News Category: Wrist

Severe and chronic wrist pain may lead to surgery that affects wrist motion. Surgeons try to preserve motion as much as possible. The basic idea is that motion is directly linked with function. The more motion there is available, the more function will be possible. This study was designed to check this belief.

Adults over the age of 45 years with normal wrist motion and function were included in the study. The older age was to match results with adults of the same age likely to have arthritis and needing wrist surgery. Everyone was right-handed for the sake of consistency.

Subjects participated in two trials wearing two different splints. One splint restricted wrist motion partially. The other splint highly restricted motion. Each subject was tested for range of motion, opinions on function and satisfaction, and a timed test of function. A special device was built to help measure circular wrist motion. A new test to measure patient’s satisfaction called the Modern Activity Subjective Survey (MASS) was developed.

The authors also developed their own special test of function called the Modern Activity Timed Test (MATT). This test measures the functional effects of restricted wrist motion on modern activities. Such activities are performed many times every day. Some of these tasks included making a cell phone call, taking money from a wallet, writing a check, using a computer mouse, or folding laundry.

Test results showed a big difference in function between the two splints. Common tasks took much longer to complete when wearing the more restrictive splint. Age and gender were not linked to the outcomes.

The authors did note that subjects in both groups had a surprisingly high degree of functional motion. This finding suggests that a large loss of motion doesn’t necessarily mean an equally large loss of function.

Future studies are needed to validate the use of the two new tests (MASS, MATT) designed for this study. Further investigation of wrist function assessing more up-to-date tasks is needed. Understanding what tasks wrists can perform when motion is restricted will help surgeons and patients when planning surgery that can relieve pain but restricts motion and thereby function.

This study is the only one of its kind. It reports on the long-term results of patients who have all had the same wrist surgery for Kienböck’s disease. This condition is a disorder of the wrist named for Dr. Robert Kienbock, a radiologist in Vienna, Austria. He was the first one to describe the problem back in 1910.

Kienböck’s disease is breakdown of the lunate bone. The lunate is a small bone in the wrist on the little finger side of the hand. It forms part of the wrist joint where it connects with the radius (bone in the forearm).

Blood supply to the area is interrupted. The bone starts to die and dissolves or fractures. Another name for this condition is avascular necrosis. There are many ways to treat this problem. Sometimes the wrist bones are fused together. In other cases a joint replacement is ideal. Trying to restore blood flow to the area in a procedure called revascularization is also possible. Removing the lunate and/or other bones in the wrist may be advised.

All patients in this study had a proximal row carpectomy (PRC). This means a row of wrist bones closest to the forearm was surgically removed (including the lunate). The follow-up period was no less than 10 years after surgery. The range of years for follow-up among the group was from 11 to 20 years.

Range of motion, grip strength, and function were measured and compared before and after surgery. The values for each of these outcomes were also compared from one side to the other. Overall values improved for all measures. Results were excellent or good with no treatment failures. These results were maintained by everyone out to an average of 15 years after the operation.

The authors suggest that PRC is a reliable motion-preserving procedure for the management of advanced Kienböck’s Disease. Patients were able to return to work without changing jobs. Some patients experienced pain with overuse or lifting but did not report this as disabling.

This is the first study to compare the results of open versus arthroscopic surgery for wrist ganglion. The authors compared the rates of ganglion recurrence between the two groups. They also looked at postoperative pain in both groups.

Two senior hand surgeons did all of the operations. Patients were randomly assigned to the open or arthroscopic group. Half the group had a minimal incision with the arthroscopic approach. The surgeon used an arthroscopic shaver to remove the ganglion and stalk down to the scapholunate ligament. The other half of the group had the ganglion removed using an open technique and skin incision. The ganglion was cut off at the base of the stalk.

Everyone was followed for at least one full year. The researchers compared a variety of factors. They looked at patient age and number of complications between the two groups. Pain, recurrence, gender (male or female), and workers’ compensation status were compared.

