Fifty patients who underwent open carpal tunnel release (OCTR) surgery at least 12 months earlier for carpal tunnel syndrome were reviewed, focusing on scar tenderness, pillar pain, and symptoms of neuroma. A total of 55 hands were studied. At an average of 20.2 months of follow-up, 5.5% had Tinel's sign, 7.3% had scar tenderness, 12.7% had pillar pain, and 18% had burning discomfort. Pillar pain was elicited in a much higher fraction of patients by using the "table test" (provocation of pillar pain by having the patient lean with his/her weight on the hands placed on the edge of a table), even when traditional tests were negative. Symptoms and signs are present in a substantial number of patients after OCTR, even after almost 2 years of follow-up. Patients should be informed of the incidence of long-term symptoms and signs after OCTR surgery.

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The purpose of this study was to examine the pathological changes in the Achilles tendon and its paratenon after intratendinous corticosteroid injections and to reveal the effects of this drug on healthy tendon. We also sought for the effects of these injections compared with compression with a clamp on the Achilles tendons of the rats. Fifty-two Achilles tendons in 26 male Wistar rats were included in the study. Betamethasone injections were applied to the left tendons at different intervals, while the right tendons served for compression with mosquito clamps for varied periods. At the end of 30 days, all of the tendons were excised and examined histopathologically according to a semiquantitative scoring system. Histopathologic evaluation demonstrated some degree of degeneration in both groups. Statistical analysis showed no significant difference among the two groups, but in macroscopic evaluation, the tendons in the betamethasone group demonstrated enlargement and strong adhesion to the subcutaneous tissue. We conclude that intratendinous betamethasone injections are as harmful as compression with a clamp and can be used as a degeneration-producing model in further studies. Enlargement of the tendon mass and strong adhesion to the subcutaneous tissue can be due to injection of the betamethasone partly outside the tendon.

No abstract

The proximal tibiofibular joint (PTFJ) can be considered to be the fourth compartment of knee joint. Although degenerative diseases of the knee joint may also have detrimental effects on the PTFJ until now, details of arthritic affection of PTFJ in the elderly who have severe femorotibial arthritis have not been described. Convenience samples of knees of elderly patients with Kellgren-Lawrence grade III-IV primary osteoarthritis were investigated further in order to determine the X-ray findings of PTFJ. Sixty knees in 34 patients with an average age of 71 years (61-86 years) were examined. Both knees were examined in 26 patients. On the radiographs, 23 joints were grade IV, 14 were grade III, and 23 were grade II. At most, only minor differences were seen between knees on the same patient in terms of lower extremity alignment, grade of TFJ degeneration, grade of PTFJ degeneration, and type of PTFJ. Interobserver correlation was good for radiographic evaluation of PTFJ (kappa = 0.557). By intraobserver analysis with McNemar test, there was no statistically significant difference between the radiographic evaluations of PTFJ (p = 0.167). Arthritic grades of PTFJ and tibiofemoral joints were strongly correlated (Pearson coefficient r = 0.58, p < 0.001). No significant relation was found between type of PTFJ and grade of arthritis (chi(2) test, p = 0.42). In the light of these findings, the proximal tibiofibular joint should be evaluated for arthritic findings that may be responsible for lateral knee pain before a total knee arthroplasty operation is considered. The type of PTFJ is not related to the degree of this joint arthritis.