Aims

In order to release the contracture band completely without damaging normal tissues (such as the sciatic nerve) in the surgical treatment of gluteal muscle contracture (GMC), we tried to display the relationship between normal tissue and contracture bands by magnetic resonance neurography (MRN) images, and to predesign a minimally invasive surgery based on the MRN images in advance.

The October 2023 Wrist & Hand Roundup³⁶⁰ looks at: Distal radius fracture management: surgeon factors markedly influence decision-making; Fracture-dislocation of the radiocarpal joint: bony and capsuloligamentar management, outcomes, and long-term complications; Exploring the role of artificial intelligence chatbot in the management of scaphoid fractures; Role of ultrasonography for evaluation of nerve recovery in repaired median nerve lacerations; Four weeks versus six weeks of immobilization in a cast following closed reduction for displaced distal radial fractures in adult patients: a multicentre randomized controlled trial; Rehabilitation following flexor tendon injury in Zone 2: a randomized controlled study; On the road again: return to driving following minor hand surgery; Open versus single- or dual-portal endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials.

Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis.

After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy.

Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve.

Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment.

Cite this article: Bone Joint J 2020;102-B(5):556–567.

Aims

The aim of this study was to assess the quality and scope of the current cost-effectiveness analysis (CEA) literature in the field of hand and upper limb orthopaedic surgery.

The April 2015 Wrist & Hand Roundup360 looks at: Non-operative hand fracture management; From the sublime to the ridiculous?; A novel approach to carpal tunnel decompression; Osteoporosis and functional scores in the distal radius; Ulnar variance and force distribution; Tourniquets in carpal tunnel under the spotlight; Scaphoid fractures reclassified; Osteoporosis and distal radial fracture fixation; PROMISing results in the upper limb

We report a new surgical technique of open carpal tunnel release with subneural reconstruction of the transverse carpal ligament and compare this with isolated open and endoscopic carpal tunnel release. Between December 2007 and October 2011, 213 patients with carpal tunnel syndrome (70 male, 143 female; mean age 45.6 years; 29 to 67) were recruited from three different centres and were randomly allocated to three groups: group A, open carpal tunnel release with subneural reconstruction of the transverse carpal ligament (n = 68); group B, isolated open carpal tunnel release (n = 92); and group C, endoscopic carpal tunnel release (n = 53). At a mean final follow-up of 24 months (22 to 26), we found no significant difference between the groups in terms of severity of symptoms or lateral grip strength. Compared with groups B and C, group A had significantly better functional status, cylindrical grip strength and pinch grip strength. There were significant differences in Michigan Hand Outcome scores between groups A and B, A and C, and B and C. Group A had the best functional status, cylindrical grip strength, pinch grip strength and Michigan Hand Outcome score. Subneural reconstruction of the transverse carpal ligament during carpal tunnel decompression maximises hand strength by stabilising the transverse carpal arch. Cite this article: Bone Joint J 2015;97-B:221–8

The October 2014 Wrist & Hand Roundup360 looks at: pulsed electromagnetic field of no use in acute scaphoid fractures; proximal interphalangeal joint replacement: one at a time or both at once; trapeziometacarpal arthrodesis in the young patient; Tamoxifen and Dupytren’s disease; and endoscopic or open for de Quervain’s syndrome?

The purpose of this study was to compare the outcome and complications of endoscopic versus open release for the treatment of de Quervain’s tenosynovitis. Patients with this condition were randomised to undergo either endoscopic (n = 27) or open release (n = 25). Visual Analogue Scale (VAS) pain and Disabilities of Arm, Shoulder, and Hand (DASH) scores were measured at 12 and 24 weeks after surgery. Scar satisfaction was measured using a VAS scale. The mean pain and DASH scores improved significantly at 12 weeks and 24 weeks (p <  0.001) in both groups. The scores were marginally lower in the endoscopic group compared to the open group at 12 weeks (p = 0.012 and p = 0.002, respectively); however, only the DASH score showed a clinically important difference. There were no differences between the groups at 24 weeks. The mean VAS scar satisfaction score was higher in the endoscopic group at 24 weeks (p < 0.001). Transient superficial radial nerve injury occurred in three patients in the endoscopic group compared with nine in the open release group (p = 0.033). We conclude that endoscopic release for de Quervain’s tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release. Cite this article: Bone Joint J 2013;95-B:947–51

The June 2013 Research Roundup³⁶⁰ looks at: a contact patch to rim distance and metal ions; the matrix of hypoxic cartilage; CT assessment of early fracture healing; Hawthornes and radiographs; cardiovascular mortality and fragility fractures; and muscle strength decline preceding OA changes.

The aim of this review is to evaluate the current available literature evidencing on peri-articular hip endoscopy (the third compartment). A comprehensive approach has been set on reports dealing with endoscopic surgery for recalcitrant trochanteric bursitis, snapping hip (or coxa-saltans; external and internal), gluteus medius and minimus tears and endoscopy (or arthroscopy) after total hip arthroplasty. This information can be used to trigger further research, innovation and education in extra-articular hip endoscopy.

