Chronic conditions of the wrist may be difficult to manage because
pain and psychiatric conditions are correlated with abnormal function
of the hand. Additionally, intra-articular inflammatory cytokines
may cause pain. We aimed to validate the measurement of inflammatory cytokines
in these conditions and identify features associated with symptoms. The study included 38 patients (18 men, 20 women, mean age 43
years) with a chronic condition of the wrist who underwent arthroscopy.
Before surgery, the Self-Rating Depression Scale (SDS), Hand20 questionnaire
and a visual analogue scale (VAS) for pain were used. Cytokine and
chemokine levels in the synovial fluid of the wrist were measured
using enzyme-linked immunosorbent assays and correlations between
the levels with pain were analysed. Gene expression profiles of
the synovial membranes were assessed using quantitative polymerase
chain reaction.Aims
Patients and Methods
Wrist block has been used to provide pain relief
for many procedures on the hand and wrist but its role in arthroscopy
of the wrist remains unexplored. Chondrotoxicity has been a concern
with the intra-articular infiltration of local anaesthetic. We aimed
to evaluate and compare the analgesic effect of portal and wrist
joint infiltration with a wrist block on the pain experienced by
patients after arthroscopy of the wrist. A prospective, randomised, double-blind trial was designed and
patients undergoing arthroscopy of the wrist under general anaesthesia
as a day case were recruited for the study. Levo-bupivacaine was
used for both techniques. The effects were evaluated using a ten-point
visual analogue scale, and the use of analgesic agents was also
compared. The primary outcomes for statistical analyses were the
mean pain scores and the use of analgesia post-operatively. A total of 34 patients (63% females) were recruited to the portal
and joint infiltration group and 32 patients (59% males) to the
wrist block group. Mean age was 40.8 years in the first group and
39.7 years in the second group (p >
0.05). Both techniques provided
effective pain relief in the first hour and 24 hours post-operatively
but wrist block gave better pain scores at bedtime on the day of
surgery (p = 0.007) and at 24 hours post-operatively (p = 0.006). Wrist block provides better and more reliable analgesia in patients
undergoing arthroscopy of the wrist without exposing patients to
the risk of chondrotoxicity. Cite this article:
Damage to the cartilage of the distal radioulnar
joint frequently leads to pain and limitation of movement, therefore repair
of this joint cartilage would be highly desirable. The purpose of
this study was to investigate the fixation of scaffold in cartilage
defects of this joint as part of matrix-assisted regenerative autologous
cartilage techniques. Two techniques of fixation of collagen scaffolds,
one involving fibrin glue alone and one with fibrin glue and sutures, were
compared in artificially created cartilage defects of the distal
radioulnar joint in a human cadaver. After being subjected to continuous
passive rotation, the methods of fixation were evaluated for cover
of the defect and pull out force. No statistically significant differences were found between the
two techniques for either cover of the defect or integrity of the
scaffold. However, a significantly increased mean pull out force
was found for the combined procedure, 0.665 N (0.150 to 1.160) This suggests that although successful fixation of a collagen
type I/III scaffold in a distal radioulnar joint cartilage defect
is feasible with both forms of fixation, fixation with glue and
sutures is preferable. Cite this article:
