www.ifssh.info ISSUE 1 FEBRUARY 2012

ezine MEMBERS NEWS • IFSSH Secretary-General update • History of the ASSH ifsshCONNECTING OUR GLOBAL HAND SURGERY FAMILY

IFSSH Committee on the musician’s hand: Musculoskeletal conditions affecting the musician

A NATIONAL QUALITY REGISTER CTS EDUCATION CLASS BECOMES FOR HAND SURGERY IN SWEDEN EFFECTIVE TREATMENT PATHWAY

February 2012

Contents 4 Editorial 22 Case study By Professor Ulrich Mennen, editor of the IFSSH ezine Answers on the scaphoid non-union case 6 Members news 21 Research roundup An update from the Secretary General CTS education class becomes eff ective treatment History of the ASSH pathway 8 Pulse 24 Journal highlights Committee report on the musculoskeletal conditions Tables of Contents from leading journals such as aff ecting the musician The American Journal of Hand Surgery, Journal of Hand Surgery Asian Volume, Journal of Hand Surgery 18 IFSHT European Volume and the Journal of Hand Therapy. A national quality register for hand surgery in Sweden 27 Upcoming events 20 Pioneer profiles List of global learning events and conferences for Professors Raoul Tubiana and Claude Verdan hand surgeons

IFSSH ezine FEBRUARY 2012 3 editorial

Editorial Endorsement of hand meetings by the IFSSH

The International Federation of Societies for The IFSSH cannot be held responsible or be Surgery of the Hand (IFSSH) often receives requests held accountable for any promotional material, to sponsor or endorse hand surgery meetings. advertisement, statement, or suggestion by any The primary aim of the IFSSH, as stated in its presenter, organisation or advertisement, either Charter, is to promote the “well-being of the Hand” written or verbal. Endorsing or supporting a in various ways. We have seen a proliferation of meeting by the IFSSH does not mean that the many aspects of the Hand being presented at views expressed are the offi cial views of the IFSSH. numerous meetings, symposia and congresses, The IFSSH has some 30 Scientifi c Committees who including aesthetics, macro and micro surgery, on occasion will produce offi cial reports. The IFSSH rehabilitation, trauma management, sport cannot endorse a private meeting which is run as a injuries, transplantation, prosthetics, congenital business for fi nancial gain. dysplasias, etc. Such activities signify the exciting The Executive of the IFSSH evaluates all requests developments of our specialty. However, it is the for endorsements of meetings. The required duty of the IFSSH as the umbrella organisation, to information should include the aim, programme, ensure, and if necessary, give guidance, that these faculty, budget, target audience, sponsors and activities are reasonable, scientifi c, credible, and not a one page promotional advertisement fi t for driven by a purely profi t or a promotional motive. publication in the ezine. The IFSSH welcomes the requests by organisers of meetings to announce their events on the IFSSH website and/or IFSSH ezine, and will gladly do so to allow all those interested to participate. However it should be clear that the IFSSH can only do so if Ulrich Mennen it has adequate information about these meetings President: IFSSH before giving offi cial approval. Editor: IFSSHezine

IFSSH disclaimer: The IFSSH ezine is the offi cial mouthpiece of the International Federation of Societies for Surgery of the Hand. The IFSSH does not endorse the commercial advertising in this publication, nor the content or views of the contributors to the publication. Subscription to the IFSSH ezine is free of charge and the ezine is distributed on a quarterly basis. To subscribe, please click here. Should you wish to support this publication through advertising, please click here. SUBSCRIBE TO THE ezine IFSSH ezine editorial team: Editor: Professor Ulrich Mennen (President of the IFSSH) Deputy Editor: Professor Michael Tonkin (President-elect of the IFSSH) ifssh Publication coordinator: Marita Kritzinger (Apex ezines) Graphic Designer: Andy Garside FORFREE

4 IFSSH ezine FEBRUARY 2012 members news

IFSSH Secretary General’s update Dear Delegates, As discussed in Las Vegas, the 2012 Delegates’ Council Meeting will be held in Antwerp, Belgium, in conjunction with the annual FESSH Congress (www.fessh2012.org). The Delegates’ Council Meeting will be held on Friday 22nd June, 10:15am-12:00pm. Further details will be sent in the near future, including the agenda and minutes of the 2011 meeting. It would be appreciated if you or an appointed member from your society could join this annual meeting to discuss the progress and plans of the IFSSH. If your society wishes to appoint a proxy, please inform the secretariat ([email protected]) and they will be included in all future correspondence relating to the meeting. We look forward to seeing you in Belgium. Kind regards, Zsolt Szabo, Secretary-General, IFSSH ASSH Founding Members

The initial meeting of the American Society for Surgery of the Hand, held at the Blackstone Hotel in Chicago in January 1946 was attended by 26 of the 35 designated founders. A portion of that group is pictured above. Left to right: Darrel T. Shaw, Joseph H. Boyes, Lot D. Howard, S. Benjamin Fowler, Sterling Bunnell, Arthur Barsky, Donald D. Slocum, Walter C. Graham, J. William Littler, William Metcalf, Richard H. Mellen, Gilbert Hyroop, Donald R. Pratt, William F. Frackelton, Robert ifssh L. Payne, Jr. Not pictured: Harvey S. Allen, Hugh Auchincloss, Julian M. Brunner, Condict W. Cutler, Homer D. Dudley, Alfred W. Farmer, Gerald Gill, Edward Hamlin, Deryl Hart, Sumner L. Koch, William M. Krigsten, Clarence A. Luckey, Henry C. Marble, Michael L. Mason, Joseph I. McDonald, James T. Mills, George S. Phalen, William H. Requarth, Thomas W. Stevenson, George V. Webster

IFSSH ezine FEBRUARY 2012 5 announcement Reaching new heights: hand surgery for sport By Loris Pegoli

The International Society for Sport hand surgeons, orthopaedic Traumatology of the Hand (ISSPORTH) surgeons, sports physicians, is devoted to the treatment of hand therapists and other hand conditions specifi cally regarding the specialists and other specialists and hand and the wrist in athletes. It was professional fi gures who have a founded in Italy in March 2011 by a major interest in the anatomy and group of hand surgeons and hand function of the hand and wrist. therapists from all over the world (from The Governance of the society is Europe, Australia, Africa, Asia, North composed by an executive board and South America). formed by a President - Alejandro Membership is open to surgeons The main purpose according to the Badia (USA), Vice-President – as well as hand therapists with an by-laws of our society are: Riccardo Luchetti (Italy), General eye to athletic trainers and allied 1. to promote the unrestricted and Secretary - Loris Pegoli (Italy), health professionals caring for the complete exchange of knowledge Treasurer- Paolo Cortese sportsman. The idea of founding a among the participating members (Italy). Furthermore there is a new scientifi c society addressing of the Society delegate representatives from the treatment of wrist and hand 2. to exchange knowledge through each continent: Mike Hayton conditions in athletes emerged from publications and scientifi c (Europe), Micheal Solomons the frequent observation, worldwide, meetings (Africa), Steven Topper (North that meetings regarding hand surgery, 3. to facilitate and expand the America), Eduardo Pereira (South sports, orthopaedics and traumatology opportunities for study and America), Moroe Beppu (Asia) often lacked presentations specifi cally research within and among the and Gregory Bain (Oceania), as regarding the subject of athletic participating members and to well as an Hand Therapist Delgate injuries. promote cooperation between Tracy Fairplay and an Olympic

