Denervation for Proximal Interphalangeal Joint Osteoarthritis.

PURPOSE: To assess the clinical and functional outcomes of proximal interphalangeal (PIP) joint denervation using a volar approach in the treatment of PIP joint osteoarthritis. METHODS: We retrospectively reviewed 11 cases treated from June 2007 to June 2016. The patients were identified and outcomes collected through a single institution's registry, collecting demographic data, comorbidities, preoperative and postoperative visual analog scale (VAS) for pain, and Disorders of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS: The ring finger was the most commonly treated. The VAS for pain improved from 7.8 to 1.4, and the DASH questionnaire improved from 43.6 to 8.7. The PIP joint active range of motion also improved from 52° to 79°. Two patients reported postoperative digital paresthesia that resolved spontaneously. There were no major complications. CONCLUSIONS: Proximal interphalangeal joint denervation is a safe technique. It achieves good clinical results and, in case of failure, a more traditional and aggressive operation remains possible. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Bilateral Nonsynchronous Pacinian Corpuscle Neuroma.

Pacinian corpuscles are rapidly adapting mechanoreceptors distributed in the dermis of the fingers and palm of the hand. A neuroma of the pacinian corpuscle is rare and extremely painful, with only a few cases reported in the literature. A 71-year-old man with pain and swelling on his left index finger, initially diagnosed as tenosynovitis resistant to nonsurgical treatment, was referred to our center. During surgery, a cluster of spherical, gray lesions close to the digital nerve was found and excised. The pathological diagnosis was neuroma of the pacinian corpuscles. Two years later, he reported the same clinical findings on his right index finger with no improvement after nonsurgical treatment. During surgery, the same lesions were found and also identified as pacinian corpuscle neuromas.

Pacinian Corpuscles Neuroma. An Exceptional Cause of Pain in the Hand.

Pacinian corpuscles are rapidly adapting mechanoreceptors mainly distributed in the dermis of the fingers and palm of the hand. A neuroma of the Pacinian corpuscle is a rare and extremely painful condition with a few cases reported in the literature, most of them, associated with local or repetitive trauma. We present a 71-year-old man with history of pain and swelling on his left index without history of previous trauma initially diagnosed as tenosynovitis resistant to conservative treatment in which we observed, directly in the subcutaneous plane, spherical, gray and in clusters lesions closer to the collateral nerve which were described by the pathological study as neuroma of the Pacinian corpuscles.

Biceps to Triceps Transfer in Tetraplegic Patients: Our Experience and Review of the Literature.

Background: Management and indications for surgery in the tetraplegic patient are highly complex because of the substantial functional deficits that they present and their effect on their daily activity. Our purpose was to evaluate the functional outcome in tetraplegic patients who underwent biceps-to-triceps transfer surgery according to Zancolli's modified technique. Methods: This is a retrospective study of 6 biceps-to-triceps transfers using Zancolli's modified technique in 4 patients. Mean follow-up was 45 months. We evaluated each patient's DASH (Disabilities of the Arm, Shoulder and Hand) score before surgery and 12 months later. Results: In the 6 arms that underwent surgery, full and active elbow extension against gravity at 12 months after surgery was achieved. The mean DASH score was 73.2 preoperatively and 20.8 twelve months postoperatively. One complication occurred. One patient reported loss of elbow flexion preventing thigh lift for transfers. This was resolved with a program of rehabilitation and specific muscle strengthening Conclusions: Zancolli's modified technique is simple and effective, with few complications, whereby we can provide more autonomy for the tetraplegic patient.