We have undertaken a large case-control study using the UK General Practice Research Database to quantify the relative contributions of the common risk factors for carpal tunnel syndrome (CTS) in the community. Cases were patients with a diagnosis of CTS and, for each, four controls were individually matched by age, sex and general practice. Our dataset included 3,391 cases, of which 2,444 (72%) were women, with a mean age at diagnosis of 46 (range 16-96) years. Multivariate analysis showed that the risk factors associated with CTS were previous wrist fracture (OR=2.29), rheumatoid arthritis (OR=2.23), osteoarthritis of the wrist and carpus (OR=1.89), obesity (OR=2.06), diabetes (OR=1.51), and the use of insulin (OR=1.52), sulphonylureas (OR=1.45), metformin (OR=1.20) and thyroxine (OR=1.36). Smoking, hormone replacement therapy, the combined oral contraceptive pill and oral corticosteroids were not associated with CTS. The results were similar when cases were restricted to those who had undergone carpal tunnel decompression.

We report a comparative study of the outcome of flexor tendon repairs mobilized by either a "passive flexion-active extension" or a "controlled active motion" regimen. We show that the controlled active motion regimen conferred significant benefits on the final range of motion and extensor lag. The rupture rate was raised with "controlled active motion" but this was not greater than levels reported by other authors using "passive flexion-active extension" regimens.

he efficacy of extracorporeal shock-wave therapy for tennis elbow was investigated using a single fractionated dosage in a randomised, double-blind study. Outcomes were assessed using the Disabilities of Arm, Shoulder and Hand questionnaire, measurements of grip strength, levels of pain, analgesic usage and the rate of progression to surgery. Informed consent was obtained before patients were randomised to either the treatment or placebo group. In the final assessment, 74 patients (31 men and 43 women) with a mean age of 43.4 years (35 to 71), were included.None of the outcome measures showed a statistically significant difference between the treatment and control groups (p > 0.05). All patients improved significantly over time, regardless of treatment. Our study showed no evidence that extracorporeal shock-wave therapy for tennis elbow is better than placebo. Tennis elbow (lateral epicondylitis) is a condition whose aetiology is poorly understood. The principal symptom is pain located at the lateral epicondyle of the humerus and the common extensor origin just distal to it. The pain quite commonly radiates distally over the extensor surface of the forearm and tends to worsen with activities which require action of the extensor muscles. The onset of symptoms is usually abrupt after an unaccustomed activity, but it may T also be gradual. It usually follows a protracted course, with the degree of pain increasing and decreasing. The principal methods of treatment include splinting, physiotherapy, ultrasound and functional bracing, as with a tennis elbow clasp. If these measures fail, injection of corticosteroids into the common extensor origin is usually given. Surgery is reserved for persistent cases. The commonly used term 'lateral epicondylitis' implies inflammation, but it has not been possible to demonstrate inflammation in pathological specimens, either in the acute or chronic form, because most patients had previously received local injections. Although extracorporeal shock wave therapy (ESWT) has been used extensively for a variety of orthopaedic conditions, the mechanism of its effect on bone and soft tissues remains controversial. Its effect on tennis elbow and on other orthopaedic conditions is unproven because of the lack of randomised, double-blind studies with adequate power. We have attempted to address this deficiency in this study. Patients and MethodsWe recruited 158 patients (70 men and 88 women) into the study all of whom had received extensive conservative treatment and were awaiting surgery. They were sent information about the planned study by post and 141 (63 men and 78 women) who responded were invited to an initial screening clinic. The senior author (LCB) examined each patient to apply the inclusion and exclusion criteria (Table I). He excluded 55 patients (28 men and 27 women), either because it was not possible to make a firm diagnosis of tennis elbow, or because they had a criterion for exclusion. An in-depth discussion of the design of the study and the proposed form of treatment was ...

IntroductionDupuytren’s disease (DD) causes progressive digital flexion contracture and is more common in men of European descent.MethodsOrthopaedic and plastic surgeons in 12 European countries (the Czech Republic, Denmark, Finland, France, Germany, Hungary, Italy, The Netherlands, Poland, Spain, Sweden and the UK) with >3 and <30 years experience reviewed the medical charts of five consecutive patients they had treated surgically for DD in 2008. Descriptive statistics are reported.ResultsIn total, 3,357 patient charts were reviewed. Mean (standard deviation) patient age was 61.9 (10.2) years; 81% were men. At the time of the procedure, 11% of patients were at Tubiana stage Ia (0–20° total flexion); 30%, stage Ib (21–45°); 34%, stage II (46–90°); 17%, stage III (91–135°); and 5%, stage IV (>135°). Percutaneous needle fasciotomy was performed in 10%, fasciotomy in 13%, fasciectomy in 69% and dermofasciectomy (DF) in 6% of patients. After surgery, fingers improved a mean of 1.9 Tubiana stages, and 54% of patients had no nodules or contracture. The rate of reported complications during the procedure was 4% overall (11% in patients undergoing DF). The most common postoperative complications reported were haematoma (8%), wound healing complications (6%) and pain (6%). No postoperative complications were reported in 77% of patients.ConclusionsIn this European study of more than 3,000 patients with DD, most patients were diagnosed at Tubiana stage I or II, the majority received fasciectomy and more than half had no nodules or contracture remaining after surgery.Electronic supplementary materialThe online version of this article (doi:10.1007/s12570-012-0092-z) contains supplementary material, which is available to authorized users.

This study presents a review of 26 cases of radial tunnel syndrome in 25 patients seen in a single hand consultant's practice over a period of 2.5 years. The protocol for diagnosis was the reproduction of patient's symptoms on pressure over a palpable tender spot along the course of the radial tunnel, painful resisted supination or resisted middle finger extension, all of which were abolished on infiltration of the tender area with a local anaesthetic solution. The presence of at least two out of three objective signs was necessary for the diagnosis. Initially all cases were treated conservatively, by steroid injection in 25 and physiotherapy in one, with long-term relief of pain in 16. Nine failures were treated surgically, with complete relief of pain in seven. Radial tunnel syndrome should be considered in the differential diagnosis of pain around the hand and or elbow.