Abstract Objective To verify the prevalence of musculoskeletal pain in amateur golfers in the State of São Paulo, Brazil. Methods The present is a cross-sectional study performed from September 2019 to March 2020 in golf clubs affiliated to Federação Paulista de Golfe (São Paulo Golf Federation). Federation players were evaluated regarding data on golf practice and sport routine by a main investigator, though an assessment form with multiple-choice questions, to determine sample characteristics and recent pain intensity by the Visual Analogue Scale. Results Approximately 359 amateur golfers were analyzed. The prevalence of pain was of 55.15% (95% confidence interval [95%CI]: 50.0% to 60.3%); the average pain intensity according to the VAS was moderate (mean ± standard deviation: 5.21 ± 2.04; odds ration [OR]: 47,98%). The golfer's age range was significantly associated with the presence of pain (p < 0.05). The highest prevalence estimate of pain was of 68.80% in the age group between 30 and 39 years (OR: 7,33; 95%CI: 2,26 to 23,85; p = 0,0009). The segments most affected by pain were the upper limbs (65.66%), followed by the spine (59.09%) and the lower limbs (32.83%). Conclusion There is a high prevalence rate of pain in Brazilian amateur golfers, especially in younger players in the age group between 30 and 39 years. Brazil crosssectional cross sectional 201 202 Federation. . Federation) investigator multiplechoice multiple choice questions Scale 35 analyzed 5515 55 15 55.15 95% 95 (95 95%CI 95CI CI [95%CI] 500 50 0 50.0 60.3% 603 60 3 60.3%) mean deviation 521 5 21 5.2 2.04 204 2 04 OR [OR] 47,98%. 4798 47,98% 47 98 47,98%) golfer s 0.05. 005 0.05 05 0.05) 6880 68 80 68.80 (OR 7,33 733 7 33 226 26 2,2 23,85 2385 23 85 0,0009. 00009 0,0009 0009 0,0009) 65.66%, 6566 65.66% , 65 66 (65.66%) 59.09% 5909 59 09 (59.09% 32.83%. 3283 32.83% 32 83 (32.83%) 20 551 1 55.1 9 (9 [95%CI 50. 60.3 6 52 5. 2.0 [OR 479 47,98 4 00 0.0 688 8 68.8 7,3 73 22 2, 23,8 238 0000 0,000 000 656 65.66 (65.66% 59.09 590 (59.09 328 32.83 (32.83% 55. ( 60. 2. 47,9 0. 68. 7, 23, 0,00 65.6 (65.66 59.0 (59.0 32.8 (32.83 47, 0,0 65. (65.6 59. (59. 32. (32.8 0, (65. (59 (32. (65 (5 (32 (6 (3

Resumo Objetivo Verificar a prevalência de dores musculoesqueléticas em golfistas amadores do estado de São Paulo. Métodos Este é um estudo transversal realizado de setembro de 2019 a março de 2020 em clubes de golfe afiliados à Federação Paulista de Golfe. Jogadores federados foram avaliados quanto a dados da prática de golfe e da rotina esportiva por um investigador principal, por meio de um formulário de avaliação com questões de múltipla escolha, para a determinação das características da amostra e da intensidade da dor recente pela Escala Visual Analógica (EVA). Resultados Cerca de 359 golfistas amadores foram analisados. A prevalência de dor foi de 55,15% (intervalo de confiança de 95% [IC95%]: 50,0% a 60,3%); a intensidade média da dor segundo a EVA foi moderada (média ± desvio padrão: 5,21 ± 2,04; razão de probabilidades [odds ratio, OR, em inglês]: 47,98%). A faixa etária dos golfistas esteve significativamente associada à presença de dor (p < 0,05). A maior estimativa de prevalência de dor foi de 68,80% na faixa etária de 30 a 39 anos (OR: 7,33; IC95%: 2,26 a 23,85; p = 0,0009). Os segmentos mais acometidos por dor foram os membros superiores (65,66%), seguidos da coluna (59,09%) e dos membros inferiores (32,83%). Conclusão Há uma alta taxa de prevalência de dor em golfistas amadores brasileiros, especialmente em jogadores mais jovens, na faixa etária de 30 a 39 anos. Paulo 201 202 Golfe principal escolha EVA. . (EVA) 35 analisados 5515 55 15 55,15 intervalo 95 IC95% IC95 IC [IC95%] 500 50 0 50,0 60,3% 603 60 3 60,3%) padrão 521 5 21 5,2 2,04 204 2 04 odds ratio OR inglês inglês] 47,98%. 4798 47,98% 47 98 47,98%) 0,05. 005 0,05 05 0,05) 6880 68 80 68,80 (OR 7,33 733 7 33 226 26 2,2 23,85 2385 23 85 0,0009. 00009 0,0009 0009 0,0009) 65,66%, 6566 65,66% , 65 66 (65,66%) 59,09% 5909 59 09 (59,09% 32,83%. 3283 32,83% 32 83 (32,83%) brasileiros jovens 20 (EVA 551 1 55,1 9 IC9 [IC95% 50, 60,3 6 52 5, 2,0 479 47,98 4 00 0,0 688 8 68,8 7,3 73 22 2, 23,8 238 0000 0,000 000 656 65,66 (65,66% 59,09 590 (59,09 328 32,83 (32,83% 55, [IC95 60, 47,9 0, 68, 7, 23, 0,00 65,6 (65,66 59,0 (59,0 32,8 (32,83 [IC9 47, 65, (65,6 59, (59, 32, (32,8 [IC (65, (59 (32, (65 (5 (32 (6 ( (3

