The aim of this work was to evaluate the diagnostic performance of grey-scale, color Doppler, and dynamic ultrasound (US) for diagnosing carpal tunnel syndrome (CTS) using the medical diagnostic test called nerve conduction study (NCS) as the reference standard, and to correlate the increase in median nerve (MN) cross-sectional area (CSA) with severity of CTS. Fifty-one patients (95 wrists) with clinical symptoms of idiopathic CTS were recruited. The CSA and flattening ratio of the MN were measured at the distal radio-ulnar joint, pisiform, and hamate levels; bowing of the flexor retinaculum was determined at the hamate level. The hypervascularity of the MN was evaluated. The transverse sliding of the MN was observed dynamically and recorded as being either normal or restricted/absent. Another 15 healthy volunteers (30 wrists) were recruited as controls. Interoperator reliability was established for all criteria. CTS was confirmed in 75 wrists (75/95: 79%; 14 minimal, 21 mild, 23 moderate, 17 severe). CSA at the pisiform level was found to be the most reliable and accurate grey-scale criterion to diagnose CTS (optimum threshold: 9.8 mm(2)). There was a good correlation between the severity of NCS and CSA (r = 0.78, p < 0.001). The sensitivity and specificity of color-Doppler and dynamic US in detecting CTS was 69, 95, 58, and 86%, respectively. Combination of these subjective criteria with CSA increases the sensitivity to 98.3%. US measurement of CSA provides additional information about the severity of MN involvement. Color-Doppler and dynamic US are useful supporting criteria that may expand the utility of US as a screening tool for CTS.

Staphylococcus aureus, the most common microbial pathogen in our findings, point to the need to adopt a lower threshold for escalation of antibiotics for immunocompromised patients with slow reversal of infection in order to reduce morbidity, mortality, number of surgeries and length of post-operative stay.

We evaluated a case of pisiform fracture with ulnar nerve compression managed with pisiformectomy. At 11 months' follow-up, the patient regained range of motion of the wrist and grip strength with no subjective loss of function and normal nerve conduction study. We compared other treatment modalities and reviewed their outcomes.

Singapore as an island nation is one of three countries in the world that has hand and reconstructive microsurgery (HRM) as an independent specialty. The 52 accredited hand surgeons serving a population of 5.7 million facilitate hassle free access to patients. Hand surgery historically is rooted very much in orthopaedic surgery as in most Asian countries with more than five decades of rapid evolution. Singapore pioneered a structured and systematic training program for HRM and the local surgeons have contributed significantly to the body of knowledge in hand surgery with targeted research and publications with three surgeons being awarded international recognition for their contributions. Singapore continues to contribute significantly to surgical volunteerism regionally through active involvement in the training of regional surgeons through their sustainable volunteer activities and through international fellowships in Singapore hospitals. The future of hand surgery in Singapore will be more competency and multidiscipline based on community-centered approach.

Radial-sided tears of the triangular fibrocartilage, though uncommon, can still be a reason for ulnar-sided wrist pain, and, at times, instability of the distal radioulnar joint. Historically, it has been believed that because of the paucity of vascularity along the radial edge of the triangular fibrocartilage complex (TFCC), any form of repair will not lead to healing, thus stating it to be an exercise in futility. Current literature deftly argues against this previously prevailing concept and supports the need of repair in case of symptomatic radial-sided TFCC tears. In our study, we describe an all-arthroscopic technique of repairing radial-sided tears using a bone anchor which can be a fast and simple procedure in the hands of an orthopaedic or hand surgeon trained in arthroscopy. This technique also circumvents the risk of injuring the superficial radial nerve and other radial-sided structures which are stated complications of the current arthroscopic repairs.