The Effect of Distal Location of the Volar Short Arm Splint on the Metacarpophalangeal Joint Motion

BACKGROUND: The goals of this study were to compare maximal metacarpophalangeal joint (MCPJ) flexion angles after application of a volar short arm splint at 3 different locations and verify the relations between the three different physical and radiological locations. METHODS: Forty dominant hands of healthy subjects were analyzed in the study. We defined a transverse skin folding line as a line drawn from the radial aspect of the thenar crease to the ulnar aspect of the distal transverse palmar crease. The distal end of the volar short arm splint was applied on 3 parallel locations to this line. Location A was on this transverse skin folding line; location B was 1 cm proximal to location A; and location C was 1 cm distal to location A. Two orthopedic surgeons measured the maximal MCPJ flexion angles of each finger except the thumb with the application of a volar short arm splint at 3 different locations as well as without a splint as a control. Radiological locations of the 3 different distal ends of the volar short arm splint were also assessed by anteroposterior radiographs of the wrist. RESULTS: When the splint was applied at location A and C, the maximal MCPJ flexion angle decreased to a mean of 83° (91% of control value) and 56° (62% of control value), respectively (compared to the control, p < 0.001). At location B, the maximal MCPJ flexion angle was a mean of 90° (99% of control value); no significant difference was observed compared to the control or without the splint (p = 0.103). On radiography, the average length from the metacarpal head to the distal end of the splint at all fingers decreased in the order of location B, A, and C (29 mm, 19 mm, and 10 mm, respectively; p < 0.001). CONCLUSIONS: We recommend applying the distal end of a volar short arm splint at proximal 1 cm to the transverse skin folding line to preserve MCPJ motion perfectly, which is located at distal 44% of the whole metacarpal bone length radiologically.

The Effect of Distal Location of the Volar Short Arm Splint on the Metacarpophalangeal Joint Motion

BACKGROUND: The goals of this study were to compare maximal metacarpophalangeal joint (MCPJ) flexion angles after application of a volar short arm splint at 3 different locations and verify the relations between the three different physical and radiological locations. METHODS: Forty dominant hands of healthy subjects were analyzed in the study. We defined a transverse skin folding line as a line drawn from the radial aspect of the thenar crease to the ulnar aspect of the distal transverse palmar crease. The distal end of the volar short arm splint was applied on 3 parallel locations to this line. Location A was on this transverse skin folding line; location B was 1 cm proximal to location A; and location C was 1 cm distal to location A. Two orthopedic surgeons measured the maximal MCPJ flexion angles of each finger except the thumb with the application of a volar short arm splint at 3 different locations as well as without a splint as a control. Radiological locations of the 3 different distal ends of the volar short arm splint were also assessed by anteroposterior radiographs of the wrist. RESULTS: When the splint was applied at location A and C, the maximal MCPJ flexion angle decreased to a mean of 83° (91% of control value) and 56° (62% of control value), respectively (compared to the control, p < 0.001). At location B, the maximal MCPJ flexion angle was a mean of 90° (99% of control value); no significant difference was observed compared to the control or without the splint (p = 0.103). On radiography, the average length from the metacarpal head to the distal end of the splint at all fingers decreased in the order of location B, A, and C (29 mm, 19 mm, and 10 mm, respectively; p < 0.001). CONCLUSIONS: We recommend applying the distal end of a volar short arm splint at proximal 1 cm to the transverse skin folding line to preserve MCPJ motion perfectly, which is located at distal 44% of the whole metacarpal bone length radiologically.

Identification of Double Compression Lesion of Ulnar Nerve after Cubital Tunnel Release

The double compression syndrome of the ulnar nerve is a rare condition. Herin, we experienced double compression of ulnar nerve at cubital tunnel and Guyon's canal by re-evaluation after surgical decompression of cubital tunnel. We might suspect the double compression lesion in cases of worsening of symptom or nerve conduction velocity findings in a relative short duration of symptom as in our case. Meticulous physical examination might be needed to detect the Guyon's canal syndrome as a comorbidity in the treatment of cubital tunnel syndrome and re-evaluation for dual compression might be recommended if the resolution of symptom was not achieved after surgical decompression of single nerve lesion.

