Anatomic observations in carpal tunnel syndrome as they relate to the tethered median nerve stress test

The Tethered Median Nerve Stress Test (TMNST) has proved to be a reliable clinical tool in the diagnosis of chronic, low-grade carpal tunnel syndrome (CTS). The TMNST consists of hyperextending the index finger at the distal interphalangeal joint with the wrist maintained in a supinated position. Proximal volar forearm pain radiation is experienced by patients with chronic CTS during this maneuver. This investigation shows that significant distal excursion of the median nerve occurs with hyperextension of the index finger and to a greater degree than with hyperextension of the adjacent digits. Pain experienced during the TMNST appears to be vascular in origin and its severity is directly related to the duration of testing. This finding emphasizes the important role of ischemia in chronic entrapment neuropathies.     

Common finger fractures and dislocations

Finger fractures and dislocations are common injuries that are often managed by family physicians. A systematic physical examination is imperative to avoid complications and poor outcomes following these injuries. Radiography (commonly anteroposterior, true lateral, and oblique views) is required in the evaluation of finger fractures and dislocations. Dorsal dislocation of the proximal interphalangeal joint is the most common type of finger dislocation. Finger dislocations should be reduced as quickly as possible and concurrent soft tissue injuries treated appropriately. Referral to a hand specialist is needed if a dislocation cannot be reduced; is unstable following reduction; or involves significant ligament, tendon, or soft tissue injury. Some common finger fractures can be treated conservatively with appropriate reduction and immobilization. Referral to a hand specialist is required if a fracture is unstable, involves a large portion (greater than 30 percent) of the intra-articular surface, or has significant rotation.     

关节镜在膝关节军事训练伤早期诊断与治疗中的价值

[目的]探讨关节镜在膝关节军事训练伤的早期诊断与治疗中的临床应用价值。[方法]对1997年7月至2008年6月在本院行关节镜检查与治疗的46例膝关节军事训练伤患者的临床资料进行回顾性分析。对术后随访达半年以上的36例患者的术前及术后Larson评分、Lysholm评分及前、后抽屉试验等物理检查结果以及患者的主观评价进行统计学分析。[结果]全部病例中除证实的X线诊断外,另发现损伤32例。共行镜下治疗40例,优良率90．0％。手术前、后相关临床指标比较差异均有显著性（P〈0．05）。[结论]膝关节军事训练伤早期行关节镜检查可全面评估损伤程度,提高诊断水平。镜下手术治疗具有创伤小,并发症少,功能恢复快等优点,为膝关节军事训练伤的理想治疗方法。     

Birth injuries to growth plates: A sheep in wolves' clothing

Growth plate injuries (Salter‐Harris type 1 or physeal fractures) of the long bones in the newborn are easily misdiagnosed as joint fractures with dislocations due to their nonossified epiphyses on plain radiographs. Diagnosis with musculoskeletal ultrasound (US) is advantageous due to its ability to visualize the nonossified epiphysis. We present two cases of humeral growth plate fractures in newborns, one at the shoulder (proximal humerus) and the other at the elbow (distal humerus). These cases emphasize the importance of quick and noninvasive diagnosis with US to avoid unnecessary intervention. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45 :511–514, 2017     

断指再植功能恢复的相关性研究

目的 探讨断指再植功能恢复的影响因素和作用程度,为指导断指再植功能康复提供依据。方法 选择完全性娄指再植成活３２列４８指,根据Ｔａｍａｉ评分,对术前、术中和术后共８项可能影响功能恢复的因素进行因素和多因素分析。结果 对断指功能有影响的因素有性别、年龄、离断类型、离断平面、近侧指间关节（ＰＩＰＪ）处理、神经和术后康复。而对运动有影响遥因素是离断类型、平面、ＰＩＰＪ处理和术后康复,对感觉有影响的因素     

Management of common finger injuries

Family physicians can manage most finger injuries, including uncomplicated fractures, proximal interphalangeal joint dislocations, closed tendon injuries and ligament sprains. Finger injuries that can cause long-term morbidity may present as minor sprains. Diagnosis requires a thorough history, systematic examination and radiographic evaluation.     

