H. Relton McCarroll

Endoscopic release of the carpal tunnel: A randomized prospective multicenter study

A 10-center randomized prospective multicenter study of endoscopic release of the carpal tunnel was carried out. Surgery was performed with a new device for transecting the transverse carpal ligament while control hands were treated with conventional open surgery. There were 122 patients in the study; 25 had carpal tunnel surgery on both hands and 97 had surgery on one hand. Of the surgical procedures, 65 were in the control group and 82 were in the device group. The endoscopic device was coupled to a fiberoptic light and a video camera. A trigger-activated blade was used to incise the transverse carpal ligament. After surgery, the best predictors of return to work and to activities of daily living were strength and tenderness variables. For patients in the device group with one affected hand, the median time for return to work was 21 1/2 days less than that for the control group. Two patients treated with the endoscopic device required reoperation by open surgical decompression; only one of these had incomplete release with the device. Two patients in the device group experienced transient ulnar neurapraxia.

Proximal row carpectomy: A multicenter study

Twenty patients underwent proximal row carpectomy and were retrospectively evaluated for pain, motion, grip strength, functional activity, and x-ray changes at a mean follow-up of 3 1/2 years. For nonrheumatoid patients, motion decreased 15% after surgery, mean grip strength improved 22%, and 82% believed their conditions were improved and said they would repeat the procedure. The procedure failed in all three patients with rheumatoid arthritis. Patients with mild preoperative arthritic changes had better results than those with advanced disease.

Centralization of the radial club hand: An ulnar surgical approach

Centralization arthroplasty via a transverse ulnar approach was used to correct radial clubhand deformity in 21 children. The patients were evaluated quantitatively by measurements of hand-forearm angle and hand-forearm position.

Characteristics of patients with hypoplastic thumbs

The records of 98 patients with 160 hypoplastic thumbs seen between 1923 and 1993 were reviewed to determine the salient characteristics of this population. Physical findings, photographs, and x-ray films were studied. Sixty-three percent of patients were male, and 63% had bilateral thumb hypoplasia, 59% had radial dysplasia, and 86% had other anomalies. An associated syndrome, most commonly the vertebral, anal, tracheosophageal, renal, and radial limb anomalies association or Holt-Oram syndrome, was present in 44%. Patients with spine, genitourinary, or gastrointestinal anomalies were most likely to have the vertebral, anal, tracheosophageal, renal, and radial limb anomalies association, those with cardiac anomalies were most likely to have Holt-Oram syndrome, and those with lower extremity anomalies were most likely to have a different syndrome. One hundred thirty-nine thumbs were classifiable, using a modification of Blauths classification; 19% were types 1 and 2, 23% were type 3, and 58% were types 4 and 5. One hundred seven operations were performed on 63 upper limbs, including 24 thumb reconstructions and 35 pollicizations. These patients must be carefully examined for bilaterality, other anomalies, and syndromes. Classification using a modification of Blauths criteria is useful and helps the surgeon determine a treatment plan.

Abductor digiti minimi opponensplasty in congenital radial dysplasia

Satisfactory results were obtained in 20 of 21 abductor digiti minimi opponensplasties performed in children with congenital radial dysplasia. A modified technique left the muscle attached to the pisiform and did not require complete dissection of the neurovascular structures. An adequate subcutaneous tunnel was made to accept the transferred muscle and laxity of the ulnar collateral ligament of the metacarpal-phalangeal joint of the thumb, a consistent finding in patients with isolated aplasia of the abductor pollicis brevis and opponens pollicis muscles, was repaired by imbrication and suture of one of the tendinous slips to the ulnar capsule.

Recovery of sensibility after suture of digital nerves

A group of 49 patients with 74 injured digital nerves was studied more than 5 years following epineurial nerve suture. Three tests of return of sensibility were used: von Frey plastic filaments, a modified Weber two-point discrimination device, and a dynamic test--the plastic ridge. The correlation between two-point discrimination and tactilegnosis in the range of 8 to 12 mm was poor. The plastic ridge device detects the presence or absence of tactilegnosis in patients in the intermediate range of two-point discrimination between 8 and 12 mm. Of the factors studied, the patients age at the time of nerve suture was found to be directly related to the return of sensibility by both two-point discrimination and ridge criteria.

Biceps tendon rerouting and percutaneous osteoclasis in the treatment of supination deformity in obstetrical palsy.

Paralytic supination deformity of the forearm, secondary to obstetrical palsy, was treated by biceps tendon rerouting in 11 children. In two patients additional pronation was obtained by subsequent percutaneous osteoclasis and rotation of the radius and ulna. Correction of the supination deformity resulted in improvement of single-handed as well as two-handed activities in all patients.

The treatment of mucous cysts: Long-term follow-up in sixty-two cases

To determine the course of the so-called mucous cyst both after various modalities of treatment and without treatment, 56 patients with 62 cysts were contacted to participate in a study with an average follow-up of 6.2 years after initial evaluation. The mucous cysts primarily occurred in elderly women and were most prevalent in the index and long fingers. Longitudinal grooving of the nail was not uncommon and may hve preceded the appearance of the cyst. Degeneration of the distal interphalangeal joint was frequently found. The long-term results after treatment with simple aspiration or decapping, or by excision with skin grafts and flaps as needed or with observation only were similar. However, surgical excision or aspiration may eliminate earlier the cosmetic disfigurement and occasional discomfort that are associated with this lesion.

Neurorrhaphy after loss of a nerve segment: Comparison of epineurial suture under tension versus multiple nerve grafts

Epineural neurorrhaphy under tension and interfascicular grafting, two methods of bridging gaps associated with loss of a nerve segment, were compared. After resection of a 2 cm length of both ulnar nerves in cats, one nerve was sutured under tension using an epineurial technique, and the other was repaired using multiple interfascicular sural nerve grafts. Six months later return of nerve function was evaluated. Subjective evaluation included ambulation, sensation, and intrinsic function. Objective measurements included muscle efficiency, maximum strength, muscle weights, and total axon counts. No statistical difference was observed between these two techniques. Histochemically, there was marked fiber type grouping of the reinnervated muscles for both types of repairs. Histologically, perineurial fibrosis and axonal disorganization were equal for both techniques, but significantly greater suture granuloma formation occurred in the nerve repaired under tension. Individual grafts retained their identity and remained distinct grossly and microscopically.

The Anatomy of the Flexor Digitorum Superficialis Relevant to Tendon Transfers

The flexor digitorum superficialis is a digastric muscle with a proximal muscle belly from which the tendons to the index, ring and little fingers arise. These tendons are not independent and are not good motors for non-synergistic transfers. Such as for finger extension. The muscle and tendon to the middle finger arise separately and are therefore more suitable for non-synergistic transfers.