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Journal of Hand Surgery (European Volume) Journal of Hand Surgery (European Volume) http://jhs.sagepub.com/ FESSH Abstracts J Hand Surg Eur Vol 2014 39: S1 DOI: 10.1177/1753193414530610 The online version of this article can be found at: http://jhs.sagepub.com/content/39/1_suppl/S1 Published by: http://www.sagepublications.com On behalf of: British Society for Surgery of the Hand Additional services and information for Journal of Hand Surgery (European Volume) can be found at: Email Alerts: http://jhs.sagepub.com/cgi/alerts Subscriptions: http://jhs.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav >> Version of Record - May 19, 2014 What is This? Downloaded from jhs.sagepub.com at UCSF LIBRARY & CKM on November 19, 2014 JHS(E) FESSH Abstracts The Journal of Hand Surgery (European Volume) 39E(Supplement 1) S1–S162 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1753193414530610 jhs.sagepub.com A-0006 The association between cubital Clinical Relevance: This study provided useful infor- tunnel morphology and ulnar neuropathy in mation regarding the pathology and surgical treat- patients with elbow osteoarthritis ment strategies for cubital tunnel syndrome in patients with elbow osteoarthritis. Y Kawanishi1, J Miyake2, S Omori1, T Murase1, K Shimada3 (1) Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan A-0023 Clinical results of percutaneous (2) Department of Orthopaedic Surgery, Sakai City Hospital, needle fasciotomy for Dupuytren’s Japan disease – Is there any correlation between (3) Department of Orthopaedic Surgery, Osaka Koseinenkin preoperative severity or Dupuytren’s Hospital, Osaka, Japan diathesis and clinical results? Purpose: Morphological changes in the cubital tunnel Y Abe, S Tokunaga during elbow motion in patients with elbow osteoar- Sakura Orthopaedic Hospital, Hand Surgery Center, Sakura thritis have not been examined in vivo. We examined City, Japan the changes in cubital tunnel morphology during elbow flexion and the characteristics of medial osteo- Purpose: Recently there has been a resurgence in the phyte development, to elucidate whether the cubital popularity of percutaneous needle fasciotomy (PNF). tunnel area and medial osteophyte size are factors It is generally thought that PNF is not effective for contributing to cubital tunnel syndrome in patients moderately severe and severe forms of Dupuytren’s with elbow osteoarthritis. disease (Abe or Tubiana Stages 3 and 4). Especially a Methods: We performed computed tomography of 13 contracture of > 60˚ in the proximal interphalangeal primary osteoarthritic elbows in patients with cubital (PIP) joint (Abe Stage 4) is more difficult to correct, tunnel syndrome (Group A) and 25 primary osteoar- because it may be accompanied by shortening of the thritic elbows in patients without cubital tunnel syn- check rein and collateral ligaments, and attenuation drome (Group B) at full extension, 90° flexion and full of the central extensor slip, which cannot be treated flexion. Cubital tunnel area, humeral and ulnar by PNF. Many authors support the view that osteophyte area and height, and the proportion of Dupuytren’s diathesis is a risk factor for recurrence osteophytes within the cubital tunnel were analysed or extension: the reported recurrence rates after PNF at each position. have been relatively high. The purpose of this study Results: The humeral osteophyte area and height, was to clarify the correlation between preoperative and the osteophyte proportion within the cubital severity and Duputren’s diathesis and the clinical tunnel were larger at full and 90° elbow flexion than results of Duputren’s disease, following PNF. at full extension. These parameters were signifi- Methods: There were 47 patients, with 99 fingers cantly greater in Group A than in Group B, at full treated. The average age was 62 years (range, 39-90 extension and at 90° flexion. Anterior parts of y). Forty patients were men and seven were women; humeral osteophytes were better developed than 31 left and 25 right hands, including one index, nine posterior parts. middle, 46 ring and 43 little finger rays underwent Conclusions: Medial osteophyte size, not cubital tun- PNF. Forty-one patients indicated a diathesis score nel area, is a factor contributing to cubital tunnel syn- of < 4 and 6 patients demonstrated > 5 points in drome in patients with elbow osteoarthritis. diathesis score. Thirty-four finger rays were in grade Compression due to cubital tunnel narrowing and 1, 32 in grade 2, 18 in grade 3 and 15 in grade 4 of traction/friction of the ulnar nerve due to medial Abe’s classification. Preoperative metacarpophalan- osteophytes during elbow flexion are causative fac- geal (MP) joint contracture averaged 35° (range, 30° tors for cubital tunnel syndrome. to 65°), and the PIP joint, 45° (range, 15° to 85°). Downloaded from jhs.sagepub.com at UCSF LIBRARY & CKM on November 19, 2014 S2 The Journal of Hand Surgery (Eur) 39(Supplement 1) We performed PNF with a 25-Gauge