Abstract Objective This study evaluated the epidemiological data and functional outcomes from patients with concomitant distal radial and scaphoid fractures treated in a single center specialized in hand surgery. Functional outcomes analysis used validated instruments. Methods Patients diagnosed with distal radial and scaphoid fractures treated from January 2011 to December 2021 underwent assessments using the Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Visual Analog Scale (VAS) for pain, goniometry, radiographic consolidation, and complications six months after surgery. Results The study included 23 patients, 73.9% men and 26.1% women. Most (56.5%) fractures occurred on the right side, and 43.5% happened on the left side. Treatment of most (56%) distal radial fractures used a locked volar plate. Functional assessment by PRWE resulted in a mean score of 35.9 points (range, 14 to 71 points), while DASH showed a mean score of 37.8 points (range, 12 to 78 points). The mean VAS was 2.33 during activities (range, 0.6 to 6.2). Conclusion Distal radial fractures associated with scaphoid fractures resulted from high-energy trauma, and most patients were males. There was a low rate of complications with surgical treatment, and the patients had satisfactory functional evolution with a low level of pain. surgery instruments 201 202 Arm DASH, , (DASH) PatientRated Patient Rated PRWE, (PRWE) (VAS pain goniometry consolidation 2 739 73 9 73.9 261 26 1 26.1 women 56.5% 565 56 5 (56.5% side 435 43 43.5 56% (56% plate 359 35 35. range, range (range 7 points, points) 378 37 8 37. points. . 233 33 2.3 06 0 6 0. 6.2. 62 6.2 6.2) highenergy high energy trauma males treatment 20 (DASH (PRWE 73. 26. 56.5 (56.5 4 43. (56 3 2. 6. 56. (56. (5 (

Resumo Objetivo Avaliar os resultados epidemiológicos e funcionais dos pacientes que apresentaram fraturas concomitantes do rádio distal e do escafoide e foram tratados em um único centro especializado em cirurgia da mão, através de instrumentos validados para analisar os desfechos funcionais desses pacientes. Métodos Foram avaliados os pacientes com diagnóstico de fratura do rádio distal e escafoide tratados de janeiro de 2011 até dezembro de 2021, através dos questionários Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE) e Escala Visual Analógica da dor (EVA); goniometria; consolidação radiográfica; complicações em seis meses de pós-operatório. Resultados Vinte e três pacientes foram incluídos no estudo, sendo 73,9% homens e 26,1% mulheres; 56,5% das fraturas ocorreram à direita e 43,5% à esquerda. A maioria das fraturas do rádio distal foi tratada com placa volar bloqueada, totalizando 56%. Na avaliação funcional pelo PRWE, obteve-se média de 35,9 pontos (variação de 14 a 71 pontos) e pelo DASH média de 37,8 pontos (variação de 12 a 78 pontos). A EVA apresentou uma média de 2,33 durante a atividade (variação de 0,6 a 6,2). Conclusão Verificou-se que as fraturas do rádio distal associadas a fraturas do escafoide foram causadas por traumas de alta energia, com o sexo masculino mais acometido. Houve baixo índice de complicações com tratamento cirúrgico e os pacientes tiveram evolução funcional satisfatória, com baixo índice de dor. mão 201 2021 Arm DASH, , (DASH) PRWE (PRWE (EVA) goniometria radiográfica pósoperatório. pósoperatório pós operatório. operatório pós-operatório estudo 739 73 9 73,9 261 26 1 26,1 mulheres 565 56 5 56,5 435 43 43,5 esquerda bloqueada 56% obtevese obteve se 359 35 35, variação 7 378 37 8 37, pontos. . 233 2 33 2,3 06 0 6 0, 6,2. 62 6,2 6,2) Verificouse Verificou energia acometido satisfatória 20 202 (DASH (EVA 73, 26, 56, 4 43, 3 23 2, 6,

ABSTRACT BACKGROUND: Congenital Anomalies of the Upper Limb (CAUL) are a group of structural or functional abnormalities that develop during intrauterine life and can lead to limb dysfunction. OBJECTIVES: To analyze the prevalence of congenital anomalies of the upper limbs in Brazil and assess maternal and neonatal variables. DESIGN AND SETTING: A cross-sectional, descriptive study was conducted on congenital upper limb malformations among live births across Brazil. METHODS: The study spanned from 2010 to 2019. Data were sourced from the Department of Informatics of the Unified Health System (DATASUS) and the Live Birth Information System (SINASC) portal. Analyses focused on the information reported in field 41 of the Live Birth Declaration Form entered into the computerized system. RESULTS: The most common anomaly in Brazil was supernumerary fingers, classified as ICD-Q69.0, affecting 11,708 children, with a prevalence of 4.02 per 10,000 live births. Mothers aged over 40 years had a 36% higher prevalence of having children with CAUL than mothers under 40 years old (OR = 1.36; 95% CI 1.19-1.56). Newborns weighing ≥ 2,499 g were 2.64 times more likely to have CAUL compared to those weighing ≥ 2,500 g (OR = 2.64; 95% CI 2.55-2.73). CONCLUSION: There was an observed increase in the reporting of CAUL cases over the decade studied. This trend serves as an alert for health agencies, as understanding the prevalence of CAUL and its associated factors is crucial for preventive medicine. BACKGROUND (CAUL dysfunction OBJECTIVES variables SETTING crosssectional, crosssectional cross sectional, sectional cross-sectional METHODS 201 2019 DATASUS (DATASUS SINASC (SINASC portal 4 system RESULTS fingers ICDQ69.0, ICDQ690 ICDQ ICD Q69.0, Q69 0 Q ICD-Q69.0 11708 11 708 11,70 402 02 4.0 10000 10 000 10,00 36 OR 1.36 136 1 95 1.191.56. 119156 1.19 1.56 . 19 56 1.19-1.56) 2499 2 499 2,49 264 64 2.6 2500 500 2,50 2.552.73. 255273 2.55 2.73 55 73 2.55-2.73) CONCLUSION studied agencies medicine 20 ICDQ69 ICDQ69.0 Q690 Q69.0 Q6 ICD-Q69. 1170 70 11,7 4. 1000 00 10,0 3 1.3 13 9 191 1.191.56 11915 119 1.1 156 1.5 5 1.19-1.56 249 49 2,4 26 6 2. 250 50 2,5 552 2.552.73 25527 255 2.5 273 2.7 7 2.55-2.73 ICDQ6 ICDQ69. Q69. ICD-Q69 117 11, 100 10, 1. 1.191.5 1191 15 1.19-1.5 24 2, 25 2.552.7 2552 27 2.55-2.7 ICD-Q6 1.191. 1.19-1. 2.552. 2.55-2. ICD-Q 1.191 1.19-1 2.552 2.55-2 1.19- 2.55-