6 IFSSH ezine FEBRUARY 2012 announcement

Committee Delegate Mike Loosemore. interest in this fascinating subject. This “Membership is ISSPORTH is still in its infancy as a on-going interest already has lead to society, but very active and growing the organisation of other meetings open to surgeons in new members from all over the and symposiums that will be held as well as hand world in a short period of time, as in the near future (February 2012 in well as gaining interest from fi gures Miami, May 2012 in therapists with not strictly related to surgery or Estonia and February 2013 in an eye to athletic rehabilitation. Many medical sub- Japan). ISSPORTH has the goal of specialty societies are established each being a society open to anybody who trainers and year. We, as would like contribute their specifi c allied health ISSPORTH and all its members, knowledge concerning the global would like to be a reference point, in treatment of athletic wrist and hand professionals collaboration with IFSSH which we injuries. consider as our parent organisation. caring for the Our inaugural symposium was For more information sportsman” organised in Milan in March 2011 with please contact us: a large number of participants thus E mail: [email protected] demonstrating that there is a great Website: www.issporth.org

IFSSH ezine FEBRUARY 2012 7 pulse: committee reports

IFSSH Committee on the musician’s hand The following Report is submitted under the auspices of the IFSSH Committee on the Musician’s Hand Chairman: Peter C. Amadio. Members: Ian Winspur, Naotaka Sakai and Massimo Ceruso Musculoskeletal conditions affecting the musician By Ulrich Mennen

Introduction to perform. One may add that regular only known once they reach puberty. Since the dawn of mankind, music practising cultivates a healthy self- The next stage is extensive training has been an integral part of human discipline. under scientifi c supervision with the culture. Music has been used for If the budding musician loses necessary backup from teachers, various purposes, such as pleasure, the enjoyment of music making, it trainers, and a range of health entertainment, worship and eventually may become a burden. professionals. This period usually lasts communication. When the eff ort to achieve becomes about 10 to 15 years. Two important factors have greater than the reward of having Musicians on the other hand, infl uenced these purposes of music achieved, loss of interest is almost usually start even before school making. Firstly, the discovery that guaranteed and a basis for ailments age. Their talent is recognised very music has a defi nite enhancing could become a reality. Once early on and is gradually promoted infl uence on the mental and cognitive pressures, demands and stresses through training and encouragement. development of children, which become the overriding driving force It is expected of them to perform at takes place even in utero. Secondly, behind the child’s playing of music, each concert without any mistakes. competition has become an integral psychosomatic symptoms and signs Musicians are also expected to adapt part of social activities, education and may develop. to their instruments (which may be training in the modern word. This is Musicians could be compared to ergonomically not suited for the transferred to young children who athletes. Although athletes may start particular individual), as well as their grow up with the constant pressure at an early age, their full potential is surroundings. Often they live a lonely

8 IFSSH ezine FEBRUARY 2012 pulse: committee reports

IFSSH ezine FEBRUARY 2012 9 pulse: committee reports

life because of long hours of practising, “the musician for any performance is warm-up and their support system may consist exercises. This will prevent micro- and only of close relatives and friends. Even practises many macro injuries to the muscle fi bres, from their colleagues one may fi nd more hours than tendons, ligaments, sliding tissue severe criticism, jealousy and even planes, and all the various receptors outright negative feelings. Furthermore, the average and nerve endings responsible for the musician practises many more athlete, often does sensory input (such as two-point hours than the average athlete, often not take a break discrimination, proprioception, does not take a break over weekends vibration sense, temperature or holidays and may perform right up over weekends or changes, light and deep pressure and into old age. Also, with the ‘normal’ holidays and may stereognosis). handicaps of everyday living such as A further aspect is the clear arthritis, injuries and other ailments, perform right up understanding that peak performance the musician often battles to adapt into old age” and endurance of fi ngers and the or tolerate these handicaps without hand can only be achieved if the seeking medical help. supporting foundation also has the The incidence of medical conditions necessary strength and endurance. in musicians is unclear but some These foundations include the elbow, reports claim that up to 90% of hydrates before an event. This keeps shoulder, neck, back and the whole musicians may suff er some ailment the tissues soft, pliable and promotes torso. Most musicians severely neglect during their career. The aim of this lubrication between tissue planes this aspect of their training. They report is to review the medical and and structures. The level of dexterity should get into a habit of regularly surgical conditions aff ecting the required from top musicians can only engaging in physical exercises, such as musician, and to provide a practical be achieved if the tissues are well non-contact sport or workout at home approach for their management (1-5). lubricated to allow gliding, and the or in a gym. muscles, which move these tissues, 3. Posture Preventative approach have enough energy (carbohydrates Musicians and their teachers often 1. Lifestyle and diet and lipids) and building blocks underestimate the importance of The old dictum ‘practise makes perfect’ (proteins). a balanced posture. Many musical is very applicable to the musician, and 2. Musculoskeletal system instruments are of a poor ergonomic long lonely hours are spent to master The best performance can be achieved design. Teachers should also be pieces. These music students often from the mid-position of a muscle, i.e. sensitive to normal anatomical miss out on normal child’s play, sport, the resting or balanced position of the variations in people. Some students socials and other activities. Parents muscle. This will allow excursion of have diffi culty in full pronation of and teachers should understand the muscle, either side of this resting their forearms which make piano that a balanced lifestyle will ensure a position, and also enhances the playing rather diffi cult. Others may balanced and healthy child. amount of muscle power generated. have connections between their Some foods are heavy on the Athletes are well aware of this tendons, which would make individual stomach and may interfere with the important physiological principle, and fi nger playing diffi cult or impossible student’s concentration. Drinks with use stretching exercises to improve (e.g. Linburg-Comstock connection gas and stimulants like caff eine should the excursion on either side of the between Flexor polices longus and best be avoided. It is important to mid-point. This should also apply to Flexor digitorum profundus of the re-hydrate the musician before any musicians (6). index fi nger), or a non-functioning performance just as an athlete re- Another indispensable preparation Flexor digitorum superfi cialis to the

10 IFSSH ezine FEBRUARY 2012 pulse: committee reports

small fi nger. Many other examples exist. Professional help in this regard could earlier. These exercises could be It is of no use to force the child to do be gained from trained occupational either isometric or isotonic muscle certain movements, if it is physically therapists, who are knowledgeable contractions. not possible or very diffi cult. A full about the physical and psychological Isometric muscle contraction neurovascular examination could demands of the performing arts. is responsible for stable fi xed joint exclude anatomical variations, which in 4. Exercise and training positions, i.e. no movement takes place, some cases could easily be rectifi ed. John Williams, the guitar player, is but the muscles stabilising the joints Musical instruments are not quoted saying that for every half- are co-contracted, whereas isotonic holy and should be considered for hour he practises he would rest for muscle contraction is responsible adaptation or change if musicians one half-hour. During the half-hour for active movement of joints. This have diffi culty in reaching certain rest, he would do stretching exercises contraction shortens and lengthens keys. Extensions and modifi cations as well as moving exercises. This is a the muscle with resultant movements, could easily be fi tted to instruments to very important physiological concept, such as the fi ngers. Stretching of allow for a more balanced hand and which needs to be understood by all muscles and nerves is an integral relaxed posture. For example, a violin musicians. Movement encourages part of exercise, which ‘resets’ the may be too short or too long, twisting blood fl ow and therefore function. full excursion of muscle and nerve the upper part of the body into an Function refers not only to muscle movement. All soft tissue structures awkward position, which will eventually power; but also to all the various need to glide, to prevent stiff ness. This lead to muscle spasms and pain. sensory modalities referred to is particularly true for nerves as well.

