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-

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 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 O principal objetivo desta pesquisa foi fazer uma comparação intraindividual dos resultados entre as técnicas de incisão ulnar aberta e retinaculótomo de Paine com incisão palmar em pacientes com síndrome do túnel do carpo (STC) bilateral. Os pacientes foram submetidos à cirurgia aberta em uma mão e cirurgia com retinaculótomo de Paine na mão contralateral. Os pacientes foram avaliados com o Boston carpal tunnel questionnaire, escala visual analógica para dor e força de preensão palmar, pinça lateral, pinça polpa-polpa e trípode. As duas mãos foram examinadas antes da cirurgia e 2 semanas, 1 mês, 3 e 6 meses após a cirurgia. Dezoito pacientes (36 mãos) foram avaliados. As pontuações da escala de gravidade dos sintomas (EGS) foram maiores no pré-operatório nas mãos submetidas à cirurgia com retinaculótomo de Paine (p = 0,023), mas menores no 3° mês após o procedimento (p = 0,030). As pontuações da escala de estado funcional (EEF) foram menores às 2 semanas, 3 meses e 6 meses (p = 0,016) nas mãos submetidas à cirurgia com retinaculótomo de Paine. Em um estudo de módulo de diferença de dois grupos, o grupo submetido à cirurgia com retinaculótomo de Paine apresentou pontuações médias de EGS na 2ª semana e 1° mês e de EEF na segunda semana inferiores a 0,8 e 1,2 pontos, respectivamente, em comparação ao grupo submetido ao procedimento aberto. As mãos submetidas à cirurgia com retinaculótomo de Paine apresentaram escores significativamente menores de EGS em 3 meses e de EEF em 2 semanas, e aos 3 e 6 meses após a cirurgia em comparação a técnica aberta. STC (STC bilateral contralateral questionnaire lateral polpapolpa polpa trípode semanas 36 (3 (EGS préoperatório pré operatório p 0,023, 0023 0,023 , 0 023 0,023) 0,030. 0030 0,030 . 030 0,030) (EEF 0,016 0016 016 grupos ª 08 8 0, 12 1, pontos respectivamente aberto ( 002 0,02 02 003 0,03 03 0,01 001 01 00 0,0

Abstract The main purpose of this research was to do an intraindividual comparison of outcomes between the open ulnar incision (OUI) and the Paine retinaculotome with palmar incision (PRWPI) techniques in patients with bilateral carpal tunnel syndrome (CTS). The patients underwent OUI surgery on one hand and PRWPI surgery on the contralateral hand. The patients were evaluated with the Boston carpal tunnel questionnaire, visual analogue scale for pain, palmar grip strength, and fingertip, key, and tripod pinch strengths. Both hands were examined in the preoperative and postoperative periods after 2 weeks, 1 month, and 3 and 6 months. Eighteen patients (36 hands) were evaluated. The symptoms severity scale (SSS) scores were higher, in the preoperative period, in the hands that underwent surgery with PRWPI (p-value =0,023), but lower in the 3rd month postoperative (p-value = 0.030). The functional status scale (FSS) scores were lower in the periods of 2 weeks, 3 months, and 6 months (p-value = 0,016) on the hands that underwent surgery with PRWPI. In a different two-group module study, the PRWPI group presents the SSS scores average on the 2nd week and 1st month, and the FSS scores average on the 2nd week, less 0.8 and 1.2 points respectively comported to open group. The hands that underwent surgery with PRWPI presented significantly lower SSS scores at 3 months postoperative, and lower FSS scores at 2 weeks, and 3 and 6 months postoperative, compared to open surgery group. (OUI (PRWPI CTS. CTS . (CTS) questionnaire pain strength fingertip key strengths weeks 36 (3 (SSS higher period pvalue p value =0,023, 0023 =0,023 , 0 023 =0,023) rd 0.030. 0030 0.030 030 0.030) (FSS 0,016 0016 016 twogroup two study nd st 08 8 0. 12 1. (CTS ( 002 =0,02 02 003 0.03 03 0,01 001 01 00 =0,0 0.0 0,0 =0, 0, =0

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 Objetivo O objetivo do presente estudo foi determinar a prevalência de ausência de tendão palmaris longus em uma amostra populacional de uma cidade multiétnica brasileira. Métodos Um estudo observacional transversal foi realizado entre outubro de 2017 e abril de 2018. Incluímos voluntários dos sexos masculino e feminino com 18 anos ou mais. A ausência do tendão palmaris longus foi determinada pedindo aos voluntários que realizassem o teste de Schaeffer bilateralmente. Resultados Foram coletados prospectivamente dados de 1.008 voluntários, 531 homens e 477 mulheres, com idade entre 18 e 74 anos (média de 38,4 anos). A ausência do tendão palmaris longus foi observada em 264 (26,2%) voluntários. A ausência bilateral foi detectada em 123 voluntários (12,2%), 60 mulheres (48,8%) e 63 homens (51,2%). A ausência unilateral foi encontrada em 141 pacientes (14,0%), 54 mulheres (38,2%) e 87 homens (61,8%) (p<0,05). Conclusão A prevalência de ausência do tendão palmaris longus em nosso estudo foi de 26,2%. Não houve diferença estatisticamente significativa bilateralmente e entre gêneros. A ausência do tendão palmaris longus foi predominante no lado direito unilateral no sexo masculino. brasileira 201 2018 1 mais 1008 008 1.00 53 47 7 média 384 38 4 38, anos. . anos) 26 26,2% 262 2 (26,2% 12 12,2%, 122 12,2% , (12,2%) 6 48,8% 488 48 8 (48,8% 51,2%. 512 51,2% 51 (51,2%) 14 14,0%, 140 14,0% 0 (14,0%) 5 38,2% 382 (38,2% 61,8% 618 61 (61,8% p<0,05. p005 p p<0,05 05 (p<0,05) gêneros 20 100 00 1.0 3 26,2 (26,2 12,2 (12,2% 48,8 (48,8 51,2 (51,2% 14,0 (14,0% 38,2 (38,2 61,8 (61,8 p00 p<0,0 (p<0,05 10 1. 26, (26, 12, (12,2 48, (48, 51, (51,2 14, (14,0 (38, 61, (61, p0 p<0, (p<0,0 (26 (12, (48 (51, (14, (38 (61 p<0 (p<0, (2 (12 (4 (51 (14 (3 (6 p< (p<0 ( (1 (5 (p< (p

Abstract Objective The objective of the study was to determine the prevalence of absence of palmaris longus tendon in a population sample from a multiethnic Brazilian city. Methods A cross-sectional observational study was carried out between October 2017 and April 2018. We included male and female volunteers aged 18 years or older. The absence of palmaris longus tendon was determined by asking the volunteers to perform the Schaeffer test bilaterally. Results We prospectively collected data on 1,008 volunteers, 531 male and 477 female, with age between 18 and 74 years (mean 38.4 years). The absence of palmaris longus tendon was observed in 264 (26.2%) volunteers. Bilateral absence was detected in 123 volunteers (12.2%), 60 female (48.8%) and 63 male (51.2%). Unilateral absence was found in 141 patients (14.0%), 54 female (38.2%) and 87 male (61.8%) (p < 0.05). Conclusion The prevalence of absence of palmaris longus tendon in our study was 26.2%. There was no statistically significant difference between gender and bilaterally. The absence of palmaris longus tendon was predominant on unilateral right side in males. city crosssectional cross sectional 201 2018 1 older bilaterally 1008 008 1,00 53 47 7 mean 384 38 4 38. years. . years) 26 26.2% 262 2 (26.2% 12 12.2%, 122 12.2% , (12.2%) 6 48.8% 488 48 8 (48.8% 51.2%. 512 51.2% 51 (51.2%) 14 14.0%, 140 14.0% 0 (14.0%) 5 38.2% 382 (38.2% 61.8% 618 61 (61.8% p 0.05. 005 0.05 05 0.05) males 20 100 00 1,0 3 26.2 (26.2 12.2 (12.2% 48.8 (48.8 51.2 (51.2% 14.0 (14.0% 38.2 (38.2 61.8 (61.8 0.0 10 1, 26. (26. 12. (12.2 48. (48. 51. (51.2 14. (14.0 (38. 61. (61. 0. (26 (12. (48 (51. (14. (38 (61 (2 (12 (4 (51 (14 (3 (6 ( (1 (5

