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Alam M, Merza Abdulla Mohamed A, Alawainati M, Haider F. The Use of Platelet-Rich Plasma in De Quervain's Tenosynovitis: A Systematic Review. Cureus 2024; 16:e74232. [PMID: 39712795 PMCID: PMC11663418 DOI: 10.7759/cureus.74232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2024] [Indexed: 12/24/2024] Open
Abstract
De Quervain's disease (DQVD) is the stenosing tenosynovitis of tendons in the first extensor compartment of the forearm. It is a common inflammatory condition that is often treated conservatively. While conservative therapy is an effective modality of treatment for a large number of patients suffering from DQVD, some patients do not improve with conservative measures. Many alternative treatment modalities are recognized in the treatment of DQVD. One of the non-surgical treatment strategies that is currently on the rise is platelet-rich plasma (PRP) injections into the first dorsal extensor compartment. It is thought that PRP injections contain growth factors that may provide a regenerative stimulus to tendon healing. Various studies evaluated as a treatment modality for different tendinopathies including DQVD. There remains, however, controversy as to the efficacy of its benefit and efficacy in treating DQVD. This paper is a systematic review of the literature conducted to evaluate the effectiveness of PRP in the treatment of DQVD. The review was conducted in line with PRISMA guidelines for systematic reviews. The review included a systematic search through PubMed, Embase, Cochrane Library, Medline, Amed, and the Web of Sciences, and was supplemented by manual search through other published online resources. The period of search was defined as January 2013 to October 2023, and the search included all studies that evaluated the use of PRP in the treatment of DQVD. A total of 1,029 records were screened; only eight studies met the inclusion criteria and were included in the study. Three randomized clinical trials and five experimental studies were included in the review. A systematic review of the evidence suggested that PRP is a promising and safe alternative to conventional steroid injections in the treatment of De Quervain's tenosynovitis. Further large sample studies are needed prior to the definitive recommendation of PRP as the gold standard for the treatment of De Quervain's tenosynovitis.
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Affiliation(s)
- Mahmood Alam
- Orthopedics and Trauma, Salmaniya Medical Complex, Manama, BHR
| | | | - Mahmood Alawainati
- Medicine, Royal College of Surgeons in Ireland, Manama, BHR
- Family Medicine, Primary Healthcare Centers, Manama, BHR
| | - Fayza Haider
- Pediatric Surgery, Salmaniya Medical Complex, Manama, BHR
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, BHR
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Bajaj S, Chhabra A, Taneja AK. 3D MRI of the Wrist: Anatomy and Clinical Applications With Comparison to 2D MRI. Semin Roentgenol 2024; 59:429-446. [PMID: 39490038 DOI: 10.1053/j.ro.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 11/05/2024]
Affiliation(s)
- Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Atul Kumar Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX.
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Godoy IRB, Yamada AF, Dilda G, Serfaty A, Skaf A, Cantarelli Rodrigues T. MRI findings of closed hand injuries in adolescent goalkeepers: a case-based review. Skeletal Radiol 2024; 53:1243-1254. [PMID: 38057436 DOI: 10.1007/s00256-023-04531-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
Soccer-related injuries in youth goalkeepers are underrepresented in epidemiological studies, despite goalkeepers experiencing distinct types of upper limb injuries and training loads compared to outfield players. Digit injuries are particularly prevalent, with up to five times more upper extremity injuries reported in this position. Such injuries can lead to interphalangeal joint instability and an increased risk of reinjury. Mechanisms of injury include falls, axial loading of digits, and rotational force due to grasping activities. The proximal interphalangeal joint is the most frequently injured in sports, followed by the metacarpophalangeal joint of the thumb. Achieving precise diagnosis can be challenging due to the complex soft-tissue anatomy of the hand. Radiologists play a crucial role in accurate diagnosis through imaging studies, enabling timely treatment. This article focuses on closed traumatic finger and thumb injuries in adolescent goalkeepers, describing injury mechanisms and outlining relevant MRI features to facilitate proper clinical approaches for diagnosis based on imaging findings.
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Affiliation(s)
- Ivan Rodrigues Barros Godoy
- Department of Radiology, Hospital Do Coração (HCor), São Paulo, SP, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
- Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - André Fukunishi Yamada
- Department of Radiology, Hospital Do Coração (HCor), São Paulo, SP, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
- Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil
- Sociedade Esportiva Palmeiras, São Paulo, SP, Brazil
| | | | | | - Abdalla Skaf
- Department of Radiology, Hospital Do Coração (HCor), São Paulo, SP, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Tatiane Cantarelli Rodrigues
- Department of Radiology, Hospital Do Coração (HCor), São Paulo, SP, Brazil.
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil.
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Krueckel J, Szymski D, Lenz J, Fluegel J, Weber J, Achenbach L, Meffert R, Alt V, Fehske K. Tennis Injuries Among German League Players: Investigating Patterns and Epidemiology of Acute and Chronic Injuries. Open Access J Sports Med 2024; 15:67-75. [PMID: 38975566 PMCID: PMC11226988 DOI: 10.2147/oajsm.s460907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/07/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose While injuries among elite tennis athletes are extensively documented, a notable research gap exists regarding tennis injuries among club-level players. This study examines tennis injuries in German league players, with a particular emphasis on the impact of racquet properties and court surfaces, distinguishing between chronic and acute injuries. Patients and Methods Retrospectively analyzing data from 600 tennis players over a 1.5-year period, a standardized questionnaire covered anthropometrics, injury characteristics, equipment usage, and court surface conditions. Results The study identified 1012 tennis-related injuries, averaging 1.7 per player. Acute injuries predominantly affected the lower extremity (56%), with ankle injuries being the most prevalent, and ligaments were the most commonly affected structures (36.4%). Chronic complaints (reported by 364 athletes) focused on the upper extremity (63.2%), primarily tendon injuries (56.8%). Racket properties exhibited no significant impact on chronic upper extremity injuries. Conclusion This study highlights a high incidence of acute lower extremity injuries, especially ankle ligament injuries, among German league tennis players. It offers crucial insights for devising targeted injury prevention strategies applicable to amateur, semi-professional, and professional tennis players, despite finding no significant link between racquet material and chronic upper extremity injuries.
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Affiliation(s)
- Jonas Krueckel
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Julia Lenz
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Julian Fluegel
- Department of Orthopaedic Surgery, Arcus Clinics Pforzheim, Pforzheim, Germany
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Leonard Achenbach
- Department of Orthopaedic Surgery, Koenig Ludwig Haus Wuerzburg, Wuerzburg, Germany
| | - Rainer Meffert
- Department of Trauma Surgery, University Hosptial Wuerzburg, Wuerzburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Kai Fehske
- Department of Trauma Surgery, University Hosptial Wuerzburg, Wuerzburg, Germany
- Department of Orthopedic and Trauma Surgery, Johanniter Waldkrankenhaus Bonn, Bonn, Germany
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Mitchell AJ, Ablove RH, Bradley E. Optimal Immobilization After Fixation of Bennett's Fracture: A Cadaveric Study. Orthopedics 2024; 47:157-160. [PMID: 38147495 DOI: 10.3928/01477447-20231220-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Treating high-level athletes involves a balance between early and safe return to play. Various types of protective immobilization have been recommended after operatively treated Bennett's fracture. The purpose of this study was to investigate if hand-based immobilization offers protection equivalent to forearm-based immobilization. MATERIALS AND METHODS A cadaveric model of Bennett's fracture was created in 8 fresh-frozen, cadaveric forearms. Osteosynthesis was performed using a single headless compression screw. Three matched pairs were casted in either hand-based or forearm length, thumb spica casts, while 2 specimens remained un-casted as controls. Specimens were mounted on a custom testing apparatus. Weights were added in 6.8-kg increments until fixation failed and the fracture displaced. Fluoroscopy was performed after each trial. We used the Kruskal-Wallis non-parametric test to compare the groups. We considered P<.05 statistically significant. RESULTS Failure of fixation occurred at 6.8 kg in the control specimens. Fixation failed in hand-based and forearm length casts at a mean of 18.1±5.1 kg. We did not find a statistically significant difference between median values of load at failure in kilograms across control specimens and 2 immobilization categories (P=.114). All specimens in the hand-based group sustained additional wrist injuries, while no additional injuries were noted in the forearm length group. CONCLUSION Our study results showed that hand-based immobilization provides equivalent protection against fixation failure for operatively treated Bennett's fractures but may predispose athletes to increased risk of wrist injury compared with traditional, forearm-based casting. [Orthopedics. 2024;47(3):157-160.].
