Management of osteoarthrosis of the thumb joints.

We present current concepts and evidence to optimize diagnosis and management of osteoarthritis in the thumb joints. Numerous options and controversies exist for surgical treatment of carpometacarpal joint arthritis. Fewer options exist for metacarpophalangeal joint arthritis. Surgical treatment for interphalangeal arthritis is mainly arthrodesis.

Technical tips for collagenase injection treatment for Dupuytren contracture.

We describe technical tips for injecting collagenase into Dupuytren cords based on experience acquired during the prerelease Food and Drug Administration clinical trials and with subsequent clinical practice. These tips include techniques for extracting the reconstituted enzyme efficiently from the vial, injecting the cord(s) with increased safety to the tendons, and anesthetizing the hand before manipulation. The tips are intended to supplement but by no means replace the manufacturer's prescribing information and training video.

How to establish an interactive eConference and eJournal Club.

With our hand team scattered across several different locations, it is difficult to find a time to get together for our weekly didactic hand conference and monthly hand journal club. In addition, traffic and tight clinical schedules sometimes force conferences to start late or be canceled. Our solution was to set up an on-line conference. Using TeamViewer to host our conference and Skype to host our journal clubs, we experienced increased attendance by both faculty and residents in our meetings. In this article, we establish a method of hosting effective on-line videoconferences to facilitate nearly universal participation of our hand team, and we hope to assist others who wish to establish similar setups in their communities.

Tendon versus nerve transfers in elbow, wrist, and hand reconstruction: a literature review.

Upper extremity reconstruction forces the surgeon to chose between several available procedures, among them tendon and nerve transfer. Few guidelines exist to assist the surgeon in this regard, and the authors, therefore, undertook a retrospective review of case series describing tendon and nerve transfer. The authors discovered a scarcity of robust reporting, particularly in regard to tendon transfer, making an objective comparison between the two techniques difficult. Tendon transfers are popular and familiar. Nerve transfers promise distinct advantages; however, excellent evidence of their superiority is lacking.

Injectable collagenase clostridium histolyticum for Dupuytren's contracture.

BACKGROUND: Dupuytren's disease limits hand function, diminishes the quality of life, and may ultimately disable the hand. Surgery followed by hand therapy is standard treatment, but it is associated with serious potential complications. Injection of collagenase clostridium histolyticum, an office-based, nonsurgical option, may reduce joint contractures caused by Dupuytren's disease. METHODS: We enrolled 308 patients with joint contractures of 20 degrees or more in this prospective, randomized, double-blind, placebo-controlled, multicenter trial. The primary metacarpophalangeal or proximal interphalangeal joints of these patients were randomly assigned to receive up to three injections of collagenase clostridium histolyticum (at a dose of 0.58 mg per injection) or placebo in the contracted collagen cord at 30-day intervals. One day after injection, the joints were manipulated. The primary end point was a reduction in contracture to 0 to 5 degrees of full extension 30 days after the last injection. Twenty-six secondary end points were evaluated, and data on adverse events were collected. RESULTS: Collagenase treatment significantly improved outcomes. More cords that were injected with collagenase than cords injected with placebo met the primary end point (64.0% vs. 6.8%, P < 0.001), as well as all secondary end points (P < or = 0.002). Overall, the range of motion in the joints was significantly improved after injection with collagenase as compared with placebo (from 43.9 to 80.7 degrees vs. from 45.3 to 49.5 degrees, P < 0.001). The most commonly reported adverse events were localized swelling, pain, bruising, pruritus, and transient regional lymph-node enlargement and tenderness. Three treatment-related serious adverse events were reported: two tendon ruptures and one case of complex regional pain syndrome. No significant changes in flexion or grip strength, no systemic allergic reactions, and no nerve injuries were observed. CONCLUSIONS: Collagenase clostridium histolyticum significantly reduced contractures and improved the range of motion in joints affected by advanced Dupuytren's disease. (ClinicalTrials.gov number, NCT00528606.)

A history of surgery in the instrument tray: eponymous tools used in hand surgery.

Hand surgery emerged as a specialty after World War II, and early hand surgeons borrowed tools from established fields of the time. These tools remain in common use today, and many are identified by the names of the men who created them. Because these men did not specialize in surgery of the hand, their history remains obscure to modern surgeons who do. We have investigated the history of eponymous instruments developed before 1945 and used widely today in American hand surgery. Reflection on these eponymous instruments reveals the rich and diverse history of hand surgery.

Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: minimum 6.5-year follow-up evaluation.

PURPOSE: Although hematoma and distraction arthroplasty has been found to be successful in the treatment of thumb basal joint arthritis in the short term, questions about its efficacy in the long term have been raised. The goal of the present study was to evaluate the results of this procedure in patients at least 6.5 years after surgery. METHODS: Twenty-two thumbs from 22 patients from a single surgeon's practice were entered into a prospective single-arm study for surgical treatment of basal thumb arthritis. Treatment consisted of piecemeal excision of the entire trapezium and 5 weeks of K-wire immobilization of the thumb metacarpal in opposition and slight distraction. No ligament reconstruction or tendon interposition was used. Motion, strength, standardized dexterity tests, stress radiographs, and outcome questionnaires including the Arthritis Impact Measurement Scales 2 were evaluated before surgery and at 6, 24, and at least 79 months after surgery. RESULTS: At 6 months after surgery, 17 of 22 patients reported complete pain relief, and at the most recent follow-up evaluation (average, 88 months after surgery) 18 patients were entirely pain free. Range-of-motion evaluation at the most recent follow-up evaluation showed 21 of 22 thumbs adducted fully into the plane of the palm, and 21 of 22 opposed to the small finger metacarpal head. Comparisons between preoperative and the recent postoperative strength measurements showed an average of 21% increase in grip strength and tip pinch strength, and an 11% increase in key pinch strength over preoperative values. Although the radiographically determined scaphoid-thumb metacarpal distance decreased with time from surgery, no correlation with strength or functional outcome measurements was found. The Arthritis Impact Measurement Scales 2 data showed postoperative improvement in the hand and finger function and arthritis pain scales. CONCLUSIONS: After trapezial excision, K-wire immobilization in a slightly overcorrected position without formal interposition or ligament reconstruction allows for restoration and maintenance of a stable, pain-free thumb that has comparable strength and motion with published reports of more complicated interventions over comparable time periods. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.