Patients are increasingly turning to the internet, and recently artificial intelligence engines (e.g., ChatGPT), for answers to common medical questions. Regarding orthopedic hand surgery, recent literature has focused on ChatGPT's ability to answer patient frequently asked questions (FAQs) regarding subjects such as carpal tunnel syndrome, distal radius fractures, and more. The present study seeks to determine how accurately ChatGPT can answer patient FAQs surrounding simple fracture patterns such as fifth metacarpal neck fractures.

Trigger finger, or stenosing tenovaginitis, is a common condition characterized by impaired flexor tendon sliding due to thickening of the A1 pulley. While open surgical release remains the gold standard for the treatment of persistent trigger finger, there is increasing interest in minimally invasive ultrasound-guided techniques to improve precision and outcomes. The purpose of this study is to evaluate the outcomes, safety, and complications associated with ultrasound-guided trigger finger release using a minimally invasive surgical knife. We performed a retrospective analysis of 297 trigger finger releases performed on 238 patients between April 2021 and December 2023. All procedures were performed on the long fingers, excluding the thumb, using ultrasound guidance under WALANT or regional anesthesia. Patients were evaluated at 6 weeks and 3 months postoperatively for symptom resolution, complications, and functional recovery. The procedure achieved a 100% success rate for complete release of the A1 pulley with no major complications or iatrogenic damage such as tendon or neurovascular injury. Minor complications, such as temporary postoperative loss of motion or localized pain, occurred in 33 cases (11.1%) and all resolved with conservative management by the three-month follow-up. Importantly, only one procedure required conversion to open surgery due to intraoperative uncertainty, where full release was confirmed. Ultrasound-guided minimally invasive trigger finger release is a safe and effective technique. It provides precise release with a low risk of complications or iatrogenic damage. As ultrasound technology advances and availability increases, this technique has the potential to become a reliable and patient-friendly alternative to classic open methods.

Dynamic compression of the median nerve under the lacertus fibrosus at the elbow causes pain and weakness. It is a frequently overlooked pathology and a cause of failed recovery after carpal tunnel release. The purpose was to present a technical note on minimally invasive ultrasound-guided lacertus syndrome surgical treatment under WALANT. We believe the technique is indicated in patients who present with a positive Hagert's triad of pain over the median nerve at the lacertus, weakness on testing of the flexor pollicis longus, second flexor digitorum profundus, and flexor carpi radialis, and a positive sensitive collapse test. Contraindications include static median nerve compression at the elbow and allergy to lidocaine. The technique is preceded by local anesthesia, which is completed under ultrasound guidance for deeper or more proximal structures. The entry point is calculated proximal to the lacertus and the special knife is introduced through a 0.5 cm incision. The lacertus is divided anterogradely under ultrasound guidance. Full recovery of strength is evidenced by the completion of the division. The patient returns to full activity within days to a week after surgery. Minimally invasive, ultrasound-guided release allows for rapid return of full-strength motion with minimal scarring.

An ulnar nerve (UN) palsy is devastating for hand function, resulting in an intrinsic minus position or claw hand with a loss of pinch grip. Distal nerve transfers facilitate faster reinnervation of hand intrinsic muscles in cases of proximal ulnar nerve lesions. The traditional anterior interosseous nerve (AIN) to UN motor transfer is commonly used, however, this still leads to long reinnervation times for the distal intrinsic muscles, important for the thumb to index pinch grip. This study investigated the feasibility of a more distal nerve transfer, from the median thenar to the deep branch of the UN (DBUN), in six cadaveric hands. A separate branch of the median nerve to the superficial head of flexor pollicis brevis (sFPB) arose distally of the thenar branch from the common digital nerve of the thumb shortly before the bifurcation of the ulnar palmar digital nerve to the thumb in all specimens, with a mean distance to the thenar branch of 8.3 ± 5.3 mm. The sFPB motor branch had a mean length of 11.5 ± 1.5 mm. The mean distance between the division of the dorsal cutaneous branch of the UN, where the AIN to UN motor transfer is usually performed, and the transfer between the sFPB branch to the DBUN was 132 ± 11 mm. A distal nerve transfer between the median innervated motor branch to the sFPB to the DBUN shortens the reinnervation distance for the first dorsal interosseous, the adductor pollicis, and the deep head of the FPB muscles, which is a prerequisite for restoration of the pinch grip.

