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Biomedical subjects

Alan E Freeland

Publications and source records attributed to Alan E Freeland.

25 records · Page 2Linked to original sources
PubMed2002

Absorptive properties of synovium harvested from the carpal tunnel.

Ischemia-induced reperfusion injury seems to play an important role in the pathophysiology of "idiopathic" carpal tunnel syndrome (CTS). The common final pathway in this developmental sequence is thought to be an intermittent increase in interstitial pressure, leading to degenerative changes in the flexor tenosynovium and fibrotic changes in the perineural tissue. We hypothesize that this concurrently leads to alteration in the physical properties of the synovium, leading to its rapid and persistent swelling. A prospective study was conducted on synovial tissue obtained from 27 CTS patients. The in vitro synovial absorption rate of CTS patients was significantly higher in the first hour compared to controls (n = 7). This difference was maintained up to 5-6 h, albeit at a slower rate. Rapid absorption and retention of fluid by the synovium led to increased interstitial pressure and nerve compression, resulting in early and persistent manifestation of symptoms in sensitized patients.

Absorption↗
PubMed2002

Biochemical evaluation of serum and flexor tenosynovium in carpal tunnel syndrome.

In total, 41 consecutive patients with "idiopathic carpal tunnel syndrome" and abnormal electrophysiologic findings who underwent carpal tunnel release were studied prospectively. The focus of this investigation was the evaluation of the levels of specific chemical mediators within the serum and flexor tenosynovium of these patients. Blood was collected from these patients within 1 week prior to carpal tunnel release, and flexor tenosynovium was obtained at time of surgery. Specimens were then analyzed to determine the levels of interleukins 1 and 6, prostaglandin E(2) (PGE(2)), and malondialdehyde bis diethyl acetal. These values were compared to those of controls who had no evidence of carpal tunnel syndrome. A significant increase was noted in the serum malondialdehyde and tenosynovial levels of malondialdehyde, interleukin 6, and prostaglandin PGE(2) compared to controls. The elevated levels of these biologic factors and the absence of interleukin 1 elevation support a noninflammatory ischemia-reperfusion etiology for so-called "idiopathic carpal tunnel syndrome" that causes progressive edema and fibrosis of the tissues within the carpal canal. These findings correlate with previous histopathology reports. We believe that "idiopathic carpal tunnel syndrome" is an "-osis" not an "-itis."

Carpal Tunnel Syndrome↗
PubMed2002

Skeletal fixation in digital replantation.

Although the primary objective of replantation is revascularization and ultimately viability of the amputated digit(s), skeletal stabilization is an important cornerstone of the composite repair and reconstructive process. If performed rapidly and securely, anatomic (or near anatomic) fracture reduction and fixation may contribute profoundly to the protection of the revascularization and the repair or reconstruction of nerves, tendons, and integument; reliable fracture healing; functional restoration; and final outcome. Conversely, less than anatomic (or near anatomic) reduction or unreliable and insecure fixation may deter successful early revascularization and, later, good function. This article reviews the various methods of fracture stabilization that may be employed, and their advantages and disadvantages. We believe that anatomic (or near anatomic) fracture reduction, reliable and stable fracture fixation, minimal additional dissection, and early active range-of-motion exercises will have a substantial effect on both viability and functional outcome in digital replantation.

Finger Injuries↗
PubMedDate not supplied

Rehabilitation for proximal phalangeal fractures.

Proximal phalangeal fracture stability is crucial for the initiation of early and effective exercises designed to recover digital and especially proximal interphalangeal joint motion. Active digital flexion and extension exercises are implemented by synergistic wrist motion. Joint blocking exercises and active tendon gliding exercises in protective blocking splints are instrumental elements of early treatment. Dynamic splinting and serial finger casting are used in recalcitrant, severe, and late presenting cases. Surgical release is a last resort in regaining proximal interphalangeal joint motion. This measure is reserved for a failure of treatment when residual proximal interphalangeal joint contracture is persistent and severe enough to cause serious impairment of digital motion and hand function.

Exercise Therapy↗
PubMedDate not supplied

Metacarpal fractures in athletes: treatment, rehabilitation, and safe early return to play.

Specialty gloves and buddy taping of adjacent fingers may cushion impact and dissipate twisting forces so that hands, thumbs, and fingers are protected during play. When fractures occur, athletes must be protected from contact until healing has progressed to a point where reinjury or complications are unlikely and performance standards and expectations can be met. This article outlines a program of fracture management principles and progressive graduated rehabilitation that phase the hand-injured athlete first into general conditioning and non-ball-handling drills, then into return to hand impact activities, body contact, ball handling, and catching with the use of protective hand gear. At this point, specialized playing orthoses, gloves, or taping may be added to the treatment regimen. Batting, the use of golf clubs, and racquet handling occur later, and finally throwing with precision, distance, velocity, and frequency is initiated. The importance of the particular sport, the position played, and hand dominance are factored into the decision-making processes. Safety of the patient and opponents is paramount. Extra-articular metacarpal fractures are discussed as a prototype for treatment, rehabilitation, and early safe return to play because of their frequent occurrence in athletes.

Athletic Injuries↗