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At least 109 records · Page 6Linked to original sources
PubMed1997

MR imaging of the carpal tunnel.

OBJECTIVE: Investigations were conducted regarding changes of carpal tunnel shape during wrist motion and the variations of space for the median nerve as well as the preoperative signs of carpal tunnel syndrome (CTS) and the postoperative restitution. METHODS: Axial MR images (1.0 T) were performed at the level of the distal radioulnar joint, pisiforme bone and hook of hamate level of 20 wrists of patients with clinical symptoms of CTS and further 20 wrists of volunteers. This was conducted with the wrist in neutral position, 45 degrees extension and 45 degrees flexion. T2-weighted signal intensity of the median nerve were measured in 18 patients pre- and postoperatively. RESULTS: The increase of the cross-sectional area of the median nerve at the pisiform level and the flattening of the median nerve at the hook of hamate level as well as the volar bowing of the flexor retinaculum at the pisiform and hook of hamate level were significantly greater in patients with CTS than in those with normal wrists (P < 0.05-0.001). In postoperative follow-up studies the distal flattening of the median nerve recovered in 94%. The signal intensity of the median nerve on T2-weighted images decreased in 67%. CONCLUSIONS: Flexion at the pisiform and hamate level as well as extension at the pisiform level narrows the space available for the median nerve potential leading to compression of the median nerve. MR imaging is accurate and reliable for diagnosis and postoperative follow-up of CTS.

Adult↗
PubMed1989

Carpal tunnel: MR imaging. Part I. Normal anatomy.

To correlate the important structures of the carpal tunnel demonstrated on magnetic resonance (MR) images with gross anatomy, the authors imaged the wrists of 20 normal volunteers and nine cadavers. The cadaver specimens were sectioned in the same planes in which they were imaged, and three other specimens were dissected. The anatomy was directly correlated with the imaged morphology. Axial images delineated well the bone and ligament walls of the carpal tunnel. The median nerve was well delimited and of moderate signal intensity. It was surrounded in some cases by fat but was consistently bound by specific tendons. The ulnar nerve and artery were visualized as they traversed the Guyon canal to their division into superficial and deep branches. Coronal images permitted optimal visualization of the triangular fibrocartilage and the radial and ulnar collateral ligaments. Quantitative studies indicated that the normal median nerve does not significantly increase in size within the carpal tunnel but does become more flattened at the level of the pisiform bone. The normal flexor retinaculum may have a slight palmar bowing.

Arteries↗
PubMed2004

Alternative approaches for regional ulnar nerve blockade: a cadaveric study.

Wrist blockade is a safe and effective alternative to general anesthesia in surgery of hand injuries. With regard to the ulnar nerve, the volar approach is used, where the needle passes through or medial to the flexor carpi ulnaris tendon; however, the ulnar artery is at risk because the needle may accidentally penetrate it, causing profuse bleeding. Alternatively, the wrist may be approached medially, the ulnar approach, and the needle tip placed posterior to the flexor carpi ulnaris tendon. To determine which of these methods may be preferable for avoiding ulnar artery injury, needles were inserted into the wrist area of cadaver hands (n = 57) using the volar and ulnar approaches; detailed dissection of the region around the inserted needles was subsequently carried out. The position of the ulnar nerve relative to the ulnar artery and injury to the artery was documented. Damage to the ulnar artery using the volar approach was 36.8% (21/57 cases) compared to no (0%) injury observed using the ulnar approach. At the level of the wrist crease just proximal to the pisiform bone, the ulnar nerve was medial to the artery in 92.9% (53/57) of cases, medial and posterior in 5.3% (3/57), and anterior to the artery in 1.8% (1/57) of cases. This study suggests that in cases where ulnar artery pulsation is not reliable, the ulnar approach may be preferable for ulnar nerve blockade due to an increased incidence of ulnar artery penetration with the volar approach.

Anesthesia, Conduction↗
PubMed1997

Rupture of flexor tendons due to pisotriquetral osteoarthritis.

We are reporting a case of a flexor profundus tendon rupture of the little finger due to pisotriquetral osteoarthrosis. Resection of the pisiform bone and resurfacing of the carpal tunnel with the joint capsule was performed for the osteoarthrosis and free tendon grafting for the tendon rupture. The tendon grafting and a subsequent tenolysis restored the function of the little finger. Other than radiological changes in the pisotriquetral joint, the diagnostic value of preoperative radiocarpal arthrography was emphasized in this rare complication of pisotriquetral arthrosis.

