that lower tolerance of trapeziometacarpal OA is not due to a difference in joint capsule innervation. On the contrary, we found a higher rate of myelinated tissues in the scaphotrapezial joint. These results suggested other pain pathways to explain clinical observations., (Copyright © 2023 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Objective: To determine if transdermally delivered fentanyl can achieve greater concentrations of fentanyl in synovial fluid when applied over a synovial structure., Study Design: Randomized, experimental study., Animals: Six healthy adult horses., Methods: Each horse had two 100 μg/h fentanyl matrix patches applied on the dorsal aspect of one, randomly assigned, carpometacarpal joint (CMCJ) for 48 h. Whole blood and bilateral synovial samples from the intercarpal joint were obtained at 0, 2, 6, 12, 24, 36 and 48 h. Fentanyl concentrations were measured with liquid chromatography-mass spectrometry., Results: All subjects achieved detectable concentrations of fentanyl in both plasma and synovial fluid. Time to peak synovial and plasma concentration was 12 h. At 6 h, the synovial concentration in the untreated carpus (0.104 ng/mL ± 0.106) was lower than plasma fentanyl concentrations 0.31 ± 0.27 (p = .036). At 12 h, both treated (0.55 ng/mL ± 0.3) and untreated (0.53 ng/mL ± 0.28) synovial fluid fentanyl concentrations were lower than plasma (0.87 ng/mL ± 0.48) concentrations (p < .001 and p = .001, respectively). Synovial concentrations of fentanyl did not differ between treated and untreated joints (p > 0.608 for all time points)., Conclusion: Application of fentanyl matrix patches directly over the CMCJ did not result in increased fentanyl concentrations in the synovial fluid of the treated intercarpal joint in normal horses., Clinical Significance: There is likely no analgesic advantage to placing fentanyl patches directly over the affected joint, as it did not result in increased synovial concentrations at the tested site., (© 2023 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)

OBJECTIVE To determine reference intervals for total nucleated cell count, total protein concentration, pH, RBC count, and percentages of neutrophils, lymphocytes, and large mononuclear cells in synovial fluid samples (SFSs) obtained from the carpal and tarsal joints of healthy swine. ANIMALS 54 healthy commercial finisher pigs that had no evidence of lameness or gross joint swelling. PROCEDURES Each pig was an esthetized, and SFSs were collected from I carpal and I tarsal joint for fluid analysis, cytologic evaluation, bacterial culture, and PCR analyses for common swine joint pathogens. Each pig was euthanized after SFS collection, and synovial tissue samples were collected for histologic assessment. If necessary, postmortem SFSs were collected. RESULTS Overall, 37 of 50 tarsal and 46 of 53 carpal SFSs met inclusion criteria of sufficient volume, no gross blood contamination, and negative results of bacterial culture and PCR analyses, and we re from joints with histologically normal synovial tissues. For the carpal and tarsal joints, upper reference limits were as follows: total nucleated cell count, 3,281 cells /µL and 2,368 cells/µL, respectively; total protein concentration, 3.6 g/dL and 3.6 g/dL, respectively; pH, 7.2 and 7.0, respectively; RBC count, 0.8 X 106 cells/µL and 0 .1 X 106 cells/µL, respectively; and percentage of neutrophils, 46.5% and 33.7%, respectively; percentage of lymphocytes, 40.6% and 56.3%, respectively; and percentage of large mononuclear cells, 92.0% and 95.3%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Results have provided reference intervals for selected variables in SFSs obtained from the carpal and the tarsal joints of healthy swine, which should be useful in diagnostic investigations of swine lameness and arthritis . [ABSTRACT FROM AUTHOR]

Objective: Intraarticular glucocorticoid injections are common in rheumatoid arthritis (RA) treatment. This study was undertaken to investigate whether ultrasound in combination with clinical examination is better than clinical examination alone at identifying joints that will benefit from intraarticular injections, and to compare the efficacy of ultrasound‐guided versus palpation‐guided procedures. Methods: In the treat‐to‐target Aiming for Remission in Rheumatoid Arthritis: a Randomised Trial Examining the Benefit of Ultrasonography in a Clinical Tight Control Regimen (ARCTIC), patients with early RA were randomized 1:1 to follow‐up with or without ultrasound. In addition to disease‐modifying antirheumatic drugs, intraarticular glucocorticoids were used to treat inflamed joints. The distribution of injections was assessed in both study groups. The relationship of clinical and ultrasound findings at the time of injection with treatment efficacy was examined, with non‐swollen joint at the next visit as the outcome measure. Treatment success was compared across study groups to evaluate ultrasound‐guided versus palpation‐guided procedures. Results: More injections were administered in the ultrasound group than in the conventional strategy group (n = 770 versus 548), especially in intercarpal joints (n = 58 versus 5) and metatarsophalangeal joints (n = 200 versus 104). Injecting clinically swollen joints without power Doppler (PD) activity on ultrasound was not efficacious compared to not injecting (odds ratio [OR] 1.3; P = 0.59). Efficacy was best in swollen joints (OR 9.0; P = 0.001) and non‐swollen joints (OR 8.4; P = 0.016) with moderate PD activity. Treatment success was similar for the ultrasound‐guided and palpation‐guided procedures. Conclusion: Our findings indicate that the efficacy of intraarticular glucocorticoid injections varies according to ultrasound findings at the time of injection, supporting the use of ultrasound as a tool to select joints that will benefit from intraarticular injections. However, ultrasound needle guidance was not superior to palpation guidance. [ABSTRACT FROM AUTHOR]

