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[PMID]:29437062
[Au] Autor:Gaspar MP; Pham PP; Pankiw CD; Jacoby SM; Shin EK; Osterman AL; Kane PM
[Ad] Endereço:Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA and Darden School of Business, University of Virginia, 100 Darden Boulevard, Charlottesville, Virginia 22903, USA.
[Ti] Título:Mid-term outcomes of routine proximal row carpectomy compared with proximal row carpectomy with dorsal capsular interposition arthroplasty for the treatment of late-stage arthropathy of the wrist.
[So] Source:Bone Joint J;100-B(2):197-204, 2018 Feb.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The aims of this study were to compare the mid-term outcomes of patients with late-stage arthritis of the wrist treated with proximal row carpectomy (PRC) and dorsal capsular interposition (DCI) arthroplasty with a matched cohort treated with routine PRC alone. PATIENTS AND METHODS: A total of 25 arthritic wrists (24 patients) with pre-existing degenerative changes of the proximal capitate and/or the lunate fossa of the radius were treated with PRC + DCI over a ten-year period. This group of patients were matched 1:2 with a group of 50 wrists (48 patients) without degenerative changes in the capitate or lunate fossa that were treated with a routine PRC alone during the same period. The mean age of the patients at the time of surgery was 56.8 years (25 to 81), and the demographics and baseline range of movement of the wrist, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and Patient-Rated Wrist Evaluation (PRWE) score were similar in both groups. RESULTS: At a mean follow-up of 5.9 years (1.8 to 11.8), significant improvements in mean grip strength, the flexion-extension arc of movement of the wrist, QuickDASH, and PRWE scores were seen in both groups. There was no diifference between the groups for any of the outcomes. One patient in the PRC + DCI group required additional surgery for a deep infection, while two in the PRC group had complications (one wound dehiscence requiring revision closure, one transient radial sensory neuritis). One patient in each group required total arthrodesis of the wrist for progressive degenerative radiocarpal changes. A total of 70 patients (93%) were satisfied with the outcomes. CONCLUSION: PRC with DCI is an effective form of treatment for late-stage arthritis of the wrist involving the capitolunate joint, with mid-term outcomes that are similar to those in patients without degenerative changes affecting the capitate or lunate fossa who are treated with a routine PRC alone. Cite this article: 2018;100-B:197-204.
[Mh] Termos MeSH primário: Artroplastia/métodos
Ossos do Carpo/cirurgia
Osteoartrite/cirurgia
Articulação do Punho/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Avaliação da Deficiência
Feminino
Seguimentos
Força da Mão
Seres Humanos
Masculino
Meia-Idade
Satisfação do Paciente
Amplitude de Movimento Articular
Retalhos Cirúrgicos
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B2.BJJ-2017-0816.R2


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[PMID]:29252744
[Au] Autor:Zimmerman RM; Allen EA; Higgins JP
[Ad] Endereço:The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland.
[Ti] Título:Chondrocyte Viability 3.5 Years Following a Vascularized Medial Femoral Trochlea Osteocartilaginous Free Flap.
[So] Source:JBJS Case Connect;6(4):e90, 2016 Oct-Dec.
[Is] ISSN:2160-3251
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:CASE: A 30-year-old woman underwent arthroscopy for wrist pain 3.5 years following a medial femoral trochlea (MFT) osteocartilaginous free flap for Kienböck disease, which provided the opportunity to examine the transferred cartilage in vivo. Arthroscopy revealed no evidence of chondrolysis, and histologic examination revealed uniformly viable chondrocytes within a matrix consistent with fibrocartilage. CONCLUSION: To the best of our knowledge, the long-term viability of chondrocytes following an MFT free flap has not been previously documented. This case provides early evidence that free tissue transfer based on the descending genicular artery can provide a durable solution for osteocartilaginous defects.