REPORT OF THE COMMITTEE ON THE MUSICIAN’S HAND The committee on the Musician’s Hand was established At this point, the Committee looks to the future and in 1995, and since then has continued with the same sees new opportunities. Firstly, an infusion of new members: Yves Allieu, MD, Peter Amadio, MD, Allen members is needed. Volunteers are welcome, and anyone Bishop, MD, Massimo Ceruso, MD, Naotaka Sakai, MD, interested in joining the committee should contact either Raoul Tubiana, MD, and Ian Winspur, MD. Over the years, the IFSSH Secretary General or the committee chair the committee has given overviews on focal dystonia, ([email protected]). Second, it is clear that the role of carpal tunnel syndrome, and cubital tunnel syndrome reeducation requires emphasis, consideration should be as they affect musicians. In addition, committee given to making this a combined IFSSH-IFSHT committee members have edited two textbooks on the subject of in the future. Finally, over the past few decades a number the musician’s hand: The Musician’s Hand, edited by Ian of multidisciplinary national societies of performing Winspur, MD, and Medical Problems of Instrumental arts medicine have been created. The groups in the Musicians, edited by Raoul Tubiana MD and Peter C. USA, UK, France, the Netherlands, Germany and Italy are Amadio, MD. The former text has been translated into particularly active. IFSSH should consider both publicising Japanese and Korean. the dates and locations of these national meetings when Care of the musician’s hand has evolved greatly since they are known, and encouraging participation of IFSSH the committee was formed. Principally, there is a greater member societies in these performing arts organisations appreciation of the importance of nonsurgical therapies, where appropriate. especially reeducation and pedagogy. An alliance of Respectfully submitted, clinician, musician, therapist and teacher is necessary for Peter C Amadio, therapeutic success in many if not most cases. MD, Chair

IFSSH ezine FEBRUARY 2012 11 pulse: committee reports

Nerves need to glide and be stretched. internal scar tissue formation and All stretching and active exercises However, prolonged continuous fi brosis with permanent symptoms must be done without pain. Pain is the stretching and compression, for and signs of nerve compression. It is signal that tissues have been damaged example, around corners at joints such therefore important to any performer (torn), which leads to infl ammation as the ulnar nerve at the elbow, causes that whenever he or she has a chance and swelling, and eventually to scar ischaemia because of reduced blood to relax between performances or (fi brosis) formation. This fi brosis will fl ow. Short-term ischaemia causes ‘pins pieces, soft tissues should be relaxed, reduce the amount of gliding of and needles’ (paraesthesias), numbness stretched and exercised to stimulate tissue planes (because of adhesions) and a burning pain, whereas longer- blood fl ow(6). Active relaxation is a and reduce the amount of muscle term ischaemia causes external and technique which physiotherapists excursion (because of restricted could teach musicians to reduce elasticity). muscle spasms, fatigue and improve blood fl ow. Relaxation exercises Approach to specific problems Table I: History can be attained by a number of One should emphasise a holistic ● Gender methods, which include the Alexander team approach to the management ● Age technique(7), the Feldenkrais of health problems in musicians(9). ● Musical history method(8) and yoga. Those most intimately involved with ● Symptoms – cramps/pain/ the musician, such as parents and weakness/sensory defi cit teachers, should be sensitive to pick (pins & needles, dead feeling, up any ailments and concerns(10). The burning sensation)/subjective Table II : Examination musician should have the courage to perception of diffi culty in ● General medical examination approach the teacher and the parents coordination and/or stiff ness ● Neurological examination – with any problems that she or he may ● Signs – sweating/heart motor/sensation face before serious conditions could rate increase/dry mouth/ ● Vascular examination – evolve. A case in point was a young, palpitations swelling/blood supply/ very talented musician, complaining ● Cognitive signs – forgetting/ sweating/temperature of severe aches, pains and spasms fright/fear ● Physical examination – in both her arms, which would only ● Behavioural signs – drugs/ pinpoint tenderness/posture/ improve on rest. Physical examination medicine/tablets/pills/alcohol/ muscle co-ordination/power did not reveal any abnormalities. cancelling performances ● Perform with instrument/ However, her history indicated that ● Social activities – friends/ simulate she would develop these symptoms parents/teachers ● Specifi c examination of only after two hours of uninterrupted ● Sporting activities – regular aff ected part high performance playing. This was exercises/relaxation exercises ● Special investigations – demanded by her teacher to ‘improve ● Hobbies sonar/x-rays/bone scans/nerve muscle power and endurance’. This kind ● Financial conduction/MRI of illogical approach, unsympathetic ● Career stresses – competition/ ● Blood test (RA, DM, Gout, behaviour with an unfounded scientifi c job security/conductor/fellow Muscle enzymes, FBC, ESR, LFT, basis should be strongly discouraged. musicians/parents CRP) It is important to explain to ● Triggering factors – overuse/ ● Diagnostic measures – local musician patients the basic anatomy type of instrument (musician- anaesthesia + steriods and workings of their bodies, and instrument interface) ● Consultations how things could go wrong. This will diminish fear, uncertainty and

12 IFSSH ezine FEBRUARY 2012 pulse: committee reports

anxiousness. It will also help to improve communication and co-operation. PHYSICAL PSYCHOLOGICAL The musculoskeletal conditions aff ecting musicians can be grouped ORGANIC POSTURAL EXTERNAL INTERNAL

into three sections: llla Table LOCAL GENERAL Overuse Patient- Stress Dystonia Ganglion Eg. RA Misuse instrument Financial Emotional 1. Common, everyday life ailments Arthritis OA Abuse interface • Death Dupuytren DM Weakness • Fear such as injuries, arthritis, rheumatic DIAGNOSIS Trigger Finger Gout Imbalance • Anxiety Anatomical In-coordination conditions and nerve compressions. abnormality Tennis elbow 2. Overuse (too much of a normal Nerve compression activity), abuse (willfully causing • Central • Neck damage) or disuse (incorrect activity • Local or position). These are seen with poor posture, imbalances, and over Conservative Relaxation Position change Psychologist ‘Begin at the beginning’ training. Medical Strengthening exercise Instrument change Counsellor Limited graded Table lllb Table Surgical Stretching exercise Instrument adaptation exercises 3. Stress related ailments such as Coordination exercise Technique change Limited graded practise Postural exercise Gadgets Re-education musicians’ cramps, spasms, and Sensory exercise Hypnosis Acupuncture dystonia. Botulinum toxin In order to arrive at a diagnosis and MANAGEMENT a plan of management, a thorough history and examination is mandatory. Table I lists some of the pertinent MDP bone scans, blood tests (to when the clinician is uncertain about points that need to be clarifi ed in order exclude conditions such as gout, the diagnosis. to put the patient and his/her problem rheumatoid arthritis, diabetes), into proper perspective. biopsies from nerve, muscle or Management synovium . This depends on the diagnosis and may Examination ● Diagnostic therapy, e.g. local be multipronged as depicted in Table Apart from the points summarised in anaesthetic with or without steroid IIIb. Table II, the following should also be injections may be indicated to Once a diagnosis is made considered: exclude or confi rm certain painful the management from the hand ● The general clinical examination conditions. surgeon’s point of view is relatively which includes sensory, motor and ● Consultations with the other team straightforward. An anatomical vascular examination, should always members or experts for second variation may be corrected, a tumour compare with the contra-lateral opinions are often helpful before a may be removed, a web space may normal side. fi nal diagnosis is made. be deepened or widened and arthritic ● Demonstration with the instrument joints may be dealt with in various is often essential to highlight the Diagnosis ways. Special consideration should of problem. It may not always be easy to arrive course be given when dealing with the ● Specifi c examination of the involved at a diagnosis. Table IIIa indicates the musician’s hand, such as placing the part should be done systematically, interrelationship between physical and surgical scar in a position which would gently and meticulously. psychological conditions; e.g. a tennis not interfere with the performance of ● Specialised investigations may be elbow could lead to poor posture the musician’s hands and fi ngers. An needed to confi rm and complement which in turn presents as a dystonia. arthroplasty for an arthritic proximal the clinical examination, e.g. sonar, Cautionary note: NEVER label a interphalangeal joint may be more nerve conduction, x-rays, technetium patient with an ‘arbitrary’ diagnosis, appropriate than an arthrodesis in

