Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence

Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1) the transverse carpal ligament and the distal forearm fascia intact, (2) only the transverse carpal ligament incised, (3) the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand

Tendon Interposition and Ligament Reconstruction with ECRL Tendon in the Late Stages of Kienböck’s Disease: A Cadaver Study

Background. The optimal surgical treatment for Kienböck’s disease with stages IIIB and IV remains controversial. A cadaver study was carried out to evaluate the use of coiled extensor carpi radialis longus tendon for tendon interposition and a strip obtained from the same tendon for ligament reconstruction in the late stages of Kienböck’s disease. Methods. Coiled extensor carpi radialis longus tendon was used to fill the cavity of the excised lunate, and a strip obtained from this tendon was sutured onto itself after passing through the scaphoid and the triquetrum acting as a ligament to preserve proximal row integrity. Biomechanical tests were carried out in order to evaluate this new ligamentous reconstruction. Results. It was biomechanically confirmed that the procedure was effective against axial compression and distributed the upcoming mechanical stress to the distal row. Conclusion. Extensor carpi radialis longus tendon has not been used for tendon interposition and ligament reconstruction in the treatment of this disease before. In view of the biomechanical data, the procedure seems to be effective for the stabilization of scaphoid and carpal bones

Çekiç parmak deformitesinde cerrahi tedavi sonuçları

Amaç: Çekiç parmak deformitesi yaygın bir yaralanmadır ve ekstansiyon eksikliğiyle sonuçlanan, genellikle ekstansiyonda parmak ucunun doğrudan darbe alması sonrası fleksiyona zorlanması ya da parmakta distal interfalangeal (DİF) eklemin laserasyonu sonucu oluşur. Yaralanma tendonun kesilmesi , distal falanks kırığı sonucu olabilir ve splintleme veya cerrahi olarak tedavi edilebilir. Metod: Ocak 2006- Ocak 2011 yılları arasında 53 çekiç parmak deformitesi kliniğimizde tedavi edildi. 41 hasta (açık yaralanması olmayan) konservatif metodlarla (plastik ve aluminyum stack splintleme) tedavi edildi. 16’sında başarılı sonuç elde edildi. Konservatif tedaviden fayda görmeyen 25 hasta ve açık yaralanması olan 12 hasta cerrahi olarak tedavi edildi. Y ve H tipi insizyonlar kullanıldı. Sonuçlar: Çalışmaya 38 çekiç parmak deformitesi olan 37 hasta(25 erkek, 12 kadın, 30.8 yaş ortalaması ve 2-64 yaş aralığı) dahil edildi. Crawford kriterlerine göre 30 hasta (%81.1) mükemmel, 4 hasta (%10.8) iyi, 2 hasta (%5.4) orta ve 1 hasta (%2.7) kötü sonuç olarak değerlendirildi. 1 hastada yüzeyel enfeksiyon, 1 hastada cilt nekrozu ve 1 hastada rekürren deformite oluştu. Tartışma: Çekiç parmak deformitesi minör yaralanma gibi görünmesine rağmen hastaların dörtte birinde yaralanmanın 6 haftalık dönemde işgücü kaybına neden olduğu bildirilmiştir. Ayrıca travmadan itibaren spor gibi aktivitelerden kaçınılmalıdır. Biz bu çalışmada açık yaralanması olan ve kapalı yöntemlerden fayda görmeyen çekiç parmak deformitesi olan hastaları cerrahi olarak tedavi ettik. Açık redüksiyon ve K teli tespiti etkili ve kolay metoddur.Introduction: Mallet finger is a common injury and is frequently the result of direct trauma to the tip of an extended finger (forced flexion) or secondary to a laceration over the dorsal distal interphalangeal (DIP) joint of a digit, resulting in a DIP extensor lag. The injury may result from either tendon disruption or a fracture of the distal phalanx and can be treated by splinting or surgery. Method: Between January 2006 and January 2011, 53 mallet finger were treated in our clinic. We treat 41 patients (without open injury) conservative methods (plastic stack splinting and aluminum stack splinting). In 16 of these; we had succesfull results. Of those 25 patients who failed with conservative treatment and 12 patients who had open wounds were treated by surgical methods. We used Y or H type incisions on DIP joint. Results: The study involved 37 patients (25 males, 12 females; mean age years; range 2 to 64 years) with 38 mallet finger deformity. 25 patients (male (%67.6), 12 patients female ( %34.4) (one of them bilateral) who had poor results were and also 12 patiens who had open injury treat with surgical treatment. Conclusion: Although mallet finger might appear as a minor injury, over a quarter of the patients with a mallet injury have been reported to be off work during a 6-week period. In addition, activities, such as sports, are often avoided during the first weeks after the trauma (3). An anatomical reduction is essential in mallet fractures. Open reduction and internal K-wire fixation can be preferred due to its low complication rate and ease of application in patients whose mallet deformity cannot be treated by closed reduction

