Gary M. Lourie

The transverse radioulnar branch from the dorsal sensory ulnar nerve: Its clinical and anatomical significance further defined

The anatomy of the dorsal sensory ulnar nerve has been well described, but a transverse branch that innervates the distal radioulnar joint and overlying skin, has not been well delineated. This study, from both an anatomic and clinical perspective, confirms its presence approximately 80% of the time and documents the size, course, and type specificity.

Annular flexor pulley injuries in professional baseball pitchers: a case series.

Closed traumatic rupture of the annular pulley has been reported in rock climbers. However, injury to the digital flexor pulley system in baseball pitchers has not been reported. This is a report of 4 professional baseball pitchers with ruptures localized to the A4 pulley of the middle finger. History, proposed mechanism of injury, physical findings, radiographic confirmation, and a tailored treatment protocol are discussed.

Remodeling Potential of Phalangeal Distal Condylar Malunions in Children

PURPOSE Distal condylar phalangeal (DCP) fractures in children are uncommon, but their periarticular location makes them problematic. Malunions are particularly difficult to treat. These fractures are generally thought to have a poor remodeling potential because their location is far from the phalangeal physis. We present 8 cases of DCP malunion in children with a mean 5-year follow-up demonstrating consistent remodeling. METHODS In this study, DCP fractures were defined as those occurring at or distal to the collateral ligament recess of the proximal or middle phalanx in skeletally immature patients. Radiographic parameters examined at the time of established malunion and at final follow-up included coronal and sagittal plane deformity and translational malalignment of the distal fragment in relation to the proximal shaft. Range of motion was measured, and a brief questionnaire was implemented to establish patient satisfaction. RESULTS We examined 8 patients with a minimum 1-year follow-up (mean, 5.3 y). Average age at injury was 8.8 years (range, 2-14 y). In the sagittal plane, fractures remodeled from an initial mean deformity of 30.9° to 0.0°; in the coronal plane, from 10.5° to 3.9°. Fracture translation in the sagittal plane corrected, as well, from a mean 57.5% at injury to 0.0% at final follow-up. There was no functionally limiting loss of motion of the digit in any patient. Subjectively, only 2 patients complained of cosmetic deformity, both of which were coronal plane deformities of the small finger. CONCLUSIONS In this case series, DCP malunions in children remodeled significantly and completely in the sagittal plane, and all patients had good final range of motion. Furthermore, patients were satisfied with nonsurgical treatment at long-term follow-up. This series describes the remodeling potential of DCP fractures in children, lending support to the previously reported cases. These findings support treating late-presenting pediatric DCP malunions nonsurgically. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Distal rupture of the palmaris longus tendon and fascia as a cause of acute carpal tunnel syndrome

Acute carpal tunnel syndrome is rare compared with its more chronic presentation. Previous reports in the literature have documented the most common causes. Rupture of the distal palmaris longus tendon into the palmaris fascia as a cause of an acute carpal tunnel syndrome has not been reported previous to this case report. Partial rupture of the tendon and hemorrhage around its insertion produced intrinsic compression on the transverse ligament and the underlying nerve.

The Zig-Zag Deformity in Pre-Axial Polydactyly A new cause and its treatment

Most cases of zig-zag deformity following treatment of pre-axial polydactyly have resulted from inadequate reconstruction of bifid bony elements. We report its development after simple suture ligature of the radial component of a bifid thumb in the form of a soft tissue tag at the level of the MP joint. Successful reconstruction has been achieved with the use of similar principles proposed for the more characteristic zig-zag deformity. Parents, paediatricians, and obstetricians should be warned that simple suture ligature of the soft tissue tag may allow the development of a zig-zag deformity and require further reconstruction.

Anatomic course of the medial antebrachial cutaneous nerve: a cadaveric study with proposed clinical application in failed cubital tunnel release.

Table 1 and Figure 1 demonstrate our surgical strategy and results with the modified Ilizarov miniexternal fixator (IM). Immediately after applying the fixator, PIP joint traction with an IM traction system was started. After opening the joint space by 3 mm and more by lateral radiograph, distraction rods were applied to apply an extension force. However, this basic IM system with rods was ineffective in some patients, even after weeks of traction. We treated such cases empirically with rubber bands instead of distraction rods to apply dynamic forces to the PIP joint. What size of rubber band should be used depends on how much the flexion of the PIP joint has been improved. Wider bands induce stronger extension force, but also more pain. If the joint was still flexed to more than 30°, we chose wide bands (size 64, length 3.5 inch, width 1/4 inch, thickness 1/32 inch) to apply a strong dynamic force. If the flexion was less than 10°, we used weak bands (size 14, length 2 inch, width 1/16 inch, thickness 1/32 inch), which applied lower forces and allowed patients to move their fingers more easily. Extensor tendon reconstruction was required in two cases owing to loss or severe attenuation of the central slip. One patient suffered a fracture through a pin site during the traction and did not gain any improvement in the range of motion (ROM). These details are shown in Table 1. In order to prevent the recurrence of deformity, we removed the apparatus and splinted the fingers with a Capener dynamic extension splint during the day and a static splint at night for at least 4 months. The average ROM of the PIP joint was improved at assessment 6 months postoperatively. A representative case is shown in Figure 1 (Case 7 in Table 1). A 58-year-old woman with diabetes had a 5-year history of flexion contracture and had undergone three operations for infective tenosynovitis. The IM was applied for 7 weeks. We extended under distraction with the metal rods for 2.5 weeks, then strong rubber bands for 1.5 weeks and weak rubber bands for 3 weeks (total duration of IM was 7 weeks). At final review 1 year later, the good result was maintained. In our experience this is a valuable technique for the most severe fixed flexion contractures.

Congenital pseudoaneurysm of the superficial palmar arch in a child: A case report

Both true and false aneurysms are rare in the upper extremity and even more so in pediatric patients. When the condition is congenital, except for those aneurysms found in the circle of Willis, existence in the upper extremity is almost unknown. The following case report describes a congenital pseudoaneurysm involving the superficial palmar arch in a child.

Dissatisfaction After First Dorsal Compartment Release for de Quervain Tendinopathy

THE PATIENT A 45-year-old woman sanitation engineer with de Quervain tendinopathy of her right dominant wrist was unsatisfied with nonsteroidal anti-inflammatory drugs, orthosis fabrication, modification of work activities, and corticosteroid injection, and requested first dorsal compartment release. Three months after surgery by another surgeon, she is not satisfied with the surgery. She is not working and has difficulty with activities of daily living.

Ulnar Nerve Tendon Transfers for Pinch

Power and tip pinch are an integral part of intrinsic hand function that can be significantly compromised with dysfunction of the ulnar nerve. Loss of power pinch is one component that can significantly affect an individuals ability to perform simple daily tasks. Tip pinch is less affected, as this task has significant contributions from the median nerve. To restore power pinch, the primary focus must be on restoring the action of the adductor pollicis primarily, and if indicated the first dorsal interosseous muscle and flexor pollicis brevis.

Relationship of surgically repaired ulnar collateral ligament injury of the thumb to the morphology of the metacarpophalangeal joint of the thumb

Su Jiang, Chye Yew Ng and Wen-Dong Xu* Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, UK Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center of Brain Science, Fudan University, Shanghai, China *Corresponding author: wendongxu@fudan.edu.cn