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JAMA 2022 Jun;327(24):2434-2445

Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri.

Importance: Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and basilar (carpometacarpal) joint arthritis of the thumb can be associated with significant disability.

Observations: Carpal tunnel syndrome is characterized by numbness and tingling in the thumb and the index, middle, and radial ring fingers and by weakness of thumb opposition when severe. It is more common in women and people who are obese, have diabetes, and work in occupations involving use of keyboards, computer mouse, heavy machinery, or vibrating manual tools. Read More

J Hand Surg Am 2022 Jun 16. Epub 2022 Jun 16.

Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Purpose: Although A1 pulley release is an effective treatment to reduce pain and improve hand function, complications may occur. More insight into risk factors for complications is essential to improve patient counseling and potentially target modifiable risk factors. This study aimed to identify factors associated with complications following A1 pulley release. Read More

BMC Surg 2022 Jun 7;22(1):221. Epub 2022 Jun 7.

Department of Ultrasonic, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Scienceand Technology of China, No. 32, West Second Section, First Ring Road, Qingyang District, Chengdu, 610072, Sichuan, China.

Background: The purpose of the present study was to evaluate the clinical effectiveness of ultrasonography-guided needle release of A1 pulley combined with corticosteroid injection by comparing it with ultrasound-guided needle release of the A1 pulley alone.

Methods: A total of 49 patients (55 fingers, thumb) with trigger fingers were included in this retrospective study. Twenty-seven fingers were treated with ultrasound-guided needle release of the A1 pulley alone (monotherapy group), and 28 fingers were treated with needle release of the A1 pulley combined with corticosteroid injection (combination group). Read More

J Hand Surg Glob Online 2022 May 11;4(3):128-134. Epub 2022 Feb 11.

Rothman Orthopaedic Institute, Philadelphia, PA.

Purpose: This study evaluated whether the location of steroid deposition (intra-articular vs extra-articular) for thumb carpometacarpal (CMC) joint arthritis affects clinical outcomes.

Methods: We prospectively enrolled 102 hands (82 patients) with thumb CMC joint arthritis. Patients received a CMC joint injection with Triamcinolone and radiopaque contrast. Read More

Musculoskeletal Care 2022 May 18. Epub 2022 May 18.

Department of Physical Medicine and Rehabilitation, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Background: Trigger finger is the most common flexor tendinopathy affecting the general population. We evaluated the effects of adding a static metacarpophalangeal joint splint to corticosteroid injection for the management of trigger finger in the short term.

Methods: We carried out a randomized controlled trial with two parallel arms in Department of Physical Medicine and Rehabilitation at a university hospital. Read More

J Wrist Surg 2022 Apr 1;11(2):145-149. Epub 2021 Oct 1.

Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Copenhagen, Denmark.

 Osteoarthritis of the thumb carpometacarpal joint (CMC-1 OA) is increasingly common with age. Conservative treatment with anti-inflammatory medication, thumb spica splinting, and steroid injection is recommended for early-stage OA, but some patients will continue to have refractory symptoms and surgery may be considered. We found it interesting to study outcomes of surgical treatment of cases with mild radiographic changes and yet symptoms severe enough to indicate surgery. Read More

Hand Clin 2022 May;38(2):161-168

Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Electronic address:

Thumb arthritis frequently is managed nonoperatively with activity modification, orthotic use, anti-inflammatory medications (oral and/or topical), and intra-articular injections. This article reviews the current literature and touches on novel modalities and future directions in the conservative treatment of thumb arthritis. Read More

Int J Surg Case Rep 2022 May 6;94:107050. Epub 2022 Apr 6.

Orthopedic Hand Surgeon, Community Memorial Health System, United States of America.

Introduction: Flexor pollicis longus (FPL) tendon rupture is a known complication after a distal radius (DR) fracture and subsequent fixation with a volar plate. A commonly accepted theory is the attrition of the flexor tendon by the prominent volar plate or theoretical injury to the tendon during the initial injury. An increasingly rare complication of distal radius open reduction internal fixation (ORIF) with volar plate fixation is stenosing tenosynovitis, more commonly known as trigger finger. Read More

J Hand Surg Glob Online 2021 Jul 8;3(4):204-209. Epub 2021 Jun 8.

Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.

Purpose: Scaphotrapezium-trapezoid (STT) joint arthritis is one of the most common forms of wrist arthritis. Conservative management often involves corticosteroid injection. Despite this, there is a scarcity of literature on palpation-guided injection techniques for the STT joint. Read More

J Hand Surg Glob Online 2021 May 23;3(3):139-148. Epub 2021 Mar 23.

Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.

Purpose: This systematic review (SR) aimed to identify the surgical interventions available for trapeziometacarpal osteoarthritis and document their efficacy on pain, physical function, psychological well-being, quality of life, treatment satisfaction, and/or adverse events.

Methods: This PROSPERO-registered SR's protocol was developed based on the Cochrane intervention review methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Among 9049 potential studies identified, 1 SR, 18 randomized controlled trials, and 40 nonrandomized controlled trials were included. Read More

Bone Jt Open 2022 Apr;3(4):321-331

Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, UK.

