To Örebro University

Introduction: Total wrist arthroplasty (TWA) is a motion-preserving treatment option for wrist arthritis. High-precision measurement methods for implant migration such as computed tomography motion-analysis (CTMA) can potentially detect poor implant fixation. The aim of this pilot study was to assess CTMA as a complementary method to diagnose aseptic loosening of TWA.

Materials and Methods: Three patients with a TWA and wrist pain during activity underwent induced displacement CT (CTMA) with alternated provocations as a complement to plain radiographs.

Results: Two of the three patients had displacement of the carpal component on CTMA. The radial component was stable in all cases. The tool was adapted to clinical routine use.

Conclusions: CT motion-analysis could be a valuable adjunct to plain radiographs in assessing component loosening in TWA.

PURPOSE: Arthroscopy remains the gold standard to diagnose ligamentous lesions in the wrist. The coronavirus disease (COVID)-19 pandemic put a strain on resources, prompting an increase in procedures performed under local anesthesia. Dry needle arthroscopy of the wrist has previously been used in the operating room. The purpose of this study was to assess the results and patient satisfaction of wrist arthroscopy under local anesthesia in an office setting.

METHODS: A prospective series of 15 patients presenting with wrist trauma and a suspected ligamentous injury to the wrist were included. All patients underwent radiography and magnetic resonance imaging (MRI) before the procedure. Dry needle arthroscopy was performed by a surgeon with a nurse assistant, in the office under local anesthesia, using a traction device for distraction of the wrist. Patient satisfaction was assessed with the Picker Patient Experience-15 (PPE-15) questionnaire.

RESULTS: The patient's mean age was 34 years (range: 18-51). There were no intraoperative complications or postoperative infections. The median PPE-15 score was 90 of 100. Visualization of the intraarticular structures was excellent.

CONCLUSIONS: Dry needle arthroscopy of the wrist under local anesthesia in an office setting seems to be a feasible method to diagnose ligament injuries of the wrist. Patient satisfaction with the procedure was high.

CLINICAL RELEVANCE: Dry needle arthroscopy of the wrist under local anesthesia in-office could facilitate and expedite diagnosis of wrist injuries.

BACKGROUND: Distal component loosening is a common mode of failure in total wrist arthroplasty (TWA). A radial hemi-wrist arthroplasty (RHWA) has the potential to avoid problems related to the distal component in TWA. The aim of this study is to investigate clinical outcomes following surgical treatment with a new RHWA design.

METHODS: In this pilot study of 20 consecutive RHWAs, patients were assessed preoperatively and postoperatively for range of motion, grip strength, Visual Analog Scale (VAS) pain scores, and functional scoring using Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), and Canadian Occupational Performance Measure. Radiographs were analyzed at 12 months and 5 years (mean, 5.1 years) postoperatively.

RESULTS: A total of 46 secondary surgeries were undertaken in 16 wrists, including 7 revisions. Another 6 patients are waiting for revision to radiocarpal arthrodesis. In non-revised patients, the DASH and PRWE scores improved, and wrist range of motion remained largely unchanged except for wrist flexion, which decreased. The VAS pain score during activity was reduced, and hand grip strength remained largely unchanged.

CONCLUSIONS: The new implant resulted in improved functional scoring and improved VAS pain scores in non-revised patients, but many cases needed secondary surgery due to persistent pain. The high revision rate is a major concern, and further use of the implant in its current form cannot be recommended.

Introduction: Intraneural ganglions are benign and rare mucinous cysts that originate within peripheral nerves and typically can lead to symptoms and signs of peripheral neuropathy. The most common location is the peroneal nerve, and the second most common location is the ulnar nerve.

Case Presentation: We present a case of a 53-year-old man who presented with increasing numbness in the ulnar aspect of the left hand and decreasing hand strength. MRI showed an intraneural ganglion, and as the patient had clinically progressive symptoms, a decision was made for surgical excision. The patient was symptom-free after the procedure and had no neurological deficits. Eighteen months later, the patient contacted us again as his symptoms had returned. A new MRI showed ganglion recurrence. Due to progressive clinical symptoms, another attempt was made to remove the ganglion surgically. Paraffin immunostains excluded other diagnoses like synovial cyst, posttraumatic neuronal cyst, Tarlov cyst, mesothelial cyst, and cystic lymphangioma. At follow-up 3 months postoperatively, the patient was symptom-free and had normal neurological findings.

Conclusion: Intraneural ganglion should be considered as a differential diagnosis of a cystic mass close to a nerve. For surgery, we favor less radical methods, such as simple decompression. 

Metallosis is a known complication of arthroplasty and has been reported for the hip, knee, and shoulder joints. Metallosis pseudotumors have been linked to an increased risk of implant failure. We report a case of pseudotumor with massive bone loss following total wrist arthroplasty (TWA) using the Maestro implant. Revision to arthrodesis is possible, but issues with bone loss have to be addressed. We recommend caution in offering TWA to young patients with high functional demands.