[Mh] Termos MeSH primário: Cartilagem/fisiologia
Condrócitos/fisiologia
Osso Semilunar/transplante
Osteonecrose/cirurgia
[Mh] Termos MeSH secundário: Adulto
Artroscopia
Transplante Ósseo
Sobrevivência Celular
Feminino
Retalhos de Tecido Biológico
Seres Humanos
Articulação do Punho/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.CC.16.00023


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[PMID]:29257019
[Au] Autor:Murphy GRF; Logan MPO; Smith G; Sivakumar B; Smith P
[Ad] Endereço:Department of Plastic and Reconstructive Surgery, Great Ormond St. Hospital for Children, London, United Kingdom.
[Ti] Título:Correction of "Wrist" Deformity in Radial Dysplasia: A Systematic Review and Meta-Analysis.
[So] Source:J Bone Joint Surg Am;99(24):2120-2126, 2017 Dec 20.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Radial dysplasia affects 1 in 6,000 to 8,000 births, classically presenting with a shortened, bowed ulna and radially deviated hand. The optimal treatment remains unclear, with several opposing approaches advocated. This review aims to clarify the long-term outcomes of nonsurgical and surgical treatment of the "wrist" deformity. METHODS: The Embase, MEDLINE, PubMed, Cochrane Central, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (ICTRP) databases were searched for published and unpublished studies reporting long-term outcomes of surgical or nonsurgical treatment of children with radial dysplasia. Results were not restricted by date or language. Primary outcomes were hand-forearm angle, ulnar length, and "wrist" active range of motion (ROM). Studies were assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria. Data for the change in hand-forearm angle were pooled using random-effects meta-analysis, and mean differences and 95% confidence intervals were obtained. Primary outcome data at last follow-up were pooled, and means and standard deviations were obtained. The PROSPERO registration of this study was CRD42016036665. RESULTS: Of 104 studies identified, 12 were included in this review. Five were retrospective cohort studies and 7 were case series. No randomized studies were found. Study quality was low or very low according to the GRADE criteria. The hand-forearm angle of nonsurgically treated patients worsened during childhood, from 66° to 84°, whereas "wrist" active ROM, at 61°, was better than that for most surgically treated patients. Ulnar length with nonsurgical treatment was predicted to be 64% of normal, but was not directly reported. Isolated soft-tissue release provided a modest reduction in hand-forearm angle compared with nonsurgical treatment. Soft-tissue distraction with centralization or radialization achieved the best hand-forearm angle correction (16° radial deviation). Radialization maintained better "wrist" active ROM (46°) and ulnar length than centralization. Microvascular second metatarsophalangeal joint transfer yielded better reported "wrist" active ROM (83°) and good ulnar length compared with other surgical techniques, but a slightly worse hand-forearm angle (28°). CONCLUSIONS: There was low-quality evidence that soft-tissue distraction plus centralization or radialization achieved the best correction of the hand-forearm angle for children with radial dysplasia. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Deformidades Congênitas da Mão/diagnóstico por imagem
Deformidades Congênitas da Mão/cirurgia
Procedimentos Ortopédicos/métodos
Rádio (Anatomia)/anormalidades
Procedimentos Cirúrgicos Reconstrutivos/métodos
Articulação do Punho/anormalidades
[Mh] Termos MeSH secundário: Fatores Etários
Feminino
Seres Humanos
Masculino
Rádio (Anatomia)/diagnóstico por imagem
Recuperação de Função Fisiológica
Medição de Risco
Resultado do Tratamento
Articulação do Punho/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.17.00164


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[PMID]:28462794
[Au] Autor:Nakipoglu Yuzer GF; Köse Dönmez B; Özgirgin N
[Ad] Endereço:Ankara Physical Medicine Rehabilitation Training and Research Hospital, Ankara, Turkey. Electronic address: guldalfunda@hotmail.com.
[Ti] Título:A Randomized Controlled Study: Effectiveness of Functional Electrical Stimulation on Wrist and Finger Flexor Spasticity in Hemiplegia.