Aged↗
PubMed2005

Pressures generated during spinal manipulation and their association with hand anatomy.

BACKGROUND CONTEXT: The role of the variation in the application manipulation itself is largely unknown. A greater understanding of its input parameters is necessary to better understand spinal manipulation outcomes. PURPOSE: The objective of this study is to determine if pressures generated during manipulation are altered by hand configuration. DESIGN/SETTING: Paired comparison of 2 different variable groups. METHODS: Sixteen chiropractors provided 2 manipulations to a rigid surface using 2 hand configurations used commonly in clinical practice: arched and flat. Interposed between the hand and the rigid surface was a pressure sensor array and radiographic cassette. For each manipulation, pressures were recorded and a radiographic image was captured. Two radiologists then located the osseous features of the hand with respect to the sensor array. RESULTS: In 15 of 16 cases, arched configurations produced peak pressures that corresponded to the radiographic location of the pisiform bone. In flat configurations, peak pressure migrated about the location of the hamate bone. Radiologists' agreement for bone position was high (kappa = 0.96). Measures of peak pressure, total pressure, and pressure distribution were statistically different between hand configurations. CONCLUSIONS: The results of this study suggest that hand configuration influences the magnitude, location, and distribution of pressure generated by the hand during manipulation. This knowledge may have importance in understanding the relation among application parameters of manipulation, therapeutic benefit, and patient safety.

Adult↗
PubMed1983

Compression of the deep palmar branch of the ulnar nerve: clinical and electromyographic findings after a new method of decompression.

Five cases of compression of the deep palmar branch of the ulnar nerve were operated upon and the hiatus released by subperiosteal removal of the pisiform bone. The clinical and electromyographical results after a minimum follow-up of eight months showed an improvement in all cases. The authors stress the importance of accurate electromyographic examination for a correct preoperative diagnosis.

Adult↗
PubMed2003

A modification in technique of abductor digiti minimi (Huber) opponensplasty.

Abductor digiti minimi opponensplasty is a well-established method of restoring opposition following median nerve trauma or in congenital deficiency of thenar intrinsic musculature. The abductor digiti minimi is detached distally and rerouted through a subcutaneous tunnel for insertion into the area of the thumb metacarpophalangeal joint. The pivot point for this rotation is the pisiform bone and it is at this site that the ulnar nerve is vulnerable to compression by the transferred muscle. We describe a modification of technique which involves complete islanding of the muscle without re-insertion of its proximal end. This eliminates the possibility of this complication without detracting from the efficacy of opposition produced by the transferred muscle.

Adolescent↗
PubMed1980

Anomalous volar branch of the dorsal cutaneous ulnar nerve: a case report.

A 17-year-old boy, who had complained of pain for many years, had an anomalous branch from the dorsal ulnar cutaneous nerve which passed ulnar to the pisiform bone and was compressed by the flexor carpi ulnaris tendon. The symptoms were relieved completely by decompression of this nerve.

Adolescent↗
PubMed1983

Dorsal wrist synovectomy in rheumatoid arthritis--a long-term study.

Dorsal wrist synovectomy, tenosynovectomy of the extensor tendons, excision of the distal ulna, ulnar-side stabilization of the wrist, and placement of the extensor retinaculum underneath the extensor tendons is an effective procedure in wrists with rheumatoid arthritis. Twenty-seven patients who had surgery on 38 wrists were followed for 5 to 14 years, with an average of 7.4 years. There were 25 female and two male patients with an average age of 54 years. Over 95% had excellent pain relief. There was significant reduction of wrist motion, but the arc of motion was within a functional range. Subsequent tendon rupture was minimal and even tendons found to be thinned out at the time of surgery remained intact. There was no recurrence of synovitis. Carpal measurements were done by using the pisiform bone as a reference point. The carpal height was maintained in 70% of the wrists. Carpal translocation occurred in 44% of the wrists. Three patients required wrist arthrodesis, and five, arthroplasty. Carpal collapse and translocation could not be predicted by preoperative x-rays. Progressive carpal collapse was associated with increasing ulnar deviation of fingers. Progression of carpal collapse and ulnar translocation occurred in a linear fashion with the years of follow-up.

Arthritis, Rheumatoid↗
PubMed1984

Transfer of the abductor digiti minimi (quinti) in radial deformities of the hand in children.

