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Multiple Pulley Rupture Following Corticosteroid Injection for Trigger Digit: Case Report
SCIENTIFIC ARTICLE Multiple Pulley Rupture Following Corticosteroid Injection for Trigger Digit: Case Report Cassie Gyuricza, MD, Eva Umoh, BA, Scott W. Wolfe, MD We report a case of pulley rupture following repeated local corticosteroid injections for trigger digit. The treatment involved exploration, tenolysis, and reconstruction using the palmaris longus tendon. (J Hand Surg 2009;34A:1444–1448. © 2009 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.) Key words Corticosteroid, pulley rupture, trigger digit. RIGGER DIGIT, OR stenosing tenosynovitis,isa local corticosteroid injection through a lateral approach condition characterized by painful locking or at the proximal phalanx10 (0.5 mL local anesthetic and Tsnapping of a digit caused by mechanical im- 0.5 mL triamcinolone acetonide 40 mg/mL [Kenalog- pingement of the flexor tendon passing through a hy- 40, Bristol-Meyers Squibb Co, Princeton, NJ]). Her pertrophic A1 pulley. Initial conservative management symptoms of pain temporarily improved, but 4 months of trigger digits with various corticosteroid preparations later, the patient returned with recurrent pain and a is well described.1–4 Side effects, including subcutane- second local corticosteroid injection was administered, ous fat atrophy, pain, depigmentation of the skin, and again using the lateral approach. During the ensuing 8 transient elevation of urine and blood glucose levels in months, the patient had persistent pain and tenderness patients with diabetes, are generally mild and self- over the A2 pulley. The patient also developed pain at limiting.5,6 We are aware of 2 previously reported cases the A1 pulley, and a third injection (0.5 mL local of delayed flexor tendon rupture following corticoste- anesthetic and 0.5 mL triamcinolone acetonide 40 mg/ 7,8 roid injections for trigger digit thought to be the result mL) was given into the palmar surface overlying the A1 of intratendinous injection. -
Clinical Excellence Series Volume V an Evidence-Based Approach to Traumatic Emergencies
Clinical Excellence Series n Volume V An Evidence-Based Approach To Traumatic Emergencies Inside Neck Trauma: Don’t Put Your Neck On The Line Orthopedic Sports Injuries: Off The Sidelines And Into The Emergency Department Blunt Abdominal Trauma: Priorities, Procedures, And Pragmatic Thinking Wrist Injuries: Emergency Imaging And Management Brought to you exclusively by the publisher of: An Evidence-Based Approach To Traumatic Emergencies CEO: Robert Williford President & Publisher: Stephanie Ivy Associate Editor & CME Director: Jennifer Pai • Associate Editor: Dorothy Whisenhunt Director of Member Services: Liz Alvarez • Marketing & Customer Service Coordinator: Robin Williford Direct all questions to EB Medicine: 1-800-249-5770 • Fax: 1-770-500-1316 • Non-U.S. subscribers, call: 1-678-366-7933 EB Medicine • 5550 Triangle Pkwy Ste 150 • Norcross, GA 30092 E-mail: [email protected] • Web Site: www.ebmedicine.net The Emergency Medicine Practice Clinical Excellence Series, Volume V: An Evidence-Based Approach To Traumatic Emergencies is published by EB Practice, LLC, 5550 Triangle Pkwy Ste 150, Norcross, GA 30092. Opinions expressed are not necessarily those of this publication. Mention of products or services does not constitute endorsement. This publication is intended as a general guide and is intended to supplement, rather than substitute, professional judgment. It covers a highly technical and complex subject and should not be used for making specific medical decisions. The materials contained herein are not intended to establish policy, procedure, or standard of care. Emergency Medicine Practice, The Emergency Medicine Practice Clinical Excel- lence Series, and An Evidence-Based Approach to Traumatic Emergencies are trademarks of EB Practice, LLC. -
Broken Bones: Common Pediatric Lower Extremity Fractures—Part III
