Brent Bamberger - Academia.edu (original) (raw)

Papers by Brent Bamberger

The Journal of Hand Surgery (Asian-Pacific Volume), 2019

Background: To compare outcomes of atraumatic hand surgeries using the WALANT technique versus in... more Background: To compare outcomes of atraumatic hand surgeries using the WALANT technique versus intravenous regional anesthesia or local anesthesia with tourniquet. Methods: We conducted a comprehensive literature search using PubMed, MEDLINE, Embase, and Cochrane Library from inception to October 2018. All randomized or quasi-randomized trials and cohort studies comparing WALANT procedure versus local anesthesia or intravenous regional anesthesia with tourniquet among atraumatic hand surgeries were included. Methodological quality and risk of bias of eligible studies were assessed by three independent reviewers. The random effects model was used due to both statistical and clinical heterogeneity among studies. Results: The search yielded 496 records, of which 9 studies were included in the systematic review. We were able to pool findings for operative time, post-operative pain scores, patient satisfaction, and complication rates. On the average, the WALANT group had longer operative...

Sports Medicine and Arthroscopy Review, Dec 27, 2022

Journal of Long-term Effects of Medical Implants, 2018

A 65-year-old male presented with an acute nondisplaced hook of hamate fracture while lifting a s... more A 65-year-old male presented with an acute nondisplaced hook of hamate fracture while lifting a suitcase. Conservative management was employed, and he was treated with a thumb spica cast. At the most recent follow-up, he demonstrated resolution of pain and restoration of motion. CT imaging confirmed osseous union. High nonunion rates following conservative management with short arm casting without thumb immobilization for hook of hamate fractures may be in part due to inadequate immobilization. Here, use of a thumb spica cast resulted in successful osseous union following an acute hook of hamate fracture.

PubMed, 2019

Introduction: The palmaris longus (PL) is very prone to anatomical variance. It may exhibit agene... more Introduction: The palmaris longus (PL) is very prone to anatomical variance. It may exhibit agenesis, reversal, and duplication. The reversal variant presents with the PLtendinous aspect proximally and the muscle belly distally. It is an important finding, and it is important to consider when making a differential diagnosis. This is the only reported case of a left distal forearm PLmuscle variant with ultrasound and magnetic resonance imaging (MRI) in a Caucasian adult male. Case report: A 28-year-old Caucasian male presented to the clinic with an abnormal ultrasound finding of a left wrist mass. The patient was instructed to get an MRI, which demonstrated and further confirmed the reversed Plmuscle. Conclusion: Although rare, anatomic muscle variance may occur in many places of the body leading to symptoms that need attention. These variants should be considered in orthopedic differential diagnosis and ruled out appropriately with proper diagnostic techniques. By making the correct diagnosis, it leads to improved patient outcomes and satisfaction both conservatively and surgically.

Sports Medicine and Arthroscopy Review, Dec 27, 2022

Abstract Upper extremity fractures of the hand, wrist, and elbow have been successfully treated w... more Abstract Upper extremity fractures of the hand, wrist, and elbow have been successfully treated with traditional plates and screws. Two key principles for surgery include restoration of native anatomy and providing adequate mechanical support to promote bone healing. 3D-printed orthopedic hardware offer a novel way to restore patient-specific anatomy and strong biomechanical bony stability. 3D-printed models can aid in preoperative planning for fracture fixation. Failure of anatomic fracture reduction and bony stabilization can result in deformity with malunion. Severe malunions are treated surgically with osteotomies to restores alignment. 3D-printed osteotomy guides offer a way to provide precise malunion correction in all three anatomic planes. Finally, 3D printing technology has been used to create specific surgical tools and hand prothesis.

PubMed, Aug 1, 2008

Humeral shaft fracture with radial nerve palsy has been a subject of debate since this entity was... more Humeral shaft fracture with radial nerve palsy has been a subject of debate since this entity was originally described by Holstein and Lewis in 1963. As the literature provides support for almost any approach in treating patients with this injury, surgeons have no definitive literary guidance. To clarify how physicians are actually treating these patients, we surveyed practice tendencies in observation versus exploration of the radial nerve. In addition, we have integrated our survey results with the current literature to propose an algorithm directing treatment of these patients.