IFSSH ezine FEBRUARY 2012 13 pulse: committee reports

certain instrument players, whereas “peak performance some swelling) ending in a painful the reverse may be true in others. The compartment syndrome. Conservative range of excursion (arc of movement) and endurance of management may include an anti- of fi nger joints need to be considered fingers and the infl ammatory drug, ice, and pressure when reconstructive surgery is done garment. If this prooves to be and may diff er depending on the type hand can only unsuccessful, a surgical decompression of instrument played. be achieved if (fasciotomy) may be indicated. During the medical examination the supporting The gliding of tissues can be the emphasis should be on evaluating curtailed severely by swelling. The balance and coordination, and not only foundation also synovium, is an anatomical structure to strength and endurance. Sometimes has the necessary enhance gliding. Once this gliding layer one sees an unbalanced posture of which is responsible for lubrication non-physiological position, which strength and is infl icted by disease and swelling, distorts the whole body resulting in a endurance” movement will be severely aff ected. strained back, twisted neck, elevated Stiff joints and fi ngers can often be shoulders, bent elbows and fl exed treated with an anti-infl ammatory drug wrists. Aches, pains and spasms will to reduce the swelling and increase surely follow; and need to be addressed movement. Swollen fi ngers can benefi t by restoring balance, prescribing and strengthening exercises, hydration, greatly by wearing elastic gloves. appropriate exercises and attending to posture, etc. RSI is an artifi cial Sensory education and the musician-instrument interface. diagnosis seeking to place blame development has never been stressed Hyperlaxity of ligaments and on some ‘other cause’ and therefore when training musicians. One modality therefore of the joints, may be a severe compensation may be claimed. To of sensation, namely proprioception, handicap to musicians. This laxity may label a condition as RSI is dangerous is such a fundamental function of all be generalised, involving joints and/ and often unsupportable. Mostly one the joints of the body that without this or tendons and ligaments; or localised, would fi nd an underlying condition (eg modality no musical instrument can be involving sets of joints, ligaments or De Quervain stenosingtenosynovitis) played. Therapists should concentrate tendons or only one joint, ligament or which is being aggravated by the on proprioceptive acuity after an injury, a tendon. Surgical plication, shortening playing of an instrument. This needs surgery or in patients with hyperlaxity. or tightening of these structures may to be treated. It is not the instrument During the rehabilitation phase, the be needed. playing which caused the condition in measurement of improvement helps Repetitive strain injuries (RSI), the fi rst instance(11), (12), (13). as a psychological boost, however it is sometimes referred to as ‘cumulative important to set limited, graded goals trauma disorders’, is a very controversial Other indications for a slow build-up especially if the topic. It would be prudent to either Compartment syndrome of certain original problem was due to overuse, make a defi nite diagnosis or regard muscles or muscle groups, eg misuse or disuse. the problem as disuse, overuse or hypothenar muscles and more Occupational cramps, or to be abuse rather than label the patient specifi c the Abductor digiti minimi, more specifi c, musicians’ cramps are with RSI. Under normal circumstances, can develop in piano players with also referred to as focal dystonia. tissues can handle extensive exposure relatively small hands who have to Provided physical conditions, postural to repetitive movements over long over-stretch to reach all the keys. imbalances and overuse injuries have periods without tissue damage, Certain demanding pieces, and having been eliminated, one may consider provided the general precautions have practised with great eff ort, may cause a diagnosis of dystonia. The cause of been taken, e.g. warming up, stretching hypertrophy of the muscle (with dystonia is still poorly understood. It

14 IFSSH ezine FEBRUARY 2012 pulse: committee reports

is suggested that the ‘strain is in the brain’, i.e. that the normal intricate THE IFSSH AND ITS COMMITTEES: interaction between the many parts in AN IMPORTANT ANNOUNCEMENT the brain which work together during music playing, becomes somehow disorganised. The delicate and complex One of the tasks of the President of the IFSSH is to appoint Chairpersons and integration between sensory input, Committee Members for the 30 Committees which form the backbone of interpretation, and motor execution the IFSSH. These Committees are extremely important in that they compile becomes scrambled. It may be reports on all the many aspects of the Hand. These include amongst others: triggered by many factors. It may terminology, anatomy, function, evaluation, management, classification, occur with one instrument, but not therapy, prognosis, etc. These reports should be seen as ‘oracles’ of the with another. Only one fi nger may be IFSSH, since they represent a balanced view of respected colleagues involved, or more than one including internationally. Serving on any of these Committees is an achievement, and other parts of the arm. Only certain an honour, but also carries a responsibility. music pieces may elicit the spasms. You may want to volunteer to offer your expertise and make a very The management thereof should be important contribution. If so, please contact the IFSSH President. very sensitive and with a great deal of empathy, understanding and patience. Guidelines that regulate the IFSSH Committee System Stressful situations such as overbearing 1. The President and the President -Elect shall work together to ensure a parents or unreasonable teachers continuity in soliciting Reports from appointed Committees. (ie reports should be identifi ed and dealt with from committees should be an ongoing process, and not restricted to the circumspection. 3 year term of a president) Assessments by occupational, 2. The Committee Chairpersons are identified for their expertise by the physical and hand therapists as well as President (and assisted by the President-Elect) and requested to solicit the psychologist could prove helpful. additional committee members (max 4) to assist in producing a report on: Once the problem is unraveled, a. a specific topic analysed and understood it is advisable b. which can be published as an ‘oracle’ of the IFSSH, to start right at the beginning c. which will not be controversial or be the view of an individual, and slowly build up to a level of d. but reflect the view of the current ethos of the Hand Surgery Fraternity, performance, which would match the e. will present the report within a designated time (max 6-9 months), ability of the musician. Again, slow, f. which will be published in the IFSSHezine and posted on the IFSSH graded, and attainable goals should be website for the benefit of all the members of the IFSSH. set. The brain therefore needs to be ‘re- set’ (14), (15), (16). 3. The reports should be concise, could be overview reports, but to the point, non-controversial, universally acceptable information, and include the Long-term strategies latest available information on the topic. It will therefore be a formal Since many conditions may be document which will reflect the viewpoint of the IFSSH community interrelated and may have an 4. The Committee shall serve for a period of 3 years, which may not emotional or a psychological overlay, necessarily coincide with the term of office of the president, ie the a combination of treatment options Committee term may overlap presidential terms. Since these are official need to be considered. This includes IFSSH committees, serving on them will be regarded as an honour and drug therapy for stage fright, anxiety, professional achievement. excessive sweating and tremors. Musicians should not use sedative

IFSSH ezine FEBRUARY 2012 15 pulse: committee reports

drugs such as the benzodiazepines, “proprioception become psychologically dependent since they cloud judgment, cause on this ‘crutch’, so that performance sleepiness and depression and lead is such a without these drugs may become to addiction. Alcohol may ‘calm the fundamental diffi cult or even impossible. nerves’ and boost one’s confi dence, but also may cloud the judgment and function of all Conclusion suppresses refl ex time. It may be wise the joints of the Very often factors such as job security to follow the general rule: Don’t drink body that without and pressure from peer and support and play. groups prevent the musician from Caff eine, which is contained this modality no making an issue of his or her specifi c in coff ee, tea and cola, may cause musical instrument ailment. Musicians should develop the tremour, anxiety and insomnia. confi dence to approach their teachers, Other drugs, such as beta-adrenergic can be played” conductors, parents and peers when receptor antagonists (e.g. propranolol) they have a problem. It is better to block the physical eff ects of adrenaline solve the problem earlier rather than such as anxiety, tremour, sweating later, as it will make rehabilitation and reduce the heartbeat. Generally, optimal performance. When these are and the earlier achievement of peak they are safe in healthy people, prescribed for the fi rst time, the dose performance much easier. Musicians but should not be used in patients and timing should be tried during should also have the right to have ‘off with asthma, heart problems and a non-important event. However, days’, make mistakes and be ‘out of pulmonary obstructive disease. Side on a cautionary note, one should synch’ with their biological clockwork. eff ects may however include slowing emphasise that these medicines Often insurmountable problems, as of fi nger movement and insomnia. should only be used as single doses seen from the musician’s perspective, These drugs do not enhance for the exceptional occasion. If a drug may indeed be a simple medical performance, but will allow a more is used regularly the musician may problem that could easily be solved.