[So] Source:J Stroke Cerebrovasc Dis;26(7):1467-1471, 2017 Jul.
[Is] ISSN:1532-8511
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIM: The objective of this study was to investigate the effectiveness of functional electrical stimulation (FES) applied to the wrist and finger extensors for wrist flexor spasticity in hemiplegic patients. METHODS: Thirty stroke patients treated as inpatients were included in the study. Patients were randomly divided into study and control groups. FES was applied to the study group. Wrist range of movement, the Modified Ashworth Scale (MAS), Rivermead Motor Assessment (RMA), Brunnstrom (BS) hand neurophysiological staging, Barthel Index (BI), and Upper Extremity Function Test (UEFT) are outcome measures. RESULTS: There was no significant difference regarding range of motion (ROM) and BI values on admission between the groups. A significant difference was found in favor of the study group for these values at discharge. In the assessment within groups, there was no significant difference between admission and discharge RMA, BS hand, and UEFT scores in the control group, but there was a significant difference between the admission and discharge values for these parameters in the study group. Both groups showed improvement in MAS values on internal assessment. CONCLUSION: It was determined that FES application is an effective method to reduce spasticity and to improve ROM, motor, and functional outcomes in hemiplegic wrist flexor spasticity.
[Mh] Termos MeSH primário: Terapia por Estimulação Elétrica/métodos
Dedos/inervação
Hemiplegia/terapia
Espasticidade Muscular/terapia
Articulação do Punho/inervação
[Mh] Termos MeSH secundário: Idoso
Fenômenos Biomecânicos
Avaliação da Deficiência
Feminino
Hemiplegia/diagnóstico
Hemiplegia/fisiopatologia
Seres Humanos
Masculino
Meia-Idade
Atividade Motora
Espasticidade Muscular/diagnóstico
Espasticidade Muscular/fisiopatologia
Exame Neurológico
Amplitude de Movimento Articular
Recuperação de Função Fisiológica
Fatores de Tempo
Resultado do Tratamento
Turquia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180109
[Lr] Data última revisão:
180109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:27773588
[Au] Autor:Srivanitchapoom P; Shamim EA; Diomi P; Hattori T; Pandey S; Vorbach S; Park JE; Wu T; Auh S; Hallett M
[Ad] Endereço:Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: prachaya.srivanitch
[Ti] Título:Differences in active range of motion measurements in the upper extremity of patients with writer's cramp compared with healthy controls.
[So] Source:J Hand Ther;29(4):489-495, 2016 Oct - Dec.
[Is] ISSN:1545-004X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY DESIGN: Exploratory case-control study. INTRODUCTION: Writer's cramp (WC) is a type of focal hand dystonia. The central nervous system plays a role in its pathophysiology, but abnormalities in the affected musculoskeletal components may also be relevant. PURPOSE OF THE STUDY: We compared the active range of motion (ROM) in patients with WC and healthy volunteers (HVs) and correlated the findings with disease duration and severity. METHODS: Affected limb joints were measured with goniometers. Patients were assessed at least 3 months after their last botulinum toxin (botulinum neurotoxin) injection, and strength was clinically normal. t tests were used to compare the ROMs of WC with matched HVs. The Spearman correlation coefficient assessed the relationship of active ROMs to the disease duration and handwriting subscore of the Dystonia Disability Scale. RESULTS: ROMs of D1 metacarpophalangeal (MCP) joint extension as well as D2 and D5 MCP flexion were significantly smaller in WC, and distal interphalangeal joint extension in D3 and D5 was significantly greater compared with HVs. There were negative correlations between D2 MCP flexion and disease duration and with Dystonia Disability Scale. DISCUSSION: Abnormalities in ROMs in WC were found. Severity and disease duration correlated with reduced D2 MCP flexion. This may be related to intrinsic biomechanical abnormalities, co-contraction of muscles, or a combination of subclinical weakness and atrophy from repeated botulinum neurotoxin injections. CONCLUSIONS: Hand biomechanical properties should not be ignored in the pathophysiology of WC. LEVEL OF EVIDENCE: 2c.