The authors report that the surgical technique used in the treatment of wrist ganglions was equal between open and arthroscopic methods. One is not superior to the other in preventing ganglion recurrence.

A larger study size is needed to confirm these results. There were a fair number of patients in both groups who did not come back for follow-up. The rate of recurrence in these patients is unknown and could change the overall results.

Arthroscopic surgery for wrist ganglion has several possible advantages. It gives the surgeon a direct view of the wrist. The procedure is less invasive than open surgery. Patients may regain wrist and hand function sooner after arthroscopic removal of the ganglion. Rate of recurrence does not appear to be different between the two approaches.

It isn’t always possible to identify wrist instability from ligamentous tears using imaging studies. Sometimes only an arthroscopic exam can make the final diagnosis. These were the findings of a retrospective (looking back) study of 64 patients with chronic wrist pain.

Thirty-five of the 64 patients had a dorsal radiocarpal ligament (DRCL) tear. The DRCL is a broad ligament along the back of the wrist that helps stabilize the wrist. When it is torn or damaged, wrist pain and instability can occur.

In most of these cases, the patients did not recall a specific injury or traumatic event causing the problem. It’s possible that repeated wrist motion could cause fraying or deformity of the ligament. Only five of the patients had an isolated DRCL tear. All the rest had some other damage in the wrist such as another ligament tear.

Without an intact and functioning DRCL, the wrist can become painful and unstable. The results of this study show that there are no clinical signs or tests that can properly identify a DRCL tear. MRIs and X-rays did not show any sign of instability.

The author suggests arthroscopic exam for chronic wrist pain that doesn’t respond to conservative care. Once an accurate diagnosis is made, then the correct treatment can be applied.

When a patient breaks the radius bone (bone closest to the wrist), sometimes it is necessary for surgery to implant a plate to strengthen the bone. Over time, the metal plates have evolved to be more effective and to limit any side effects or problems later from the surgery.

This article presents two patients who developed flexor tendon injuries following insertion of a volar plate. The first patient, a 57-year-old woman complained of pain three months following initial surgery to repair her fracture. She complained of pain in the wrist and forearm, and wrist flexibility was limited. A volar plate was implanted and the patient recovered well, with no complaints of pain following surgery.

After eight months, the patient returned, complaining of pain in the wrist and difficult pinching and writing, along with weakness. Upon examination of the x-rays, the surgeon noted that the bone had healed well, but the plate appeared to be out of position. During surgery, it was found that the plate had frayed the tendon. This was repaired and the patient returned full strength by six weeks following the repair.

The second patient was a 51-year-old woman who had her wrist fracture repaired immediately with a plate. The patient had full use of her hand and was pain free at eight weeks following the surgery. Six months after the surgery, the patient returned with complaints of thumb pain and loss of function. She was also unable to flex her thumb. X-rays showed healing of the bone, but the plate was moved a bit to the side.

During surgery, the surgeon discovered that the tendon had ruptured. The plate was removed and the tendon was repaired, and the patient regained full use of her hand with no pain.

The authors write that because these tendon injuries are possible due to the positioning of the plate, patients should be warned before surgery of the possibility of tendon injury and the resulting need for surgical repair. They suggest that such patients be followed for at least one year following surgery.

Surgeons and medical students from Temple University in Philadelphia reviewed a condition called de Quervain disease. This painful wrist problem is also referred to as tenosynovitis or stenosing tendovaginitis.

The condition is recognized when patients report pain with gripping or grasping objects. The painful symptoms occur at the base of the thumb. The pain increases when raising objects while keeping the wrist in a neutral position. Moving the wrist away from the thumb side of the hand makes the symptoms worse.

Friction from repeated motions causes wear and tear on the soft tissues in the first dorsal compartment. There are six compartments or tunnels along the back of the wrist and hand. These tunnels are made up of fibrous connective tissue and bone. They provide a place for the tendons to slide and glide during motion of the wrist and hand.

