During a 12-year period, the authors treated 25 patients with 26 complications of previous carpal tunnel surgery. Twenty-four of these patients were referred following initial surgery elsewhere. The most frequent complication identified was neuroma of the palmar cutaneous branch of the median nerve in 14 of the cases. Other complications were hypertrophic scars, dysesthesias after multiple procedures to release the carpal tunnel, joint stiffness, failure to relieve symptoms, and neuromas of the dorsal sensory branch of the radial nerve. All of these complications are potentially preventable. With a properly placed incision, exposure carried out under magnification, and surgery under direct vision the majority of these complications may be prevented. It is further noted that the technique of transverse incision at the wrist for release of the carpal tunnel is potentially dangerous and should be abandoned.

Both lower extremities of 10 cadavers (20 specimens) were dissected to delineate the course of the saphenous nerve and its two major divisions (sartorial and infrapatellar branches). The course of the saphenous nerve followed the standard text description, except at the point in the sartorius muscle where the infrapatellar branch exited to become a subcutaneous structure. The location of this branch varied slightly in each cadaver but was the same for both lower extremities in the same cadaver. The location of the sartorial nerve and its relationship to the tendons of the pes anserinus was consistant in all 20 specimens. Since 69% of a group of 75 patients found altered sensation significant after routine sectioning of the infrapatellar nerve following medial meniscectomy, a group of surgeons at the University of Michigan is now protecting the infrapatellar branch of the saphenous nerve at operation. Early results on a small number of patients indicate that no alteration in sensation occurs if the nerve is carefully retracted.

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The evaluation and treatment of injuries of the ulnar collateral ligament of the metacarpopha. langeal joint of the thumb remain controversial. In a retrospective study that was done to assess our ability to determine whether displacement of the ligament (a Stener lesion) was present, we reviewed our accumulated[ experience with patients who had an injury of this lig.. ament who were treated surgically between 1972 and 1984. Since our method of evaluation changed in 1977, we compared the preoperative and operative diagnoses in the twenty patients who were treated surgically from 1972 through 1976 with those in the twenty patients who were so treated from 1977 through 1984. Considering all forty patients who were treated operatively, sixteen (40 per cent) had a typical Stener lesion, and in two others (5 per cent) the ulnar collateral ligament was rolled up ~on itself and lying beneath the adductor aponeurosis. From 1972 through 1976, stability was tested with the metacarpophalangeal joint in complete extension or in varying amounts of flexion. Of the twenty thumbs that were evaluated by this technique and.were treated surgically, 20 per cent had a Stener lesion. From 1977 through 1984, stability was tested with the joint in full flexion because of the findings in anatomical stfidies that were completed in 1977; the incidence of a Stener lesion in the twenty thumbs that were treated by repair or reattachment of the ligament during this time was 70 per cent. We believe that when no fracture is present, a proper physical examination of an injured thumb is sufficient to determine the degree of instability of the ulnar collateral ligament, and that a five-stage grading system of injuries that appear to involve the ulnar side of the metacarpophalangeal joint of the thumb is helpful in separating them into operative and non-operative groups. * No benefits in any form have been received or Will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

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