Hand clinics
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The advantages of proper management of postsurgical pain include fewer postoperative complications; increased early ambulation and mobilization; decreased opportunity for chronic pain syndromes to occur; shorter, less complicated rehabilitation; greater patient satisfaction; and increased patient adherence to prescribed regimens. In turn, greater adherence positively affects pain management and, therefore, patients, satisfaction with their surgeon. A variety of approaches may be used for the management of acute pain, and the "psychological preparation" of the patient prior to surgery plays a significant role. ⋯ Many of the approaches can be carried out relatively easily by the physician and his or her staff; in some cases, specialists, such as psychologists trained in behavioral medicine, are needed. Variables that affect patient adherence, both positively and negatively, include patient motivations, the nature and chronicity of the disorder, treatment variables, and the quality of the patient-doctor relationship. Physician behaviors may encourage or discourage patient adherence.
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This article concerns traction lesions of the brachial plexus in adults, focusing on management and recovery. Open wounds of the plexus are now treated surgically as soon as possible. The subsequent rehabilitation is the same as that for closed traction lesions of the brachial plexus in which significant recovery is expected.
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Reviewing the history and etiology of extensor pollicis longus tendon rupture shows the most compelling mechanism of rupture apparently is interruption of the tendon's vascularity secondary to hemorrhage and pressure, which causes the damaged tendon to be more susceptible to rupture secondary to late ischemic necrosis and attrition. Treatment options tried have included direct repair, tendon grafting, and tendon transfer. The authors recommend the extensor indicis proprius tendon transfer as the most predictable procedure to restore the original function of the EPL. This technique can be performed reliably, requires little postoperative re-education, and has few associated complications.
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The treatment options for the soft-tissue mallet finger, in both its acute and chronic forms, continue to generate some degree of controversy. Priority always should be given to nonoperative management of these injuries. This translates into a 6- to 8-week period of uninterrupted immobilization of the DIP joint with an external splint. ⋯ In summary, mallet injuries are treated using closed, nonoperative techniques. The period of time after injury that this nonoperative treatment can be delayed and still be effective is being extended and the absolute outside time limit still is not known. When surgery is done, we prefer the simple placement of a transarticular Kirschner wire for 6 to 8 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
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Fractures of the distal radius and scaphoid are the two most common intra-articular fractures of the wrist. For the distal radius, visual inspection and lavage, reduction of fracture fragments, and pin fixation conducted under arthroscopic control more accurately restore the smooth articular surfaces than is possible using traditional closed manipulation and ligamentotaxis. A technique for arthroscopically assisted reduction and screw fixation for fractures of the scaphoid is described using a modified Herbert screw. These techniques have the combined advantages of more accurate fracture reduction, reduced surgical trauma, and earlier mobilization of the wrist.