The triple compression stress test for diagnosis of tarsal tunnel syndrome.

BACKGROUND: The diagnosis of tarsal tunnel syndrome (TTS) lacks objectivity and consistency. METHODOLOGY: A new test was designed, called triple compression stress test (TCST), to elicit stress on posterior tibial nerve and its branches, in an attempt to provoke signs of its entrapment. In this test, the ankle is placed in full planter flexion and the foot in inversion, with even, constant digital pressure applied over the posterior tibial nerve. Basic clinical examination to fifty patients with symptoms suggestive of TTS in one or both feet was done. Forty healthy volunteers (80 feet) were enrolled as a control group in the study. We then performed our designed clinical TCST, as well as, basic conventional electrodiagnostic studies bilaterally on all patients and controls. Consecutively, electrodiagnostic TCST was done for patients with negative basic nerve conduction results. RESULTS: The clinical TCST was positive in 61 out of 65 (93.8%) symptomatic feet. It provoked symptoms in 6 new asymptomatic feet. The electrodiagnostic TCST was positive in 78 feet, of which 67 had a positive clinical test and 11 had false negative clinical test. Both tests were negative in all the control feet. Clinical TCST sensitivity was 85.9% while specificity was 100%. CONCLUSION: TCST achieved a simple, fast and very reliable provocative maneuver to increase the sensitivity of TTS diagnosis both clinically and electrophysiologically.

Salvage of failed trochanteric fracture fixation using the Revitan curved cementless modular hip arthroplasty.

Failed internal fixation of an intertrochanteric or subtrochanteric fracture often leads to persistent pain and diminished function. This study evaluated 16 patients treated with Revitan curved cementless modular stem (Zimmer GmbH, Winterthur, Switzerland). At a mean follow-up period of 60 months, all patients demonstrated clinically significant pain relief and return to ambulation after salvage total hip arthroplasty. Mean Harris Hip Score improved from 17.8 to 87.7 points postoperatively. Radiographic follow-up demonstrated stable stem and bony ingrowth in 16 patients without evidence of subsidence. Eight patients had slight awareness of lateral trochanteric pain with no compromise of activities, and 1 patient had nonunion of the greater trochanter. Revitan curved cementless modular stem represents a useful treatment option in salvage total hip arthroplasty of failed pertrochanteric fixation.

The new "dual osteotomy": combined open wedge and tibial tuberosity anteriorisation osteotomies.

The high frequency with which medial compartment osteoarthritis is associated with patellofemoral osteoarthritis makes the addition of tibial tuberosity anteriorisation to high tibial osteotomy an appealing solution, despite the discouraging previously reported long-term results when tubercle anteriorisation was combined with a Coventry closed wedge technique. We conducted a prospective study of a new osteotomy combination: "the dual osteotomy". An open wedge high tibial osteotomy was combined with 1- to 1.5-cm Maquet-like tibial tuberosity anteriorisation. Thirty-four knees in 30 patients underwent surgery, including ten knees in nine male patients and 24 knees in 21 female patients with a mean age of 45 years (age range 34-58 years). All patients had varus medial compartment osteoarthritis and patellofemoral osteoarthritis with preoperative anatomical tibiofemoral angle exceeding 5 degrees . Twenty-four months after surgery, final evaluation detected improvement in the Knee Society clinical rating system function score from a mean of 61.3 (range 30-80) preoperatively to a mean of 87.3 (range 50-100) postoperatively and in the knee pain score from 27.3 (range 10-30) to 47 (range 30-50) postoperatively. Based on the rating system, at final follow-up, 70% of patients experienced no pain, 13% had mild or occasional pain, 10% had pain on stairs only, and 7% had pain during walking and on stairs. Anatomical tibiofemoral angles from 0 to 10 degrees valgus were achieved in 91% of operated knees, and union was achieved in all cases within six to twelve weeks after surgery. The dual osteotomy was effective in the short term in cases of medial compartment osteoarthritis associated with patellofemoral osteoarthritis.