Biomedical subjects
Publications and source records attributed to C Wulle.
The slender accessory tendon of the flexor pollicis longus muscle is described. It is found in 10 to 54% of the cases of trigger thumb, but approximately in the same frequency in the normal thumb too. A literature review of the incidence and genesis is presented.
The chronic entrapment syndromes of the tendons of the hand are: stenosing tendovaginitis of the flexor and extensor tendons, the trigger wrist, and the intersection-syndrome. Pathogenesis, symptoms, diagnosis and differential diagnosis are presented. The focus is on the localization of the individual disease and its particularities. Therapy and possible complications are discussed subsequently.
In 1980, we presented the synovialis flap plasty for the treatment of carpal tunnel syndrome recurrence. Since May 1979, we performed 41 secondary procedures, and among them 14 synovialis flap plasties. The results were very good in three patients, good in eight, satisfactory in two, and poor in one, but this patient with the poor result reported subjective improvement.
Between 1987 and 1990, we operated 32 hands of 30 patients for basal joint arthrosis. After extirpation of the trapezium, a part of the abductor pollicis longus is pulled through and wrapped around the flexor carpi radialis, similar to the Lundborg method. This creates a tendinous web, which supports the first metacarpal bone. Patient assessment revealed good to very good results with only one dissatisfied patient; the objective evaluation showed two thirds good and one third poor results, comparable to those of alternative methods of creation of a tendon web with the flexor carpi radialis (Weilby) or the extensor carpi radialis longus (Necking and Eiken). The essential point is a permanent distance between the base of the first metacarpal bone and both the scaphoid and the base of the second metacarpal bone under normal conditions as well as under loading.
We did follow-up examinations of flexor tendon sutures of 161 digits in 151 patients treated according to the Mantero-technique. They revealed that the urgence différée still has its merits today. The results of the sutures in zone 2 correspond to those of zone 1, if only one tendon is affected (zone 2.1), while they are clearly inferior, when two tendons are involved (zone 2.2).
The causes, symptoms and therapy of intersection syndrome are discussed, cases presented and the literature reviewed. If intersection syndrome does not respond favorably to conservative treatment, we perform synovialectomy and incision of the thick fascia of the abductor pollicis longus muscle.
A series of 161 digits with flexor tendon division in zones 1 and 2 have been reviewed after management by the method described by Mantero. The concept of "urgence différée" (delayed primary suture) is still valid. In zone 2, we distinguish between division of tendons, where only profundus is divided (zone 2.1) and, where both profundus and superficialis are divided (zone 2.2). Results from zone 2.1 are comparable to results from zone 1. Overall, our results are of the order of those achieved by management according to Kleinert, but we would maintain that the Mantero technique is easier to perform and more confortable for the patient.
The authores reports on the "open-palm-technique" used in those patients in whom after excision of the Dupuytren's tissue and passive maximal extension of the fingers the skin in the palm cannot be closed without undue tension. Postoperative complications such as hematoma accumulation and edema can be avoided by this method. Neither the length of treatment nor the duration of incapacity is prolonged by this technique.
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We recommend simply removing an enchondroma without filling the cavity with cancellous bone or plaster-of-Paris. This method can also be applied to other benign bone conditions, such as aseptic necrosis.
The authors present three cases of peritendinitis calcarea in the extensor tendons of the wrist and the flexor tendons of the fingers. The symptoms were gout-like pain attacks and local inflammation. In the X-rays calcification was seen within the tendon sheath. The symptoms and the calcification disappeared spontaneously in a few months. In these rare cases there is no indication for surgery.
The palmar carpal ligament is defined as the distal border of the fascia antebrachii. It is proposed that this name is not used for the region of the fascia antebrachii proximally to this structure or for parts of the retinaculum distal to this structure, i.e. in the hypothenar region. The palmar carpal ligament has been found to be a cause of posttraumatic irritation of the ulnar and median nerve at the wrist proximal to the carpal tunnel or Guyon's canal.
The authors discusses two malignant tumors of the soft tissue of the hand: the malignant fibrous histiocytoma and the extraskeletal myxoid chondrosarcoma. With each tumor two patients were involved. One patient with malignant fibrous histiocytoma required amputation at the fourth and fifth carpometacarpal joints, one patient with extraskeletal myxoid chondrosarcoma amputation in the proximal third of the forearm. Both remained free of metastases. Also the other two patients after surgical excision and amputation in the third metacarpal bone respectively, are free of recurrences or metastases till now.
The connection between the dorsal branch of the ulnar nerve and the proper digital nerve of the little finger--described by Camper 1760 and by Kaplan 1963 more proximally--is shown in the little finger of four patients.
Exact definition of the recurrent carpal tunnel syndrome. Presentation of the methods of operation for the recurrent carpal tunnel syndrome corresponding to the indication basing on the causes of the recurrences.
Within a period of five months, in eleven of all the cases examined, the author found the M. abductor digiti minimi longus as was described by Frohse and Fränkel in 1908. It ran from the fascia antebrachii through the Canal de Guyon to the hypothenar muscle mass. Vascularization and innervation were by the ulnar artery and nerve. This muscle must be assigned to the hypothenar muscular system, while a variation of the palmaris longus muscle, which is found in the same region and frequently described in the literature is supplied by the median nerve. Further, the literature has held this muscle to be the cause of compression of the ulnar nerve. In the author's view, the compression of the nerve is caused by the distal transverse ligament of the fascia antebrachii. By severing this transverse ligament, regeneration of the nerve is made possible.
A case of hypoplastic thumb with anomalies of the radial carpal bones is reported, believed to be atavistic in origin.