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Della Rosa N, Vita F, Pederiva D, Pilla F, Donati D, Faldini C, Adani R. Combined repair of scapholunate ligament (SL) and triangular fibrocartilage complex (TFCC) lesions in chronic trauma of the wrist: surgical treatment of 14 patients. Musculoskelet Surg 2024; 108:69-75. [PMID: 37227663 DOI: 10.1007/s12306-023-00787-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Injuries of the scapholunate ligament (SL) and of the triangular fibrocartilage complex (TFCC) represent the main ligament injuries of the traumatic wrist. A double injury of the SL and TFCC ligaments is quite common in the trauma setting, and clinical examination is fundamental. MRI allows to detection of a TFCC and SL ligament injury, but wrist arthroscopy is still the gold standard for diagnosis. We present the clinical results of the combined reconstruction of chronic scapholunate ligament and TFCC injury. MATERIALS AND METHODS Fourteen patients were treated at our hospital with a combined scapholunate ligament and TFCC complex repair. All patients were surgically treated by the same senior author, after a diagnostic arthroscopy that revealed a lesion of both structures. A comparison between the pre-operative and post-operative pain and function was carried out using VAS, Disability of Arm, Shoulder and Hand score (DASH) and Patient-Related Wrist/Hand Evaluation score (PRWHE). Wrist range of motion and strength were also compared following surgery. RESULTS All patients had a mean follow-up of 54 months. A statistically significant improvement was observed both with the reduction in pain (VAS from 8.9 to 5) and with the improvement of functionality scores (DASH from 63 to 40 and PRWHE from 70 to 57) and with the increase in ROM and strength. In only one patient (7%), because of pain and instability, a supplement operation was needed (Sauve-Kapandji procedure) 3 months after the initial surgery. CONCLUSIONS The simultaneous repair of the SL and TFCC complex has shown a good success rate in both decreasing pain and regaining functionality.
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Affiliation(s)
- Norman Della Rosa
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Fabio Vita
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy.
| | - Davide Pederiva
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Federico Pilla
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Danilo Donati
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
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Sekiguchi T, Saito S, Ogura T, Tsuchiya A, Shiratsuchi H. Abnormal Wrist Sagittal Kinematics in Gymnasts With Dorsal Wrist Pain: A New Syndrome. Am J Sports Med 2024; 52:232-241. [PMID: 38164673 DOI: 10.1177/03635465231204361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The pathology of dorsal wrist pain in gymnasts without abnormal radiographic findings remains unclear. PURPOSE/HYPOTHESIS The purpose of this study was to identify abnormal wrist sagittal kinematics in gymnasts with dorsal wrist pain. It was hypothesized that gymnasts with dorsal wrist pain would show abnormal sagittal kinematics with reversible hypermobility of the intercarpal joint. STUDY DESIGN Controlled laboratory study. METHODS Participants included 19 wrists in male gymnasts with dorsal wrist pain, 18 wrist in male gymnasts without wrist pain, and 20 adult men without a history of wrist pain. Magnetic resonance imaging (T2-weighted sagittal images) findings at 0°, 30°, 60°, and 90° of wrist extension were used in kinematic analysis. The angles and translations of the radiolunate, capitolunate, and third carpometacarpal joint were measured and compared between the 3 groups. RESULTS At 90° of wrist extension, gymnasts with dorsal wrist pain had a significantly lower radiolunate joint angle (28.70°± 6.28° vs 36.19°± 7.81°; P = .020) and a significantly higher capitolunate joint angle (57.99°± 6.15° vs 50.50°± 6.98°; P = .004) and distal translation (1.17 ± 0.50 mm vs 0.46 ± 0.62 mm; P = .002) than gymnasts without dorsal wrist pain. CONCLUSION Gymnasts with dorsal wrist pain showed abnormal wrist sagittal kinematics. These novel findings may facilitate understanding of dorsal wrist pain, which can be recognized as a new syndrome termed "gymnast's lunate dyskinesia."
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Affiliation(s)
- Takahiro Sekiguchi
- Department of Rehabilitation, Funabashi Orthopaedic Clinic, Funabashi, Chiba, Japan
| | - Shinobu Saito
- Japan Community Health care Organization (JCHO) Tokyo Joto Hospital, Koto-ku, Tokyo, Japan
| | - Takahiro Ogura
- Sports Medicine Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Akihiro Tsuchiya
- Sports Medicine Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
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Zamri M, Lans J, Eberlin KR, Garg R, Jupiter JB, Chen NC. Reintervention, PROMs, and Factors Influencing PROMs Following Surgery for de Quervain's Tenosynovitis. J Hand Microsurg 2023; 15:165-174. [PMID: 37388568 PMCID: PMC10306984 DOI: 10.1055/s-0041-1731105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Objective The aims of this study are to describe and identify the factors that influence patient reported outcomes following surgery of de Quervain's tenosynovitis. The secondary objective is to report the rate of reintervention following surgery of de Quervain's tenosynovitis. Patients and Methods Outcomes using the numerical rating scale (NRS) for pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), the Patients Reported Outcome Measurement Information System Pain Interference (PROMIS PI), and a custom de Quervain's questionnaire were obtained. A multivariable linear regression analysis was performed to identify independent factors associated with patient-reported outcomes. Results Seventy-six patients who underwent de Quervain's release participated. The average age was 52.8 years (95% confidence interval: 49.6-56.1) and median follow-up age was 7.0 years (interquartile range [IQR]: 4.3-12.0). Outcomes were: NRS of pain was 0 (IQR: 0.0-3.0), the median QuickDASH was 6.82 (IQR: 0.00-28.41), the median PRWE score was 4.0 (IQR: 0.00-18.50), and the median PROMIS PI score was 43.90 (IQR: 38.70-53.90). Eighteen (23.7%) of the patients reported pain with thumb activities, four of whom had a reintervention. Additionally, 21 (26.9%) patients reported decreased strength in the thumb compared to the contralateral side, of which two underwent a reintervention. In total, eight patients underwent reintervention of which seven had a second surgery and one had a cortisone injection. Conclusion Roughly 1 in 20 patients following de Quervain's release undergoes reintervention. Patients with high PROMIS PI scores report poor surgical outcomes more frequently. Patients with high PROMIS PI scores report higher NRS pain scores ( p < 0.05), higher QuickDASH scores ( p < 0.05), and higher PRWE scores ( p < 0.05). In practice, careful consideration of PROMIS PI scores and psychosocial factors are recommended before considering reintervention.
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Affiliation(s)
- Meryam Zamri
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Jonathan Lans
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Kyle R. Eberlin
- Hand Surgery Service, Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Rohit Garg
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jesse B. Jupiter
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Neal C. Chen
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Hanson ZC, Thompson RG, Andrews JR, Lourie GM. Boutonniere Versus Pseudoboutonniere Deformities: Pathoanatomy, Diagnosis, and Treatment. J Hand Surg Am 2023; 48:489-497. [PMID: 36593154 DOI: 10.1016/j.jhsa.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 03/07/2022] [Accepted: 10/28/2022] [Indexed: 01/01/2023]
Abstract
Finger injuries involving the proximal interphalangeal (PIP) joint are common, particularly among athletes. Injury severity is often underappreciated at initial presentation and may be dismissed broadly as a "jammed finger" injury. Delayed diagnosis and treatment of certain injuries can have an important impact on the patient's chance of regaining full function. Central slip and PIP volar plate injuries are frequently encountered injuries that, if left untreated, can lead to the permanent loss of function of the proximal interphalangeal joint. Despite the differing mechanisms of these 2 pathologies, volar plate hyperextension injuries often present with a PIP joint flexion contracture and mild distal interphalangeal joint hyperextension deformity. This is similar to a boutonniere deformity seen after an injury to the central slip, and thus, has been referred to as a "pseudo-boutonnière" deformity. Distinguishing these 2 diagnoses is important, as treatment differs, and highlights the importance of thoroughly understanding the anatomy and relevant clinical applications when evaluating PIP joint injuries.
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Affiliation(s)
- Zachary C Hanson
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA.
| | - Robert Gil Thompson
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA
| | - James R Andrews
- Division for Orthopaedics and Sports Medicine, The Andrews Institute, Gulf Breeze, FL
| | - Gary M Lourie
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA; Orthopaedic Hand Surgery, The Hand & Upper Extremity Center of Georgia, Atlanta, GA
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Flores DV, Umpire DF, Rakhra KS, Jibri Z, Belmar GAS. Distal Radioulnar Joint: Normal Anatomy, Imaging of Common Disorders, and Injury Classification. Radiographics 2023; 43:e220109. [DOI: 10.1148/rg.220109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dyan V. Flores
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Darwin Fernández Umpire
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Kawan S. Rakhra
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Zaid Jibri
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Gonzalo A. Serrano Belmar
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
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The Role of the Hand Surgery Consultant in the Care of the Football Athlete. Sports Med Arthrosc Rev 2022; 30:184-188. [DOI: 10.1097/jsa.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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Dittman LE, Kakar S. CMC Mimickers: Differential Diagnosis and Work-Up for Radial-Sided Wrist Pain. Hand Clin 2022; 38:149-160. [PMID: 35465933 DOI: 10.1016/j.hcl.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In patients with radial-sided wrist pain, a myriad of possible etiologies exists and as such, a detailed history, examination, and, where indicated, imaging is obtained to try and aid with its diagnosis. The purpose of this article is to provide an overview of radial-sided wrist pain, diagnostic modalities and discuss current treatment options. More detailed information is out-of-scope for this article and if needed, we would guide the reader to seek out other selected texts, as indicated.