Aims: Osteoarthritis (OA) affecting the thumb carpometacarpal joint (CMCJ) is a common painful condition. In this study, we aimed to explore clinicians' approach to management with a particular focus on the role of specific interventions that will inform the design of future clinical trials.

Methods: We interviewed a purposive sample of 24 clinicians, consisting of 12 surgeons and 12 therapists (four occupational therapists and eight physiotherapists) who managed patients with CMCJ OA. Read More

J Hand Surg Am 2022 Apr;47(4):e13

Department of Orthopedic Surgery, Northwestern University, Chicago, IL.

J Hand Surg Am 2022 Apr;47(4):e11

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom; Department of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, United Kingdom.

Hand (N Y) 2022 Apr 2:15589447221081862. Epub 2022 Apr 2.

Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Background: Prior studies suggest steroid injections may affect infection rates following thumb carpometacarpal joint (CMCJ) arthroplasty. However, it is unclear whether injections prior to CMCJ arthroplasty affect functional outcomes, primarily Quick Disabilities of the Arm, Shoulder, and Hand (qDASH).

Methods: We retrospectively identified patients who underwent thumb CMCJ arthroplasty from 2015 to 2019. Read More

Biomolecules 2022 03 20;12(3). Epub 2022 Mar 20.

1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece.

Adipose tissue and its regenerative products which are isolated with enzymatic or mechanical processing of the harvested fat have been studied in a wide range of degenerative diseases, including osteoarthritis of the knee and hip. Intra-articular injection of these products can provide symptomatic relief of pain and postpone surgery. However, their use in the treatment of thumb carpometacarpal joint (CMCJ) osteoarthritis is limited and just a few studies have been published on that topic. Read More

J Hand Surg Eur Vol 2022 Jul 10;47(7):734-741. Epub 2022 Mar 10.

Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Surgical A1 pulley release can considerably reduce pain and improve hand function, but individual outcomes are highly variable. This study aimed to identify factors contributing to self-reported pain and hand function 3 months postoperatively. We included 2681 patients who had received surgical treatment for a trigger finger or thumb and who completed the Michigan Hand outcomes Questionnaire (MHQ). Read More

Z Orthop Unfall 2022 Mar 10. Epub 2022 Mar 10.

Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie / Handchirurgie, Klinikum Lüdenscheid, Lüdenscheid, Deutschland.

Background: Initial results after autologous fat transfer for treatment of thumb carpometacarpal joint osteoarthritis have been promising. But long-term results have not yet been available.

Methods: In a prospective study, 42 patients with thumb carpometacarpal joint osteoarthritis were observed for a mean time of 5 years after autologous fat transfer. Read More

PLoS One 2022 8;17(3):e0264203. Epub 2022 Mar 8.

Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.

Intra-articular injection of platelet rich plasma (PRP) has been reported to decrease pain and improve function in knee osteoarthritis. There are few reports on the effect of PRP in the treatment of osteoarthritis in the hand. Our aim was to evaluate the effect of PRP-injections on pain and functional outcome in the short-term for osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal (STT) joint. Read More

World J Clin Cases 2022 Feb;10(4):1320-1325

Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou 310000, Zhejiang Province, China.

Background: The radial nerve (RN) splits into two main branches at the elbow: The superficial branch of RN (SBRN) and the deep branch of RN. The SBRN can be easily damaged in acute trauma due to its superficial feature.

Case Summary: A 55-year-old male patient injured his right wrist 10 mo ago. Read More

Surg J (N Y) 2022 Jan 17;8(1):e28-e33. Epub 2022 Jan 17.

Department of Plastic Surgery, Apollo Multispecialty Hospital, Kolkata, West Bengal, India.

Minimally invasive reconstruction combines principles of tissue engineering and regenerative medicine for healing complex wounds. This approach was successfully demonstrated on a 64-year-old diabetic and hypertensive male patient, who was brought unconscious to our emergency after surviving an automobile collision with severe brain and right-dominant upper extremity injuries. Uncontrolled hyperglycemia, severe anemia, diffuse axonal brain injury, wrist drop, and loss of thumb extension and abduction were noted. Read More

J Hand Surg Am 2022 Jun 17;47(6):586.e1-586.e8. Epub 2022 Jan 17.

TriHealth Hatton Research Institute, Cincinnati, OH.

Purpose: This study evaluated the use of intraoperative local injection of liposomal bupivacaine to decrease opioid use in the early postoperative period for patients undergoing outpatient thumb carpometacarpal joint arthroplasty.

Methods: A prospective, randomized, controlled, single-blinded study was designed to compare 2 groups of patients for opioid use, pain scores, and nonopioid pill consumption within 5 days after surgery. The investigational group received an intraoperative injection of 10 ml (133 mg) liposomal bupivacaine. Read More

Life (Basel) 2022 Jan 13;12(1). Epub 2022 Jan 13.

Department of Traumasurgery, Kepler University Hospital, Krankenhausstrasse 9, 4020 Linz, Austria.