The Journal of Hand Surgery, Jul 1, 2015

THE PATIENT A 46-year-old, healthy, right-handed, active, cross-fit athlete had 2 months of incre... more THE PATIENT A 46-year-old, healthy, right-handed, active, cross-fit athlete had 2 months of increasing right posterior elbow pain with triceps exercises before presentation. On examination, he has pain with resisted elbow extension and tenderness at the triceps insertion with no defect. Radiographs of the elbow show a small olecranon spur but no osteoarthrosis. Magnetic resonance imaging (MRI) shows increased signal in the lateral and long heads of the triceps insertion.

Hand, Sep 1, 2009

Double dislocations of the finger interphalangeal and/or metacarpophalangeal joints are a rare en... more Double dislocations of the finger interphalangeal and/or metacarpophalangeal joints are a rare entity. Sixtyfour cases of distal and proximal interphalangeal joint double dislocations have been previously reported. Five cases of metacarpophalangeal and interphalangeal double dislocations of the thumb have also been reported. Only one case has been reported in the English literature regarding simultaneous dislocations of the distal interphalangeal and metacarpophalangeal joints in the nonthumb digit. The directions of the dislocation were the same; both were dorsal. We report, to our knowledge, the first ever case of a double dislocation a non-thumb digit in opposing directions-volar at the metacarpophalangeal joint and dorsal at the distal interphalangeal joint.

The Journal of Hand Surgery, Oct 1, 2020

Office-based surgery (OBS) with wide-awake local anesthesia no tourniquet (WALANT) surgery is a s... more Office-based surgery (OBS) with wide-awake local anesthesia no tourniquet (WALANT) surgery is a safe and cost-effective care model that is convenient for patient and provider alike. Currently, the practice is growing, but in the majority of North America the ambulatory-care center is still the most common setting for hand surgery. This article discusses the practical issues of implementing OBS with WALANT including clinical setup and workflows for OBS, negotiating payor contracts, and managing liability.

Journal of Bone and Joint Surgery, American Volume, 1996

We identified a shear fracture of the distal articular surface of the humerus, with anterior and ... more We identified a shear fracture of the distal articular surface of the humerus, with anterior and proximal displacement of the capitellum and a portion of the trochlea, in six patients (five female and one male). The average age of the patients was thirty-eight years (range, ten to sixty-three years). Each fracture was the result of a fall from a standing height. A characteristic radiographic abnormality, which we have termed the double-arc sign, was seen on the lateral radiograph of each patient and represented the subchondral bone of the displaced capitellum and the lateral trochlear ridge. All patients were managed with open reduction, internal fixation, and early motion of the elbow. The average duration of follow-up was twenty-two months (range, eighteen to twenty-six months). The fracture united in all patients at an average of six weeks (range, four to nine weeks), without radiographic evidence of osteonecrosis of the fracture fragment. Flexion of the elbow averaged 141 degrees (range, 130 to 150 degrees), with an average flexion contracture of 15 degrees (range, 0 to 40 degrees). Pronation of the forearm averaged 83 degrees, and supination averaged 84 degrees. All patients had a good or excellent functional result, according to the elbow-rating scale of Broberg and Morrey.

Current Opinion in Orthopaedics, Aug 1, 2005

The journal of hand surgery, Dec 1, 1998

The purpose of this study was to measure the amount of active flexion from a neutral position in ... more The purpose of this study was to measure the amount of active flexion from a neutral position in normal thumb metacarpophalangeal and interphalangeal joints and compare the results with previously published reports. One hundred and nineteen subjects (238 thumbs) volunteered to have active flexion of the metacarpophalangeal (MP) and interphalangeal (IP) joints of the thumb measured with a computerized Greenleaf goniometer by a certified hand therapist. The mean MP flexion was 59° and IP flexion was 67°. The results of this study suggest that the accepted normal values of thumb flexion should be reconsidered, particularly as a guide for determining impairment.