[Mh] Termos MeSH primário: Toxinas Botulínicas/uso terapêutico
Distúrbios Distônicos/tratamento farmacológico
Amplitude de Movimento Articular/fisiologia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Estudos de Casos e Controles
Distúrbios Distônicos/diagnóstico
Distúrbios Distônicos/reabilitação
Articulação do Cotovelo/fisiopatologia
Feminino
Articulações dos Dedos/efeitos dos fármacos
Articulações dos Dedos/fisiopatologia
Seres Humanos
Injeções Intralesionais
Masculino
Meia-Idade
Amplitude de Movimento Articular/efeitos dos fármacos
Valores de Referência
Medição de Risco
Índice de Gravidade de Doença
Fatores Sexuais
Resultado do Tratamento
Articulação do Punho/fisiopatologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
EC 3.4.24.69 (Botulinum Toxins)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29068934
[Au] Autor:Giacalone F; di Summa PG; Fenoglio A; Sard A; Dutto E; Ferrero M; Bertolini M; Garcia-Elias M
[Ad] Endereço:Turin, Italy; Lausanne, Switzerland; and Barcelona, Spain From the Department of Hand Surgery, CTO-Maria Adelaide Trauma and Orthopaedic Hospital; the Department of Plastic, Reconstructive, and Hand Surgery, Centre Hospitalier Universitaire Vaudois; and the Institut Kaplan.
[Ti] Título:Resurfacing Capitate Pyrocarbon Implant versus Proximal Row Carpectomy Alone: A Comparative Study to Evaluate the Role of Capitate Prosthetic Resurfacing in Advanced Carpal Collapse.
[So] Source:Plast Reconstr Surg;140(5):962-970, 2017 Nov.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The Resurfacing Capitate Pyrocarbon Implant associated with proximal row carpectomy has been used to treat symptomatic advanced carpal collapse, widening the indications of proximal row carpectomy to patients with capitate head arthritis. The authors retrospectively compared their case series of implant versus carpectomy alone, analyzing whether prosthetic implant outcomes could be similar to those of proximal row carpectomy even with a higher stage of osteoarthritis. METHODS: Fifty-seven patients who underwent surgery for wrist osteoarthritis (minimum follow-up, 2 years) were selected retrospectively. Twenty-five patients (scapholunate advanced collapse/scaphoid nonunion advanced collapse stage III to IV and Kienböck disease stage IV) underwent proximal row carpectomy plus Resurfacing Capitate Pyrocarbon Implant (group A); 32 patients (scapholunate advanced collapse/scaphoid nonunion advanced collapse stage I to II and Kienböck disease stage III) underwent carpectomy alone (group B). Mean follow-up was 33 months. Patients were evaluated clinically and radiographically. Patient-Rated Wrist Evaluation and Disabilities of the Arm, Shoulder, and Hand questionnaire scores were assessed. RESULTS: Group A showed consistent pain relief (visual analogue scale score of 2), while preserving wrist mobility (flexion, 27 degrees; extension, 33 degrees) and grip strength (54 percent compared with the contralateral side). Average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 20, and average Patient-Rated Wrist Evaluation score was 28. No statistically significant difference was observed between groups for all outcomes, except for better extension (p < 0.05) in group B. CONCLUSIONS: Even starting from a higher grade of osteoarthritis, Resurfacing Capitate Pyrocarbon Implant plus proximal row carpectomy showed satisfying results, compared with those obtained with just carpectomy. Data show that indications for proximal row carpectomy can be widened by using the implant, without worsening outcomes. The implant could be a useful alternative to more aggressive salvage procedures in case of capitate head and lunate fossa osteoarthritis involvement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
[Mh] Termos MeSH primário: Artroplastia de Substituição/métodos
Carbono
Ossos do Carpo/cirurgia
Prótese Articular
Osteoartrite/cirurgia
Articulação do Punho/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Artroplastia de Substituição/instrumentação
Ossos do Carpo/diagnóstico por imagem
Ossos do Carpo/patologia
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Osteoartrite/diagnóstico por imagem
Osteoartrite/patologia
Radiografia
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (pyrolytic carbon); 7440-44-0 (Carbon)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003759


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[PMID]:28957551
[Au] Autor:Boer AC; Burgers LE; Mangnus L; Ten Brinck RM; Nieuwenhuis WP; van Steenbergen HW; Reijnierse M; Huizinga TWJ; van der Helm van Mil AHM
[Ad] Endereço:Department of Rheumatology.