Pollux adductus deformity is an accompanying symptom of thumb carpometacarpal osteoarthritis. We describe a case of a patient who presented with increased muscle tone of the adductor pollicis muscle and chronic pain in the thenar musculature, i.e. Read More

Hand (N Y) 2022 Jan 7:15589447211068184. Epub 2022 Jan 7.

Cleveland Clinic Foundation, OH, USA.

The saline load test is routinely used to recognize other joints' traumatic arthrotomies; however, there are currently no studies evaluating the novelty of this test for metacarpophalangeal joints (MCPJs). This study aimed to investigate the effectiveness and sensitivity of saline load testing in identifying the traumatic arthrotomies of the MCPJs using human cadavers. This was a cadaveric study of 16 hands (79 MCPJs). Read More

J Ultrason 2021 Nov 15;21(87):e357-e360. Epub 2021 Dec 15.

Department of Orthopedic Surgery, Suwa Central Hospital, Nagano, Japan.

Perineural hydrodissection is a minimally invasive technique using an injection of fluid to dissect the perineural plane and tissue space. This report describes a case of palsy of the descending branch of the posterior interosseous nerve (PIN) which was recovered by targeted ultrasound-guided perineural hydrodissection. Ultrasonographic examination was performed, and multiple stenotic lesions interrupted by hyperechoic bands within the fascicles of the PIN were found. Read More

J Pediatr Orthop 2022 Mar;42(3):e285-e289

Division of Orthopaedics, Children's Hospital of Philadelphia.

Background: Animal studies have shown evidence of neurotoxicity from inhalational anesthesia, yet clinical studies have been less conclusive. While ongoing studies investigate the clinical significance of anesthesia-associated neurodevelopmental changes in young children, reducing anesthetic exposure in pediatric orthopaedic surgery is prudent. The primary objective of this study is to determine if local anesthetic injection before surgical incision versus after surgical release decreased inhalational anesthetic exposure in children undergoing unilateral trigger thumb release. Read More

Orthopade 2022 Jan 15;51(1):2-8. Epub 2021 Dec 15.

Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.

Background: There are numerous non-surgical treatment options for basal thumb osteoarthritis (OA).

Objectives: Aetiology, clinical appearance and diagnosis of basal thumb OA, explanation of the individual non-surgical treatment options, presentation of the current state of studies.

Material And Methods: Search for case analyses, studies, systematic reviews and meta-analyses using PubMed and LIVIVO. Read More

Indian J Radiol Imaging 2021 Jul 26;31(3):605-610. Epub 2021 Oct 26.

Innovision Imaging, Mumbai, Maharashtra, India.

 To demonstrate the role of radiographs and ultrasound (USG) in the diagnosis of calcific tendinitis and periarthritis in the wrist and hand and the efficacy of USG-guided barbotage for its management.  A retrospective chart review was performed in six patients who presented with acute-onset pain in the wrist and hand varying from 3 days to 2 weeks. Four patients had tenderness over pisiform and two patients had pain along the lateral aspect of the wrist and thumb. Read More

Hand Surg Rehabil 2022 02 11;41(1):54-58. Epub 2021 Nov 11.

Service de Chirurgie Plastique, Reconstructrice et Esthétique - Brûlés - Chirurgie de la Main, Centre Hospitalier et Universitaire de Bordeaux, Pellegrin CFXM, Place Amélie-Raba-Léon, 33076 Bordeaux, France; Collège de santé, Université́ de Bordeaux, 146 Rue Léo-Saignat, 33076 Bordeaux, France.

This study aimed to evaluate the effect of bone marrow aspirate concentrate (BMAC) in the treatment of osteoarthritis of the thumb first carpometacarpal joint. Injections were carried out in 27 thumbs. According to the Dell classification, there were 2 stage I, 11 stage II, 13 stage III and 1 stage IV cases. Read More

Transl Neurosci 2021 Jan 1;12(1):346-350. Epub 2021 Oct 1.

Department of Physical Medicine and Rehabilitation, Hôtel-Dieu du Centre Hospitalier de l'Université de Montréal, 3840, Saint-Urbain St., Montreal, QC, H2W 1T8, Canada.

Hand spasticity with a flexor pattern is a common problem affecting stroke patients and can result in pain, contractures, esthetic concerns, skin maceration, and overall loss of function. Poststroke (≥6 months) hemiparetic adult patients having a Modified Ashworth Scale (MAS) score of ≥1 for metacarpophalangeal flexion and thumb adduction spasticity were selected to receive an ultrasound-guided 20% ethyl alcohol block performed perineurally at the level of the deep branch of the ulnar nerve. Their MAS scores were evaluated pretreatment at 1 month and the change in MAS scores was assessed using Wilcoxon's test. Read More

Proc Natl Acad Sci U S A 2021 11;118(45)

School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332;

Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other pathogens with pandemic potential requires safe, protective, inexpensive, and easily accessible vaccines that can be developed and manufactured rapidly at a large scale. DNA vaccines can achieve these criteria, but induction of strong immune responses has often required bulky, expensive electroporation devices. Here, we report an ultra-low-cost (<1 USD), handheld (<50 g) electroporation system utilizing a microneedle electrode array ("ePatch") for DNA vaccination against SARS-CoV-2. Read More