Miami Hand Center

The purpose of the study was to compare the safety and effectiveness of ultrasound-guided carpal tunnel release (UGCTR) and open carpal tunnel release (OCTR) in real-world clinical settings. Patients with carpal tunnel syndrome were prospectively enrolled in the multicenter MISSION registry and treated with unilateral UGCTR or OCTR by experienced surgeons. Outcomes included the Boston Carpal Tunnel Questionnaire Symptom Severity and Boston Carpal Tunnel Questionnaire Functional Status Scale, pain (0-10 scale), opioid use, health-related quality of life (EuroQoL 5-Dimension 5-Level), satisfaction (overall and wound), and adverse events through 3 months. Baseline group characteristics were balanced using propensity score matching. A total of 178 patients per group were analyzed. The predominant anesthesia methods differed between groups (84.8% wide awake local anesthesia no tourniquet with UGCTR; 68.5% monitored anesthesia with OCTR). Ultrasound-guided carpal tunnel release was associated with shorter incisions (5.2 vs 16.5 mm) and less sutured wound closure (14.6% vs 100%), but longer procedure times (15 vs 6 minutes). At 3 months, UGCTR showed minor statistical advantages in Boston Carpal Tunnel Questionnaire Symptom Severity (group difference: -0.14 points), Boston Carpal Tunnel Questionnaire Functional Status Scale (group difference: -0.16 points), and pain severity (group difference: -0.6 points), with no statistical differences in EuroQoL 5-Dimension 5-Level (group difference: 0.03 points) or overall satisfaction (group difference: 4.9%). Opioid use was less common (10.2% vs 49.1%), wound satisfaction was higher (94.2% vs 84.0%), and wound symptoms were less severe after UGCTR (60.7% vs 22.8% with no sensitivity or pain). Nonserious adverse event rates were comparable (1.1% vs 0.0%). Ultrasound-guided CTR and OCTR provided safe and effective symptom relief in routine clinical practice. Ultrasound-guided CTR was associated with less anesthesia, shorter incisions, reduced opioid use, and fewer wound symptoms, whereas procedure time was shorter with OCTR. Technique selection should be guided by shared decision making, considering patient expectations and surgeon's judgment. Therapeutic II.

Objetivo: Avaliar a eficácia e segurança dos fios de polidioxanona (PDO) no tratamento de alopecia androgenética (AAG), alopecia areata localizada e eflúvio telógeno crônico. Métodos: Oito participantes (três homens, cinco mulheres; média de idade: 39,13 ± 6,36 anos) com AAG leve a moderada (Hamilton-Norwood II-III ou Ludwig I-II, exceto um caso Ludwig III), alopecia areata (placa ≤ 5 cm²) ou eflúvio telógeno crônico receberam 10–40 fios PDO monofilamentares no couro cabeludo, em padrões linear ou radial. Avaliações clínicas (exame visual, fotodocumentação) e questionários em escala Likert de 5 pontos (1 = muito insatisfeito; 5 = muito satisfeito) foram realizados aos 14, 30 e 90 dias pós-procedimento. Resultados: Observou-se aumento de 15–35% na densidade capilar, com repilação completa em alopecia areata. A percepção subjetiva foi alta, com médias de 4,75 ± 0,46 (crescimento e redução da queda), 4,50 ± 0,76 (qualidade do cabelo) e 4,50 ± 0,76 (satisfação geral). Cinco participantes notaram crescimento aos 30 dias. Todos recomendariam o tratamento (média 10 ± 0), sem eventos adversos. Apenas um participante usou terapias concomitantes (finasterida e minoxidil). Conclusão: Os fios PDO demonstraram eficácia e segurança no tratamento de alopecias, com alta satisfação e potencial sinérgico em terapias combinadas. A amostra pequena e a ausência de tricoscopia quantitativa são limitações. Estudos com amostras maiores e métodos objetivos são necessários para validar os achados.

Healthy early childhood development unfolds in the context of relationships with important caregivers, including early educators. Grounded in the evidence on early relational health, the 8‐week Hand in Hand Foundations Course for Early Childhood Educators teaches a novel connection‐based approach to understanding and responding to young children's emotions. Educators learn five tools for bolstering connection during emotional experiences (Staylistening), increasing positive and playful interactions with children (Special Time, Playlistening), responding to challenging behavior (Setting Limits), and creating sustainable, peer‐supported reflective practice groups (Listening Partnerships). The goal is to foster stronger educator‐child relationships, improve well‐being for educators and children, and build a culture of connection and reflection in ECE. This mixed‐methods pilot study of the Foundations Course in the United States investigated educators’ experiences with the course, soliciting input on the feasibility of using the tools in the classroom and areas for improving the course. Educators reported that the theories resonated with them, they incorporated many of the tools, and they saw benefits for children and the ECE community. They also expressed a need for ongoing learning opportunities, implementation scaffolding, and organizational support. These findings have implications for supporting educator and child social‐emotional health and potential future revisions for the course.

The purpose of this study was to analyze the effect of autologous fat transfer on outcomes in patients with basilar thumb arthritis. Twenty-three patients with carpometacarpal (CMC) arthritis underwent autologous fat transfer under fluoroscopic guidance. Autologous fat was harvested from the abdomen and separated with nonadherent gauze (Telfa). After processing, 2 mL of fat was injected into the CMC joint. All patients were placed in a prefabricated thermoplastic splint for 2 weeks postoperatively. Patients completed the Disability of Arm-Shoulder-Hand Questionnaire (DASH) questionnaire both preoperatively and postoperatively at 1, 6, and 12 months. Paired t tests were used to compare pretreatment to posttreatment DASH scores. Significance was set at a P value less than 0.05 (95% confidence interval [CI]). The average preoperative DASH score was 51.81 (95% CI, 45.85-57.76). Average postoperative DASH score at 1-month follow-up was 26.16 (95% CI, 19.76-32.57), followed by a DASH score at 6-month follow-up of 22.49, 95% CI (15.41-29.54), and a DASH score at 12-month follow-up of 26.62 (95% CI, 17.68-35.56). Improvements in DASH score were as follows: 26.49 at 1 month postoperatively (P < 0.01), 30.64 at 6 months postoperatively (P < 0.01), and 26.89 at 12 months postoperatively (P < 0.01). No major adverse events were observed. Autologous fat transfer for the treatment of CMC osteoarthritis significantly improved hand function in our cohort. Additional studies of fat transfer are warranted to better understand the physiologic mechanisms and therapeutic benefits.

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