Most patients with post-traumatic and/or degenerative wrist arthritis present with pain and limitation of activities of daily living. Wrist denervation using a two-incision technique is an alternative to proximal row carpectomy and partial or total wrist arthrodesis. The purpose of this study was to evaluate whether two-incision denervation is a valid procedure for reducing pain in wrist arthritis of different etiologies. A retrospective study of fifty-four patients, mean age 56 years, operated on by one senior surgeon at a single center was designed. Inclusion criteria were chronic wrist pain of various etiologies, patients with previous wrist surgery were excluded. Preoperative pain was reported on a visual analog scale, and at least twelve months postoperatively, patient-rated wrist/hand assessment, pain, and range of motion were assessed. RESULTS: 54.8% of the population presented with post-traumatic osteoarthritis of the wrist (scaphoid non-union advanced collapse or scapholunate advanced collapse). 71.5% of the population underwent surgery on the dominant extremity. After clinical evaluation, the mean PRWHE was 15.76 (±14.53), with total joint motion of 68 ° (±14.44), flexion 64.5 ° (±13.36), extension 76 ° (±7.71), pronation 72.4 ° (±6.20), and supination 74.8 ° (±9.21). The overall mean pain reduction was 60% and there were no re-operations. Two-incision total wrist denervation is a valid technique for the treatment of wrist pain of various etiologies, leaving a good range of motion and acceptable autonomy in activities of daily living. If this technique fails, more invasive techniques such as proximal row carpectomy, partial or total wrist arthrodesis, and wrist arthroplasty can be used.

Radial nerve compression at the arcade of Frohse is a rare but significant condition that typically presents with pain primarily after exertion and at night on the dorsal side of the forearm, more distally than tennis elbow pain, and weakness of the wrist extensors and the long fingers and thumb extensors. Traditional treatment often involves open surgery, resulting in significant scarring. This study introduces a novel percutaneous radial nerve release technique under complete ultrasound guidance and highlights its efficacy and safety. The procedure involves identifying the entry point, lateral of the radial nerve, allowing for targeted release of the superficial fascia surrounding the supinator muscle without damaging nearby vascular or nerve structures. A cadaveric study was performed on ten fresh-frozen specimens to validate the entry point and route, which successfully demonstrated complete fascial release without complications. Preliminary clinical results from five patients showed complete resolution of symptoms associated with radial tunnel syndrome with no reported complications. The technique results in a significantly smaller incision (<1 cm) compared to traditional methods (up to 10 cm) and can be performed under WALANT anesthesia, making it suitable for the outpatient setting. This approach offers a minimally invasive alternative for patients with isolated posterior interosseous nerve compression and highlights the importance of ultrasound guidance in achieving optimal results. Because the technique requires a learning curve, it is recommended for surgeons with experience in ultrasound-guided procedures.

Compression of the median nerve in the carpal tunnel is a frequent pathology with severe functional impact. An ultrasound-guided technique was developed to preserve structures, diminish scar fibrosis and enable fast return to full activity. Its advantages are safety and low additional cost. Ultrasound-guided carpal tunnel release is indicated in moderate and severe carpal tunnel syndrome persisting after conservative treatment. A preoperative ultrasound scan is recommended to evaluate anatomy. Recurrent carpal tunnel syndrome, secondary carpal tunnel syndrome and anatomic variants compromising the safety of transverse carpal ligament division are contraindications. The procedure is performed under local anesthesia without tourniquet. The entry point is a short transverse incision proximal to the wrist crease. The transverse carpal ligament is divided anterogradely, using a dedicated blade under ultrasound control, making sure no nerves, tendons or blood vessels are injured. The final step is to check that the division is complete. Early return to use of the hand is permitted. Reports of similar techniques demonstrated early symptomatic relieve, favorable patient-reported outcome measures from within 1 week after surgery to 2 years' follow-up, with early return to normal daily activity and work. The complications rate is low: many series showed no complications. Comparative studies between ultrasound-guided carpal tunnel release and the mini-open technique reported similar or greater and quicker symptom relief, less scar pain and better strength. Final functional results tend to be similar.

