{"title":"How I Approach a Patient with CRPS - A Shifting Paradigm (History, Examination, Investigations, Classification and Treatment).","authors":"Francisco Del Piñal","doi":"10.1142/S2424835525400028","DOIUrl":"10.1142/S2424835525400028","url":null,"abstract":"<p><p>The author's approach to a patient with CRPS is presented. The key is to classify the patient into any of the following groups: wrong diagnosis, psychogenic-dystonic hand, nerve injury (complex regional pain syndrome [CRPS] 2), flare reaction (FR) and the remaining would comprise the real CRPS 1 patient. The first three do not represent any mysterious condition, but require addressing the underlying problem, while a FR - a minor form of CRPS 1 - is, for the most, self-resolved by physical therapy. The remaining group, i.e. the true CRPS 1 case, have a condition known as irritative carpal tunnel syndrome (ICTS): release of the transverse carpal ligament yields a 94% cure rate. Even though the treatment is the same, carpal tunnel syndrome (CTS) and ICTS are very different conditions. In summary, there is a paradigm shift in handling CRPS patients. Further research to understand the pathophysiology and the failures is needed. <b>Level of Evidence:</b> Level V (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"229-234"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuji Saeki, Sotetsu Sakamoto, Yasunori Hattori, Kazuteru Doi
{"title":"Pinning the Thumb Carpometacarpal Joint in Abduction Can Reduce Skin Irritation from Suzuki Frame Treatment for Metacarpophalangeal Joint Fractures.","authors":"Yuji Saeki, Sotetsu Sakamoto, Yasunori Hattori, Kazuteru Doi","doi":"10.1142/S242483552572004X","DOIUrl":"10.1142/S242483552572004X","url":null,"abstract":"<p><p>Comminuted intra-articular fractures of the metacarpophalangeal joint (MCPJ) of the thumb are difficult to treat because of challenges with anatomical fixation. The pins and rubbers traction system (PRTS), described by Suzuki et al., is a minimally invasive technique that enables early range-of-motion training while maintaining joint congruency. PRTS exhibits advantages relative to other dynamic external fixation techniques due to its simplicity, low cost and compact design. It has been used mainly in treating primarily proximal interphalangeal joint (IPJ) fractures. We present two patients where we used a PRTS for comminuted intra-articular fractures of the thumb MCPJ with good outcomes. We temporarily pinned the carpometacarpal joint (CMCJ) in maximum abduction to avoid skin irritation from the ulnar aspect of the axial traction wire in thumb adduction. <b>Level of Evidence:</b> Level V (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"326-330"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sensory Nerve Transfer for Intractable Neuropathic Pain in a Case of C<sub>8</sub>-T<sub>1</sub> Root Avulsion in Brachial Plexus Injury.","authors":"Sanjay Maurya, Shivam Beniwal, Onkar Singh","doi":"10.1142/S2424835525720051","DOIUrl":"10.1142/S2424835525720051","url":null,"abstract":"<p><p>Neuropathic pain in root avulsion brachial plexus injury (BPI) is severe and unrelenting. Routine analgesics and other described methods often provide inadequate pain relief. We report a patient with neuropathic pain following C<sub>8</sub>T<sub>1</sub> root avulsion injury, which was successfully managed with end-to-side ulnar sensory branch transfer to the median nerve. Postoperatively, there was a marked reduction in pain score as determined by visual analogue score (VAS) and a marked improvement in the daily sleep interference scale (DSIS). This option may be considered in patients with severe neuropathic pain in lower root avulsion injury in BPI. <b>Level of Evidence:</b> Level V (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"317-320"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gugri Manjunatha Sunay, Samayam Srinath-Kiran, Praveen Bhardwaj, S Raja Sabapathy
{"title":"Concomitant Ipsilateral Hourglass-Like Constrictions of Suprascapular and Axillary Nerves: Report of a Rare Case.","authors":"Gugri Manjunatha Sunay, Samayam Srinath-Kiran, Praveen Bhardwaj, S Raja Sabapathy","doi":"10.1142/S2424835525720075","DOIUrl":"10.1142/S2424835525720075","url":null,"abstract":"<p><p>Hourglass-like constriction (HGC) of the nerve is a rare cause of nerve palsy and has been reported for many nerves. We were unable to find previous reports of concomitant constriction of the suprascapular and axillary nerve in literature. Our patient was a young male with shoulder paralysis of 7-months duration. On exploration we found two HGCs of the suprascapular and axillary nerves. A neurolysis of the suprascapular nerve was carried out. The axillary nerve constriction was deemed to be severe and a nerve transfer using the branch innervating the medial head of the triceps motor was done. Patient recovered excellent shoulder function at 1-year post-surgery. Awareness about this rare occurrence will prevent poor outcome from addressing the constriction at only one site. Nerve surgery should be considered for patients who do not show any improvement in 6 months. <b>Level of Evidence:</b> Level IV (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"312-316"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael El Leow, Mark E Puhaindran, Alphonsus K S Chong