With repeated use, the tendons and surrounding connective tissue starts to thicken. Sometimes the tissue becomes so dense, it is five times the normal size. There isn’t so much of a problem with inflammation in de Quervain’s as there is with degeneration of the tissue.

The condition is diagnosed based on symptoms and exam. The surgeon conducts several tests specific to de Quervain’s. One of those tests is the Finkelstein test. The examiner grasps the patient’s thumb and quickly moves the wrist and hand toward the little finger. Reproducing the pain with this motion is considered a positive test for de Quervain’s.

Patients with arthritis may have a positive Finkelstein test, too. There are several other tests that may be better for diagnosing de Quervain’s. One is the Eichoff maneuver. It is similar to Finkelstein’s. First, the patient’s thumb is placed inside the fist. Then the patient bends the fist toward the little finger.

Treatment is reviewed starting with nonsurgical intervention. Rest, splinting, and antiinflammatory drugs or steroid injections are tried first. Specific details of each treatment modality are presented.

Surgery to release the tissue along the top of the dorsal compartment may be needed. This takes the pressure off the tendons. The surgeon must be careful to avoid cutting the radial sensory nerve located in the same area.

Surgery can be a challenge because the anatomy of the dorsal compartment is different from patient to patient. The authors provide a detailed step-by-step description of their preferred technique.

Results from surgical release of de Quervain disease are excellent. Complications may occur in a small number of patients. These include persistent pain, scarring, or neuritis. A second surgery may be needed to address these problems.

According to this new study, extensor retinaculum impingement may be the source of wrist pain in certain athletes. The extensor retinaculum is a band of fibrous tissue across the back of the wrist. It covers the extensor tendons of the fingers and thumb. Impingement is another word for pinching.

Overuse of the wrist into a position of extension can cause impingement. Increased friction and pressure lead to pinching of the extensor retinaculum onto the tendons. Athletes at greatest risk include platform divers and gymnasts. Athletes who participate in the shot put event in track and field are also at risk.

The medical records of seven athletes with symptoms in eight wrists were reviewed. Symptoms included wrist pain and tenderness across the back of the hand. This site corresponded to the location of the extensor retinaculum. The painful symptoms were made worse by hyperextending the wrist.

Swelling was present and all seven athletes had a positive provocative test. This test is done by extending the wrist as far as possible. Then resistance is given to the fingers while the patient tries to bend the fingers back further. A positive test occurs when pain is brought on by this position with resisted motion.

Patients were treated with conservative care at first. This included rest, ice, and antiinflammatory drugs. Steroid injection was another option. The two athletes who were treated by injection returned to their previous level of sports without any further pain.

Most of the athletes wanted to get back to their sport as quickly as possible. They chose surgery instead. The surgeon cut a portion of the retinaculum and released the synovial covering over the tendons. It was believed that these were keeping them from moving freely.

The athletes who had surgery were also able to return to full participation in their sport. They did not have any return of their symptoms. After recovery from the operation, the provocative test was negative.

During the procedure, the surgeon was able to see thickening of the retinaculum. Swelling and inflammation of the lining around the tendons was also present. This is called tenosynovitis. The authors then compared their findings with the anatomy from 10 cadavers. A cadaver is a body preserved after death for study.

They found that half of the cadaver wrists had signs of retinaculum thickening. This thickening may be a risk factor for developing the impingement syndrome. Athletes who repeatedly hyperextend the wrist while loading it with their body weight may turn the predisposed wrist into a problem.

Wrist fractures can be difficult to treat. Despite almost 100 years of treatment for scaphoid fractures, the best treatment is still not determined. The scaphoid bone is located in the first row of wrist bones just below the radius. The radius is one of two bones in the forearm. Both the radial bone and the scaphoid bone are on the thumb side of the wrist.

