Modified Extensor Indicis Proprius Opponensplasty.

Conséquences sur la force d’extension active de l’extenseur propre de l’index après prélèvement pour transfert tendineux : à propos de 19 cas cliniques

Tendon repair with intercalated partial extensor carpi radialis longus tendon graft for chronic extensor pollicis longus tendon rupture.

To lead a quality life, tendon repair must be performed in a trauma causing damage to the extensor tendon of the hand. The aim of this study is to study the structures that can be used as donor tendons. Fifty-four dissected adult hands were examined to study the pattern of the extensor tendons on the dorsum of the hand. The most common distribution patterns of the extensor tendons of the fingers were as follows: a single extensor indicis proprius (EIP) tendon which inserted ulnar to the extensor digitorum (ED)-index; a single ED-index; a single ED-middle; a single ED-ring; an absent ED-little; a double extensor digiti minimi (EDM), and a single ED-ring to the little finger. The frequency of the number of tendons is as follows: a single (87.03%) EIP, a single ED-index (100%), a single (92.6%) ED-middle, a single (75.9%) ED-ring, and an absent (68.5%) or a single (24.1%) ED-little. A double (88.9%) EDM tendons were seen. The thickest type of juncturae tendinum (JT) is found primarily between the ring and little fingers (90%). Suitable excessive tendon and the thickest JT as donor tendon were found in the fourth intermetacarpal space. The present findings, especially the fourth intermetacarpal space, may explain why incisions on the dorsum of the hand should be large and performed with particular care. It is necessary to have a thorough understanding of the arrangements of the multiple extensor muscles and their junctural connections of the hand when tenoplasty or tendon transfer is required.

F163. Role of ultrasonography in severe distal median nerve neuropathy

Extensor pollicis longus (EPL), the long extensor tendon for the thumb, is one of the commonest tendon to rupture and require treatment. In case of closed rupture of EPL, direct repair is usually not possible, requiring tendon reconstruction to restore function. Traditionally, extensor indicis proprius (EIP) tendon is transferred under general or regional anaesthesia through two (or more) incisions. The author proposes and demonstrates that it is possible to carry out this transfer through one short incision under local anaesthesia with good outcome and minimal complications.

Severe carpal tunnel syndrome with long-standing sensorimotor deficits was treated using carpal tunnel release combined with Burkhalter opponensplasty utilizing the extensor indicis proprius tendon. The patient presented with significant functional limitation due to loss of thumb opposition. Following surgery and rehabilitation, she demonstrated restored thumb function, improved grip performance, and complete relief from numbness and tingling. This case highlights the effectiveness of EIP opponensplasty as a dependable reconstructive option in advanced CTS with thenar muscle atrophy, offering functional recovery without compromising index finger movement.

Background: The authors conducted a prospective, multi-centre study to assess the impact of carpal tunnel release (CTR) on Two-Point Discrimination (2-PD), Quick Disabilities of Arm, Shoulder and Hand Score (Q-DASH), and Distal Motor Latency (DL). The primary aim was to determine the change in outcome measurements (2-PD, Q-DASH and DL) preoperatively and postoperatively at 6 months and 1 year. The secondary aims of the study were to determine whether the postoperative outcomes were different at the 6-month and 1-year follow-up and if there was difference in outcomes based on the preoperative severity of carpal tunnel syndrome (CTS). Methods: A total of 205 hands in 171 patients underwent CTR at five hospitals over a 2-year period. A total of 110 hands in 94 patients were followed-up and analysed. The 2-PD, Q-DASH and DL were measured for all patients preoperatively and at 6 months and 1 year postoperatively. Patients were divided into two groups 'mild' and 'severe' based on pre-operative DL score (mild ≤ 8.1 msec). The change in preoperative and postoperative 2-PD, Q-DASH and DL values were compared. The change in pre-operative and post-operative 2-PD and Q-DASH values were also compared between the 'mild' and 'severe' groups. Results: The 2-PD, Q-DASH and DL showed significant improvement at 6-month and 1-year follow-ups compared to pre-operative values. However, there were no significant differences in all three parameters between the 6-month and 1-year measurements. There was significant improvement in preoperative and postoperative 2-PD and Q-DASH scores between the mild and severe groups. Conclusions: CTR is an effective treatment for patients with CTS with significant improvement in all three outcome parameters (2-PD, Q-DASH and DL). The improvement in outcome plateaus at 6 months and additional follow-up may not be useful. Level of Evidence: Level II (Therapeutic).