Survey for Musculoskeletal Pain of Korean Junior Tennis Players / 대한스포츠의학회지

The aim of this survey was to analyze the characteristics of musculoskeletal pain of Korean junior tennis players and its effect on games and psychology of players. Surveys were administered to 30 healthy male junior tennis players who took part in a 50th national junior tennis meet in 2015. We analyzed the incidence, location, cause and preferred prevention or treatment method of musculoskeletal pain, the correlation between training time and musculoskeletal pain as well as the effect of musculoskeletal pain on games and psychology of players. Overall, 22 out of 30 (73.3%) responded the experience of musculoskeletal pain. The incidence of lower extremity pain (16 out of 30, 53.3%) were higher than upper extremity pain (9 out of 30, 30%) and low back pain (8 out of 30, 26.7%). The long training hours per day (r=0.574, p=0.001) and old age (r=0.390, p=0.033) were correlated with intermittent back pain in univariate anlaysis. In multivariate ananlysis, the long training hours per day was a single risk factor of intermittent low back pain (p=0.038, odds ratio 10.01). 43.3% of players responded that the insufficent preventive conditioning program was thought to be the cause of musculoskeletal pain. The most preferred treatment or prevention method for musculoskeletal pain was rehabilitation (55.3%). Twelve players reported the negative affection of musculoskeletal pain to the performance in game. Six players experienced the frustration, 9 players experienced the loss of interest and 9 players experienced the emotional avoidance of games due to the musculoskeletal pain.

Review of Meniscal Allograft Transplantation Focusing on Long-term Results and Evaluation Methods

With recognition of the biomechanical role of the meniscus, such as load distribution and joint stability in the knee joint, there has been a shift in the treatment of meniscal tears from open total meniscectomy to preservation of the meniscal functions as much as possible with symptomatic relief. Recently, technical development of meniscal surgery, with advanced arthroscopic equipment and instruments, enables biological reconstruction of load bearing functions in the meniscus deficient knee through allograft tissue transplantation as well as repair of torn menisci. Meniscal allograft transplantation (MAT) has been considered as one of the few viable treatment options for the young meniscectomized knees based on various animal experiments and clinical studies. Still, there is insufficient evidence for the long-term chondroprotective effect of human MAT. Some long-term follow-up studies showed that the technique resulted in graft degeneration, deformation, and tear, and structural changes in the remodeling process in early MAT cases, disrupting functional restoration of the original meniscus. Nevertheless, advanced outcomes are documented in some recent studies. The purpose of this article is to review the mid- and long-term follow-up results of MAT and to improve understanding of MAT with evaluation methods of meniscal transplants using magnetic resonance imaging or second-look arthroscopy.

Prevalence And Risk Factor of Degenerative Disease of Adjacent Segment after Anterior Cervical Arthrodesis

STUDY DESIGN: A retrospective radiologic and clinical analysis of 48 patients following anterior cervical fusion. OBJECTIVES: To examine the prevalence of symptomatic adjacent segment disease after anterior cervical fusion and determine the risk factors affecting its progression. SUMMARY OF LITERATURE REVIEW: Symptomatic adjacent segment disease appears to occur at a rate of 2% to 3% per year. MATERIALS AND METHODS: Forty-eight patients, who were followed up for more than 3 years after anterior cervical arthrodesis, were enrolled in this study. A modification of the Robinson criteria was used for the clinical evaluation and the radiographic grading of Hilibrand was used for the radiology evaluation. Kaplan-Meier survival analysis was used to examine the survival rate. Age, gender, number of fusion segments, preoperative ROM, angle of lordosis, spinal canal diameter and radiologic degeneration of adjacent segments were selected as potential risk factors. The subjects were divided into two groups according to their clinical symptoms. RESULTS: Symptomatic adjacent segment disease developed in 11 of the 48 patients(22.9%). The disease free survival rates were 88.7%, 82.4% and 58.7% at 5, 10 and 15 years, respectively. A study of the risk factors showed that preoperative degenerative changes and narrow spinal canal in the adjacent segments were significant. However, there were no significant associations with age, gender, number of fusion segments, preoperative ROM and angle of lordosis. CONCLUSION: The prevalence of symptomatic adjacent segment disease after anterior cervical fusion was considerable and higher when the patients had preoperative degenerative changes and a narrow spinal canal in the adjacent segments.