The abductor digit minimi (quinti) transfer is an opposition plasty which is rarely used because of the large armamentarium of other possible transfers. However, it is a very good technic to use in radial side dysplasia in children, especially in the case of four-fingered hands in which it can improve the results of pollicisation. A series of 14 cases with 13 "good" or "very good" results is presented. An anatomical study has defined the distal insertion, distinct from that of the flexor digiti quinti brevis, the vascularisation (Mathes's type II) and the innervation of the muscle. The division of the muscle from the pisiform bone is not recommended because of the risk of pedicular injury.

Child↗
PubMedDate not supplied

[Transposition operation in paralysis of extensor muscles of the hand--intermediate-term results].

AIM: The surgical reconstruction of the dorsiflexion of the wrist and the abduction of the thumb in paralyzed radial nerve for the improvement of the useability of the hand is described. Likewise, the early functional subsequent treatment is described. Indications and contraindications are represented in detail. METHOD: Between October 1997 and May 2000 we treated 10 patients by the following method: The musculus flexor carpi ulnaris tendon is cut near the pisiform bone, transferred subcutaneously and fixed on the tendons of the extensor communis digitorum communis muscle. The tendon of the palmaris longus muscle is fixed on the tendon of the extensor pollicis longus muscle. After the swelling in the hand has subsided, the patients are supplied with a dynamic splint in order to avoid adhesions. RESULTS: According to the score suggested by Haas, 9 patients achieved a very good result (median: 30 degrees dorsiflexion), one patient had a good result (0 degree dorsiflexion). CONCLUSION: Adhesions could be avoided and the time of rehabilitation could be shortened by the operation method described. The operations result in an improvement of hand function and as well as patient satisfaction.

Adolescent↗
PubMed2001

Palmar tilt of the distal radius: influence of off-lateral projection initial observations.

PURPOSE: To evaluate the effect of slight off-lateral positioning of the wrist on measurements of the palmar tilt of the distal radius on lateral views and to determine how this effect can be corrected quantitatively. MATERIALS AND METHODS: Seven cadaveric forearms in neutral and various oblique positions (5 degrees, 10 degrees, 15 degrees, 20 degrees ) of supination and pronation were examined with lateral radiography. The palmar tilt of the distal radius measured on the radiographs was correlated with each position of the wrist and the distance between the position of the palmar cortex of the pisiform bone (P) and a reference point (point 0), which was defined as the midpoint within the interval between palmar cortices of the distal scaphoid pole and of the capitate head (P0 distance). The same measurements were performed on 11 wrists during arthrography. RESULTS: The apparent palmar tilt of the distal radius increased with supination of the forearm. Regression analysis with the P0 distance as independent and palmar tilt as dependent variables resulted in a slope of 0.95 in the seven cadaveric wrists and of 0.92 in the 11 wrist arthrograms. The squares of the correlation coefficients (R(2)) were 0.89 in cadaveric wrists and 0.69 in 11 wrist arthrograms. CONCLUSION: Differences in the palmar tilt produced by off-lateral projections of the wrist can be estimated from the measured difference of the P0 distance. A 1-mm difference in the P0 distance corresponds to a difference in the palmar tilt of approximately 1 degrees.

Adult↗
PubMed2002

Pisotriquetral joint: assessment with MR imaging and MR arthrography.

PURPOSE: To evaluate magnetic resonance (MR) imaging and MR arthrographic findings in the pisotriquetral joint (PTJ) and their contribution to assessment of PTJ osteoarthritis. MATERIALS AND METHODS: Images of 22 fresh human cadaveric PTJs were obtained with both conventional and arthrographic MR techniques. The MR appearances of all intraarticular and periarticular structures were analyzed and correlated with anatomic slices. Two readers graded visibility of anatomic structures and severity of joint abnormalities. Differences in the visibility ratings at standard MR imaging and at MR arthrography were calculated. Association between the type of pisiform insertion of ligament or muscle with cartilaginous abnormalities of the PTJ was assessed. The association between cartilaginous lesions and osteoarthritic changes was calculated. RESULTS: The tendon sheath, the fibrous capsule, and cartilaginous surfaces were better visualized at MR arthrography than at MR imaging. Pisohamate and pisometacarpal ligaments were slightly better seen on MR arthrograms. Tendons, muscles, and retinacular structures were well demonstrated at both conventional MR and MR arthrography. Cartilaginous lesions and osteophytes were easily identified and were detected more often in the pisiform bone than in the triquetral bone. Communication of the PTJ with the radiocarpal joint was noted in 18 (82%) of 22 wrists. CONCLUSION: MR imaging and/or MR arthrography allows visualization of all anatomic structures of the PTJ. MR arthrography improves visualization of findings of osteoarthritis.

