The exact etiology of carpal bossing is unknown. The evidence would seem to indicate that it is acquired rather than congenital. Repeated slight trauma causing pressure at the involved joint has been suggested as one factor. Another hypothesis is that trauma causes a slight rupture of the dorsal ligament of the involved joint with subsequent spur formation. Many of the cases reported have occurred in persons in occupations requiring frequent movement of the fingers, such as typists, seamstresses, surgeons, knitters, and woodcarvers. Show
SymptomsNo characteristic symptoms have been reported. The usual complaint, if any, is mild aching and easy fatigability of the wrist. No functional disturbance has been recorded other than a clicking sensation due to slipping of the extensor tendon over the boss. Clinical and Radiographic FindingsThe essential feature is a small bony tumor on the dorsal aspect of the wrist over the third metacarpal-carpal joint (Fig. 1). Radiographically (Figs. 2–4), this is best demonstrated in the lateral projection in palmar flexion. There is a bony overgrowth of the dorsal aspect of both the capitate and the third metacarpal bones at the joint margins, producing a characteristic double beak or bossing. No erosion, sclerosis of the joint margin, or narrowing of the joint space is evident. TreatmentIn most instances of carpal bossing, conservative management is adequate for relief of the minor symptoms. In cases treated by surgical intervention, recurrence of the deformity has been frequent. Relief of the symptoms, however, has usually been obtained. Case ReportA colored male kitchen-helper, aged 38, had a tumor over the dorsal aspect of the right wrist. This had been present for several years but had caused no symptoms until four months before admission, when the patient struck his hand while at work. After this, he complained of pain on motion of the extensor tendon of the middle finger. Physical examination revealed a bony hard mass at the junction of the third metacarpal and capitate bones. On motion of the middle finger, the dorsal extensor tendon would apparently slide over the mass, causing pain. The pain persisted despite conservative treatment, and operation was undertaken. A bony exostosis with overlying thickened bursa, arising from the capitate bone and impinging upon the metacarpal, was removed. The pathologist stated that there was no evidence of osteochondroma, reactive bone sclerosis, or osteoarthritis (Fig. 5). An unusual fracture of the trapezium was found on computed tomography examination after plain radiographs failed to demonstrate any bony pathology. This coronal fracture has not been previously mentioned in the literature. Management included open reduction and internal fixation with 2 lag screws. References (0)2020, Clinics in Sports Medicine 2015, Chirurgie de la Main Citation Excerpt : Carpal coronal fractures are rare [1–12]. Show abstractNavigate Down Carpal coronal fractures are rare. We report the case of a 15 year-old male who fell from a balcony and suffered a displaced coronal fracture of the capitate, hamate and triquetrum. The diagnosis, which was initially made based on the X-rays, was confirmed by CT scan. Open reduction and internal fixation using Herbert screws was performed. To the best of our knowledge, this is the first published case of a coronal fracture of these three bones. The patient returned to normal activities after six months. Les fractures coronales du carpe sont rares. Nous rapportons le cas d’un jeune homme de 15 ans qui, dans les suites d’une chute d’un balcon, a présenté une fracture déplacée coronale du capitatum, de l’hamatum et du triquetrum. Le diagnostic, suspecté sur les radiographies initiales, a été confirmé par un scanner. Un vissage en compression de ces différentes lésions a été réalisé. Il s’agit, à notre connaissance, du premier cas rapporté associant la fracture coronale de ces trois os. Le patient a pu reprendre ses activités dans un délai de 6 mois. Carpal Fractures in Athletes Excluding the Scaphoid2009, Hand Clinics Citation Excerpt : The carpal canal view best demonstrates trapezial ridge fractures (Fig. 14).63 CT is useful in chronic cases involving trauma to the wrist and for identifying occult ridge fractures or the rare coronal fracture (Fig. 15).64 Nondisplaced trapezial body fractures can be treated with thumb spica immobilization for 4 to 6 weeks. Show abstractNavigate Down A wide range of hand and wrist injuries occur in today's recreational and elite athletes and account for 3% to 9% of all sports injuries. The onus is on the physician to discriminate between injuries that can be managed with an early return to sport, and those injuries that place the athlete at risk of further injury if they are not managed aggressively from the outset. The physician and the athlete must understand the balance between safe, early return to sport, and prompt surgical treatment that prevents late disability. Fractures of the carpal bones excluding the scaphoid2002, Journal of the American Society for Surgery of the Hand Citation Excerpt : Occasionally, CT may be required to delineate an acute or chronic ridge fracture. Body fractures, especially if associated with concomitant thumb CMC joint dislocation, are often distinguishable on standard wrist radiographs, although CT is sometimes required to visualize the fracture.28 An oblique lateral, with the ulnar aspect of the hand down and the forearm in 20° of pronation, may reveal more subtle body fractures by decreasing the radiographic overlap between the trapezoid and trapezium.26 Show abstractNavigate Down Carpal fractures excluding the scaphoid can cause morbidity that is disproportionate to their incidence because they are easily overlooked and are often harbingers of a wider wrist injury. Failure to recognize a more global injury pattern can result in undertreatment and permanent wrist dysfunction. Diagnosis requires a high index of suspicion, familiarity with carpal topography to guide the physical examination, and judicious use of specialized radiographic views and ancillary imaging techniques. Copyright © 2002 by the American Society for Surgery of the Hand Surgical treatment of intra-articular fractures of the trapezium2002, Journal of Hand Surgery Show abstractNavigate Down Eleven patients with intra-articular fractures of the trapezium were evaluated after surgical treatment with a mean follow-up time of 47 months (range, 25–80 mo). There were 6 vertical split and 5 comminuted fractures. All fractures involved high-energy trauma in men. Five resulted from motorcycle accidents. An associated Bennett's fracture occurred in 4 patients. Three fractures went undiagnosed at the time of initial evaluation. At late follow-up evaluation, 8 of 11 patients experienced some pain, mainly at the trapeziometacarpal articulation. There was no statistical difference in thumb motion, wrist motion, or grip and pinch strength between the affected and unaffected extremity. Radiographs revealed degenerative changes at the trapeziometacarpal articulation in 5 of 11 fractures. No patient was disabled and no patient changed occupation as a result of the hand injury. Based on the good results obtained with surgical intervention we advocate open reduction and internal fixation for fractures with either articular displacement >2 mm or carpometacarpal subluxation. (J Hand Surg 2002;27A:697–703. Copyright © 2002 by the American Society for Surgery of the Hand.) Transverse carpal ligament disruption associated with simultaneous fractures of the trapezium, trapezial ridge, and hook of hamate: A case report1999, Journal of Hand Surgery Show abstractNavigate Down Traumatic disruption of the transverse carpal ligament associated with fractures of the trapezial ridge and hook of hamate is a known entity. Only one report of a coronal fracture of the trapezium has been mentioned in the literature. We report a combination of these two injury patterns. Diagnosis was aided by computed tomography. Treatment involved excision of the trapezial ridge and hook of hamate fragments with lag screw fixation of the trapezial body fracture. (J Hand Surg 1999;24A:152–155. Copyright © 1999 by the American Society for Surgery of the Hand.) Research article The Journal of Hand Surgery, Volume 40, Issue 5, 2015, pp. 984-986 Show abstractNavigate Down Two patients with an anteriorly positioned ulnar nerve at the elbow, identified during cubital tunnel release, are presented. Upon encountering an empty cubital tunnel, additional dissection found the ulnar nerve to course posterior to