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Biomedical subjects

D R Steinberg

Publications and source records attributed to D R Steinberg.

At least 19 recordsLinked to original sources
PubMed2001

Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture.

A classification system for disruption patterns of the sigmoid notch of the radius associated with distal radius fractures has not been established. Using plain x-rays and corresponding computed tomography (CT) scans we characterized and quantified the types of sigmoid notch involvement in 20 consecutive distal radius fractures with radiocarpal joint extension. Plain radiographs revealed fracture extension into the sigmoid notch in only 7 cases (35%) and the CT scans demonstrated fracture extension into the sigmoid notch in 13 cases (65%). Of the 13 fractures with sigmoid notch involvement, 9 (69%) were displaced and 4 (31%) were nondisplaced. Sigmoid notch articular step-off (n = 7) and gapping (n = 9) were detectable on the CT scans but not on the x-rays. Plain x-rays appear to underestimate sigmoid notch involvement following distal radius fractures. In addition, CT appears to be a superior diagnostic modality for quantifying sigmoid notch fracture step-off and articular gapping.

Adult↗
PubMed2001

Computed tomography scanning of intra-articular distal radius fractures: does it influence treatment?

The purpose of this study is to determine whether the addition of computed tomography (CT) results in changes in the evaluation and treatment of intra-articular distal radius fractures. Fifteen intra-articular distal radius fractures were evaluated independently by 4 hand surgeons. Plain x-rays were reviewed initially followed by the corresponding CT scans for comparison of articular step-off and gapping, comminution, and treatment. Kappa coefficients (kappa) of intraobserver and interobserver reliability for treatment plans were generated. Computed tomography scans improved the sensitivity of measurement of articular surface gapping, improved the accuracy of detection of comminution and distal radioulnar joint involvement, and altered proposed treatment plans within observers (intraobserver agreement: kappa =.54, moderate) and improved agreement of proposed treatment plans between observers (kappa =.34 to kappa =.44, fair to moderate). Computed tomography scanning influenced observers to change treatment plans and resulted in increased interobserver reliability in the proposed management of these injuries.

Humans↗
PubMed2001

Effects of forearm rotation on the clinical evaluation of ulnar variance.

Neutral rotation radiographs of the wrist are recommended to standardize the measurement of ulnar variance because it is known that changes in forearm rotation result in changes of this measurement. The purpose of this study was to examine whether there are clinically measurable differences in ulnar variance between radiographs in various degrees of forearm rotation in human subjects. Forty-five wrist radiographs of 15 normal adults were obtained in 3 positions: maximum forearm pronation, neutral rotation, and maximum supination. The ulnar variance on each view was measured by 3 independent observers using a standard millimeter ruler. The average absolute difference in ulnar variance was 0.4 mm between pronation, 0.6 mm between pronation and supination, and 0.2 mm between neutral and supination. Although we found a statistically significant difference in ulnar variance between the pronated and neutral positions, this difference may not be clinically significant and may not justify concerns of forearm position during the radiographic evaluation of ulnar variance.

Adult↗
PubMed2000

The early history of arthroplasty in the United States.

Arthroplasty is defined in the broadest sense as a reconstructive procedure that alters the structure or function of a joint. The first recorded procedures done in the United States in the early nineteenth century and the introduction of modern total joint replacement in the 1970s will be discussed. Although major surgical procedures occasionally were performed in the early 1800s, it was not until the introduction of general anesthesia and antiseptic techniques during the latter half of the nineteenth century that the field of surgery could be developed. Procedures involving the major joints of the upper and lower extremities are described. These procedures include resection and interposition arthroplasties, joint debridement, procedures done to correct complications of hip fractures and developmental dysplasia of the hip, cup arthroplasties, endoprosthetic replacement, hinge arthroplasties, resurfacing procedures, and early total joint replacement.

Anesthesia↗
PubMed2000

Evaluating the source and content of orthopaedic information on the Internet. The case of carpal tunnel syndrome.

