ABSTRACT
The purpose of this study was to assess sensory and functional nerve recovery after digital nerve injury in patients with an end-to-end suture (S) or with implantation of a collagen conduit (C) to bridge a nerve gap. Fifteen S and 11 C with a follow-up of 6-36 months and 28 healthy control participants were enrolled. Methods of assessments were quantitative sensory testing, the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), range of motion and the painDetect questionnaire. After both procedures, sensory profiles showed largely recovered function of C and Aδ fibres but severe loss of Aß-fibre function leading to increased mechanical detection thresholds. There was only minimal allodynia. Severe pain was absent. Patients with conduits reported more functional impairment, especially in work performance, which correlated with the assessed loss of Aß-fibre function. LEVEL OF EVIDENCE: III.
Subject(s)
Finger Injuries/surgery , Fingers/innervation , Peripheral Nerve Injuries/surgery , Recovery of Function , Adult , Case-Control Studies , Collagen , Disability Evaluation , Female , Finger Injuries/physiopathology , Fingers/surgery , Follow-Up Studies , Humans , Male , Middle Aged , Neurosurgical Procedures/methods , Outcome Assessment, Health Care , Pain Measurement , Peripheral Nerve Injuries/physiopathology , Prostheses and Implants , Quality of Life , Recovery of Function/physiology , Surveys and Questionnaires , Suture Techniques , Touch Perception/physiologyABSTRACT
OBJECTIVE: Ruptures of ulnar-sided triangular fibrocartilaginous complex (TFCC) often occur in cases of trauma. Golden standard for diagnosis is the arthroscopy of the wrist. TFCC lesions are classified according to their location if traumatic in origin or if degenerative according to their severity. MATERIALS AND METHODS: Recent literature has focused on the ruptures of ulnar-sided triangular fibrocartilaginous complex. This article describes conservative, operative and arthroscopic surgical techniques to reconstruct the triangular fibrocartilaginous complex and restore distal radioulnar joint stability. RESULTS: The main therapeutic goal should be the stabilization of the DRUJ by reattachment of the torn ligaments in ulnar-sided ruptures to the deep fibers in the fovea. This reinsertion can be performed by transosseous suture, a suture anchor or open. CONCLUSION: Central TFCC tears are typically located close to the sigmoid notch of the radius and are either traumatic or degenerative in origin. While central TFCC lesions are usually treated by arthroscopic debridement using small joint punches or a bipolar high frequency system, the ulnar TFCC avulsions can also be refixed arthroscopically in different techniques.
Subject(s)
Arthroscopy , Joint Instability/surgery , Triangular Fibrocartilage/injuries , Wrist Injuries/surgery , Debridement , Humans , Joint Instability/diagnosis , Suture Anchors , Triangular Fibrocartilage/surgery , Wrist Injuries/diagnosis , Wrist JointABSTRACT
We report on an intraosseous gout manifestation in the middle phalanx of the left index finger of a 54-year-old patient.
