A complete analysis of the surgical treatment for cubital tunnel syndrome: an umbrella review.

BACKGROUND: Numerous original studies have been presented regarding various surgical treatments for cubital tunnel syndrome (CubTS). The results of these analyses regarding the different surgical treatments for CubTS frequently differ and, in some cases, contradict each other, creating confusion. Therefore, our umbrella review aimed to summarize the evidence from meta-analyses and systematic reviews regarding the surgical treatments of CubTS, and along with the new, more detailed outcomes, provide an evidence-based tool for surgeons performing these procedures. MATERIALS AND METHODS: To perform this umbrella review, a systematic search was conducted for meta-analyses investigating CubTS in PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO medical databases. RESULTS: Detailed comparison of surgical outcomes, such as clinical improvement, complications, or reoperation rates, of different treatment methods for CubTS was performed. New risk ratios in all categories were established based on all of the primary studies available in the literature. DISCUSSION: The goal of the present umbrella review was to gather and summarize all data about the surgical treatments for CubTS in the available literature and provide new outcomes and an evidence-based tool for surgeons performing these procedures. Each comparison of the surgical techniques has been discussed, and the present study's results were compared with the outcomes of the previous studies.

Treatment Options for Tennis Elbow - An Umbrella Review.

INTRODUCTION: The main goal of the present umbrella review was to provide the most up-to- date and evidence-based results regarding the various treatment options for tennis elbow (TE), which hopefully will significantly decrease the confusions existing in the literature. Furthermore, our study differs from past analytical studies because, as to the best of the authors' knowledge, is the first to provide independent (not in comparison to other treatment) statistical results regarding the effectiveness of each TE treatment. MATERIALS AND METHODS: Major medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO were searched. The overall search process was conducted in 3 stages. RESULTS: A total of 40 studies met the inclusion criteria and were included in this study. Out of those 40 meta-analyses, a total of 160 primary studies were screened in order to extract the data and perform a statistical analysis. CONCLUSION: The present umbrella review underlines the efficiency of injection therapies, especially autologous blood, and platelet-rich plasma, while simultaneously proving the ineffectiveness of acupuncture and shock wave therapy as treatments for TE. Furthermore, the value of other known conservative treatment modalities, such as physical therapy, has been demonstrated.

Arthrofibrosis - a myth or true joint disorder?

Authors, mostly specialists on rehabilitation and orthopedic surgery prove that arthrofibrosis is a commonly overlooked phenomenon, which may lead to serious limitation in the range of movement, leading to limitation in patients quality of functioning. The main goal of this article is to emphasize the importance of understanding a such complex condition. Non typical patomechanism, lack of biomarkers dedicated to this dysfunction and general lack of understanding in this pathology causes that risk factors and the most effective strategies remain vastly unknown. Pathophysiology of the arthrofibrosis in the joints is definitely multifactorial, but intense production of collagen seems to be the main factor. Most modern pharmacological methods concentrate on the regulation of collagen fiber production and reducing the inflammation. Inflammation from joint contractures stimulates the proliferation of activated cells that results in the production of extracellular matrix macromolecules to form fibrotic tissue that is deposited into the capsule, thereby resulting in fibrosis. Lack of unified classification scale is caused by relatively high variation of the functions fulfilled by particular joints and each treatment plan should be constructed individually. Quality of surgical treatment and physical therapy play a major role in both prevention and treatment of such complex condition as arthrofibrosis. Both iatrogenic mistakes and overly aggressive manual therapy are some of main factors increasing the risk of this pathological condition. Introducing properly conducted physical therapy treatment in the early stage is crucial to main the range of movement and preventing this significant problem.

Anatomy of the deep brachial artery - general overview (cadaveric study) - discussion on terminology.

There are only very few studies on the anatomy of the deep brachial artery - DBA (arteria profunda brachii), both regarding its course, branching pattern and contribution to the cubital rete. Most of the textbooks are based on data which remain unchanged for years. The aim of this article was to summarize the current knowledge on this vessel, based on the anatomical and clinical studies and other sources available including also own cadaveric study. We tried to present also some controversies regarded to the nomenclature of the branches of the DBA.

