BACKGROUND:Reconstruction of the lateral ulnar collateral ligament (LUCL) may be required to restore elbow stability. Minimizing changes in graft length through the arc of motion prevents deforming forces and loss of integrity. Currently, no consensus exists regarding the elbow flexion angle that minimizes LUCL deformation. The goal of this study was to determine the elbow flexion angle that would minimize graft length variability. METHODS:Cadaveric specimens were prepared by reflecting the LUCL. A grid was made on the lateral epicondyle for various ligament origin points. Distances from each point in the grid to the supinator crest were recorded at 5 different angles with average lengths calculated. Variation around this length at each angle was measured. RESULTS:Across the lateral epicondyle, the angle with the least variability from the average was 60°, significantly lower than other angles. Across all points, the minimal variability via a quadratic model was between 50° and 60°. CONCLUSIONS:Graft length variability is influenced by the angle of elbow flexion during fixation. Our results indicate that this variability is minimized when the graft is fixated between 50° and 60° of flexion. Improving variability of an LUCL reconstruction may decrease graft stretching during elbow motion and maximize graft function while minimizing long-term complications.
Carpal tunnel syndrome (CTS) is commonly treated with surgical release of the transverse carpal ligament. However, predicting postoperative recovery remains challenging. To summarise the current relationship between preoperative objective severity measures and postoperative recovery and direct the development of future research, a systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. MEDLINE, Embase, Scopus, CENTRAL, CINAHL and Web of Science were searched from database inception to April 19, 2026. Seventeen studies (1997-2024) were included in this review. Nerve conduction studies (NCSs) were the most common preoperative modality, followed by ultrasound, electromyography and carpal tunnel pressure. Eleven studies reported an association between preoperative severity and clinical outcome, whereas 6 studies found no association. Notably, non-NCS modalities demonstrated positive associations; however, they were underrepresented in the literature. This review provides important insight into the relationship between objective preoperative CTS severity and recovery. More importantly, it provides guidance on the research required to establish the relationship and direct patient counselling.
Background: Fibro-osseous pseudotumour of the digit (FOPD) is a rare, benign soft-tissue lesion that mimics infection and malignancy due to its rapid growth, pain, and radiological features. Misdiagnosis can result in inappropriate treatment, including unnecessary ablative surgery. Methods: A narrative literature review was conducted using PubMed and Embase, supplemented by reference screening. Case reports and case series of FOPD involving the digits of the hands or feet were included. Data were synthesised to identify clinical, histopathological, radiological, and management patterns. In addition, we report a recurrent case of FOPD misdiagnosed as tenosynovitis. Results: Twenty-two case reports published between 2015 and 2025 and four large case series prior to 2015 yielded a total of 134 patients. Fibro-osseous pseudotumor of the digit typically affects young to middle-aged adults (mean age, 36 years) with a slight female predominance. Lesions presented as rapidly enlarging painful nodules, occasionally associated with prior trauma, and were frequently mistaken for infection or extraskeletal osteosarcoma. Complete surgical excision was the definitive treatment, with recurrence reported rarely and almost exclusively following incomplete excision. Our case demonstrated recurrence after initial debridement, with subsequent definitive excision leading to functional recovery, although residual stiffness and sensory disturbance persisted. Conclusions: Fibro-osseous pseudotumor of the digit should be considered in the differential diagnosis of rapidly enlarging digital lesions. Complete surgical excision is curative in most cases, while molecular markers such as ubiquitin-specific peptidase 6 may refine the diagnosis in morphologically ambiguous presentations. Future research should prioritise the development of standardised diagnostic criteria, prognostic markers, and long-term outcome reporting.
We present the case of a 19-year-old gentleman with a rare digital dermocutaneous fibroma of the tendon sheath (FTS). The dermocutaneous and flexor sheath involvement of this mass presented unique challenges to wide excision and definitive soft tissue defect coverage. Fibroma of the tendon sheath is a benign lesion with a recurrence rate of up to 24%, giving it an aggressive profile. Previous reports of digital FTS are limited to subcutaneous involvement managed with simple excision and closure. To date, this is the first report of the successful treatment of a digital dermocutaneous FTS with wide excision and staged full-thickness skin grafting.