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Affiliation(s)
| | - Sanjeev Kakar
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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13
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Hanson ZC, Lourie GM. Middorsal Wrist Pain in the High-Level Athlete: Causes, Treatment, and Early Return to Play. Orthop J Sports Med 2022; 10:23259671221088610. [PMID: 35480067 PMCID: PMC9036339 DOI: 10.1177/23259671221088610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
Wrist injuries in the competitive athlete are a common reason for evaluation related to an acute injury or after symptoms have become chronic. While radius- and ulna-sided wrist pain are common topics covered in the literature, middorsal wrist pain is more common than the available literature would suggest. Missed diagnoses and inadequate treatment can significantly increase athlete morbidity and delay return to play. The goal of this article was to review the differential diagnosis of middorsal wrist pain in the athlete and discuss the diagnosis, treatment, and early return to play for each condition.
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Affiliation(s)
- Zachary C. Hanson
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Gary M. Lourie
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
- The Hand & Upper Extremity Center of Georgia, Atlanta, Georgia, USA
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Christen S, Vögelin E. Sonography, My Personal Assistant at Hand Outpatient Clinic. Hand Clin 2022; 38:19-29. [PMID: 34802605 DOI: 10.1016/j.hcl.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ultrasonography in hand surgery offers the option of imaging trauma consequences or degenerative problems in the wrist and fingers, involving bones, joints, ligaments, tendons, annular pulley, carpal and digital changes, soft masses, and foreign bodies including dynamic changes during motion. In the hands of the treating surgeon, ultrasonography allows immediately to plan conservative treatment versus surgery, to precisely infiltrate joints or tendon spaces as well as to perform miniinvasive assisted surgery.
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Affiliation(s)
- Samuel Christen
- Hand, Plastic and Reconstructive Surgery, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007 St.Gallen, Switzerland
| | - Esther Vögelin
- Hand Surgery and Surgery of Peripheral Nerves, Plastic and Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland.
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15
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Flynn LS, Richard GJ, Vincent HK, Bruner M, Chen C, Matthias RC, Zaremski JL, Farmer KW. Swing Type and Batting Grip Affect Peak Pressures on the Hook of Hamate in Collegiate Baseball Players. Orthop J Sports Med 2021; 9:23259671211060807. [PMID: 34926710 PMCID: PMC8671670 DOI: 10.1177/23259671211060807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background Bat swing and grip type may contribute to hook of hamate fractures in baseball players. Purpose To compare the effects of swing type and batting grip on the pressure and rate of pressure development over the hook of hamate in collegiate baseball players. Study Design Descriptive laboratory study. Level of evidence, 3. Methods This was an experimental quasi-randomized study of bat grip and swing differences in National Collegiate Athletic Association Division I baseball players (N = 14; age, 19.6 ± 1.1 years [mean ± SD]). All participants performed swings under 6 combinations: 3 grip types (all fingers on the bat shaft [AO], one finger off the bat shaft [OF], and choked up [CU]) and 2 swing types (full swing and check swing). Peak pressure and rate of pressure generation over the area of the hamate were assessed using a pressure sensor fitted to the palm of the bare hand over the area of the hamate. Wrist angular velocities and excursions of radial ulnar deviation were obtained using 3-dimensional motion analysis. Results The OF-check swing combination produced the highest peak pressure over the hamate (3.72 ± 2.64 kg/cm2) versus the AO-full swing (1.36 ± 0.73 kg/cm2), OF-full swing (1.68 ± 1.17 kg/cm2), and CU-full swing (1.18 ± 0.96 kg/cm2; P < .05 for all). There was a significant effect of condition on rate of pressure development across the 6 conditions (P = .023). Maximal wrist angular velocities were 44% lower in all check swing conditions than corresponding full swing conditions (P < .0001). The time to achieve the maximal wrist angular velocity was longest with the AO-full swing and shortest with the CU-check swing (100.1% vs 7.9% of swing cycle; P = .014). Conclusion The OF-check swing condition produced the highest total pressure reading on the hook of hamate. Check swing conditions also had the steepest rate of pressure development as compared with the full swing conditions. Clinical Relevance Batters who frequently check their swings and use an OF or AO grip may benefit from bat modifications or grip adjustment to reduce stresses over the hamate. Athletic trainers and team physicians should be aware of these factors to counsel players in the context of previous or ongoing hand injury.
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Affiliation(s)
| | - George J Richard
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Heather K Vincent
- Department of Physical Medicine and Rehabilitation, UF Health Sports Performance Center, University of Florida, Gainesville, Florida, USA
| | - Michelle Bruner
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Cong Chen
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert C Matthias
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Jason L Zaremski
- Department of Physical Medicine and Rehabilitation, UF Health Sports Performance Center, University of Florida, Gainesville, Florida, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
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17
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Öztürk T, Burtaç Eren M. Is it really safe to evaluate symptomatic extensor carpi ulnaris tendon instability by magnetic resonance imaging (MRI)? Acta Orthop Belg 2021. [DOI: 10.52628/87.2.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The extensor carpi ulnaris (ECU) tendon is in the sixth extensor compartment of the wrist and is isolated from other tendons by a different sheath. Extensor carpi ulnaris pathologies are characterized by pain locally localized to the wrist ulnar side. Outpatient records and wrist MRI (magnetic resonance imaging) tests were retrospectively scanned between January 2018 and July 2019. By examining the anamnesis and examination notes of the patients in the outpatient clinic records, patients with wrist ulnar side pain, pain or sensitivity on the ulnar styloid and provocation test (synergy) were assigned to the first study group (Group 1).The second study group was composed of patients who underwent wrist MR for the diagnosis or differential diagnosis of a synovial cyst around the wrist, without ulnar side pain (Group 2).While evaluating MR images in the axial plane, the depth and width of the ulnar groove, thickness of the ECU tendon were measured. The position of the ECU tendon relative to the ulnar groove and the forearm rotation during the shooting were recorded.105 cases evaluated, there were 41 cases in the symptomatic subgroup and 64 cases in the asymptomatic subgroup. Among all patients, the mean patient age was 38.05.In the evaluation according to whether cases were symptomatic or not, there was no significant relationship between being symptomatic and the degree of instability and MR withdrawal position.
Our study suggests that ECU instability in MR is not a specific condition, and detection of MR in instability may not be associated with a patient’s symptoms.
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18
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McCool L, Tonkin B, Guo D, Guo D, Senk A. Ultrasound Measurements of the First Extensor Compartment: Determining the Transection Limits for Ultra-minimally Invasive Release of De Quervain Tenosynovitis. Hand (N Y) 2021; 16:644-649. [PMID: 31540554 PMCID: PMC8461189 DOI: 10.1177/1558944719873435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: De Quervain syndrome is the second most common compressive tendinopathy. Although the length of the first extensor compartment (FEC) has been studied previously, there is no documented reported comparison study of short-axis and long-axis sonographic measurements. The thread technique, or Guo Technique, has been applied to carpal tunnel syndrome, trigger finger, and superficial peroneal compressive neuropathy. To perform this procedure, it is critically important to accurately identify the boundaries for transection. Methods: Twenty-one fresh frozen cadaver upper extremities were examined under ultrasound to determine the length of the extensor retinaculum (ER) over the FEC. Using the sonographic landmarks, the ERs were measured in short axis and long axis over their proximal to distal margins and from the distal margins to the distal edges of the radial styloids. These sonographic measurements were then compared with gross anatomical measurements. Results: The short-axis sonographic measurement of the ER on average was 22.53 mm (95% confidence interval [CI] = 20.79-24.05 mm). The long-axis sonographic measurement of the ER on average was 15.65 mm (95% CI = 13.70-17.78 mm). The average length of the ER by gross anatomical dissection was 22.40 mm (95% CI = 21.15-23.51 mm). Conclusions: The short axis is not significantly different from the gross anatomical measurement; however, the long axis is significantly lower than the gross anatomical measurement. The results support the idea that the short axis is more accurate than the long axis.