References 5. Brockman R, Chamagne Artists 1989; 4:159-62. Upper Extremity Motions in the 1. Winspur I, and Wynn Parry CB. P,Tubiana R. The upper extremity 9. Rietveld B. Performing arts clinics Workplace Are Not Hazardous. J The Musician’s Hand. J Hand Surg in musicians. In:Tubiana R (Ed.): – a Dutch approach. Performing Hand Surg: 1997,22A(l):19-29. 1997;22B(4):433-40 The Hand, Philadelphia, W B Arts medical News, 1995; 3:12-18. 14. Critchley N. Occupational 2. Winspur I. The professional Saunders 1990 4:873-85 10. Graff man G. Doctor; can you palsies in musical performs. musician and the hand surgeon. 6. Eins M, Dedekind K, Mennen lend an ear? Medical Problems of In: Critchley N, Henson R In: Vastamaki M et al (Eds): U. Mobilization of the Nervous Performing Artists, (Journal) 1986; (Eds): Music and the brain. Proceedings of the 6th Congress System of the Upper Limb; 1:3-4. London,Heinemann,1977:365. of IFSSH. Helsinki, Bologna, SA Bone & Joint Surgery 11. Vender MI, Kasdan ML, Truppa 15. Lederman R. Neuromuscular Monduzi Editori, 1995:1207-11. 1966;6(3):110-23 KL. Upper extremity disorders. problems in the performing arts. 3. Wynn Parry CB. Musicians suff er a 7. Rosenthal E. The Alexander A literature review to determine Muscle and Nerve 1994, 17:569- variety of problems. J Hand Surg Technique, what it is and how work-relatedness. J Hand Surg 577. 1994; 19B (Supplement):11-12. it works. Medical Problems of 1995; 20A:534-41. 16. Altenmüller E. Focal dystonia: 4. Amadio PC, Russotti GN. performing Artists, (Journal) 12. Barton NJ, Hooper G, Noble J, advances in brain imaging and Evaluation and treatment of 1987; 2:53-57 Steel WM. Occupational causes of understanding of fi ne motor hand and wrist disorders in 8. Spire M. The Feldenkreis Method. disorders in the upper limb. BMJ control in musicians. Hand Clinics musicians. Hand Clinics 1990; An interview with Anat Baniel. 1992; 304:309-11. 2003:19; 523-538 6:405-162. Medical Problems of Performing 13. Hadler NM, Hill C. Repetitive

16 IFSSH ezine FEBRUARY 2012 COMING SUMMER 2012

Thieme is pleased to announce the launch of the Journal of Wrist Surgery, a new original research publication devoted to open and arthroscopic surgery of the wrist joint.

editorial board

Editor in Chief David J. Slutsky M.D.

Deputy Editors Gregory Bain (Australia) Luc De Smet (Belgium) Guillaume Herzberg (France) Pak-Cheong Ho (Hong Kong) Philippe Liverneaux (France) Christophe Mathoulin (France) Toshiyasu Nakamura (Japan)

We look forward to receiving your manuscripts via our online submission website: http://mc.manuscriptcentral.com/jws For author instructions and further information about publishing in or subscribing to the Journal of Wrist Surgery, visit www.thieme.com/jws IFHST Hand Therapy

IFSHT: Hand Therapy HAKIR A national quality register for hand surgery in Sweden

Editor’s note: “The Hand Therapy Relevance and purpose register. We are aiming for a complete contribution in this issue comes from Many medical disorders manifest in national coverage within the next 2-3 Sweden. In an eff ort to measure the the hands and one out of fi ve injuries years. outcome of surgery and therapy in an emergency ward is a hand injury, as well as various methods and often in young and active patients. Design and outcome measures procedures, a broad based national Hand function is important for the All patients that are operated on at registry is being introduced to monitor individual’s independence in activities the hand surgery department are the effi cacy of the management of daily living, as well as for the ability included in a basic registration. This of various hand conditions. This to work. The seven specialised hand includes data on which operation has National Registry could reveal surgery departments in Sweden been performed, all complications interesting information, such as together perform approximately 20 that may have lead to a second ‘claimed results’ (third party involved) 000 operations per year. Within the operation, e g, infection, tendon vs ‘ perceived results’(second party speciality of hand surgery there has rupture, nerve damage etc, and the involved) vs. ‘ patient satisfaction’(fi rst been no previous national quality use of prophylactic antibiotics. In the party involved) !” register. HAKIR aims to continuously basic registration, all patients also and with standardised methods, follow receive a questionnaire before the up hand surgical quality of care, using operation, as well as 3 and 12 months patient reported outcomes, as well as postop. The questionnaire includes objective measurements in order to 8 visual analogue scales on specifi c gradually increase eff ectiveness and hand symptoms, as well as a validated improve patient care and safety. disability score (QuickDASH). After surgery, patient satisfaction is also National coverage and annual volume scored. For ten selected operation All seven departments specialised in types, an extended registration is hand surgery in Sweden take active added including more information part in HAKIR and will in time start to on the procedure performed and also

18 IFSSH ezine FEBRUARY 2012 IFHST Hand Therapy

functional outcome measures, such as occupational therapists mostly and implants for fracture surgery. range of motion and grip strength. perform the measurements, since The relatively small number of they are accustomed to measuring patients makes it diffi cult to perform Reporting data and able to show good reliability for randomised controlled trials with Reporting of data into the register comparison. suffi cient statistical power. Through takes place on four occasions; before standardised and continuous follow- surgery, at the time of surgery, 3 and Feedback and data analysis up of hand surgical quality of care, 12 months post surgery. HAKIR is All participating departments have including patient reported outcomes entirely web-based; including the complete and continuous access to as well as functional outcomes, questionnaire, but it is also possible their own data and are responsible surgical techniques can be compared to register on paper. Patients get for giving feedback to the individual and techniques associated with a reminders for postop questionnaires patient, as well as for using the data higher risk of complications are more through a sms-service and register in clinical improvement. A data report easily sorted out. Quality registries their data on-line. is presented at the annual meeting also promote the standardisation of of the Swedish Society for Surgery of surgical methods and postoperative National measurement manual the Hand and at the annual register treatments, which can help optimise In order to reach high reliability day. Continuous feedback, general health care. Last but not least, this new and validity in the register, the information and all protocols are register will ensure that the patient rehabilitation units in all Hand Surgery available at the register website: www. reported experience of care receives departments have developed a hakir.se. more attention. Swedish clinical assessment. This assessment is called the National Why is HAKIR important? Annika Elmstedt RPT Measurement Manual and includes During the last decades, several new Head of the Rehabilitation unit, Dept. of range of motion and strength and expensive surgical techniques Hand Surgery, measurements of the elbow hand have been introduced in the practice Södersjukhuset, Stockholm and fi ngers. Physiotherapists and of hand surgery; e g, joint prostheses www.hakir.se

