Review and update on the management of triangular fibrocartilage complex injuries in professional athletes

Triangular fibrocartilage complex injuries are common in amateur and professional sports.These injuries are mainly caused by acute or chronic repetitive axial loads on the wrist,particularly on the ulnar side and in association with rotations or radial/ulnar deviations.In order to treat professional athletes,a detailed specific knowledge of the pathology is needed.Moreover,the clinician should fully understand the specific and unique environment and needs of the athletes,their priorities and goals,the type of sport,the time of the season,and the position played.An early diagnosis and appropriate management with the quickest possible recovery time are the uppermost goals for both the athlete and the surgeon.A compromise between conservative vs surgical indications,athletes’needs and expectations,and financial implications should be achieved.Arthroscopic procedures should be timely planned when indicated as they could allow early diagnosis and treatment at the same time.Conservative measures are often used as first line treatment when possible.Peripheral lesions are treated by arthroscopic repair,whilst central lesions are treated by arthroscopic debridement.Further procedures(such as the Wafer procedure,ulnar osteotomies,etc.)have specific indications and great implications with regard to rehabilitation.

Epidemiology of work-related hand and wrist injuries in a referral center: A descriptive study

BACKGROUND Occupational hand and wrist injuries(OHWIs)account for 25%of work-related accidents in low-and middle-income countries.In Colombia,more than 500000 occupational accidents occurred in 2021,and although the rate declined to less than 5%in 2020 and 2021,at least one in four accidents involved a hand or wrist injury.AIM To describe the OHWIs in workers seen at the emergency room at a second-level hospital in Colombia.METHODS An observational study was performed using data from workers who experienced OHWIs and attended a second-level hospital,between June,2020 and May,2021.The overall frequency of OHWIs,as well as their distribution by sociodemo-graphic,clinical,and occupational variables,are described.Furthermore,association patterns between sex,anatomical area(fingers,hand,wrist),and type of job were analyzed by correspondence analysis(CA).RESULTS There were 2.101 workers treated for occupational accidents,423(20.3%)were cases of OHWIs,which mainly affected men(93.9%)with a median age of 31 years and who worked mainly in mining(75.9%).OHWIs were more common in the right upper extremity(55.3%)and comprised different types of injuries,such as contusion(42.1%),laceration(27.9%),fracture(18.7%),and crush injury(15.6%).They primarily affected the phalanges(95.2%),especially those of the first finger(25.7%).The CAs showed associations between the injured anatomical area and the worker’s job that differed in men and women(explained variance>90%).CONCLUSION One out of five workers who suffered occupational accidents in Cundinamarca,Columbia had an OHWI,affecting mainly males employed in mining.This occupational profile is likely to lead to prolonged rehabilitation,and permanent functional limitations.Our results might be useful for adjusting preventive measures in cluster risk groups.

Hemiarthroplasty for irreparable distal radius fractures in the elderly:A comprehensive review

BACKGROUND Elderly patients maintaining functional independence can now be candidates for primary wrist hemiarthroplasty to manage acute irreparable distal radius fractures(DRFs).However,further investigation with long-term follow-up is required to validate these initial findings.AIM To review the literature on the outcomes of distal radius hemiarthroplasty with available implants to assess its viability as a treatment option.METHODS A comprehensive review of the literature was conducted using electronic databases,including PubMed,Medline,and Scopus.The search terms employed were"distal radius fracture","hemiarthroplasty","wrist arthroplasty",and related terminology.The search was restricted to articles published in English from 1980 until June 2023.Inclusion criteria encompassed cases or case series of DRF treated with hemiarthroplasty,providing clinical or radiographic outcomes,and published in peer-reviewed journals.RESULTS A total of 2508 articles from PubMed and 883 from Scopus were identified initially.Following screening and removal of duplicates,13 articles met the inclusion criteria.These articles,predominantly clinical retrospective studies,provided insights into hemiarthroplasty outcomes,including functional improvements and complications.Hemiarthroplasty was a treatment option for complex DRF,particularly those cases with severe comminution,intraarticular involvement,or severe osteoporosis.Functional outcomes demonstrated improvements in pain relief,wrist mobility,and grip strength,with variability across studies.Complications included implant loosening,infection,nerve injury,and stiffness,with varying incidence rates influenced by surgical techniques and implant choice.Long-term outcomes were inadequately documented,warranting further research.CONCLUSION Hemiarthroplasty is a promising treatment for irreparable DRF in the elderly.Long-term outcomes and complications require further study.

