Pronator Syndrome and JHS Spotlight Manuscripts

Chuck and Chris continue the initiative working with The Journal of Hand Surgery on a quarterly journal club.  Nash and Macerena choose the articles from the previous quarter and Chris and Chuck review the articles and discuss practical implications.  See articles below.

In addition, we discuss a case of possible pronator syndrome together with carpal tunnel syndrome including debate on the role of nerve studies, physical examination, and ultrasound.

1) Rames JD, Emanuels AF, Tunaboylu MF, Moran SL. A 40-Year Retrospective Evaluation of Vascularized Bone Grafting for Kienböck Disease. J Hand Surg Am. 2026 Jan;51(1):13.e1-13.e9. doi: 10.1016/j.jhsa.2025.07.025. Epub 2025 Aug 29. PMID: 40879579.

2) Suzuki T, Kiyota Y, Matsumura N, Sato K, Nakamura M, Iwamoto T. Anatomical Reconstruction of the Terminal Tendon and Lateral Band for Severe Chronic Tendon Mallet Injury. J Hand Surg Am. 2026 Jan;51(1):92.e1-92.e7. doi: 10.1016/j.jhsa.2025.04.025. Epub 2025 Jun 21. PMID: 40542795.

3) Lee C, Shin S, Fraipont G, Hung V, McGarry MH, Lee TQ. Dermal Allograft Augmentation With Proximal Row Carpectomy: A Biomechanical Study. J Hand Surg Am. 2026 Feb;51(2):143-152. doi: 10.1016/j.jhsa.2025.05.006. Epub 2025 Jul 4. PMID: 40613810.

4) Jaarsma EH, Ring D, Tonn MD, Brinkman N. Do Patients Older Than 40 Years with Work Claims for Unilateral Wrist Symptoms Have Symmetric, Bilateral MRI Signal Changes That Do Not Correspond with Symptoms? J Hand Surg Am. 2026 Mar;51(3):313-320. doi: 10.1016/j.jhsa.2025.11.012. Epub 2026 Jan 29. PMID: 41609546.

5) Pohl NB, Brush PL, Parson JP, Fitzgerald P, Charlton A, Beredjiklian PK, Fletcher DJ. Incidence and Predictors of Subsequent Triggering Requiring Treatment After Trigger Finger Release. J Hand Surg Am. 2026 Feb;51(2):203.e1-203.e8. doi: 10.1016/j.jhsa.2025.02.009. Epub 2025 Apr 9. PMID: 40202483.

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As always, thanks to @iampetermartin for the amazing introduction and concluding music.

For additional links, the catalog.  Please see https://www.ortho.wustl.edu/content/Podcast-Listings/8280/The-Upper-Hand-Podcast.aspx

Transcript

Summary

Carpal Tunnel Treatment Approaches

Charles and Christopher discussed a case of a patient with carpal tunnel symptoms and potential median nerve compression in the proximal forearm. They debated the use of nerve studies, ultrasound-guided steroid injections, and surgical approaches for conditions like carpal tunnel and cubital tunnel syndrome. Christopher shared his perspective on when nerve testing and steroid injections are useful, particularly for cubital tunnel, while Charles described his clinical approach to diagnosing and treating these conditions. They concluded by inviting listeners to share their experiences and insights on these topics via email.

Environmentally Friendly Surgical Practices Discussion

Charles and Christopher discussed the topic of environmentally friendly surgical practices, including the use of disposable instrumentation and reusable items like drapes. They expressed interest in bringing on an expert to discuss this further, particularly in light of their new site planning and CMS changes to site of service reimbursement. The conversation concluded with a brief mention of an upcoming peripheral nerve course supported by Checkpoint Surgical, and they acknowledged the 5 journal articles selected for their JHS Journal Club discussion.

Vascularized Bone Grafting Study Retrospective

Charles and Christopher discussed a 40-year retrospective study on vascularized bone grafting for Kienböck's disease led by Steve Moran at Mayo Clinic. The study found that revascularization procedures worked better in patients with early-stage disease, while PRCs performed well in late-stage disease. Charles noted that while the findings align with common sense, the study doesn't change his practice of combining radial shortening osteotomy with vascularized bone flaps for early-stage disease with ulnar negative variance. 

Bilateral MRI Study Discussion

Charles and Christopher discussed a study on bilateral MRIs for wrist pain in older patients, particularly in work compensation cases. They noted that while MRI findings are common, they should be correlated with the patient's physical examination and reported symptoms rather than over-interpreted. Charles highlighted the value of non-typical evaluation practices in contributing to the literature, while Christopher praised the research methodology used in the study. They agreed to continue discussing three more papers in future meetings.

Terminal Tendon Reconstruction

Christopher and Charles reviewed a study from Tokyo surgeons on reconstructing terminal tendons for severe chronic mallet injuries, though both expressed skepticism about implementing this technique due to its complexity and existing effective alternatives. 

Rothman Study on Trigger Finger Release and Future Interventions

They then examined a study from the Rothman Institute about trigger finger releases, which found that 40% of patients required subsequent treatment in either the same or different fingers. Christopher appreciated this study for providing specific statistics to share with patients about potential outcomes after trigger finger release surgery.

Dermal Allograft Wrist Study Discussion

Christopher and Charles discussed a biomechanical study from Cedars-Sinai on dermal allograft augmentation with PRC for wrist joint mechanics. The study demonstrated that double-layer dermal allografts can reduce contact pressures and improve joint mechanics closer to normal wrist function, though the procedure appears technically challenging. While both agreed the research addressed an important biomechanical issue, they questioned its clinical relevance, particularly given the lower complication profile and good outcomes of PRC compared to scaphoid excision and four-corner fusion. They noted the study's industry funding and discussed potential cost implications of the procedure.