{"title":"Silicone Locking-Liner Socket with a Lightweight Aesthetic Prosthesis for Short Congenital Forearm Stumps: A Report of Two Patients.","authors":"Michael El Leow, Mark E Puhaindran, Alphonsus K S Chong","doi":"10.1142/S2424835525720063","DOIUrl":"10.1142/S2424835525720063","url":null,"abstract":"<p><p>Conventional prosthetic sockets can be uncomfortable and restrictive to elbow flexion when fitted on short forearm stumps due to their high trimline. We report improved patient experience after switching to a locking silicone-liner socket in conjunction with a lightweight aesthetic prosthesis in two congenital transradial amputees with short stumps who were previously dissatisfied with their conventional prosthesis. To reduce weight, the forearm section of the prosthesis was constructed using a lightweight design. Seven of eight attributes, namely aesthetics, comfort, suspension, ease of donning/doffing, weight, range of motion, skin issues and overall satisfaction, were rated by both patients as having improved versus their conventional prosthesis, with no change reported regarding issues of the skin. Our experience suggests that transradial amputees with short stumps who had problems with conventional fittings due to socket impingement and prosthesis weight may benefit from an approach combining a locking-pin liner suspension with a lightweight prosthesis. <b>Level of Evidence:</b> Level V (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"321-325"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hui Neng Lim, Mala Satku, Jieying Xu, Lam-Chuan Teoh
{"title":"Palmar Z-Osteotomy for Distal Radius Fractures.","authors":"Hui Neng Lim, Mala Satku, Jieying Xu, Lam-Chuan Teoh","doi":"10.1142/S2424835525500286","DOIUrl":"10.1142/S2424835525500286","url":null,"abstract":"<p><p><b>Background:</b> Distal radius fractures (DRFs) are a common injury with fracture parameters guiding surgical treatment. Palmar plating is the most common method of fixation in patients needing surgical fixation. However, in fractures with a complete or nearly intact volar cortex, reduction of the fracture fragments may be challenging with the palmar approach. We use a novel Z-osteotomy technique to address this issue and report on our outcomes. <b>Methods:</b> This is a retrospective review of all patients where a volar Z-osteotomy technique was used. We assessed pre-, intra- and postoperative radiographic parameters, fracture union and final wrist range of motion of all patients. <b>Results:</b> Twelve DRFs in 11 patients were analysed. All fractures were successfully plated palmarly with volar tilt 9-14 (average: 11.3) and all achieved fracture union. This was maintained in the final radiographs with good clinical wrist range of motion. <b>Conclusions:</b> The volar Z-osteotomy technique described allows surgeons to achieve anatomical reduction of volar tilt in DRFs where the volar cortex is intact with good clinical and radiological outcomes. <b>Level of Evidence:</b> Level IV (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"281-286"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Risk Factors Associated with Collapse of Distal Radius Fractures after Volar Locking Plate Fixation in Older Adults.","authors":"Sanglim Lee, Suk Ha Jeon","doi":"10.1142/S2424835525500298","DOIUrl":"10.1142/S2424835525500298","url":null,"abstract":"<p><p><b>Background:</b> This study aimed to identify the risk factors associated with re-displacement or collapse of distal radius fractures treated using volar locking plates in older adults. <b>Methods:</b> We conducted a retrospective analysis of 131 patients aged ≥65 years with distal radius fractures who underwent volar locking plate fixation. The collapse was classified into three categories: 'radial collapse' was determined as the top decile of patients with the greatest decrease in radial inclination; 'dorsal collapse' was defined by volar tilt angle on lateral or 25° tilted lateral views and 'height collapse' by radial height. To identify the factors related to these three types of collapses, we compared the clinical and radiological parameters between the wrists with each type of collapsed and non-collapsed wrists. <b>Results:</b> Dorsal collapse had no significant associated factors and radial collapse had osteoporosis as a significant different factor. The height collapse group was associated with older age, had a higher prevalence of high-energy injury mechanisms and a limited range of flexion-extension at final follow-up and larger distance between the articular surface and distal screws. <b>Conclusions:</b> The volar locking plate may effectively prevent three types of collapses. Height collapse group included patients with increased age, high-energy injury mechanisms and limited range of flexion-extension at the time of final follow-up. To prevent collapse, the longest possible distal screws must be inserted just beneath the subchondral bone. <b>Level of Evidence:</b> Level IV (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"262-270"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmad Dashtbozorg, Hooman Shariatzadeh, Sina Shariati, Mahmoud Shariatirad
