Tratamiento de la artrosis escafotrapeciotrapezoidea aislada con artroplastia de recubrimiento con anclaje escafoideo / Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage

Objetivo. El propósito de este estudio es mostrar los resultados obtenidos con el empleo de la artroplastia de recubrimiento con anclaje escafoideo en el tratamiento de la artrosis escafotrapeciotrapezoidea (ETT) aislada. Material y método. Se realiza un estudio observacional, descriptivo y retrospectivo del tratamiento de 10 pacientes con artrosis ETT aislada sintomática durante los años 2013 a 2015. El seguimiento medio es de 26meses (12-50). Se han evaluado los resultados clínicos, los funcionales y la satisfacción del paciente. Resultados. Los pacientes se encuentran satisfechos, obteniendo una media de 2,1 (0-3) en la escala VAS y de 16 (2-28) en el cuestionario DASH, reincorporándose a las actividades laborales en los primeros 3meses posquirúrgicos. La recuperación del arco de movilidad en comparación con la muñeca contralateral es del 96% en extensión, del 95% en flexión, del 87% en inclinación cubital y del 91% en inclinación radial. La fuerza puño media es del 95% y la fuerza de pinza, del 95%, en comparación con el lado contralateral. No han surgido complicaciones intraoperatorias ni alteraciones en la alineación carpiana posquirúrgicas. Conclusiones. La artroplastia de recubrimiento con anclaje escafoideo supone una alternativa novedosa y satisfactoria en el tratamiento de la artrosis ETT aislada. Lograr un balance adecuado entre la fuerza y la movilidad de la muñeca, sin producir una desestabilización carpiana, es importante para obtener resultados clínicos y funcionales satisfactorios (AU)

Objective. The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. Material and method. An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. Results. The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. Conclusion. Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results (AU)

Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage. / Tratamiento de la artrosis escafotrapeciotrapezoidea aislada con artroplastia de recubrimiento con anclaje escafoideo.

OBJECTIVE: The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. MATERIAL AND METHOD: An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. RESULTS: The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. CONCLUSION: Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results.

La cirugía del síndrome del túnel carpiano en pacientes de edad avanzada / The surgery of carpal tunnel syndrome in elderly patients

Objetivo: Presentamos los resultados a largo plazo de la cirugía de descompresión del nervio mediano en la muñeca en pacientes de edad avanzada. Métodos: Estudio prospectivo histórico, de larga evolución, en 98 pacientes intervenidos de síndrome del túnel carpiano, considerados por grupos de edad, con un tiempo postoperatorio medio de diez años. Se realizó la valoración con el cuestionario clínico-funcional de Levine, electromiografía y dinamometría de los pacientes estudiados. Resultados: Para la mayor parte de las preguntas del cuestionario de Levine, así como para los valores de velocidad sensitiva y latencia motora del nervio mediano, encontramos diferencias favorables con respecto a la valoración preoperatoria. Sin embargo, los datos de fuerza de presión manual fueron desfavorables. Conclusiones: En pacientes de edad avanzada, la sección completa del ligamento transverso del carpo permite mantener diferencias favorables en la mayoría de los parámetros estudiados tras diez años desde la cirugía, siendo el tratamiento quirúrgico una opción recomendable(AU)

Purpose: We present in this article the long term outcomes of median nerve release at the wrist in elderly patients. Methods: Historical prospective long term study over 98 patients that received surgical treatment of carpal tunnel syndrome considered by aging and with a mean follow-up of ten years. A clinical-functional (with the Levine Questionnaire), electromyographic and dynamometric evaluation of the patients studied have been carried out. Results: For most of the items of the Questionnaire of Levine, as well as for the values of sensitive velocity and motor latency of the median nerve, we have found favourable differences with respect to the preoperative evaluation. The data of grip strength are unfavourable. Conclusions: In elderly patients, complete section of the carpal transverse ligament, allows maintaining favourable differences in most of the parameters studied, after ten years from the surgery, being the surgical treatment a recommendable option(AU)

The long-term post-operative electromyographic evaluation of patients who have undergone carpal tunnel decompression.

We present the electromyographic (EMG) results ten years after open decompression of the median nerve at the wrist and compare them with the clinical and functional outcomes as judged by Levine's Questionnaire. This retrospective study evaluated 115 patients who had undergone carpal tunnel decompression at a mean of 10.47 years (9.24 to 11.36) previously. A positive EMG diagnosis was found in 77 patients (67%), including those who were asymptomatic at ten years. It is necessary to include both clinical and functional results as well as electromyographic testing in the long-term evaluation of patients who have undergone carpal tunnel decompression particularly in those in whom revision surgery is being considered. In doubtful cases or when there are differing outcomes, self-administered scales such as Levine's Questionnaire should prevail over EMG results when deciding on the need for revision surgery.