Hand clinics
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Neuromas primarily arise from iatrogenic injury, trauma, or chronic irritation. Given the disabling symptoms of neuromas, an array of treatment strategies exist, with varied results. Successful treatment relies on accurate identification of the offending nerve, containment of the regenerating fascicles, and cessation of mechanical or other noxious stimuli over the regenerating nerve end. The choice of treatment depends in part on the nerve affected, whether it involves critical or noncritical sensation, and its location.
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Flexor tendon reconstruction poses both a technical challenge to the hand surgeon and a rehabilitative challenge to the patient and therapist. The modified Paneva-Holevich technique, using a pedicled intra-synovial graft, is a safe and reliable means of staged flexor tendon reconstruction, offering a number of theoretical advantages over classic free-tendon grafting techniques. Clinical outcomes are at the least comparable, if not superior, to those achieved following free-tendon techniques with most authors reporting a low requirement for third stage tenolysis.
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The wide-awake approach to flexor tendon repair has decreased our rupture and tenolysis rates and permitted us to get consistently good results in cooperative patients. The wide-awake surgery allows the repair of gaps of the surgical repair site revealed with intraoperative active movement testing of the repair We are now doing midrange active movement after primary tendon repair. After tenolysis, full-range active motion is possible even before skin closure. We no longer perform flexor tendon repair with the tourniquet, sedation, and muscle paralysis of general or block (Bier or axillary) anesthesia.
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Trapeziectomy has been regaining popularity in treatment of thumb carpometacarpal (CMC). Current approaches to trapeziectomy use Kirschner wire fixation to prevent subsidence of the thumb metacarpal into the newly created trapeziectomy space. ⋯ A technique using a suture-button device to suspend the thumb allows for earlier mobilization of the thumb and potentially leads to a faster overall recovery. Preliminary results are promising, but further studies must be conducted to confirm the long-term efficacy of this suture-button suspensionplasty.