De Quervain's tenosynovitis is an overuse disease that involves a thickening of the extensor retinaculum, which covers the first dorsal compartment. A case study approach was utilized in this article to demonstrate many of the available medical and occupational therapy modalities to treat this condition. A 34-year-old right hand-dominant female who works in a daycare facility presents with radial side wrist pain during lifting activity for the past 4–6 weeks. The patient was diagnosed with de Quervain's tenosynovitis and conservative care was initiated. Conservative care involved anti-inflammatory medication and corticosteroid injections as well as occupational therapy to include splinting, activity modification, modalities, manual treatment, and therapeutic exercise. Although conservative care assisted the patient with her symptoms initially, she returned with increased pain and discomfort after 2 months time. At that point, surgery was discussed and performed to release the first dorsal compartment as well as the sub-compartment. The patient was provided with a splint postoperatively and initiated occupational therapy for edema and scar management, therapeutic exercise, and desensitization. Ultimately, the patient was able to return to work pain free.

Surgical release of the transverse carpal ligament for the treatment of carpal tunnel syndrome (CTS) is, in general, a very successful procedure. Some patients, however, fail this standard release and have persistent or recurrent symptoms. Such recalcitrance may relate to incomplete release but more often relates to perineural or intraneural fibrosis of the median nerve. While there is no good treatment for intraneural fibrosis, numerous procedures have evolved in an attempt to treat perineural fibrosis which restricts nerve gliding. These include procedures to isolate the nerve from scar as well as procedures to bring neovascularization to the median nerve. This review describes the various surgical treatment options for recalcitrant CTS as well as their reported outcomes.

Background: Upper extremity length and circumference abnormalities are present in a number of conditions in the pediatric population. In most cases, upper limb hypoplasia and hypertrophy are diagnosed when one limb appears substantially different from the other during physical examination. However, occasionally when this discrepancy exists, it can be difficult to determine which limb is the abnormal one. The purpose of this study was to establish normal values for upper extremity length, circumference, and rate of growth in children aged 0 to 17 years. Methods: In all, 377 participants had 4 measurements taken of each upper extremity: upper arm length, upper arm circumference, forearm length, and forearm circumference. Statistical analysis was performed to identify differences and rates of growth. Results: Mean values for arm and forearm length and circumference for each age, 0 to 17 years, were established. The determination of a child’s expected arm length is dependent on his or her height, age, and sex, while the calculation of a child’s expected forearm length depends on his or her weight, age, and sex. Male and female arms and forearms have similar growth rates of lengths and circumferences. No significant differences were found between right and left extremities for each of the 4 measurements taken. Conclusions: Contralateral limbs can be used for comparison of length and circumference of the arm and forearm in cases of unilateral upper extremity abnormality. The establishment of normal values for upper extremity length, circumference, and growth rate will be a useful diagnostic tool for upper extremity hypoplasia and hypertrophy.

Background: Knowledge is limited about the diagnosis and treatment of modified Gartland type-IV supracondylar humeral fractures. We determined the prevalence of type-IV fractures, identified preoperative characteristics associated with these injuries, and assessed operative treatment characteristics. Methods: We retrospectively identified patients <16 years of age who underwent operative treatment of a supracondylar humeral fracture at 2 centers between 2008 and 2016. We compared patient, injury, and treatment characteristics between type-IV and type-III fracture groups (1:4, cases:controls). Preoperative radiographs were assessed by 4 pediatric orthopaedists blinded to fracture type. The odds of a fracture being type IV were assessed using univariate logistic regression for individual radiographic parameters. Significance was set at alpha = 0.05. Results: Type-IV fractures accounted for 39 (1.3%) of the supracondylar humeral fractures treated operatively during the study period. A type-IV fracture was associated with the following radiographic parameters: flexion angulation (odds ratio [OR] = 17; 95% confidence interval [CI] = 4.9 to 59), valgus angulation (OR = 5.6; 95% CI = 1.6 to 20), and lateral translation (OR = 4.1; 95% CI = 1.6 to 11) of the distal fragment; osseous apposition between the proximal and distal fragments (OR = 4.0; 95% CI = 1.8 to 9.0); and propagation of the fracture line toward the diaphysis of the proximal segment (OR = 9.2; 95% CI = 1.6 to 53). We found no significant differences in patient or injury characteristics between the groups. Compared with type-III fractures, type-IV fractures were treated more frequently with open reduction and percutaneous pinning (13% compared with 3.8%; p = 0.04) and were associated with longer mean operative time (82 ± 42 compared with 63 ± 28 minutes; p = 0.001). Conclusions: We identified 5 preoperative radiographic parameters associated with greater odds of a supracondylar humeral fracture being type IV rather than type III. No patient or injury characteristic differed significantly between the groups. Substantial overlap likely exists between type-IV and flexion-type fractures. Type-IV fractures were associated with longer operative time and were treated with open reduction more frequently than were type-III fractures. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.