[Ti] Título:Using a reference when defining an abnormal MRI reduces false-positive MRI results-a longitudinal study in two cohorts at risk for rheumatoid arthritis.
[So] Source:Rheumatology (Oxford);56(10):1700-1706, 2017 Oct 01.
[Is] ISSN:1462-0332
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objectives: The use of hand and foot MRI in the diagnostic process of RA has been advocated. Recent studies showed that MRI is helpful in predicting progression from clinically suspect arthralgia (CSA) to clinical arthritis, and from undifferentiated arthritis (UA) to RA. Symptom-free persons can also show inflammation on MRI. This study aimed to evaluate if MRI findings in symptom-free volunteers are relevant when defining a positive MRI. Methods: Two hundred and twenty-five CSA patients and two hundred and one UA patients underwent MRI of MCP, wrist and MTP joints at baseline and were followed for 1 year on progression to arthritis and RA, respectively, as reported previously. MRI was considered positive if ⩾ 1 joint showed inflammation (called uncorrected definition), or if ⩾ 1 joint had inflammation that was present in < 5% of persons of the same age category at the same location (called 5% corrected definition). Test characteristics were compared for both definitions. Results: By using MRI data of symptom-free volunteers as reference, specificity of MRI-detected inflammation increased from 22 to 56% in CSA patients, and from 10 to 36% in UA patients. The sensitivity was not affected; it was 88 and 85% in CSA patients and 93 and 93% in UA patients. The accuracy also increased, from 32 to 60% in CSA patients and 22 to 44% in UA patients. Conclusion: The use of a reference population resulted in a substantial reduction of false-positive results, without influencing the sensitivity. Although common for other tests in medicine, this phenomenon is novel for MRI in the early detection of RA.
[Mh] Termos MeSH primário: Artrite Reumatoide/diagnóstico por imagem
Imagem por Ressonância Magnética/estatística & dados numéricos
Avaliação de Sintomas/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Artralgia/diagnóstico por imagem
Artrite/diagnóstico por imagem
Diagnóstico Precoce
Reações Falso-Positivas
Feminino
/diagnóstico por imagem
Mãos/diagnóstico por imagem
Seres Humanos
Estudos Longitudinais
Imagem por Ressonância Magnética/métodos
Masculino
Articulação Metacarpofalângica/diagnóstico por imagem
Articulação Metatarsofalângica/diagnóstico por imagem
Meia-Idade
Valor Preditivo dos Testes
Valores de Referência
Sensibilidade e Especificidade
Avaliação de Sintomas/métodos
Articulação do Punho/diagnóstico por imagem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170929
[St] Status:MEDLINE
[do] DOI:10.1093/rheumatology/kex235


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[PMID]:28858099
[Au] Autor:Gao ZY; Tao H; Xu H; Xue JQ; Ou-Yang Y; Wu JX
[Ad] Endereço:aDepartment of Rehabilitation bDepartment of Trauma Surgery cDepartment of Joint Surgery dDepartment of Obstetrics, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
[Ti] Título:A novel classification of the anatomical variations of the first extensor compartment.
