Treatment of dynamic scaphoid instability.

BACKGROUND: Chronic wrist pain attributable to scaphoid instability without fixed deformity (dynamic instability) presents a treatment dilemma. The diagnosis usually is delayed, missing the opportunity for direct repair. The intercarpal fusion, tenodesis, and capsulodesis procedures create a fixed deformity. This report presents an outcome study of a new treatment for dynamic scaphoid instability that spanned more than 5 years. METHODS: Arthroscopic evaluation was used to confirm the diagnosis for 105 wrists of 102 patients who had experienced wrist pain for an average of 24.4 months. The treatment for these patients involved transferring two thirds of the extensor carpi radialis longus through the distal pole of the reduced scaphoid volarly to the intact flexor carpi radialis. The postoperative follow-up period averaged 63 months. RESULTS: The average grip strength increased by 65%. The average active wrist extension-flexion increased by 9%, with an average radial deviation loss of 6 degrees. The overall results, as measured by the modified Green and O'Brien clinical wrist scale, were as follows: excellent (49%), good (24%), and fair (26%). Good to excellent results were reported by 85% of the patients. Pain relief was reported by 94% of the patients, and 93% of the patients would recommend the procedure to others. CONCLUSIONS: Scaphoid instability without fixed deformity is a complex problem. Conventional treatments have drawbacks. The new technique produced positive results that are quite promising for the management of dynamic scaphoid instability.

Conservative treatment of carpal tunnel syndrome: an outcome study of adjunct exercises.

We conducted a prospective study to evaluate the effect of a new non-surgical protocol for treating carpal tunnel syndrome (CTS). It incorporates the Carpal Tunnel Decompression Exercise Program (Exercise Program) into conventional non-surgical treatment. Twenty-eight patients (33 hands) met the inclusion criteria and were followed for 18 months. The outcome measurement tools used were the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS). The outcome tools were administered at admission and repeated at 1, 2, and 18 months after admission to the treatment program. Using the adjunct treatment, 80% of the hands in the mild category and 71% in the moderate category were successfully treated without surgery. All patients in the severe category required surgery. The average success rate of our adjunct non-surgical treatment protocol was 67%, a substantial improvement over the 18% to 34% success rate reported nationally for conventional treatment methods. Furthermore, improvement in the outcome of carpal tunnel syndrome by the adjunct non-surgical treatment can result in significant savings in human suffering, medical cost, lost work time, and socioeconomic distress.