IFSSH ezine FEBRUARY 2012 19 Remembering our Pioneers

Pioneers in Hand Surgery

IFSSH Pioneer profile: Professor Raoul Tubiana Professor Tubiana has made major contributions to Hand Surgery in his authorship of major texts and scientifi c articles, his promotion and development of specialised hand surgery centers and his leadership in organisation of hand societies and teaching programmes. Professor Tubiana was born in Constantine. He studied medicine at the University of Paris, and completed his Medical Thesis in 1939. Following a year in the French Army, he was an intern of the Paris Hospitals from 1940 to 1942. Professor Tubiana’s excellence in Hand Surgery is partly the result of a remarkable multidisciplinary exposure and training as he relates so well in his book The Hand*. For three years he served as an Army Medical Offi cer with the French Liberation Forces in North Africa, Corsica, and France. While at the Reconstructive Surgery Unit of the First French Army, he was exposed to the Orthopaedic Surgery discipline, through the infl uence of Merle d’Aubigne and to the Plastic Surgery discipline through John M. Converse after completing his training in Orthopaedic Surgery. He developed a strong interest in hand injuries and burns. This has stimulated him to take a series of study trips, fi rst to England, visiting Gillies, McIndoe, Mowlem, Seddon, and Pulvertaft. He spent further 1966 and was Chief Editor of the Annals of Hand Surgery. time in the United States with Sterling Bunnell, Sumner Koch, Professor Tubiana was an honorary or corresponding Michael Mason, and Harvey Allen. member of many international societies including the Professor Tubiana was a Founding Member and British Orthopaedic Association, the American Society for Secretary General of the French Society for Surgery of Surgery of the Hand, the German, Italian, South American, the Hand from 1964 to 1972 and its President in 1973. He Dutch and Canadian Societies for Surgery of the Hand. was President of the French Society of Plastic Surgery in Professor Tubiana was a member of the Academy of Surgery 1972, and President of the British Society for Surgery of the and a Chevalier of the Legion of Honor. Hand in 1973. Professor Tubiana was the President of the Professor Tubiana and his wife Claude lived on the banks International Federation of Societies for Surgery of the Hand of the River Seine in Paris, overlooking the Notre Dame from 1972 to 1974. Cathedral. He was a collector and connoisseur of the fi ne Professor Tubiana was Associate Professor at the art which was refl ected in an outstanding collection of art University of Paris, Scientifi c Director of the Hand Institute masterpieces. since 1972, Chief Editor of the G.E.M.’s Monographs since “The Hand”, Vol 1 p XXI – XXXII, W B Saunders, Philadelphia, 1981

20 IFSSH ezine FEBRUARY 2012 Remembering our Pioneers

IFSSH Pioneer profile: Professor Claude Verdan Professor Verdan developed the fi rst clinic especially devoted to Hand Surgery. His work on primary suture of fl exor tendons infl uenced world thinking on this subject. His writings and presentations on the care of wounds of the hand are classical. He has had great interest in History and Art as related to the hand. Professor Verdan was a graduate of the Faculty of Medicine of Lausanne, Switzerland, where he distinguished himself by receiving the Medaille d’Or de la Faculte et le Prix Cèsar Roux. He did his postgraduate training in Lausanne, Geneva and Zurich, where he studied medicine, pathology, bacteriology and surgery. In 1946 he founded the Clinique Chirurgicale et Permanence de Longeraie in Lausanne and later became Chief of the Surgical Clinic of the University of Lausanne. He was Professor of Surgery at the Medical Faculty of the University of Lausanne where he also served Professor Verdan has been guest professor at many as Dean from 1972 to 1974, and later as Professor Honoris renowned Hand Surgery centers throughout the world. Causa. Professor Verdan was made a member of the Senate He delivered the Sterling Bunnell Memorial Lecture in of the Swiss Academy of Medical Sciences in 1974. San Francisco in 1971. He is the author of more than 320 Professor Verdan was a member of many national and publications and of three textbooks, including one on the international societies of Plastic and Reconstructive Surgery, “History of the Swiss Society of Plastic, Reconstructive and Hand Surgery, Orthopaedic Surgery, and Surgery, including Aesthetic Surgery.” Professor Verdan was a writer and an societies from France, Germany, Austria, Belgium, Spain, Italy, artist who has created several sculptures on his topic of England, and the United States. He is a founding member of fascination, the Hand. the Swiss Society for Surgery of the Hand which he served as Following his retirement from practice, Professor Verdan Secretary General from 1966 to 1972. He served as President was the dedicated Chief Editor of the Annals of Hand of several prestigious groups including the Sociètè Suisse Surgery from 1981 to 1985. In Lausanne, he has created the de Medecine des Accidents et des Maladies Professionnelles Musèe de la Main de L’Homme, a museum dedicated to the (1961-1966), the French Society of Plastic and Reconstructive study of the human hand and its fundamental importance Surgery (1964), the Swiss Society of Plastic and Reconstructive in the hierarchy of human evolution and values. Surgery (1973-19074), and the Groupe d’Etude de la Main Professor Verdan iwas an associate member of the (1975-1976). Professor Verdan was an Emeritus Member of Surgical Academy, Paris, and a Chevalier of the Legion of the International Society of Surgery and of the International Honor. Society of Orthopaedic and Traumatology. He and his wife Sylva resided in Lausanne, Switzerland.

IFSSH ezine FEBRUARY 2012 21 Case Study

Case Study

In our previous issue we posted this x-ray and asked what further management you would recommend.

HISTORY: 25 year old, male, right dominant, auditor, enjoys sport Injury: fell on left hand. November 2007 Diagnosis: Scaphoid fracture First operation: 2008 screw fi xation Second operation: 2009 screw fi xation & bone grafting Third operation: 2010 K-wire fi xation & bone grafting and radius stylodectomy Now: avascular necrosis proximal pole left scaphoid non-union Clinically: slight discomfort, more with axial pressure, no pain, wrist extension 0-30°, wrist fl exion 0-35°

Here is what some of our readers suggested: ● Vascularized bone graft or resect ● Scaphoidectomy + 4-corner and 12 weeks. Two mini (2.0) screws: distal scaphoid – Jim Urbaniak, USA fusion – Mario Luc, Canada better rotational stability, no « empty ● My proposal to the patient would ● If nearly no pain: let it be and » space between the threads, small be vascularized bone graft as a free protection splint for sports. If volume. Should be at least equal to from the medial femoral condyl symptomatic : large cortico-cancellous a vascularized bone graft, because or pediculated from the secon bone graft (iliac crest = good quality) big defect. - Michael Sturzenegger, metacarpal on the FDMA - Binka and fi xation with 2 mini screws and Switzerland Popova, UK casting for 3 months, rx controls 4,8 Thank you for sharing your answers!