Study Design Descriptive Epidemiological Study. Introduction Ligament tears between carpal bones are easily missed on initial presentation, but can have potentially debilitating effects on the patient if they progress to an instability. They are usually the result of a fall onto an outstretched hand with the wrist in hyperextension. Current incidence of carpal instability after these falls is unknown. Purpose of the Study Using established clinical and radiological measures, we sought to establish the cumulative incidence of carpal instability in people who have fallen onto an outstretched hand in the second year after injury. We also sought to describe its relationship with functional impairment. Methods We used emergency department records of an inner-urban tertiary hospital to contact all patients who presented with wrist pain following fall onto outstretched hand who were between one and two years after injury. Carpal instability was defined by blinded radiological evaluations and provocative clinical tests, including Scaphoid Shift (Watson’s) test, Ballottement, and mid-carpal shift test. Wrist-related pain and disability was measured using the Patient-Rated Wrist and Hand Evaluation. Results Of the 279 potentially eligible cases, only 146 were contactable, and fifty (28 male, 22 female; mean age of 48 years) attended for assessment. We found a cumulative incidence of 44% of carpal instability within the second year after injury. Of these, 12 (24%) cases had scapho-lunate instability, 12 (24%) had luno-triquetral instability and 7 (14%) had mid-carpal instability. There were no significant correlations between clinically confirmed carpal instability and pain, function, or work participation. Discussion and Conclusion This study found a higher than anticipated cumulative incidence of carpal instability in the second year after injury, which may reflect volunteer bias. Patients should be advised to monitor symptoms in the year after injury and seek a review if symptoms of pain, clicking or clunking arise. Level of Evidence II [ABSTRACT FROM AUTHOR]

Introduction: In the current literature, there is no consensus of using tendons vs ligaments as a graft source for joint reconstruction. The aim of this review is to determine the potential superiority of tendons vs ligaments in joint reconstruction. Methods: A literature search was performed to find relevant articles exploring the properties of tendons and ligaments. Functional, structural (gross and histological), biochemical, and biomechanical properties were compared. Results: Tendons have a stiffer structure to hold muscle to bone whereas ligaments have a more elastic structure to allow for movement between bones. Ligaments have a narrower crimp distance, ovoid cells, and a higher concentration of alpha smooth muscle associated with higher elasticity and tolerated strain. It has been shown that tendons undergo "ligamentization" when used to reconstruct ligaments. However, even after remodelling, important differences still persist, never reaching the functional status of the intact ligament. Conclusions: There is a theoretical clinical advantage of using ligaments as a graft source in complex multiaxial joints where stretching and full range of motion (ROM) is crucial (e.g. radiocarpal, carpal joints). Tendon grafts may be more desirable in lower limb reconstructions and in mainly uniaxial joints where excessive and constant vector of stress is applied. Level of evidence: IIIa. [ABSTRACT FROM AUTHOR]

Background: Increased motion at the scaphotrapeziotrapezoidal (STT) joint and compensatory hypermobility of metacarpophalangeal (MP) joint contribute to the total abduction and adduction motion of the thumb after trapeziometacarpal (TM) joint arthrodesis. However, there were no detailed studies to evaluate the contribution of motion of each joint towards total thumb mobility.Methods: We conducted a comparative study on thumb joint motion in 56 hands who underwent TM joint arthrodesis against that of 56 hands in normal subjects. Dynamic radiographs were performed and the angles subtended by the first (M1) and second (M2) metacarpals were to measure radial abduction and adduction, and volar abduction and adduction. In addition, angles subtended by the thumb proximal phalanx (P1) and M1 in abduction and adduction were measured to evaluate the hypermobility of the MP joint.Results: The average total arcs of M1M2 motion in normal subjects in radial and volar abduction-adduction planes were 24° and 35° respectively. The arthrodesis group averaged 9° of motion in the radial abduction and adduction plane and 8° in the volar abduction and adduction plane. P1M1 volar adduction angle was significantly larger in the arthrodesis group, suggesting that the arthrodesis group had larger compensatory motion of the MP joint in volar adduction compared to normal subjects.Conclusions: These findings on the amount of hypermobility of MP joint after TM joint arthrodesis are valuable information for optimal postoperative rehabilitation protocol. To achieve good range of motion of thumb abduction and adduction following TM joint arthrodesis, emphasis must be placed in obtaining maximum potential motion of STT joint rather than hypermobility of MP joint. [ABSTRACT FROM AUTHOR]

