[Comparison of efficacy and complication of classic and short palmar incision in the patients with carpal tunnel syndrome]

Classic open incision is used usually in surgical release of carpal tunnel syndrome, but its complications are painful scar and delayed rehabilitation. The other method used, short palmar incision seems to have fewer complication and easier rehabilitation. Therefore, the aim of this study was to compare the efficacy and complications of these two surgical methods. In this clinical trial, the patients candidate for surgery were randomly divided in two groups of 51. One group was operated with classic incision and the other was operated with short palmar incision. The rate of infection, surgical scar, tenderness and pain in incision, paresthesia and numbness, Tinnel test, Phallen test and recovery of sensory symptom postoperatively in the two groups in 3 weeks and 3 months after the operation were registrated and compared using Fisher, X2 and t-student tests. In the case of wound infection and damage to median nerve and its palmar branch no difference was seen in the two groups. Tenderness at the incision site in the case and control groups was 7.8% and 58.8% at the third week and was 2% and 47.1% in the third month, respectively [P<0.05]. The mean of pain intensity in the case and control groups was 1.64 +/- 0.22% and 2.04 +/- 0.23% at the third week [P<0.001] and was 1.28 +/- 0.14% and 1.39+0.18% in the third month, respectively [P>0.05]. There were no significant differences between the two groups in the cases of the amount of paresthesia, numbness and recovery of sensory symptoms. Regarding the similar effectiveness in both classic and short palmar incision and less post-operation complication of the later method, this method is recommended for surgical release of median nerve of wrist

[ investigation of the repair of acute trauma of flexor tendons of zone II]

Despite the tremendous investigation in the areas of flexor tendon anatomy, biomedhanics, nutrition, healing and adhesion formation return of satisfactory digital performance following for the hand surgeons. This is a descriptive cross sectional study which investigates the results of primary repair of acute trauma [less than 10 days] to flexor tendons of zone II. After initial exam, the operation was done by an experienced hand surgeon. The operation was done mostly in first 24 hours [primary repair] and in some cases in 10 days [delayed primary repair]. All FDP lacerations were repaired with 4/0 nylon modified Kessler core suture and 6/0 nylon circumferential running suture. Post operation mobilization was done by using a dorsal splint in 40 degree wrist flexion and 60 degree metacarpophalengeal flexion and interphalengeal extent ion from finger tips to elbow. Early motion was begun one or two days after operation with modified Kleinert regimen, in children who could not cooperate in motion, long cast was used all patens completed follow up every two weeks for 6 weeks and every three weeks for another 6 weeks. The results were evaluated to buck-gramcko classification system at least 3 months after treatment. The results analyze was done using SPSS software and Kruskal-Wallis and man Whitney tests. The study was done on 37 patients with injured flexor tendons,%67 male and%33 female with average age of 26. The results were excellent 22 [%37.3] and good in 21 [%35.6 and fair in%20.3 and bad in 4 [%6.8]. The most common complications were mild to moderate adhesion [%45] and cold intolerance [%36]. Results of tendons repair were better in females than those in males [p value =%0.399]. The best result was repair of isolated FDS. Results of repairing both FDP and FDS were the same as repairing FDP and resecting FDS [P value =%0.0006] final results were better in non dominant had [p value =%0.0025]. The repair of flexor tendons of zone II has various side effects and demands more and more primary repair measures on the part of an experienced surgeon

Osteoid osteoma of elbow. Two case reports and review of literature

Although osteoid osteoma is a relatively common lesion, it rarely occurs at elbow. We report two cases of osteoid osteoma of elbow in trochlea. Diagnosis was delayed because of non-specific clinical and radiological features. The two patients suffered from flexion contracture of elbow due to synovitis, while at the same time, pronation and supination remained normal. Only one of the patients complained of specific nocturnal pain. Both patients had latencies between the onset of symptoms and the appearance of radiological signs. Open surgical excision of the nidus resulted in complete relief and motion recovery in both cases. Diagnostic difficulties and treatment options are discussed below

Electrophysiogical findings in a family with hereditary neuropathy and liability to pressure palsies

Hereditary neuropathy with liability to pressure palsies is an autosomal dominant and demyelinative peripheral neuropathy which characterized by reversible episodes of sensorimotor deficits after neural compression injuries. Their clinical hallmarks are recurrent and painless focal neuropathies maintly preceded by minor trauma or compression at entrapment sites of peripheral nerves. We describe multiple compression mononeuropathies in an individual who presented with left sided ulnar palsy after drilling for a period of 8 hours and report neurophysiologic findings in two clinically asymptomatic family members. We believe that this entity may be clinically and neurophysiologically underdiagnosed by orthopaedic surgeons and electromyographers. Electrophysiological abnormalities can be detected even in asymptomatic patients and it should be considered in differential diagnosis of patients with atypical presentations of compression neuropathies

study on the effect of applying cast splints in treatment of tennis elbow

Background: tennis elbow is a common orthopedic disease affecting elbow in middle aged people. Ninety percent of patients are cured using conservative treatments. In the past, emphasis was placed on the use of long arm splints for its treatment; however, recent studies put doubt on the use of this method of treatment for the complications arising from the application of splints. The results of using long arm splints for the treatment of tennis elbow were evaluated in our study

Methods: this was a case series non randomized clinical trial involving 25 patients treated with long arm castsplints, and 25 patients treated without the use of splint. Local corticosteroid injections and oral NSAIDs were administered for all patients. The two groups were compared in the third week, third month and sixth month of their treatment for the presence of local tenderness and pain in passive flexion test of wrist and fingers against resistance. Using SPSS 9.0, data were analyzed via repeated measurements test of ANOVA

Results: patients in case and control groups had mean ages 43.6 +/- 7.2 and 43.6 +/- 6 years, respectively. Prior to any treatments, all patients in this study suffered from pain and tenderness in the origin of forearm extensor muscles. Their pain exacerbated upon passive flexion of wrist and fingers against resistance. No significant difference was seen in third week, third month and sixth month [P value =0.32], and no significant difference was seen in the results of our tests regarding the presence of local tenderness and pain in passive flexion of wrist and fingers against resistance between the two groups

Conclusions: after a follow-up period of six months, this study demonstrated no statistically significant difference between the two groups treated with and without long arm splints