ABSTRACT Purpose: Various postoperative protocols have been proposed to improve outcomes and accelerate nerve regeneration. Recently, the use of physical exercise in a post-surgical neurorraphy procedure has shown good results when started early. We experimentally investigated the hypothesis that post-operative exercise speeds up results and improves clinical and morphologic parameters. Methods: Isogenic rats were randomly divided into four groups: 1 SHAM; 2 SHAM submitted to the exercise protocol (EP); 3 Grafting of the sciatic nerve; and 4 Grafting of the sciatic nerve associated with the EP. The EP was based on aerobic activities with a treadmill, with a progressive increase in time and intensity during 6 weeks. The results were evaluated by the sciatic functional index (SFI), morphometric and morphologic analysis of nerve distal to the lesion, and the number of spinal cord motor neurons, positive to the marker Fluoro-Gold (FG), captured retrogradely through neurorraphy. Results: Functional analysis (SFI) did not show a statistical difference between the group grafted with (–50.94) and without exercise (-65.79) after 90 days. The motoneurons count (Spinal cord histology) also showed no diference between these groups (834.5 × 833 respectively). Although functionally there is no difference between these groups, morphometric study showed a greater density (53.62) and larger fibers (7.762) in GRAFT group. When comparing both operated groups with both SHAM groups, all values were much lower. Conclusions: The experimental model that this aerobic treadmill exercises protocol did not modify nerve regeneration after sciatic nerve injury and repair with nerve graft.

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 As fraturas da porção distal do rádio estão entre as mais comuns do esqueleto. A consolidação viciosa pode ocorrer em até um terço dessas fraturas e acarretar restrição de movimento e dor no punho, com consequente limitação ou incapacidade laboral. O tratamento desta condição implica em osteotomia corretiva das deformidades, o que necessita de um planejamento pré-operatório criterioso em virtude de sua complexidade tridimensional, notadamente naquelas em que há acometimento articular. Assim, recentemente, tem sido utilizada a prototipagem a partir da reconstrução 3D da tomografia computadorizada (TC), o que permite o planejamento com realização da osteotomia em modelo anatômico tridimensional, com o melhor entendimento da deformidade, aproximando-se da situação realística da cirurgia, o que torna o procedimento mais seguro, ágil e previsível. O objetivo do presente estudo é apresentar esta técnica e seu emprego em dois casos clínicos.

Abstract Distal radial fractures are very common. Vicious consolidation can occur in up to one third of these fractures, resulting in wrist pain, restricted movement, and, eventually, physical limitation or disability. The treatment of this condition consists in corrective osteotomy, which requires careful preoperative planning due to its three-dimensional complexity, especially in injuries with joint involvement. Recently, prototyping based on three-dimensional (3D) reconstruction of computed tomography (CT) scans has been used for osteotomy planning in a 3D anatomical model. It allows a better understanding of the deformity in a realistic surgical approach, leading to safer, faster, and more predictable procedures. The aim of the present study is to present this technique and show its use in two clinical cases.

Resumo Objetivos Avaliar a prevalência da ausência de função dos tendões do músculo flexor superficial do quarto e quinto dedos em uma população brasileira. Métodos Estudo prospectivo foi realizado no departamento de ortopedia e traumatologia de um hospital universitário. O estudo foi desenvolvido no período de outubro de 2017 a abril 2018. A amostra foi formada por voluntários sem histórico de trauma, cirurgia ou qualquer afecção dos membros superiores. Foram incluídos neste estudo indivíduos de ambos os gêneros com idade igual ou superior a 18 anos. A avaliação da função do tendão do múculo flexor superficial do quarto e quinto dedos foi realizada por meio de testes clínicos por três examinadores independentes. Para análise dos dados foi utilizado o programa GraphPad Prism 5.0 (GraphPad Software, San Diego, CA, EUA). Resultados Foram analisados 1.008 voluntários totalizando 2.016 mãos. A prevalência da ausência de função do tendão do músculo flexor superficial do quarto dedo foi de 0,56% na mão direita e 0,99% na mão esquerda. Em relação ao gênero, foi verificado na mão direita uma maior prevalência da ausência de função do flexor superficial do quarto dedo no gênero feminino quando comparado ao masculino (p= 0,0328). Na mão esquerda não foi observada diferença entre os gêneros (p= 0,7562). A ausência de função do músculo flexor superficial no quinto dedo foi de 34,53% na mão direita e de 30,06% na mão esquerda. Quando analisamos o quinto dedo em relação aos gêneros, foi verificado que a prevalência da ausência de função do músculo flexor superficial foi mais frequente no gênero feminino que no masculino, tanto na mão direita (p= 0.0001) como na mão esquerda (p= 0.0003). Conclusão Apesar de haver estudos realizados separadamente em diversas etnias, não havia na literatura dados referentes à prevalência da ausência de função do músculo flexor superficial do quarto e quinto dedos da mão em uma população miscigenada como a brasileira.

