Progressive Ulnar Neuropathy due to anomalous Distal Forearm Muscle: Distal Forearm Decompression.

This case study examines a 45-year-old man who presented with advanced ulnar innervated intrinsic muscle atrophy in the hand, and clawing of the ring and little fingers. This case is unique due to discovery of an anomalous distal forearm muscle with the spontaneous onset and rapid nature of progressive neuropathic symptoms. Further, this patient demonstrated primarily intrinsic motor deficits and denied any sensory deficits on presentation. At surgery, an anomalous distal forearm muscle was found to be compressing the ulnar nerve. This muscle crossed in an oblique fashion, originating from the volar forearm fascia and inserted into the pisiform and proximal abductor digiti minimi fascia. At 5 months after surgery, the patient's ulnar innervated intrinsic muscle strength was improved but still not normal. This case study details the patient's presentation, assessment, surgical management, and postoperative outcome.

Hand Trauma Network in the United States: ASSH Member Perspective Over the Last Decade.

PURPOSE: Upper extremity trauma is common, however the provision of emergency call for hand trauma can be challenging for hospital systems and hand surgeons. Over the past decade, the American Society for Surgery of the Hand (ASSH) has developed the Hand Trauma Network and an Emergency Hand Care Committee to refine care for hand trauma patients. METHODS: The ASSH administered surveys to members about the provision of emergency hand call in 2010 and 2019. Demographic information was collected including surgeon age, years in practice, board certification, practice setting, and ACS trauma level. Other survey questions included willingness and obligation to take call, as well as barriers to providing emergency call. Financial aspects of call were also queried. RESULTS: Survey responses were obtained from 672 surgeons in 2010 and 1005 surgeons in 2019. There was a decrease in surgeons with obligatory hand call from 2010 to 2019 (70% vs 50%, P < .05) and an increase in the number of surgeons not taking hand call in 2019 (34%) compared to 2010 (18%, P < .05). In both surveys, the main barrier for providing hand call was "lifestyle considerations," 39% (2010) and 47% (2019). There was no change in the percentage of surgeons working at facilities that provide 24/7 emergency hand call services or the percentage of hand surgeons paid to take call. CONCLUSIONS: Certain aspects of providing emergency hand surgery care have not changed substantially in the past decade, including the number of centers that provide emergency hand coverage. A greater number of surgeons are not taking any hand call. Further efforts are required to promulgate advances in hand trauma call by the ASSH. CLINICAL RELEVANCE: The development of the ASSH Hand Trauma Network has not yet resulted in substantive improvement in the number of facilities that provide emergency hand coverage or the number of hand surgeons providing emergency hand care.

Impact of the Current United States Health Care Environment on Practice: A Private Practice Viewpoint.

The evolving healthcare landscape creates unique challenges for private practitioners. They experience the same issues that face physicians in general - including increased regulatory/documentation burdens and downward financial pressures - but without the safety nets that exist in larger healthcare systems. Costs are born more directly, as there are fewer providers over which to spread expenditures. Financial reserves are less robust, making margins thinner to maintain profitability. Guaranteed referral streams are absent, requiring additional effort and creative solutions to maintain patient volume. As hospital systems expand, private practitioners must remain nimble, while maintaining excellent service and outcomes, in order to stay ahead.