10173-06_ON2506-Hart.qxd 11/9/06 3:51 PM Page 390 Broken Bones: Common Pediatric Lower Extremity Fractures—Part III Erin S. Hart ▼ Brenda Luther ▼ Brian E. Grottkau Lower extremity injuries and fractures occur frequently in young usually have pain with hamstring stretching and hip flex- children and adolescents. Nurses are often one of the first ion/abduction). Patients also frequently demonstrate an healthcare providers to assess a child with an injury or fracture. antalgic gait and have pain during their activity or sport. Although basic fracture care and principles can be applied, An anteroposterior radiograph of the pelvis usually reveals nurses caring for these young patients must have a good under- the avulsed fragment. Comparative views of the contralat- standing of normal bone growth and development as well as eral side are often helpful in confirming the diagnosis and avoiding further unnecessary advanced imaging studies. common mechanisms of injury and fracture patterns seen in This injury is usually treated symptomatically and often children. Similar to many of the injuries in the upper extremity, involves rest, application of ice, and relaxation of the in- fractures in the lower extremity in children often can be treated volved tendon (O’Kane, 1999). Conservative treatment of nonoperatively with closed reduction and casting. However, this pelvic avulsion fractures is usually successful. Crutches are article will also review several lower extremity fractures that often needed for several weeks to reduce symptoms and frequently require surgical intervention to obtain a precise rest the extremity involved. Complications following pelvic anatomical reduction. Common mechanisms of injury, fracture avulsion fractures in children are rare, and most patients patterns, and current management techniques will be discussed. -
Top Hand, and Wrist Problems
12/10/2016 TOP HAND, AND WRIST Disclosures PROBLEMS: HOW TO • None SPOT THEM IN CLINIC Nicolas H. Lee, MS MD [email protected] UCSF Dept of Orthopaedic Surgery Assistant Clinical Professor Hand, Upper Extremity and Microvascular Surgery Dec. 10 th , 2016 Outline Outline • Carpal Tunnel Syndrome •Carpal Tunnel Syndrome • Trigger Finger • • Basal Joint arthritis Trigger Finger • Basal Joint arthritis • De Quervain tenosynovitis • De Quervain tenosynovitis • Mallet Finger • Mallet Finger • Ganglion cyst • Ganglion cyst 1 12/10/2016 Carpal Tunnel Syndrome • Compression of median nerve in carpal tunnel • Irritation of the nerve presents as numbness/pain 10 structures 9 flexor tendons Median nerve https://www.pinterest.com/pin/429812358163325007/ Anatomy (motor) Etiology 1. Idiopathic – most common 2. Anatomic – rare • Thenar Muscle (OAF) 3. Systemic – DM, hypothyroidism • Opponens Pollicis (deep) 4. **** Occupational Exposure • Abductor Pollicis Brevis (superficial) **** “A direct relationship between repetitive work • Flexor Pollicis Brevis activity (eg, keyboarding) and CTS has never been (superficial 1/2) objectively demonstrated.” 1 http://teachmeanatomy.info/upper-limb/muscles/hand/ 2 12/10/2016 Rare anatomic causes Carpal Tunnel Syndrome ● HPI – systemic risk factors Tenosynovitis CMC arthritis ◦ More common in: Ganglion Fracture 1) Diabetics 2) Hypothyroidism 3) Pregnancy (20-45%) Persistent Median artery Acromegaly Abnormal muscle Tumor Carpal Tunnel Syndrome ● CC: ◦ “I wake up at night and my hands are asleep” ◦ “I have to shake them to get the blood flowing again” ◦ “I have to run them under warm water and then I can go back to sleep” ◦ “Fingers go numb when I drive” ◦ “My hand goes numb when I use my cell phone” ◦ “I am always dropping things” Carpal Tunnel Syndrome Cranford, C.S. -
Cause Analysis and Enlightens of Hand Injury During the COVID-19 Outbreak and Work Resumption Period
Cause analysis and enlightens of hand injury during the COVID-19 outbreak and work resumption period Qianjun Jin Zhejiang University School of Medicine First Aliated Hospital Haiying Zhou Zhejiang University School of Medicine Hui Lu ( [email protected] ) Zhejiang University https://orcid.org/0000-0002-2969-4400 Research Keywords: Hand injuries, COVID-19, Outbreak, Work resumption, Medical supplies, Surgery Posted Date: December 4th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-40035/v3 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/16 Abstract Background: In light of the new circumstances caused by the current COVID-19 pandemic, an enhanced knowledge of hand injury patterns may help with prevention in factories as well as the management of related medical