Abstract Objective This study aimed to evaluate and compare the clinical and functional outcomes of two surgical procedures performed in patients with severe grade III and IV rhizarthrosis. Methods We evaluated 39 patients who underwent two surgical techniques for rhizarthrosis treatment: trapeziectomy using the Kuhns technique or tendon interposition, with a minimum follow-up period of 6 months. The primary outcome assessment used the specific Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire, and the secondary outcome evaluation employed the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and the visual analog scale (VAS). Results There was no statistically significant difference between groups in the TASD, QuickDASH, and VAS results, and both techniques demonstrated good functional and pain outcomes. No complication required a new surgical approach. We found a positive correlation between TASD and QuickDASH questionnaire scores, suggesting their effectiveness in assessing functionality and disability in subjects with rhizarthrosis. Conclusion Trapeziectomy using the Kuhns technique and tendon interposition proved effective in the surgical treatment of rhizarthrosis. There was no significant difference between the techniques concerning functional outcomes. 3 followup follow up months (TASD Arm Shoulder (QuickDASH VAS. . (VAS) results approach scores (VAS

Resumo Objetivo O objetivo deste estudo é avaliar e comparar os resultados clínicos e funcionais de dois procedimentos cirúrgicos realizados em pacientes com rizartrose grave graus III e IV. Métodos Avaliamos 39 pacientes submetidos a 2 técnicas cirúrgicas para o tratamento da rizartrose: trapeziectomia pela técnica de Kuhns ou com interposição tendínea, com mínimo de 6 meses de seguimento. O desfecho primário foi avaliado pelo questionário específico Sintomas e Incapacidade da Artrose Trapeziometacarpiana (Trapeziometacarpal Arthrosis Symptoms and Disability, TASD, em inglês), e os desfechos secundários, pela versão abreviada do Questionário de Incapacidades do Braço, Ombro e Mão (Disabilities of the Arm, Shoulder, and Hand, QuickDASH, em inglês) e a Escala Visual Analógica (EVA). Resultados Não houve diferença estatisticamente significantiva entre os grupos nos resultados do TASD, QuickDASH e EVA e ambas as técnicas demonstraram bons resultados funcionais e da dor. Não houve complicações que necessitassem de nova abordagem cirúrgica. Verificamos uma correlação positiva entre as pontuações no TASD e no QuickDASH, o que sugere que ambos são eficazes na avaliação da funcionalidade e incapacidade da rizartrose. Conclusão A trapeziectomia com técnica de Kuhns e com interposição tendínea se mostraram efetivas no tratamento cirúrgico da rizartrose. Não houve diferença significativa entre as técnicas em relação aos resultados funcionais. IV 3 seguimento Trapeziometacarpal Disability inglês, inglês , secundários Braço Disabilities Arm Shoulder Hand EVA. . (EVA) dor cirúrgica (EVA

Abstract Objective: To evaluate the safety and effectiveness of a modified pull-out suture technique in patients undergoing primary repair surgery for injuries to the flexor tendons of the fingers with Total Active Motion (TAM) as the primary outcome. Method: A total of 29 patients (38 fingers) were chosen from both sexes, aged between 18 and 65 years with clean acute tendon laceration occurring within 15 days, in the Verdan’s zone II of flexor tendon in the hand, when only the deep flexor tendon was sutured, either associated or not with digital nerve injury. The patients were operated on using the proposed technique and evaluated at 3, 9 and 24-weeks PO. The primary outcome was the assessment of Total Active Movement (TAM) and 3 classifications were employed: Strickland, IFSSH and Buck-Gramcko. Results: We observed a total active motion (TAM) of 209.3 °at the end of 24 weeks; 83.0% of Good and Excellent results by the Modified Strickland Classification, 93% of Excellent results by the IFSSH Classification, and 97% of Good and Excellent results using the Buck-Gramcko Classification. There were no cases of rupture, but tendon adhesion was observed in 3 fingers. Conclusion: The present suture technique proved to be safe and effective with a low rate of complications, obtaining an excellent functional result in terms of total active mobility, according to the evaluations and classifications used. Objective pullout pull out TAM (TAM Method 2 38 (3 sexes 1 6 days Verdans Verdan s hand sutured injury 24weeks weeks PO employed BuckGramcko. BuckGramcko Buck Gramcko. Gramcko Results 2093 209 209. 830 83 0 83.0 Classification 93 97 rupture Conclusion complications mobility used ( 20 8 83.

Resumo Objetivo: Avaliar a segurança e a efetividade da técnica de sutura pull-out modificada nos pacientes submetidos à cirurgia de reparo primário das lesões dos tendões flexores nos dedos, tendo como desfecho primário o movimento ativo total (TAM). Método: Foram escolhidos 29 pacientes (38 dedos), de ambos os sexos, com idade entre 18 e 65 anos, com laceração tendinosa aguda e limpa, ocorrida em até 15 dias, na zona II de Verdan do tendão flexor da mão, quando apenas o tendão flexor profundo foi suturado, associada ou não à lesão do nervo digital. Os pacientes foram operados pela técnica proposta e avaliados em 3, 9 e 24 semanas PO. O desfecho primário foi a avaliação do movimento ativo total (TAM) e foram empregadas 3 classificações: Strickland, IFSSH e Buck-Gramcko. Resultados: Observamos um movimento ativo total (TAM) de 209,3° ao final de 24 semanas; 83,0% de resultados Bons e Excelentes pela Classificação de Strickland Modificada, 93% de resultados Excelentes pela Classificação IFSSH e 97% de resultados Bons e Excelentes pela Classificação Buck-Gramcko. Não houve casos de ruptura, mas foi observada aderência tendínea em 3 dedos. Conclusão: A presente técnica de sutura mostrou-se segura e eficaz com baixo índice de complicações, obtendo excelente resultado funcional em termos de mobilidade ativa total, de acordo com as avaliações e classificações utilizadas. Objetivo pullout pull out dedos TAM. TAM . Método 2 38 (3 , dedos) sexos 1 6 anos limpa dias mão suturado digital PO (TAM BuckGramcko. BuckGramcko Buck Gramcko. Gramcko Buck-Gramcko Resultados 2093 209 209,3 830 83 0 83,0 Modificada 93 97 ruptura Conclusão mostrouse mostrou se complicações utilizadas ( 20 209, 8 83,

