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Replacement of the Proximal Pole of the Scaphoid With a Pyrolytic Carbon Implant: A Case Study of Successful Rehabilitation
(brachial plexus exploration, nerves or tendon transfers (local or with microsurgery), and two patients were free from previous operative procedures. Results: All of the eleven patients of this study have improved the muscular strength and the arc of active elbow flexion. Nine patients (82%), reached muscular strength M3/M4, and the mean arc of active elbow flexion were 948 . Conclusions: The modified Steindler flexorplasty proved to be efficient in treatment of upper trunk brachial plexus lesion, with better results in patients with muscular strength M2/M3. There is no direct relation between preoperative hand grip and improvement in the arc of active elbow flexion. Relevance: The upper trunk brachial plexus lesion is very severe and the lack of elbow flexion limits a lot the functional use of the upper limb in daily and work activities. It is very important to find ways to better restore elbow flexion, improve function and quality of life of these patients.
OBJECTIVES 1. To evaluate functional and arc of movements of upper limb after modified Steindler procedure. 2. To demonstrate the rehabilitation process based on the surgical procedure.
REPLACEMENT OF THE PROXIMAL POLE OF THE SCAPHOID WITH A PYROLYTIC CARBON IMPLANT: A CASE STUDY OF SUCCESSFUL REHABILITATION Lin Taylor, Toowoomba Hand Therapy, Australia Purpose: The treatment of scaphoid fractures has been an ongoing challenge for hand therapists, often creating a pitfall for successful rehabilitation. Scaphoid fractures are the most common carpal fractures, with its highest occurrence in males aged 15–30 years. Proximal pole fractures account for approximately 20% of
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JOURNAL OF HAND THERAPY
cases seen and are usually the most complex to treat due to their susceptibility to avascular necrosis following injury. Resulting scaphoid non-unions can lead to complex arthritic changes and extend to carpal collapse due to the loss of spatial coherence amongst the wrist bones. Although relatively new on the clinical and surgical scene across the world, the use of a pyrolytic carbon implant to replace the proximal pole of the scaphoid has already shown vast benefits. While long term follow up is still required, studies to date have shown that this implant is able to allow adaptive mobility during movement of the first carpal row, as well as restoring radio-scaphoid anatomy and preserving the efficiency of the radial column and carpal height. The implant remains stable and does not require fixation with the distal scaphoid, thereby decreasing friction with surrounding structures. This poster presents a case study of a 29-year-old man who sustained a complex fracture to the proximal pole of his left scaphoid whilst working as a tyre fitter in Australia. The failure of conservative treatment resulted in subsequent surgery involving replacement of the proximal pole with the pyrolytic carbon implant. Methods: Case Study. Results: The poster documents the man’s initial journey following surgery, through the specific stages of hand therapy and recovery, and then his eventual successful return to function and work. Conclusions: The use of a pyrolytic carbon implant to replace the proximal pole of the scaphoid has already demonstrated positive outcomes. While long-term research is still required, current studies indicate that the use of this implant can significantly impact on the way scaphoid non-unions are treated, with the goal of improving long term functional outcomes for the person. Relevance: As shown in this poster, even though this is a new form of treatment, arguably the use of pyrolytic carbon implants in the wrist will lead to very significant changes in the future surgical management of scaphoid non-unions, as well as subsequent hand therapy. This is an issue of vital importance
for all current and future hand therapists.
OBJECTIVES 1. The purpose of this poster is to provide education on the use of a pyrolytic carbon implant to replace the proximal pole of the scaphoid following non-union. Although this is a new and innovative treatment, information will be provided and discussed. 2. The second objective of this poster presentation is to document a case study of successful rehabilitation, including the specific stages of hand therapy, following this new and innovative surgery.