conditions. Methods: A sample of 95 patients were admitted to an orthopedics department with an emergent hand injury within half a year of the COVID-19 outbreak. Data were collected between January 23rd, 2020 and July 23rd, 2020. Information was collected regarding demographics, type of injury, location, side of lesions, mechanism of injuries, place where the injuries occurred, surgical management, and outcomes. Results: The number of total emergency visits due to hand injury during the COVID-19 outbreak decreased 37% when compared to the same period in the previous year. At the same time, work resumption injuries increased 40%. In comparison to the corresponding period in the previous year, most injured patients during the COVID-19 outbreak were women (60%) with a mean age of 56.7, while during the work resumption stage, most were men (82.4%) with a mean age of 44.8. -
Injury-Induced Hand Dominance Transfer
University of Kentucky UKnowledge University of Kentucky Doctoral Dissertations Graduate School 2010 INJURY-INDUCED HAND DOMINANCE TRANSFER Kathleen E. Yancosek University of Kentucky, [email protected] Right click to open a feedback form in a new tab to let us know how this document benefits ou.y Recommended Citation Yancosek, Kathleen E., "INJURY-INDUCED HAND DOMINANCE TRANSFER" (2010). University of Kentucky Doctoral Dissertations. 18. https://uknowledge.uky.edu/gradschool_diss/18 This Dissertation is brought to you for free and open access by the Graduate School at UKnowledge. It has been accepted for inclusion in University of Kentucky Doctoral Dissertations by an authorized administrator of UKnowledge. For more information, please contact [email protected]. ABSTRACT OF DISSERTATION Kathleen E. Yancosek The Graduate School University of Kentucky 2010 INJURY-INDUCED HAND DOMINANCE TRANSFER _________________________________ ABSTRACT OF DISSERTATION _________________________________ A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Rehabilitation Sciences in the College of Health Sciences at the University of Kentucky By Kathleen E. Yancosek Lexington, Kentucky Director: Carl Mattacola, PhD, ATC Lexington, Kentucky 2010 Copyright © Kathleen E. Yancosek 2010 ABSTRACT OF DISSERTATION INJURY-INDUCED HAND DOMINANCE TRANSFER Hand dominance is the preferential use of one hand over the other for motor tasks. 90% of people are right-hand dominant, and the majority of injuries (acute and cumulative trauma) occur to the dominant limb, creating a double-impact injury whereby a person is left in a functional state of single-handedness and must rely on the less- dexterous, non-dominant hand. When loss of dominant hand function is permanent, a forced shift of dominance is termed injury-induced hand dominance transfer (I-IHDT). -
Your Guide to Trigger Finger Surgery Brian J
Your Guide to Trigger Finger Surgery Brian J. Bear, MD OrthoIllinois Hand, Wrist, and Elbow Center of Excellence Care Team and Contact Numbers: Brian J. Bear, MD Main Phone line . 815-398-9491 OrthoIllinois Kailey - Lead Nurse . .815-398-9491 324 Roxbury Road Ronda - Surgery Scheduler . 815-484-6969 Rockford, IL Sadie - Office Scheduler . .815-484-6996 TABLE OF CONTENTS Learn about Dr. Bear . 2 What is Trigger Finger/Trigger Thumb?. 3 Surgical Treatment v Description of Trigger Finger Release . 3 The Surgical Experience v Information to Keep in Mind Prior to Surgery . 4 v Pre-Admission Guide for Surgery . 5 v Pre-operative Phase . 6 v Intra-operative Phase . 7 v Post-operative Phase . 8 After Surgery v While You Recover at Home . 9 Commonly Asked Questions . 10-11 What Can I Do After Surgery? . 13 1 Learn More About Dr. Bear I would like to take this opportunity to tell you more about myself and my experience in health care. Originally from Winnetka, Illinois, I attended Northwestern University graduating in 1987, cum laude, president of Mortar Board Senior Honor Society and a member of Phi Betta Kappa. I continued my studies at Northwestern University School of Medicine, receiving my medical degree in 1991 as a member of Alpha Omega Alpha honor society. Following my graduation, I pursued advanced orthopedic training at Cornell Hospital for Special Surgery, which is ranked as the top orthopedic hospital in the United States. In addition, I completed a specialized training fellowship program in elbow and hand surgery at the Mayo Clinic. My practice is focused on shoulder, elbow, hand, microvascular, traumatic, and reconstructive surgery. -