Sakroiliak eklemi tutan sakrum kist hidatiği: Olgu sunumu

Amaç: Ciddi ve ilerleyici bel ağrısına neden olan ve yanlış tanı almış nadir görülen bir kist hidatik vakasını tanımlamak. Giriş: Hidatik hastalık ya da hidatidozis dünyada yaygın bir insan sestod enfeksiyonudur ve karakteristik coğrafi k bir dağılıma sahiptir. Karaciğer ve akciğerler en sık tutulur. Vakalarda kemik tutulumu %4den daha azdır. Vertebral hidatik hastalık nadirdir. Sakroiliak eklem bulguları ve bel ağrısı ayırıcı tanıyı zorlaştırır ve bu nadir durum yanlış tanıya neden olabilir. Olgu Sunumu: Sakrum ve pelvisin sekonder hidatit kistlerinin kalça ağrısına neden olduğu 21 yaşında bayan hasta sunuldu. Başka bir merkezde sakroileit ve siyatik ağrısı tanısı almış ve tedavisi başarısız olan hasta kliniğimize sevk edildi. Fizik muayenesi ve radyolojik testleri sol sakrumdan başlayıp sakroiliak kemiğe uzanan iliak kemik lezyonlarını açığa çıkardı. Sonuç: Medikal tedaviyi takiben, küretaj ve greftleme uygulandı. Lezyondan çıkarılan materyalin makroskopik görünümü ve histopatolojik değerlendirilmesi hidatit hastalık ile uyumluydu. 11 aylık takibinde nüks gözlenmedi ve hasta semptomsuzdu. Tartışma: Erken dönemlerinde kemik hidatik hastalığı yanlış tanı alabilir. Hastalık ilerler ve kemiği destrükte eder. Hidatitk hastalık öyküsü olan ve kas-iskelet şikâyetleri olan hastalarda hidatik kist hastalığı ihtimali akılda tutulmalıdır. Debride edilen vertebrada kalan kavitenin kemik greftiyle doldurulmasının daha güvenilir olduğuna inanıyoruz.Objective: To describe a rare instance of hydatid cyst that caused severe and progressive low-back pain and misdiagnosed as sacroili itis. Introduction: Hydatid disease or hydatidosis is a serious human cestode infection in the world and has a characteristic geographic distribution. The liver and lungs are most frequently involved organs. Bone involvement is less than 4% in cases. Vertebral hydatid disease is uncommon. Signs of sacroiliac joint and low-back pain cause dif fi culties in diff erential diagnosis and this rare condition may be mis diagnosed. Case Report: A case of a 21-year-old woman with hip pain had been caused by a secondary hydatid cyst of the sacral and pelvic areas. Patient was diagnosed sacroiliitis and sciatica in another center. As treatment for these failed, the patient referred to our clinic. Physical examination and radiological tests revealed iliac bone lesions, which is starting from left sacral area and extending to sacroiliac joint. Results: Following medical treatment, curettage and grafting were performed. Macroscopic image and histopathological evaluation of the material which removed from lesion fi eld was consistent with hydatid disease. No recurrence was detected and patient was symp tom free at 11 months follow up. Conclusions: Bone hydatid disease is misdiagnosed in early periods. It progresses and the bone is de structed. In patients with a history of hydatid disease and with mus culoskeletal complaints, a possible disease of hydatid cyst should be should be kept in mind. And which is safer in management of re maining cavity, bone grafting or acrylic cement? We think that bone grafting is safe in management of remaining cavity

Nerve sheath tumor, benign neurogenic slow-growing solitary neurilemmoma of the left ulnar nerve: A case and review of literature

This paper represent a report of a case with ulnar nerve schwannoma(neurilemmoma), benign neurogenic slow-growing, tumors originating from Schwann cells along the course of a nerve (1) (2) (3). Schwannomas are the most common tumors of the peripheral nerves which occur in the adults (0.8–2%) (5). Usually they progress slowly and so they can remain painless swellings for a few years before other symptoms appear. Most of these lesions could be diagnosed clinically, are mobile in the longitudinal plane along the course of the involved nerve but not in the transverse plane (7). EMG, MRI, and ultrasonography are useful tools in the diagnosis. The definitive treatment of benign peripheral nerve schwannomatosis is complete enucleation of the tumor mass without damaging the intact nerve fascicles followed by confirmatory hystopathological examination (12). We present the case of a 62 years old right hand-dominant female who notice a slow increasing bulge over the inner aspect of her distal volar left forearm superior to the wrist, for a longer period of time not exactly specified; this was tracked and associated by pain, tingling and numbness over inner one and half fingers of her left hand in progress until the presentations. A diagnosis of soft-tissue tumor was presumed clinically. The other investigations were ultrasonography (US), nerve conduction studies (NCSs) such as sensory nerve action potential (SNAP) and compound muscle action potential (CMAP). In this case IRM was suggestive of a benign growth in her left ulnar nerve in the forearm region. Microsurgical techniques were used for ample enucleation of the tumor the distal volar left forearm. Subsequent histopathological examination confirmed the presumed diagnosis of a benign cellular schwannoma. At her last follow-up one month after surgery, the patient was neurological gradually improving sensory and motor function and she is highly satisfied with the results of surgery