Clinical and laboratory features of juvenile idiopathic arthritis with wrist involvement:Results of a retrospective cohort study

BACKGROUND Previous studies in the pre-biological era showed an association of wrist inflammation in juvenile idiopathic arthritis(JIA)with progressive disease course,polyarticular involvement and failure of methotrexate treatment.AIM To describe features of JIA,associated with wrist arthritis.METHODS Data from about 753 JIA patients were included in this retrospective cohort study.The clinical and laboratory features of patients with and without wrist involvement were analyzed.RESULTS Wrist involvement was found in oligoarthritis(5.8%),RF(−)/RF(+)polyarthritis(44.9%/15.0%),enthesitis-related arthritis(17.7%),and systemic(58.6%)JIA categories.Unilateral wrist involvement was typical for oligoarthritis patients,bilateral involvement was either equal to that of unilateral involvement or was more frequent in other categories.Wrist arthritis was found to be associated with female sex,a low incidence of uveitis,and more indications of systemic inflammation,including elevated levels of C-reactive protein,erythrocyte sedimentation rate,and platelets,as well as involvement of the cervical spine,temporomandibular,shoulder,elbow,metacarpophalangeal,proximal interphalangeal,distal interphalangeal,hip,ankle,and tarsus arthritis.The number of patients with hip osteoarthritis and hip replacement was also higher.Wrist arthritis was associated with a lower probability of achieving remission[hazard ratio(HR)=1.3(95%CI:1.0-1.7),P=0.055],and a higher probability of being treated with biologics[HR=1.7(95%CI:1.3-2.10,P=0.00009)].CONCLUSION Wrist arthritis in JIA patients is a marker of a severe disease course,characterized by more intensive inflammation,unfavorable outcomes,and.requiring more intensive treatment with early administration of biologics.Close monitoring of wrist inflammation with ultrasound and MR assessment with early biological treatment might improve the outcomes.

High-resolution 3T Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex in Chinese Wrists： Correlation with Cross-sectional Anatomy

Background：The injury of the triangular fibrocartilage complex （TFCC） is a common cause of ulnar-sided wrist pain.The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging （MRI） could demonstrate the detailed complex anatomy of TFCC in Chinese.Methods：Fourteen Chinese cadaveric wrists （from four men and three women;age range at death from 30 to 60 years;mean age at 46 years） and forty healthy Chinese wrists （from 20 healthy volunteers,male/female：10/10;age range from 21 to 53 years with a mean age of 32 years） in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study.All cadavers and volunteers had magnetic resonance （MR） examination of the wrist with coronal T 1-weighted and proton density-weighted imaging with fat suppression in three planes,respectively.MR arthrography （MRAr） was performed on one of the cadaveric wrists.Subsequently,all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw （six in coronal plane,four in sagittal plane,and four in axial plane）.The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists.Results：Triangular fibrocartilage,the ulnar collateral ligament,and the meniscal homolog could be best observed on images in coronal plane.The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane.The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane.The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr.Conclusion：High-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese.