Hand Clinics, Feb 1, 2002

The external fixator has evolved from a simple device to a concept used to treat a spectrum of pr... more The external fixator has evolved from a simple device to a concept used to treat a spectrum of problems. Malgaigne first described external fixation in 1843 for the stabilization of patellar fractures. From this early beginning, physicians such as Lambotte, Hoffman, and Ilizarov continued to develop fixators that resemble those that are in use today. Early applications were mainly for lower extremity trauma. Even today, open tibial fractures are the primary indication for fixator use [2]. Upper extremity use became more prevalent in the 1970s, again mainly for trauma indications such as hand and distal radius fractures [21,32]. In 1975, Volkov and Oganesian [42] first described the distraction concept to restore function around the knee and elbow. Referring specifically to the elbow, others have expanded on this principle to include the many applications found today. This paper reviews the indications, alternatives, and potential complications for external fixation about the elbow.

PubMed, Sep 1, 2004

Approximately 8700 injuries from home exercise equipment occur annually in children in the United... more Approximately 8700 injuries from home exercise equipment occur annually in children in the United States. Home treadmills, which have been growing steadily in popularity during the past decade, pose a specific hazard to infants and children aged 5 years or younger, a population at increased risk of injury to the upper extremities (ie, arm, forearm, wrist, hand, and fingers). The authors also provide an illustrative report of case of a 2-year-old boy whose hand injury resulted from a home treadmill. Analysis and frequency reporting of United States Consumer Product Safety Commission data for home treadmill injuries in this demographic group are presented. From January 1, 1996, to September 30, 2000, the number of home treadmill injuries reported to the National Electronic Injury Surveillance System was 1009. Three hundred of these (29.7%) were in infants and children aged to 5 years. Abrasions or contusions (or both) of the upper extremities were the most common injury. Although the number of home treadmill injuries to children being reported is low, the potential for costly and serious complications has been demonstrated previously. The authors conclude that additional home treadmill safety measures and guidelines must be established.

Hand, Aug 23, 2017

Background: Cubital tunnel syndrome is the second most common compression neuropathy affecting th... more Background: Cubital tunnel syndrome is the second most common compression neuropathy affecting the upper extremity. The aim of this study was to determine the preferred surgical treatment for cubital tunnel syndrome by members of the American Society for Surgery of the Hand (ASSH). Methods: We invited members of the ASSH research mailing list to complete our online survey. They were presented with 6 hypothetical cases and asked to choose their preferred treatment from the following options: open in situ decompression, endoscopic decompression, submuscular transposition, subcutaneous transposition, medial epicondylectomy, and conservative management. This was assessed independently and anonymously through an online survey (SurveyMonkey). Results: 1069 responses were received. Seventy-three percent of the respondents preferred to continue conservative management when a patient presented with occasional paresthesias for greater than 6 months with a normal electromyogram (EMG) or nerve conduction velocity (NCV). Sixty-five percent picked open in situ decompression if paresthesias, weakness of intrinsics, and EMG/NCV reports of mild to moderate ulnar nerve entrapment was present. More than 50% of respondents picked open in situ decompression, as their preferred treatment when sensory loss of two-point discrimination of less than 5 or more than 10 was present in addition to the findings mentioned above. Seventy-nine percent of the respondents said their treatment algorithm would change if ulnar nerve subluxation was present. Conclusions: Our survey results indicate that open in situ decompression is the preferred operative procedure, if there is no ulnar nerve subluxation, among hand surgeons for cubital tunnel syndrome.