Poor healing or nonunion of a fractured scaphoid can result in wrist pain and loss of motion. These two symptoms then result in loss of function. The use of percutaneous fixation to treat scaphoid fractures is the subject of this report. Percutaneous fixation refers to a thin, headless screw inserted through the skin into the broken bone. The screw holds the broken pieces together until healing occurs.

This type of surgical repair can be done on both displaced and nondisplaced fractures. A displaced fracture is one in which the broken pieces have shifted and no longer line up evenly. A special type of X-ray imaging called fluoroscopy is used to help guide the surgeon.

The authors provide a detailed description of the surgery. Photos of the various headless compression screws commonly used in this operation are included. Additional photos of patient wrist placement during the procedure are also provided. X-rays showing the placement of the screw and evidence of healing eight weeks after the surgery are part of this report.

Studies reviewed on the use of percutaneous fixation for scaphoid fractures report 100 per cent success. The fracture healed with very few problems. Stable fractures respond well to this type of fixation. The ligaments and surrounding soft tissues don’t have to be cut open. Patients don’t have to wear a cast. They can get back to their regular activities quickly.

When complications do occur, the patients report wrist pain and joint stiffness. Wrist deformity is also possible if the fracture doesn’t heal in a good position. Time lost at work is another result sometimes listed as a negative outcome.

All in all, percutaneous fixation results in a solid fracture union. Recent advances in screw design and fluoroscopy have made it possible to treat complicated scaphoid fractures without open surgery and without immobilization. Surgeons have found that the sooner the patient starts moving the wrist again, the faster their recovery. This is good news for any patient!

Surgeons have spent the last 40 years working on finger and wrist joint replacements for patients with painful and crippling arthritis. Different designs have come and gone. Materials have improved. Long-term results are now available after 20 to 40 years of follow-up with patients.

In this report, surgeons from the University of Cincinnati College of Medicine give a review and an update on joint replacements for the hand and wrist. When available, long-term results are given.

Three joint replacements are included: proximal interphalangeal (PIP) joint, metacarpophalangeal (MCP) joint, and the wrist. The PIP joints are the middle joints of the fingers. The MCP joints form what we refer to as the knuckles. Before implants were developed, patients had to rely on a joint fusion to stop their pain. Unfortunately, a fusion also limits motion.

Implants for the PIP joints made of silicone were popular at first. But long-term results showed motion wasn’t improved. Deformities were not corrected. And over time, the implant could break or sink down into the bone. The same problems were reported with MCP joint implants. The early good results reported with silicone implants tend to decline after 10 years.

Pyrolytic carbon implants had variable results. Pain was improved but strength and motion were not changed. Researchers are now studying titanium as a potentially better material for these implants.

Over the years, wrist joint replacements have undergone similar changes in design, materials used, and surgical technique. Wrist implants today are usually metal-on-polyethylene (plastic). The stem that fits into the forearm bone is porous coated. This gives the surface a rough base for bone to fill in and around.

Implant loosening and wrist imbalance are the two main problems with wrist replacements. Pain can get worse when the joint does not match up or if the joint pinches the soft tissues.

Two new designs are being investigated to help with these problems: the biaxial total wrist and the Universal prosthesis. Long-term results of these new implants aren’t available yet.

However, early results suggest these implants make a good choice for patients with low demand for wrist motion and strength. It’s still better than a wrist fusion and the patient can always have a fusion later if the implant fails some years down the road.

Kienbock’s disease is a disease that affects the blood flow to a small bone in the hand, called the lunate. If the blood supply is cut off completely, the bone dies. Patients with Kienbock’s disease often need to have surgery. The success rates for the various surgeries range from 55 percent to 88 percent. Because different surgeries have been tried with varying success, the authors of this study wanted to see if a procedure called the distal radius shortening osteotomy would provide good long-term outcomes. This procedure involves shortening the bone in the arm (the radius) and relieves pressure on the lunate.