{"title":"The Long-Term Effects of Radial Head Excision for Mason Type 3 Radial Head Fracture.","authors":"Ahmad Dashtbozorg, Hooman Shariatzadeh, Sina Shariati, Mahmoud Shariatirad","doi":"10.1142/S2424835525500304","DOIUrl":"10.1142/S2424835525500304","url":null,"abstract":"<p><p><b>Background:</b> Radial head fractures with comminution and displacement present challenges in achieving optimal treatment outcomes in the long term. This study aims to evaluate the long-term effects of radial head excision (RHE) in patients with Mason type 3 fractures. <b>Methods:</b> We conducted a retrospective study of patients with a Mason type 3 radial head fracture who underwent primary RHE between January 2010 and January 2020. The primary outcome was the Mayo elbow performance score (MEPS). Additionally, joint stability and arthritis, and the carrying angle were recorded for each patient. <b>Results:</b> In total, 61 patients (21; 34% female) with a follow-up range of 3-13 years were examined. The mean (SD) total MEPS was 91.8 (9.2). The results were excellent for 46, good for 12 and fair for 3 patients. A model of total MEPS adjusted for sex, age and follow-up time showed a significant effect of patient age on treatment success (<i>p</i> < 0.001). Thirteen patients (21%) showed elbow instability. Six individuals had increased valgus laxity. The mean carrying angle was 19° (range: 11°-27°) on the injured side and 9° (4°-15°) on the uninjured side, <i>t</i>(120) = 12.608, <i>p</i> < 0.001. Overall, 37 patients had degenerative changes in the operative elbow. <b>Conclusions:</b> Benefits of RHE persist for a long time with predominantly excellent elbow function and minimal complications. An increase in the carrying angle, joint instability and degenerative changes are to be expected. Patient age at the time of the surgery can affect treatment outcomes. <b>Level of Evidence:</b> Level IV (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"254-261"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Evaluation of Trigger Digits.","authors":"Sandeep Jacob Sebastin","doi":"10.1142/S2424835525010040","DOIUrl":"10.1142/S2424835525010040","url":null,"abstract":"","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"331-332"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Comparison of the Effect of Wrist Immobilisation on the Outcomes of Cerclage Wire Fixation of Spiral or Oblique Metacarpal Fractures.","authors":"Wuttipong Siriwittayakorn, Parod Teantunyakij, Wattanai Atthakorn, Jirawat Chotayakul, Wichit Siritattamrong","doi":"10.1142/S2424835525500353","DOIUrl":"10.1142/S2424835525500353","url":null,"abstract":"<p><p><b>Background:</b> There are limited studies on cerclage wiring (CW) for simple spiral or oblique metacarpal shaft fractures. It is generally believed that this fixation technique is not rigid and requires postoperative immobilisation. This study aims to compare the effect of wrist immobilisation on the outcomes of cerclage wire fixation of spiral or oblique metacarpal fractures. <b>Methods:</b> The study included 29 patients, divided into two groups: Group A, with 14 patients who had no postoperative immobilisation, and Group B, with 15 patients who were splinted after surgery. The primary outcomes were metacarpophalangeal (MCP) joint range of motion (ROM), quick disabilities of arm, shoulder and hand (Q-DASH) score and patient-rated wrist evaluation (PRWE) score. All patients were followed until 12 weeks post-surgery. <b>Results:</b> Patients in Group A had significantly better MCP joint ROM at 2 and 4 postoperative weeks. The Q-DASH and PRWE scores were significantly better in Group A at 2 postoperative weeks but showed no difference after the splint was removed. All fractures united within 12 weeks after surgery. There were no cases of infection, implant breakage or re-fracture. <b>Conclusions:</b> Postoperative immobilisation after CW in simple spiral or oblique metacarpal shaft fractures led to reduced MCP joint ROM and functional outcomes in the early postoperative period. Early gentle mobilisation can be encouraged immediately following surgery. <b>Level of Evidence:</b> Level III (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"299-305"},"PeriodicalIF":0.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}