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Affiliation(s)
| | - Brionn Tonkin
- Minneapolis Veterans Affairs Medical Center, MN, USA
| | | | | | - Alexander Senk
- Minneapolis Veterans Affairs Medical Center, MN, USA,Alexander Senk, Department of Physical Medicine & Rehabilitation, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
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19
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Lin CC, Patel NA, Itami Y, McGarry MH, Shin SS, Lee TQ. Biomechanical Analysis of Thumb Ulnar Collateral Ligament Tear Kinematics. Hand (N Y) 2021; 16:467-473. [PMID: 31431075 PMCID: PMC8283111 DOI: 10.1177/1558944719868518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Thumb ulnar collateral ligament (UCL) injuries are common, but the kinematics of these injuries have not been comprehensively described, especially regarding kinematic changes with progressive UCL injury. Methods: Eleven cadaveric thumbs underwent kinematic testing under 4 conditions: intact, partial tear (50%) of the proper UCL, full tear of the proper UCL, and complete tear of both the proper and accessory UCL. Kinematic testing parameters included varus/valgus stress, pronation/supination, and volar/dorsal translation at -10 degree, 0 degree, 15 degree, and 30 degree of metacarpophalangeal flexion. Results: Partial tear of the proper UCL did not result in significant increases in laxity in any direction compared with intact (P ≥ .132). Full tear of the proper UCL resulted in a significant increase in valgus angulation (18.8° ± 1.7° vs 11.5° ± 1.5°; P = .024) and pronation (15.4° ± 2.5° vs 12.6° ± 2.3°; P = .034) at 30 degree of flexion relative to intact. Complete tear of both the proper and accessory collateral ligaments resulted in increased valgus angulation at all degrees of flexion (P < .001). Complete tear also resulted in a significant volar translation at 0 degree, 15 degree, and 30 degree of flexion (P ≤ .016). Conclusion: Partial tear of the proper UCL does not significantly affect the stability of the joint, but full tear of the proper UCL increases valgus instability at 30 degree of flexion. Complete tear of the UCL is necessary for increased varus/valgus instability at all degrees of flexion and results in significant increases in pronation/supination and volar translation.
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Affiliation(s)
- Charles C. Lin
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA,Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Nilay A. Patel
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA,Department of Orthopaedic Surgery, University of California Irvine, Orange, CA, USA
| | - Yasuo Itami
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA,Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Michelle H. McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Steven S. Shin
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, CA, USA,Steven S. Shin, Cedars-Sinai Kerlan-Jobe Institute, 6801 Park Terrace Drive #400, Los Angeles, CA 90045, USA.
| | - Thay Q. Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
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20
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Shin YE, Kim SJ, Kim JS, Kwak KY, Kim JH, Kim JP. Efficiency of magnetic resonance imaging for diagnosing unstable ligament injuries around the thumb metacarpophalangeal joint: A comparison to arthroscopy. J Orthop Surg (Hong Kong) 2021; 28:2309499020978308. [PMID: 33345693 DOI: 10.1177/2309499020978308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study aimed to assess the accuracy of MRI in identifying ulnar collateral ligament (UCL), radial collateral ligament (RCL), and volar plate (VP) injuries of the metacarpophalangeal joint (MCPJ) of the thumb by comparing with diagnostic arthroscopy. METHODS A total of 56 consecutive patients (56 thumbs) who underwent arthroscopy of MCPJ of thumb were enrolled. MRI findings reviewed by consensus reading of two blinded radiologists were compared with arthroscopic examination. Statistical data, including sensitivity, specificity, accuracy, were analyzed. Additionally, the performance characteristics between 3.0-tesla (39 thumbs) and 1.5-tesla (17 thumbs) MRI and acute (≤4 weeks after injury) and chronic (>4 weeks) injuries were compared. RESULTS Of the 56 thumbs, 38 thumbs (67.9%) showed complete correspondence between MRI and arthroscopic findings. The sensitivity, specificity and accuracy of MRI for detecting UCL injuries were 78.8%, 87.0%, and 82.1%, respectively. The sensitivity, specificity and accuracy of MRI for detecting RCL injuries were 85.7%, 91.4%, and 85.7%, respectively. The sensitivity, specificity, and accuracy of MRI for detecting VP injuries were 89.5%, 89.2%, and 81.0%, respectively. 3.0-tesla MRI showed higher correspondence with arthroscopic observation (76.9%) than 1.5-tesla MRI (47.1%) (p = 0.028). For acute injuries, 78.4% showed complete correspondence between MRI and arthroscopic findings, whereas 47.4% with chronic injuries revealed complete agreement (p = 0.019). CONCLUSION Overall, MRI is moderately effective in evaluating ligamentous lesions around MCPJ of thumb, but MRI is more sensitive in diagnosing acute injuries. Furthermore, 3.0-tesla MRI can provide results with better accuracy for diagnosing ligamentous lesions around MCPJ of thumb. However, the sensitivity and the specificity are not applicable to all ligament injuries, but only the severe one which would agree for surgical options.
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Affiliation(s)
- Yong-Eun Shin
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Sung-Joon Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Jeong-Sang Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Kwon-Young Kwak
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Ji-Hyo Kim
- Department of Teaching Education, College of Liberal Arts, Dankook University, Cheonan, Republic of Korea
| | - Jong-Pil Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
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21
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Erpala F, Ozturk T. "Snapping" of the extensor carpi ulnaris tendon in asymptomatic population. BMC Musculoskelet Disord 2021; 22:387. [PMID: 33902526 PMCID: PMC8077812 DOI: 10.1186/s12891-021-04271-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background Extensor carpi ulnaris tendinopathy (ECU) can be one cause of ulnar side wrist pain and it is more prominent in pronation-supination movements against resistance. In supination, flexion, and ulnar deviation within the ulnar groove, the tendon is tense and becomes predisposed to subluxation or dislocation. Snapping occurs during this dislocation and relocation. As a result of this friction between the tendon sheath and ulnar groove, tendinopathy and pain occur. ECU tendon is an important structure that contributes to the dynamic stability of wrist therefore resulting degeneration contributes disruption of distal radioulnar joint and causes wrist instability. Methods Participants without active wrist complaints who presented to the outpatient clinic between 2019 and 2020 were included. Provocation test was performed and participants with snapping were evaluated with ultrasound to determine subluxation or dislocation. Participants asked to indicate approximately how much time they spent daily on the phone, computer and game console. The distribution of data was evaluated with the Kolmogorov-Smirnov test. Quantitative data that were not normally distributed were evaluated using the Mann-Whitney U test, and Student’s t-test was used for normally distributed data. The Chi-square test was used to compare categorical variables. For all tests, p < 0.05 was considered statistically significant. Results Four hundred and fifteen women and 340 men were included in the study. Fifty of the 755 participants (6.6 %) had snapping. 22 of the 755 participants (2.9 %) had dislocation or subluxation on ultrasound. Three (13.6 %) participants had dislocation and 19 (%86.4) participants had subluxation on ultrasound. All 50 of the participants with snapping had significant repetitive trauma and sports activities. It was determined that 21 of the 22 participants who were found to have subluxation or dislocation by ultrasound had more than two hours of hobby activity and significantly more participants had more than two hours of activity compared to the group without subluxation or dislocation. Conclusions This study with a large number of participants will contribute to the literature in terms of evaluating the contribution of technological devices, such as computers, smartphones, and consoles to chronic wrist pain and the prevalence of ECU snapping in the asymptomatic population. Trial registration Date of Approval; 19.02.2019, Approval Number; 19-KAEK-045.
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Affiliation(s)
- Firat Erpala
- Department of Orthopaedics and Traumatology, Cesme Alpercizgenakat State Hospital, 35930, Izmir, Turkey.
| | - Tahir Ozturk
- Department of Orthopaedics and Traumatology, Gaziosmanpasa University, Tokat, Turkey
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22
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Patel H, Lala S, Helfner B, Wong TT. Tennis overuse injuries in the upper extremity. Skeletal Radiol 2021; 50:629-644. [PMID: 33009583 DOI: 10.1007/s00256-020-03634-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Tennis is a popular sport with high levels of participation. This article aims to describe how upper extremity overuse injuries occur in relation to tennis biomechanics and to review their imaging characteristics and implications for management. In particular, we will review the imaging patterns of internal impingement, scapular dyskinesis, lateral and medial epicondylitis, ulnar collateral ligament insufficiency, valgus extension overload, capitellar osteochondritis dissecans, extensor carpi ulnaris tendinosis and instability, tenosynovitis, triangular fibrocartilage complex injuries, and carpal stress injuries. CONCLUSION Tennis is a complex and physically demanding sport with a wide range of associated injuries. Repetitive overloading commonly leads to injuries of the upper extremity. An understanding of the underlying mechanisms of injury and knowledge of these injury patterns will aid the radiologist in generating the correct diagnosis in both the professional and recreational tennis athlete.