BACKGROUND:This biomechanical study investigates whether reconstruction of expansile lesions of the metacarpal with fibular allograft and a dual-plate construct is strong enough for immediate postoperative weightbearing. METHODS:Twelve cadaveric middle finger metacarpals (6 matched pairs) from adult donors were used. One side of each pair was randomly assigned to undergo allograft reconstruction with dual plating (experimental construct). The matched contralateral side was assigned to the control construct, a transverse fracture with standard, 8-hole dorsal plating. In the experimental construct, an expansile bone lesion was simulated in the native metacarpal by resecting 1.5 cm from the proximal carpometacarpal joint to 1.5 cm from the distal articular surface and was reconstructed with fibular allograft. Biomechanical testing was performed by a 6-degree-of-freedom robotic KUKA manipulator. The distal portion of each specimen was clamped in place, and a cantilever bending force was applied by the KUKA to test the load to failure. Failure was defined as periprosthetic fracture, fracture displacement, or screw pullout. Paired t tests were used to compare load to failure between matched pairs (R studio). Significance was set at P < .05. RESULTS:The load to failure of dual-plate allograft constructs did not significantly differ from that of the control construct, 494.7 ± 239.07 N (95% CI, 243.81-745.59 N) versus 342.2 ± 99.9 N (95% CI, 237.45-447.04 N), P = .19. Experimental constructs failed at the proximal allograft-native bone interface. Control constructs failed via fracture displacement. CONCLUSIONS:Dual-plate fixation constructs for allograft reconstruction of the metacarpal are comparable in mechanical stability to standard metacarpal fracture fixation that allow for immediate postoperative range of motion.
BACKGROUND:Patients with type 2 diabetes mellitus (T2DM) have a higher incidence of trigger finger and are more likely to require operative A1 pulley release. The impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy on treatment progression remains unclear. This study evaluated the association between GLP-1RA use and progression to operative A1 pulley release following corticosteroid injection for trigger finger in patients with T2DM. METHODS:A retrospective analysis was conducted using the TriNetX Research Network to identify adults with T2DM and trigger finger who underwent an initial corticosteroid injection. Patients were grouped by GLP-1RA exposure and propensity-matched (1:1) for demographics, comorbidities, and other diabetic medications. The primary outcome was A1 pulley release at 6, 12, and 24 months after injection. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated, and balance was assessed using standardized mean differences <0.10. RESULTS:A total of 69 222 patients met inclusion criteria (5871 with GLP-1RA exposure and 63 351 without). After matching, 5863 patients remained in each cohort. Glucagon-like peptide-1 receptor agonist use was not associated with a significant difference in 6-month release rates (6.1% in GLP-1RA users vs 6.8% in nonusers). However, GLP-1RA users had lower release rates at 12 (10.6% vs 11.9%; RR, 0.89; 95% CI, 0.81-0.99; P = .027) and 24 months (14.2% vs 15.7%; RR, 0.90; 95% CI, 0.83-0.98; P = .016). These differences corresponded to absolute risk reductions of 1.4% and 1.7%, or numbers needed to treat of 71 and 59, at 12 and 24 months, respectively. CONCLUSION:Glucagon-like peptide-1 receptor agonist therapy was associated with a small but statistically significant reduction in progression to A1 pulley release at 12 and 24 months after corticosteroid injection for trigger finger in patients with T2DM.Level of evidence: Level III.
BACKGROUND:No-show visits at hand surgery clinics are costly to the health care system and negatively affect clinic efficiency. Elucidating factors associated with increased likelihood of a no-show could facilitate interventions to minimize time and money lost. A 2015 study at an academic institution in Boston, Massachusetts, showed that younger age, Hispanic/Black race, unmarried status, Monday/Tuesday appointments, and residence near the office are risk factors for hand clinic no-shows. No similar studies have been done in a rural setting. We hypothesized that similar factors would play a role at a southwestern safety-net hospital with a majority rural catchment area. METHODS:A retrospective cross-sectional study was performed looking at all patient visits in our southwestern academic orthopedic hand surgery practice from January 1, 2022, to December 31, 2023. Demographic, temporal, environmental, and clinical factors and their relationships to the likelihood of a no-show were analyzed using pairwise comparisons and a multivariable logistic generalized linear mixed-effects model. RESULTS:A total of 3586 patients were seen during 6539 office visits in the 2-year study period. The no-show rate was 25.8%. Independent risk factors for no-shows in the multivariable model were age <55 years old, male sex, Black race, return visit, fall/summer appointment, high Social Deprivation Index, self-pay and Medicaid insurance, and attending surgeon. CONCLUSIONS:The American Southwest and New England differ considerably, yet many factors that contribute to clinic no-shows in both locations are consistent. Identifying at-risk populations and allocating resources appropriately may decrease the rate of clinic no-shows.
BACKGROUND:Open carpal tunnel release (OCTR) is an effective surgical treatment option for carpal tunnel syndrome (CTS). This study evaluates hand surgeon expectations of postoperative recovery versus patient-reported outcomes following OCTR through Patient-Reported Outcomes Measurement Information System (PROMIS) surveys. METHODS:Patients who underwent OCTR (Common Procedure Terminology 64721) for CTS performed by 5 hand surgeons were evaluated (2021-2024). PROMIS pain-interference (P-PI) and pain-upper extremity (P-UE) surveys were completed at 2-week, 6-week, and 3-month intervals postoperatively. Patients who underwent simultaneous hand procedures with OCTR and/or had perioperative complications were excluded. Hand surgeons completed PROMIS P-PI and P-UE surveys for theoretical patient groups to predict postoperative recovery in the same timeframe. Higher P-PI scores suggest greater pain, and higher P-UE scores suggest better functionality. RESULTS:Sixty-eight patients were included. Among patients with minimal comorbidities/mild CTS (n = 33), surgeons predicted less pain (P-PI = 38.7 vs 54.8, P = .004) and better functionality (P-UE = 59.8 vs 35.5, P = .00005) compared to mean patient scores at 3 months postoperatively. For patients with multiple comorbidities/mild CTS (n = 17), surgeons predicted less pain (P-PI = 40.7 vs 52.7, P = .013) and better function (P-UE = 53.0 vs 41.3, P = .034) at 3 months postoperatively. In the same cohort, surgeons predicted better function at 2 weeks postoperatively (P-UE = 30.4 vs 36.2, P = .032). For severe CTS patients (n = 18), surgeons predicted less pain (P-PI = 45.6 vs 54.3, P = .009) and better function (P-UE = 37.9 vs 28.5, P = .047) at 6 weeks postoperatively. CONCLUSIONS:Hand surgeons may be overly optimistic about recovery timelines for patients undergoing OCTR, specifically underestimating how pain may interfere with daily tasks and their upper-extremity function at 3 months postoperatively.
BACKGROUND:Proximal phalanx fractures are common hand injuries that can result in significant functional impairment if inadequately treated. While multiple fixation strategies exist, the optimal approach remains debated. Intramedullary headless screw fixation has gained interest due to its minimally invasive nature and ability to allow early mobilization. This study evaluates clinical, radiographic, and functional outcomes following fixation with a single intramedullary device. METHODS:A retrospective review was performed of patients undergoing proximal phalanx fracture fixation with the ExsoMed InFrame nail at a single center. Data collected included demographics, operative time, alignment, time to union, return to activity, range of motion, therapy participation, follow-up duration, and complications. RESULTS:Fifty-one patients with a total of 57 fractures were included, with a mean age of 44.3 years (range, 17-76). Fractures involved 1 thumb, 15 index, 8 middle, 15 ring, and 18 small fingers. Mean operative time was 71.7 minutes, and final coronal alignment averaged 3.56°. Radiographic union occurred at a mean of 5.0 weeks, and unrestricted activity was achieved at 8.2 weeks. At a mean follow-up of 10.7 weeks, active and passive total arc of motion averaged 202.4° and 213.9°, respectively. Seventeen patients participated in hand therapy (mean 5.4 visits). Complications included stiffness in 24 digits, tenolysis in 3 digits, hardware removal in 1 digit, and periprosthetic fracture in 1 digit. CONCLUSIONS:Intramedullary fixation with the ExsoMed InFrame system provides reliable union and favorable early functional outcomes. However, the high rate of postoperative stiffness highlights the need for structured rehabilitation and further comparative study.