22 IFSSH ezine FEBRUARY 2012 research roundup

CTS education class becomes effective treatment pathway United Kingdom

A study led by Sarah Dalton, a highly ulnar nerve symptoms or trigger “the new CTS specialised Hand Therapist, undertook fi nger/thumb. to evaluate the carpal tunnel class “Many patients are referred with class provides of patients and to assess outcome CTS to the hand therapy department an efficient and and effi ciency. In order to determine and seeing patients in a class situation the effi ciency and effi cacy of the helped to standardise advice and effective treatment management of patients with CTS treatment and allow effi cient working pathway for within a class setting, the results were practice,” she explained, adding that at patients with CTS” assessed and reviewed over a one-year the six-week telephone follow-up 47% period. patients required no further treatment, During this time, patients were 42% patients were recommended provided with an appointment for the for further investigation, and 11% of CTS class. All attendees completed patients either had or planned to have an initial assessment form and a 1:1 carpal tunnel decompression. assessment by a physiotherapist. A Sarah believes the new CTS class computer-based presentation was provides an effi cient and eff ective delivered within the class and patients treatment pathway for patients with were provided with prefabricated wrist CTS. “It’s important to understand splints in a neutral position and an that early referral to hand therapy education leafl et. Eighty-nine patients is advisable if splinting is to help were followed up by a telephone minimise/resolve symptoms. In call at six weeks and completed a addition, the role of nocturnal splinting telephone outcome form. A discharge and the use of neutral splinting (versus letter was completed and sent to splinting in classic future position of the referrer advising of the patients’ extension) are also important. This JOURNAL REFERENCE outcome with further treatment also demonstrates the role of patient Service development and recommendations if appropriate. education in helping with ergonomic evaluation of a new carpal tunnel For Sarah, the most interesting induced symptoms,” she concluded. syndrome education class outcome of this research was that Hand Therapy March 2010 vol. 15 most patients had improved or no. 1 13-19 resolved their nocturnal symptoms [http://ht.rsmjournals.com/ with nocturnal splinting, many did content/15/1/13.abstract] not have cervical referred symptoms, however some patients referred had

IFSSH ezine FEBRUARY 2012 23 Journal Highlights

Below is a selection of contents pages from the latest issues of the following leading hand surgery journals. Hover your mouse over each article heading and click to go to the original abstract page of the article. Hand Volume 6, Number 4, December 2011

■ Percutaneous fasciotomy for the ■ Retrospective analysis demonstrates no ■ Tendon injury produces changes in treatment of Dupuytren’s disease—a advantage to operative management of SSCT and nerve physiology similar to systematic review - Saoussen Salhi, Etienne distal ulna fractures - Emily A. Williams and carpal tunnel syndrome in an in vivo rabbit Cardin-Langlois and Mario Luc Jeff rey B. Friedrich model - Tamami Moriya, Chunfeng Zhao, ■ Upper extremity and digital replantation ■ Analysis of the inter- and intra-observer Stephen S. Cha, James D. Schmelzer and - Marco Maricevich, Brian Carlsen, Samir agreement in radiographic evaluation Phillip A. Low, et al. Mardini and Steven Moran of wrist fractures using the multimedia ■ A new technique of locked, fl exible ■ A retrospective multicenter study messaging service - Andrea Ferrero, Guido intramedullary nailing of spiral and of the Artelon® carpometacarpal joint Garavaglia, Roland Gehri, Ferruccio Maenza comminuted fractures of the metacarpals: implant - Robert Bell, Sanjay Desai, Hugh and Gianfranco John Petri, et al. a series of 21 cases - Mandar V. Agashe, House, Terrence O’Donovan and Andrew ■ Transillumination of hand tumors: a Sanjay Phadke, Vikas M. Agashe and K. Palmer cadaver study to evaluate accuracy and Hemant Patankar ■ Surgical management for malignant intraobserver reliability - Holger C. Erne, ■ Transverse anatomic landmarks for the tumors of the thumb - Mark E. Puhaindran, Thomas R. Gardner and Robert J. Strauch A1 pulley of the thumb - Ron Hazani, Josh Corey P. Rothrock and Edward A. ■ Changing trends in pediatric upper Elston and Bradon J. Wilhelmi Athanasian extremity electrical burns - Simon G. Talbot, Joseph Upton and Daniel N. Driscoll

Journal of Hand Surgery (European Volume) Volume 37, Issue 2, February 2012

■ Simplifying four-strand fl exor tendon ■ Two-year outcomes of Elektra prosthesis ■ Accuracy of intrasheath injection repair using double-stranded suture: for trapeziometacarpal osteoarthritis: a techniques for de Quervain’s disease: a a comparative ex vivo study on tensile longitudinal cohort study cadaveric study strength and bulking ■ Addition–subtraction osteotomy with ■ Comparison of surgical treatment and ■ Bioreactor optimization of tissue ligamentoplasty for symptomatic trapezial nonoperative management for radial engineered rabbit fl exor tendons in vivo dysplasia with metacarpal instability longitudinal defi ciency ■ Severe ulnar nerve entrapment at the ■ Improvement in pinch function after ■ Bone bridge resection for correction elbow: functional outcome after minimally surgical treatment for thumb in the plane of distal radial deformities after partial invasive in situ decompression of the hand growth plate arrest: two cases and surgical ■ Socioeconomic deprivation and the ■ Arthrodesis of the wrist with bone technique epidemiology of carpal tunnel syndrome autograft and Hoff mann external fi xation

24 IFSSH ezine FEBRUARY 2012 journal highlights

Journal of Hand Therapy Volume 25, Issue 1, January 2012

■ Eff ectiveness of Diff erent Methods ■ Eff ect of Total End Range Time on ■ A Retrospective Review to Determine of Resistance Exercises in Lateral Improving Passive Range of Motion - the Long-term Effi cacy of Orthotic Devices Epicondylosis—A Systematic Review - Kenneth R. Flowers, Paul C. LaStayo for Trigger Finger - Kristin Valdes Jayaprakash Raman, Joy C. MacDermid, ■ Common Interlimb Asymmetries and ■ The Hamilton Inventory for Complex Ruby Grewal Neurogenic Responses during Upper Limb Regional Pain Syndrome: A Cognitive ■ Eff ect of Lateral Epicondylosis on Grip Neurodynamic Testing: Implications for Debriefi ng Study of the Clinician-based Force Development - Amrish O. Chourasia, Test Interpretation - Benjamin S. Boyd Component - Tara Packham, Joy C. Kevin A. Buhr, David P. Rabago, Richard ■ Cross-cultural Adaptation and MacDermid, James Henry, James R. Bain Kijowski, et al. Psychometric Testing of the Hindi Version ■ The Long-term Relationship of the Patient-rated Wrist Evaluation - between Duration of Treatment and Saurabh P. Mehta, Bhavna Mhatre, Joy C. Contracture Resolution Using Dynamic MacDermid, Amita Mehta Orthotic Devices for the Stiff Proximal ■ Management of Dominant Upper Interphalangeal Joint: A Prospective Extremity Injuries: A Survey of Practice Cohort Study - Celeste Glasgow, Jenny Patterns - Kathleen E. Yancosek Fleming, Leigh R. Tooth, Richard L. Hockey

