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Niloofar Akhoondzadeh - One of the best experts on this subject based on the ideXlab platform.
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corticosteroid injection with or without Thumb Spica Cast for de quervain tenosynovitis
Journal of Hand Surgery (European Volume), 2014Co-Authors: Mohsen Mardanikivi, Mahmoud Karimi Mobarakeh, Farzaneh Bahrami, Kevyan Hashemimotlagh, Khashayar Sahebekhtiari, Niloofar AkhoondzadehAbstract:Purpose To compare the corticosteroid injection (CSI) with or without Thumb Spica Cast (TSC) for de Quervain tendinitis. Methods In this prospective trial, 67 eligible patients with de Quervain tenosynovitis were randomly assigned into CSI + TSC (33 cases) and CSI (34 cases) groups. All patients received 40 mg of methylprednisolone acetate with 1 cc lidocaine 2% in the first dorsal compartment at the area of maximal point tenderness. The primary outcome was the treatment success rate, and the secondary outcome was the scale and quality of the treatment method using Quick Disabilities of Arm, Shoulder and Hand and visual analog scale scores. Results The groups had no differences in mean age, sex, and occupation. The visual analog scale and Quick Disabilities of the Arm, Shoulder and Hand scores were similar in both groups before the treatment. The treatment success rate was 93% in the CSI + TSC group and 69% in the CSI group. Although both methods improved the patients' conditions significantly in terms of relieving pain and functional ability, CSI + TSC had a significantly higher treatment success rate. Conclusions The combined technique of corticosteroid injection and Thumb Spica Casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes. Type of study/level of evidence Therapeutic II.
Scott W Wolfe - One of the best experts on this subject based on the ideXlab platform.
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regarding corticosteroid injection with or without Thumb Spica Cast for de quervain tenosynovitis
Journal of Hand Surgery (European Volume), 2014Co-Authors: Scott W WolfeAbstract:To the Editor: I was interested in the January 2014 article by Mardani-Kivi et al concerning the efficacy of a Thumb Spica Cast when used to supplement corticosteroid injection for de Quervain tendinopathy. Their findings differ markedly from those of Weiss et al, that immobilization did not add to the benefit of injection alone, and I applaud the authors for studying this in a prospective fashion. However, I am concerned that the authors used methylprednisolone acetate (Depo-Medrol 40 mg) for their injections. Depo-Medrol, a fat-soluble glucocorticoid preparation, is not specifically indicated for use in subdermal locations in the United States. The package insert contains abundant bold-font warnings concerning the risk of subcutaneous placement of the drug (shown below). A quick review of the literature demonstrates several serious complications from the injection of fat-soluble corticosteroids in patients with de Quervain disease, including but not limited to subcutaneous atrophy, skin depigmentation, capillary fragility, bleeding, scar revision, and tendon rupture. Mardani-Kivi et al reported no complications in their series, and I would like to know whether they identified any of the complications mentioned above, or others in longer-term follow-up. It is difficult to inject the first dorsal compartment without at least some leakage of the injected material into the surrounding subcutaneous tissue. Most authors document a 2to 3-month lag time before the appearance of skin depigmentation. I advise considerable caution with the use of methylprednisolone acetate injection for the treatment of de Quervain disease. From the package insert LAB-0160-3.0 Pfizer, Inc. (New York, NY), revised August 2008:
Ingrid Kjellin - One of the best experts on this subject based on the ideXlab platform.
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Does Thumb Immobilization Contribute to Scaphoid Fracture Stability?