BACKGROUND:While targeted muscle reinnervation (TMR) has been used for both prophylaxis and treatment of symptomatic neuromas after upper-extremity amputations, the impact of timing on outcomes after TMR remains unclear. We hypothesized that performing TMR acutely would improve pain and patient-reported outcomes compared to delayed TMR without an increased risk of complications. METHODS:A single-center prospective registry was reviewed to identify patients with a history of TMR in the setting of transradial or transhumeral amputations. Patient demographics were reviewed, and patients with less than 3 months of follow-up were excluded. Acute TMR was defined as occurring within 30 days of the initial amputation, and delayed TMR as occurring beyond 30 days. Patient-reported outcomes and complications were reviewed. RESULTS:Thirty-one limbs in 29 patients met inclusion criteria, with 21 limbs in the acute TMR group and 10 limbs in the delayed group. There were no differences in demographics or comorbidities between the two groups. The acute TMR group had lower final pain visual analog scale scores (1.6 vs 5.1, P = .001) and better Veterans-Rand 12-Item Health Survey (VR-12) mental component scores (31.5 vs 55.9, P = .011), with trends toward lower rates of depression. There was no difference in the postoperative complication rate between groups (P = .99). CONCLUSIONS:Performing TMR acutely may improve long-term pain and mental health outcomes for upper-limb amputees. Acute TMR can be done safely without increasing the risk of complications.
BACKGROUND:Chronic postamputation pain is frequently caused by symptomatic neuroma formation. Advanced nerve interface procedures, including targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI), were developed to enhance prosthetic control and have been shown to reduce phantom and residual limb pain. However, data regarding how surgical timing relates to postoperative complications and reoperations remain limited. This study evaluated postoperative outcomes after acute and delayed TMR/RPNI in upper-extremity amputees. METHODS:We retrospectively analyzed 48 upper-extremity amputations in 42 patients who underwent TMR and/or RPNI. Procedures were classified as acute (prophylactic) or delayed (symptomatic). Baseline and operative variables were analyzed using Mann-Whitney U and chi-square tests. Multivariable logistic regression was used to evaluate the association between surgical timing and postoperative complications after adjustment. RESULTS:Of 48 limbs, 25 (52.1%) underwent acute and 23 (47.9%) delayed procedures. Baseline characteristics differed in smoking history, amputation etiology, and number of nerves treated. Complication rates were 20.0% and 21.7%, respectively. Wound-related complications occurred predominantly after acute procedures, whereas recurrent neuroma reoperations occurred predominantly after delayed procedures. Unexpected reoperation rates at 1 year were 12.0% and 21.7%, respectively. Mean 1-year pain scores were lower after acute than delayed procedures (2.09 vs 3.70). CONCLUSIONS:Acute and delayed TMR/RPNI had similar complication and reoperation rates, with differing event patterns. Surgical timing was not significantly associated with complications after adjustment, though meaningful differences cannot be excluded due to heterogeneity and limited power. These findings support individualized timing and the need for larger prospective studies including patient-reported outcomes.