Treatment of Large Avulsion Injury in Perianal, Sacral, and Perineal
Hu et al. BMC Surgery (2019) 19:65 https://doi.org/10.1186/s12893-019-0529-1 RESEARCH ARTICLE Open Access Treatment of large avulsion injury in perianal, sacral, and perineal regions by island flaps or skin graft combined with vacuum assisted closure Fu Xing Hu1†, Xiao Xuan Hu2†, Xue Lin Yang1, Xing Hai Han1, Yong Bo Xu3, Kun Li3, Li Yan3*† and Hai Bo Chu3*† Abstract Background: Traumatic avulsion injuries to the anus, although uncommon, can result in serious complications and even death. Management of anal avulsion injuries remains controversial and challenging. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure. Methods: Island flaps or skin graft combined with vacuum assisted closure, diverting ileostomy, the rectum packed with double-lumen tubes around Vaseline gauze, negative pressure drainage with continuous distal washing, wounds with skin grafting as well as specialized treatment were performed. Results: The injuries healed in all patients. Six cases had incomplete perianal avulsion without wound infection. Wound infection was seen in four cases with annular perianal avulsion and was controlled, and the separated prowl lacuna was closed. The survival rate in 10 patients who underwent skin grafting was higher than 90%. No anal stenosis was observed after surgery, and ileostomy closure was performed at 3 months (six cases) and 6 months (four cases) after surgery, respectively. Conclusions: Covering a wound with an island flap or skin graft combined with vacuum assisted closure is successful in solving technical problems, protects the function of the anus and rapidly seals the wound at the same time. -
Trigger Finger
PATIENT EDUCATION Trigger Finger Trigger Finger "Trigger finger" sounds like a malady that might affect gunslingers or hunters. In fact, this common condition results in a finger bent as if to pull a trigger. People over 40 years of age with a history of diabetes or rheumatoid arthritis are especially at risk to develop this condition. How it develops Although the exact cause of trigger finger is unknown, the progression of the condition is well documented. Trigger finger involves the tendons and pulleys in the hand that bend the finger. The tendons connect the muscles of the forearm with the bones of the fingers. Each tendon is covered by a slick lining or sheath. When you bend your fingers, the tendons glide back and forth, guided by a restraining pulley or yoke. When the tendon sheath becomes inflamed, it swells and may develop a knot or thickening in the tendon. The knot passes through the pulley as the finger bends, but gets stuck as the finger straightens. This causes further irritation and results in a vicious circle of irritation, swelling, catching and more irritation until finally, the finger locks in a bent position. Diagnosis No Xrays are needed to diagnose trigger finger. Your doctor will examine your hand and fingers, and use the findings to make the diagnosis. The finger may be swollen and there may be a bump, or nodule, over the joint in the palm of the hand. The finger may be stiff and painful. Although it may seem that the problem is in the knuckles, it is actually at the joint nearest the palm of the hand. -
Unusual Ignition of a Bullet Causing Hand Injury: Case Report
CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector Injury Extra 45 (2014) 9–11 Contents lists available at ScienceDirect Injury Extra jou rnal homepage: www.elsevier.com/locate/inext Case report Unusual ignition of a bullet causing hand injury: Case report a, b b b Abdul Kerim Yapici *, Salim Kemal Tuncer , Umit Kaldirim , Ibrahim Arziman , c Mehmet Toygar a Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Ankara, Turkey b Department of Emergency Medicine, Gulhane Military Medical Academy, Ankara, Turkey c Department of Forensic Medicine, Gulhane Military Medical Academy, Ankara, Turkey A R T I C L E I N F O Article history: Accepted 10 November 2013 1. Introduction 2. Case report The incidence of firearm related non-fatal and fatal accidents A 35 year-old man was