UNASSIGNED: The Linburg-Comstock (LC) anomaly is a common tendinous connection between the flexor pollicis longus and flexor digitorum profundus (FDP), most frequently to the FDP of the index finger. The purpose of this study was to obtain epidemiologic data on the LC anomaly in a healthy, ethnically diverse population and to study the effect of the LC anomaly on grip strength, tip pinch strength, key pinch strength, and chuck pinch strength.
UNASSIGNED: We examined 500 healthy subjects (292 females and 208 males) bilaterally for the presence of the LC anomaly. Each subject had their grip strength, tip pinch strength, key pinch strength, and chuck pinch strength measured bilaterally using a dynamometer for grip strength and a pinch meter for all pinch strength measurements.
UNASSIGNED: The LC anomaly was present in 213 of the 500 subjects (43%). One hundred one subjects (47%) had a unilateral presentation, and 112 (53%) subjects had a bilateral presentation. The LC anomaly was associated with a weaker tip pinch strength. When examining the LC anomaly among different ethnic groups, the highest prevalence was found in the Hispanic (57%) population followed by Caucasian (50%), Asian (41%), and African American (31%) populations.
UNASSIGNED: The LC anomaly has different prevalence according to ethnicity, with a higher prevalence in the Hispanic and Caucasian populations and a lower overall prevalence in the African American populations. The LC anomaly can also result in weaker tip pinch strength.

UNASSIGNED: Stenosing flexor tenosynovitis is commonly treated by injection of corticosteroids into the flexor tendon sheath. However, there is no consensus in the literature regarding the optimal technique, specifically when not utilizing ultrasound guidance. Here, we present a cadaver study in which 3 common techniques of flexor sheath injection were compared with regard to their accuracy and safety profiles.
UNASSIGNED: Fifteen fresh-frozen cadaver hands (60 digits) were evenly divided into 3 groups (20 digits per group). Digits in each group were injected with methylene blue dye using 1 of the 3 techniques (palmar-to-bone, palmar supra-tendinous, and mid-axial). The fingers were then dissected and were inspected for location of dye, as well as injury to tendon or digital nerves.
UNASSIGNED: The mid-axial technique demonstrated the greatest accuracy with the highest rate of all intra-sheath injection, 15 of 20 digits (75%), while the palmar-to-bone technique produced the most combined intra- and extra-sheath injections, 13 of 20 digits, (65%) and the palmar supra-tendinous technique resulted in the most all extra-sheath injections, 9 of 20 digits (45%). The difference in rates of all intra-sheath injection was significant (P = .01). The mid-axial technique also produced the fewest intra-tendinous injections 0 of 20, although this result did not reach statistical significance (P = .15).
UNASSIGNED: Compared to other common non-image guided flexor tendon sheath injection techniques, the mid-axial injection technique was found to be the most accurate in producing all intra-sheath injection and least likely to result in intra-tendinous injection.

The ostrich is the largest living bird and has unique characteristics in its locomotor system that differentiate it from other bird species. The purpose of this study was to provide a reference atlas of reference-interval computed tomography (CT) and cross-sectional anatomy of the tarsometatarsal region and digits in the ostrich (Struthio camelus). The pelvic limbs of 25 ostriches were used for this imaging study. The transverse CT images were obtained from the middle third of the tarsometatarsal bone to the distal end of the third digit. The specimens were frozen and sectioned with an electric band saw at 1.5-2 cm intervals. The CT images were compared with the corresponding frozen cross sections. The bones, ligaments, and tendons were identified and labeled at each 1.5-2 cm intervals. The CT images provided anatomic details of the tendons and ligaments in the tarsometatarsal region and digits of the ostrich. The transverse CT images provided an excellent depiction of the anatomic structures of the leg and foot when compared with the corresponding frozen cross sections. The information presented in this study may be used as an initial reference when evaluating the CT images of an ostrich\'s tarsometatarsal region and digits. Moreover, the information provided in this report may be helpful in determining definitive diagnoses of musculoskeletal disorders affecting the lower leg in this species.

Background: Proximal phalanx fractures are common injuries of the hand with multiple treatment options. Intramedullary (IM) screw fixation has become more widely used, and early outcomes are promising. However, biomechanical data regarding this type of fixation are sparse. Methods: Two methods of IM screw fixation of proximal phalanx fractures were tested in cadaver specimens. All specimens were treated with a single antegrade headless compression screw, with half getting the addition of a blocking screw. To test the most common deforming force of flexion-extension, each phalanx was subjected to apex volar 3-point bending using the Materials Testing System test frame. Results: There was no significant difference in the stiffness of 3-point bending with single antegrade screws alone and with a blocking screw (mean, 63.1 vs 52.2 N/mm; P = .27). When comparing smaller with larger specimens, stiffness of the small group was significantly greater than that of the large group when both fixation methods were included (85.3 vs 30.1 N/mm; P < .0002). When comparing stiffness with percent fill of the screw within bone, there was a moderately positive correlation (0.51). Conclusions: Addition of a blocking screw did not increase the stability of the IM screw fixation construct for proximal phalanx fractures. When comparing specimen size, the smaller bones were stiffer under 3-point bending load, regardless of the type of fixation. In addition, those specimens that had a larger longitudinal screw length to bone length ratio were stiffer. These findings provide valuable information as techniques for IM screw fixation of proximal phalanx fractures continue to evolve.

Background: The first-line treatment for trigger finger is a corticosteroid injection. Although the injectable solution is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience more pain at the time of injection. Methods: C Patients with trigger finger were prospectively randomized into 2 cohorts to receive triamcinolone (1 mL, 40 mg) plus 1% lidocaine with epinephrine (1 mL) or triamcinolone (1 mL, 40 mg) plus normal saline (1 mL, placebo). Both patient and surgeon were blinded to the treatment arm. The primary outcome was pain measured using a (VAS) immediately following the injection. Results: Seventy-three patients with a total of 110 trigger fingers were enrolled (57 lidocaine with epinephrine and 53 placebo). Immediate postinjection pain scores were significantly higher for injections containing lidocaine with epinephrine compared with placebo (VAS 3.5 vs 2.0). Conclusions: In the treatment of trigger finger, corticosteroid injections are effective and have relatively little associated pain. This study shows there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, surgeons looking to decrease injection pain should exclude the anesthetic, but they should discuss the trade-off of foregoing short-term anesthesia with patients. Using only a single drug (ie, corticosteroid alone) is not only less painful but is also more simple, efficient, and safe; this has therefore become our preferred treatment method.

OBJECTIVE: In this study, the disparity between the lengths of the lateral and medial digit in cows with a Rusterholz sole ulcer compared to non-affected cows was investigated.
METHODS: In total, 100 hind feet were collected from slaughtered cows. Twenty-five feet had a pre-ulcerative lesion at the typical site, 26 had an ulcer < 1 cm² and 24 had an ulcer > 1.5 cm². Twenty-five normal feet were used as controls. The lengths of the metatarsal condyles and phalanges (Ph) were measured on plantarodorsal radiographs and three different overall lengths of the digits were generated. The software program SPSS was used for analysis.
RESULTS: The mean lengths of Ph1 and Ph2 and the three mean overall lengths of the lateral digit were greater than those of the medial digit while the length of Ph3 was longer on the medial digit. With one exception, the comparison of overall length 2 of the pre-ulcerative lesion with the control group, the within-feet differences of the ulcer groups were not significantly different from the difference of the controls.
CONCLUSIONS: These results corroborate the length asymmetry of the bovine digits but further studies are needed to evaluate the effect of the asymmetry of the digits on the development of sole ulcers.