BACKGROUND: The Internet has become a popular source of medical information for patients. Authors of health-related web pages are not required to adhere to any standard for medical content or accuracy. The goal of the present study was to assess the type, quality, and reliability of information about carpal tunnel syndrome that is available on the Internet. METHODS: The search phrase "carpal tunnel syndrome" was entered into five commonly used World Wide Web search engines. The search results then were given as an ordered list of universal resource locators, or web-site addresses. The top (first) fifty web sites from each of the five searches were combined to create a master roster of 250 web-site addresses. These web sites then were evaluated for authorship and content, and an informational value score ranging from 0 to 100 points was assigned to each. RESULTS: Thirty-three percent of the sites sold commercial products for the evaluation or treatment of carpal tunnel syndrome. An additional 30 percent were commercial web sites that did not sell products. Only 23 percent of the sites were authored by a physician or an academic organization. Fewer than half of the sites offered conventional information. Twenty-three percent of the sites offered unconventional or misleading information. The mean informational value of the web sites was 28.4 of a possible 100 points. CONCLUSIONS: The information about carpal tunnel syndrome on the Internet is of limited quality and poor informational value. The public and the medical communities need to be aware of these limitations so that the quality of medical information available on the World Wide Web can be improved.

Carpal Tunnel Syndrome↗
PubMed1999

Consequences of knuckle cracking: a report of two acute injuries.

A question commonly asked of physicians focuses on the possible deleterious effects of knuckle cracking. Patients are usually concerned that the risk of arthritis is increased by the habit; however, reports addressing the potential long-term consequence are controversial. We present two cases in which acute injuries were suffered while the patients were attempting to crack their knuckles. Both injuries responded well to conservative treatment. Our investigation shows that acute injuries can result from the forceful manipulation needed to achieve the audible pop of cracking knuckles and that patients should be counseled accordingly.

Adult↗
PubMed1999

Utility of obtaining radiographs in patients with trigger finger.

We performed a combined retrospective and prospective study on the utility of obtaining radiographs in patients with trigger finger. Ninety-three patients with a total of 110 involved fingers were reviewed. The average age of the patients was 52 years, and 61% had involvement of their dominant hand. There were 54 women and 39 men. Eighty-four percent of the radiographs were reviewed retrospectively, and 16% of the radiographs were reviewed prospectively. There were no abnormal findings in 62% of the radiographs [corrected]. Thirty-one percent had radiographic abnormalities that were not currently clinically significant. Four percent had radiographic findings that correlated with other clinical problems. No radiographic finding changed our management. Patients with stenosing flexor tenosynovitis without a history of injury or inflammatory arthritis do not need routine radiographs.

Female↗
PubMed1998

The significance of the three volar spaces in forearm compartment syndrome: a clinical and cadaveric correlation.

The goal of this study was to assess the importance of the 3 volar spaces in forearm compartment syndrome in a prospective manner. A cadaveric model was developed to correlate with our clinical experience. All but 1 of 21 volar compartments (superficial volar, deep volar, and pronator quadratus spaces) in 7 patients in our clinical series decompressed adequately after release of the superficial volar fascia. One patient needed further release of the pronator quadratus compartment; he had suffered a combined crush and vascular injury. All volar compartments in our cadaveric model decompressed with superficial fasciotomy. Prefasciotomy and postfasciotomy pressures should be obtained from all 3 compartments of the volar forearm. Superficial fasciotomy usually adequately decompresses the entire volar forearm; however, in the event that deep compartment pressures remain high after superficial fasciotomy, release of the affected space is indicated.

Adult↗
PubMed1996

Anatomy of the median nerve at the wrist. Open carpal tunnel release--classic.

An understanding of the normal anatomy of the carpal tunnel and a variety of associated anomalies is important for the physician treating carpal tunnel syndrome. There are many strong arguments for open surgical decompression of the median nerve where full visualization of the transverse carpal ligament and contents of the carpal tunnel can be expected. The authors describe their preferred operative technique and post-operative management for carpal tunnel release.

Carpal Tunnel Syndrome↗
PubMed1995

Decision making in upper extremity problems in the elderly.

As life expectancy continues to increase, orthopaedists must become more knowledgeable about upper extremity problems common to geriatric patients. Alternatives to direct repair of certain soft tissue injuries must be considered, because of their diminished healing ability and the morbidity associated with prolonged immobilization. Osteoporosis present in these patients affects surgical management of difficult fractures. Acquired soft tissue disorders such as nerve compression and Dupuytren's contractures often will require operative intervention to improve hand function. Osteoarthritis and rheumatoid arthritis disproportionately affect this age group. A variety of conservative and operative treatments are available to improve quality of life in these patients.