The use of ultrasonography (US) as a non-invasive method to evaluate and diagnose musculoskeletal disorders has increased in recent years. This cross-sectional study assessed the cross-sectional area (CSA) of the median nerve using US in patients with carpal tunnel syndrome (CTS). Clinical and demographic data of patients were recorded. Nerve conduction studies (NCS), US, and needle electromyography (EMG) were performed. In addition, US evaluated the flattening ratio (FR) and CSA of the median nerve. This study assessed 600 wrists of 300 patients with CTS referred to Golestan Hospital (Ahvaz, Iran) for nine months. There were 102 males and 198 females, with a mean age of 46.83±9.50 years. Many patients were aged 40-59 years old. Furthermore, 240 patients had bilateral CTS. The hands affected by CTS were categorized into three groups based on the severity of CTS: mild (298 hands, 49.7%), moderate (164 hands, 27.3%), and severe (138 hands, 23%). Substantial differences were detected in the average age, CSA of the median nerve, body mass index (BMI), ring-finger method (RF), FR, and outcomes in Tinel's sign and Phalen's test based on the severity of CTS (P<0.05). The increase in CSA of the median nerve was related to the severity of CTS. In addition, the US could effectively evaluate the severity of CTS. Utilizing US to measure the CSA of the median nerve was beneficial for identifying and assessing the severity of CTS. However, it should not be regarded as a substitute for NCS. Integrating NCS, US, and needle EMG can enhance diagnostic accuracy and provide more comprehensive insights into severity and underlying causes of CTS. These findings may help healthcare professionals prioritize and improve the quality of diagnosis, treatment, and care for patients with CTS.

Reduction in median nerve cross-sectional area at the forearm correlates with axon loss in carpal tunnel syndrome

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. It is a combination of symptoms and signs caused by the compression of the median nerve as it passes in the carpal tunnel at the wrist. It is an important cause of functional disability, and is the commonest cause of referral to the Electro diagnostic laboratory. CTS is studied extensively. However, its pathophysiology still unclear and most of the cases still idiopathic especially in middle aged women. Objective: To correlate between severity of CTS and abnormality of lipid profile, and to establish the relationship between severity of CTS and age, Body mass index (BMI), in Egyptian middle aged women. Patients and Methods: This study included 155 female cases and controls recruited from the Neurology outpatient clinics of Al-Hussein University Hospital and Al Sahel Teaching Hospital during the period from November 2018 to September 2019, 103 cases with the clinical and neurophysiological diagnosis of idiopathic carpal tunnel syndrome. The study demonstrated the relation between age, lipid profile, BMI and severity of carpal tunnel syndrome in this group of females in comparison to the 52 females as a controls. Results: Age, high BMI, higher cholesterol and LDL levels, were correlated with severity of CTS, while Cholesterol and LDL were much higher among the cases compared to controls. HDL was less in the patients. Conclusion: Abnormal lipid profile, higher BMI, obesity and poor living circumstances could influence the incidence and severity of CTS among middle aged Egyptian women.

Forearm median motor conduction velocity (FMCV) is reduced in carpal tunnel syndrome (CTS). The aim of this study was to investigate the association of FMCV with age and severity of median nerve compression. Forearm median motor conduction velocity and median nerve motor distal latencies were measured in 312 CTS hands. Forearm median motor conduction velocity correlated negatively with age. This correlation persisted in the subgroups of hands with severe and less severe CTS. Forearm median motor conduction velocity correlated negatively with the degree of compression (as measured by median nerve motor distal latencies). This correlation persisted in subgroup of hands with severe CTS but not in less severe ones. Multiple regression analysis comparing the influence of age and median nerve motor distal latencies on FMCV showed higher standardized coefficients (beta) value for age than for median nerve motor distal latencies, suggesting a greater influence for age. The beta value for age is higher in severe group than in less severe group, suggesting that age has higher influence on FMCV in severe group. The degree of compression influences FMCV in hands with severe CTS but not in hands with less severe CTS. This difference in severe and less severe CTS may be because of the differences in the underlying pathophysiological processes in the 2 entities.