HAND, 2008Co-Authors: J. Mark Schramm, Minhthy Nguyen, Montri D. Wongworawat, Ingrid KjellinAbstract:Immobilization protocols for nondisplaced scaphoid fractures have included the elbow, wrist, and Thumb. This study attempts to demonstrate whether or not immobilization of the Thumb makes a difference in preventing motion at the scaphoid fracture site. Using six fresh frozen forearm specimens, a transverse waist scaphoid fracture was created through a dorsal approach. Metallic markers were imbedded on either side of the fracture. Sutures were secured to the flexor pollicus longus (FPL) and extensor pollicus longus (EPL). Each specimen was loaded in extension and flexion by attaching 50-g weights to the EPL and FPL, first with no Casting, then with a short arm Cast, and finally a short arm Thumb Spica Cast. Angulation and displacement at the fracture site were measured in the coronal, sagittal, and axial planes utilizing image reconstructions from computed tomography. One-way ANOVA with repeated measures and Tukey–Kramer multiple comparison test post hoc analysis were used for statistical evaluation. There was no significant difference in fracture angulation or rotation between Spica and short arm Casts. There was a significant difference in angulation and rotation in all three planes when comparing between Casting and no Casting, p
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Does Thumb Immobilization Contribute to Scaphoid Fracture Stability
Hand, 2007Co-Authors: J. Mark Schramm, Minhthy Nguyen, Montri D. Wongworawat, Ingrid KjellinAbstract:Immobilization protocols for nondisplaced scaphoid fractures have included the elbow, wrist, and Thumb. This study attempts to demonstrate whether or not immobilization of the Thumb makes a difference in preventing motion at the scaphoid fracture site. Using six fresh frozen forearm specimens, a transverse waist scaphoid fracture was created through a dorsal approach. Metallic markers were imbedded on either side of the fracture. Sutures were secured to the flexor pollicus longus (FPL) and extensor pollicus longus (EPL). Each specimen was loaded in extension and flexion by attaching 50-g weights to the EPL and FPL, first with no Casting, then with a short arm Cast, and finally a short arm Thumb Spica Cast. Angulation and displacement at the fracture site were measured in the coronal, sagittal, and axial planes utilizing image reconstructions from computed tomography. One-way ANOVA with repeated measures and Tukey–Kramer multiple comparison test post hoc analysis were used for statistical evaluation. There was no significant difference in fracture angulation or rotation between Spica and short arm Casts. There was a significant difference in angulation and rotation in all three planes when comparing between Casting and no Casting, p < 0.05. In our cadaveric model, wrist immobilization is crucial for nondisplaced scaphoid waist fractures, and short arm Casting was just as effective as Thumb Spica Casting in preventing fracture displacement.
Amir Reza Kachooei - One of the best experts on this subject based on the ideXlab platform.
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letter regarding corticosteroid injection with or without Thumb Spica Cast for de quervain tenosynovitis
Journal of Hand Surgery (European Volume), 2014Co-Authors: Michael Rivlin, Philip E Blazar, Amir Reza KachooeiAbstract:1. Gregor S, Maegele M, Saurland S, Krahn JF, Peinemann F, Lange S.Negative pressure wound therapy: a vacuum of evidence? Arch Surg.2008;143(2):189e196.2. Ubbink DT, Westerbos SJ, Nelson EA, Vermeulen H. A systematicreview of topical negative pressure therapy for acute and chronicwounds. Br J Surg. 2008;95(6):685e692.3. Brown KM, Harper FV, Aston WJ, O’Keefe PA, Cameron CR.Vacuum-assisted closure in the treatment of a 9-year-old child withsevere and multiple dog bite injuries of the thorax. Ann Thorac Surg.2001;72(4):1409e1410.4. Durai R, Mownah A, Ng PC. Bridge vacuum-assisted closure: a noveltechnique of using a single vacuum machine for multiple adjacentwounds. Int J Clin Pract. 2010;64(1):93e94.
Scott Tashman - One of the best experts on this subject based on the ideXlab platform.
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scaphoid fracture displacement with forearm rotation in a short arm Thumb Spica Cast
Journal of Hand Surgery (European Volume), 1999Co-Authors: Steven A Kaneshiro, Joseph M Failla, Scott TashmanAbstract:Abstract Three-dimensional motion between the fragments of an experimental scaphoid waist fracture was measured during dynamic forearm pronation and supination in a short-arm Thumb Spica Cast with and without applied tendon loads. Metal markers placed in each fragment were tracked using high-speed biplane radiographic image sequences and stereophotogrammetric analysis. Peak displacements (from the intact state) exceeded 1 mm in all specimens, with the largest movements occurring in the radial direction during pronation (mean: 2.1 mm unloaded, 2.5 mm loaded). Total range of displacement motion between fragments exceeded 3 mm (mean ulnar/radial direction: 3.4 mm unloaded, 4.1 mm loaded). Dorsal/palmar and proximal/distal displacements were minimal except at the extremes of forearm pronation/supination. Rotations between fragments were small (within ±6°) and varied considerably across specimens. No significant differences were found between loaded and unloaded trials. Thus, in the absence of long-arm Thumb Spica Casting to limit forearm rotation, significant motion between the fragments of a scaphoid waist fracture is likely. (J Hand Surg 1999;24A:984–991. Copyright © 1999 by the American Society for Surgery of the Hand.).