Recurrent intramuscular lipoma at extensor pollicis brevis:A case report

BACKGROUND This report describes and discusses recurrent intramuscular lipoma(IML)of the extensor pollicis brevis(EPB).An IML usually occurs in a large muscle of the limb or torso.Recurrence of IML is rare.Recurrent IMLs,especially those with unclear boundaries,necessitate complete excision.Several cases of IML in the hand have been reported.However,recurrent IML appearing along the muscle and tendon of EPB on wrist and forearm has not been reported yet.CASE SUMMARY In this report,the authors describe clinical and histopathological features of recurrent IML at EPB.A 42-year-old Asian woman presented with a slowgrowing lump in her right forearm and wrist area six months ago.The patient had a history of surgery for a lipoma of the right forearm one year ago with a scar of 6cm on the right forearm.magnetic resonance imaging confirmed that the lipomatous mass,which had attenuation similar to subcutaneous fat,had invaded the muscle layer of EPB.Excision and biopsy were performed under general anesthesia.On histological examination,it was identified as an IML showing mature adipocytes and skeletal muscle fibers.Therefore,surgery was terminated without further resection.No recurrence occurred during a follow-up of five years after surgery.CONCLUSION Recurrent IML in the wrist must be examined to differentiate it from sarcoma.Damage to surrounding tissues should be minimized during excision.

Bridge plating in the setting of radiocarpal instability:Does distal fixation to the second or third metacarpal matter?A cadaveric study

BACKGROUND Radiocarpal dislocations are rare but potentially devastating injuries.Poorer outcomes are associated with inadequate or lost reduction,such as ulnar translocation,but no consensus exists on the ideal fixation technique.Dorsal bridge plate fixation has been described for various settings in the treatment of complex distal radius fractures and can be fixed distally to the second or third metacarpal,but its application for radiocarpal dislocations has not been established.AIM To determine whether distal fixation to the second or third metacarpal matters.METHODS Using a cadaveric radiocarpal dislocation model,the effect of distal fixation was studied in two stages:(1)A pilot study that investigated the effect of distal fixation alone;and(2)a more refined study that investigated the effect of described techniques for distal and proximal fixation.Radiographs were measured in various parameters to determine the quality of the reduction achieved.RESULTS The pilot study found that focusing on distal fixation alone without changing proximal fixation results in ulnar translocation and volar subluxation when fixing distally to the second metacarpal compared with the third.The second iteration demonstrated that anatomic alignment in coronal and sagittal planes could be achieved with each technique.CONCLUSION In a cadaveric radiocarpal dislocation model,anatomic alignment can be maintained with bridge plate fixation to the second metacarpal or the third metacarpal if the described technique is followed.When considering dorsal bridge plate fixation for radiocarpal dislocations,the surgeon is encouraged to understand the nuances of different fixation techniques and how implant design features may influence proximal placement.

Intra-Articular Distal Radius Fracture with Lunate Fossa Rotated and Associated Lesions: Radiologic Analysis

Introduction: Intra-articular distal radial fractures in young patients occur in high energy trauma which can lead to a combination of bone and ligaments lesions. An articular step superior to 2 mm is pejorative, for that an adequate radiologic analysis is necessary accessing to the best surgical treatment. The purpose of our study was to investigate this type of fracture and expose radiologic analysis (radiograph and CT-scan) of bone and ligamentous associated lesions of this specific twisted lunate facet fracture for recognizing it and accessing to the best surgical treatment. Patients and Methods: Seven patients with severely displaced type 4 articular fractures of the distal radius whose wrists had been exposed to violent compression are reported in our series, they are required open treatment for the reduction and fixation of disrupted articular surfaces by using an antero-medial approach which allows direct access to the fragment of the lunate facet and easier visualization of the distal radio-ulnar joint. Results: All the patients were clinically examined with antero-posterior and lateral X ray, completed by a CT scan, all the fractures were type IV according to Melone classification. In all of our seven cases there was a lesion of the distal radioulnar joint (DRUJ) identified in the CT scan. The CT scan allowed us to individualize well the void of the lunate fossa and calculate his exact degree of rotation, which is very important for planning therapeutic management. Discussion: In all of our cases the CT scan was to expose all of the osseous and ligamentous injuries;in the sagittal reconstruction we were able to objectify and calculate the exact degree of the rotation of the lunate fossa fragment;in the frontal reconstruction the void of the lunate fossa is visible and in the axial reconstruction we can determine the incongruence of the distal radio-ulnar joint (DRUJ). Intra-articular involvement has long been recognized as a poor prognostic factor in fractures of the distal radius. However, despite early studies reporting poor results with non operative treatment for these injuries, most authors opposed operative intervention, due to lack of a good radiological analysis and the CT scan;knowledge that a number of studies have shown that inadequate reduction of intra-articular distal radius fractures leads to the development of arthritis.

