Background Controversy exists regarding the factors influencing the duration of work incapacity after surgically treated carpal tunnel syndrome (CTS).
AimTo determine relevant factors related to return to work.
MethodsSurgical technique, clinical factors, demographic factors, other medical problems, psychosocial factors, work-related and economical factors were reviewed in patients operated on for CTS. Statistical multivariate analyses were performed to identify the baseline factors influencing the work incapacity period.
ResultsA total of 107 cases were reviewed. Professional exposure to repetitive movements and heavy manual handling activity were associated with a longer return-to-work interval. The duration of work incapacity period was not significantly related to the socioprofessional category of the patient (selfemployed or employee) or to the type of the procedure (open versus endoscopic surgery).Conclusion Work-related features have a more important influence on return to work than personal, pathological or surgical features.
A cohort of 119 patients with carpal tunnel syndrome completed the questionnaire of the Dutch version of the DASH score pre-operatively and one year postoperatively. The mean DASH score decreased from 38.2 to 22.0. There was a significant correlation with the Boston carpal tunnel outcome score (r=0.78). With an effect size of 0.87 and a standardized mean response of 0.69, the Dutch version of the DASH is highly responsive for the evaluation of the outcome of surgery for carpal tunnel syndrome.
The aim of this anatomical study was to find out if total denervation of the elbow joint is technically feasible. The endbranches of the brachial plexus of eight fresh-frozen upper arm cadavers were dissected with optical loupe magnification. All major nerves of the upper limb (except the axillary and the medial brachial cutaneous nerve) give some terminal articular endbranches to the elbow. The articular endbranches arise from muscular endbranches, cutaneous endbranches, or arise straight from the main nerves of the brachial plexus. A topographic diagram was made of the different nerves innervating the elbow joint. The ulno-posterior part of the elbow is innervated by the ulnar nerve and some branches of medial antebrachial cutaneous nerve. The radial-posterior part of the elbow is innervated exclusively by the radial nerve. The ulno-anterior part of the elbow is innervated by the median nerve and the musculocutaneous nerve. The radio-anterior part of the elbow is innervated by the radial nerve and the musculocutaneous nerve. These elbow innervation findings are relevant to both anatomical and clinical field as they provide evidence that the total denervation of the elbow joint is impossible. Nevertheless, partial denervation, like denervation of the lateral epicondyle or the ulnar part of elbow, is technically possible.
Introduction: Hamate dislocation is an uncommon injury, and there are only 17 reported cases in the literature. Ten of them are isolated injuries, and in 7 cases the hamate dislocation is a part of other injuries of the hand. Hamate dislocation can be caused by both direct and indirect forces, or as a part of complex injury of the wrist and hand. Case Report: A case report of a 26-year-old man who presented with a machine injury to his hand with a volar hamate dislocation which was initially missed in the Emergency department as a volar lacerated wound of the hand and was subsequently discovered in the Orthopaedic clinic 6 weeks later. Conclusion: This is only the second report in literature of a neglected hamate dislocation being surgically treated and the 18th reported case of a hamate dislocation over the last 130 years. The direction of dislocation depends on the direction of force applied. Surgical treatment with fixation is optimal even for neglected cases. There was no incidence of avascular necrosis of hamate reported, reflecting the almost equal volar and dorsal blood supply of the hamate.
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