J. Russell Moore

Tendon ruptures in the rheumatoid hand: Analysis of treatment and functional results in 60 patients

Seventy-six reconstructive procedures were performed to treat tendon rupture in 60 patients with rheumatoid arthritis. Tendon rupture commonly occurred in the extensors to the ring and small fingers. However, ruptures of extensors and several flexor tendons were also encountered. Single or double tendon ruptures responded successfully to a variety of tendon transfers. Reconstruction for multiple tendon ruptures is a salvage procedure that is often associated with extensor lag and impairment of overall function. Early aggressive treatment of distal radioulnar joint derangements in the rheumatoid wrist is recommended to forestall many cases of tendon rupture.

Localized nodular tenosynovitis: experience with 115 cases.

One hundred fifteen cases of localized nodular synovitis (giant cell tumor of the tendon sheath) were reviewed. The optimal treatment for these lesions is unknown, and a high recurrence rate exists. Growths arose from most of the synovial sites of the hand, including joints, capsular ligaments, and tendon sheaths. Deformation of the bone surface was commonly seen; however, bone invasion was uncommon. The histologic features may vary, but the lesions are always benign and do not metastasize. Treatment consisted of thorough local excision and adjacent joint exploration when appropriate. Recurrence occurred in 10 cases (9%) with one to five additional surgical procedures needed to eradicate the lesion.

Gouty tenosynovitis in the hand

Gouty tenosynovitis can present as an infection, tendon rupture, nerve compression, or digital stiffness. In ten patients, extensive urate deposition was encountered in the extensor tendons at both the wrist and digital levels in addition to involvement of the flexor tendons in the carpal canal and digital theca. Direct nerve or muscle involvement was not observed in the hand. Medical therapy, which is now the cornerstone of treatment for most aspects of gout, may not be the best treatment for tophaceous deposits in the hand. Operative treatment may be required to debulk tophaceous deposits, improve tendon gliding, decompress nerves, allow increased range of motion of joints, and ameliorate pain.

Posttraumatic ulnar subluxation of the extensor tendons: A reconstructive technique

Ulnar subluxation of the extensor digitorum communis over the metacarpal head can compromise the function of the extensor mechanism to the affected digit. Extensor displacement can be posttraumatic, developmental, congenital, or caused by arthritis of the metacarpophalangeal joint. A tendon centralizing procedure was performed on five digits in three patients who had posttraumatic ulnar subluxation of the extensors at the metacarpophalangeal joint after conservative management failed. No recurrences of subluxation have been noted in this series, and all patients have regained full range of motion.

Independent index extension after extensor indicis proprius transfer

The extensor indicis proprius was used to restore mobility to a variety of hand movements in 27 patients. Retained independent index finger extension was obtained in a majority of patients postoperatively. Potential postoperative complications of index extension lag and deviation may be avoided if the extensor indicis proprius is sectioned immediately proximal to the dorsal hood. A corresponding laboratory study was undertaken to better define the anatomic constraints limiting independent finger extension. Distinct differences between juncturae tendinum and extensor compartment musculature help explain why the index finger may function as a relatively independent unit.

Neonatal compartment syndrome

Two cases of forearm compartment syndrome in neonates are presented. The compartment syndrome may be initiated before actual delivery and may appear in an advanced stage. In both children good clinical results were achieved when standard guidelines for managing compartment syndrome and established Volkmanns contracture were applied. Although uncommon, compartment syndrome should be considered in the differential diagnosis of the neonate who is unable to move an extremity.

Arthritis of the basal joint of the thumb. A critical analysis of treatment options

The basal joint of the thumb is commonly afflicted with degenerative changes, especially in postmenopausal women. This can be debilitating because of the importance of the thumb to overall hand function. There are a variety of treatment options for the patient with arthritis of the basal joint of the thumb. Most patients can successfully be treated conservatively, which includes splinting, antiinflammatory medications, physical therapy, and activity modification. For those who fail conservative therapy, surgical treatment is based on clinical staging. Patients with early degenerative changes are candidates for ligament reconstructive procedures or arthrodesis. Those with more advanced disease may benefit from excision, tendon interposition arthroplasty, suspensionplasty, silicone implant arthroplasty, or total joint arthroplasty. The advantages and disadvantages of each procedure, as well as the relative indications and contraindications of each, are critically assessed.

Congenital pseudarthrosis of the forearm

Congenital pseudarthrosis of the forearm is a rare condition in which traditional treatment methods have proven unsatisfactory. We report a case of congenital pseudarthrosis of the radius and ulna successfully treated by resection of the distal ulna and excision of the radial pseudarthrosis with replacement by an interpositional free vascularized fibular graft.

Osteocartilaginous lesions of the digits in children: An experience with 10 cases

Osteocartilaginous lesions, which are considered to be one of the most common neoplasms of bone, are seldom found in the hand. These are distinct from subungual exostoses or turret exostoses. When present in the hand in children, these lesions may limit function, cause cosmetic deformity, alter the growth of a digit, and pose a problem in diagnosis. Experience with these osteocartilaginous lesions in 10 children, (nine boys and one girl) is reviewed. Six patients had some degree of deviation or early rotation of the involved digit secondary to abnormal bone growth. There was no definite history of antecedent trauma; however, most parents assumed this to be a causative factor. Patients were treated by excision of the lesion and joint contouring when necessary. Follow-up ranged from 1.5 to 13 years, and there was good functional restoration, minimal growth disturbance, and no recurrence in any patient.

A complete dislocation of the thumb metacarpal

Multiple dislocations of a single finger are rare. We report a patient with complete dislocation of the thumb metacarpal, a condition not reported previously. A 9 year follow-up shows the patient to have a normal-appearing, strong, and painless hand.