No abstract

Background: The Boston Carpal Tunnel Questionnaire (BCTQ) has a symptom severity scale (SSS) with 11 questions and a functional status scale (FSS) with 8 questions. The final score for each scale is the sum divided by the number of questions and ranges between 1 and 5. A score of 1 indicates they have no complaints and 5 indicates high severity and functional loss. Unfortunately, this single digit score does not permit a detailed analysis of the symptoms and functional status. The aim of this study is to conduct an in-depth comparison of preoperative complaints using the BCTQ between patients with severe carpal tunnel syndrome (SCTS) and recurrent carpal tunnel syndrome (RCTS). Methods: This is a retrospective cohort study on the preoperative status of 37 patients with SCTS and 18 patients with RCTS using the BCTQ. The questions in the SSS and FSS were classified into four groups based on the responses of patients, namely a low complaint (LC) (1–1.99), moderate complaint (MC) (2–2.99), high complaint (HC) (3–3.99), and severe complaint (SC) (4–5) groups. The patients in the SCTS and RCTS groups were compared to find differences in age, gender, hand dominance, and responses to questions in the SSS and FSS. Results: The age of patients in the SCTS group (76.06 years) was significantly higher compared to the RCTS group (51.11 years). There was no significant difference between the two groups with regard to gender or hand dominance. The top question with SC or HC response in the SCTS group was problems in grasping small objects (SSS) and fastening buttons (FSS) and in the RCTS group was tingling in the hand (SSS) and difficulty with opening a jar (FSS). Conclusions: An in-depth analysis of the BCTQ allowed us to compare and understand differences in symptoms and function between patients with SCTS and RCTS. Level of Evidence: Level III (Therapeutic)

Because of its variable origin and course, the thenar branch of the median nerve is at risk during carpal tunnel release. Transection results in thenar atrophy and non-functioning of the opponens pollicis, abductor pollicis brevis and flexor pollicis brevis muscles. A late neurorrhaphy and hypothenar fat pad flap were performed to restore nerve conduction and thus muscle function after accidental transection of the thenar branch of the median nerve during an open carpal tunnel release 216 days earlier.During the eight months follow-up, we noted progression in daily functioning, muscle strength and a decrease in muscle atrophy. Electromyography confirmed extensive improvement of the thenar motor function.The hypothenar fat pad flap may have an advantage in late nerve repair, providing a tension-free gliding surface, as well as arterial blood supply to the newly repaired nerve branch.

Does the location of the disc herniation (medial or lateral) influence the clinical features and prognosis of lumboradiculalgia? [La localisation de la hernie discale (médiane ou latérale) influence-t-elle la présentation clinique et le pronostic de la lomboradiculalgie?], Thèse de Médecine: Angers 2013.

We report on the feasibility of a technique for total hip replacement with in situ preparation of the femoral stem through a superior approach and with the use of standard instruments. From December 2017 to august 2018, 100 patients were recruited for total hip replacement. 80 patients underwent THA through a superior approach with femoral broaching before femoral neck cut. We evaluated feasibility, complications and early functional outcome. There were no major complications. Postoperative leg length discrepancy was on average +0.6mm and offset -0.5mm. The mean acetabular cup inclination was 42.0° and the mean anteversion was 14.5°. The mean WOMAC score was 46 before, 76 at 1 month and 86 at 3 months after surgery. Functional scores (OARSI) were significantly improved at 3 months. Superior in situ total hip replacement is a reliable and reproducible technique with an excellent clinical outcome. It is an iteration to the posterior approach, hence the learning curve is steep and if needed, conversion to a standard posterior approach is possible.