Carpal Tunnel Syndrome (CTS) is a compressive neuropathy of the median nerve in the carpal tunnel. It is the most common peripheral entrapment neuropathy. The surgical management includes dividing the flexor retinaculum to decompress the median nerve. Post-operative mobilization of the wrist is controversial. Some surgeons splint the wrist for 2–4 weeks whilst others encourage early mobilization. The literature has been inconclusive as to which method is most beneficial. The purpose of this study is to review the literature regarding the effectiveness of wrist immobilization following open carpal tunnel decompression. We reviewed all published clinical trials claiming to evaluate the mobility status following open carpal tunnel release. Studies not in the English language as well as those with small number of patients (n < 30) were excluded. There were five studies that fulfilled the eligibility criteria and were included in this review. We conclude that there is no beneficial effect from post-operative immobilization after open carpal tunnel decompression when compared to early mobilization.
A new type of carpal coalitionDear Sir, Coalition of the carpal bones can occur in various configurations with numerous reports highlighting different combinations. Carpal coalition is usually asymptomatic and is often an incidental finding observed on radiographs obtained for various reasons. We report an unusual case of bilateral carpal coalition.A 31-year-old healthy Afro-Caribbean man presented to the hand clinic with symptoms of palmar hyperhidrosis. Examination revealed full pain free wrist movement bilaterally. Radiographs of his wrist
Background: Anterior cruciate ligament (ACL) reconstruction and meniscal repair are two commonly performed arthroscopic soft tissue surgeries. It can be challenging for training surgeons to become proficient in these techniques. The aim of our study is to investigate the viability of porcine stifles as training models for ACL reconstruction and meniscal repair. Method: A training session was held with various participants comparing the use of porcine stifles vs. sawbone replicas. Tendon harvesting, joint arthroscopy, meniscal repair and ACL reconstruction were performed on both groups of joints. The two training methods were compared by the completion of a questionnaire by four participants. Results: Porcine stifles were found to be a suitable alternative to human knee joints. Tactile sensation of performing these procedures with porcine stifles more closely resembled that of a human knee. Visualisation of the joint and its structures was considerably easier in the saw bone model, but the porcine stifle better resembled real life scenarios. The medial joint compartment was notably more difficult to visualise and access relative to the lateral compartment, increasing procedure time when repairing the medial meniscus.
Conclusion:Porcine stifles provide a suitable model for education and surgical training for ACL reconstruction and meniscal repair for trainee surgeons. They are easy to procure, cost-effective, and better replicate the complexities of these procedures in human knees compared to sawbones. We believe that practically this provides an ideal platform for simulation scenarios which are similar to humans and fulfils the ethical mandates of beneficence and non-maleficence.
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