Abstract Objective: To evaluate the usefulness of the Phalen test and the Tinel sign in the prognosis and the impact on quality of life in the clinical course of patients with carpal tunnel syndrome undergoing surgical treatment through the traditional open approach. Methods: The present is a cohort study on prognosis. We included 115 patients with high probability of receiving a clinical diagnosis of carpal tunnel syndrome with indication for surgical treatment. All patients underwent the Phalen test and Tinel sign and answered the Boston Carpal Tunnel Questionnaire before and after the surgical treatment. Results: The estimates for the probability of the time until remission of the Phalen test at 2, 4 and 16 weeks postoperatively were of 3.54% (95% confidence interval [95% CI]: 1.16%–8.17%), 0.88% (95%CI: 0.08%–4.38%) and 0.88% (95%CI: 0.08% to 4.38%) respectively, and, for the Tinel sign, they were of 12.39% (95%CI: 7.13%–19.18%), 4.42% (95%CI : 1.65%–9.36%) and 2.65% (95%CI : 0.70%–6.94%) respectively. There was a reduction in the postoperative score on the Boston Carpal Tunnel Questionnaire of 1.8 points for symptom severity (p < 0.001) and of 1.6 points for functional status (p < 0.001). Conclusion: Phalen test remission was earlier than that of the Tinel sign, but, when performed as of the second postoperative week, they were prognostic factors favorable to the clinical course, with improved quality of life. Objective approach Methods 11 Results 2 1 354 3 54 3.54 95% 95 (95 [95 CI CI] 1.16%–8.17%, 116817 1.16%–8.17% , 8 17 1.16%–8.17%) 088 0 88 0.88 95%CI 95CI 0.08%–4.38% 008438 08 38 008 0.08 4.38% 438 respectively 1239 12 39 12.39 7.13%–19.18%, 7131918 7.13%–19.18% 7 13 19 18 7.13%–19.18%) 442 42 4.42 1.65%–9.36% 165936 65 9 36 265 2.65 0.70%–6.94% 070694 70 6 94 1. p 0.001 0001 001 0.001. . Conclusion but week 35 5 3.5 (9 [9 11681 1.16%–8.17 0.8 0.08%–4.38 00843 00 0.0 4.38 43 123 12.3 713191 7.13%–19.18 44 4.4 1.65%–9.36 16593 26 2.6 0.70%–6.94 07069 0.00 000 3. ( [ 1168 1.16%–8.1 0. 0.08%–4.3 0084 4.3 12. 71319 7.13%–19.1 4. 1.65%–9.3 1659 2. 0.70%–6.9 0706 116 1.16%–8. 0.08%–4. 7131 7.13%–19. 1.65%–9. 165 0.70%–6. 070 1.16%–8 0.08%–4 713 7.13%–19 1.65%–9 0.70%–6 07 1.16%– 0.08%– 71 7.13%–1 1.65%– 0.70%– 1.16% 7.13%– 1.65% 0.70% 1.16 7.13% 1.65 0.70 1.1 7.13 0.7 7.1 7.

