Hand Center Recent Publications

Rotator cuff injuries, especially those involving the supraspinatus tendon (SST), are common and often result from repetitive stress rather than a single traumatic event. This review examines how cyclic loading below the level needed to cause an immediate tear can gradually accumulate damage in the SST, eventually overwhelming the body's natural repair processes and increasing the risk of full tendon rupture. The authors analyzed findings across multiple model systems and found a consistent pattern of fatigue damage progression, suggesting that tendons respond to overuse in a predictable, generalizable way. This consistency is significant because it raises the possibility of identifying early warning signs and developing interventions before serious injury occurs. The authors call for future research to better define the SST's fatigue life — including how much load, how often, and for how long it can be applied before injury — and to enable real-time strain analysis during everyday activities.

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 amputated thumb is not possible, surgeons must find alternative ways to rebuild the thumb. This case series describes an immediate osteoplastic reconstruction technique, in which a bone graft and a pedicled groin flap—a section of skin and tissue from the patient's own hip area—are used to reconstruct the thumb right after injury, rather than waiting weeks or months. 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 a standard amputation revision would have provided. Patients required only about one additional minor procedure on average, such as tissue trimming or hardware removal, and all showed stable outcomes for at least one year. This approach is significant because it offers a simpler, faster, and more accessible alternative to complex microsurgical thumb reconstruction, with minimal complications at the donor site and consistent, reproducible results.

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.

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.