Abstract/Text: Introduction de Quervain's tenosynovitis is a common pathologic condition of the hand. Finkelstein's test has long been considered to be a pathognomonic sign of this diagnosis, yet most clinicians and instruction manuals erroneously describe what is in fact the Eichhoff's test, which is thought to produce similar pain by tendon stretching in a normal wrist. The purpose of this study was to compare Finkelstein's test with Eichhoff's test in asymptomatic individuals. Materials and Methods Thirty-six asymptomatic participants (72 wrists) were examined using both Finkelstein's and Eichhoff's tests with a minimum interval of 24 hours between the tests. Results The results showed that Finkelstein's test was more accurate than Eichhoff's test. It demonstrated higher specificity, produced significantly fewer numbers of false-positive results, and also caused significantly less discomfort to patients. Conclusion This study recommends Finkelstein's test as the clinical examination of choice for the diagnosis of de Quervain's disease.

Abstract/Text: Scaphoid fractures are common but present unique challenges because of the particular geometry of the fractures and the tenuous vascular pattern of the scaphoid. Delays in diagnosis and inadequate treatment for acute scaphoid fractures can lead to nonunions and subsequent degenerative wrist arthritis. Improvements in diagnosis, surgical treatment, and implant materials have encouraged a trend toward early internal fixation, even for nondisplaced scaphoid fractures that could potentially be treated nonoperatively. Despite the advent of newly developed fixation techniques, including open and percutaneous fixation, the nonunion rate for scaphoid fractures remains as high as 10% after surgical treatment. Scaphoid nonunions can present with or without avascular necrosis of the proximal pole and may show a humpback deformity on the radiograph. If left untreated, scaphoid nonunions can progress to carpal collapse and degenerative arthritis. Surgical treatment is directed at correcting the deformity with open reduction and internal fixation with bone grafting. Recently, vascularized bone grafts have gained popularity in the treatment of scaphoid nonunions, particularly in cases with avascular necrosis. This article reviews current concepts regarding the treatment of scaphoid fractures and nonunions.

Abstract/Text: PURPOSE: A large series of patients with Preiser's disease was reviewed to compare 2 potentially different categories of this disorder: complete versus partial vascular impairment of the scaphoid bone as determined by magnetic resonance imaging (MRI).
METHODS: Nineteen patients with Preiser's disease were identified retrospectively from 2 institutions. Using MRI criteria, 2 disease patterns were identified: diffuse necrosis and/or ischemia of the scaphoid (type 1 disease, 11 cases) and segmental vascular impairment of the scaphoid (type 2 disease, 8 cases). Risk factors for osteonecrosis, treatment methods, and serial radiographs were reviewed in all cases. Sixteen patients were examined for the purpose of this study at an average follow-up of 25 months.
RESULTS: MRI signal changes of necrosis and/or ischemia involved 100% of the scaphoid in type 1 cases and on average approximately 42% in type 2 cases (range, 33% to 66%). In type 1 cases, regardless of the treatment used, the scaphoid typically fragmented and collapsed. In type 2 cases, scaphoid architecture was altered minimally after similar treatment methods. A history of wrist trauma was significantly more common in type 2 cases, and the results of treatment were generally better in this group of patients (mean Mayo modified wrist scores, 86 vs 58 points).
CONCLUSIONS: This study supports the concept of 2 patterns of scaphoid involvement in Preiser's disease. Type 1 cases are characterized by MRI signal changes of necrosis and/or ischemia involving the entire scaphoid bone. Patients in this group have a propensity for scaphoid deterioration. Type 2 cases have MRI signal changes involving only part of the scaphoid. These patients commonly report a history of wrist trauma, show fewer tendencies toward scaphoid fragmentation, and may have a more favorable clinical outcome.