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Affiliation(s)
- Hanisha Patel
- New York Presbyterian Hospital - Columbia University Medical Center, 622 W 168th Street, New York, NY, 10032, USA.
| | - Sonali Lala
- Division of Musculoskeletal Radiology, New York Presbyterian Hospital - Columbia University Medical Center, 622 W 168th Street, New York, NY, 10032, USA
| | - Brett Helfner
- Zwanger and Pesiri Radiology, 150 Sunrise Hwy, Lindenhurst, New York, NY, 11757, USA
| | - Tony T Wong
- Division of Musculoskeletal Radiology, New York Presbyterian Hospital - Columbia University Medical Center, 622 W 168th Street, New York, NY, 10032, USA
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23
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Meirelles LM, Fernandes CH, Ejnisman B, Cohen M, dos Santos JBG, Faloppa F. Mudando os conceitos para o diagnóstico da Síndrome do Túnel do Carpo em atletas do halterofilismo do esporte adaptado. Rev Bras Ortop 2020; 55:755-758. [PMID: 33364655 PMCID: PMC7748937 DOI: 10.1055/s-0040-1709737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
Objective
To examine the prevalence of carpal tunnel syndrome in powerlifting athletes with disabilities.
Methods
The present study evaluated the presence and intensity of pain (numerical scale), nocturnal paresthesia (self-report), and nerve compression (Tinel and Phalen signs) in wheelchair- and non-wheelchair-bound powerlifting athletes with disabilities. The clinical diagnosis of carpal tunnel syndrome was confirmed by the presence of two or more signs/symptoms.
Results
In total, 29 powerlifting athletes with disabilities were evaluated. None of the athletes reported the presence of pain or nocturnal paresthesia. The Tinel sign was present in 1 (3.45%) wheelchair-bound athlete. A positive Phalen test was present in 3 (10.35%) athletes (1 wheelchair-bound and 2 non-wheelchair-bound). Concurrent positive Tinel sign and Phalen sign tests were found in 2 (6.89%) athletes (1 wheelchair-bound and 1 non-wheelchair-bound).
Conclusion
Carpal tunnel syndrome was clinically diagnosed in 2 (6.89%) out of 29 powerlifting athletes with disabilities.
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Affiliation(s)
- Lia Miyamoto Meirelles
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Carlos Henrique Fernandes
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Benno Ejnisman
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Moises Cohen
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Baptista Gomes dos Santos
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Flavio Faloppa
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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24
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Chambers SB, McGregor ME, Isa D, Langohr DG, Johnson JA, Suh N. Loading at the distal radius and ulna during active simulated dart throw motion. J Orthop 2020; 22:513-519. [PMID: 33132624 DOI: 10.1016/j.jor.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022] Open
Abstract
Loading at the distal forearm during dart throw motion (DTM) has been examined under static loads but there is no consensus on how loading is affected by active motion. In this work two implants were designed to measure forearm loading in a cadaveric model of wrist motion. Loads through the radius and ulna were significantly greater in reverse DTM than forward DTM. Radius loads were greatest in extended and radial deviated positions, and ulnar loads were greatest in flexed and ulnar deviated position. This work gives insight into the biomechanics of loading of the forearm to guide further studies.
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Affiliation(s)
- Spencer B Chambers
- Department of Plastic and Reconstructive Surgery, Western University, St. Joseph's Health Care, Room D1-204, 268 Grosvenor Street, London, Ontario, Canada
| | - Martine E McGregor
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave W, Waterloo, Ontario, Canada
| | - Diana Isa
- Department of Orthopedic Surgery, The Moncton Hospital, 100 Arden Street, Moncton, New Brunswick, Canada
| | - Daniel G Langohr
- Department of Biomedical Engineering, Lawson Health Research Institute, St. Joseph's Health Care, 268 Grosvenor Street, London, Ontario, Canada
| | - James A Johnson
- Department of Biomedical Engineering, Lawson Health Research Institute, St. Joseph's Health Care, 268 Grosvenor Street, London, Ontario, Canada
| | - Nina Suh
- Department of Orthopedic Surgery & Plastic and Reconstructive Surgery, Western University, Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, 258 Grosvenor Street, London, Ontario, Canada
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25
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Abstract
The distal radial physis is a common site for injury in gymnasts because of the significant amount of load applied during upper extremity weight-bearing. Wrist pain has been reported in up to 88% of gymnasts. The long-term consequences of overuse wrist injuries, such as distal radial physeal arrest, include degenerative conditions that often cause pain and functional limitations. In the more immediate stage of many overuse injuries, early diagnosis can promote quicker care and recovery and thus faster return to play. Less time lost to injury can be very important in maintaining an athlete's quality of life.
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26
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Bhattacharya AK, Awan OA, Fenerty S, Taqi I, Jonnalagadda P, Ling S, Ali S. Repetitive Strain Injuries of the Upper Extremity: Imaging of Tendon Pathology and Compressive Neuropathies. Curr Probl Diagn Radiol 2020; 50:512-522. [PMID: 32826098 DOI: 10.1067/j.cpradiol.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/22/2022]
Abstract
Repetitive strain injuries (RSIs) encompass a broad clinicopathologic spectrum which includes discrete patterns of tissue injury involving tendons, bursae and nerves although an element of subjective symptomatology may be contributory. Upper extremity RSIs include De Quervain's tenosynovitis, intersection syndromes, epicondylitis, ulnar, and median neuritis as well as other compressive neuropathies. It is estimated that RSIs cost the US economy over $60 billion annually and while detailed clinical examination remains the diagnostic mainstay, imaging can aid in diagnosis, guide management and reduce costs.
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Affiliation(s)
| | - Omer A Awan
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Sarah Fenerty
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Irfan Taqi
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | | | - Stephen Ling
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, PA
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27
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Meirelles LM, Fernandes CH, Ejnisman B, Cohen M, Gomes Dos Santos JB, Albertoni WM. The prevalence of carpal tunnel syndrome in adapted Sports athletes based on clinical diagnostic. Orthop Traumatol Surg Res 2020; 106:751-756. [PMID: 32360556 DOI: 10.1016/j.otsr.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/26/2020] [Accepted: 02/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Electrical studies are often used to diagnose carpal tunnel syndrome (CTS). We noticed differences in results when we considered the clinical tests. OBJECTIVES What's the prevalence of CTS in adapted sports athletes based on clinical diagnostic? Is there any relationship between the presence of symptoms and the use of wheelchairs, the type of sport practiced, dominance and how long the sport had been practiced? HYPOTHESIS The prevalence of CTS in adapted sports athletes is close to that of the general population. STUDY DESIGN Cross-sectional study. METHODS We evaluated adapted athletes. Data collection included the dominant side, type of sports, sports practice time, wheelchair or non-wheelchairs users. To evaluate intensity of pain in the hands, we used the numerical pain rating scale (NPRS). For the evaluation of nocturnal paresthesia, we asked athletes about this symptom's presence. We evaluated the presence of paresthesia through the Tinel signal and Phalen test. For this study's purpose, we characterized CTS by the presence of two or more signs or symptoms. RESULTS We evaluated 72 athletes, 144 hands. No athlete reported pain in the hands or nocturnal paresthesia. Fifteen athletes had at least one sign or symptom in a total of 21 hands. The presence of two concomitant clinical symptoms occurred in 4 (6%) right hands and 3 (4%) left hands. The presence of more than two concomitant clinical symptoms did not occur in any hand. We did not find a relation between the presence of signs and/or symptoms with the type of adapted sport, wheelchair use, the dominant side and the time of sports practice. DISCUSSION Reviewing the literature we observed that the most researchers used electrodiagnostic studies to determine the diagnosis of CTS on persons with disabilities, without considering physical examination. CONCLUSION The prevalence of CTS in the disabled athletes was 6 in 72 (8%). LEVEL OF EVIDENCE III.
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Affiliation(s)
| | | | - Benno Ejnisman
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
| | - Moises Cohen
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
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28
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Abstract
Ulnar abutment (ulnocarpal impaction) syndrome may be a source of ulnar-sided wrist pain in the athlete. This condition results from excessive load transfer across the triangular fibrocartilage complex and ulnocarpal joints with characteristic degenerative changes. It frequently occurs in patients with either static or dynamic ulnar positive variance. Treatment is tailored to the athlete and their sporting demands. Surgical treatment focuses on addressing ulnar variance to unload the ulnocarpal joint, with multiple surgical options, including the metaphyseal closing wedge osteotomy achieving this goal. This review focuses on the presentation, biomechanics, and treatment options for ulnar abutment syndrome in the athlete.
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Affiliation(s)
- Thomas R Acott
- The Core Institute, 9321 W Thomas Road, Suite 205, Phoenix, AZ 85037
| | - Jeffrey A Greenberg
- Indiana Hand to Shoulder Center, 8501 Harcourt Road, Indianapolis, IN 46260, USA.
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29
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Abstract
An athlete's hands are susceptible to a variety of acute and cumulative traumas depending on their chosen sport. Depending on the timing of the injury, the immediate requirements of the athlete, and future aspirations, treatment strategies may need individual customization. This article offers a brief review of the anatomy and complex function of the extensor mechanism, discusses the etiologies of various extensor injuries, and outlines the multiple treatment options and expected outcomes.