The researchers performed 13 procedures in 12 patients, who were an average of 31 years old (ranging from 20 to 44 years). Nine patients were available for follow-up for an average of 22 years, ranging from 16 to 31 years. To assess the surgery’s outcome, the patients used the Visual Analog Scale (VAS), which rates pain on a level from 0 to 10, with 10 being the worst. The researchers used the Disabilities of the Arm, Shoulder, and Hand (DASH) scores; DASH scores are from 0 to 100, with 100 being the worst possible outcome. The patients’ wrists were measured for range of motion and grip strength; x-rays were also taken.

The findings showed after the surgery, the average VAS score for pain was 2.4 (responses ranged from 1 to 10) and for satisfaction at 2.2 (responses ranged from 0 to 8). The DASH score average was 14, with a range of 0 to 68. Of the nine patients available for follow up, 8 were able to return to work. The range of motion on the affected hands was still less than that of the other hand, as was the grip strength.

The authors point out that their study was very small with limited follow up, so they warn that the results may not be generalizable. They note that although the disease did progress in some patients, it appeared to stabilize in all after 10 years.

The scaphoid bone in the wrist can present some complex treatment problems if and when a fracture doesn’t heal. This condition is called a scaphoid nonunion. In this article, the surgical treatment of scaphoid nonunion is presented.

The authors point out that without surgical treatment, a scaphoid nonunion can get much worse. The bone itself can collapse. This results in an unstable wrist. The bones don’t line up so any use of the wrist causes uneven wear and tear on the joints. Osteonecrosis (death of the bone) arthritis can be the end results.

The goal of surgery is to knit the broken pieces of bone back together. The alignment of the wrist must be treated, too. Some types of breaks can disrupt blood supply to the bone, so the surgeon examines this carefully.

Surgical setup and instrumentation used are described in detail. Whether or not the incision is made from the front (volar) of the wrist or the back (dorsum) of the wrist depends on what’s going to be done. The volar approach is used when a bone graft is needed. It also helps save the blood supply.

A dorsal approach is used when the fractured piece is on the wrist-side (rather than the finger) side of the hand. This is called a proximal pole nonunion. Healing is often much slower for this type of fracture injury. Screws or wires are used to hold the bone together during the healing process. This is called fixation or instrumentation.

Rehab and postoperative management tips are also included. The authors list a group of pearls and pitfalls for surgeons to consider with each operation. For example, when operating from the volar side of the wrist, ligaments such as the radioscaphocapitate should be saved as much as possible. This helps prevent the bone from slipping back into a partial dislocation.

Insertion points for the arthroscope are described and shown. For all procedures, X-rays and MRIs help identify problems that should be corrected during the operation.

Patients should be advised prior to the surgery that stiffness and pain are common after the operation. In fact, these symptoms can be worse after surgery than they were before surgery. Nerve damage can also occur, although every effort is made to avoid this.

In this study the results of closed surgery for 11 patients with chronic scapholunate (SL) instability are reported. SL instability occurs when the interosseous ligament between these two bones (scaphoid and lunate) is torn. Closed surgery more than three months after this injury isn’t usually advised. The authors report suboptimal results with the technique they tried.

Eleven patients with chronic SL instability who didn’t want open surgery were included. Arthroscopy was used to remove all traces of the torn ligament. This procedure is called debridement.

Removing the torn ligament down to bleeding bone may help produce scar tissue to help stabilize the joint. The two bones were also wired together to hold them in place during healing. The wire was removed eight weeks later.

The operation was a failure for three patients. They ended up having a wrist fusion to eliminate the pain. Four of the remaining eight patients were pain free. The other four had pain with everyday activities and decreased grip strength.

Grip strength and range of motion were never back to normal. X-rays showed bone gapping in all patients during gripping activities. No one had an unstable wrist.

Some patients were followed for up to three years but the authors pointed out the need for long-term results. How long does the surgery hold up? Does arthritis set in? Do younger patients have better results? Does the repair hold up for patients who work as manual laborers? The authors hope to answer these questions as part of the follow-up for this study.