THE EFFECTS OF VIBRATORY STIMULATION ON CHRONIC PAIN AFTER MEDIAN NERVE INJURY—A BEHAVIORAL AND FMRI STUDY Sadako Tsubota, Sapporo Medical University, Masayuki Abe, Jiro Kurata, Japan Purpose: We report a case of chronic limb pain that was effectively treated with a vibratory stimulus. Methods: A 45-year-old male patient had his left forearm injured by a chain saw. Despite immediate surgical repair followed by repeated nerve blocks and motor rehabilitation for a year, he suffered from persistent pain and allodynia at the left forearm in the area innervated by the median nerve. We started a new regimen including a vibratory stimulus at 250 Hz and coordinated motor tasks. We also evaluated pain behavior using a pain rating score (0–10) and McGill Pain Questionnaire Short Form (MPQ-SF), and examined for a possible abnormal cerebral response to tactile stimulus using functional magnetic resonance imaging (fMRI). Results: After 12 weeks, the pain rating score decreased from 8.5 to 4.5, although MPQ-SF did not show a significant change. A tactile stimulus
OBJECTIVES 1. To evaluate functional and arc of movements of upper limb after modified Steindler procedure. 2. To demonstrate the rehabilitation process based on the surgical procedure.
REPLACEMENT OF THE PROXIMAL POLE OF THE SCAPHOID WITH A PYROLYTIC CARBON IMPLANT: A CASE STUDY OF SUCCESSFUL REHABILITATION Lin Taylor, Toowoomba Hand Therapy, Australia Purpose: The treatment of scaphoid fractures has been an ongoing challenge for hand therapists, often creating a pitfall for successful rehabilitation. Scaphoid fractures are the most common carpal fractures, with its highest occurrence in males aged 15–30 years. Proximal pole fractures account for approximately 20% of
e6
JOURNAL OF HAND THERAPY
cases seen and are usually the most complex to treat due to their susceptibility to avascular necrosis following injury. Resulting scaphoid non-unions can lead to complex arthritic changes and extend to carpal collapse due to the loss of spatial coherence amongst the wrist bones. Although relatively new on the clinical and surgical scene across the world, the use of a pyrolytic carbon implant to replace the proximal pole of the scaphoid has already shown vast benefits. While long term follow up is still required, studies to date have shown that this implant is able to allow adaptive mobility during movement of the first carpal row, as well as restoring radio-scaphoid anatomy and preserving the efficiency of the radial column and carpal height. The implant remains stable and does not require fixation with the distal scaphoid, thereby decreasing friction with surrounding structures. This poster presents a case study of a 29-year-old man who sustained a complex fracture to the proximal pole of his left scaphoid whilst working as a tyre fitter in Australia. The failure of conservative treatment resulted in subsequent surgery involving replacement of the proximal pole with the pyrolytic carbon implant. Methods: Case Study. Results: The poster documents the man’s initial journey following surgery, through the specific stages of hand therapy and recovery, and then his eventual successful return to function and work. Conclusions: The use of a pyrolytic carbon implant to replace the proximal pole of the scaphoid has already demonstrated positive outcomes. While long-term research is still required, current studies indicate that the use of this implant can significantly impact on the way scaphoid non-unions are treated, with the goal of improving long term functional outcomes for the person. Relevance: As shown in this poster, even though this is a new form of treatment, arguably the use of pyrolytic carbon implants in the wrist will lead to very significant changes in the future surgical management of scaphoid non-unions, as well as subsequent hand therapy. This is an issue of vital importance
for all current and future hand therapists.
OBJECTIVES 1. The purpose of this poster is to provide education on the use of a pyrolytic carbon implant to replace the proximal pole of the scaphoid following non-union. Although this is a new and innovative treatment, information will be provided and discussed. 2. The second objective of this poster presentation is to document a case study of successful rehabilitation, including the specific stages of hand therapy, following this new and innovative surgery.
THE EFFECTS OF VIBRATORY STIMULATION ON CHRONIC PAIN AFTER MEDIAN NERVE INJURY—A BEHAVIORAL AND FMRI STUDY Sadako Tsubota, Sapporo Medical University, Masayuki Abe, Jiro Kurata, Japan Purpose: We report a case of chronic limb pain that was effectively treated with a vibratory stimulus. Methods: A 45-year-old male patient had his left forearm injured by a chain saw. Despite immediate surgical repair followed by repeated nerve blocks and motor rehabilitation for a year, he suffered from persistent pain and allodynia at the left forearm in the area innervated by the median nerve. We started a new regimen including a vibratory stimulus at 250 Hz and coordinated motor tasks. We also evaluated pain behavior using a pain rating score (0–10) and McGill Pain Questionnaire Short Form (MPQ-SF), and examined for a possible abnormal cerebral response to tactile stimulus using functional magnetic resonance imaging (fMRI). Results: After 12 weeks, the pain rating score decreased from 8.5 to 4.5, although MPQ-SF did not show a significant change. A tactile stimulus