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Affiliation(s)
- Spencer Skinner
- Division of Hand Surgery, Department of Orthopedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, PO Box 980153, Richmond, VA 23298, USA
| | - Jonathan Isaacs
- Division of Hand Surgery, Department of Orthopedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, PO Box 980153, Richmond, VA 23298, USA.
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Levy SM, Reid M, Montgomery AM, Botterill E, Kovalchik SA, Omizzolo M, Malara F, Wood TO, Hoy GA, Rotstein AH. Do magnetic resonance imaging abnormalities of the non-dominant wrist correlate with ulnar-sided wrist pain in elite tennis players? Skeletal Radiol 2020; 49:407-415. [PMID: 31401682 DOI: 10.1007/s00256-019-03285-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players that use the double-handed backhand technique. This study aimed to define the relationship between ulnar-sided wrist pain in symptomatic and asymptomatic elite tennis players, and the presence of abnormalities on magnetic resonance imaging (MRI). MATERIALS AND METHODS Fourteen symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls who did not play tennis, were analyzed prospectively, after undergoing MRI of their non-dominant wrist. Five anatomical regions were analyzed, thought to relate to ulnar-sided wrist pain. These consisted of the triangular fibrocartilage complex (TFCC), ulnar collateral ligament (UCL), extensor carpi ulnaris tendon (ECU), osseous-articular structures, and ganglia. Images were independently reviewed by two blinded musculoskeletal radiologists. RESULTS Non-dominant, ulnar-sided, wrist pain in elite tennis players was not statistically significantly associated with an increased number of MRI abnormalities when compared with asymptomatic tennis players (p > 0.05). However, some evidence of statistical association was seen with an increased prevalence of ECU tendon abnormalities (OR = 8.0, 95% CI = (0.74, 20.00), p = 0.07). A statistically significant increase in MRI abnormalities of osseous structures (OR = 15.1, 95% CI = (1.56, 656.05), p = 0.02) and the dorsal radioulnar ligament (DRUL) (OR = 12.5, 95% CI = (2.15, 111.11), p = 0.03), was observed in symptomatic players compared with controls. CONCLUSIONS Non-dominant, ulnar-sided, wrist pain in a subgroup of elite tennis players using a double-handed backhand technique is not associated with a statistically significant increased prevalence of MRI abnormalities when compared with asymptomatic tennis players, other than some evidence of statistical association with ECU tendon abnormalities. Therefore, significance of MRI abnormalities should be interpreted in the context of clinical findings.
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Affiliation(s)
- Sidney M Levy
- Victoria House Medical Imaging, I-MED Radiology Network, Melbourne, Victoria, Australia.
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia.
| | - Machar Reid
- Tennis Australia, Melbourne, Victoria, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Elissa Botterill
- Victoria House Medical Imaging, I-MED Radiology Network, Melbourne, Victoria, Australia
| | - Stephanie A Kovalchik
- Tennis Australia, Melbourne, Victoria, Australia
- Institute of Exercise, Sport and Active Living, Victoria University, Melbourne, Victoria, Australia
| | | | - Frank Malara
- Victoria House Medical Imaging, I-MED Radiology Network, Melbourne, Victoria, Australia
| | | | - Gregory A Hoy
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Andrew H Rotstein
- Victoria House Medical Imaging, I-MED Radiology Network, Melbourne, Victoria, Australia
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Reid M, Wood T, Montgomery AM, Botterill E, Kovalchik S, Omizzolo M, Malara F, Rotstein A, Hoy G. MRI does not effectively diagnose ulnar-sided wrist pain in elite tennis players. J Sci Med Sport 2020; 23:564-568. [PMID: 32081605 DOI: 10.1016/j.jsams.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 12/06/2019] [Accepted: 01/05/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players using a double-handed backhand technique. This study investigated the radiological changes of the non-dominant wrist in elite symptomatic and asymptomatic players using this technique as well as healthy controls. We compared clinical findings to radiological abnormalities. DESIGN Cross-sectional design with blinded radiological assessment, and contemporaneous clinical assessment of symptomatic players. METHODS Magnetic resonance images (MRI) of wrists related to non-dominant ulnar-sided pain, were taken in 14 symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls which were then independently reviewed for abnormalities by blinded radiologists. Total abnormalities and global between-group differences in the triangular fibrocartilage complex (TFC), ulnar collateral ligament (UCL), extensor carpi ulnaris (ECU) and supporting structures, osseous-articular lesions and ganglia were assessed. These were then compared to clinical examinations of the symptomatic players to assess agreement. RESULTS Symptomatic players reported a mean 3.64 abnormalities, being exactly 1 abnormality greater than asymptomatic players (2.64) and controls (2.50), suggesting similar asymptomatic lesions in all three groups. Players with pain reported significantly more osseous-articular lesions, ECU tendon and dorsal radio-ulnar ligament abnormalities, while changes to the UCL may reflect an isolated problem in specific wrists. There were no between-group differences in the presence of ganglia, most TFC structures nor ECU subsheath tear and subluxation. CONCLUSIONS Clinicians should carefully consider radiological changes alongside their clinical diagnosis of non-dominant wrist pain in tennis players due to possible tennis-related changes and/or asymptomatic findings.
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Affiliation(s)
- Machar Reid
- Tennis Australia, Australia; University of Western Australia, Australia.
| | | | | | | | - Stephanie Kovalchik
- Tennis Australia, Australia; Institute of Exercise, Sport and Active Living, Victoria University, Australia
| | | | | | | | - Gregory Hoy
- Melbourne Orthopaedic Group, Monash University, Department of Surgery, Australia
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Effect of Ulnar-Based Orthotics and Strengthening Exercises on Subjects With Ulnar Wrist Pain. J Sport Rehabil 2020; 29:206-212. [PMID: 30676202 DOI: 10.1123/jsr.2018-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 10/26/2018] [Accepted: 12/03/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT In comparison with the published research on the surgical management of ulnar wrist pain, fewer studies that discuss the nonsurgical management of ulnar wrist pain exist. OBJECTIVE The purpose of this pilot study was to investigate the effect of ulnar-based wrist orthotics and strengthening exercises on subjects with ulnar wrist pain. STUDY DESIGN Prospective randomized controlled pilot study. SETTING Research laboratory. PARTICIPANTS Thirty subjects with acute and subacute ulnar wrist pain and age ranging from 18 to 53. INTERVENTIONS Participants were randomized to receive either ulnar-based orthotics, ulnar-based orthotics plus strengthening exercises, or placebo intervention. MAIN OUTCOME MEASURES The authors measured pain and function using the Patient-Rated Wrist Evaluation questionnaire, and grip strength using the JAMAR dynamometer, at baseline and at 2- and 4-week postrandomization. A mixed analysis of variance modeling was used to investigate the effect of the intervention over time. RESULTS There were statistically significant differences between the 2 intervention groups and the control group regarding improvement in pain, function, and strength, whereas there were no statistically significant differences between the 2 intervention groups over the 3 measurement occasions regarding the outcome measures. CONCLUSION Based on the results, orthotics intervention is as effective as orthotics plus strengthening exercises in improving pain, function, and grip strength in subjects with ulnar wrist pain. LEVEL OF EVIDENCE Therapy, level 2b individual Randomized Controlled Trial.
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Özcan Ç. El falanks kırıklarında açık redüksiyon ve plak ile fiksasyonun sonuçları. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.560382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3141-3154. [PMID: 31106876 DOI: 10.1002/jum.15025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/25/2019] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Abstract
Trigger finger is a common pathologic condition of the digital pulleys and flexor tendons in the hand. The key clinical finding is a transient blockage of the digit when it is flexed with subsequent painful snapping when it is extended. Imaging is a helpful guide for establishing the severity of the disease, identifying the underlying cause, and deciding the appropriate management. This narrative review aims to recall the anatomic and pathologic bases and describe the ultrasound features of trigger finger, also including common ultrasound findings and complications after therapy. Ultrasound enables an accurate static and dynamic evaluation of trigger finger as well as a comparison with the adjacent normal digits and thus should be considered the radiologic modality of first choice for its diagnosis.
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Affiliation(s)
| | - Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
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Zwibel H, DiFrancisco-Donoghue J, DeFeo A, Yao S. An Osteopathic Physician's Approach to the Esports Athlete. J Osteopath Med 2019; 119:756-762. [PMID: 31657829 DOI: 10.7556/jaoa.2019.125] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Esports is gaining acceptance in the world of professional, collegiate, and high school athletics. However, there is a lack of information for osteopathic physicians about the health concerns and appropriate treatment of esports athletes. Because of the sedentary nature of the sport and accompanying poor posture, esports athletes are likely to have musculoskeletal injuries of the neck, back, and upper extremities. Additionally, these athletes may have metabolic disturbances resulting from light-emitting diode computer monitors as well as mental health concerns regarding gaming addiction and social behavior disorders. The authors explore the osteopathic physician's role in promoting health and reducing injury in this new gaming phenomenon.