and to penetrate through the intermuscular septum 3 to 5 cm proximal to the medial epicondyle. It then ran anterior to the pronator-flexor mass before entering the forearm between the ulnar and the humeral heads of the flexor carpi ulnaris. Although a rare anatomical anomaly, an anteriorly positioned ulnar nerve is potentially an underreported finding. In individuals with cubital tunnel syndrome, diagnosis and surgical treatment may be negatively affected if the surgeon fails to recognize the aberrant anatomy. Upper extremity surgeons should also be mindful of this rare anomaly when performing elbow arthroscopy or medial epicondyle release to prevent inadvertent injury to the nerve. Research article Chirurgie de la Main, Volume 34, Issue 5, 2015, pp. 264-268 Show abstractNavigate Down Multiple metacarpal dislocations combined with carpal fracture – dislocations are rare injuries. We report a new combination of these injuries where fracture–dislocation of the base of the 1st metacarpal bone occurred simultaneously with a comminuted fracture of the trapezium, dislocation of the trapezoid and metacarpal joints (2nd to 5th) and an avulsion fracture of the hamate. This specific carpal injury has not been previously described and our description will contribute to understanding the mechanism of these complex injuries. The injury pattern in the case featured here was multifaceted and resulted from rupture of both transverse and longitudinal carpal columns. According to the Garcia-Elias classification of axial carpal disruptions, this particular injury mechanism was a combined axial–radial–ulnar type injury. These injuries are extremely rare and are only sporadically described in the literature. Trapeziectomy, followed by open, partial, low-profile screw fixation of the fracture of the first metacarpal and open reduction and pinning of the carpometacarpal joints and the trapezoid injury yielded a good result at the 1-year follow-up. L’association de multiples luxations carpo-métacarpiennes et de luxations-fractures des os du carpe est rare. Nous rapportons une constellation jusqu’à présent non décrite de ces lésions, associant une luxation-fracture de la base du 1er métacarpien, une fracture comminutive du trapèze, une luxation du trapézoïde et des bases des métacarpiens II à V, enfin une fracture-avulsion de l’hamatum. Un tel traumatisme du carpe n’avait pas encore été décrit et sa description va aider à comprendre le mécanisme de ces traumatismes complexes. Dans notre cas, le type de traumatisme était complexe et résultait de la rupture simultanée des colonnes carpiennes à la fois dans les plans transversal et longitudinal, permettant ainsi de le ranger comme un type axial combiné radio-ulnaire dans la classification des lésions axiales du carpe de Garcia-Elias. Ces lésions sont extrêmement rares et rapportées sporadiquement dans la littérature. Une trapézectomie, suivie du vissage à foyer ouvert de la fracture du 1er métacarpien, la réduction à foyer ouvert et l’embrochage des articulations carpo-métacarpiennes permirent d’obtenir un bon résultat au recul d’un an. Research article Neurosurgery Clinics of North America, Volume 24, Issue 2, 2013, pp. 249-274 Research article Chirurgie de la Main, Volume 34, Issue 5, 2015, pp. 234-239 Show abstractNavigate Down Anterior submuscular transposition of the ulnar nerve described by Dellon can solve the dynamic component of cubital tunnel syndrome at the elbow. We carried out a retrospective, single-surgeon study. The McGowan scale as modified by Goldberg (MG) was used preoperatively and at the final assessment; the QuickDASH was completed at the final assessment. The cohort comprised of 82 patients (38 females, 44 males) with a mean age of 61.2 years (37–92). The preoperative MG grade was: stage I (52%), IIA (28%), IIB (16%), III (4%). Three postoperative complications (3.5%) were recorded: two hematomas that did not require surgical revision and one case of elbow stiffness that resolved with physical therapy. Mean follow-up was 11.1 years (11–12). We identified 5 cases of confirmed recurrences (5.9%), 7 of secondary deterioration (8.5%) and 3 of initially poor result (3.5%). Sixty-six patients (86%) considered themselves cured at the final assessment. The MG scale at the last follow-up was: stage 0 (85.5%), I (9%), IIA (5%), III (0%). The QuickDASH was 11.88 (11–16). Mean time to recurrence was 6.3 years (1.5–10). Dellon's anterior submuscular transposition can be considered a reliable procedure. Eighty-six percent of patients were cured and 6% recurrence rate was noted. However, this is a demanding procedure. La technique chirurgicale de transposition submusculofasciale de Dellon permet de répondre au problème dynamique du syndrome du nerf ulnaire au coude. Nous avons mené une étude rétrospective, mono-opérateur. Un classement selon la classification de McGowan modifiée par Goldberg (MG) était réalisé en préopératoire et à la révision ainsi qu’un score QuickDASH à la révision. La série était constituée de 82 patients (38 femmes et 44 hommes) d’âge moyen 61,2 ans (37–92). La répartition des stades MG préopératoires était : stade I (52 %), IIA (28 %), IIB (16 %), III (4 %). Trois complications postopératoires (3,5 %) ont été notées : deux hématomes sans reprise et une raideur résolutive. Le recul moyen était de 11,1 ans (11–12). Ont été noté : 5 récidives avérées (5,9 %), 7 dégradations secondaires (8,5 %) et 3 résultats insuffisants d’emblée (3,5 %). Soixante-six patients (86 %) se considéraient guéris à la révision. Le MG à révision était : stade 0 (85,5 %), I (9 %), IIA (5 %), IIB (1,2 %) et III (0 %). Le score QuickDASH était de 11,88 (11–16). Le délai moyen de récidive était de 6,3 ans (1,5–10). La transposition selon Dellon peut être considérée comme une technique fiable. Quatre-vingt-six pourcent des patients se considéraient guéris et 6 % de récidives étaient notées. Elle nécessite cependant une technique rigoureuse. Research article Individualizing Urinary Incontinence Treatment: Research Needs Identified at NIDDK WorkshopThe Journal of Urology, Volume 199, Issue 6, 2018, pp. 1405-1407 <dm:abstracts xmlns:dm="http://www.elsevier.com/xml/dm/dtd"><ce:abstract xmlns:ce="http://www.elsevier.com/xml/common/dtd" xml:lang="en" id="abs0010" view="all" class="author"><ce:section-title id="sectitle0010">Abstract</ce:section-title><ce:abstract-sec id="abssec0010" view="all"><ce:simple-para id="abspara0010" view="all">Despite intensive work in the field, urinary incontinence (UI) treatment is characterized by unintended side effects, uncertain durability, high risk of complications, and inconsistent outcomes. Therapy is generally directed toward underlying anatomic and physiologic causes, with little attention to important cognitive, psychosocial and behavioral aspects of UI. Recognition that the variability in UI treatment success is likely driven at least in part by individual variability—combined with a demonstrated need for better outcomes for patients with UI; a torrent of technical advances involving -omic, mobile health, and data science technologies; and growth of intra- and transdisciplinary research—has made the development of a science base to enable better targeting of UI treatments based on individual patient characteristics both interesting and feasible<ce:bold>.</ce:bold> The National Institute of Diabetes and Digestive and Kidney Diseases convened expert stakeholders to conceptualize research needed to individualize UI treatment.</ce:simple-para><ce:simple-para id="abspara0015" view="all">Such research will be facilitated by an interdisciplinary approach that considers factors spanning urinary, local/regional and systemic biology; individual behaviors; mind and mental functioning; and social determinants of health. Over time, continued interdisciplinary collaboration will likely contribute to the evolution of a transdisciplinary perspective that may enhance and accelerate future research.