Aged↗
PubMed1989

Carpal tunnel: MR imaging. Part II. Carpal tunnel syndrome.

The magnetic resonance (MR) images of 14 wrists of patients with carpal tunnel syndrome (CTS) were studied. Four general findings visible regardless of the cause of CTS included swelling of the median nerve, best evaluated at the level of the pisiform bone; flattening of the median nerve, most reliably judged at the hamate level; palmar bowing of the flexor retinaculum, best visualized at the level of the hamate bone; and increased signal intensity of the median nerve on T2-weighted images. Findings related to cause were tendon sheath edema in traumatic tenosynovitis, synovial hypertrophy in rheumatoid tenosynovitis, a ganglion cyst, and excessive amount of fat within the carpal tunnel, a persistent median artery, and a large adductor pollicis muscle. Knowledge of these findings may permit more rational choice of treatment. In four cases in which symptoms persisted after surgery, findings valuable in explaining or predicting the failure included incomplete incision of the flexor retinaculum, excessive fat within the carpal tunnel, persistent neuritis of the median nerve, and development of neuromas.

Adult↗
PubMed1990

Distal ulnar neuropathy as a cause of finger tremor: a case report.

A secretary/typist developed work-related pain along the hypothenar aspect of the dominant hand. This was later followed by involuntary, finally continuous tremorous movements of the 4th and 5th fingers. Electromyographic abnormalities were limited to myokymia of 3rd and 4th interossei muscles. Surgical decompression of Guyon's canal with removal of the pisiform bone resulted in a complete cure.

Fasciculation↗
PubMed1996

Functional cooperation between the non-paralogous genes Hoxa-10 and Hoxd-11 in the developing forelimb and axial skeleton.

The Abdominal B-related Hoxa-10 gene displays similar expression patterns in the differentiating forelimbs and hindlimbs of the mouse, with preferential expression around the humeral and femoral cartilages and more diffuse expression in distal regions. We found that a targeted disruption of Hoxa-10 has almost no effect in the forelimbs, while it affects the proximal hindlimb skeleton. The alterations were located along the dorsolateral side of the femur (labium laterale), with an enlargement and distal shift of the third trochanter, a misshapen lateral knee sesamoid, a supernumerary 'ligament' connecting these structures and an occasional duplication of the femoral trochlea. Some Hoxa-10-/- mutant mice developed severe degenerative alterations of the knee articulation upon ageing. Viable Hoxa-10/Hoxd-11 double mutant mice were produced by genetic intercrosses. The compound mutation resulted in synergistic forelimb phenotypic alterations, consisting of: (i) an exacerbation of Hoxd-11-/- phenotypic traits in the carpal and digital region, e.g. more pronounced truncations of the ulna styloid, pyramidal and pisiform bones and of some metacarpal and phalangeal bones and (ii) marked alterations in a more proximal region which is nearly unaffected in Hoxd-11-/- single mutants; the entire radius and ulna were truncated and thickened, with deformations of the ulna proximal extremity. Thus, functional redundancy can occur even between non-paralogous Abdominal B-related Hox genes. The double Hoxa-10/Hoxd-11 mutation also conferred full penetrance to the sacral and caudal vertebrae transformations which are approximately 50% penetrant in Hoxd-11-/- single mutants, revealing that functional cooperation can also occur between non-paralogous Hox gene products in axial skeleton patterning.

Abnormalities, Multiple↗
PubMed1989

Occult fractures of the carpals and metacarpals: demonstration by CT.

Occult fractures of the carpals and metacarpals occur frequently and are associated with major disability. The cross-sectional display and superior resolution of CT are well suited to the demonstration of these fractures. Sixteen patients with pain and negative conventional radiographs were chosen for further evaluation by CT. Imaging was performed in two planes and showed 21 fractures. The transaxial plane was the most revealing imaging plane. Coronal imaging was equal or superior to the transaxial plane in most fractures of the scaphoid, lunate, capitate, and pisiform bones and of the bases of the metacarpal bones. The direct sagittal plane was the best imaging plane in one patient with fractures of the scaphoid and lunate bones. After discovery of the fracture on CT, surgical removal of the avulsed fracture fragment was recommended in seven patients and fusion was recommended in three. Eight patients had a marked decrease in pain after the surgical procedure. The accuracy of CT for the demonstration of occult fractures may result in earlier recognition of these fractures and a reduction in the associated disability.

Carpal Bones↗