Hand surgery: Asia Pacific Volume 16, Issue 3 2011

■ Ultrasonographic fi ndings in cubital ■ Locking palmar plate fi xation for dorsally ■ High defi nition ultrasound as diagnostic tunnel syndrome caused by a cubitus displaced fractures of the distal radius: a adjunct for incomplete carpal tunnel varus deformity H. Shimizu, M. Beppu, T. preliminary report - Koji Moriya, Hidehiko release - Ter Chyan Tan, Chong Jin Yeo and Arai, H. Kihara and K. Izumiyama Saito, Yuji Takahashi and Hiroyuki Ohi Einar Wilder Smit ■ Continuous peripheral nerve block in ■ Prevention of fl exor pollicis longus ■ Opponoplasty without postoperative forearm for severe hand trauma Ryusuke tendon rupture after volar plate fi xation of immobilization - Ichiro Okutsu, Ikki Osada, Mineyuki Zukawa, Eiko Seki and distal radius fractures - Kaoru Tada, Kazuo Hamanaka and Aya Yoshida Tomoatsu Kimura Ikeda, Kenji Shigemoto, Seigo Suganuma ■ Outcomes of silastic trapezium ■ The fl exor carpi radialisbrevis muscle and Hiroyuki Tsuchiya replacements - D. P. A. Jewell, M. B. S. — an anomaly in forearm musculature: ■ Clinical outcomes of excision Brewster and M. A. Arafa a review article - S. Y. M. Ho, C. J. Yeo, S. J. arthroplasty for Kienbock’s disease - ■ Hand infection in diabetic patients - Sebastin, T. C. Tan and A. Y. T. Lim Tomoya Matsuhashi, Norimasa Iwasaki, Amir Jalil, Philip Ian Barlaan, Boris Kwok ■ Wrist denervation in isolation: a Hiroyuki Kato, Michio Minami and Akio Keung Fung and Josephine Wing-Yuk Ip Minami prospective outcome study with patient ■ Proximal phalanx injection for trigger selection by wrist blockade - P. A. Storey, ■ Macromastia: a risk factor for carpal fi nger: randomized controlled trial - K. T. Lindau, V. Jansen, S. Woodbridge, L. C. tunnel syndrome? - Ana Silva Guerra, Pataradool and T. Buranapuntaruk Bainbridge and F. D. Burke Carlos Marques Correia, José Manuel ■ Accurate radiographic measurement Videira e Castro and Maria Angélica of the distal radial tilt - Benjamin Rajabi, Almeida Oyvind Roed, Kristian Roed, Paal Sandoe Alm-Paulsen, Harald Russwurm and Vilhjalmur Finsen

IFSSH ezine FEBRUARY 2012 25 journal highlights

Journal of Hand Surgery: American volume Volume 37, Issue 2, February 2012

■ Cellular Apoptosis and Proliferation in ■ Minimum 4-Year Follow-Up on ■ Community-Acquired Methicillin- the Middle and Late Intrasynovial Tendon Contralateral C7 Nerve Transfers for Resistant Staphylococcus aureus Hand Healing Periods Ya Fang Wu, You Lang Brachial Plexus Injuries David Chwei-Chin Infections in the Pediatric Population Zhou, Wei Feng Mao, Bella Avanessian, Paul Chuang, Catherine Hernon Michael Thomas Chung, Patrick Wilson, Y. Liu, Jin Bo Tang ■ Role of Wrist Arthrodesis in Patients Brian Rinker ■ An Analysis of the Pull-Out Strength of Receiving Double Free Muscle Transfers ■ Objective Structured Assessment of 6 Suture Loop Confi gurations in Flexor for Reconstruction Following Complete Technical Skill in Upper Extremity Surgery Tendons Brachial Plexus Paralysis Ahmad Addosooki, Ann VanHeest, Bradley Kuzel, Julie Agel, T. Karjalainen, M. He, A.K.S. Chong, A.Y.T. Kazuteru Doi, Yasunori Hattori, Abhijeet Matthew Putnam, Loree Kalliainen, James Lim, J. Ryhane Wahegaonkar Fletcher ■ Surgical Repair of Multiple Pulley ■ Predicting the Outcome of Revision ■ Arthroscopic Knotless Peripheral Injuries—Evaluation of a New Combined Carpal Tunnel Release John D. Beck, Justin Triangular Fibrocartilage Repair William B. Pulley Repair G. Brothers, Patrick J. Maloney, John H. Geissler Deegan, Xiaoqin Tang, Joel C. Klena V. Schöffl , T. Küpper, J. Hartmann, I. Schöffl ■ Intrafocal Pin Plate Fixation of Distal Ulna ■ Meta-analysis of Imaging Techniques Fractures Associated With Distal Radius ■ The Eff ect of the Number of Cross- for the Diagnosis of Complex Regional Fractures Brian J. Foster, Randy R. Bindra Stitches on the Biomechanical Properties Pain Syndrome Type I Zachary J. Cappello, of the Modifi ed Becker Extensor Tendon Morton L. Kasdan, Dean S. Louis Repair Kyung-Chil Chung, Bong Jae Jun, Michelle H. McGarry, Thay Q. Lee ■ Ability of Near Infrared Spectroscopy to Measure Oxygenation in Isolated Upper ■ Predictors of Pain During and the Day Extremity Muscle Compartments Ashley After Corticosteroid Injection for Idiopathic L. Cole, Richard A. Herman Jr, Jonathan B. Trigger Finger Abhishek Julka, Ana-Maria Heimlich, Sahir Ahsan, Brett A. Freedman, Vranceanu, Apurva S. Shah, Frank Peters, Michael S. Shuler David Ring ■ Reconstruction of Distally Degloved ■ Trigger Finger Treatment: A Comparison Fingers With a Cross-Finger Flap and a of 2 Splint Designs Kauser Tarbhai, Susan Composite-Free Flap From the Dorsum Hannah, Herbert P. von Schroeder of the Second Toe Bin Wang, Xu Zhang, ■ Interobserver Reliability of Computed Wenping Jiang, Tiepeng Ma, Hao Li, Hui Tomography to Diagnose Scaphoid Waist Wang Fracture Union Geert A. Buijze, Mathieu ■ Reconstruction of an Entire Metacarpal M.E. Wijff els, Thierry G. Guitton, Ruby and Metacarpophalangeal Joint Using Grewal, C. Niek van Dijk, David Ring, The a Fibular Osteocutaneous Free Flap and Science of Variation Group Silicone Arthroplasty Neil F. Jones, Brian P. ■ The Fixation Strength of Scaphoid Bone Dickinson, Scott L. Hansen Screws: An In Vitro Investigation Using ■ Exaggerated Infl ammatory Response Polyurethane Foam Louise A. Crawford, Eric and Bony Resorption From BMP-2 Use in S. Powell, Ian A. Trail a Pediatric Forearm Nonunion Andrew W. ■ Single Versus Double End-to-Side Ritting, Elizabeth W. Weber, Mark C. Lee Nerve Grafts in Rats Nahoko Iwakura, Seiji ■ Long-Term Results of Forearm Ohtori, Tomonori Kenmoku, Takane Suzuki, Shortening and Volar Radiocarpal Kazuhisa Takahashi, Kazuki Kuniyoshi Capsulotomy for Wrist Flexion Deformity in Children With Amyoplasia Ronald C. Burgess, Rudy Robbe

26 IFSSH ezine FEBRUARY 2012 upcoming events

Upcoming events

Sociedade Brasileira de Cirurgia da Mao (Brazilian Hand Surgery Society) 32nd National Meeting April 28-30, 2012 Sao Paulo, Brazil Chairman: Ivan Chakkour www.mao2012.com.br e: [email protected]

14th Congreso Sudamericano de Cirugia de la Mano (14th South American Hand Surgery Meeting) In conjunction with the 33rd National Meeting of the Brazilian Hand Surgery Society April 25-27, 2013 Rio de Janeiro, Brazil

Chairmen: Luiz Carlos Sobania (South America) and Anderson Vieira Monteiro (Brazil) e: [email protected]

IFSSH ezine FEBRUARY 2012 27 upcoming events PENCIL THIS IN YOUR DIARY 2012 New Zealand Hand Surgery Society Conference

Sunday 12 - Wednesday 15 August 2012

Millennium Hotel, Queenstown

AUGUST 2012

SUN MON TUE WED THU FRI SAT 1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 27 21 28 2229 2330 3124 25 26 INTERNATIONAL GUEST PRESENTER DR AMIT GUPTA KENTUCKY, USA

CONFERENCE CONVENORS DR JIM ARMSTRONG & DR CHRIS LOWDEN

Conference Secretariat  PO Box 247, ASHGROVE, QLD 4060  332 Waterworks Road, ASHGROVE, QLD 4060

 [email protected] Taylored Images - Conference Meeting & Event  +61 7 3366 2205  +61 7 3366 5170

“Tayloring Your Image”  www.tayloredimages.com.au

28 IFSSH ezine FEBRUARY 2012 ifsshezine