Resumo Objetivo: Avaliar a utilidade do teste de Phalen e do sinal de Tinel no prognóstico e o impacto na qualidade de vida no curso clínico de pacientes com síndrome do túnel do carpo submetidos ao tratamento cirúrgico por via aberta clássica. Métodos: Trata-se de um estudo de coorte sobre prognóstico. Foram incluídos 115 pacientes com alta probabilidade de diagnóstico clínico de síndrome do túnel do carpo com indicação de tratamento cirúrgico. Todos os pacientes foram submetidos ao teste de Phalen e ao sinal de Tinel, e responderam ao questionário de Boston antes e depois do tratamento cirúrgico. Resultados: As estimativas de probabilidade do tempo até a remissão do teste de Phalen em 2, 4 e 16 semanas pós-operatórias foram de 3,54% (intervalo de confiança de 95% [IC95%]:1,16%–8,17%), 0,88% (IC95%: 0,08%–4,38%) e 0,88% (IC95%: 0,08%–4,38%), respectivamente, e, do sinal de Tinel, foram de 12,39% (IC95%: 7,13%–19,18%), 4,42% (IC95%: 1,65%–9,36%) e 2,65% (IC95%: 0,70%–6,94%), respectivamente. Na pontuação pós-operatória no Questionário de Boston, houve redução de 1,8 ponto para a gravidade dos sintomas (p < 0,001), e de 1,6 ponto para o estado funcional (p < 0,001). Conclusão: A remissão do teste de Phalen foi mais precoce do que a do sinal de Tinel, mas, realizados a partir da segunda semana de evolução pós-operatória, esses testes foram fatores prognósticos favoráveis ao curso clínico, com melhora da qualidade de vida. Objetivo clássica Métodos Tratase Trata se 11 Resultados 2 1 pósoperatórias pós operatórias 354 3 54 3,54 intervalo 95 IC95%1,16%–8,17%, IC95116817 IC IC95% 1,16%–8,17% , IC95 8 17 [IC95%]:1,16%–8,17%) 088 0 88 0,88 (IC95% 0,08%–4,38% 008438 08 38 0,08%–4,38%, respectivamente 1239 12 39 12,39 7,13%–19,18%, 7131918 7,13%–19,18% 7 13 19 18 7,13%–19,18%) 442 42 4,42 1,65%–9,36% 165936 65 9 36 265 2,65 0,70%–6,94%, 070694 0,70%–6,94% 70 6 94 0,70%–6,94%) pósoperatória operatória 1, p 0,001, 0001 0,001 001 0,001) 0,001. . Conclusão mas pósoperatória, operatória, 35 5 3,5 IC95%1,16%–8,17% IC9511681 116817 1,16%–8,17 IC9 [IC95%]:1,16%–8,17% 0,8 (IC95 0,08%–4,38 00843 123 12,3 713191 7,13%–19,18 44 4,4 1,65%–9,36 16593 26 2,6 07069 0,70%–6,94 000 0,00 00 3, IC95%1,16%–8,17 IC951168 11681 1,16%–8,1 [IC95%]:1,16%–8,17 0, (IC9 0,08%–4,3 0084 12, 71319 7,13%–19,1 4, 1,65%–9,3 1659 0706 0,70%–6,9 0,0 IC95%1,16%–8,1 IC95116 1168 1,16%–8, [IC95%]:1,16%–8,1 (IC 0,08%–4, 008 7131 7,13%–19, 1,65%–9, 165 070 0,70%–6, IC95%1,16%–8, IC9511 116 1,16%–8 [IC95%]:1,16%–8, 0,08%–4 713 7,13%–19 1,65%–9 07 0,70%–6 IC95%1,16%–8 IC951 1,16%– [IC95%]:1,16%–8 0,08%– 71 7,13%–1 1,65%– 0,70%– IC95%1,16%– 1,16% [IC95%]:1,16%– 0,08% 7,13%– 1,65% 0,70% IC95%1,16% 1,16 [IC95%]:1,16% 0,08 7,13% 1,65 0,70 IC95%1,16 1,1 [IC95%]:1,16 7,13 0,7 IC95%1,1 [IC95%]:1,1 7,1 IC95%1, [IC95%]:1, 7, IC95%1 [IC95%]:1 [IC95%]: [IC95%] [IC95% [IC95 [IC9 [IC

Resumo Objetivo Avaliar a eficácia da infiltração da solução salina hipertônica como agente esclerosante no cisto sinovial dorsal do punho. Método Pacientes de ambos os sexos, com 18 anos ou mais, com diagnóstico clínico e ultrassonográfico de cisto sinovial, e sem nenhum tratamento prévio foram selectionados. Série de casos em que 50 pacientes foram submetidos a aspiração do conteúdo do cisto e infiltração da solução salina hipertônica (2 ml solução de cloreto de sódio 20% e 1 ml de lidocaína 2%). Seguimento realizado por 24 semanas, durante as quais foram avaliados os parâmetros dor, força, arco de movimento, função (questionários quick disabilities of the arm, hand, and shoulder [quickDASH] e brief Michigan), recorrência e complicações. ResultadoForam avaliados 46 pacientes por 24 semanas, 18 (39,1%) cistos evoluíram para cura e 28 (60,9%) cistos apresentaram recorrência. Não houve diferença estatisticamente significante nos quesitos força e arco de movimento. Não houve diferença clinicamente significante nos escores dos questionários. As complicações mais frequentes foram dor e edema. Conclusão A infiltração com solução salina hipertônica para tratamento do cisto sinovial dorsal do punho mostrou taxa de recorrência de 60,9%. sexos selectionados 5 2 ( 20 2%. 2% . 2%) semanas movimento questionários arm hand quickDASH [quickDASH Michigan, Michigan , Michigan) 4 39,1% 391 39 (39,1% 60,9% 609 60 9 (60,9% edema 39,1 3 (39,1 60,9 6 (60,9 39, (39, 60, (60, (39 (60 (3 (6

Abstract Objective To evaluate the efficacy of hypertonic saline infiltration as a sclerosing agent in the dorsal synovial cyst of the wrist. Method Patients of both genders, aged 18 years or older, with clinical and ultrasound diagnosis of synovial cyst, and without any previous treatment were selected. Case series in which 50 patients underwent aspiration of the contents of the cyst and infiltration of the hypertonic saline solution (2 ml sodium chloride solution 20% and 1 ml of lidocaine 2%). The patients were followed up for 24 weeks, when the parameters pain, strength, range of motion, function (quickDASH and Brief Michigan question), recurrence, and complications were evaluated. Results A total of 46 patients were evaluated for 24 weeks, 18 (39.1%) cysts evolved to resolution, and 28 (60.9%) presented recurrence. There was no statistically significant difference in the effect force or in the range of motion. There was no clinically significant difference in the scores of the questionnaires. The most frequent complications were pain and edema. Conclusion Infiltration with hypertonic saline solution for the treatment of dorsal synovial cyst of the wrist showed a recurrence rate of 60.9%. genders older selected 5 2 ( 20 2%. 2% . 2%) weeks strength motion quickDASH question, question , question) 4 39.1% 391 39 (39.1% resolution 60.9% 609 60 9 (60.9% questionnaires edema 39.1 3 (39.1 60.9 6 (60.9 39. (39. 60. (60. (39 (60 (3 (6

