Normal Values of the Second Interosseous Pinch: A Measurement of Pure Ulnar-Innervated Intrinsic Muscles of the Hand.

PURPOSE: The second palmar interosseous muscle is innervated solely by the ulnar nerve, and second palmar interosseous pinch (2IP) strength may be a good indicator of ulnar nerve motor function. The goal of this study was to describe the 2IP test and establish its normative values, stratified by age, sex, and dominance. METHODS: Volunteers were recruited to participate in this study at various community locations. Patients over the age of 18 years were eligible for this study. Demographic information on all subjects was collected. The volunteers were asked to pinch a hydraulic pinch gauge between the index and middle finger proximal phalanges with the proximal and distal interphalangeal joints flexed and without recruiting the thumb. Three 2IP measurements were taken for each hand. Descriptive statistics and analysis of covariance were performed to determine the effect of age, sex, dominance, and side on 2IP. We analyzed the 2IP strength using the 2IP test across 3 trials to determine whether it was affected by repeated testing. RESULTS: Two hundred thirty-eight patients met the inclusion criteria (45 ± 21 years, 55% women, 87% right-hand dominant). There was no statistically significant difference between dominant and nondominant hands or among the 3 trials. There was a statistically significant correlation between age and 2IP strength ranging between 0.32 and 0.44 kg. Age and sex showed a statistically significant association with 2IP strength, with patients of older age and women having weaker 2IP. CONCLUSIONS: We determined normative values for 2IP strength using a sample from a normal population. More studies are needed to validate these results. CLINICAL RELEVANCE: Second interosseous pinch strength may be a useful tool to assess ulnar nerve function.

Trapeziectomy With Intermetacarpal Suspension: A Surgical Technique.

A wide variety of techniques are available for surgical management of thumb carpometacarpal osteoarthritis, and current literature does not favor one in particular. We present a simple method that relies on anchoring the thumb metacarpal using the intermetacarpal ligament. This technique is time-efficient, technically simple, cost effective, and does not require donor tendons, hardware, or powered instruments.

Providing Orthopaedic Care for the Incarcerated: Obstacles and Challenges.

Scant information on healthcare delivery to inmates is available in the medical literature. Healthcare provision to inmates has different rules than that for the general population and presents particular challenges for orthopaedic surgeons because of the nature of this population and restrictions imposed by their confinement. This population is typically of a lower socioeconomic status and is less well educated, has accumulated injuries over a lifetime, and has a considerable prevalence of communicable and blood-borne diseases, along with a high prevalence of smoking and high-risk behavior, such as drug-seeking, abuse, and self-inflicted injury. These variables add levels of complexity of care, including the determination of medical necessity for orthopaedic referral, the logistics of transportation and follow-up, access to durable medical equipment and ancillary services, and the choices the orthopaedic provider must make to optimize care within these limitations.

Internal Rotation Behind-the-Back Angle: A Reliable Angular Measurement for Shoulder Internal Rotation Behind the Back.

BACKGROUND: The hand-behind-back method is the accepted technique to evaluate shoulder internal rotation, is highly popular, and is endorsed by the American Academy of Orthopaedic Surgeons. It remains, however, subject to intra- and interexaminer discrepancy and has been challenged by several recent publications. HYPOTHESIS: Internal rotation behind the back can be evaluated with a measurable angle, which eliminates the need to estimate spinal level, decreases the effect of unrelated joints, and allows collection of numeric rather than categoric data. STUDY DESIGN: Descriptive laboratory study. METHODS: We defined the internal rotation behind-the-back (IRB) angle as that between the ulna and the line of gravity. A pendulum is attached to a standard goniometer. The patient is asked to reach the highest point along the midline of the back. The goniometer is centered over the pisiform, and the angle between the ulnar axis and the pendulum is measured. Two examiners assessed both shoulders of 60 volunteers with no shoulder pathology using this technique on 2 occasions. Both examiners were blinded to each other's values. We applied the paired Student t test and calculated Pearson correlation coefficients and weighted Cohen kappa values. RESULTS: The IRB angles ranged from 50° to 125°. The difference of the mean, as measured with the Student t test, was 0.6° (95% confidence interval: 0.1°, 1.3°) and 0.6° (95% confidence interval: -0.8°, 1.8°); the Pearson correlation coefficients were 0.98 and 0.92; and the weighted kappa values were 0.88 and 0.77 for interobserver and intraobserver analyses, respectively. CONCLUSION: The IRB angle is easy to measure, is reproducible, and does not rely on determination of spinal level. It provides numeric data and may eliminate some of the uncertainty associated with the estimation of spinal level. CLINICAL RELEVANCE: The IRB angle may eliminate some of the uncertainty associated with the estimation of spinal level.