Multi-Segmental Osteocutaneous Free Fibula Flap for Three-Dimensional Post-Traumatic Thumb and Wrist Reconstruction

Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.

The Development of Dynamic Compliant Wrist for Robots

Based on an analysis of the relative shaft-to-hole position and attiude errors, as well as of the mechanics and Kinematics in the process of automatic assembly of industrial robots, the paper studies the principle of construction of dynamic wrists. Type I-3 and Ⅱ-6 dynamic compliant wrists have been designed and made. Prblems in the production of compliant elements and the connection between compliant elements and wrists were also solved. A study on the results of tests of the function of two kinds of dynamic compliant wrists shows that the dynamic compliant wrist's compliancy function can be improved by adding metallic materials having higher longitudinal and transverse rigidity into the softer elstomer. And the design Principle is proved to be feasible and practicable. It can be expected that the use of dynamic compliant wrist will greatly lower the technical requirements of the shaft-hole assembly and the requirements in the resetting accuracy.

Computer-assisted Surgery for Scaphoid Fracture

The computer-assisted surgery (CAS)has significantly improved the accuracy, reliability and outcomes of traumatic,spinal,nerve surgery and many other operations with a less invasive way.The application of CAS for scaphoid fractures remains experimental.The related studies are scanty and most of them are cadaver researches.Some intrinsic defects from the registration procedure,scan and immobilization of limbs may inevitably result in deviations. Some deviations become more obvious with operations of small bones (such as scaphoid)although they are acceptable for spine and other orthopedic surgeries.We reviewed the current literatures on the applications of CAS for scaphoid operation and summarized technical principles,scan and registration methods,immobilization of limbs and their outcomes.On the basis of the data,we analyzed the limitations of this technique and envisioned its future development.

Free Flow-through Anterolateral Thigh Flaps for Wrist High-tension Electrical Burns:A Retrospective Case Series

Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018.The clinical and pathological data were extracted from electronic hospital medical records.We obtained follow-up information through clinic visits.Results The injury sites for all 8 patients were the wrists,specifically 5 right and 3 left wrists,all of which were on the flexor side.Five patients had ulnar artery embolism necrosis and patency,with injury to the radial artery.Two patients had ulnar and radial arterial embolization and necrosis.The last patient had ulnar arterial embolization and necrosis with a normal radial artery.After debridement,the wound area ranged from 12 cm×9 cm to 25 cm×16 cm.The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns.Free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)were used to repair the wounds.The prognosis for all patients was good after six months to one year of follow-up.Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice.The use of free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.

Artificial tiger bone powder for improving the quality of life in elderly patients with fracture

Objective: To investigate the application of artificial tiger bone powder on fracture healing time, wrist functional recovery and quality of life (QOL) in elderly patients with distal radius fracture. Methods: The study was a randomised controlled trials performed from January 2015 to December 2016 in a hospital. Elderly patients with distal radius fracture were divided into the treatment and the control groups by the random sealed envelope method. All patients were given splint or plaster fixation after manipulative reduction, and functional exercise, the treatment group was also given artificial tiger bone powder orally (trade name: Jintiange capsule), the control group was given an oral placebo in their appearance and usage identical with the treatment group. Prior to treatment and 6, 12 months after treatment, the wrist function was assessed by range of motion, including flexion-extension, radial-ulnar and pronation-supination, and the QOL was assessed by the Mos 36-item Short Form Health Survey. Each patient's fracture healing time was recorded. Results: Before treatment, there were no significant differences in wrist function and QOL between the two groups. At 6 and 12 months after treatment, the wrist function and QOL in the treatment group were better than those in the control group, the differences were statistically significant (P < 0.05). The fracture healing time in the treatment group was shorter than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion: The early usage of artificial tiger bone powder for elderly patients with distal radius fracture can promote the healing of fracture, recovery of wrist joint function, and ultimately improve the QOL for elderly patients.