Incorporation of the sphenoid sinuses' septum / septa in the carotid canal - evaluation before the FESS.

The purpose of the research was to define the frequency prevalence of the incorporation of sphenoid sinuses' septum / septa in the carotid canal of the adult population. MATERIALS AND METHODS: 296 computed tomography (CT) scans of the patients (147 females, 149 males), who did not present any pathology in the sphenoid sinuses, were evaluated in this retrospective analysis. Spiral CT scanner - Siemens Somatom Sensation 16 - was used to glean the medical images. Standard procedure applied in the option Siemens CARE Dose 4D. No contrast medium was administered. Multiplans reconstruction (MPR) tool was used in order to obtain frontal and sagittal planes from the transverse planes previously received. RESULTS: Bilateral incorporation of the main septum (MS) in the carotid canal was not present in any of the patients, whereas unilateral incorporation was noticed in 21.96% of the patients (17.68% females, 26.17% males). On the right side it occurred in 11.82% of cases (10.88% females, 12.75% males), and on the left side in 10.14% of cases (6.8% females, 13.42% males). Bilateral incorporation of the additional septum (AS) was found in 8.45% of the patients (4.08% females, 12.75% males), whereas unilateral incorporation was noted in 28.37% of the patients. It was seen on the right side in 11.82% of cases (12.93% females, 10.74% males), and on the left side in 16.55% cases (15.65% females, 17.45% males). The most common variant was the incorporation of only one of the septa (either the MS or the AS) in the wall of the carotid canal unilaterally. Such situation took place in 30.07% of the patients (29.25% females, 30.87% males). Incorporation of two septa on the same side was noticed in 4.39% of cases (4.08% females, 4.7% males), and incorporation of three septa in 0.34% of cases (0.7% males). CONCLUSIONS: The anatomy of the paranasal sinuses is varied to a great extent, hence performing a CT scan is crucial before the scheduled surgery, as it may lessen the unforeseeable surgical complications, that may result from the high prevalence of variants in the sinuses.

Vascular density of inferior tibiofibular joint - cadaveric experimental study.

The study was carried out on 50 human lower legs obtained during autopsies (KBET: 122.6120.315.2016). The anatomy of the joint was studied using classical anatomical description methods. Based also on literature we have reviewed the current knowledge on the inferior tibiofibular joint blood supply considering the important clinically aspect - vascular density. Authors of this paper postulate relatively low vascular density of the region described and potential worse condition for healing in case of injury or after surgical procedures performed. We also postulate that ligament screws should be positioned with special respect to time limit which enables proper healing of the syndesmosis.

Anatomical variability and histological structure of the ulnar nerve in the Guyon's canal.

OBJECTIVES: The goal of our study was to analyze the prevalence of variations, branching patterns, and histology of the ulnar nerve (UN) in Guyon's canal to address its importance in hand surgery, particularly decompression of the UN. METHODS: Fifty fresh cadavers were dissected bilaterally, and the nerve in the area of Guyon's canal was visualized. Samples for histology were also taken and prepared. The collected data were then analyzed. RESULTS: Morphometric measurements of the hands and histological studies were not found to have significant differences when compared by left or right side or by sex. Three major branching patterns were found, with division into deep and superficial UN being the most common (85%). Additional findings included a majority (70%) presenting with a cutaneous branch within the canal and/or with an anastomosis of its distant branches with those of the median nerve (57%). CONCLUSION: The UN is most commonly found to divide into a superficial and deep ulnar branch within Guyon's canal. However, additional branches and anastomoses are common and should be taken into careful consideration when approached during surgery in the area, particularly during decompression procedures of Guyon's canal.

Angiogenesis and pro-angiogenic factors in uterine fibroids - facts and myths.

Uterine leiomyomata present major problem for females. Although they are benign tumors their frequency is associated with many symptoms like infertility, abdominal pain, menorrhagia. Authors based on their own morphological studies and review of the literature try to indicate main factors causing angiogenesis within leiomyomata and its influence on tumor growth. The strongest proangiogenic factor seems to be hypoxia, which stimulates up- and down-regulation of numerous genetically determined substances. Also mechanical pressure acting upon newly growing vessels is one of the factors which may determine formation of so called "vascular pseudocapsule" around the lesion.