Hand, Sep 8, 2016

Background: Wrist hemiarthroplasty has emerged as a motion-sparing option for severe wrist arthri... more Background: Wrist hemiarthroplasty has emerged as a motion-sparing option for severe wrist arthritis. It is technically easy with advantages of limited bone resection and no risk of nonunion. Given the relative infancy of the procedure in clinical practice, there are limited data on patient outcomes. Methods: Eleven patients were treated with wrist reconstructive hemiarthroplasty. Indications included 1 patient with scaphoid nonunion advanced collapse, 9 patients with scapholunate advanced collapse, and 1 patient with capitolunate arthritis. Average age was 63 years; average follow-up was 4 years. Objective parameters included Disabilities of the Arm Shoulder and Hand (DASH), grip strength, and range of motion. Implant failure defined by necessity of revision procedure. Results: DASH scores initially improved postoperatively but were not statistically significant. Grip strength was 60% of contralateral side. Postoperative range of motion at 6 months was flexion 40.3°, extension 39.3°, supination 87.0°, pronation 77.8°, radial deviation 14.5°, and ulnar deviation 13.8°. A 45% failure rate was observed. Complications included failure with conversion to Total Wrist Arthroplasty (TWA; n = 2) or wrist fusion (n = 3) secondary to development of ulnar-sided wrist pain. One additional patient experienced severe wrist pain but declined additional surgery. Conclusions: Wrist hemiarthroplasty in our series had a significant failure rate. In each case of failure, the patient developed ulnar-sided wrist pain. In the presence of more reliable procedures, wrist hemiarthroplasty is not indicated in its current incarnation.

The Journal of Hand Surgery, 2014

Purpose To test the null hypothesis that there are no differences in the priorities and preferenc... more Purpose To test the null hypothesis that there are no differences in the priorities and preferences of patients with idiopathic trigger finger (TF) and hand surgeons. Methods One hundred five hand surgeons of the Science of Variation Group and 84 patients with TF completed a survey about their priorities and preferences in decision making regarding the management of TF. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Patients desired orthotics more and surgery less than physicians. Patients and physicians disagreed on the main advantage of several treatment options for TFs and on disadvantages of the treatment options. Patients preferred to decide for themselves after receiving advice, whereas physicians preferred a shared decision. Patients preferred booklets, and physicians opted for Internet and video decision aids. Conclusions Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic TFdifferences that might be addressed by a decision aid. Clinical relevance Information that helps inform patients of their options based on current best evidence might help them understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

Jbjs reviews, Feb 1, 2020

» Carpal tunnel syndrome is the most common compression neuropathy. » Despite the prevalence of c... more » Carpal tunnel syndrome is the most common compression neuropathy. » Despite the prevalence of carpal tunnel syndrome, many other conditions present with similar symptoms (numbness, tingling, thenar atrophy, and weakness).

The Journal of Hand Surgery (Asian-Pacific Volume), 2019

Background: To compare outcomes of atraumatic hand surgeries using the WALANT technique versus in... more Background: To compare outcomes of atraumatic hand surgeries using the WALANT technique versus intravenous regional anesthesia or local anesthesia with tourniquet. Methods: We conducted a comprehensive literature search using PubMed, MEDLINE, Embase, and Cochrane Library from inception to October 2018. All randomized or quasi-randomized trials and cohort studies comparing WALANT procedure versus local anesthesia or intravenous regional anesthesia with tourniquet among atraumatic hand surgeries were included. Methodological quality and risk of bias of eligible studies were assessed by three independent reviewers. The random effects model was used due to both statistical and clinical heterogeneity among studies. Results: The search yielded 496 records, of which 9 studies were included in the systematic review. We were able to pool findings for operative time, post-operative pain scores, patient satisfaction, and complication rates. On the average, the WALANT group had longer operative...

Sports Medicine and Arthroscopy Review, Dec 27, 2022

Journal of Long-term Effects of Medical Implants, 2018

A 65-year-old male presented with an acute nondisplaced hook of hamate fracture while lifting a s... more A 65-year-old male presented with an acute nondisplaced hook of hamate fracture while lifting a suitcase. Conservative management was employed, and he was treated with a thumb spica cast. At the most recent follow-up, he demonstrated resolution of pain and restoration of motion. CT imaging confirmed osseous union. High nonunion rates following conservative management with short arm casting without thumb immobilization for hook of hamate fractures may be in part due to inadequate immobilization. Here, use of a thumb spica cast resulted in successful osseous union following an acute hook of hamate fracture.