The median nerve compression in the carpal tunnel is the most common compression syndrome of the upper limb. In most cases it is idiopathic but may also occur from anatomical, traumatic, endocrine, rheumatic or tumoral causes. Chow's endoscopic technique was initially used to treat this disease and then modified to a mini-open approach through a single palmar incision. This incision is similar to the one used in endoscopic release by Agee. After exposing the proximal part of the transverse carpal ligament a meniscus knife is advanced until there is a complete section of the ligament, without endoscopic equipment. Between 2004 and 2006, 200 hands in 179 patients with a diagnosis based on clinical and electromyographic criteria were operated by this mini-open technique. The mean follow-up was 49 months (minimum of 34 months and a maximum of 70 months). 50 randomly selected patients were submitted to the self-administered Boston questionnaire. 50 patients treated by the minimal-incision decompression during the same period were also given the questionnaire. The aesthetic satisfaction was registered as well as if they would have surgery on the other hand or would recommend the procedure. This mini-open technique is another technique available to the surgeon that allows very similar functional results to endoscopic surgery, without use of specific material and with a shorter surgical time

Over recent years hip arthroscopic surgery has evolved into one of the most rapidly expanding fields in orthopaedic surgery. Complications are largely transient and incidences between 0.5% and 6.4% have been reported. However, major complications can and do occur. This article analyses the reported complications and makes recommendations based on the literature review and personal experience on how to minimise them.

Introduction. Although the majority of patients with plantar fasciitis respond to non- surgical management, between 5 and 10% of patients require surgical intervention. The aim of this study is to compare the results of open plantar fascia release with the results following a less invasive endoscopic release. Methods. A consecutive series of patients who underwent open plantar fascia release (group one) was compared to a similar group who underwent endoscopic plantar fascia release (group two). Each patient was assessed retrospectively using the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score. In addition, the patient's overall satisfaction with the procedure, time taken to return to full activity, and the complication rate was determined. Finally, pre- and post-operative radiographs were assessed for arch collapse in group two. Results. The demographics of the two groups were comparable. Group one contained 36 patients (38 ft) and group two contained 66 patients (70 ft). The mean follow up for both groups was 22 months. The mean AOFAS score for each group was comparable pre-operatively, however the post-operative score was significantly better for group two. The time taken to return to full activities was significantly quicker in the endoscopic group, and post-operative pain levels and satisfaction rates were also significantly better. Radiographs demonstrated no arch collapse in group two following the procedure. Conclusions. When surgery for plantar fasciitis is indicated, the results of this study have demonstrated an endoscopic approach offers a safe alternative to an open procedure. Furthermore, endoscopic release is associated with an accelerate activities and a higher patient satisfaction rate

Purpose of the study: The cervicobrachial outlet syndrome is an anatomic and clinical entity related to intermittent or permanent compression of the brachial plexus trunks, and/or the subclavian artery and vein as they pass through six successive spaces in the thoracic cervicobrachial outlet, including the intercostoscalenic space. The purpose of this work was to evaluate the feasibility of endoscopic exploration of the infra-clavicular portion of the outlet and the options for therapeutic interscalenic release. Material and methods: Cadaver study of 12 shoulders: 3 male, 3 female. dissection of the supra and infra-clavicular region (n=3) to identify zones of potential impingement and determine the structures constituting the outlet;. dissections (n=2) centred on the different zones considered as potential endoscopic portals;. endoscopies (n=2) via a supra-lateral clavicular approach followed by dissection;. endoscopies (n=2) via a supra-lateral clavicular approach followed by dissection with insertion of landmarks then a new endoscopy;. Endoscopies (n=3) via a supra-lateral clavicular approach to achieve intercalenic release followed by control dissection. Results: The medial and lateral clavicular approaches identified two zones of less risk considering the proximity of the neck vessels and the phrenic and suprascapular nerves. A first, it was difficult to localize the brachial plexus endoscopically. This was achieved after dissection and insertion of landmarks. Five endoscopic procedures had to be performed to localize the plexus and starte the interscalenic release. Minute identification of the entry points for the trocars, as a perfect orientation of the instruments was necessary to achieve the procedure. The control dissections did not identify any vessel or nerve injury. Discussion: Few data in the literature examine the question of endoscopic interscalenic release. Unlike Krishnan and Pinzer, we found that endoscopic exploration of the outlet at possible, but difficult, procedure. Use of an arthropump remains to be evaluated because of the distension and impregnation of the tissues. Insufflations with CO2 might be an alternative. Conclusion: To our knowledge, a supra-clavicular approach for endoscopic exploration of the brachial plexus has not been described. Exploration of the outlet via this approach might be a less invasive procedure than conventional surgery. Complementary research is necessary to evaluate the morbidity of the different techniques