admitted to emergency department has increased worldwide [1–5]. Most of firearm accidents result with a complaint of injury related to the third web space, third often due to human errors included extreme carelessness while finger pulp and thenar region of right hand. On detailed handling, carrying or storing a loaded firearm [3]. Most of the questioning, he reported that he was cleaning a machine gun unintentional or intentional nonfatal gunshot injuries involve an (type MG-3) after target practice in a shooting range. He did not extremity [6]. Most gunshot injuries to the hand are result of low- check visually and physically whether there were any bullets or velocity handguns [7]. While low-energy firearm injuries are not in the chamber. -
Common Hand, Wrist and Elbow Problems
12/15/2018 COMMON HAND, WRIST Disclosures AND ELBOW PROBLEMS: Research Support: HOW TO SPOT THEM IN San Francisco DPH CLINIC Standard Cyborg Nicolas H. Lee, MD UCSF Dept of Orthopaedic Surgery Assistant Clinical Professor Hand, Upper Extremity and Microvascular Surgery Dec. 15th, 2018 DIP joint pathologies Mucous Cyst – ganglion cyst of DIP joint 1. Mucous Cyst 2. Mallet Finger 3. Jersey Finger 1 12/15/2018 Xray Treatment “Jammed Finger” Mallet Finger • Recurrence rate with aspiration/needling? 40-70% • Recurrence rate with surgical debridement of osteophyte? Jersey Finger 0-3% • Do nail deformities resolve with surgery? Yes - 75% 2 12/15/2018 Mallet Finger Mallet finger Soft Tissue Mallet • 6 weeks DIP immobilization in extension • Night time splinting for 4 weeks Bony Mallet http://www.specialisedhandtherapy.com.au/ Red Flag Mallet Finger Red Flag Jersey Finger When to Refer: Flexor Digitorum Profundus (FDP) 1. Big fragment strength testing 2. Volar subluxation of the distal phalanx http://nervesurgery.wustl.edu/ http://www.orthobullets.com REFER ALL JERSEY FINGERS ASAP!!! 3 12/15/2018 Trigger Finger and Thumb Trigger finger • Presentation • Clicking or frank locking • Especially at night or morning • May also present with just pain at the A1 pulley Trigger Finger Primary Trigger Finger • Physical Examination • Most Common • Locking or clicking over the A1 pulley • “Idiopathic” • Tenderness at the A1 pulley • No known cause 4 12/15/2018 Secondary “Congenital” • Associated with known disease • Infantile form • Disease cause thickening in tendon/pulley • “congenital” is a misnomer • Diabetes • Rheumatoid arthritis • Amyloidosis • Sarcoidosis Treatment Options Trigger finger Splinting •Nonoperative • Splint to prevent MCP or •Observation PIP flexion. -
Searching for Information on Occupational Accidents
SEARCHING FOR INFORMATION ON OCCUPATIONAL ACCIDENTS DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Shih-Kwang Chen, M.S. ***** The Ohio State University 2008 Dissertation Committee: Approved by Professor Philip J. Smith, Adviser Professor Jerald R. Brevick Adviser Professor Steven A. Lavender Industrial and Systems Engineering Graduate Program Copyright by Shih-Kwang Chen 2008 ABSTRACT Effective retrieval of the most relevant documents on the topic of interest from the Internet is difficult due to the large amount of information in all types of formats. Studies have been conducted on ways to improve information retrieval (IR). One approach to improve searches in large collections, such as the Web, is to take advantage of semantic representations in pre-existing relational databases that have been developed for explicit purposes besides supporting Internet searches in general. In an effort to enhance IR on the Internet, a prototype of a topic-oriented search agent, SAOA-1, was developed to use embedded semantics and domain-specific knowledge extracted from such a database. Activated when a set of retrieved keywords appears related to the topic of “occupational accidents”, SAOA-1 constructs an alternative search query and pruned lists of suggested refinements by applying the search engine knowledge and the domain- specific knowledge and semantics extracted from a relational database. Information seekers could then use the alternative search query or refine it further with a modified search query developed by SAOA-1 based on its semantic representation of the topic of occupational accidents to complete context-sensitive pruning of the semantic neighborhood.