Abstract/Text: PURPOSE: Type II lunate morphology has recently been shown to decrease the incidence of dorsal intercalated segment instability (DISI) deformity in patients with scaphoid nonunions. A similar association has been suggested for scapholunate dissociation, but a formal comparison has yet to be performed. The purpose of this study was to determine if an association exists between lunate morphology and DISI in cases of scapholunate dissociation.
METHODS: A retrospective review was performed on 58 patients with the diagnosis of scapholunate dissociation as determined by use of radiographs, magnetic resonance imaging, arthrotomy, and arthroscopy. Posteroanterior radiographs were used to assess the presence of a medial facet on the lunate and to determine the distance between the capitate and the triquetrum. A DISI deformity was defined as a radiolunate angle >15 degrees, and scapholunate instability was defined as a scapholunate angle >60 degrees using the tangential method. Statistical analysis was performed with a chi-squared test and kappa test.
RESULTS: Twenty-five patients had a type I lunate, and 33 patients had a type II lunate. A total of 15 patients had DISI deformity on preoperative radiographs; of these, 10 patients with a type I lunate and 5 patients with a type II lunate had DISI deformity. This difference was found to be significant.
CONCLUSIONS: In cases of scapholunate dissociation, type II lunates were associated with a significantly lower incidence of DISI despite having radiographic or arthroscopic evidence of a complete scapholunate interosseous ligament tear. Osseous morphology may play a role in the development of a radiographic DISI deformity. Further research is required to assess the clinical importance of this finding and the biomechanical cause of this phenomenon.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Abstract/Text: Small occult dorsal wrist ganglia, which are not visible or palpable, may be painful. Clinically, there is tenderness over the scapholunate ligament and pain with hyperextension of the wrist with normal radiographs and an otherwise normal examination. We reviewed 20 patients with suspected occult ganglia who underwent an MRI scan and subsequently underwent surgical excision of the cyst. We compared the MRI diagnosis with the intra-operative findings and the histological evaluation of the surgical specimen to determine the accuracy of MRI in identifying an occult ganglion. When intra-operative determination of disease was used as a standard, the sensitivity of MRI scanning was 83%, the specificity was 50%, the positive predictive value was 94% and the accuracy 80%. Using histology as the standard, the sensitivity was 80%, the specificity 20%, and the positive predictive value 75%.

Abstract/Text: BACKGROUND: Idiopathic ulnar impaction syndrome can be defined as a degenerative condition of the ulnar aspect of the wrist in patients with congenital or dynamic positive ulnar variance without a history of fracture or premature physeal arrest. The purpose of this study was to evaluate the clinical features of idiopathic ulnar impaction syndrome and the outcomes of ulnar shortening osteotomy for this group of patients.
METHODS: Thirty-one wrists in twenty-nine patients with idiopathic ulnar impaction syndrome were treated with an ulnar shortening osteotomy. Ulnar variance was measured on an anteroposterior radiograph of the wrist, and radioulnar distance was measured on a lateral radiograph, with the forearm in neutral rotation, to evaluate any displacement of the ulnar head from the distal aspect of the radius. All patients were followed clinically and radiographically for a mean of thirty-two months.
RESULTS: An average preoperative ulnar variance of +4.6 mm (range, 2 to 7.5 mm) was reduced to an average of -0.7 mm (range, -4 to +1 mm) postoperatively. Preoperatively, the modified Gartland and Werley score was an average (and standard deviation) of 69.5 +/- 7.6, with twenty-four wrists rated poor and seven rated fair. Postoperatively, the score improved to an average of 92.5 +/- 8.0, with twenty-four wrists rated excellent; five, good; one, fair; and one, poor. Dorsal subluxation of the distal aspect of the ulna was found concomitantly in nine wrists, and it was found to be reduced by the shortening osteotomy. Seven patients had cystic changes in the carpal bones preoperatively, but these were not evident one to two years after the operation.
CONCLUSIONS: Ulnar shortening osteotomy improved wrist function in patients with idiopathic ulnar impaction syndrome and reduced the subluxation of the distal radioulnar joint, which is commonly found in these patients. Degenerative cystic changes of the ulnar carpal bones appear to resolve following the shortening osteotomy.