[So] Source:Medicine (Baltimore);96(35):e7875, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The presence of a septum in the first extensor compartment is closely associated with the pathophysiology of de Quervain disease, and affects the efficacy of corticosteroid injection and surgical release. This study aimed to examine the incidence and length of the first extensor compartment septum.Forty sides of the wrists in 20 cadavers were used. The presence of a septum in the first extensor compartment was examined. The septum length was recorded with the radial styloid process as the reference point.The anatomical variations of the first extensor compartment were classified into 3 types. Type I compartment was found in 7 sides in males (29.2%) versus 6 sides in females (37.5%, P = .733), type II was found in 6 sides in males (25%) versus 1 side in females (6.25%, P = .21), and type III was found in 11 sides in males (45.8%) versus 9 sides in females (56.25%, P = .56). There was no significant difference in the septum length between males and females (5.3 ±â€Š2.3 vs 4.8 ±â€Š1.1 mm, P = .54).The incidence of a septum in the first extensor compartment is approximately 50%. The mean septum length is 5 mm. Injection at 5 mm proximal to the radial styloid process has a great chance of delivering the steroids into both subcompartments. Exposure to 5 mm proximal to the radial styloid process can avoid the overlook of subcompartment and achieve adequate decompression of the first extensor compartment.
[Mh] Termos MeSH primário: Doença de De Quervain/patologia
Tendões/anatomia & histologia
Articulação do Punho/anatomia & histologia
[Mh] Termos MeSH secundário: Corticosteroides/administração & dosagem
Cadáver
Doença de De Quervain/terapia
Descompressão Cirúrgica/métodos
Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007875


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[PMID]:28829171
[Au] Autor:Chang AL; Yu HJ; von Borstel D; Nozaki T; Horiuchi S; Terada Y; Yoshioka H
[Ad] Endereço:1 Department of Radiological Sciences, University of California, Irvine, 101 The City Dr S, Rte 140, Orange, CA 92868.
[Ti] Título:Advanced Imaging Techniques of the Wrist.
[So] Source:AJR Am J Roentgenol;209(3):497-510, 2017 Sep.
[Is] ISSN:1546-3141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This article covers the technical aspects and clinical applications of recent advancements in wrist MRI techniques, including T2 and T1rho mapping, compressed sensing, and isotropic 3D imaging using driven equilibrium sequences, variable-flip-angle refocusing pulse sequences, and parallel imaging. The clinical applications of these techniques include the quantitative analysis of cartilage and triangular fibrocartilaginous complex (TFCC) degeneration, faster scanning times, and improved resolution of complex wrist anatomy, allowing differentiation of degenerative from traumatic TFCC tears and improved morphologic evaluation of chondromalacia. CONCLUSION: MRI of the wrist and of the musculoskeletal system has had multiple novel and exciting advancements in recent years. Several of these advancements, such as parallel imaging, are already in clinical use, and others will be entering the clinical realm in the near future. An understanding of these techniques allows one to use their advantages to greatest effect.
[Mh] Termos MeSH primário: Diagnóstico por Imagem/métodos
Artropatias/diagnóstico por imagem
Traumatismos do Punho/diagnóstico por imagem
Articulação do Punho/diagnóstico por imagem
[Mh] Termos MeSH secundário: Meios de Contraste
Seres Humanos
Aumento da Imagem/métodos
Interpretação de Imagem Assistida por Computador/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Contrast Media)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170823
[St] Status:MEDLINE
[do] DOI:10.2214/AJR.17.18012


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[PMID]:28721601
[Au] Autor:Gil JA; Kamal RN; Cone E; Weiss AC
[Ad] Endereço:Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA.
[Ti] Título:High Survivorship and Few Complications With Cementless Total Wrist Arthroplasty at a Mean Followup of 9 Years.
[So] Source:Clin Orthop Relat Res;475(12):3082-3087, 2017 Dec.