ABSTRACT BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition greatly affects patients’ quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions. OBJECTIVE: This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS. DESIGN AND SETTING: Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil METHODS: We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners. RESULTS: Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were “low” or “very low”. PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman’s correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA. CONCLUSION: Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies. REGISTRATION NUMBER IN PROSPERO: CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328) BACKGROUND (CTS patients work decisions OBJECTIVE SETTING institution Paulo METHODS adults MetaAnalyses Meta Analyses (PRISMA (AMSTAR examiners RESULTS Fiftyfive Fifty five 76 low “low very low. . low” metaanalysis meta analysis 15.61 1561 15 61 (15.6 10.40 1040 10 40 0.008, 0008 0.008 , 0 008 0.008) 8.43 843 8 43 (8.4 5.59 559 5 59 0.009 0009 009 7.95 795 7 95 (7.9 6.06 606 6 06 0.043. 0043 0.043 043 0.043) intraobserver intra observer > ( 0.8, 08 0.8 0.8) Spearmans Spearman s 0829 829 0.829 of0857 of0 857 of0.857 interobserver inter CONCLUSION Overall betterquality PROSPERO CRD CRD4202017232 https//www.crd.york.ac.uk/PROSPERO/display_record.phpID=CRD42020172328 httpswwwcrdyorkacukPROSPEROdisplayrecordphpIDCRD42020172328 httpswwwcrdyorkacukPROSPEROdisplayrecordphpIDCRD https //www.crd.york.ac.uk/PROSPERO/display_record.php ID=CRD42020172328 www crd york ac uk display record php ID (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328 15.6 156 1 (15. 10.4 104 4 000 0.00 00 8.4 84 (8. 5.5 55 7.9 79 9 (7. 6.0 60 004 0.04 04 0. 082 82 0.82 of085 85 of0.85 CRD420201723 phpID https//www.crd.york.ac.uk/PROSPERO/display_record.phpID=CRD4202017232 httpswwwcrdyorkacukPROSPEROdisplayrecordphpIDCRD4202017232 wwwcrdyorkacukPROSPEROdisplayrecordphp IDCRD42020172328 IDCRD ID=CRD4202017232 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD4202017232 15. 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ABSTRACT BACKGROUND: The diagnostic criteria for carpal tunnel syndrome (CTS) lack uniformity. Moreover, because CTS is a syndrome, there is no consensus as to which signs, symptoms, clinical and complementary tests are more reproducible and accurate for use in clinical research. This heterogeneity is reflected in clinical practice. Thus, establishing effective and comparable care protocols is difficult. OBJECTIVE: To identify the diagnostic criteria and outcome measures used in randomized clinical trials (RCTs) on CTS. DESING AND SETTING: Systematic review of randomized clinical trials carried out at the Federal University of São Paulo, São Paulo, Brazil. METHODS: We searched the Cochrane Library, PubMed, and Embase databases for RCTs with surgical intervention for CTS published between 2006 and 2019. Two investigators independently extracted relevant data on diagnosis and outcomes used in these studies. RESULTS: We identified 582 studies and 35 were systematically reviewed. The symptoms, paresthesia in the median nerve territory, nocturnal paresthesia, and special tests were the most widely used clinical diagnostic criteria. The most frequently assessed outcomes were symptoms of paresthesia in the median nerve territory and nocturnal paresthesia. CONCLUSION: The diagnostic criteria and outcome measures used in RCTs about CTS are heterogeneous, rendering comparison of studies difficult. Most studies use unstructured clinical criteria associated with ENMG for diagnosis. The Boston Questionnaire is the most frequently used main instrument to measure outcomes. REGISTRATION: PROSPERO (CRD42020150965- https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150965). BACKGROUND (CTS uniformity Moreover signs research practice Thus difficult OBJECTIVE (RCTs SETTING Paulo Brazil METHODS Library PubMed 200 2019 RESULTS 58 3 reviewed CONCLUSION heterogeneous REGISTRATION CRD42020150965 CRD (CRD42020150965 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=150965. httpswwwcrdyorkacukprosperodisplayrecordphpRecordID150965 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID https //www.crd.york.ac.uk/prospero/display_record.php RecordID=150965 . www crd york ac uk prospero display record php RecordID 150965 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150965) 20 201 5 CRD4202015096 (CRD4202015096 phpRecordID https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=150965 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID15096 wwwcrdyorkacukprosperodisplayrecordphp RecordID150965 RecordID=15096 15096 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150965 2 CRD420201509 (CRD420201509 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=15096 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID1509 RecordID15096 RecordID=1509 1509 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=15096 CRD42020150 (CRD42020150 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=1509 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID150 RecordID1509 RecordID=150 150 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1509 CRD4202015 (CRD4202015 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=150 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID15 RecordID150 RecordID=15 15 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150 CRD420201 (CRD420201 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=15 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID1 RecordID15 RecordID=1 1 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=15 CRD42020 (CRD42020 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=1 RecordID1 RecordID= https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1 CRD4202 (CRD4202 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID= https://www.crd.york.ac.uk/prospero/display_record.php?RecordID= CRD420 (CRD420 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID https://www.crd.york.ac.uk/prospero/display_record.php?RecordID CRD42 (CRD42 CRD4 (CRD4 (CRD

Resumo O dedo em gatilho é uma afecção frequente. Não obstante a tenossinovite e a alteração da polia A1 serem identificados como fatores desencadeantes, não há consenso sobre a verdadeira causa na literatura, sendo que a sua verdadeira etiologia permanece desconhecida. O diagnóstico é puramente clínico na maior parte das vezes. Ele depende unicamente da existência do travamento do dedo no decorrer da movimentação flexão ativa. O tratamento do dedo em gatilho geralmente se inicia com intervenções não cirúrgicas que são instituídas por pelo menos 3 meses. Nos pacientes em quem haja apresentação inicial com deformidade em flexão ou incapacidade de flexão do dedo, pode haver indicação mais precoce do tratamento cirúrgico em razão da intensidade do quadro álgico e da incapacidade funcional do paciente. No presente artigo de revisão, apresentaremos as modalidades e o nosso algoritmo para o tratamento do dedo em gatilho. frequente A desencadeantes literatura desconhecida vezes ativa meses paciente revisão

Abstract Trigger finger is a frequent condition. Although tenosynovitis and the alteration of pulley A1 are identified as triggering factors, there is no consensus on the true cause in the literature, and its true etiology remains unknown. The diagnosis is purely clinical most of the time. It depends solely on the existence of finger locking during active bending movement. Trigger finger treatment usually begins with nonsurgical interventions that are instituted for at least 3 months. In patients with initial presentation with flexion deformity or inability to flex the finger, there may be earlier indication of surgical treatment due to pain intensity and functional disability. In the present review article, we will present the modalities and our algorithm for the treatment of trigger finger. condition A factors literature unknown time movement months disability article