PubMed, 2019

Introduction: The palmaris longus (PL) is very prone to anatomical variance. It may exhibit agene... more Introduction: The palmaris longus (PL) is very prone to anatomical variance. It may exhibit agenesis, reversal, and duplication. The reversal variant presents with the PLtendinous aspect proximally and the muscle belly distally. It is an important finding, and it is important to consider when making a differential diagnosis. This is the only reported case of a left distal forearm PLmuscle variant with ultrasound and magnetic resonance imaging (MRI) in a Caucasian adult male. Case report: A 28-year-old Caucasian male presented to the clinic with an abnormal ultrasound finding of a left wrist mass. The patient was instructed to get an MRI, which demonstrated and further confirmed the reversed Plmuscle. Conclusion: Although rare, anatomic muscle variance may occur in many places of the body leading to symptoms that need attention. These variants should be considered in orthopedic differential diagnosis and ruled out appropriately with proper diagnostic techniques. By making the correct diagnosis, it leads to improved patient outcomes and satisfaction both conservatively and surgically.

Sports Medicine and Arthroscopy Review, Dec 27, 2022

Abstract Upper extremity fractures of the hand, wrist, and elbow have been successfully treated w... more Abstract Upper extremity fractures of the hand, wrist, and elbow have been successfully treated with traditional plates and screws. Two key principles for surgery include restoration of native anatomy and providing adequate mechanical support to promote bone healing. 3D-printed orthopedic hardware offer a novel way to restore patient-specific anatomy and strong biomechanical bony stability. 3D-printed models can aid in preoperative planning for fracture fixation. Failure of anatomic fracture reduction and bony stabilization can result in deformity with malunion. Severe malunions are treated surgically with osteotomies to restores alignment. 3D-printed osteotomy guides offer a way to provide precise malunion correction in all three anatomic planes. Finally, 3D printing technology has been used to create specific surgical tools and hand prothesis.

PubMed, Aug 1, 2008

Humeral shaft fracture with radial nerve palsy has been a subject of debate since this entity was... more Humeral shaft fracture with radial nerve palsy has been a subject of debate since this entity was originally described by Holstein and Lewis in 1963. As the literature provides support for almost any approach in treating patients with this injury, surgeons have no definitive literary guidance. To clarify how physicians are actually treating these patients, we surveyed practice tendencies in observation versus exploration of the radial nerve. In addition, we have integrated our survey results with the current literature to propose an algorithm directing treatment of these patients.

The Journal of Hand Surgery, Jul 1, 2015

THE PATIENT A 46-year-old, healthy, right-handed, active, cross-fit athlete had 2 months of incre... more THE PATIENT A 46-year-old, healthy, right-handed, active, cross-fit athlete had 2 months of increasing right posterior elbow pain with triceps exercises before presentation. On examination, he has pain with resisted elbow extension and tenderness at the triceps insertion with no defect. Radiographs of the elbow show a small olecranon spur but no osteoarthrosis. Magnetic resonance imaging (MRI) shows increased signal in the lateral and long heads of the triceps insertion.

Hand, Sep 1, 2009

Double dislocations of the finger interphalangeal and/or metacarpophalangeal joints are a rare en... more Double dislocations of the finger interphalangeal and/or metacarpophalangeal joints are a rare entity. Sixtyfour cases of distal and proximal interphalangeal joint double dislocations have been previously reported. Five cases of metacarpophalangeal and interphalangeal double dislocations of the thumb have also been reported. Only one case has been reported in the English literature regarding simultaneous dislocations of the distal interphalangeal and metacarpophalangeal joints in the nonthumb digit. The directions of the dislocation were the same; both were dorsal. We report, to our knowledge, the first ever case of a double dislocation a non-thumb digit in opposing directions-volar at the metacarpophalangeal joint and dorsal at the distal interphalangeal joint.

The Journal of Hand Surgery, Oct 1, 2020

Office-based surgery (OBS) with wide-awake local anesthesia no tourniquet (WALANT) surgery is a s... more Office-based surgery (OBS) with wide-awake local anesthesia no tourniquet (WALANT) surgery is a safe and cost-effective care model that is convenient for patient and provider alike. Currently, the practice is growing, but in the majority of North America the ambulatory-care center is still the most common setting for hand surgery. This article discusses the practical issues of implementing OBS with WALANT including clinical setup and workflows for OBS, negotiating payor contracts, and managing liability.