Knee injuries in general practice

Careful technique of examination of the knee joint allows to establish the diagnosis of the most frequent knee joint injuries already through simple clinical and radiological evaluation: Recurrent dislocation of the patella with the Apprehension sign; meniscal injuries with the test of McMurray, pain on the joint line and pain on passive hyperextension; the anterior cruciate ligament tear with Lachman's sign and the Pivot Shift test and posterior cruciate injury with the Sag sign. Further imaging techniques allow to establish a definite diagnosis, which has replaced in many cases the classical, purely diagnostic arthroscopy. Thanks to careful aspiration of the knee joint the patient can be referred with a more precise diagnosis to the traumatologist and orthopaedic surgeon. Meniscal lesions don't have to be treated as emergencies with exception of the locked knee. Equally, in presence of a fresh tear of the anterior cruciate ligament a delay of surgery for eight weeks may be beneficial, be it only to rehab and prepare the knee joint for surgery. Posterior cruciate ligament tears should only be treated by a few centers, since they demand a high degree of experience. The same accounts for the new techniques for the treatment of cartilage lesions like the mosaicplasty or the autologous chondrocyte implantation.     

Whiplash injuries

Whiplash injuries are very common and usually are associated with rear-end collisions. However, a whiplash injury can be caused by any event that results in hyperextension and flexion of the cervical spine. These injuries are of serious concern to all consumers due to escalating cost of diagnosis, treatment, insurance, and litigation. Most acute whiplash injury cases respond well to conservative treatments, which result in resolution of symptoms usually within weeks to a few months after the injury occurred. Chronic whiplash injuries often are harder to diagnose and treat and often result in poor outcomes. Current research shows that various structures in the cervical spine receive nociceptive innervation and potentially may be the cause of chronic pain symptoms. One potential pain generator showing promise is the facet or zygapophyseal joints. Various researchers have proven that these joints are injured during whiplash injuries and that diagnosis and temporary pain relief can be obtained with facet joint injections. The initial evaluation of any patient should follow an organized and stepwise approach, and more serious causes of neck pain must first be ruled out through the history, physical examination, and diagnostic testing. Treatment regimens should be evidence-based, focusing on treatments that have proven to be effective in treating acute and chronic whiplash injuries.     

Palmar dislocation of the proximal interphalangeal joint--an injury not to be missed

Palmar dislocations of the proximal interphalangeal (PIP) joint are associated with long term complications if suboptimally treated. Six cases of palmar dislocation of the PIP joint are presented and a systematic approach in the diagnosis and management of such injuries in the accident and emergency department is described.     

Palmar dislocation of the proximal interphalangeal joint--an injury not to be missed.

Palmar dislocations of the proximal interphalangeal (PIP) joint are associated with long term complications if suboptimally treated. Six cases of palmar dislocation of the PIP joint are presented and a systematic approach in the diagnosis and management of such injuries in the accident and emergency department is described.     

Acute finger injuries: part I. Tendons and ligaments

Improper diagnosis and treatment of finger injuries can cause deformity and dysfunction over time. A basic understanding of the complex anatomy of the finger and of common tendon and ligament injury mechanisms can help physicians properly diagnose and treat finger injuries. Evaluation includes a general musculoskeletal examination as well as radiography (oblique, anteroposterior, and true lateral views). Splinting and taping are effective treatments for tendon and ligament injuries. Treatment should restrict the motion of injured structures while allowing uninjured joints to remain mobile. Although family physicians are usually the first to evaluate patients with finger injuries, it is important to recognize when a referral is needed to ensure optimal outcomes.     