We report a case of CAF in the hand of a young adult woman. This patient's age exceeded the usual range for CAF. While surgical excision led to fifth digit stiffness and bowstringing, further diagnostic delays could have resulted in much worse outcomes due to tumor invasion of the tendons. This case suggests reevaluating the upper age limit for diagnosis and considering CAF in adults with suggestive clinical features.

Cornelis et al. reported an isolated DRUJ infection treated with open surgery to prevent spread to the radiocarpal joint. We suggest that arthroscopy, proven effective in other joint infections and technically feasible for the DRUJ without damaging the TFCC,could have been a less invasive and effective alternative.

This study aimed to evaluate the outcomes of a novel antegrade, ultrasound-guided release of the first extensor tendon compartment for treating De Quervain's disease.

Restoring elbow flexion following brachial plexus injury (BPI) is essential for improving arm function and quality of life in adults. This study aimed to compare the efficacy of Oberlin II and intercostal nerve (ICN) neurotization techniques for restoring elbow flexion in adults with upper and middle trunk brachial plexus palsy.

The purpose of this study was to evaluate the results of a novel retrograde ultrasound-guided A1 pulley release technique for the treatment of trigger thumb. We conducted a retrospective, single-center study of 42 patients who underwent ultrasound-guided A1 pulley release for clinically diagnosed trigger thumb between September 2022 and December 2023. All cases were graded according to the Green classification of trigger finger severity. Inclusion criteria were patients aged >18 years who failed conservative treatment (non-steroidal anti-inflammatory drugs, physical therapy, or steroid injections) for at least six weeks. Exclusion criteria were previous trigger thumb surgery, metacarpophalangeal or trapeziometacarpal arthrodesis, and documented allergy to local anesthetics. Outcome measures were pain intensity (visual analog scale, VAS), Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scores, and complication rates. The mean age of the patients was 37.8 years (range: 27-72). Based on Green's classification, we treated 5 grade I, 26 grade II, 6 grade IIIA, and 5 grade IIIB cases. At one month follow-up, all patients had resolution of the triggering. The mean VAS score improved significantly from 7.2 to 1.3 and the Quick-DASH score decreased from 51 to 9.1. There were no major complications. Open A1 pulley release for trigger thumb is effective but carries risks to the palmar radial digital nerve, especially in open surgery. Alternative methods such as ultrasound-guided and percutaneous release offer similar results with fewer complications. Recovery is faster for trigger thumb (2 weeks) compared to trigger finger (5 weeks). Some patients may experience prolonged symptoms after surgery. Open surgery has a 12% complication rate and a 2.4% revision rate. Ultrasound-guided percutaneous release is safer and allows real-time visualization during the procedure. Retrograde ultrasound-guided A1 pulley release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus. It offers advantages over traditional approaches, including improved cosmetic outcomes, the absence of sutures, and the ability for patients to resume daily activities and light work immediately postoperatively.

A non-invasive thermoplastic orthosis combined with targeted exercise effectively addresses proximal interphalangeal joint (PIPj) stiffness. Stabilizing the metacarpophalangeal joint at 60 ° enables optimal torque transfer, improving flexion and correcting compensatory patterns. Posture maintenance prevents elastic recoil,enhancing tissue elongation. Preliminary results show improved kinematic control and functional recovery.