Intra-articular pathologies associated with chronic ankle instability.

Chronic ankle instability causes intra-articular lesions, which may lead to secondary degenerative changes. The aim of this study was to evaluate the usefulness of the ankle arthroscopy for the evaluation and treatment of intra-articular pathologies associated with chronic ankle instability. Between January 2013 and March 2016, 25 anterior ankle arthroscopies with modi ed anatomic Broström-Duquennoy-Tourne lateral ankle ligaments reconstructions were performed. In arthroscopy all patients (100%) had some intra-articular pathologies: 75% synovitis or so tissue scarring, 19% - deep chondral defect, 56% - superficial chondral lesion, 52% - osteophytes, 24% - bony or avulsion fragments, 20% - loose bodies. All intra-articular pathologies were treated during procedure. In conclusion, it is recommended to perform anterior ankle arthroscopy in addition to lateral ankle ligament reconstruction to diagnose and treat intra-articular lesions.

Vascular density, angiogenesis and pro-angiogenic factors in uterine fibroids.

Angiogenesis is a process of development of new vessels from the preexisting vascular network of a host. This is process which is seen in many physiological situations but it accompanies also a development of different lesions, i.e. neoplasms. Uterine fibroids are one of the most frequent lesions which affect human internal female genital tracts. Authors briefly review most important pro-angiogenic factors, based on their own observation as well as reviewing current literature. They pay much attention to vascular density which is significantly changed in the uterine tumors.

Blood vessels of the shin - anterior tibial artery - anatomy and embryology - own studies and review of the literature.

Injuries of the lower leg are rather frequent in every day orthopedic routine. Process of healing takes quite a long time and is commonly dependent on the proper vasculature. e study was carried out on 50 human lower legs obtained during autopsies. The anatomy of the vascular system of the leg was studied using classical anatomical dissection methods. Based also on literature we have reviewed the current knowledge on the vascularization of the lower leg and its embryological background.

Blood vessels of the shin - posterior tibial artery - anatomy - own studies and review of the literature.

Anatomy of the vascular system of the leg was studied using classical anatomical dissection methods. Based also on literature we have reviewed the current knowledge on the vascularization of the lower leg and its embryological background with special respect toward the posterior tibial artery and its branches.

Syndrome of canal of Guyon - definition, diagnosis, treatment and complication.

Syndrome of canal of Guyon is the second after carpal tunnel syndrome, compression syndrome in the wrist. Opposite to median nerve compression, ulnar nerve compression is not very popular. However it impairs functioning of the hand even more than median nerve lesion. Authors deal with definition, possible diagnostic methods, treatment and most frequent complication.

Main health-related quality-of-life issues in patients after a distal radius fracture.

AIM: The aim of this study was to identify and assess the degree and clinical course of the main health-related quality-of-life (HRQoL) issues in patients after a distal radius fracture (DRF). MATERIALS AND METHODS: Patients were eligible if they were between 18-80 years and were within 1-3 days after a non-comminuted DRF. All patients filled out the Polish version of the IOF QLQ, the SF-36 and a demographic questionnaire. Assessment points were set as soon as possible after the fracture, 7 days, 6 weeks, 3 months, and 6 after the fracture. Standard statistical analyses were performed. RESULTS: During the 16 month recruitment period a total of 71 patients (55 women - 77.5%), with a mean age of 64.1 ± 12.4 years, were included in the study group. All patients suffered from Colles type fractures. Attrition to follow-up was acceptable. At baseline, basing on the IOF QLQ scale scores, DRF patients had the most significant problems with physical function (82.8/100; with 100 representing the worst possible HRQoL), and general health (78.1/100). Basing on SF-36 scale scores patients most significant problems were associated with role limitations due to physical health problems (15.1/100; with 100 representing the best possible HRQoL), and bodily pain (39.5/100). CONCLUSIONS: Concluding, this study shows that the main issues with which patients with and extra-articular DRF struggle the most are pain of the fractured extremity and physical dysfunction. These symptoms are most pronounced in the early post-injury period, and in the majority of patients steadily decrease over a period of six months.

Inferior tibiofibular joint (tibiofibular syndesmosis) - own studies and review of the literature.