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Kim W, Kim Y, Park HS. In Vivo Measurement of Thumb Joint Reaction Forces During Smartphone Manipulation: A Biomechanical Analysis. J Orthop Res 2019; 37:2437-2444. [PMID: 31286563 DOI: 10.1002/jor.24405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/25/2019] [Indexed: 02/04/2023]
Abstract
The relationship between arthritis or repetitive stress injuries (RSIs) in thumbs and rapidly increasing hours of smartphone usage is not fully elucidated. We evaluated axial joint reaction forces (AJRFs) and thumb torques in 19 healthy subjects performing typical smartphone tasks, which included tapping, tap game, and swiping. We measured force and torque when a subject tapped or swiped the panel of the smartphone and analyzed the motions of each joint using surface markers and motion capture systems. We calculated AJRFs and torques on each thumb joint using inverse dynamics. The results were then compared with representative activities such as computer keyboard typing and handwriting. The mean AJRFs/torques at the thumb carpometacarpal joint (CMCJ) while tapping the smartphone and tap gaming were 12.5 N/95.5 N mm and 21.1 N/187.21 N mm, respectively. AJRFs and torques were significantly higher during tap gaming activities than during simple tapping subtasks (p = 0.003 and p < 0.001, respectively). Compared with those during computer keyboard typing, the mean AJRFs and torques at the CMCJ during smartphone tapping was 3 (p = 0.075) and 1.4 times (p = 0.680) larger, respectively. Considering the rapidly increasing dependency on smartphones in our daily lives, long-term exposure of the thumb to repetitive AJRFs and torques may lead to an acceleration of arthritis or aggravation of RSIs in thumbs. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2437-2444, 2019.
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Affiliation(s)
- Wanlim Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwongil, Songpa-gu, Seoul, 138-736, South Korea
| | - Yusung Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daehak-ro 291, Yuseong-gu, Daejeon, 305-701, South Korea
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daehak-ro 291, Yuseong-gu, Daejeon, 305-701, South Korea
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Narang A, Gupta S, Kanojia RK, Sinha S. An unusual Pattern of Flexor Digitorum Profundus Avulsion Injury with a Large Extra-articular Bony Fragment. J Orthop Case Rep 2019; 9:65-67. [PMID: 31559231 PMCID: PMC6742862 DOI: 10.13107/jocr.2250-0685.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Avulsion injury of the flexor digitorum profundus (FDP) tendon, commonly known as jersey finger, is seen in contact sports players such as rugby and football. There are mainly three patterns of this type of injury as mentioned in the Leddy and Packer classification on the basis of the level of retraction of the tendon. Subsequently, a Type IV injury was added by Smith, where the tendon was also separated from the avulsed bony fragment. It is the level of tendon retraction and the status of the long and the short vincula post-injury that determines the outcome of repair in these types of injuries. Case Report: Here, we report an unusual case of jersey finger injury in a 45-year-old male patient, where the FDP tendon was found in front of the middle phalanx with a large, fractured fragment of the middle third of the distal phalanx attached to it. This type of injury pattern has not been acknowledged in the commonly used classification systems. The patient was operated with open reduction and K-wire fixation of the bony fragment with a good functional outcome. Conclusion: While treating the cases of jersey finger injuries in sports players and general population, one should be aware of such rare patterns which can then be easily managed with proper pre-operative planning.
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Affiliation(s)
- Amit Narang
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - Sumit Gupta
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | | | - Siddhartha Sinha
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
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Llopis E, Restrepo R, Kassarjian A, Cerezal L. Overuse Injuries of the Wrist. Radiol Clin North Am 2019; 57:957-976. [DOI: 10.1016/j.rcl.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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40
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ECU tendon subluxation: A nonspecific MRI finding occurring in all wrist positions irrespective of ulnar-sided symptoms? Eur J Radiol 2019; 116:192-197. [DOI: 10.1016/j.ejrad.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 02/25/2019] [Accepted: 05/09/2019] [Indexed: 11/17/2022]
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Abstract
This study determined the effect of skill level (ITN 3 vs. ITN 8) on the tennis serve biomechanics and analysed the impact of forearm fatigue on dominant arm mechanisms between the two groups (expert vs. non-expert tennis players). The motion capture system with 17 reflective markers attached on anatomic landmarks of the participant was used for data collection. A total of 12 expert and 11 non-expert tennis players performed the required serving tasks. The ball speed of the expert group was significantly faster than that of the non-expert group during non-fatigued and fatigued states (p < 0.001). The wrist radial/ulnar deviation angle at impact was significantly different between non-fatigued and fatigued states for top-spin (p = 0.030) and flat serves (p = 0.018). A significant increase in extensor carpi ulnaris (ECU) and extensor carpi radialis (ECR) muscle activity during extension (p < 0.010) was observed, with that of the ECU being an ulnar deviation. Both the ECU and ECR might contribute to wrist joint and racket handle stability for the coming acceleration and impact while fatigue occurs. Fatigue might substantially influence non-experts' dominant forearms because of the significantly different elbow joint angles and dominant arm syndromes they displayed as compared with the experts.
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Affiliation(s)
- Lin-Hwa Wang
- Institute of Physical Education, Health & Leisure Studies, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Cheng Lo
- Physical Education Office, Kun Shan University, Tainan, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
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Fram B, Wall LB, Gelberman RH, Goldfarb CA. Surgical transposition for chronic instability of the extensor carpi ulnaris tendon. J Hand Surg Eur Vol 2018; 43:925-930. [PMID: 29742949 DOI: 10.1177/1753193418773036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Painful extensor carpi ulnaris tendon instability has various treatments with limited available outcome data. We treated 12 wrists of 11 patients (including eight collegiate or professional athletes) with dorsal transposition of the extensor carpi ulnaris tendon to lie over the 5th compartment, stabilized with a retinacular sling from 2010-2015. All patients had symptom resolution and returned to sport at the pre-injury level by 3 months after surgery. Mean post-surgical Patient Reported Outcomes Measurement Information System (PROMIS) upper extremity score was 56, and PROMIS pain interference score was 42. Patient overall satisfaction averaged 9.8 points on a 10-point scale for the procedure and pain decreased by 6 points on a 10-point scale from before surgery to final follow-up. We conclude that surgical treatment of the extensor carpi ulnaris tendon instability via dorsal transposition of the extensor carpi ulnaris tendon is an effective surgical option for all patients including the high level athlete. Level of evidence: IV.
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Affiliation(s)
- Brianna Fram
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard H Gelberman
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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43
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Sonographic imaging of hand and wrist injuries: applications in the ER setting. Emerg Radiol 2018; 26:227-240. [DOI: 10.1007/s10140-018-1649-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/26/2018] [Indexed: 01/14/2023]
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44
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Stuelcken M, Mellifont D, Gorman A, Sayers M. Wrist Injuries in Tennis Players: A Narrative Review. Sports Med 2018; 47:857-868. [PMID: 27699697 DOI: 10.1007/s40279-016-0630-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The wrist/hand complex forms the crucial final link in the kinetic chain between the body and the racquet and therefore has a number of important roles in the production of all tennis strokes. However, the internal and external loads that are created at the wrist during these strokes have the potential to contribute to pain and injury. Therefore, the purposes of this narrative review are to (1) determine the extent of the problem of wrist pain/injury in tennis players, (2) identify bony and soft tissue structures of the wrist that are susceptible to damage as a result of tennis play and (3) explore factors that may influence the development of wrist pain/injury in tennis players. The epidemiological data revealed two important points. First, some evidence suggests wrist pain/injury accounts for a higher percentage of total injuries in more recent studies (2014-2015) than in early studies (1986-1995). Second, the relative frequency of wrist pain/injury compared with other well-recognized problem areas for tennis players such as the shoulder complex, elbow and lumbar spine is noticeably higher in more recent studies (2014-2015) than in early studies (1986-1995), particularly among females. Collectively, this would seem to indicate that the problem of wrist pain/injury has increased in the modern game. In fact, some wrist injuries appear to be related to the use of certain forehand grip types and the predominant use of the two-handed backhand. While the loads experienced at the wrist during tennis stroke production seem to be below threshold levels for a single event, the cumulative effects of these loads through repetition would appear to be an important consideration, especially when inadequate time is allowed to complete normal processes of repair and adaptation. This is supported by the evidence that most wrist injuries in tennis are associated with overuse and a chronic time course. The complex interaction between load, repetition, and training practices in tennis, particularly among young developing players who choose a path of early specialization, needs to be further explored.