Rheumatoid arthritis (RA) affecting the wrist is common. Surgery is advised when medical treatment doesn’t stop the progression of the disease. The goals are to reduce pain, save wrist function, and prevent deformity. In this article doctors from Canada review the early surgical management of wrist RA.

Two-thirds of all patients with RA have wrist symptoms in the first two years. This number increases to 90 percent by 10 years. The joint, tendons, and cartilage can all be affected. Bone erosion and thinning of the tendons occurs. The bones in the wrist shift and sometimes even rotate and collapse. Joints often dislocate. The tendons may rupture.

Surgery to repair tendons, replace joints, or fuse the wrist may be needed. Surgery can even be done to prevent tendon rupture. This is called prophylactic surgery. The authors say it’s best to do as much as possible during each operation. Early surgical intervention can prevent further tendon rupture and prevent disability.

Each of the surgical procedures is reviewed. The authors offer other surgeons their ideas about when and how to do each one. They admit that early surgical treatment is still a highly debated topic. They feel that the short-term benefits are worth it to the patient even if the disease process isn’t stopped in the long run.

Carpal tunnel syndrome (CTS), tennis elbow, and cubital tunnel syndrome…these are just three of the most common arm problems workers seek medical care for. But whether or not the problem is work-related can’t be decided by the patient or doctor based on symptoms. It’s a legal decision with different laws in each state.

Studies show there is a wide range of risk factors for these common conditions. The group affected most often by CTS is middle-aged women who don’t work outside the home. So the debate continues: are these problems really caused by work conditions? Or is there a pre-existing condition and work is the last straw?

One of the largest studies done of 1,757 workers concluded repetitive work was not a risk factor. Other studies disagree. In the end doctors must examine the patient and make a medical decision based on what the law says. Is work the cause of the problem according to the legal definition? If it’s not then the case can’t be covered by worker’s compensation.

When the scaphoid bone on the thumb side of the wrist is broken it may not heal. This is called a nonunion fracture. In time degenerative changes occur and arthritis sets in. This doesn’t happen with all nonunion scaphoid fractures. In this study, researchers show why this happens.

Using a special 3-dimensional (3-D) imaging technology, 20 patients with nonunion scaphoid injuries were examined. Using CT scan and computer software a 3-D model was made for each patient. Both bones of the forearm (radius and ulna) and the scaphoid were included. The authors used a mirror image of the uninjured wrist to match the bone placement.

The location of the fracture on the scaphoid was mapped. Any shifting or displacement of the bone fragments was also shown. The injured wrist was compared to the normal wrist by superimposing the injured view over the normal CT image.

Based on the location of the fracture, two types of scaphoid nonunion were described. The first was distal (farther away from the forearm) and the second was proximal (closer to the forearm). The broken piece moved away from the main bone, sometimes shifting and rotating. This causes a wrist deformity as the bones around the scaphoid shift, too.

Using 3-D imaging the authors were able to show that the location of scaphoid nonunion fractures determines the final outcome. Patients with distal fractures end up with more deformity and a worse result. The location of the break causes instability of the entire first row of wrist bones. Surgery is needed to correct the deformity and restore the wrist.

Researchers from the Hand and Upper Extremity Clinic in Boston, MA take a look at this question. They looked at general health, patient satisfaction, and function of the arm and hand as measures of outcome.

Twenty-two patients with posttraumatic arthritis had a wrist fusion called arthrodesis. The authors reviewed type of injuries leading up to the need for wrist fusion. The method of surgery was also reviewed.

Most patients said they would have this operation again if needed. Hoever they would gladly have another surgery to restore motion if it was possible. Although the pain was improved after fusion, most patients still had some pain rated from mild to severe.

The authors conclude patients with painful posttraumatic wrist arthritis may have to give up motion to get pain relief. Wrist arthrodesis doesn’t get rid of all pain but does improve function.