Entrapment neuropathies in diabetes mellitus

Neuropathy is a common complication of diabetes mellitus(DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies(EN), which are focal forms, are so frequent at any stage of the diabetic disease, that they may be considered a neurophysiological hallmarkof peripheral nerve involvement in DM. Indeed, EN may be the earliest neurophysiological abnormalities in DM,particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. This remarkable frequency of EN in diabetes is underlain by a peculiar pathophysiological background. Due to the metabolic alterations consequent to abnormal glucose metabolism,the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage,making them more prone to entrapment in anatomically constrained channels. This review discusses the most common and relevant EN encountered in diabetic patient in their epidemiological, pathophysiological and diagnostic features.

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography(MDCT) in suspected scaphoid fractures.METHODS: One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities.RESULTS: Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients(42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT(P < 0.01) concerning scaphoidfracture detection. The mean effective dose of MDCT was 0.1 m Sv compared to 0.002 m Sv of conventional radiography.CONCLUSION: Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.

Optimal surgical approach for the treatment of Quervains disease: A surgical-anatomical study

AIM To determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the nerves which at risk are the superficial branch of the radial nerve(SBRN) and the Lateral Antebrachial Cutaneous Nerve(LABCN).METHODS Twenty embalmed arms were dissected and the course of the SBRN and the LABCN in each individual arm was marked and the distance between the two branches of the SBRN at the location of the First Extensor Compartment(FEC) was measured. This data was used as input in a visualization tool called Computer Assisted Anatomy Mapping(CASAM) to map the course of the nerves in each individual arm. RESULTS This image visualizes that in 90% of the arms, one branch of the SBRN crosses the FEC and one branch runs volar to the compartment. The distance between the two branches was 7.8 mm at the beginning of the FEC and 10.2 mm at the end. Finally the angle of incision at which the chance of damage to the nerves is lowest, is 19.4 degrees volar to the radius.CONCLUSION CASAM shows the complexity of the course of the SBRN over the FEC. None of the four widely used incision techniques has a significantly lower chance of iatrogenic nerve damage. Surgical skills are paramount to prevent iatrogenic nerve damage.

Arthrodesis of the wrist in rheumatoid arthritis

In rheumatoid arthritis the small joints of the feet and hands are the first targets of the autoimmune process. In about one half of the patient the wrist is involved in the first stages of the disease(two years) increasing up to nearly 90 percent after a decade often including both sides. Osteoarthritis of the wrist is one of the most common conditions encountered by hand surgeons. One aim of all treatment options is to achieve the best possible hand function without pain. If conservative treatment fails, operative treatment is necessary. Choice of surgical treatment depends on the soft tissue and bone situation. Techniques can be differentiated by joint preservation or joint replacement. The first include radio-synoviorthesis, synovectomy and tendon repair, the latter resection-arthroplasty, total joint arthroplasty and arthrodesis. In this paper arthrodesis of the wrist as one treatment option is reviewed.

Influence of volar margin of the lunate fossa fragment fixation on distal radius fracture outcomes:A retrospective series