INTRODUCTION: Wrist arthroscopy is an evolving procedure. The purpose of this study was to report the outcome of diagnostic arthroscopy of the wrist using a new tool, the NanoScope, under wide-awake local anesthesia with no tourniquet (WALANT).

PATIENTS AND METHODS: This was a prospective study of 30 consecutive patients with suspected ligament tear after wrist trauma and remaining symptoms after initial conservative management. All patients had an MRI prior to the NanoScope procedure.

RESULTS: The patients comprised 17 men and 13 women, with a mean age of 31 years. One patient declined the NanoScope procedure following their MRI. In the remaining 29 patients, NanoScope wrist arthroscopy revealed 19 cases of triangular fibrocartilaginous complex (TFCC) tears and 11 tears of the scapholunate (SL) or lunotriquetral (LT) ligaments. The correlation between preoperative MRI and the findings from NanoScope arthroscopy was poor. Six patients had additional surgery after the NanoScope arthroscopy, comprising three TFCC sutures, one SL and one LT ligament reconstruction respectively, and one wrist arthrodesis. No complications related to the NanoScope arthroscopies were noted.

CONCLUSION: NanoScope arthroscopy of the wrist is safe, is well-suited for surgery in WALANT, and has superior diagnostic capacity compared to MRI. Further studies are warranted to determine the role of the NanoScope in the management of wrist ligament pathologies.

LEVEL OF EVIDENCE: This is a level 4 study.

PURPOSE OF THE STUDY: The purpose of this study was to assess the patient experience of trapeziectomy under WALANT for trapeziometacarpal joint (TMJ) osteoarthritis (OA) in a prospective study with 2-year follow-up.

MATERIAL AND METHODS: The study included 23 patients with TMJ OA undergoing trapeziectomy with WALANT. All patients were seen by a hand therapist preoperatively and at 3, 12, and 24 months postoperatively. At each visit, VAS pain scores, thumb range of motion, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. The Picker Patient Experience (PPE-15) questionnaire was administered within 2 weeks of surgery.

RESULTS: All 23 patients completed the PPE-15 questionnaire. Their mean age was 64 years. The 21 patients who remained at the 24-month follow-up all said they would choose the same anaesthesia method again. At this follow-up, VAS pain scores, thumb range of motion, key pinch grip and DASH scores had improved significantly, while thumb opposition and hand grip strength remained largely unchanged. The majority of patients felt well informed before and during the procedure, and all patients rated pain relief as good or satisfactory. Nearly 40% of patients reported receiving inadequate information about the postoperative medications.

DISCUSSION: Patients have a positive attitude to trapeziectomy with WALANT, and seem to prefer WALANT over other methods of anaesthesia. Trapeziectomy with WALANT for TMJ OA is a safe procedure and appears to give a functional outcome similar to trapeziectomy under general anaesthesia.

CONCLUSIONS: Trapeziectomy with WALANT for TMJ OA is safe, preferred by patients and has similar clinical outcome as trapeziectomy in general anesthesia.

BACKGROUND: Adequate postoperative pain treatment is important for quality of life, patient satisfaction, rehabilitation, function, and total opioid consumption, and might lower both the risk of chronic postoperative pain and the costs for society. Prolonged opioid consumption is a well-known risk factor for addiction. Previous studies in upper extremity surgery have shown that total opioid consumption is a third of the amount prescribed, which can be explained by package size. The aim of this study was to examine whether implementation of prepacked takehome analgesia bags reduced the quantity of prescribed and dispensed opioids.

MATERIAL AND METHODS: We introduced prepacked take-home analgesia bags for postoperative pain treatment in outpatient surgery. The bags came in two sizes, each containing paracetamol, etoricoxib, and oxycodone. The first 147 patients who received the prepacked analgesia bags were included in the study, and received a questionnaire one month after surgery covering self-assessed pain (visual analog scale of 0-10) and satisfaction (0-5), as well as opioid consumption. Prescription data after introducing the analgesia bags were compared with data before the bags were introduced.

RESULTS: Of the 147 patients included in the study, 58 responded. Compared to standard prescription (small bag group: 14 oxycodone immediate release capsules (5 mg), large bag group: additional 28 oxycodone extended release tablets (5 mg), based on the smallest available package), the patients in the small analgesia bag group received 50% less oxycodone and 67% less for the large bag group. Patients with small bags consumed a median of 0.0 mg oxycodone and those with large bags consumed a median of 25.0 mg oxycodone. The median satisfaction was 5.0 (range: 2-5) and the median pain score was acceptable at the first postoperative day. Prescription data showed a significant reduction of 60.0% in the total amount of prescribed opioids after the introduction of prepacked analgesia bags.

CONCLUSIONS: The introduction of prepacked analgesia bags dramatically reduced the quantity of opioids prescribed after outpatient hand surgery. Patient satisfaction was high and the postoperative pain level was acceptable.