BACKGROUND:Accurate intraoperative assessment of scaphoid screw position is limited by complex anatomy and standard fluoroscopic imaging. The surgical goal is near-central placement within a narrow corridor rather than a single geometric center. This study evaluates a dedicated axial fluoroscopic view for intraoperative assessment of screw centrality. METHODS:A retrospective study included 54 patients who underwent scaphoid fixation with intraoperative fluoroscopy, including a dedicated axial view, and postoperative computed tomography (CT). Screw deviation from the geometric center of the scaphoid waist was measured on CT and compared with axial view measurements. Agreement was assessed using Spearman correlation and Bland-Altman analysis. Subgroup analyses were performed based on fracture characteristics. RESULTS:Mean screw deviation was 1.73 ± 1.07 mm on CT and 1.25 ± 0.73 mm on the axial view. The mean absolute difference was 0.82 ± 0.99 mm. The axial view showed modest correlation with CT and a small systematic underestimation (mean bias -0.47 ± 1.20 mm), with wide 95% limits of agreement (-2.82 to 1.87 mm). Individual axial-view measurements should not be interpreted as interchangeable with CT. Displaced fractures demonstrated greater deviation on the axial view. Union was achieved in 93% of cases using a CT-based definition of osseous bridging. CONCLUSIONS:The axial fluoroscopic view provides additional intraoperative information for assessing scaphoid screw position. Its value lies in detecting relative eccentricity at the guidewire or screw stage rather than replicating CT measurements. This technique may help surgeons judge case-specific acceptability of guidewire trajectory and reduce unrecognized malposition.
Background: Thumb carpometacarpal (CMC) instability is a controversial topic in hand surgery. This international survey examined the terminology, diagnostic approaches, and treatment strategies used by surgeons worldwide, and explored variations by geographic region and surgical specialty. Methods: A cross-sectional survey was developed in collaboration with experienced hand surgeons and approved by the research committees of the Federation of European Societies for Surgery of the Hand and the American Association for Hand Surgery. The survey was distributed globally. Responses were analyzed by region and specialty. Results: Responses were obtained from 208 surgeons across 38 countries. Most preferred the term ‘Thumb CMC instability’ (77%), whereas 16% used ‘Stage I thumb CMC arthritis’. Encounter frequency varied widely, with responses ranging from daily (3%) to rarely (34%). Diagnosis was primarily based on clinical assessment of laxity, supported by radiographs (96%). Nonsurgical management was most commonly selected as first-line treatment (88%), with most surgeons proceeding to surgery only if symptoms persisted (76%). A wide range of surgical techniques was reported, with Eaton-Littler ligament reconstruction used most frequently (32%). U.S. surgeons reported encountering CMC instability more frequently than European surgeons. Choice of surgical technique differed by specialty, with plastic surgeons favoring ligament reconstruction and orthopedic surgeons more often selecting salvage procedures or arthroscopy. Conclusions: Thumb CMC instability is widely recognized but remains inconsistently defined, diagnosed, and managed. These findings highlight opportunities to improve and standardize care. We advise consistent use of the term ‘thumb CMC instability’ to improve communication in clinical practice and research.
BACKGROUND:Distal ulnar fractures can be challenging to manage, and noncompressive intramedullary screws may be a potential solution to this problem. The purpose of this study was to review our institutional experience with retrograde screw fixation of distal ulna fractures compared with conventional plating methods. METHODS:A retrospective cohort study was designed to compare adult patients who had undergone retrograde intramedullary screw fixation for a distal third ulna fracture in a single health system between June 2021 and February 2024 with controls who underwent conventional plate and screw fixation. Demographic, radiographic, implant, outcome and complication variables were compared between cohorts using inverse probability of treatment weighting. RESULTS:Twenty-four patients who underwent intramedullary screw fixation were compared with 24 controls. All patients achieved radiographic union, with similar proportions achieving union at typical follow-up intervals between cohorts. Operative time was 43 minutes faster and time to mobilization was 11 days earlier in the screw cohort. Differences in prevalence of complications between cohorts did not achieve statistical significance (15% in screw cohort vs 36% in control cohort). CONCLUSIONS:We found retrograde intramedullary screw fixation was able to achieve union in all fractures with a low complication profile and similar wrist range of motion at final follow-up compared with conventional plate and screw fixation. Intramedullary screw fixation was associated with significantly faster operative time and faster time to mobilization postoperatively.