BACKGROUND Distal radius fractures accompanied by the volar margin of the lunate fossa(VMLF)lesions are often overlooked or inadequately reduced in clinical practice.AIM To investigate the impact of VMLF fragment in distal radius fractures on the stability and function of the wrist joint.METHODS This was a retrospective study of patients with distal radius fractures who underwent surgical treatment between January 2013 and December 2017.The patients were divided into two groups according to whether the VMLF fragments were fixed or not.X-rays and computed tomography were performed before surgery,immediately postoperatively,and at 1,3,and 6 mo to measure the scapholunate angle,radiolunate angle,capitolunate angle,and effective radiolunate flexion(ERLF).The Mayo wrist score and disabilities of the arm,shoulder,and hand(DASH)score were determined at 1 year.RESULTS Thirty-five patients were included.There were 15 males and 20 females.Their mean age was 52.5±14.3(range:19-70)years.There were 38 wrists(17 on the left side,15 on the right,and three bilateral;16 in the fixed group,and 22 in the unfixed group).The interval between trauma and surgery was from 1 h to 1 mo.The incidence of postoperative wrist instability in the unfixed group(86.4%)was higher than in the fixed group(25.0%)(P≤0.001).Ten patients had ERLF>25°in the unfixed group and none in the fixed group(P=0.019).The Mayo wrist score was 94±5.7 in the fixed group and 68±15.1 in the unfixed group(P<0.001).The DASH score was 4.6±2.5 in the fixed group and 28.5±19.5 in the unfixed group(P<0.001).CONCLUSION Injuries of VMLF,even small fractures,might damage the radial-lunar ligament,leading to postoperative wrist instability,sagittal force line imbalance,and poor recovery of wrist joint function.

Idiopathic tenosynovitis of the wrist with multiple rice bodies: A case report and review of literature

BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery,and there are still many uncertainties regarding its diagnosis and treatment.CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature.A total of 43 articles and 61 cases were included in the literature review.Our case had a usual presentation:it was similar to those in the literature.The affected population was mainly older adults,with an average age of 59.43(range,3 to 90)years.The male-to-female ratio was 1.54:1(37/24).Most of them showed limited swelling and pain,only 23.0%had carpal tunnel symptoms,and the average disease duration was 18.03(0.5-60)mo.Wrist flexor tendon sheath involvement was the most common(95.1%,58/61),and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis(34.4%,21/61),nontuberculous mycobacteria(24.6%,15/61),idiopathic tenosynovitis(31.1%,19/61),and others(9.84%,6/61).There were 10 patients with recurrences;in 6 of them,were due to non-tuberculous mycobacterial infections.CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation,and established a clinical management algorithm for wrist tenosynovitis with rice bodies,which can provide some reference for our clinical diagnosis and treatment.The symptoms of rice-body bursitis of the wrist are insidious,nonspecific,and difficult to identify.The aetiology is mainly idiopathic tenosynovitis and mycobacterial(tuberculosis or non-tuberculous)infections;the latter are difficult to treat and require long-duration systemic combination antibiotic therapies.Therefore,before a diagnosis of idiopathic tenosynovitis is made,we must exclude other causes,especially mycobacterial infections.

Wrist circumference: A new marker for insulin resistance in African women with polycystic ovary syndrome

BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS women.Research has shown that hyperinsulinemia is correlated with increased bone mass.Given that most women with PCOS are insulin resistant,which is independent from body fat and characterized by hyperinsulinemia,it could be hypothesized that there would be an increased bone mass in the patient as a result.Subsequently,increased bone mass could be measured using the wrist circumference method.AIM To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.METHODS Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group,were enrolled in the study(mean age 24.33±5.36 years).Fasting biochemical parameters,and the Homeostasis Model Assessment of insulin resistance(HOMA-IR)and body composition were evaluated.The nondominant wrist circumference was measured manually,as was the waist circumference(WC),hip circumference,height and weight.Calculated measures included evaluation of body mass index(BMI),Waist-to-Height(WHtR)and Waist-to-hip ratio(WHR).In addition,body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.RESULTS The non-dominant wrist circumference was more closely correlated with HOMAIR(r=0.346;P=0.003)and was the best anthropometrical marker correlated with IR(P=0.011)compared with other anthropometrical markers in women with PCOS:Dominant Wrist Circumference(r=0.315;P=0.007),Waist Circumference(WC)(r=0.259;P=0.028),BMI(r=0.285;P=0.016),WHR(r=0.216;P=0,068)and WHtR(r=0.263;P=0.027).The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic(ROC)curve analysis showed that the area under the ROC curve was 0.72.A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.CONCLUSION Non-dominant wrist circumference is,to date,the best anthropometrical marker of IR in Sub-Saharan African women with PCOS.It could be suggested as an easy-to-detect marker for assessing IR.