Although median nerve neuropathy and carpal tunnel syndrome (CTS) are known complications of both untreated and acutely treated distal radius fracture, median neuropathy after correction of distal radius malunion is not commonly reported in hand surgery literature. We describe a patient with severe CTS after corrective osteotomy, open reduction internal fixation (ORIF) with a volar locking plate (VLP), and bone grafting for distal radius malunion. We report a case of severe acute CTS as a complication of corrective osteotomy with bone grafting for distal radius malunion. The patient was treated with surgical exploration of the median nerve and carpal tunnel release. The authors report a case of acute CTS after ORIF with VLP for a distal radius malunion warranting surgical exploration and carpal tunnel release. Treatment teams must be aware of this potential complication so that the threshold for reoperation is low and irreversible damage to the median nerve is prevented.

The Extensor Indicis Proprius Opponensplasty although not widely exercised by hand surgeons has previously been shown to produce good results in the restoration of thumb opposition. Over the last 5years the Extensor Indicis Proprius was selectively used in cases where the Flexor Digitorum Superficialis was unavailable or inappropriate. In a small case series operating on a total of six male patients with an average age of 32 and follow up of 12months we have been impressed by the functional outcome and lack of donor site morbidity. The Extensor Indicis Proprius is expendable with minimal donor site morbidity, is of sufficient length and has an optimal line of pull to provide a superior mechanical advantage and a favourable torque when compared to Flexor Digitorum Superficialis.

In up to 30% of patients with carpal tunnel syndrome (CTS), the cross-sectional area (CSA) of the median nerve may not be enlarged. We hypothesize that this could be the result of secondary atrophy of the nerve in severe CTS. The aim of this study was to measure the ultrasonographic CSA of the median nerve at the wrist in patients with severe CTS. In 14 consecutive patients with clinically and electrophysiologically defined severe CTS, the CSA of the median nerve was measured and compared with that of control subjects. CSA of the median nerve exceeded the upper limit of normal in the majority of patients with severe CTS. Atrophy of the median nerve in severe CTS does not explain negative ultrasonographic test results. Instead, the CSA of the median nerve is enlarged in most patients with severe CTS.

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Diagnosis is based on clinical history, physical examination, and electrophysiological studies. Imaging techniques are performed for difficult-to-diagnose cases because they provide information about the morphology of the median nerve. More recently, it has been shown that Doppler ultrasonography can detect increased intraneural blood flow in CTS. The aim of our study is to evaluate the relationship between the severity of CTS, hypervascularization, and cross-sectional area (CSA) to determine the diagnostic value of Doppler ultrasonography.Patients and methods: The study group comprised 125 wrists of 75 patients who had been diagnosed with CTS, both clinically and electrophysiologically. The control group comprised 100 wrists of 50 healthy volunteers. Wrists were classified into five stages of CTS severity based on electrophysiologic studies. A radiologist examined the wrists blindly with grayscale images and Doppler ultrasonography to assess CSA and hypervascularization.Results: A total of 121 wrists were included. There were 28 wrists with minimal CTS severity stage, 36 with mild, 36 with moderate, and 21 with severe. The sensitivity and specificity of CSA and hypervascularization in detecting CTS was 90.9, 94.0, 93.4, and 90.0%, respectively. There was a significant correlation between CTS severity and hypervascularization (p < 0.005) for all stages.Conclusion: Our study shows that Doppler ultrasonography results strongly correlate with CTS severity. Hence, this is a useful method for diagnosing CTS and estimating its severity.