Resumo Objetivo Avaliar a prevalência de variações anatômicas encontradas em pacientes com síndrome do túnel do carpo submetidos a liberação cirúrgica por via aberta clássica. Métodos Foram incluídos um total de 115 pacientes com alta probabilidade de diagnóstico clínico de síndrome do túnel do carpo, com indicação para o tratamento cirúrgico. Estes pacientes realizaram eletroneuromiografia e ultrassonografia para confirmação diagnóstica. Foram submetidos ao tratamento cirúrgico por via aberta clássica, no qual foi realizado um inventário completo da ferida operatória na busca e visualização de variações anatômicas intra e extra túnel do carpo. Resultados A prevalência total das variações anatômicas intra e extra túnel do carpo encontradas neste estudo foi de 63,5% (intervalo de confiança [IC]95%: 54,5-72,4%). A prevalência do músculo transverso do carpo foi de 57,4% (IC95%: 47,8-66,6%), do nervo mediano bífido associado à artéria mediana persistente foi de 1,7% (IC95%: 0,0-4,2%) e do nervo mediano bífido associado à artéria mediana persistente e ao músculo transverso do carpo foi de 1,7% (IC95%: 0,0-4,2%). Conclusão A variação anatômica extra túnel do carpo mais prevalente foi o músculo transverso do carpo e a variação anatômica intra túnel do carpo mais prevalente foi o nervo mediano bífido associado à artéria mediana persistente. O achado cirúrgico de uma variação anatômica extra túnel do carpo, como o músculo transverso do carpo, pode nos indicar a presença de outras variações anatômicas intra túnel do carpo associadas, como nervo mediano bífido, artéria mediana persistente e variações anatômicas do ramo recorrente do nervo mediano.

Abstract Objective To evaluate the prevalence of anatomical variations encountered in patients with carpal tunnel syndrome who underwent carpal tunnel classical open release. Methods A total of 115 patients with a high probability of clinical diagnosis for carpal tunnel syndrome and indication for surgical treatment were included. These patients underwent electroneuromyography and ultrasound for diagnostic confirmation. They underwent surgical treatment by carpal tunnel classical open release, in which a complete inventory of the surgical wound was performed in the search and visualization of anatomical variations intra- and extra-carpal tunnel. Results The total prevalence of anatomical variations intra- and extra-carpal tunnel found in this study was 63.5% (95% confidence interval [CI]: 54.5-72.4). The prevalence of the carpal transverse muscle was 57.4% (95% CI: 47.8-66.6%), of the bifid median nerve associated with the persistent median artery was 1.7% (95% CI: 0.0-4.2%), and the median bifid nerve associated with the persistent median artery and the transverse carpal muscle was 1.7% (95% CI: 0.0-4.2%). Conclusion The most prevalent extra-carpal tunnel anatomical variation was carpal transverse muscle. The most prevalent intra-carpal tunnel anatomical variation was median bifid nerve associated with the persistent median artery. The surgical finding of an extra-carpal tunnel anatomical variation, such as the transverse carpal muscle, may indicate the presence of other associated carpal intra tunnel anatomical variations, such as the bifid median nerve, persistent median artery, and anatomical variations of the recurrent median nerve branch.

Resumo Objetivo Verificar se, em uma população adulta com queixa não traumática dos membros superiores, (1) os questionários Disability of the Arm, Shoulder and Hand (DASH, na sigla em inglês) e Michigan Hand Questionnaire (MHQ, na sigla em inglês) estão suscetíveis ao “efeito de teto”, comparando com amostra de não-doentes; (2) determinar pontos de corte de performance diagnóstica e correlação interquestionários para DASH e MHQ em ambas as amostras. Método Estudo prospectivo, comparativo e não randomizado. Incluímos 150 pacientes, 75 no grupo caso (com doença) e 75 no grupo controle (sem doença). Trata-se de amostra de pacientes recém-admitidos em ambulatório de cirurgia da mão. Os controles foram pareados de forma balanceada de acordo com a inclusão dos casos. Determinamos a presença de efeito de teto por meio da taxa de respostas máximas (> 15%) e associamos curvas receiver operating characteristic (ROC, na sigla em inglês) para a determinação de pontos de corte para a determinação de doentes, associados a medidas de sensibilidade e especificidade. Consideramos p < 0.05 para significância estatística. Resultados Os questionários DASH e MHQ não demonstraram o efeito de teto para o grupo com doença. A porcentagem de pacientes do grupo caso com nota máxima foi de n = 18 (24%) no DASH e de 0% no MHQ. Para o grupo sem doença, 1 (1,33%) dos participantes pontuou com nota máxima para DASH, enquanto nenhum pontuou para o MHQ. Na determinação de casos, escores de DASH de 7,1 apresentam sensibilidade de 80% e especificidade de 60,3%. Para o MHQ, um escore de 76,9 apresenta sensibilidade de 56,2% e especificidade de 97,3%. Conclusão Os questionários DASH e MHQ são ferramentas confiáveis na mensuração do impacto das morbidades das mãos e dos punhos nas atividades diárias dos pacientes e não são suscetíveis a efeito de teto. O questionário DASH é mais sensível para a identificação de doentes, enquanto o MHQ é mais específico. Em situações nas quais se espera um incremento funcional mais discreto (ou mais específico), o MHQ parece mais adequado.