Scapholunate interosseous ligament injuries are prevalent and often challenging to diagnose radiographically. Four-dimensional CT allows visualization of carpal bones during motion. We present a cadaveric model of sequential ligamentous sectionings ("injuries") to quantify their effects on interosseous proximities at the radioscaphoid joint and scapholunate interval. We hypothesized that injury, wrist position, and their interaction affect carpal arthrokinematics. Eight cadaveric wrists were moved through flexion-extension and radioulnar deviation after injuries. Dynamic CT images of each motion were acquired in each injury condition using a second-generation dual-source CT scanner. Carpal osteokinematics were used to calculate arthrokinematic interosseous proximity distributions during motion. Median interosseous proximities were normalized and categorized by wrist position. Linear mixed-effects models and marginal means tests were used to compare distributions of median interosseous proximities. The effect of wrist position was significant for both flexion-extension and radioulnar deviation at the radioscaphoid joint; the effect of injury was significant for flexion-extension at the scapholunate interval; and the effect of their interaction was significant for radioulnar deviation at the scapholunate interval. Across wrist positions, radioscaphoid median interosseous proximities were less able to distinguish injury conditions versus scapholunate proximities. Median interosseous proximities at the scapholunate interval are majoritively able to detect differences between less (Geissler I-III) versus more (Geissler IV) severe injuries when the wrist is flexed, extended, and ulnarly-deviated. Dynamic CT enhances our understanding of carpal arthrokinematics in a cadaveric model of SLIL injury. Scapholunate median interosseous proximities in flexion, extension, and ulnar deviation best demonstrate ligamentous integrity. • Cadaveric scapholunate ligament injury can be simulated under ultrasound guidance. • Dynamic CT-assessed carpal motion can serve as a biomarker for ligament integrity. • Ligament injuries modify radioscaphoid and scapholunate interosseous proximities. • Injury location within the scapholunate ligament affects carpal kinematics. [ABSTRACT FROM AUTHOR]

From the perspective of a multidisciplinary team, the authors describe the first reported use of ultrasound guidance for steroid injection into the pisotriquetral joint to relieve wrist pain of a person with spinal cord injury undergoing acute inpatient rehabilitation. Musculoskeletal ultrasound guidance was used to improve the accuracy of a corticosteroid injection of the pisotriquetral joint and the basal thumb in a 70-year-old man with paraplegia experiencing multifocal degenerative wrist pain. There was no bleeding or bruising after the injections, and the patient reported complete pain resolution 1 wk after the injections, which continued for over 1 yr. A multidisciplinary team was key in diagnosis, selection of treatment, and evaluation of treatment effect. Corticosteroid injection of the pisotriquetral joint under ultrasound guidance can be used as a treatment modality for managing wrist pain stemming from that joint. Further investigation and studies evaluating the use of ultrasound versus other imaging modalities for injection of the wrist are indicated. [ABSTRACT FROM AUTHOR]

The carpus is a complex articulation, which is often involved in injuries in equine athletes. The objective of this study was to suggest a didactic approach for ultrasonography training for the examination of the carpal joint in horses. Ultrasonograhy examination was performed in a healthy 14-year-old horse. The images were compared with those of a dissected anatomic specimen of the carpal region of a senior horse and with those reported in the literature. Identifiable structures were as follows: (dorsal) tendon of the muscle extensor carpi radialis, tendon of the muscle extensor carpi obliquus, tendon of the muscle commom digital extensor, dorsal synovial outpouchings, joint capsule and fat cushion, (lateral) tendon of the muscle lateral digital extensor, lateral collateral ligament (deep and superficial components), (medial) medial collateral ligament (deep and superficial components) and (palmar) palmar intercarpal ligament, carpal sheath, carpal tunnel, superficial digital flexor tendon, proximal origin of the deep digital flexor tendon, and palmar carpal ligament. Prior knowledge of the anatomy in combination with the study of anatomical specimens is essential for recognizing musculoskeletal structures during ultrasound examination, contributing to the training and learning processes. [ABSTRACT FROM AUTHOR]