BACKGROUND:Scaphoid fracture nonunion remains a clinically significant complication after nonoperative management. While tobacco use is a known risk factor, the association between cannabis use and nonunion risk is less well defined. This study evaluated whether cannabis use, alone or combined with tobacco use, is independently associated with increased rates of scaphoid fracture nonunion and subsequent surgical intervention. METHODS:A retrospective cohort study was conducted using a national health care database from 2010 to 2021. Adult patients with acute scaphoid fractures initially managed nonoperatively were identified. After inclusion and exclusion criteria were applied, 260 806 patients were analyzed and stratified into 4 groups: non-users (n = 165 699), tobacco-only users (n = 75 504), cannabis-only users (n = 4225), and combined cannabis and tobacco users (n = 15 378). Cohorts were matched for age, sex, and comorbidities. Primary outcomes included scaphoid nonunion at 6, 12, and 24 months and rates of surgical intervention. Multivariable logistic regression was used to evaluate independent associations between substance use and nonunion (P < .05). RESULTS:Cannabis use was associated with higher nonunion rates. At 12 months, nonunion occurred in 1.9% of non-users, 3.2% of tobacco-only users, 3.9% of cannabis-only users, and 6.2% of combined users (P < .001). At 24 months, rates increased to 2.0%, 3.6%, 4.3%, and 6.9%, respectively (P < .001). Multivariable analysis demonstrated increased odds of nonunion among cannabis-only users (odds ratio [OR] = 1.05, P = .043), tobacco-only users (OR 1.27, P < .001), and combined users (OR = 1.43, P < .001). CONCLUSIONS:Cannabis use is independently associated with increased scaphoid fracture nonunion following nonoperative management, with a synergistic association observed among combined cannabis and tobacco users.
BACKGROUND:Distal radius fractures (DRFs) are common, especially among the elderly, due to reduced bone density and a higher risk of falls. This study aims to compare radiographic outcomes and plate-related complications between volar locking plating (VLP) and dorsal wrist-spanning bridge plating (DBP) in the elderly population. METHODS:We performed a retrospective chart review of patients aged 65 years and above who underwent surgical fixation for DRFs by VLP or DBP at a single institution. Pre- and postoperative radiographs were evaluated for metadiaphyseal involvement length, ulnar variance, radial height, radial inclination, and volar tilt. Concomitant injuries were recorded and compared between groups. RESULTS:Patients in the DBP and VLP groups were similar in age at the time of surgery (DBP: 73.7 years; VLP: 71.4 years; P = .09), though those treated with DBP had a significantly higher body mass index (DBP: 31.4 vs VLP: 27.4; P < .05). Patients presenting with isolated wrist injuries were comparable between groups. Postoperative radiographic measurements-including ulnar variance, radial height, radial inclination, and volar tilt-showed no statistically significant differences between DBP and VLP (P > .05 for all). CONCLUSIONS:In this single-center, multi-surgeon study, DBP for distal radius fractures in elderly patients produced radiographic outcomes comparable to VLP fixation. These results support DBP as a viable option in select older adults. Larger, multicenter studies with patient-reported outcomes on long-term follow-up are needed to define optimal patient selection and functional outcomes.
Isolated dislocation of the capitate is an exceedingly rare carpal injury and is typically associated with high-energy trauma and complex ligamentous disruption. We present a case of a delayed-diagnosis isolated volar dislocation of the capitate with a small associated chip fracture, not conforming to classic perilunate instability patterns, and review relevant literature that describes similar case presentations and treatment modalities. A 29-year-old man presented with wrist pain and median nerve paresthesias 2 weeks after the injury. Imaging demonstrated volar migration of the proximal capitate relative to the lunate fossa. The patient underwent open reduction, carpal tunnel release, and temporary Kirschner wire fixation. At final follow-up, he demonstrated resolution of neuropathy and functional wrist motion. This case highlights an unusual injury pattern, emphasizes the importance of careful radiographic evaluation in patients with persistent symptoms, and suggests a potential mechanism of transient ligamentous failure rather than frank rupture.