Journal of Bone and Joint Surgery, American Volume, 1996

We identified a shear fracture of the distal articular surface of the humerus, with anterior and ... more We identified a shear fracture of the distal articular surface of the humerus, with anterior and proximal displacement of the capitellum and a portion of the trochlea, in six patients (five female and one male). The average age of the patients was thirty-eight years (range, ten to sixty-three years). Each fracture was the result of a fall from a standing height. A characteristic radiographic abnormality, which we have termed the double-arc sign, was seen on the lateral radiograph of each patient and represented the subchondral bone of the displaced capitellum and the lateral trochlear ridge. All patients were managed with open reduction, internal fixation, and early motion of the elbow. The average duration of follow-up was twenty-two months (range, eighteen to twenty-six months). The fracture united in all patients at an average of six weeks (range, four to nine weeks), without radiographic evidence of osteonecrosis of the fracture fragment. Flexion of the elbow averaged 141 degrees (range, 130 to 150 degrees), with an average flexion contracture of 15 degrees (range, 0 to 40 degrees). Pronation of the forearm averaged 83 degrees, and supination averaged 84 degrees. All patients had a good or excellent functional result, according to the elbow-rating scale of Broberg and Morrey.

Current Opinion in Orthopaedics, Aug 1, 2005

The journal of hand surgery, Dec 1, 1998

The purpose of this study was to measure the amount of active flexion from a neutral position in ... more The purpose of this study was to measure the amount of active flexion from a neutral position in normal thumb metacarpophalangeal and interphalangeal joints and compare the results with previously published reports. One hundred and nineteen subjects (238 thumbs) volunteered to have active flexion of the metacarpophalangeal (MP) and interphalangeal (IP) joints of the thumb measured with a computerized Greenleaf goniometer by a certified hand therapist. The mean MP flexion was 59° and IP flexion was 67°. The results of this study suggest that the accepted normal values of thumb flexion should be reconsidered, particularly as a guide for determining impairment.

Hand Clinics, Feb 1, 2002

The external fixator has evolved from a simple device to a concept used to treat a spectrum of pr... more The external fixator has evolved from a simple device to a concept used to treat a spectrum of problems. Malgaigne first described external fixation in 1843 for the stabilization of patellar fractures. From this early beginning, physicians such as Lambotte, Hoffman, and Ilizarov continued to develop fixators that resemble those that are in use today. Early applications were mainly for lower extremity trauma. Even today, open tibial fractures are the primary indication for fixator use [2]. Upper extremity use became more prevalent in the 1970s, again mainly for trauma indications such as hand and distal radius fractures [21,32]. In 1975, Volkov and Oganesian [42] first described the distraction concept to restore function around the knee and elbow. Referring specifically to the elbow, others have expanded on this principle to include the many applications found today. This paper reviews the indications, alternatives, and potential complications for external fixation about the elbow.

PubMed, Sep 1, 2004

Approximately 8700 injuries from home exercise equipment occur annually in children in the United... more Approximately 8700 injuries from home exercise equipment occur annually in children in the United States. Home treadmills, which have been growing steadily in popularity during the past decade, pose a specific hazard to infants and children aged 5 years or younger, a population at increased risk of injury to the upper extremities (ie, arm, forearm, wrist, hand, and fingers). The authors also provide an illustrative report of case of a 2-year-old boy whose hand injury resulted from a home treadmill. Analysis and frequency reporting of United States Consumer Product Safety Commission data for home treadmill injuries in this demographic group are presented. From January 1, 1996, to September 30, 2000, the number of home treadmill injuries reported to the National Electronic Injury Surveillance System was 1009. Three hundred of these (29.7%) were in infants and children aged to 5 years. Abrasions or contusions (or both) of the upper extremities were the most common injury. Although the number of home treadmill injuries to children being reported is low, the potential for costly and serious complications has been demonstrated previously. The authors conclude that additional home treadmill safety measures and guidelines must be established.