Clinical Outcome and Causative Factor in Patients of Structural Failure after Rotator Cuff Repair

PURPOSE: We wanted to evaluate the relationship between the clinical outcomes and cuff integrity after open rotator cuff repair and we wanted to analyze the causes of rotator cuff retear. MATERIALS AND METHODS: 78 patients who underwent open rotator cuff repair were enrolled from 2004 to 2006. All the patients were observed for a minimum follow-up of 12 months and they were evaluated by magnetic resonance imaging (MRI). The clinical outcomes were accessed by dividing the patients into the retear group and the intact group. The groups were also compared to analyze the cause of rotator cuff retear according to the preoperative tear size, the symptom duration, and so on. RESULTS: The clinical outcome of the retear group (n=22) was improved significantly after operation (p<0.001, p<0.001), but the muscle power was not improved significantly (p=0.099, p=0.243). More retears were found in the patients who had a larger preoperative tear (p<0.001) and the symptom duration of the retear group was longer (p=0.027). CONCLUSION: Although there were retear after rotator cuff repair, the clinical outcomes were improved. Yet the muscle power of the supraspinatus and external rotator were not improved significantly. There were more retears for the cases that had a larger preoperative tear size and a longer duration of symptoms.

The Comparison of the Results Between AO Internal Fixator (Long lever-arm) and Screw-Rod System (Short lever-arm) Through Posterior Approach in Unstable Thoracolumbar Fractures / 대한척추외과학회지

STUDY DESIGN: Prospective study. OBJECTIVES: To analyze the outcome of posterior reduction and fixation with the AO internal fixator and with the screw-rod system in unstable thoracolumbar fractures and to investigate differences in effectiveness between the two methods. SUMMARY OF LITERATURE REVIEW: In unstable thoracolumbar fractures, fixation with the AO internal fixator is an effective method for posterior reduction. However, the results of correction are quite variable. MATERIALS AND METHODS: We analyzed 51 patients with unstable thoracolumbar fractures who underwent correction through posterior approach between 1997 and 2003. We divided the patients into two groups: Patients in Group A (25 cases) were treated with the AO internal fixator, and patients in Group B (26 cases) were treated with the screw-rod system. We added transpedicular bone grafts for 17 patients in Group A. We evaluated correction of deformity (anterior and posterior height of vertebral body, sagittal index, disc height), loss of correction, spinal canal clearance, and neurological recovery. RESULTS: Comparing correction of deformity, we saw better results in Group A than in Group B in regards to sagittal index and anterior height of vertebral body. However, we saw a higher degree of correction loss in the anterior height of the vertebral body in Group A. We grafted autogenous bone into the fracture site by transpedicular approach for 17 patients in Group A. We saw less correction loss in the anterior vertebral body height and sagittal index. In regard to spinal canal clearance, we saw better results in Group A (18%) than in Group B (10%). As for neurological recovery, we could not find any statistically significant difference between the two groups. CONCLUSIONS: Through an operative procedure, we could achieve better results in restoration of anterior vertebral height and canal clearance with the AO internal fixator system. Further study is necessary to keep the reduced state of vertebral height.