Abstract/Text: PURPOSE: The objective of this study was to conduct a follow-up evaluation of an arthroscopic reattachment technique using an avulsed deep component of the triangular fibrocartilage complex (dc-TFCC) from the fovea of the distal ulna (ulnar fovea).
METHODS: A retrospective study was performed on a consecutive cohort of 12 patients who underwent arthroscopic reattachment of the avulsed dc-TFCC into the ulnar fovea over a 24-month period. The mean age was 31 years (range, 20 to 50 years). There were 6 men and 6 women. This technique anchors the avulsed portion of the dc-TFCC to the ulnar fovea by means of a repair suture passed through the created osseous tunnel from the ulnar neck to the foveal surface. Postoperative clinical and functional outcomes were quantitatively evaluated with the Modified Mayo Wrist Score. The Disabilities of the Arm, Shoulder and Hand questionnaire served to assess each patient's subjective outcome. A questionnaire regarding each patient's return to his or her previous job was also completed. Radiographic evaluation was based on computed tomography and magnetic resonance imaging examinations.
RESULTS: At the mean follow-up of 30 months, all patients had significant reduction of wrist pain. The mean Modified Mayo Wrist Score was 92.5 ± 7.5, and all patients were rated as having excellent or good clinical results. The Disabilities of the Arm, Shoulder and Hand score significantly improved from 59.5 ± 18.5 to 7.7 ± 11.9 postoperatively (P < .0001). Of the 9 working patients, 7 returned to their previous work. Two patients had occasional extensor carpi ulnaris tendinitis after surgery. Magnetic resonance images at 12 weeks postoperatively showed findings indicating attachment of the triangular fibrocartilage complex (TFCC) to the fovea.
CONCLUSIONS: Arthroscopic reattachment of the avulsed TFCC to the ulnar fovea by the described technique is a valid alternative for treating avulsion of the foveal TFCC insertion.

Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Abstract/Text: Triangular fibrocartilage complex (TFCC) insertion into the fovea of the distal ulna plays a crucial role in stabilizing the distal radioulnar joint. Consequently, surgical reattachment against avulsion of the foveal TFCC insertion is required to stabilize the distal radioulnar joint. However, because of technical difficulties, no arthroscopic procedure for such a lesion has currently been established. We present a new technique for arthroscopic reattachment of the avulsed TFCC into the fovea. An osseous tunnel 2.9 mm in diameter is created from the ulnar neck to the foveal surface. Under arthroscopic guidance, a nonabsorbable suture passed into a 21-gauge needle is placed into the TFCC through the osseous tunnel. The avulsed portion of the TFCC is anchored to the fovea by means of a repair suture passed through the TFCC. To achieve normal tension of the TFCC, the suture is tied onto the periosteum around the proximal entrance of the osseous tunnel. Our arthroscopic technique is relatively simple and has great advantages for progressive healing at the attachment site between the TFCC and the fovea.

Abstract/Text: Although osteoarthritis (OA) of the wrist and fingers is routinely diagnosed using plain film, a thorough assessment of cartilage injuries using CT-arthrography, MR imaging, or MR-arthrography remains necessary before any surgical procedure. MR imaging is ideally suited for delineating the presence, extent, and complications of degenerative spinal disease, including OA of the spine involving the disk space, vertebral endplates, facet joints, or supportive and surrounding soft tissues. Other imaging modalities such as CT, dynamic radiography, myelography, and discography may provide complimentary information in selected cases. This article focuses on imaging of OA of the wrist and hand and the lumbar spine, with an emphasis on current MR imaging grading systems available for the assessment of discovertebral lesions.

Abstract/Text: BACKGROUND: The aim of the study was to report characteristics of isolated hook of hamate fractures related to sports that require a strong grip and to identify factors affecting early diagnosis and recovery period.
METHODS: A comprehensive literature search was conducted using MEDLINE, EMBASE, SCOPUS, Web of Science, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and the clinical trials registry and database of the US National Institutes of Health (ClinicalTrials.gov). There were no limits on the language or year of publication.This article included case reports and literature reviews for patients with isolated hook of hamate fractures related to sports that require a strong grip from 1977 to 2016.Two experienced reviewers extracted data from each study. The following data were extracted: sample size, patient's characteristics, cause of injury, injury side, time to diagnosis and symptoms, physical examination results, diagnostic work-up, treatment, complications, and recovery period.
RESULTS: A total of 21 case reports and literature reviews with 120 patients satisfied our inclusion criteria. There was no significant difference in the time to diagnosis between the group before computed tomography (CT) was widely used and the group after CT was widely used. Recovery period showed a positive relationship with age (coefficient = 0.418, P < .01), time from injury to diagnosis or surgery (coefficient = 0.206, P < .05), and type of athlete (coefficient = 0.270, P < .01). On multiple stepwise regression analysis, recovery period was significantly associated with age (β = 0.418, P = .00), but not with time from injury to diagnosis or surgery.
CONCLUSIONS: Advance in diagnostic techniques does not guarantee early diagnosis of hook of hamate fractures. Strong suspicion of the disease with physical examination and carefully hearing patient's history are important for early diagnosis and management for patients with hook of hamate fractures.