ABSTRACT
Abstract Patients with radial-sided wrist pain can be challenging to diagnose and treat. Various physicians, including emergency physicians, primary care physicians, and orthopedic or plastic surgeons can be involved in the initial and subsequent evaluation. We delve into the differential diagnosis of radial-sided wrist pain including osteoarticular, ligament, tendon, nerve, and other pathologies. We review the physical exam findings, diagnostic studies, and treatment options for each pathology based on recent and updated literature.
Resumen Los casos de pacientes que presentan dolor radial de muñeca pueden ser de difícil diagnóstico y tratamiento. Varias especialidades médicas, incluidas emergentólogos, médicos de atención primaria, cirujanos ortopédicos o cirujanos plásticos, pueden estar involucrados desde el inicio de la patología y subsecuente evaluación. Pro fundizamos aquí en el diagnóstico diferencial del dolor radial de muñeca incluyendo las debidas a patologías osteoarticulares, ligamentosas, tendinopatías y neuropatías, entre otras. Esta revisión incluye examen físico, estudios diagnósticos, y opciones terapéuticas para cada condición con base en la literatura reciente y actualizada.
ABSTRACT
Interosseous atrophy of the hand is not an exclusive finding of rheumatoid arthritis, and in the case of amyotrophic lateral sclerosis it has a significant diagnostic and prognostic value. The physical examination and evidence of the "split hand" sign or sign of the double anatomical snuffbox is a finding that should alert the clinician to the need for complementary studies in order to rule out neurological pathology.
La atrofia de interóseos de la mano no es un hallazgo exclusivo de la artritis reumatoide, en el caso de la esclerosis lateral amiotrófica tiene un valor diagnóstico y pronóstico significativo, por lo que la exploración física y la evidencia del signo de la mano partida o signo de la doble tabaquera anatómica es un hallazgo que debe alertar al clínico de la necesidad de realizar estudios complementarios para descartar una enfermedad neurológica.
Subject(s)
Humans , Female , Aged , Spinal Cord Diseases , Central Nervous System Diseases , Amyotrophic Lateral Sclerosis , Nervous System DiseasesABSTRACT
Distal transradial access for vascular interventions has gained ground recently. While the novel approach is associated with reduced radial artery occlusion and faster hemostasis, it could be related with prolonged procedural time, higher crossover rate and increased radiation, comparing to conventional transradial approach. Whether the radiation is increased in the procedures performed by the novel approach remains unambiguous. In the specific article, we aim to review the current literature and to propose possible explanations for this phenomenon. Could radiation be the Achilles’ heel of distal transradial artery access?
ABSTRACT
The anatomical snuffbox is a small triangular area situated in the radial part of the wrist, often used to perform clinical and surgical procedures. Despite the frequency with which this area is used, there is scarce information in literature about its details. The objective of this study is detailed knowledge of the anatomical snuffbox's anatomy and its components, the reported alterations at this portion, besides the clinical uses and significance of this area.
La tabaquera anatómica, es una pequeña área triangular ubicada en la parte radial de la muñeca utilizada a menudo para realizar procedimientos clínicos y quirúrgicos. A pesar de la frecuencia con la que se utiliza esta zona, escasea la información acerca de sus detalles en la literatura. El objetivo de este estudio es conocer con detalle la anatomía de la tabaquera anatómica y sus componentes, las alteraciones reportadas a ese nivel, y los usos e importancia clínica de esta región.
Subject(s)
Humans , Radial Artery/anatomy & histology , Radial Nerve/anatomy & histology , Wrist/anatomy & histology , Anatomic Variation , Wrist/blood supply , Wrist/innervationABSTRACT
Objective Retrospective analysis of experience of distal upper limb autologous arteriovenous fistula for hemodialysis access and treatment of arteriovenous fistula occlusion was conducted.Methods To summarize the clinical data of 214 cases of initial autologous arteriovenous fistula and 22 cases of treatment of arteriovenous fistula occlusion were carried out from Aug.2007 to Mar.2011,comparing the success rate and long-term patency rate.Results Two hundred and fourteen cases of initial autologous arteriovenous fistula,in which 168 cases were cephalic vein-radial artery side-to-side anastomosis at snuffbox,46 cases were cephalic vein-radial artery end-toside anastomosis at proximal wrist,the success cases were 203 (94.8％),the failed cases were 11 (5.2％),limb edema in 82 cases and there was no steal syndrome and heart failure.The primary patency rate was 95.2％ at 1 year and 91.3％ at 2 years.There were 22 patients accepted treatment of arteriovenous fistula occlusion,in which,8 cases were embolectomy due to acute occlusion,8 cases were thrombectomy and balloon dilation because of anastomotic stricture and thrombosis and 1 failed,5 cases were proximal anastomosis again after chronic occlusion.Conclusions Autologous arteriovenous fistula of the distal upper limb,especially from the place of snuffbox which is the preferred method for autologous arteriovenous fistula.And deal with arteriovenous fistula occlusion actively can often extend the usage time of the autologous blood vessels and improve the life quality of patients.
ABSTRACT
Objective To summarize and investigate the therapeutic effects of reconstruction of contracture of the first web space with snuff-box flap. Methods Eighteen patients with contracture of the first web space were treated by snuff-box flap. The width and the angle of the first web space was 19 mm and 20°on average. According to the first web space skin defects, the flap designed to nasopharyngeal fossa centers as rotation point, the radial line when the forearm in the neutral position as the axis. Results The followedup for 5-26 months revealed that 17 flaps had a success, but 1 case was partly necrosis. The width of the first web space was augmented by an aveage of 45 mm, the angle of the first web space was augmented by an average of 50°. Conclusion It is ralatively simple and reliable to repair the contracture of the first web space using the snuff-box flap.
ABSTRACT
This study concerns 110 patients who were underwent anatomical snuffbox arteriovenous fistula at Department of Surgery, Holy Family Hospital, College of Medicine, The Catholic University of Korea, from January 1995 to December 1997. We analysed the overall and success patency rate between diabetic and non-diabetic patients. The results obtained are as follows: 1) 52 operations were performed on male patients and 58, on females. And mean age was 51 years. 2) Average follow-up period was 19 months. 3) Early failure rate of all cases was 17 cases (15%), 2 cases (6%) in diabetic patients and 15 cases (9.7%) in non-diabetic patients. 4) Overall patency rates of all patients were 76.6, 72.0, 68.8 and 64.9% at 6, 12, 18 and 24 months and success patency rates were 90.7, 85.2, 81.4 and 76.8% after creation of anatomical snuffbox arteriovenous fistulas. 5) Overall patency rates of diabetic patients were 78.8, 74.8, 74.8 and 59.8% at 6, 12, 18 and 24 months and success patency rate were 83.4, 79.4, 79.4 and 63.5%. 6) Overall patency rate of non-diabetic patients were 75.9, 71.0, 66.6 and 66.6% at 6, 12, 18 and 24 months and success patency rate were 94.5, 88.4, 83.0 and 83.0%.