INTRODUCTION:Elbow lateral collateral ligament reconstruction is used to restore joint stability and mandates accurate characterization of where the centerline of ulnohumeral joint rotation (CLOR) is located on the lateral epicondyle. We hypothesized that the centerline of rotation is located in the same region as the geometric center of the capitellum. METHODS:Twenty-nine nonarthritic uninjured elbows were analyzed with three-dimensional modeling of computed tomography (CT) scans performed on each elbow. The projection of the CLOR on the cortex of the lateral epicondyle was recorded as was the center of the capitellum in the transverse plane. The relationship of these points to a fixed point on the lateral epicondyle was measured. RESULTS:A consistent region on the lateral epicondyle was identified where the CLOR intersected the outer cortex of the lateral epicondyle. This intersection did not significantly differ from the center of the capitellum in the sagittal plane. CONCLUSIONS:This study demonstrates that the center of the capitellum as viewed laterally is clinically equivalent to the CLOR and thus defines the location where a lateral ligament reconstruction limb may be placed to maximize isometric motion. This knowledge may be of surgical importance when locating a point of rotational isometry.
BACKGROUND:Carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS) are the most common upper extremity compressive neuropathies. Although often considered isolated conditions, they may occur concomitantly, and the clinical significance of dual compression remains poorly defined. This study evaluated whether concomitant CTS/CuTS represents a distinct clinical subgroup characterized by greater objective motor impairment compared with isolated entrapment syndromes. METHODS:Eighty-six adults evaluated between 2021 and 2025 were prospectively enrolled, including isolated CTS (n = 32), isolated CuTS (n = 26), and concomitant CTS/CuTS (n = 28). Standardized examinations assessed sensory findings and intrinsic motor strength using Medical Research Council grading. Multivariable logistic and ordinal regression analyses identified predictors of decreased intrinsic muscle strength. RESULTS:Patients with isolated CTS were older than those with isolated CuTS or concomitant disease (P = .0012). Cervical spine disease was more prevalent in concomitant CTS/CuTS (P = .0187). Sensory complaints and provocative test findings were similar across groups. However, patients with concomitant CTS/CuTS demonstrated significantly reduced intrinsic motor strength, with lower abductor pollicis brevis strength compared with isolated CTS (P = .0308) and lower abductor digiti minimi strength compared with isolated CuTS (P = .0319). Concomitant disease independently predicted decreased abductor pollicis brevis strength (adjusted odds ratio = 3.55, P = .0471). CONCLUSIONS:Concomitant CTS/CuTS is associated with greater baseline intrinsic motor impairment despite similar sensory findings, suggesting that dual-site compression reflects greater motor involvement rather than the incidental coexistence of 2 isolated entrapment syndromes.
BACKGROUND:The purpose of this study was to: (1) examine the demographic and socioeconomic factors associations with lack of formal hand therapy after operatively treated distal radius fractures (DRFs); and (2) determine whether formal postoperative therapy was associated with differences in patient-reported function, range of motion (ROM), and incidence of complications after operatively treated DRFs. METHODS:This study analyzed adult patients (>18 years) with operatively treated DRFs at a tertiary center between September 2020 and December 2023. It examined the associations between demographic factors and socioeconomic status (measured by the Area Deprivation Index and Social Vulnerability Index [SVI]) with attendance at postoperative therapy. Patient-Reported Outcomes Measurement Information System (PROMIS) scores and wrist motion were compared between the therapy and no therapy cohorts at 4 to 6 weeks postoperatively and at final follow-up (median 86 days). RESULTS:Among 344 patients analyzed, 279 patients (81%) attended hand therapy, whereas 65 patients (19%) did not. Lack of insurance or Medicaid insurance and higher Transportation/Housing SVI percentile (more disadvantaged) independently predicted not attending formal postoperative therapy. At both 4 to 6 weeks and final follow-up, formal postoperative therapy attendance was not associated with statistical differences in PROMIS scores, wrist motion, or incidence of complications. CONCLUSIONS:Disadvantaged patients are less likely to have access to postoperative therapy but the routine alternative of providing in-office instructions for home stretching does not compromise early recovery. While this study suggests that formal postoperative therapy is not needed universally, in practice we have seen individual patients that greatly benefited from attending rehabilitation.