Successful treatment of a guitarist with a finger joint injury using instrument-assisted soft tissue mobilization: a case report

Finger injuries are common and can greatly affect a musician’s quality of life. A 55-year-old man, who had injured the proximal interphalangeal joint of the left index finger 6 months prior to any intervention, was treated with a manual therapy approach incorporating instrument-assisted soft tissue mobilization (IASTM). Initial examination findings included self-reported pain and functional limitations and physical impairments that significantly impeded his ability to play the acoustic guitar. He was treated once a week for 6 weeks with IASTM, joint mobilization, therapeutic exercise, and ice massage. Additionally, a home exercise program and self-care instructions were provided. The patient gained positive outcomes with improvements in pain (Numerical Pain Rating Scale while playing the guitar: initial 5/10, discharge 1/10) and function (Disability Arm Shoulder Hand Sports-Performing Arts Optional Module: initial 75; discharge 6·25), each reaching a minimum clinically important difference. Importantly, he was able to play the guitar with minimal to no pain as desired. Physical measures also improved, including an immediate gain in finger range of motion with IASTM alone. Manual therapy approaches integrating IASTM may provide an effective conservative treatment strategy for patients with finger/hand conditions in the performing arts and other patient populations.     

Successful treatment of a guitarist with a finger joint injury using instrument-assisted soft tissue mobilization: a case report

Finger injuries are common and can greatly affect a musician’s quality of life. A 55-year-old man, who had injured the proximal interphalangeal joint of the left index finger 6 months prior to any intervention, was treated with a manual therapy approach incorporating instrument-assisted soft tissue mobilization (IASTM). Initial examination findings included self-reported pain and functional limitations and physical impairments that significantly impeded his ability to play the acoustic guitar. He was treated once a week for 6 weeks with IASTM, joint mobilization, therapeutic exercise, and ice massage. Additionally, a home exercise program and self-care instructions were provided. The patient gained positive outcomes with improvements in pain (Numerical Pain Rating Scale while playing the guitar: initial 5/10, discharge 1/10) and function (Disability Arm Shoulder Hand Sports-Performing Arts Optional Module: initial 75; discharge 6·25), each reaching a minimum clinically important difference. Importantly, he was able to play the guitar with minimal to no pain as desired. Physical measures also improved, including an immediate gain in finger range of motion with IASTM alone. Manual therapy approaches integrating IASTM may provide an effective conservative treatment strategy for patients with finger/hand conditions in the performing arts and other patient populations.     

Contribution of the extrinsic and intrinsic hand muscles to the moments in finger joints

OBJECTIVE: The purpose of this current work is to develop a method of estimating force produced by the extrinsic and intrinsic hand muscles, and to estimate the contribution of these muscles to the finger joint moments. DESIGN: Experimental methods and a biomechanical model were developed for the estimation of (a) moments produced at finger joints, and (b) contribution of the intrinsic and extrinsic muscles to the moments, (c) forces of the extrinsic and intrinsic muscles within individual fingers. BACKGROUND: Because of the differential insertions of the extrinsic flexors, it is possible to isolate their mechanical effect at finger joints. METHODS: During the experiment, the location of force application was varied in parallel along individual fingers. The points of force application were on the distal phalanx, at the distal interphalangeal joint, or at the proximal interphalangeal joint. RESULTS: When the point of force application was varied in the proximal direction from the distal phalanx to the proximal interphalangeal joint the moment at a given joint decreased. The intrinsic and extrinsic muscle forces were dependent on the experimental conditions. The extrinsic muscles were the major contributors in counterbalancing finger joint moments when the point of force application was distal beyond the proximal interphalangeal joint. CONCLUSION: This current work provides both an experimental protocol and a biomechanical model that allows estimation of the contribution of the intrinsic and extrinsic muscles to finger joint moments. RELEVANCE: This study suggests ways of identifying the source of functional deficiency in the hand.     