Aged↗
PubMed1995

A quantitative system for staging avascular necrosis.

Much of the current confusion and contradiction on the treatment of avascular necrosis of the femoral head is caused by the lack of an agreed efficient, quantitative system for evaluation and staging. We have used a new system to evaluate over 1000 hips with avascular necrosis during a period of 12 years; it has proved to be very valuable. The system is based on the sequence of pathological events known to take place. It allows accurate quantification in both early and later stages, does not use older, invasive diagnostic procedures, and incorporates the newer techniques of bone scanning and MRI. Clinical records of pain and reduced function are not a specific part of the system, although they help to determine treatment and outcome. Hips are first placed into one of seven stages from 0 to VI, based upon the type of radiological change. The extent of involvement is then measured. This allows more accurate evaluation of progression or resolution and better comparison of different methods of management. The system also helps to provide a prognosis and to decide on the best available method of treatment.

Disease Progression↗
PubMed1992

The utility of portable nerve conduction testing for patients with carpal tunnel syndrome: a prospective clinical study.

The usefulness and accuracy of a portable instrument, the electroneurometer, for measuring distal motor latencies was determined in a prospective study of 28 patients (51 hands) with carpal tunnel syndrome and 10 controls (18 hands). There was a close correlation of distal motor latencies from the electroneurometer with those from formal electrodiagnostic testing. The average distal motor latency of controls was 3.3 +/- 0.4 msec, compared with a mean value of 5.2 +/- 1.8 msec in symptomatic hands. The sensitivity of the neurometer test alone was 69% (9 false-negatives); when combined with quantitative sensibility testing, sensitivity increased to 84%. Specificity of the neurometer test alone was 100% (no false-positives). The portable electroneurometer is a convenient, painless, inexpensive device for screening patients with carpal tunnel syndrome. Formal electrodiagnostic testing is indicated for differentiation of lesions present at different levels, for detection of subtle sensory changes, and for use in those patients in whom surface electrode usage is ineffective.

Adult↗
PubMed1992

Acute flexor tendon injuries.

Current surgical techniques and controlled postoperative mobilization have significantly decreased the amount of intertendinous adhesions that plagued earlier attempts at repair. Nevertheless, the ability to recover normal function after flexor tendon injury remains a challenging and often elusive goal. In the civilian population, good to excellent results may be expected in 69% to 90% of patients. A thorough understanding of tendon anatomy and physiology, attention to atraumatic surgical technique, and a well-designed postoperative therapy regimen will ensure satisfactory results in the majority of cases. Further improvements can be expected as we continue to make advances in the areas of suturing technique, rehabilitation, and pharmacologic intervention.

Acute Disease↗
PubMed1989

Progesterone-responsive urticaria and eosinophilia.

A 30-year-old black albino woman was first observed with a 4-year history of monthly urticarial episodes associated with hypereosinophilia. Hives consistently began at the end of menses and lasted for 1 to 2 weeks. A comprehensive evaluation excluded underlying malignancy and infection. There was no evidence of extracutaneous visceral involvement consistent with the primary hypereosinophilic syndrome. A 6-month prospective evaluation was performed, during which daily hive symptoms were recorded and weekly determinations of eosinophils, serum total IgE, progesterone, estradiol, and 24-hour urine histamine were obtained. Eosinophil counts (range, 4002 to 37,350 cells per cubic millimeter) increased in association with the onset of hives and decreased to baseline levels after their resolution. The 24-hour urine histamine peaked at the onset of each urticarial episode. When serum progesterone levels increased, the hives were quiescent and peripheral eosinophils decreased to baseline levels. Progesterone caused in vitro dose-related inhibition of antihuman IgE-induced histamine release from peripheral basophils of this patient. Treatment with oral medroxyprogesterone resulted in remission of urticaria and a decrease in eosinophil counts. This patient represents a unique case of chronic cyclic urticaria and hypereosinophilia that appears to be modulated by the effects of progesterone.

Adult↗