Journals Techniques in Hand & Upper Ext...

Techniques in Hand & Upper Extremity Surgery
Junichiro Shibuya, Masatoshi Takahara, Hiroshi Satake, Michiaki Takagi
Subcutaneous anterior transposition of the ulnar nerve is a common surgical treatment for cubital tunnel syndrome. However, there are surgical failures associated with the new compressive sites at the edge of flexor carpi ulnaris (FCU) and resubluxation posterior to the medial epicondyle of the transposed nerve. To reduce the muscle volume at the edge of FCU, we approach the ulnar nerve by dividing the muscle belly of the FCU humeral heads. This procedure can reduce repeated traction forces on the transposed nerve at the edge of the FCU...
May 13, 2024: Techniques in Hand & Upper Extremity Surgery
Luis Carlos Diaz, Enrique Vergara-Amador
ABSTRACT: We describe a new technique of transferring the motor branch ulnar nerve (UN) to the axillary nerve (AN) by posterior approach. Three patients with C5, C6, and C7 brachial plexus injury were operated. By supraclavicular approach, the spinal accessory was transferred to the suprascapular nerve. By posterior approach in the arm, the AN was identified within the quadrilateral space, and the UN was identified medially with intrafascicular dissection of a motor fascicle, which is lifted to 4 cm in length and transferred to AN...
April 23, 2024: Techniques in Hand & Upper Extremity Surgery
Ricardo Kaempf de Oliveira, João Pedro Farina Brunelli, Fernando Corella Montoya, Pedro J Delgado
Synovial or ganglion cysts are the most common soft tissue tumors of the wrist and hand and can arise from joints or tendons. Intratendinous synovial cysts, in contrast, are rare and their pathogenesis is still a matter of debate. The treatment of synovial cysts of articular origin using arthroscopy is commonly used with good results. For cysts of tendon origin, that is, extra-articular, when located at the ankle, shoulder, knee, and wrist, endoscopic treatment has also been described in a procedure called tenoscopy...
April 18, 2024: Techniques in Hand & Upper Extremity Surgery
Ankur Khanna, Clarence J Clark, Brandon J Yuan, Jennifer Tangtiphaiboontana, Jonathan D Barlow
Fixation of olecranon fractures, especially those with minimal proximal bone and those that present with significant comminution, can be technically challenging. Current open reduction and internal fixation (ORIF) methods, such as tension band wire (TBW) constructs, plate fixation (PF), and intramedullary screws (IMSF), have demonstrated high rates of reoperation and symptomatic implants. We present the omega plate technique, which utilizes a mini-fragment plate passed under the triceps tendon insertion, allowing maximal implant surface area contact with small, proximal olecranon fracture fragments...
April 1, 2024: Techniques in Hand & Upper Extremity Surgery
Paula A Pino, Christopher S Crowe, Kitty Y Wu, Peter C Rhee
Spastic wrist flexion deformities both limit the functional use of the hand for grasp and pinch producing a stigmatizing appearance. Tendon transfers and total wrist arthrodesis are treatment options for this condition depending on the patient's characteristics, the latter the most commonly used in patients with severe wrist flexion deformities. Tendon transfers alone in this scenario have the tendency for recurrent deformity due to tenorrhaphy failure or soft tissue creep and resultant loss of tension. Total wrist arthrodesis is a more invasive procedure, which can have hardware or fusion problems and that is irreversible...
March 28, 2024: Techniques in Hand & Upper Extremity Surgery
Nuttara Wiboonthanasarn, Kanon Limudomporn, Chairoj Uerpairojkit, Piyabuth Kittithamvongs, Sopinun Siripoonyothai, Navapong Anantavorasakul, Kanchai Malungpaishrope
Extensor indicis proprius (EIP) opponensplasty is one of the commonly used techniques to restore thumb abduction and opposition in patients with thenar muscle dysfunction from various causes of median nerve palsy. However, its subcutaneous route around the distal ulna may not represent a straight line of pull, and part of the extensor hood sometimes has to be harvested along with the EIP tendon to gain adequate length to reach the insertion. The purpose of the study is to present the alternative method of EIP opponensplasty and report the clinical outcomes...
March 27, 2024: Techniques in Hand & Upper Extremity Surgery
Arakua Welbeck, Charles A Goldfarb, Ryan P Calfee, Christopher J Dy
Flexor pollicis longus rupture is an uncommon but potentially debilitating complication after volar locking plate fixation of distal radius fractures, occurring secondary to tendon attrition against the implant. This nature of tendon injury typically precludes primary repair. This paper will illustrate 2 reconstruction techniques, an interpositional tendon graft and a tendon transfer, that have been utilized successfully by the authors.
March 22, 2024: Techniques in Hand & Upper Extremity Surgery
Joseph Saleh, Ethan D Patterson, Corinne Aillerie, Patrick Tohmé, Neil J White
Intra-articular distal humerus fractures present various challenges with a wide array of treatment options. Open reduction internal fixation remains the treatment of choice. In older patient populations with poor bone quality and short-end segment fractures with articular comminution, open reduction internal fixation, however, may bring on unsurmountable technical challenges. Total elbow arthroplasty and elbow hemiarthroplasty (EHA) may offer superior functional outcomes in these cases. During EHA for fractures, the medial and lateral columns are reconstructed with the collateral ligaments to restore elbow stability...
March 8, 2024: Techniques in Hand & Upper Extremity Surgery
Fa Yu Chan, Caroline Lam, Roger Butorac, Laurent Willemot
Snapping triceps syndrome is a rare cause of medial elbow pain and ulnar neuritis caused by subluxation and triggering of the medial tricipital muscle belly over the medial distal humeral ridge and condyle. The diagnosis and surgical management of snapping triceps syndrome can be challenging due to the subtlety of the symptoms and the infrequent presentation. Despite the diagnosis relying largely on clinical examination, noninvasive dynamic ultrasonography may facilitate detection. Correct recognition of this condition is crucial in the avoidance of surgical misadventure and revision surgery...