Abstract Objectives To evaluate the prevalence of absence of flexor digitorum superficialis muscle tendons function of the fourth and fifth fingers of the hand in the Brazilian population Methods Prospective study performed at the orthopedics and traumatology department of a university hospital. The study was conducted from October 2017 to April 2018. The sample consisted of volunteers with no history of upper limb trauma, surgery or any other condition. This study included both male and female individuals over 18 years old. The flexor digitorum superficialis muscle tendons of the fourth and fifth fingers were evaluated through clinical tests by three independent examiners. The data were analyzed using GraphPad Prism 5.0 (GraphPad Software, San Diego, CA, USA). Results A total of 2,016 hands from 1,008 volunteers were analyzed. The prevalence of absence of flexor digitorum superficialis muscle tendon function of the fourth finger was 0.56% at the right hand and 0.99% at the left hand. At the right hand, this prevalence was higher in females compared to males (p= 0.0328). No difference between genders was noted in the left hand (p= 0.7562). The prevalence of absence of flexor digitorum superficialis muscle tendon function of the fifth finger was 34.53% in the right hand and 30.06% in the left hand. This prevalence was higher in females compared to males, both at the right hand (p= 0.0001) and the left hand (p= 0.0003). Conclusion Even though there are studies performed separately in different ethnic groups, there were no data in the literature regarding the prevalence of absence of flexor digitorum superficialis muscle tendons function of the fourth and fifth fingers of the hand in a multiethnic population such as the Brazilian one.

Resumo Objetivo Determinar a prevalência da anomalia de Linburg-Comstock em uma amostra populacional brasileira. Métodos Estudo observacional transversal realizado no período de outubro de 2017 a abril de 2018. Foram incluídos voluntários dos gêneros feminino e masculino, com idade igual ou superior a 18 anos. A presença da anomalia de Linburg-Comstock foi determinada pela realização dos testes clínicos descritos por Linburg e Comstock. Os dados foram analisados por meio do software GraphPad Prism, sendo consideradas diferenças com valores de p < 0,05. Resultados O estudo analisou 1.008 voluntários (2.016 mãos) com idade média de 38,3 anos, dos quais 531 (52,67%) eram do gênero masculino, e 477 (47,33%) eram do gênero feminino. A anomalia de Linburg-Comstock foi diagnosticada em 564 voluntários (55,95%) da população estudada, sendo bilateral em 300 (53,2%), direita em 162 (28,72%), e esquerda em 102 (18,08%). Não foram encontradas diferenças significativas quando se comparou a prevalência entre os gêneros. Porém, foi encontrada uma maior prevalência da anomalia direita na população masculina (n = 99; 70,21%) do que na feminina (n = 63; 51,21%), com p = 0,0016. Além disso, a presença da dor pela manobra descrita por Linburg e Comstock foi mais prevalente nas mulheres (n = 150; 54,94%) do que nos homens (n = 105; 36,08%), com p = 0,0001. Estes resultados mostram a importância dos estudos epidemiológicos sobre a anomalia de Linburg-Comstock, principalmente com o intuito de investigar a presença de afecções associadas. Conclusão A prevalência da anomalia de Linburg-Comstock na população estudada foi de 55,95%, sendo bilateral em 53,2% dos voluntários. A presença da conexão foi observada com maior frequência do lado direito em homens, mas o sintoma dor foi mais frequente nas mulheres.

Abstract Objective To determine the prevalence of the Linburg-Comstock anomaly in a Brazilian population sample. Methods A cross-sectional observational study was carried out between October 2017 and April 2018. We included male and female volunteers aged 18 years or older. The presence of the Linburg-Comstock anomaly was determined by performing the clinical tests described by Linburg and Comstock. The data were analyzed using the GraphPad Prism software, and we considered differences with p < 0.05. Results The study analyzed 1,008 volunteers (2,016 hands) with a mean age of 38.3 years, 531 (52.67%) of which were male, and 477 (47.33%) were female. The Linburg-Comstock anomaly was diagnosed in 564 (55.95%) individuals, and it was bilateral in 300 (53.2%) of them, right-sided in 162 (28.72%), and left-sided in 102 (18.08%). No significant differences were found when comparing the prevalence between genders. However, a the prevalence of the right-sided anomaly in the male population (n = 99; 70.21%) was higher than in the female one (n = 63; 51.21%), with p = 0.0016. In addition, the presence of pain by the maneuver described by Linburg and Comstock was more prevalent in women (n = 150; 54.94%) than in men (n = 105; 36.08%), with p = 0.0001. These results show the importance of epidemiological studies on the Linburg-Comstock anomaly, mainly in order to investigate the presence of associated conditions. Conclusion The prevalence of the Linburg-Comstock anomaly in the studied population was of 55.95%, and it was bilateral in 53.2% of the volunteers. The presence of the connection was observed more frequently in the right side and among men, but the pain symptom was more frequent among women.

