MEDLINE Abstracts: Wrist Pathology Etiology
What's new concerning injuries of the wrist and what causes them? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics.

Grant AC, Cook AA
Muscle Nerve. 2000;23:933-938

Prior reports of handcuff-related neuropathies have been retrospective or small series of cases selected for their unusual electrophysiological or historical features. We conducted a prospective 27-month study at a large, urban, teaching hospital of all patients with a complaint of hand numbness, weakness, or paresthesias attributed to overtightened handcuffs. Forty-one patients were evaluated clinically, and electrodiagnostic testing was performed on 18. In the group with electrodiagnostic testing, neuropathies due to overtightened handcuffs were detected in 22 superficial radial, 12 median, and 9 ulnar nerves. The correlation between clinical and electrodiagnostic findings was best for superficial radial neuropathies, some of which were severe. Median and ulnar nerve injuries were generally mild. Similar clinical findings were obtained in the group without electrodiagnostic testing. Handcuff-related injury to the most commonly affected nerve, the superficial radial, can be severe and permanent.









Wintman BI, Fowler JL, Baratz ME
Am J Orthop. 2000;29:229-232

A complete dislocation of the trapezium from its fossa is rare. We present a case of a 36-year-old man with a complete ulnar and volar dislocation of the trapezium. The trapezium was reduced with manual manipulation and was held in anatomic position by using multiple Kirschner wires. The patient's clinical course is reviewed and similar cases from the literature are discussed









Moholkar K, Smyth H
J Hand Surg [Am]. 2000;25:358-359

A 41-year-old man experienced severe pain in the forearm after undergoing ulnar shortening osteotomy to treat positive ulnar variance, a complication of a fracture of the distal end of the radius. The patient had compartment syndrome with compartment pressure of 55 mm Hg. A decompressive fasciotomy of the volar compartment provided total relief of pain and, subsequently, full recovery of all functions. We report the case and discuss the serious nature of compartment syndrome, its associated complications, and methods of diagnosis and management.









Nagle DJ
J Am Acad Orthop Surg. 2000;8:45-55

Chronic wrist pain remains a challenge to diagnose and treat. A thorough history and physical examination are key. Various imaging techniques are essential to the evaluation of the patient with chronic wrist pain. Standard radiography, computed tomography, cinearthrography, magnetic resonance imaging, radionuclide imaging, arthroscopy, and arteriography all may have a role in assessment, and the orthopaedic surgeon should be familiar with the indications, strengths, and weaknesses of each. Laboratory tests may also be useful in evaluation. No all-inclusive algorithm can be applied in this setting; therefore, the physician must rely on his or her diagnostic acumen to successfully assess and treat chronic wrist pain.









Watson HK, Weinzweig J, Guidera PM, Zeppieri J, Ashmead D
J Hand Surg [Br]. 1999;24:307-315

Limited wrist arthrodesis is a useful method for treating specific carpal disorders that maximizes residual wrist motion and strength while eliminating pain. Selective fusion of specific carpal units can be used in degenerative arthritis, rotary subluxation of the scaphoid, midcarpal instability, scaphoid nonunion, Kienbock's disease, and congenital synchondrosis or partial fusion of specific carpal joints. This report presents our experience with more than 1000 limited wrist arthrodeses, and provides a review of the indications and technical considerations for specific intercarpal fusions, and subsequent results. To date this is the largest series of intercarpal arthrodeses and the study has demonstrated that these techniques are reliable and effective in dealing with a wide range of wrist disorders.