The aim of this randomized controlled study was to determine whether administration of lignocaine with adrenaline is less painful when injected at room temperature compared to refrigerated temperature. A cohort of 50 patients undergoing unilateral carpal tunnel decompression was randomized to room temperature or refrigerated local anaesthetic. Pain scores were assessed using a 10 mm visual analogue scale. Mean pain scores were 4.0 (SD +/- 1.5) for room temperature and 6.5 (SD +/- 1.7) for refrigerated local anaesthetic (P < 0.001). This study demonstrates that patients experience greater pain levels with administration of local anaesthetic at refrigerated temperatures prior to open carpal tunnel release.

Pain and disability caused by ganglia of the hand and wrist were assessed using a patient-rated wrist evaluation questionnaire in 75 patients. Dorsal wrist ganglia were the most painful and disabling. However, the majority of ganglia cause little pain or disability. Consequently, referral by General Practitioners should be confined to those with pain, disability or failure of conservative management.

Forty-two patients with a whiplash injury were assessed at the time of injury, after 3 months, 2 years and a mean of 7.5 years. The range of neck movement, pain, its effect on lifestyle, and psychometric testing were determined in each of the patients. Between 2 and 7.5 years, 5 (12%) described improved symptoms, 12 (29%) complained of continuing pain and 14 (33%) reported increased severity of symptoms since the accident. Neck pain was the commonest complaint in 23 (55%) and low back pain in 18 (43%). Radiation of pain was more common in the severely symptomatic patients. There was no significant difference in either the ages or sex of the patients between the symptomatic and asymptomatic groups. Anxiety and depression correlated well with symptom severity. None of the asymptomatic patients revealed any degree of psychological disturbance compared with 30 (77%) in the symptomatic groups. Symptoms largely stabilised within 3 months but there was significant fluctuation in symptom severity between 3 months and 2 years. This suggests that outcome cannot be accurately assessed during this time. In order to effectively manage those most severely affected by whiplash, patients should be identified within the first 12 weeks following injury if the outcome of their injury is to be modified.

Eighty eight incompetent perforating vein (IPV) ligations were performed in 64 patients who were followed up for a minimum of two years, mean 4.4 years. The long term results were good in 85% of cases. It is suggested that IPV ligation is the optimum treatment for venous ulceration and lipodermatosclerosis in patients who have only calf vein damage and that in most cases preoperative ascending venography is not necessary.