G. Raimbeau

Work increases the incidence of carpal tunnel syndrome in the general population

The purpose of this study was to estimate the incidence of carpal tunnel syndrome (CTS) in a general population according to employment status and to assess the proportion of cases attributable to work. CTS occurring in patients aged 20–59 years living in the French Maine and Loire region were included prospectively from 2002 to 2004. Medical and occupation history was gathered by mailed questionnaire. Incidence rates of CTS and relative risks (RRs) of CTS were computed in relation to employment status. The attributable fractions of risk of CTS to work among the exposed persons (AFEs) were calculated. A total of 1168 patients (819 women, 349 men) were included during the 3‐year period. The mean incidence rate of CTS per 1000 person‐years was higher in employed than unemployed persons (1.7 vs. 0.8 in women and 0.6 vs. 0.3 in men). The excess risk of CTS was statistically significant for male (RR 4.2) and female (RR 3.0) blue‐collar workers and female lower‐grade white‐collar workers (RR 2.5). The AFE to work in general was 47% (95% confidence interval: 39–54) in women. AFEs reached higher values in female blue‐collar workers [67% (65–68)] and lower‐grade services, sales, and clerical white‐collar workers [61% (57–64)]. The AFE in male blue‐collar workers was 76% (72–80). These data show a higher incidence of CTS in the working than the non‐working population and suggest that a substantial proportion of CTS cases diagnosed in lower‐grade white‐collar and blue‐collar workers are attributable to work. Muscle Nerve, 2008

Attributable risk of carpal tunnel syndrome according to industry and occupation in a general population.

OBJECTIVE An epidemiologic surveillance network for carpal tunnel syndrome (CTS) was set up in the general population of a French region to assess the proportion of CTS cases attributable to work in high-risk industries and occupations. METHODS Cases of CTS occurring among patients ages 20-59 years living in the Maine and Loire region were included prospectively from 2002 to 2004. Medical and occupation history was gathered by mailed questionnaire for 815 women and 320 men. Age-adjusted relative risks of CTS and the attributable risk fractions of CTS among exposed persons (AFEs) were computed in relation to industry sectors and occupation categories. RESULTS Twenty-one industry sectors and 8 occupational categories for women and 10 sectors and 6 occupational categories for men were characterized by a significant excess risk of CTS. High AFE values were observed in the manufacturing (42-93% for both sexes), construction (66% for men), and personal service industries (66% for women) and in the trade and commerce sectors (49% for women). High AFE values were observed in lower-grade white-collar occupations for women (43-67%) and blue-collar occupations for men (60-74%) and women (48-88%). CONCLUSION The attributable proportions of CTS cases among workers employed in industry sectors and occupation categories identified at high risk of CTS varied between 36% and 93%.

Lateral epicondylitis treatment by extensor carpi radialis fasciotomy and radial nerve decompression: is outcome influenced by the occupational disease compensation aspect?

INTRODUCTION The etiology, treatment, and patient management in cases of chronic epicondylitis, within the legislation on occupational disease, remain highly controversial. HYPOTHESIS Recognition as an occupational disease has a negative influence on the functional result of epicondylitis treated with aponeurotomy and neurolysis of the motor branch of the radial nerve. PATIENTS AND METHODS Twenty-eight patients (30 cases of epicondylitis) were operated between January 2007 and January 2008. There were nine men and 19 women whose mean age was 46.1 years. A preoperative EMG found anomalies in the deep posterior interosseous nerve in all cases. Patients were divided into two groups: one group of patients recognized as having an occupational disease and a group of patients whose disease was not considered occupation-related. RESULTS The patients were seen at follow-up at a mean 21.8 months. In the group of patients with occupational disease, there were six excellent, nine good, and five acceptable results; in the second group, there were six excellent, two good, and two acceptable results. CONCLUSION Recognition of epicondylitis as an occupational disease has a significant influence only on the time to pain relief and the result on strength. LEVEL OF EVIDENCE Level IV. Retrospective study.

Vein conduit associated with microsurgical suture for complete collateral digital nerve severance.

The aim of this study is to present the long term results of a series of 53 vein conduit grafts as first line therapy to repair complete severance of one or more collateral digital nerves. The surgical technique included an epi-perineural suture of the nerve under minimal tension, associated with a vein graft harvested from the back of the hand to cover the nerve. None of the patients presented with a neuroma, spontaneous pain or had stopped using the injured finger. Sensibility results were good or very good in 67% of cases. The scar at the donor site was very light or invisible. A total of 96% of patients were satisfied or very satisfied. This simple technique, by protecting the injured nerve, results in a rate of sensory nerve recovery that is comparable or better than that of other series in the literature, without neuroma and with minimal scarring at the donor site.