Most scaphoid (bone) fractures in the wrist occur from a fall, punch, or car accident. Two treatment options are compared in this study: surgery versus casting.

One group of patients was put in a below-the-elbow case for six weeks. The second group had surgery to insert a screw to hold the bone together during healing. Results were measured using pain, grip strength, motion, and function.

The authors review the advantages and disadvantages of screw (internal fixation) versus casting the wrist. With the cast patients have a longer period of time without movement. Stiffness and loss of grip strength delay return to work or play.

Surgery has risks and complications. The bone might split when trying to put the screw in place. The hole drilled for the screw might be in the wrong place the first time requiring a second hole. With surgery there’s always the risk of infection, delayed healing, and scar tissue. More serious problems such as death and permanent disability are also possible.

The results of this study show no overall benefit of early fixation with a screw compared with a wrist cast. In fact the authors suggest surgery for this problem is over treatment. Patients are exposed to additional surgical risks.

They advise other surgeons to treat conservatively with casting. Watch for signs of delay or failure to heal. Surgery may be helpful around six weeks post-injury if there isn’t union of the bone.

A surgeon at the Hand Center in Boston treated 38 patients with wrist arthritis. All had been in an accident or had a wrist fracture. All were treated with a wrist fusion for chronic pain and instability. Patients were asked how the loss of wrist motion has affected their arm function.

Patients were interviewed and examined at the Hand and Upper Extremity Center. General health was evaluated. Unlike patients with rheumatoid arthritis, most patients with post-traumatic arthritis were in good overall health. No other joints were involved.

Arm pain, grip strength, and function were also measured. More than half the patients still had pain. Grip strength was 20 percent less than the uninvolved side.

Patients were asked if they would have another operation to restore motion if it was available. Almost everyone agreed they would have another operation if it could make their wrist move again. This was true even for patients who said they were satisfied with the results of their fusion.

The authors conclude patients who sacrifice wrist motion for comfort and function would still like their full motion back.

Medical costs continue to rise at a rapid rate. Cases of carpal tunnel syndrome (CTS) aren’t helping matters. Researchers are looking for ways to diagnose problems like CTS using clinical tests instead of expensive medical studies. This is called a clinical prediction rule (CPR).

One way to do this is to compare the results of clinical tests with medical studies and see if the outcomes are the same. In this study patients with CTS were given nerve and muscle tests (nerve conduction velocity and electromyography).

After a brief rest, the patients were tested by two different physical therapists (PTs). The PTs gave standard CTS tests used to test for nerve compression. A total of 21-items were tested. Four tests combined with the patient’s age (over 45 years) were found to be predictive of CTS.

The most helpful sign was the flick sign. The patient shakes his or her hand and the symptoms go away. The simple question, “Do you have trouble with fumbling or dropping objects from your affected hand?” was also predictive of CTS. The two most commonly used tests (Phalen’s test and the Tinel sign) were not diagnostic of CTS.

This study was the first step in finding a CPR for the diagnosis of CTS. More study is needed to verify the findings of this study before it can be used on a regular basis.

This study reports the result of removing the pisiform bone in the wrist for painful arthritis. The pisiform is on the little-finger (ulnar) side of the wrist. It’s embedded in the flexor carpi ulnaris tendon. It connects to the triquetrum bone with a single joint. Ligaments connect it to two other bones in the wrist.

Besides degenerative arthritis, ulnar-sided wrist pain can be caused by ganglion cysts, fracture, gout, or calcium deposits. In this study 21 patients had their pisiform removed. The tendon and ligaments around the pisiform were left untouched so function was preserved.

Patients were followed for up to three years. Twenty (20) were pain free. Only one patient had pain with strenuous activity. Wrist motion was equal to the wrist on the other side. The authors conclude that removing the pisiform when medical treatment hasn’t relieved wrist pain doesn’t interfere with hand function.