A simple wrist arthroscopy tower: the wrist triangle.

Several wrist arthroscopy towers are commercially available. In this report, the use of a triangular holder as a cheap, mobile, radiolucent tower for wrist arthroscopy is described, which can be useful in a cost-conscious surgical practice.

Scaphoid hemiresection and arthrodesis of the radiocarpal joint.

Radiocarpal arthritis is frequently the result of trauma and/or degenerative disease. The leading causes are malunited or nonunited fractures of the radius or scaphoid, radiocarpal or intercarpal dislocations or dissociations, or a form of primary osteoarthritis or inflammatory arthritis. Management focuses on reducing pain, increasing function, and preserving some degree of motion when possible. Total wrist arthrodesis remains the ultimate salvage procedure. Several surgical procedures attempt to preserve some motion including proximal row carpectomy; lunotriquetrocapitohamate (4-corner) or luno-capito-hamate (3-corner) fusion with scaphoid excision; radiolunate or radioscapholunate; and lunocapitate arthrodesis, and total wrist replacement arthroplasty. These have been used with various success rates. The choice of the procedure depends on which articulation(s) are diseased and which are spared. Motion-sparing procedures require healthy articular cartilage at the site of preserved motion. This paper described scaphoid hemiresection and arthrodesis of the radiocarpal joint, the SHARC procedure.

Ulnar or radial shortening osteotomy with a single saw cut.

PURPOSE: To determine which currently commercially available saw blades could be held at 45 degrees to the bone to reproducibly provide 2.0, 2.5, and 3.0 mm of ulna or radius shortening. METHODS: Commercially available saw blades were tested for their ability to achieve the osseous shortening at a 45 degrees angle cut. RESULTS: When held at a 45 degrees angle to the bone, 2 Stryker 0.64-mm-thick blades achieved a mean shortening of 2.0 mm. A single Linvatec 1.2-mm-thick blade achieved a mean osseous shortening of 2.1 mm. Two Dyonics 0.65-mm-thick blades achieved a mean osseous shortening of 2.7 mm. Two Dyonics 0.89-mm-thick saw blades achieved a mean osseous shortening of 3.1 mm. Three Stryker 0.38-mm-thick saw blades mounted with the middle blade "upside down" with regard to the 2 outer blades achieved a mean osseous shortening of 3.2 mm. Two Linvatec 0.8-mm-thick saw blades achieved a mean osseous shortening of 3.1 mm. CONCLUSIONS: The findings of this study can help guide surgeons who desire to reproducibly shorten the ulna or radius by 2.0, 2.7, or 3.2 mm using a single saw cut to ensure a parallel osteotomy gap.

Nuchal-type fibroma of the ankle: a case report.

Nuchal-type fibroma is rare benign fibrous tumor that has the potential to recur. It is typically located in the subcutaneous tissues of the posterior aspect of the neck, although it can affect other anatomical sites. Extranuchal involvement occurs most commonly in the back, shoulder, and face, as well as other sites specified in single case reports. In this report, we describe the case of a patient presenting with a nuchal-type fibroma arising in the ankle. The lesion infiltrated the superior extensor retinaculum. Marginal resection was performed, and there was no evidence of recurrence after 12 months of follow-up. To our knowledge, this is the first report of a nuchal-type fibroma localized to the ankle.

Medium to long-term follow-up following correction of pes cavus deformity.

Pes cavus is a multiplanar deformity that involves the 3 foot-joint complexes. Description of the deformity is not well standardized and the surgical management does not have a comprehensive algorithm to follow. Treatment should be tailored to the patient's requirements, foot condition, and the potential for future progression of the deformity. This study describes a heterogeneous group of patients treated surgically and followed for 5 to 28 years. The benefits and risks are discussed, together with pitfalls encountered.