Simplified scaphoid reconstruction technique with Zaidemberg's vascularized radial graft

For more than 10 years, we have been using a simplified reconstruction technique for scaphoid non-unions that involves the use of a graft first described by Zaidemberg et al. [1]. This approach requires that an island bone graft harvested from the radial styloid and pedicled on the 1,2-intercompartmental supraretinacular artery be embedded into the site of the non-union. The objective of our technical modifications was to simplify the harvesting and handling of the graft and the internal fixation. This technique is only used for cases of scaphoid non-union with avascular changes in the proximal fragment, repeated non-union after bone grafting and internal fixation, chronic non-union with osteophyte formation in the dorso-radial aspect and fracture secondary to Preiser disease.

Focal periosteal chondroma of the hand: a review of 24 cases.

INTRODUCTION Periosteal chondroma is a benign cartilaginous tumour that is less common than enchondroma and rarely arises at the hand. PATIENTS AND METHOD We report a retrospective review of 24 patients with focal periosteal chondroma of the hand and a mean follow-up of seven years and four months. The 13 females and 11 males had a mean age of 41 years and three months. RESULTS Radiographs performed to investigate a hard lump on a finger established the diagnosis in 23 (95.8%) patients, and histological documentation was obtained consistently. The proximal and distal phalanges were the most common sites of involvement. The tumour recurred in a single patient, a 10-year-old child, 10 months after surgery. CONCLUSION No other complications were recorded. Tumour excision and curettage of the lesion are the suggested treatments for periosteal chondroma. Most recurrences occur early after initial surgery. LEVEL OF EVIDENCE Level IV.

Neuroma-in-continuity of the median nerve managed by nerve expansion and direct suture with vein conduit.

Autologous nerve grafting is the current standard for bridging large gaps in major sensory and motor nerves. It allows both function and pain improvement with predictable results. Clinical observations of nerve elongation caused by tumours have prompted experimental animal studies of induced gradual elongation of the nerve stump proximal to the gap. This technique allows direct suturing of the two nerve ends to bridge the gap. Here, we describe a case of neuroma-in-continuity of the median nerve managed by resection and direct suture after nerve elongation with a tissue expander. We are not aware of similar reported cases. Secondary repair 3 years after the initial injury improved the pain and hypersensitivity and restored a modest degree of protective sensory function (grade S1).

An Original Technique in Madelung’s Deformity The Reverse Wedge Osteotomy of the Distal Radius

Objective/Hypothesis: Madelung’s deformity results from a growth defect in the ventral and medial part of the growth plate of the distal extremity of the radius, causing a disorientation of the ulnar part of radial glenoid. Surgical procedures to improve aesthetics and function for Madelung’s deformity are numerous and difficult to assess because the disease is uncommon. We propose and evaluate an original technique in a retrospective study of 19 wrists: the reverse wedge osteotomy (RWO) of the distal radius. Materials and Methods: Twelve women and 1 man Madelung’s deformity were treated from 1992 to 2016. The wrists (6 bilateral, 7 unilateral) were reviewed by an independent examiner at an average follow-up of 6 years (6 months-22 years). Surgery was motivated by aesthetic and functional discomfort at the average age of 23 years, before any complication. RWO was developed to reorient the radial joint surface while reducing overall radius length as little as possible. Osteotomy was performed through an anteroradial or radial approach with an average time under 2 h. The bone wedge was harvested from the excess cortical on the dorsal and radial aspect of the radius. The circumferential wedge was then removed, reversed, and put back into the osteotomy to ensure closing on cortical excess and lengthening on the opposite side. Fixation was achieved by an anterior locking plate in all cases. An associated osteotomy of the ulna was necessary to avoid an ulnocarpal conflict for 4 cases with severe deformity. Objective (morphology of the wrist, range of motion, and grip strength) and subjective (Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores) data were analyzed. Radiological settings were taken from McCarroll’s criteria. A vector model of the procedure was established to estimate osteotomy angles from 2 indexes from McCarroll. The nonparametric Wilcoxon test (P < .05) was used for statistical analysis. Results: All cases achieved fusion at 3 months. Eight of the 19 wrists had the plate removed. There was no complication except for hypoesthesia on the radial side of the thenar eminence in 2 cases. Aesthetics and range of motion improved. Improvement was significant for flexion, pronation, and supination with preserving the grip strength, as well as the radiological parameters of McCarroll: significant correction of the palmar and ulnar deviation of the radial epiphysis, as well as rising of the lunate and palmar displacement of the carpus. Average Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were less than 30 out of 100 at review. All patients were satisfied aesthetically and functionally. Conclusions: The corrective power of RWO is well adapted to the severe radial epiphyseal dystrophy of Madelung’s deformity. Clinical and radiological results are convincing and meet patients’ expectations. RWO has a special place among the techniques proposed so far. The flattening of the dorsal aspect of the wrist is hoped to provide long-term protection against extensor tendon tear. Vector model allows preoperative planning and optimizes the realization.