needle, accord- satisfaction. Furthermore, we aimed to elucidate any ing to the Eaton and Van Rijssen’s technique. factors that could help in selecting patients for either Immediately post-procedure and at least 12 months surgical approach. We included in this study 63 after treatment (range, 12-26 mo), we examined the patients with bilateral carpal tunnel syndrome, diag- correlation between clinical success defined as a nosed by history and examination. Patients were correction to 5° or less contracture and Abe’s stage. offered the option of simultaneous or staged (> 6 We also examined the correlation between recur- weeks) decompression. A staged decompression was rence, defined as 20° or less over the original post- undertaken in 33 patients (Group 1), whilst 30 under- procedure corrected level and Abe’s diathesis score. went simultaneous decompression (Group 2). We also reviewed the records for complications, Patients completed a questionnaire regarding the excluding recurrence. functional difficulties during the initial 2-week period Results: PNF provided successful correction to 5° or following surgery. This combined the Levine func- less contracture immediately, in 100% of Grade1, 94% tional score, the Quick-Dash score, a visual analogue of Grade 2, 54% of Grade 3 and 30% of Grade 4. At score for pain assessment, level of satisfaction, along final follow-up, 89% improvement of the correction with the time before returning to work. The func- was maintained for MP joints and 66% for PIP joints. tional difficulties were greater overall with simulta- There was recurrence of 20° or less over the original neous decompression. The main problems were in post-procedure corrected level in 2% of MP joints and activities that required dexterity, strength or both 33% of PIP joints. Recurrence occurs more often in hands, such as cutting food and washing. There was Abe’s Grade 3 (50%) and Grade 4 (67%) fingers than in no difference in simple tasks such as the ability to Grade 1 (4%) and Grade 2 (13%). The recurrence rate hold a book or use the telephone. Patients undergo- was also higher by over 5 points in the diathesis score ing simultaneous decompression also found it sig- group (33%) than the group with < 5 points (11%). nificantly harder to socialize, which is probably a Other complications: none, except for skin tears, reflection of the overall greater difficulty in functional which occurred in 18 digits. activities in this group. There was no statistical dif- Conclusions: PNF is effective for mild to moderate ference in pain (p = 0.93), with means of 3.3 in both Dupuytren’s disease (Abe’s Stage 3 and 4). Our results groups, nor in patient satisfaction, with means of 7.7 showed that PNF can be better for patients with the and 7.6 for Groups 1 and 2, respectively (p = 0.88); mild-to-moderate form. Recurrence is higher in the however, whereas 93.3% would undergo staged severe form of the disease, but the procedure can be decompression again, only 80% would undergo repeated. These features make this technique a valid simultaneous decompression again (p = 0.14). The alternative in treating the mild-to-advanced stages of 20% that would prefer a staged procedure cited func- Dupuytren’s disease. tional difficulties as their concern, whereas the 6.7% that would change from staged to simultaneous sur- A-0028 Bilateral carpal tunnel syndrome: gery found it inconvenient to have two periods of staged or simultaneous surgery? recuperation. The only significant functional difficulty for the simultaneous group was in the ability to use D R Dickson, T Boddice, A M Collier the toilet. A significant decrease occurred in the total Harrogate District Hospital, Harrogate, UK time off work in both manual and non-manual work- ers, with on average 2-3 weeks for simultaneous sur- Carpal tunnel syndrome presents bilaterally in up to gery versus 6 weeks for the staged decompression. 87% of patients. Whilst the condition can sometimes Age, sex and pre-operative functional difficulties had be successfully managed non-operatively, many no influence on the post-operative functional difficul- require surgery. The surgical decision is whether to ties. Patients on medication for depression or anxiety undergo either a staged or simultaneous decom- were significantly more likely to report functional dif- pression. A simultaneous approach requires only one ficulties or dissatisfaction with simultaneous surgery period of recovery from surgery and therefore, (p = 0.008). Most patients are satisfied with a simul- reduced time off work and decreased costs; however, taneous decompression for patients, but they must there are potentially increased functional difficulties, be highly motivated and become aware of the short- as they are without an un-operated hand to rely on. term functional difficulties following surgery. It We aimed to quantify the difficulties during the initial allows for an earlier return to work, with no increase recuperation from surgery.
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