[Is] ISSN:1528-1132
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Total wrist arthroplasty (TWA) has been described as traditionally being performed with fixation in the radius and carpus with cement. The TWA implant used in our series has been associated with promising results in studies with up to 6 years followup; however, studies evaluating survivorship, pain, and function with this implant are limited. QUESTION/PURPOSE: (1) To report ROM and pain scores after wrist reconstruction with cementless fourth-generation TWA at a mean followup of 9 years (range, 4.8-14.7 years). (2) To report complications of a cementless fourth-generation TWA and the cumulative probability of not undergoing a revision at a mean followup of 9 years. METHODS: This is a retrospective case series of 69 patients who were treated for pancarpal wrist arthritis between 2002 and 2014. Of those, 31 had inflammatory arthritis (rheumatoid arthritis [n = 29], juvenile rheumatoid arthritis [n = 1], and psoriatic arthritis [n = 1]); all of these patients received TWA with the cementless implant studied in this investigation. Another 38 patients had osteoarthritis or posttraumatic arthritis; in this subgroup, 28 patients were 65 years or younger, and all underwent wrist fusion (none were offered TWA). Ten patients with osteoarthritis were older than 65 years and all were offered TWA; of those, eight underwent TWA, and two declined the procedure and instead preferred and underwent total wrist arthrodesis. The mean age of the 39 patients who had TWA was 56 ± 8.9 years (range, 31-78 years) at the time of surgery; 36 were women and three were men. The patients who underwent TWA were seen at a minimum of 4 years (mean, 9 years; range, 4-15 years), and all had been examined in 2016 as part of this study except for one patient who died 9 years after surgery. The dominant wrist was involved in 60% (25) of the patients. All patients were immobilized for 4 weeks postoperatively and then underwent hand therapy for 4 to 6 weeks. Pain and ROM were gathered before surgery as part of clinical care, and were measured again at latest followup; at latest followup, radiographs were analyzed (by the senior author) for evidence of loosening, defined as any implant migration compared with any previous radiograph with evidence of periimplant osteolysis and bone resorption. Subjective pain score was assessed by a verbal pain scale (0-10) and ROM was measured with a goniometer. Complications were determined by chart review and final examination. Kaplan Meier survival analysis was performed to estimate the cumulative probability of not undergoing a revision. RESULTS: The mean preoperative active ROM was 34 ± 18° flexion and 36° ± 18° extension. Postoperatively, the mean active ROM was 37° ± 14° flexion and 29° ± 13° extension. The mean difference between the preoperative pain score (8.6 ± 1.2) and postoperative pain score (0.4 ± 0.8) was 8.1 ± 1.9 (p < 0.001). Implant loosening occurred in three (7.7%) patients. No other complications occurred in this series. Kaplan-Meier survivorship analysis estimated the cumulative probability of remaining free from revision as 78% (95% CI, 62%-91%) at 15 years. CONCLUSION: Cementless fourth-generation TWA improves pain while generally preserving the preoperative arc of motion. The cumulative probability of remaining free from revision at 14.7 years after the index procedure is 77.7% (95% CI, 62.0%-91.4%). Future studies should compare alternative approaches for patients with endstage wrist arthritis; such evaluations-which might compare TWA implants, or TWAs with arthrodesis-will almost certainly need to be multicenter, as the problem is relatively uncommon. LEVEL OF EVIDENCE: Level IV, therapeutic study.
[Mh] Termos MeSH primário: Artroplastia de Substituição/instrumentação
Prótese Articular
Osteoartrite/cirurgia
Articulação do Punho/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Artralgia/etiologia
Artrometria Articular
Artroplastia de Substituição/efeitos adversos
Fenômenos Biomecânicos
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Osteoartrite/diagnóstico por imagem
Osteoartrite/fisiopatologia
Medição da Dor
Dor Pós-Operatória/etiologia
Desenho de Prótese
Amplitude de Movimento Articular
Recuperação de Função Fisiológica
Reoperação
Estudos Retrospectivos
Fatores de Tempo
Resultado do Tratamento
Articulação do Punho/diagnóstico por imagem
Articulação do Punho/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171117
[Lr] Data última revisão:
171117
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170720
[St] Status:MEDLINE
[do] DOI:10.1007/s11999-017-5445-z



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