[Carpal tunnel in complex regional pain syndrome: a case report].

INTRODUCTION: When treating complex regional pain syndrome (CRPS) a positive outcome can be expected when the condition is identified and therapy is begun in the first six months. Nevertheless, symptoms may not improve by standard treatment as expected. One of the possible reasons for this is the coexistence of associated compressive neuropathies in the affected hand. CASE OUTLINE: A 50-year old female patient with history of CRPS on the left hand which developed as a complication of lateral epicondilytis treated with immobilization is presented. She continued to suffer from intensive pain in her hand despite pharmacological pain relief and initiation of a complex rehabilitation program. Electrophysiologic testing revealed the coexistence of conjoined severe carpal tunnel syndrome. After she underwent surgical decompression pain relief occurred and overall functional results improved. CONCLUSION: Failure of therapy response in CRPS should alert the clinican to check for associated compressive neuropathy. Detection of this complication can prevent further damage of the nerve, hasten recovery of CRPS, and prevent eventual permanent disability of the hand.

[Relevant factors in the treatment of digital nerve injury of the hand].

INTRODUCTION: In his work the orthopaedic surgeon deals with a large number of peripheral nerve injuries, especially of the upper extremity. Most of these injuries involve the hand (30%). OBJECTIVE: The aim of the study was to analyze the influence of some factors (age, aetiology, level of injury, associated injuries) on surgical treatment outcome of digital nerve injury of the hand. METHODS: At the Department for Microsurgery 72 hospitalized patients were operated on due to the injury of common palmar digital nerves and proper palmar digital nerves. All operations were performed within the first 48h after injury and primary neurosuture was done in all. Beside the evaluation of demographic parameters, we also assessed aetiology of injury, associated injuries, level of injury, as well as the vascular status of the injured finger. Functional recovery was measured by the Medical Research Council (MCR) scale (S0-S4). RESULTS: We found a statistically significant difference in sensory recovery according to age and aetiology of injury (p < 0.05). Better results of sensory recovery were detected in cases with undamaged artery or where anastomosis was done, but without statistical significance. There was no statistical significance difference regarding the level and associated injuries. CONCLUSION: Two major factors in the recovery of digital nerve function are patient's age and mechanism of injury. Having in mind the limited degree of recovery, the patient should be precisely informed preoperatively on the nature of injury and realistically expected results.

Patellofemoral disorders and instability.

Originally the main idea was to obtain a stable patella, i.e., to stabilize the "slipping patella". In the past many conditions like patella alta, ligamentous laxity, PF bone hypoplasia, weakness of the quadriceps muscle, genu valgum or genu recurvatum were thought to predispose to patellar instability. For a long period muscle exercises were instituted to strengthen the weak m.vastus medialis and to make vastus lateralis stronger. This pulls the patella laterally, especially during running or jumping, when lateral luxation of the patella occurs. Muscle imbalance as well as anatomical abnormalities are the basis both for patellar instabilities and reasonable surgical procedures were: proximal extensor mechanism realignment, proximal capsular reefing, patellar tendon splitting and its medial transfer. On the other hand bone procedures on the hypoplastic lateral femoral condyle were also performed by Albee, as well as tibial tubercle transfer and trochleoplasty by deepening of the trochlea (Dejour). An understanding of the pathoanatomic basis is the corner stone for

[Operative treatment of flexor pollicis longus tendon with Krackow suture, functional results--preliminary results].

INTRODUCTION: Surgical treatment of the injuried flexor tensons is the important part of hand surgery. Tendon adhesions, ruptures, joint contcatures-stifness are only one part of the problem one is faced during the tendon treatment. In spite of improvement in surgical technique and suture material, the end result of sutured flexor tendons still represent a serious problem. THE AIM: To present of operative treatment of flexor pollicis longus injury with Krakow suture technique. METHODS: All patients are treated in the first 48 hours after the accident. The regional anesthesia was performed with use of turniquet. Beside spare debridement, the reconstruction of digital nerves was done. All patients started with active and pasive movements-excercises on the first postoperative day. Follow-up was from 6 to 24 months. In evaluation of functional recovery the grip strenght, pinch strenght, range of movements of interphalangeal and metacarpophalangeal joiht and DASH score were used. RESULTS: In the last two years there were 30 patients, 25 males (83.33%) and 5 females (16.66%). Mean age was 39.8 years, ranged from 17 to 65 years. According to mechanism of injury the patients were divided in two groups: one with sharp and other with wider zone of injury. Concomitant digital nerve lesions was noticed in 15 patients (50%). CONCLUSION: the Krackow sutrue allowed early rehabilitation, which prevent tendon adhesions, enabled faster and better functional recovery.

[Digital nerve injury of the hand-epidemiologic and clinical analysis].

The aim of this study was to show the significance of epidemiologic factors of digital nerve injury and their social influence. 108 patients were operated with primary suture within first 48 h after injury. We record factors as sex, age, etiology, dominance and level of injury. Results of sensory recovery were measured by Medical Research Council scale (MCR). Males predominantly sustain this injury (83.3%) and we seen more frequently in the young adults. Average age is 34.7 years (from 16 to 70). These injuries rarely isolated and most of them are in the zone II (48.1%). The full recovery we have only in nine patients. Digital nerve injury of the hand are more often found in young mail adults who are work active. They are out of work even six months, and sometimes even more. Some of these injuries leaves permanent disability which have a socio-economic importance.