Hand, Aug 23, 2017

Background: Cubital tunnel syndrome is the second most common compression neuropathy affecting th... more Background: Cubital tunnel syndrome is the second most common compression neuropathy affecting the upper extremity. The aim of this study was to determine the preferred surgical treatment for cubital tunnel syndrome by members of the American Society for Surgery of the Hand (ASSH). Methods: We invited members of the ASSH research mailing list to complete our online survey. They were presented with 6 hypothetical cases and asked to choose their preferred treatment from the following options: open in situ decompression, endoscopic decompression, submuscular transposition, subcutaneous transposition, medial epicondylectomy, and conservative management. This was assessed independently and anonymously through an online survey (SurveyMonkey). Results: 1069 responses were received. Seventy-three percent of the respondents preferred to continue conservative management when a patient presented with occasional paresthesias for greater than 6 months with a normal electromyogram (EMG) or nerve conduction velocity (NCV). Sixty-five percent picked open in situ decompression if paresthesias, weakness of intrinsics, and EMG/NCV reports of mild to moderate ulnar nerve entrapment was present. More than 50% of respondents picked open in situ decompression, as their preferred treatment when sensory loss of two-point discrimination of less than 5 or more than 10 was present in addition to the findings mentioned above. Seventy-nine percent of the respondents said their treatment algorithm would change if ulnar nerve subluxation was present. Conclusions: Our survey results indicate that open in situ decompression is the preferred operative procedure, if there is no ulnar nerve subluxation, among hand surgeons for cubital tunnel syndrome.

Hand, Sep 8, 2016

Background: Wrist hemiarthroplasty has emerged as a motion-sparing option for severe wrist arthri... more Background: Wrist hemiarthroplasty has emerged as a motion-sparing option for severe wrist arthritis. It is technically easy with advantages of limited bone resection and no risk of nonunion. Given the relative infancy of the procedure in clinical practice, there are limited data on patient outcomes. Methods: Eleven patients were treated with wrist reconstructive hemiarthroplasty. Indications included 1 patient with scaphoid nonunion advanced collapse, 9 patients with scapholunate advanced collapse, and 1 patient with capitolunate arthritis. Average age was 63 years; average follow-up was 4 years. Objective parameters included Disabilities of the Arm Shoulder and Hand (DASH), grip strength, and range of motion. Implant failure defined by necessity of revision procedure. Results: DASH scores initially improved postoperatively but were not statistically significant. Grip strength was 60% of contralateral side. Postoperative range of motion at 6 months was flexion 40.3°, extension 39.3°, supination 87.0°, pronation 77.8°, radial deviation 14.5°, and ulnar deviation 13.8°. A 45% failure rate was observed. Complications included failure with conversion to Total Wrist Arthroplasty (TWA; n = 2) or wrist fusion (n = 3) secondary to development of ulnar-sided wrist pain. One additional patient experienced severe wrist pain but declined additional surgery. Conclusions: Wrist hemiarthroplasty in our series had a significant failure rate. In each case of failure, the patient developed ulnar-sided wrist pain. In the presence of more reliable procedures, wrist hemiarthroplasty is not indicated in its current incarnation.

The Journal of Hand Surgery, 2014

Purpose To test the null hypothesis that there are no differences in the priorities and preferenc... more Purpose To test the null hypothesis that there are no differences in the priorities and preferences of patients with idiopathic trigger finger (TF) and hand surgeons. Methods One hundred five hand surgeons of the Science of Variation Group and 84 patients with TF completed a survey about their priorities and preferences in decision making regarding the management of TF. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Patients desired orthotics more and surgery less than physicians. Patients and physicians disagreed on the main advantage of several treatment options for TFs and on disadvantages of the treatment options. Patients preferred to decide for themselves after receiving advice, whereas physicians preferred a shared decision. Patients preferred booklets, and physicians opted for Internet and video decision aids. Conclusions Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic TFdifferences that might be addressed by a decision aid. Clinical relevance Information that helps inform patients of their options based on current best evidence might help them understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

Jbjs reviews, Feb 1, 2020

» Carpal tunnel syndrome is the most common compression neuropathy. » Despite the prevalence of c... more » Carpal tunnel syndrome is the most common compression neuropathy. » Despite the prevalence of carpal tunnel syndrome, many other conditions present with similar symptoms (numbness, tingling, thenar atrophy, and weakness).