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Affiliation(s)
- Max Stuelcken
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia.
| | - Daniel Mellifont
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia
| | - Adam Gorman
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia
| | - Mark Sayers
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia
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45
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Maloney E, Zbojniewicz AM, Nguyen J, Luo Y, Thapa MM. Anatomy and injuries of the pediatric wrist: beyond the basics. Pediatr Radiol 2018; 48:764-782. [PMID: 29557490 DOI: 10.1007/s00247-018-4111-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/12/2018] [Accepted: 02/27/2018] [Indexed: 11/30/2022]
Abstract
Ligamentous injuries of the pediatric wrist, once thought to be relatively uncommon, are increasingly recognized in the context of acute high-energy mechanism trauma and chronic axial loading, including those encountered in both recreational and high-performance competitive sports. Recent advances in MR-based techniques for imaging the pediatric wrist allow for sensitive identification of these often radiographically occult injuries. Detailed knowledge of the intrinsic and supportive extrinsic ligamentous complexes, as well as normal developmental anatomy and congenital variation, are essential to accurately diagnose injuries to these structures. Early identification of ligamentous injury of the pediatric wrist is essential within the conservative treatment culture of modern pediatric orthopedics because treatment of these lesions often necessitates surgery, and outcomes often depend on early and sometimes aggressive intervention. In this article, we review MR arthrogram technique and pediatric wrist anatomy, and correlate appearances on MR and selected ligamentous pathologies of the pediatric wrist.
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Affiliation(s)
- Ezekiel Maloney
- Department of Radiology, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Andrew M Zbojniewicz
- Division of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, College of Human Medicine, Helen DeVos Children's Hospital, Advanced Radiology Services, Michigan State University, Grand Rapids, MI, USA
| | - Jie Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yu Luo
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, TN, USA
| | - Mahesh M Thapa
- Department of Radiology, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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Bai RJ, Zhang HB, Zhan HL, Qian ZH, Wang NL, Liu Y, Li WT, Yin YM. Sports Injury-Related Fingers and Thumb Deformity Due to Tendon or Ligament Rupture. Chin Med J (Engl) 2018; 131:1051-1058. [PMID: 29692376 PMCID: PMC5937313 DOI: 10.4103/0366-6999.230721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Hand injuries are very common in sports, such as skiing and ball sports. One of the major reasons causing hand and finger deformity is due to ligament and tendon injury. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) can demonstrate the complex anatomy of the fingers and thumb, especially the tendons and ligaments, and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities. Methods: Sixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers. A total of 20 healthy volunteers' hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study. All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression (PD FS) in axial, coronal, and sagittal plane, respectively. Subsequently, all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw (six in coronal plane, six in sagittal plane, and four in axial plane). The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament (UCL) at the metacarpal phalangeal joint (MCPJ) of thumb between 20 healthy volunteers and 44 patients (confirmed by surgery) were analyzed. Results: The normal ligaments and tendons in 16 cadaveric hands and 20 volunteers' hands showed uniform low-signal intensity on all the sequences of the MRI. Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb, 12 cases with UCL injury at MCPJ of the thumb (Stener lesion = 8 and non-Stener lesion = 4), 6 cases with the central slip injury, 12 cases with terminal tendon injury, and 14 cases with flexor digitorum profundus injury. The ligaments and tendons disruption manifested as increased signal intensity and poor definition, discontinuity, and heterogeneous signal intensity of the involved ligaments and tendons. Conclusions: Sports injury-related fingers and thumb deformity are relatively common. MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the fingers and thumb. It is a useful tool for accurate diagnosis of the sports-related ligaments and tendons injuries in hand.
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Affiliation(s)
- Rong-Jie Bai
- Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Hui-Bo Zhang
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing 100020, China
| | - Hui-Li Zhan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Zhan-Hua Qian
- Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Nai-Li Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Yue Liu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing Institute of Traumatology and Orthopedics, Beijing 100035, China
| | - Wen-Ting Li
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Yu-Ming Yin
- Radiology Associates, LLP, 1814 South Alameda Street, Corpus Christi, TX 78404, USA
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Awan WA, Babur MN, Masood T. Effectiveness of therapeutic ultrasound with or without thumb spica splint in the management of De Quervain's disease. J Back Musculoskelet Rehabil 2018; 30:691-697. [PMID: 28035912 DOI: 10.3233/bmr-160591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The management of De Quervain's disease is determined more by Intuition than scientific data. The choice of first line conservative option for the management of De Quervain's disease is still a topic of debate. AIM To evaluate the effectiveness of therapeutic ultrasound with or without spica splint in the management of De Quervain's disease (DQD). DESIGN Randomized controlled trial (RCT). SETTING Outpatient department of Al-Nafees Medical College Hospital, Islamabad, Pakistan. POPULATION Thirty patients who had the history of the De Quervain's disease for at least 6 months were enrolled in the study. The ages of the patient were 30-50 year. The population included housewives, maids, painters, and teachers. METHODS Thirty patients were divided into two groups. The control group was treated with therapeutic ultrasound while in the experimental group thumb spica splitting was also added. The data was collected from the subjects through Quick Disabilities of the Arm, Shoulder and Hand questionnaire. The demographic data was presented in the form of tables. Intervention-induced changes within the groups were investigated using paired sample t-test while independent sample t-test was used to compare the two groups. RESULTS Significant changes within both groups (p ≤ 0.05) were observed as a result of intervention. Additionally, significant differences in some instrument items were found between experimental and control group (p ≤ 0.05) after intervention. However, some items did not demonstrate significant changes in both groups likely because there was no effect of De Quervain's disease on those items before the intervention. CONCLUSION The results showed that the use of therapeutic ultrasound and spica splint together is more effective than using therapeutic ultrasound alone in the conservative management of De Quervain's disease. CLINICAL REHABILITATION IMPACT This study provides evidence to the relevant clinicians and professionals on the utility of therapeutic ultrasound combined with thumb spica splint in the conservative management of DQD.
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Murphy AC, Muldoon SF, Baker D, Lastowka A, Bennett B, Yang M, Bassett DS. Structure, function, and control of the human musculoskeletal network. PLoS Biol 2018; 16:e2002811. [PMID: 29346370 PMCID: PMC5773011 DOI: 10.1371/journal.pbio.2002811] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/15/2017] [Indexed: 11/18/2022] Open
Abstract
The human body is a complex organism, the gross mechanical properties of which are enabled by an interconnected musculoskeletal network controlled by the nervous system. The nature of musculoskeletal interconnection facilitates stability, voluntary movement, and robustness to injury. However, a fundamental understanding of this network and its control by neural systems has remained elusive. Here we address this gap in knowledge by utilizing medical databases and mathematical modeling to reveal the organizational structure, predicted function, and neural control of the musculoskeletal system. We constructed a highly simplified whole-body musculoskeletal network in which single muscles connect to multiple bones via both origin and insertion points. We demonstrated that, using this simplified model, a muscle's role in this network could offer a theoretical prediction of the susceptibility of surrounding components to secondary injury. Finally, we illustrated that sets of muscles cluster into network communities that mimic the organization of control modules in primary motor cortex. This novel formalism for describing interactions between the muscular and skeletal systems serves as a foundation to develop and test therapeutic responses to injury, inspiring future advances in clinical treatments.
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Affiliation(s)
- Andrew C. Murphy
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sarah F. Muldoon
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Mathematics, University of Buffalo, Buffalo, New York, United States of America
| | - David Baker
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Adam Lastowka
- Haverford College, Haverford, Pennsylvania, United States of America
| | - Brittany Bennett
- Haverford College, Haverford, Pennsylvania, United States of America
- Philadelphia Academy of Fine Arts, Philadelphia, Pennsylvania, United States of America
| | - Muzhi Yang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Applied Mathematical and Computational Science Graduate Group, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Danielle S. Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Abstract
OBJECTIVE This article reviews the normal anatomy of the extensor tendons of the wrist as well as the clinical presentation and MRI appearances of common tendon abnormalities, such as tears, tenosynovitis, intersection syndromes, and associated or predisposing osseous findings. Treatment options are also discussed. CONCLUSION We review the anatomy and normal MRI appearance of the clinically important dorsal extensor tendons of the wrist, in addition to the spectrum of abnormalities associated with these tendons.
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Balakatounis K, Angoules AG, Angoules NA, Panagiotopoulou K. Synthesis of evidence for the treatment of intersection syndrome. World J Orthop 2017; 8:619-623. [PMID: 28875127 PMCID: PMC5565493 DOI: 10.5312/wjo.v8.i8.619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/17/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023] Open
Abstract
Intersection syndrome is a rare sports overuse injury occurring through friction at the intersection of the first and second compartment of the forearm. Differential diagnosis must be carefully made, especially from De Quervain tendonsynovitis. Clinical examination provides with the necessary information for diagnosis, still magnetic resonance imaging scans and ultrasonography may assist in diagnosis. Treatment consists mainly of rest, use of a thumb spica splint, analgetic and oral nonsteroidal anti-inflammatory drugs and after 2-3 wk progressive stretching and muscle strengthening. Should symptoms persist beyond this time, corticosteroid injections adjacent to the site of injury may be useful. In refractory cases, surgical intervention is warranted.
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