The study was carried out on 50 human lower legs obtained during autopsies. The anatomy of the joint was studied using classical anatomical description methods. Based also on literature we have reviewed the current knowledge on the inferior tibiofibular joint.

Anatomy of Guyon's canal - a systematic review.

Carpal tunnel syndrome is the first on the list of peripheral nerve lesions in the upper limb. Most of the anatomical facts about this syndrome are widely known. The Guyoun's canal is the second reason for compression syndrome in the wrist. Anatomy of this is region still remains controversial. This is why authors tried to compile some latest findings accompanied by their own observation, and added some clinical notes, which might be useful both for orthopedic surgeons and well as for representatives of basic sciences.

Preliminary validation of the IOF QLQ and comparison with the SF-36 in patients after a distal radius fracture.

AIM: The aim of this study was to report preliminary validation data on the Polish version of the International Osteoporosis Foundation Quality of Life Questionnaire (IOF QLQ) for patients with a distal radius fracture (DRF). MATERIALS AND METHODS: Patients were eligible if they were between 18-80 years and were within 1-3 days after a non-comminuted DRF. All patients filled out the Polish version of the IOF QLQ, the Short Form 36 (SF-36) and a demographic questionnaire. Assessment points were set as soon as possible after the fracture, 7 days, 6 weeks, and 3 months after the fracture. Standard va- lidity and reliability analyses were performed. RESULTS: Fifty-eight patients (42 women - 72.4%) agreed to take part in the study (mean age of the group 65.7 ± 9.3 years). Cronbach's alpha coefficients showed positive internal consistency (0.82- 0.87). The interclass correlations for the IOF QLQ domains and the overall score ranged from 0.82 to 0.93. Satisfactory convergent and discriminant validity of the IOF QLQ was seen. CONCLUSIONS: Preliminary data show that the Polish version of the IOF QLQ for patients with a DRF is a reliable and valid tool for measuring health-related quality-of-life (HRQoL). However, further studies are needed to demonstrate the full psychometric and clinical properties of the IOF QLQ in patients with a fracture of the wrist.

Topography of ulnar nerve and its variations with special respect to carpal region.

Ulnar nerve supplies small muscles of the hand and apart from the median nerve is the main coordinator of precise movements performed both in the medical and dental practice. Based on their anatomical and clinical experience, authors revised a knowledge on this nerve with special respect to its topography, variation in the wrist.

Branches and arterial supply of the recurrent artery of Heubner.

The aim of this study was to describe the branches and arterial supply of the recurrent artery of Heubner (RAH) in order to provide detailed information to neurosurgeons operating in this area of the brain. A total of 70 human brains (39 male and 31 female) obtained from cadavers (aged 31-75 years) during routine autopsies were examined; brains from individuals who died due to neurological disorders were not included in the study. Immediately after dissection the arteries were perfused with acrylic paint emulsion through the circle of Willis or electively through the RAH. Brains were fixed in a 10 % solution of formaldehyde and sectioned; the sections were analyzed under a stereoscopic light microscope (magnification 2-40×). The RAH was present in 138 hemispheres with a mean of 1.99 per hemisphere. Mean RAH length was 25.2 mm and the mean diameter, in its place of origin, was 1 mm. Between two and 30 (mean 9.4) branches originated from the stem of the RAH. Each branch then divided into 2-40 smaller branches (mean 19). Primary branches were divided and named in accordance with their course and arterial supply. Primary RAH branches include the anterior perforating substance, sylvian fissure, olfactory, frontal, hypothalamic, optic tract and connecting branches. Left and right hemispheres were asymmetrically supplied by RAH branches, but none of these discrepancies were of statistical significance.

Median nerve (anatomical variations) and carpal tunel syndrome - revisited.

Carpal tunnel syndrome belongs to the most common causative factors of surgical interventions in the wrist region. Anatomy of carpal tunnel and median nerve is a subject of current revision. Authors paid attention to etiology of the syndrome based on review of literature and their own anatomical studies. They remind basic knowledge on the median nerve and indicate that only based on number of dissections a good orthopedic surgeon may acquire experience necessary to perform procedures in a most appropriate way.