John M. Agee

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.

Endoscopic carpal tunnel release: a prospective study of complications and surgical experience.

A 63-center prospective study of endoscopic carpal tunnel release using the Agee Carpal Tunnel Release System was conducted in 1049 procedures in 988 patients. Prior experience with endoscopic release varied significantly among surgeon participants. Surgeons evaluated the newly redesigned system for blade visibility, blade height, and mechanical function. Data on patient complications were collected at the time of surgery and 3-4 weeks postoperative. The results indicated minimal complications and no confirmed injuries to vessels or nerves; the symptoms from one possible digital nerve injury eventually resolved completely. Surgeons were able to observe the point of entry of the blade into the transverse carpal ligament in 97.5% of procedures. Introduction of the blade assembly into the carpal tunnel was rated easy or adequate in 90.6% of procedures, and blade height was rated adequate in 97.4% of procedures.

The Sauve-Kapandji procedure for reconstruction of the rheumatoid distal radioulnar joint

Our experience with the Sauve-Kapandji procedure for reconstruction of the rheumatoid distal radioulnar joint is reported. Twenty-one wrists in 17 patients were followed for an average of 39 months postoperatively. Average range of motion at follow-up evaluation was pronation to 78 degrees and supination to 86 degrees. X-ray films demonstrated that significant ulnarward and palmarward translocation of the carpus was prevented. The Sauve-Kapandji procedure provides a stable ulnar side support in the rheumatoid wrist with distal radioulnar degeneration.

Unstable fracture dislocations of the proximal interphalangeal joint of the fingers: A preliminary report of a new treatment technique

A linkage of Kirschner wires activated by a single rubber band creates a force couple across a fracture-dislocated proximal interphalangeal joint. The method dynamically achieves concentric joint reduction, which is maintained through a full active range-of-joint flexion and extension. Two case reports accompany a description of the technique.

Treatment of comminuted distal radius fractures: an approach based on pathomechanics

Following dorsally displaced fractures of the distal radius, the classic position of immobilization is with the wrist flexed and in ulnar deviation. This is not the position of function and entails morbidity in the form of finger stiffness, which may require prolonged rehabilitation. We treated 20 consecutive, comminuted, intraarticular distal radial fractures using a new external fixation system with the wrist in a neutral to extended position, thereby promoting metacarpophalangeal joint flexion by relatively relaxing the finger extensor tendons. Supplemental pin fixation was used in eight cases. Most patients were performing active digital motion on the day of surgery and 95% maintained functional finger motion during treatment. All fractures healed uneventfully. Palmar tilt was restored in 55% of patients in spite of a wrist neutral or extended position. This method of fixing distal radial fractures allows restoration of anatomy while avoiding hand stiffness.

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.

The use of skeletal extension torque in reversing Dupuytren contractures of the proximal interphalangeal joint.

Dupuytren contracture of the proximal interphalangeal (PIP) joint can be reversed by an extension torque transmitted from an external device, the Digit Widget, by skeletal pins to the middle phalanx. This extension torque, generated by the same elastic bands dentists use to align teeth, gradually restores length to soft tissues palmar to the PIP joints axis of rotation. Simultaneously, tissues dorsal to the joints axis will shorten toward normal length as the PIP progressively straightens. Although the contractile nodules and bands of Dupuytren disease may be excised either before or after reversal of the joints contracture, a 2-staged approach is preferred: (1) reverse the PIP flexion contracture, and (2) excise the diseased tissue from the straightened finger. We believe this 2-staged approach yields better results. In addition, it is technically easier to avoid injury to nerves and arteries while excising the nodules and bands, when one operates through palmar skin of more nearly normal length.

Moment arms of the digital flexor tendons at the wrist: Role of differential loading in stability of carpal tunnel tendons

When a flexor digitorum superficialis tendon crossing a flexed or extended wrist has a load applied to it in excess of that applied to adjacent tendons, that tendon may translate across the carpal tunnel. In 6 cadaver specimens, each of the 9 carpal tunnel tendons was loaded with a baseline tension of 85 g and the moment arms of the flexor pollicis longus and the 4 flexor digitorum superficialis tendons were determined. Applying a higher 540-g load to individual flexor digitorum superficialis tendons and the flexor pollicis longus while loading the remaining tendons with the baseline 85-g tension significantly changed the moment arms from those measured under baseline load. The results demonstrated that tendons with applied differential loads in the carpal tunnel shift their positions, as revealed by their changing moment arms.