</ce:simple-para></ce:abstract-sec></ce:abstract></dm:abstracts> Research article Arthroscopic treatment of basal joint arthritis by partial trapeziectomy with ligament reconstruction: Short-term results from a prospective study of 20 patientsHand Surgery and Rehabilitation, Volume 38, Issue 2, 2019, pp. 102-107 Show abstractNavigate Down Partial trapeziectomy for basal joint arthritis is an alternative to total trapeziectomy that preserves the height of the thumb column. Using arthroscopy reduces the incidence of periarticular lesions and the risks of complications. The purpose of this prospective single-center study was to evaluate the results of arthroscopic partial trapeziectomy combined with suspension and interposition ligament reconstruction using half of the abductor pollicis longus tendon. Twenty patients (18 women, 2 men) with a mean age of 55 years (43–65 years) were operated using this technique between November 2013 to February 2015. Patients were evaluated clinically and radiologically at 1 month, 3 months, 6 months and 12 months after surgery. The 20 patients were reviewed after 12 months. The subjective QuickDASH score improved from the 3rd post-operative month (P = 0.0029) from 50.6 preoperatively to 30.3 after 3 months, 17.6 after 6 months and 9.6 after 12 months. Pain was reduced in the 1st month post-operative (P < 0.0001). The Kapandji Score and pinch strength improved from the 3rd month (P = 0.034). Return to work was possible for 19% of employed patients after 1 month, 44% after 3 months and 87.5% after 6 and 12 months. Eighty-eight percent of the patients were satisfied or very satisfied after 3 months and 95% after 6 and 12 months. Pain levels, range of motion and QuickDASH Score are similar to those of open partial trapeziectomy described in the literature. However, recovery seems to be faster with this arthroscopic technique. Arthroscopic treatment of basal joint arthritis, which limits capsule and ligament lesions, leads to good short- and medium-term results in terms of pain relief and thumb motion while preserving strength. 4 (Prospective, non-randomized). La trapézectomie partielle est une alternative à la trapézectomie totale dans la rhizarthrose, permettant de conserver la hauteur de la colonne du pouce. L’abord arthroscopique permet de réduire les lésions périarticulaires et les risques de complications. Cette étude prospective monocentrique avait pour but d’évaluer les résultats de la trapézectomie partielle arthroscopique associée à une ligamentoplastie de suspension et d’interposition à l’abductor pollicis longus. Vingt patients d’âge moyen de 55 ans (43–65 ans), 18 femmes et 2 hommes, furent opérés entre novembre 2013 et février 2015 selon cette technique. Les patients furent revus à 1 mois, 3 mois, 6 mois et 12 mois postopératoires pour une évaluation clinique et radiologique. Les 20 patients ont été revus au recul de 12 mois. Le score subjectif QuickDASH était amélioré dès le 3ème mois postopératoire (p = 0,0029) variant de 50,6 en préopératoire à 30,3 à 3 mois, 17,6 à 6 mois et 9,6 à 12 mois. La douleur était améliorée dès le premier mois (p < 0,0001). Le score de Kapandji et la force de pince étaient améliorés à partir du 3ème mois (p = 0,034). La reprise du travail intéressait 19 % des actifs à 1 mois, 44 % à 3 mois et 87,5% à 6 mois et 12 mois. Quatre-vingt-huit pour cent des patients étaient satisfaits ou très satisfaits à 3 mois et 95 % à 6 mois et 12 mois. Les résultats sur la douleur, les mobilités et le score QuickDASH sont équivalents à ceux de trapézectomie partielles à ciel ouvert décrits dans la littérature. Cependant, la rapidité de récupération semble être meilleure avec cette technique arthroscopique. Ce traitement arthroscopique de la rhizarthrose limitant les lésions capsulo-ligamentaires donne de bons résultats à court et moyen termes sur la récupération de la douleur et des mobilités du pouce en conservant la force. 4 (Prospectif non randomisé. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Which projection best demonstrates the carpal interspaces?Upper Extremeties. Which carpal bone must be seen on the AP projection of the thumb?Chapter 5. Which routine projection of the elbow best demonstrates the olecranon process in profile?The elbow internal oblique view is a specialized projection, utilized to demonstrate both the coronoid process in profile and the olecranon process sitting within the olecranon fossa of the humerus.
What is the name of the joint found between the proximal and distal phalanges of the first digit?Interphalangeal Joint (IP)
The thumb digit has only two phalanges (bones) so it only has one joint. The thumb interphalangeal (IP) joint is similar to the distal interphalangeal (DIP) joint in the fingers.
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Which projection best demonstrates pathology involving the first carpometacarpal joint
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