Open anterior surgery, including release and instrumentation, is a widely used technique for correction of dorsal and dorsolumbar curves. In the past we have used various different devices to maintain correction. These include Dwyer cable, Zeilke rods, Webb-Morley rods, vertebral staples and the Kaneda system. Any of these can be combined with posterior correction, stabilization and grafting. Several of these techniques have been successfully adapted for the treatment of our cases in Egypt. We encounter severe deformities due to their late presentation. Over the last five years we have used anterior endoscopic release. All had posterior instrumentation. Results: We did anterior release in 20 scoliosis cases and corpectomy in 10 cases. These were compared with another twenty cases who were treated by open anterior and posterior surgery. The results are very encouraging regarding degree of correction; hospital stay; and costs as compared with our historical series of conventional two-stage surgery. There are a number of constraints on using endoscopic techniques. Surgeons require long training and close co-operation. It is contraindicated in those cases with adhesions and patients unfit for one lung anaesthesia. We found the technique is safe and effective. We recommend it for treatment of rigid curves to gain good results and to reduce hospital costs

Introduction and Aims: To describe the arthroscopically assisted technique of medial patello-femoral ligament reconstruction using a hamstring tendon and evaluate the results of the procedure. Since April 2001 the senior author has performed 20 cases. One was bilateral. Average age was 30 years (range 17–52). Method: The study group comprised nine males and 11 females. The indication for surgery was recurrent lateral dislocation in 13 and lateral mal-alignment in the remaining seven. Thirteen of the 20 had undergone prior surgery, eight an isolated lateral release and five a lateral release combined with open extra-synovial medial retinacular plication. Key features of this technique are use of the 70-degree arthroscope in the supero-lateral portal, endoscopic lateral release and use of semitendinosis or gracilis tendon attached distally. The tendon is passed through drill holes in the medial aspect of the patella and attached to a clinically isometric point near the medial femoral condyle. The tension is assessed arthroscopically and clinically before attachment. The semitendinosis tendon was used in 11 cases and gracilis in 10. Results: All had subjective improvement with regard to patellar instability, activity level and relief of pain. There were no recurrent dislocations. The only patient in whom the tendon was attached to the distal adductor magnus required revision surgery with improvement after attachment of another tendon to bone at the isometric point. Mean follow-up was 17 months (range 4–33 months). The mean time to return to work was five weeks (range five days–12 weeks) and return to sport 10 weeks (range 3–16 weeks). The Fulkerson patello-femoral joint evaluation score improved from 46/100 pre-operatively to 74/100. Only four described the state of the knee subjectively as fair and the rest good or excellent. All patients regained full range of motion. Conclusion: This arthroscopically assisted technique of medial patello-femoral ligament reconstruction using a hamstring tendon allows the patella to be seen and felt to articulate in the trochlea groove. It allows early rehabilitation, minimal post-operative pain, provides patella stability and significant functional improvement with rapid recovery and a low incidence of skin numbness

Introduction A randomised, double blind controlled study of the short term results of single portal endoscopic carpal tunnel release (ECTR) versus open carpal tunnel release (OCTR) is presented. Methods Twenty patients undergoing bilateral carpal tunnel release were inducted into the study. Each patient had one side performed as an ECTR and the other as an OCTR. The side that ECTR was performed on was randomised. Assessment was performed at one, two and six weeks post-operatively by the patient and a blinded hand therapist. The patient was blinded at the one week review. Assessment looked at pain, function and satisfaction, as well as objective strength and motion. Results All patients prefered the side of the endoscopic release at one, two and six weeks. ECTR was associated with less pain, greater ease of use, improved strength and better motion. Conclusions There is a significantly improved short term outcome, on both subjective and objective measures, with endoscopic carpal tunnel release compared to open carpal tunnel release

Introduction Ulnar nerve entrapment is the second commonest upper limb nerve entrapment syndrome. The purpose of this study was to determine the safety and efficacy of the Agee endoscopic system in ulnar nerve decompression at the elbow. This is the first report of its use in the elbow. Methods Six preserved cadaveric elbow specimens were used. One surgeon performed the endoscopic releases via a three centimetre longitudinal incision between the medial epicondyle and olecranon. All six specimens were examined independently with loupe magnification. This was done by extending the original incision to 20 cm. The ulnar nerve was assessed with regard to adequate decompression. The branching of the ulnar nerve at the elbow, as well as the presevation of these branches after the endoscopic procedure, was also studied. Results In all six specimens, the arcade of Struthers, the cubital tunnel retinaculum, and the flexor carpiulnaris aponeurosis were completely divided. There were an average of three motor branches to flexor carpiulnaris at a mean position of 21 mm distal to the medial epicondyle. Most of these were on the radial side of the nerve. The ulnar nerve was also found to give one to two sensory branches, at a mean position of nine millimetres proximal to the medial epicondyle. All the motor and sensory branches were found to be intact after the endoscopic procedure. Conclusions This study shows that the Agee endoscopic system is both safe and effective. It is a relatively simple procedure but cadaveric practice is recommended to obtain familiarity with the technique and the endoscopic view of the anatomy