Abstract Objective The present study aimed to verify whether, in an adult population with nontraumatic complaints in the upper limbs, (1) the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) are susceptible to a “ceiling effect” when compared with a sample of healthy subjects; and (2) to determine cutoff points for diagnostic performance and the intercorrelation for DASH and MHQ in both samples. Methods This was a prospective, comparative, nonrandomized study. In total, 150 subjects were included, with 75 in the case group (with disease) and 75 in the control group (without disease). This was a sample of patients recently admitted to a hand surgery outpatient clinic. Controls were matched to clinical cases according to inclusion. The ceiling effect was determined by a maximum response rate (> 15%); receiver operating characteristic (ROC) curves determined cutoff points for sickness definition, and DASH and MHQ sensitivity and specificity. Statistical significance was set at p < 0.05. Results The DASH and MHQ questionnaires had no ceiling effect for the case group. In this group, 18 (24%) patients had the maximum DASH score, but none (0%) had the maximum MHQ score. For the control group, 1 (1.33%) subject had the maximum DASH score, but none scored for MHQ. For case determination, DASH scores of 7.1 had 80% sensitivity and 60.3% specificity, whereas MHQ scores of 76.9 had 56.2% sensitivity and 97.3% specificity. Conclusion The DASH and MHQ questionnaires are reliable tools to measure the impact of hand and wrist morbidities on daily activities, and they are not susceptible to ceiling effects. The DASH questionnaire is more sensitive for patient identification, whereas the MHQ is more specific. As such, the MHQ seems more appropriate when a more specific functional increase is expected.

ABSTRACT BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition greatly affects patients’ quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions. OBJECTIVE: This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS. DESIGN AND SETTING: Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil METHODS: We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners. RESULTS: Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were “low” or “very low”. PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman’s correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA. CONCLUSION: Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies. REGISTRATION NUMBER IN PROSPERO: CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328)

RESUMO Objetivo: A profilaxia e o tratamento da ossificação heterotópica ainda são controversos. O objetivo desta pesquisa foi avaliar a efetividade das intervenções para prevenir o desenvolvimento da ossificação heterotópica após a fixação cirúrgica das fraturas do acetábulo. Métodos: Foi realizada uma revisão sistemática com pesquisa nas bases de dados PubMed/MEDLINE, Embase, LILACS e Cochrane até 4 de agosto de 2020, sem restrições quanto ao idioma e ano de publicação. Foram incluídos apenas ensaios clínicos randomizados realizados em humanos sem restrições com base na dosagem dos tratamentos, no uso e na duração da profilaxia. Cálculos de metanálise foram realizados utilizando o software Review Manager desenvolvido pela Cochrane. Resultados: Dois estudos compararam o uso de radioterapia e indometacina e três compararam o uso de indometacina com um grupo placebo ou não indometacina. Os cálculos de metanálise não indicaram diferenças estatísticas entre radioterapia versus indometacina (RR 1.45, IC de 95% 0.97 a 2.17, p = 0,55) e indometacina versus placebo ou não indometacina (RR 0.85, IC de 95% 0.68 a 1.06, p = 0,59). Conclusão: Não há evidências suficientes para afirmar que a utilização da radioterapia ou da indometacina é efetiva para prevenir a formação da ossificação heterotópica após cirurgias por fraturas do acetábulo. Além disso, o número de complicações foi maior no grupo indometacina quando comparado ao placebo ou à não intervenção. Nível de Evidência I, Revisão Sistemática.

ABSTRACT Objective: Heterotopic ossification is defined as the formation of trabecular bone in soft tissues. It is a common complication after surgical treatment of acetabular fractures. However, its prophylaxis and treatment are still controversial. The objective of this research is to evaluate the effectiveness of actions to prevent the development of heterotopic ossification after surgical correction of acetabular fractures. Methods: A systematic review was carried out with research in the databases PubMed/MEDLINE, Embase, LILACS and Cochrane until August 4, 2020, without restrictions on language and year of publication. Only randomized clinical studies carried out in humans without restrictions based on the dosage of treatments, use and duration of prophylaxis were included in this review. Results: Two studies compared the use of radiotherapy and indomethacin and three compared the use of indomethacin with a placebo or non-indomethacin group. The meta-analysis calculations did not indicate statistical differences between radiotherapy versus indomethacin (RR 1.45, IC 95% 0.97 to 2.17, p = 0,55) and indomethacin versus placebo or not indomethacin (RR 0.85, IC 95% 0.68 to 1.06, p = 0,59). Conclusion: There is insufficient evidence to affirm that the use of radiotherapy or indomethacin are effective to prevent the formation of heterotopic ossification after surgery for fractures of the acetabulum. In addition, the number of complications was higher in the indomethacin group when compared to placebo or no intervention. Level of Evidence I, Systematic Review.

ABSTRACT BACKGROUND: There are several anesthetic techniques for surgical treatment of carpal tunnel syndrome (CTS). Results from this surgery using the “wide awake local anesthesia no tourniquet” (WALANT) technique have been described. However, there is no conclusive evidence regarding the effectiveness of the WALANT technique, compared with the usual techniques. OBJECTIVE: To evaluate the effectiveness of the WALANT technique, compared with intravenous regional anesthesia (IVRA; Bier’s block), for surgical treatment of CTS. DESIGN AND SETTING: Randomized clinical trial, conducted at Hospital Alvorada Moema and the Discipline of Hand Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. METHODS: Seventy-eight patients were included. The primary outcome was measurement of perioperative pain through a visual analogue scale (VAS). The secondary outcomes were the Boston Questionnaire score, Hospital Anxiety and Depression Scale (HADS) score, need for use of analgesics, operating room times, remission of paresthesia, failures and complications. RESULTS: The WALANT technique (n = 40) proved to be superior to IVRA (n = 38), especially for controlling intraoperative pain (0.11 versus 3.7 cm; P < 0.001) and postoperative pain (0.6 versus 3.9 cm; P < 0.001). Patients spent more time in the operating room in the IVRA group (59.5 versus 46 minutes; P < 0.01) and needed to use more analgesics (10.8 versus 5.7 dipyrone tablets; P = 0.02). Five IVRA procedures failed (5 versus 0; P = 0.06). CONCLUSIONS: The WALANT technique is more effective than IVRA for CTS surgery.