Pre-operative electrodiagnostic testing predicts time to resolution of symptoms after carpal tunnel release.

UNLABELLED: The purpose of this study was to determine if nerve conduction studies predict time to resolution of symptoms after carpal tunnel release. A total of 56 patients undergoing open carpal tunnel release were prospectively enrolled. Pre-operative presence of nocturnal symptoms and daytime numbness/tingling were documented. Pre-operative nerve conduction studies were reviewed and classified as mild, moderate, or severe. After open carpal tunnel release, patients were contacted by phone within 48 hours, at 1 week, and then at 2-week intervals for up to 9 months or until both nocturnal and daytime symptoms had resolved. This study found that patients with mild or moderate carpal tunnel syndrome experience a faster time to resolution of daytime numbness and tingling when compared with patients with severe carpal tunnel syndrome. Nocturnal symptoms resolved quickly in both groups. The results of this study are in contrast to previous studies that found little to no value of nerve conduction studies in predicting post-operative functional and subjective outcomes. LEVEL OF EVIDENCE: IV.

Operative treatment with radial shortening in Kienböck's disease.

Eighty-eight patients underwent radial shortening for Kienböck's disease. Prerequisites for surgery were radiographic studies positive for Kienböck's disease without evidence of radiocarpal arthritis and wrist pain unrelieved by conservative management. Thirty-nine patients were evaluated by subjective questionnaire at a mean postoperative follow-up of 86 months (range: 24-188 months). Following surgery, a significant decrease was noted in pain severity, frequency, and duration. Functional status improved postoperatively, with the most significant gains noted in the following activities: opening jars, opening car doors, carrying bags, and shoveling. Only 3 of 34 patients employed outside the home were unable to return to their original occupations due to their wrist problems. Seventy-six patients were evaluated by physical examination at a mean postoperative follow-up of 31 months (range: 3-87 months). Objective evaluation by physical examination revealed a significant improvement in wrist motion and grip strength. Seventy-seven patients underwent radiographic evaluation at a mean postoperative follow-up of 31 months (range: 3-180 months). A significant progression in Lichtman stage of Kienböck's disease was noted despite the favorable subjective findings and high satisfaction ratings. Thirty-six of 39 patients stated they would undergo the surgery again. The long-term data demonstrate radial shortening in patients with stage II-IIIA Kienböck's disease provides substantial improvement over preoperative status.

A comparison of plate and pin fixation for arthrodesis of the rheumatoid wrist.

This retrospective study compared plate fixation versus pin fixation in 57 patients with rheumatoid arthritis who underwent wrist arthrodesis. Fixation was achieved by using plates in 32 patients and longitudinal pins in 25 patients. Clinical follow-up averaged 29 months (range: 12-57 months) and radiographic follow-up averaged 16 months (range 12-39 months). Union occurred in 97% of the wrists fixed with plates and in 96% of the wrists fixed with pins. There were 6 (19%) complications in the plate group and 7 (28%) complications in the pin group. Three (12%) wrists fixed with pins moved from the immediate postoperative position to a position of relative volar flexion, while radiographs showed no changes in wrist position in the plate group. With both methods, successful arthrodesis stabilized the wrist in a high percentage of patients. Plate fixation offers an excellent alternative method for arthrodesis of the rheumatoid wrist.

Proximal row carpectomy: clinical evaluation.

Proximal row carpectomy as a treatment of disorders of the radiocarpal joint remains controversial despite numerous reports documenting clinically successful outcomes. Criticism includes postoperative loss of grip strength, unsatisfactory range of motion, prolonged rehabilitation time, and the potential for progressive painful arthritis. Twenty-seven patients were studied to address these concerns. The average length of follow-up was 4 years. Postoperative pain relief was achieved in 26 patients, allowing 24 of the 27 patients to return to their previous activity status within an average of 4.5 months after surgery. In all cases, range of motion matched or surpassed preoperative values. Grip strength improved to an average of 80% of the contralateral side. A detailed radiographic analysis of the radii of curvature of the lunate fossa and the capitate showed that the radius of curvature of the capitate is approximately two thirds of the corresponding value of the lunate. Motion between the capitate and the radius is translational with a moving center of motion, which may dissipate load on the radius and explain the relative success of the procedure.