内镜在胆道损伤诊断与治疗中的价值

目的探讨内镜在胆道损伤诊断与治疗中的价值。方法通过Medline(1996—2004)光盘检索有关内镜诊断与治疗胆道损伤的文献。结果在胆道损伤诊断中，内镜逆行胰胆管造影术(ERCP)可以明确胆道损伤的部位及程度。在胆道损伤的治疗方面，各种内镜治疗方法的合理应用，对小范围的主胆管缺损、胆囊管残端漏、小范围的胆道狭窄等病变能获得较好的治疗效果，而主胆管横断、大范围胆道狭窄的内镜冶疗效果较差。结论内镜是一种胆道损伤诊断与治疗的基本方法，在治疗方面，其适应证的把握是重要的。     

Double dislocation of the proximal and distal interphalangeal joints of the little finger

A 32-year-old amateur goalkeeper sustained simultaneous dislocation of the proximal and distal interphalangeal joints following a hyperextension injury. This was reduced under a digital nerve block. Neighbour finger strapping and early mobilisation achieved a full range of movements at both joints when reviewed three weeks after the initial injury.     

Fingertip injuries

The family physician often provides the first and only medical intervention for fingertip injuries. Proper diagnosis and management of fingertip injuries are vital to maintaining proper function of the hand and preventing permanent disability. A subungual hematoma is a painful condition that involves bleeding beneath the nail, usually after trauma. Treatment requires subungual decompression, which is achieved by creating small holes in the nail. A nail bed laceration is treated by removing the nail and suturing the injured nail bed. Closed fractures of the distal phalanx may require reduction but usually are minimally displaced and stable, and can be splinted. Open or intra-articular fractures of the distal phalanx may warrant referral. Patients with mallet finger cannot extend the distal interphalangeal joint because of a disruption of the extensor mechanism. Radiographs help to differentiate between tendinous and bony mallet types. Most mallet finger injuries heal with six to eight weeks of splinting, but some require referral. Flexor digitorum profundus avulsion always requires referral. Dislocations of the distal interphalangeal joint are rare and usually occur dorsally.     

开放性胸腹联合伤12例诊治分析

目的 总结开放性胸腹联合伤的诊断治疗经验。方法 回顾1997年4月～2000年10月收治的开放性胸腹联合伤12例，对其损伤类型、临床特征、和诊断、治疗情况进行了分析。结果 本组12例，11例治愈，1例死亡。死亡率8．3％。结论 及时正确诊断，并根据不同类的损伤进行合理的治疗，大多数伤员预后良好。     

Effect of simulated rock climbing finger postures on force sharing among the fingers

OBJECTIVE: To study the forces applied by each finger in different joint postures simulating rock climbing gripping postures. DESIGN: Subjects in sitting posture applied fingertip forces perpendicular to horizontal force sensors in three different finger postures. BACKGROUND: Data provided by the literature indicate that middle and ring finger are commonly injured. However, no quantitative assessment of the forces applied by each finger related to the joint postures has been made. METHODS: Six elite rock climbers performed finger flexion in a single-finger task and a four-finger task. The tests were conducted in an extended posture, a curved posture (the joints belonging to the finger were flexed) and an intermediate posture (the joints were flexed, except the distal one which was fully extended). Each fingertip force was expressed in absolute value and in percentage of the maximal force capacity of the finger. RESULTS: The greater force was applied by the middle finger (20.8 N), whatever the posture. The relative involvement amounted to 105% for the ring finger in the curved posture. CONCLUSIONS: The great force applied by the middle finger and the great relative involvement of the ring finger in the curved posture seem to be the main factors of injuries of these fingers. RELEVANCE: The analysis of force sharing among the fingers during different joint postures mimicking rock climbing is essential to a better understanding of finger injuries.     

胸腹联合伤的临床诊断与手术治疗

目的 分析胸腹联合伤的临床表现特征,总结胸腹联合伤的早期诊断与手术治疗的特点,以降低病死率.方法 对我院30例胸腹联合伤患者采取回顾性分析的方法 ,分析不同原因的损伤类别及不同临床症状与手术方式.结果 治愈28例,治愈率93.3%;死亡2例,死亡率6.7%.主要并发症有:肺部感染、创口感染、连性肠梗阻.结论 对胸腹联合伤的早期确诊和早期手术治疗是救治成功关键