March 1, 2024: Techniques in Hand & Upper Extremity Surgery
Chao Long Azad, Nicholas A Orlando, Allan J Belzberg, Sami H Tuffaha
Improving upper extremity function in high cervical spinal cord injury (SCI) patients with tetraplegia is a challenging task owing to the limited expendable donor muscles and nerves that are available. Restoring active wrist extension for these patients is critical because it allows for tenodesis grasp. This is classically achieved with brachioradialis (BR) to extensor carpi radialis brevis (ECRB) tendon transfer, but outcomes are suboptimal because BR excursion is insufficient and its origin proximal to the elbow further limits the functionality of the tendon transfer, particularly in the absence of elbow extension...
February 27, 2024: Techniques in Hand & Upper Extremity Surgery
Jia Choong, Michalis Hadjiandreou, Pauline McGee, Wee Leon Lam
Syndactyly release aims to address skin deficits by resurfacing web spaces and sides of digits to allow independent digital motion while minimizing the risk of web creep and scar contractures. Conventional methods include the use of a dorsal and interdigitating flaps with full-thickness skin grafts. More recently, there have been several descriptions of "graftless" syndactyly release without skin grafts, thus avoiding a further (usually distant) donor site. However, the indications of when and when not to use these techniques remain unclear...
June 1, 2024: Techniques in Hand & Upper Extremity Surgery
Alexander Y Shin
No abstract text is available yet for this article.
June 1, 2024: Techniques in Hand & Upper Extremity Surgery
Muntasir Mannan Choudhury, Robert Tze Jin Yap, Jackson Kian Hong Jiang, Dawn Sinn Yii Chia, Andrew Yuan Hui Chin
Traumatic foveal tears of the triangular fibrocartilage complex lead to ulnar-sided wrist pain and instability, resulting in painful motion and loss of grip strength with a severe impact on the overall function of the upper limb. Surgical repair is nothing new and has traversed through the realm of open repair to arthroscopic assisted to all arthroscopic repair techniques over the many decades, with arthroscopic repairs showing better visualization, lesser trauma, and equally favorable patient outcomes. Techniques had varied from using trans osseous tunnels to bone anchors, with or without the usage of special jigs...
March 1, 2024: Techniques in Hand & Upper Extremity Surgery
Alexander Y Shin
No abstract text is available yet for this article.
March 1, 2024: Techniques in Hand & Upper Extremity Surgery
Nathan S Lanham, Christopher Michael Belyea, Joel R Peterson, Charles M Jobin
Elbow arthroscopy is an important surgical technique for the treatment of various elbow pathologies. Range of indications for elbow arthroscopy include, but are not limited to, diagnostic evaluation, removal of loose bodies, synovectomy, contracture releases, lateral epicondylitis treatment, and adjunct use for fracture reduction. Surgeons' understanding of anatomy and portal placement is critical for successful treatment. This article reviews the relevant surgical anatomy, portal placement, patient positioning, surgical indications, and complications for this technique...
March 1, 2024: Techniques in Hand & Upper Extremity Surgery
Lindley B Wall, Charles A Goldfarb
Syndactyly reconstruction often times leaves areas of skin deficit that require coverage for healing. Numerous techniques have been reported to address the deficits, including graftless technique, which utilizes mobilization of adjacent skin for coverage, full-thickness skin grafting, and skin substitute grafts. The technique described here demonstrates the ease of the use of skin substitutes for coverage in syndactyly reconstruction and reports the expected outcomes.
February 22, 2024: Techniques in Hand & Upper Extremity Surgery
Jack G Graham, Daniel E Davis
Maintaining the reduction of a transverse humeral shaft fracture can be particularly challenging while applying a compression plate for definitive fixation. Nitinol compression staples are being increasingly utilized in orthopedic surgery due to their unique ability to apply continuous compression between staple legs at body temperature. We have found them to be particularly useful in the maintenance of the reduction of transverse humeral shaft fractures before compression plate application. This simple technique allows for the removal of reduction clamps and precise plate placement...
February 2, 2024: Techniques in Hand & Upper Extremity Surgery
Patrick Goetti, William R Aibinder, Natalie R Rollick, Dominique M Rouleau, Kenneth J Faber
Symptomatic varus malunion after proximal humeral fractures is associated with weakness and painful limitation of shoulder range of motion. When there is conformity of the articular surface and no avascular necrosis, a head-preserving procedure is best indicated. Arthroscopic arthrolysis, subacromial decompression, and tuberoplasty have been described for the treatment of mild deformity. In cases with more severe deformity, corrective extracapsular lateral closing wedge valgus osteotomy has been reported as a reliable treatment option, in terms of both pain relief and improved function...
December 15, 2023: Techniques in Hand & Upper Extremity Surgery
Stuart W Jones, Fiona C Campbell, Douglas A Campbell
Nonanatomic surgical stabilization of the unstable extensor carpi ulnaris (ECU) tendon (where the subluxing tendon is re-routed away from the bony groove in the distal ulna) utilizes a flap of extensor retinaculum to create a new retaining sheath that will stabilize the tendon during forearm rotation movements. When this surgery fails, the extensor retinaculum tissue does not regenerate with sufficient structural strength to be used again. Previously, a different approach has then been needed for revision surgery, often using more complex surgical techniques with a substantially greater impact on recovery...
December 13, 2023: Techniques in Hand & Upper Extremity Surgery
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