HAND Holding in tough times

Ultrasound guided ‘skinning the cat’ #NeoArmory:

‘When there are multiple surgeries described for a single pathology, you can safely say, none of them works the best” – one of our Profs.

But it can’t be more far from true for carpal tunnel syndrome as most of them seem to work (okay-ish). When you have multiple ways to ‘skin-the-cat’ why not try the new Orthopaedic fad, the ultrasound!

Sovereign Medical, have just the right Sono-instruments® (that’s actually the name) for this. Their purpose made blade can be used under USS guidance and a sub 2mm incision for a sutureless procedure.

The procedure can be done in an office setup under local anesthetic. They allow quick return to work and better pain levels immediate post op.

Although USS guided CTRs are not entirely a new concept, having a dedicated instrumentation helps standardize steps. The company is actively collecting PROMs data and hopefully we can get an efficacy study soon.

Fritz Dequervain - a man known for tenosynovitis &……. yup - IODINE: #FromTheHistory:

Dequervain ‘s tenosynovitis is something we all have seen and treated this very common condition. What used to be called washerwoman’s thumb in the 19th century and nowadays with all the gadgets, it has become texting thumb. The man behind this eponym is Fritz Dequervain, son of a pastor in Sion, Switzerland, was brought up in a very religious environment which led him to become quite a stoic (obviously not in a pure sense) and develop a relentless work ethic. Under the shadow of the giant of Medicine, Theodore Kocher, Dequervain was trained and he eventually took over his place.

Actually, if we took a time machine and went back to meet our man in the early 20^th century he surely wouldn’t have spoken about thumbs, but Iodine. His mentor, Kocher as you might already know got a Nobel prize for his study on Thyroid gland. Fritz was seeing a lot of goitres, actually, it was 100% among children in that area at that time. So, Fritz started feeling that operating or treating goitres and cretinism was like a band aid and not sustainable. The idea of Iodine as treatment or the idea that Iodine deficiency as a cause for goitres was not new but was already proposed and proven. But our man, he became an evangelist of public health and proposed something and brought it into reality, Iodine supplementation for the general public with fortification of common salt with Iodine. And voila, goitres, were gone!

Keyhole Fusions #SurgicalPearl:

Have you ever feared addressing scaphoid nonunions in open surgery - too small of a bone to debride/graft, jeopardise vascularity of the remaining bone? Try Arthroscopic fixation - a time tested one at this point of time. Check this evidence from Burnier et al. Read the step wise procedure details below.

• Setup: Regional anesthesia, tourniquet on, wrist put in traction (around 5 kg).

• Take bone graft from distal radius - Small incision near Lister’s tubercle → cancellous bone harvested using a trocar.

• Standard wrist portals (3/4, 6R, midcarpal portals) are created - Check cartilage, ligaments, synovitis – get an idea of joint condition.

• Use probe/feeler → identify exact gap of nonunion.

• Remove fibrous tissue + sclerosis using curette, shaver, drill.

• Important step → you should see bleeding bone (means viable bone).

• If no bleeding → suspect AVN of proximal pole.

• Make a clean cavity ready to accept graft.

• Use trocar through portal → deliver bone into the defect.

• Pack it tightly - Compress graft with probe until defect is fully filled (no gaps).

• Release traction, once grafting is done.

• Fix the scaphoid (osteosynthesis) Either screw or K-wires depending on case.

• Proximal pole → may need scapholunate pinning.

• Stability + graft fill confirmed → close.

Your Hand radiograph says it all!! #MostCited:

Fragility fractures associated with osteoporosis and osteopenia are a common cause of morbidity and mortality. Current methods of diagnosing low bone mineral density require specialised dual X-ray absorptiometry (DXA) scans. Plain hand radiographs may have utility as an alternative screening tool, although optimal diagnostic radiographic parameters are unknown, and measurement is prone to human error.

Luan et al. developed a machine learning model with 1424 hand radiographs with various grades of bone density from normal to osteoporosis, validated with parallel DXA hip T-scores, with a sensitivity of 84.6% at a specificity of 84.6%. This is a start towards the next wave of accessible, cost-effective, automated diagnosis to initiate earlier treatment of osteoporosis/osteopenia.

Events to check out:

5th Madrid Shoulder Course 12 – 14^th Nov 2026 Madrid, Spain

Chennai Sports Injury Conclave 13 – 14^th June 2026 Chennai, India

The Oswestry GAIT Course 2026 10 – 12 June 2026 Oswestry, United Kingdom

Have a Marvelous May ahead mates!