Recent Publications

Rotator cuff injuries, especially those affecting the supraspinatus tendon (SST), are extremely common and can significantly limit a person's ability to work, exercise, or perform everyday tasks. This review examines how the SST responds to repetitive overuse injury, which differs from sudden tears and can lead to either healing or progressive degeneration depending on a range of biological and lifestyle factors. Key factors that increase the risk of degeneration include older age, smoking, high cholesterol, diabetes, and applying too much physical load to the tendon before it has recovered. On average, tendons heal at roughly 1% per day, a rate that can be slowed in females due to lower collagen production rates. While MRI remains the standard tool for diagnosing SST injuries, ultrasound imaging is emerging as a practical, real-time method for tracking structural and mechanical changes in the tendon, potentially helping clinicians identify activity levels that put patients at risk for complete rupture.

Traumatic thumb amputation can severely impair hand function, and when reattachment of the original thumb is not possible, surgeons must rely on reconstructive techniques that are often delayed, complex, and require specialized microsurgical resources. This case series describes an immediate osteoplastic thumb reconstruction technique, in which a bone graft and a pedicled groin flap — a flap of skin and tissue from the groin area that remains attached to its original blood supply — are used to rebuild the thumb shortly after injury. Five patients underwent this procedure between 2016 and 2018, with an average initial surgery time of about 158 minutes, and patients gained an average of 3.3 cm in thumb length compared to what would have been achieved with a standard revision amputation. Patients required an average of 1.2 additional minor procedures, such as tissue debulking or hardware removal, and maintained stable outcomes for at least 12 months. This approach offers a simpler, more accessible alternative to microsurgery-dependent techniques, with shorter hospital stays and minimal complications at the donor site, making it a practical option for a wider range of surgical settings.

This study investigated how surgeons reconstruct the large wounds left behind after treating necrotizing soft tissue infections (NSTIs) — a severe, life-threatening bacterial infection that rapidly destroys skin and muscle — in the upper extremities. Researchers reviewed medical records of 99 patients treated at a single hospital between 2014 and 2019, analyzing wound sizes, number of surgical cleanings, reconstruction techniques, and complications. The average patient required about 3.4 debridement surgeries to remove infected tissue, and the resulting wounds were substantial, with a median size of 100 cm². Most surviving patients had their wounds successfully closed using relatively straightforward techniques such as delayed primary closure, skin grafting, or a combination of both, while a smaller number required more complex reconstructive flap procedures. The findings are significant because they demonstrate that, despite the severity of these infections — which resulted in amputation for 7 patients and death for 12 — the majority of patients achieved successful wound reconstruction with a low rate of major complications, providing useful guidance for surgical planning in this challenging patient population.

Researchers developed a therapeutic gaming platform that combines a custom surface electromyography (sEMG) device with a video game to improve rehabilitation for patients with upper extremity weakness caused by conditions like stroke, spinal cord injury, and peripheral nerve injuries. The system detects small amounts of voluntary muscle activity and uses it as a biofeedback signal to control gameplay, encouraging active muscle engagement rather than passive exercise. The platform was tested in a pilot study of 19 patients during a single 30-minute session, including 11 patients who had undergone nerve or tendon transfer surgeries, and the device successfully detected muscle signals across 10 different muscles in the arm, forearm, and hand. Patients and their hand therapists rated the system as enjoyable, motivating, and easy to use, suggesting strong potential for improving therapy adherence. These findings indicate that sEMG-based therapeutic gaming is a promising rehabilitation tool that merits further study, particularly for building strength and supporting motor relearning after complex nerve and tendon transfer procedures.

This study examined how surgeons manage finger reattachment (replantation) when only the artery can be repaired and no suitable vein is available to restore normal blood drainage. Researchers conducted a systematic review, analyzing 55 published articles that described 1,498 individual finger replantations where venous repair was not performed. Because blood cannot drain naturally without venous repair, various techniques to relieve congestion were evaluated, including medicinal leech therapy and surface bleeding methods, along with different anticoagulation strategies to prevent clotting. The overall survival rate for reattached fingers was 78.5%, though results varied considerably depending on the specific technique used and the study reviewed. The findings suggest that the inability to repair a vein should not automatically disqualify a patient from replantation, and that surgeons should choose the most appropriate drainage technique based on individual patient circumstances and injury type.

This study investigated which factors best predict death and amputation in patients with necrotizing soft tissue infections (NSTIs) of the upper extremity, a rapidly progressing and life-threatening condition that destroys tissue and causes widespread organ dysfunction. Researchers retrospectively analyzed data from 99 patients treated at a single tertiary care center, calculating established clinical severity scores—the LRINEC and qSOFA—alongside patient characteristics and surgical details to identify meaningful predictors of outcomes. Among the cohort, 12 patients died in the hospital and 7 underwent amputation, with the strongest independent predictor of death being vasopressor dependency outside of surgical anesthesia, indicating that patients requiring blood pressure support beyond the operating room were at the greatest risk. Notably, the LRINEC score, a widely used tool for diagnosing necrotizing fasciitis severity, did not effectively predict either death or amputation in this upper extremity population. These findings highlight the importance of early recognition, aggressive resuscitation, and prompt surgical debridement in managing upper extremity NSTIs, while also suggesting that current scoring systems may have limited utility for guiding prognosis in this specific patient group.

Pyogenic extensor tenosynovitis is a serious infection of the tendon sheaths on the back of the wrist that can lead to spontaneous tendon rupture, a rare but severe complication. This report describes two patients who developed this condition following penetrating injuries — one from a cat bite and one from injection drug use — both of which introduced bacteria into the wrist's extensor tendon system. One patient underwent surgical reconstruction using a tendon graft taken from the forearm, while the other declined surgery and was left with permanent functional limitations. The cases demonstrate that untreated or delayed infections in the dorsal wrist can destroy tendon tissue, leading to loss of finger extension and requiring complex surgery and rehabilitation to restore function. The authors emphasize that early surgical intervention is critical to preventing tendon rupture and the long-term disability that follows.