Orthopedic abnormalities of farmreared blue foxes (Vulpes lagopus) have increased recently, creating new concerns about their welfare. Therefore, skeletal condition of obese juvenile blue foxes was evaluated for relationships to degree of obesity. Two pilot study groups included less obese foxes (N = 5) and more obese foxes (N = 5); the latter group had visible carpal joint laxity and locomotor deficits. The principal aims were to examine forelimb deformities and abnormal locomotion in light of degree of obesity. Overt and incipient (mild or developing) pathology were prevalent and reflected degree of obesity. It is likely that genetic selection and feeding practices were primary underlying problems, but disrupted mineral nutrition and housing practices may have been involved as well. These observations underscore the importance of new actions and additional studies of breeding, nutrition, and housing practices, with the ultimate goal of enhancing the welfare of farmed foxes. [ABSTRACT FROM AUTHOR]

We report a rare case of dislocation of second to fourth carpometacarpal (CMC) joints of the right hand with combined dorsal and ulnarward displacement of the second to fourth digits and fracture of the shaft of the first metacarpal associated with degloving injury. These injuries were diagnosed early and treated successfully with closed reduction and internal fixation using Kirschner wires. The functional outcome was good at follow-up at 5 years. A high index of suspicion is required to successfully diagnose and treat this condition. [ABSTRACT FROM AUTHOR]

Numerous surgical procedures have been described to treat trapeziometacarpal osteoarthritis, but no approach is currently considered superior. Good long-term outcomes have been reported with multiple procedures. No studies have been published comparing outcomes of the Arpe joint replacement (Biomet, Valence, France) with those of ligament reconstruction and tendon interposition (LRTI) using the Burton-Pellegrini technique. The study objective was to compare clinical outcomes between these techniques. Sixty-five patients with Eaton stage III osteoarthritis of the thumb were included in this retrospective follow-up study. Patients were assigned to LRTI (LRTI group) or total joint replacement (Arpe group) and were followed for a mean of 4.8 years. The LRTI group included 34 patients and the Arpe group included 31. Clinical outcome variables were determined preoperatively and every 6 months postoperatively. Pain relief and functional improvement were similar between groups. Pinch strength and range of motion were superior in the Arpe group. Metacarpophalangeal hyperextension appeared to be prevented in the Arpe group but increased over the follow-up period in the LRTI group. However, the complication rate was higher in the Arpe group. Arthroplasty with the Arpe prosthesis can be considered in selected patients who require greater strength and range of motion, although it has been associated with a higher complications rate. [Orthopedics. 2017; 40(4):e681-e686.]. [ABSTRACT FROM AUTHOR]

Background: Congenital carpal coalition is usually seen as an incidental finding. The incidence of carpal coalition has been reported from 0.1 to 9.5 %; highest incidence has been reported in people of African descent. The purpose of our study is to evaluate the incidence and subtypes of carpal coalition in an Asian population. Methods: Review of the radiographs of the patients in our distal radius fracture database from 2009 to 2014 was conducted to determine the incidence and type of carpal coalition. Results: 4141 patients' wrist radiographs were reviewed. 2 cases of carpal coalition were identified; this leads to an incidence of 0.048%. One was of luno-triquetral type and the other was of capito-hamate type. Conclusions: The preliminary results of our study indicate that carpal coalition in the Asian population is less common than that reported in the Western literature. Our results are inconclusive as to the type of carpal coalition that is more common. [ABSTRACT FROM AUTHOR]

Hamate-pisiform coalition is an exceptional form of carpal coalition. Case reports are essential to gain a better understanding of this variant. We report a case of congenital bilateral hamate-pisiform coalition in a 20-year-old male discovered in the context of a right wrist trauma. Radiographs also revealed a bilateral scapholunate diastasis. Clinical examination and radiological findings suggested that the right wrist scapholunate diastasis was related to scapholunate instability. Left wrist scapholunate diastasis could be related to (1) a pathological feature or (2) a normal variant associated with hamate-pisiform coalition. Lateral radiographs showed a volar C-shaped osseous bridge corresponding to the coalition. We associated it with a new sign: the "carpal C-sign". Computed tomography with three-dimensional reconstruction provides helpful information about the type of coalition (osseous versus non-osseous) and excludes potential fracture. We discuss the specific embryologic features of the hamate-pisiform coalition, as well as its prevalence, radiographic classification, clinical significance, and treatment. [ABSTRACT FROM AUTHOR]