Resumo Objetivo Avaliar os efeitos da natação na regeneração nervosa após a lesão do nervo ciático em ratos Wistar. Métodos Um total de 30 ratos Wistar foram divididos em 3 grupos: grupo Sham + Nat: animais que não foram submetidos à cirurgia de enxerto e foram submetidos à natação (n = 10); grupo Enxerto: animais que foram submetidos à cirurgia de enxerto autólogo de nervo ciático (n = 10); e grupo Enx + Nat: animais submetidos à cirurgia de enxerto autólogo de nervo ciático e à natação (n = 10). Os resultados foram analisados pelo software GraphPad Prism 5.0 (GraphPad Software, San Diego, CA, EUA). Resultados Na primeira avaliação, todos os valores do índice funcional do ciático (IFC) foram semelhantes (p = 0.609). Após 30 dias do procedimento cirúrgico, foram observadas diferenças entre todas as comparações: Sham + Nat (−34,64 ± 13,89) versus Enxerto (−145,9 ± 26,06), grupos Sham + Nat versus Enx + Nat (−89,40 ± 7,501), grupos Enxerto (−145,9 ± 26,06) versus Enx + Nat (−89,40 ± 7,501). Nas medidas (60 e 90 dias), não houve diferença estatística entre os grupos Enxerto e Enx + Nat, com valores significativamente menores em relação ao grupo controle (p < 0,001). O número de motoneurônios apresentou diferenças nas comparações entre os grupos Sham + Nat e Enxerto (647,1 ± 16,42 versus 563,4 ± 8,07; p < 0,05) e Sham + Nat e Enx + Nat (647,1 ± 16,42 versus 558,8 ± 14,79; p < 0,05), não havendo diferença entre os grupos Enxerto e Enx + Nat. Conclusão Os animais submetidos ao protocolo de natação após o procedimento de enxerto do nervo ciático não apresentaram diferenças nos valores de IFC e nos números de motoneurônios quando comparados com grupo controle. Portanto, este tipo de protocolo não é eficiente para reabilitação de lesões nervosas periféricas que necessitam de enxerto, sendo necessários novos estudos.

Abstract Objective To evaluate the effects of swimming on nerve regeneration after sciatic nerve injury in Wistar rats. Methods A total of 30 Wistar rats was divided into 3 groups: Sham + Nat group animals that were not submitted to graft surgery and were submitted to swimming (n = 10); Graft group: animals submitted to autologous sciatic nerve graft (n = 10); and Graft + Nat group: animals submitted to autologous sciatic nerve graft surgery and to swimming (n = 10). The results were analyzed on the software (GraphPad Software, San Diego, CA, USA). Results In the first evaluation, all sciatic functional index (SFI) values were similar (p = 0.609). Thirty days after the surgical procedure, we observed differences between all the comparisons: Sham + Nat (−34.64 ± 13.89) versus Graft (−145.9 ± 26.06); Sham + Nat versus Graft + Nat (−89.40 ± 7.501); Graft (−145.9 ± 26.06) versus Graft + Nat (−89.40 ± 7.501). In the measurements (60 and 90 days), there was no statistical difference between the Graft and Graft + Nat groups, with significantly lower values in relation to the control group (p < 0.001). The number of motor neurons presented differences in the comparisons between the Sham + Nat and Graft groups (647.1 ± 16.42 versus 563.4 ± 8.07; p < 0.05), and between the Sham + Nat and Graft + Nat groups (647.1 ± 16.42 versus 558.8 ± 14.79; p < 0.05). There was no difference between the Graft and Graft + Nat groups. Conclusion Animals submitted to the swimming protocol after the sciatic nerve grafting procedure did not present differences in the SFI values and motor neuron numbers when compared to the control group. Therefore, this type of protocol is not efficient for the rehabilitation of peripheral nerve lesions that require grafting. Therefore, further studies are needed.