Hereditary disorders with maladies of the wrist and elbow.
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Adolescent↗
Biomedical subjects
D S Louis
Publications and source records attributed to D S Louis.
Congenital hand and forearm anomalies.
Congenital anomalies of the hand and forearm remain a continuing challenge for the patient and the patient's family. Health care professionals, including the pediatrician, the orthopedic surgeon, and the hand surgeon, all have roles to play in the treatment of these patients. This article reviews the literature for the past year with special emphasis on recent developments in the genetic transmission of some of these interesting congenital differences.
Child↗
Carpal tunnel syndrome: a case of median nerve injection injury and a safe and effective method for injecting the carpal tunnel.
The carpal tunnel syndrome is a compressive neuropathy of the median nerve at the wrist. The local injection of corticosteroid is an effective treatment modality in properly selected cases; however, this usually efficacious and safe procedure may result in serious complications if insufficient attention is paid to technique. A recent case of severe median nerve injury secondary to local steroid injection at the wrist prompted this report. We present a safe and effective method for injection of the carpal tunnel syndrome.
Adrenal Cortex Hormones↗
Carpal tunnel syndrome in the work place.
The management of patients with the CTS that appears to be related to occupational tasks is a complex issue. At this time, there is no definite evidence to show that any job is the sole cause of an individual worker's symptom complex. Management of patients in this situation requires surgical restraint coupled with an understanding of the worker's overall lifestyle. The most effective outcomes for all concerned appear to occur when there is cooperation among the patient, the physician, and the employer or his or her representatives. The recent prospective study by MacDougal that attempted to correlate job classifications with surgical outcome may be a very positive step in this direction.
Carpal Tunnel Syndrome↗
Carpal tunnel syndrome: a clinicopathologic study.
We evaluated 44 patients with carpal tunnel syndrome and performed histological evaluations of tenosynovium taken at the time of carpal tunnel release. Age, disease and work history, radiographs, and outcome were assessed. The clinical parameters were then compared with the histologic features to determine if the histology was predictive of the clinical course of carpal tunnel syndrome. We found no significance in the histologic changes in patients with carpal tunnel syndrome when age, duration of symptoms, work history, radiographs, and outcome were evaluated.
Adult↗
Divergent single-column fractures of the distal part of the humerus.
We report an unusual intra-articular fracture of the distal part of the humerus that was seen in five patients, including one who had the fracture bilaterally. The fractures were characterized by three features. First, the fractures were initiated in the trochlear groove as a result of a direct impact on the olecranon, which divided the trochlea and then split the two columns of the humerus divergently. Second, the fractures occurred exclusively in adolescents and young adults (average age, fifteen years old; range, thirteen to twenty years old). Third, all of the fractures were seen in patients who had a large fossa or septal aperture between the coronoid and olecranon fossae. Four of the fractures involved the right side and two, the left. There were three fractures of the lateral column and three of the medial column. Because the periosteum, the capsule, and the ligaments remained intact despite intra-articular displacement of the distal part of the humerus, these fractures were also characterized by inherent proximal stability. The fractures were treated with closed reduction and percutaneous internal fixation to reduce the displacement between the two halves of the trochlea. All of the fractures united. Four patients (five elbows) regained full motion by eight months; one patient was lost to follow-up. Current classification systems that describe single-column fractures of the distal part of the humerus should be modified to include this unusual fracture pattern.
Adolescent↗
Cryptococcus infection of the hand.
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Aged↗
The survival of cytochalasin-induced polykaryons following exposure to cytotoxic agents.
Using CHO-K1, HeLa S3 and two Walker lines (WR and WS) differentially sensitive to cis-diamminedichloroplatinum(II) (cisplatin), the survival after exposure to cisplatin, mitomycin C, vinblastine, vincristine or cytosine arabinoside has been determined either of clonogens or of cells rendered polyploid by post-exposure incubation in the presence of cytochalasin B (CB). It is suggested that the inhibition of cytokinesis by CB permits an assessment to be made of the fraction of damage whose expression is cell division-related, possibly including that resulting from a loss or malsegregation of genetic material. It was found that the response of polykaryons in comparison to clonogens was both agent- and cell line-dependent. After cisplatin exposure, polykaryon survival (defined as the ability to accumulate at least 16C DNA) declined exponentially with dose and was qualitatively, and to some extent quantitatively, similar to that observed previously after irradiation. In HeLa S3, giant cells induced by 10-20Gy irradiation in the absence of CB exhibited a radiation dose-dependent reduction in the relative frequency of highly polyploid cells which was similar to that observed in CB-induced polykaryons.
Animals↗
Hand manifestations of oxalosis.
Oxalosis is an unusual metabolic disease that results either from an inherited hepatic enzyme deficiency or as the result of poor oxalate clearance during chronic hemodialysis. We present two cases of oxalosis and describe the hand manifestations of this condition and their treatment. One patient had painful, progressive gangrene, whereas in the other the disease took an indolent course with small palmar crystalline deposits.
Adult↗
Long-term follow-up of scaphoid-trapezium-trapezoid arthrodesis.
A series of 19 consecutive patients who underwent scaphoid-trapezium-trapezoid arthrodesis for chronic scapholunate instability or isolated arthrosis was reviewed. The average follow-up of 14 patients was 62 months. Eight of these 14 patients had significant residual symptoms and/or functional limitations at follow-up, and 11 had complications, including radiocarpal arthrosis (six patients), trapeziometacarpal arthrosis (four patients), and nonunion (three patients). Fusion without reduction of the scaphoid to a normal orientation was predictive of a poor result, but normal scaphoid positioning did not preclude development of arthrosis. Development of a painful degenerative thumb carpal-metacarpal joint may occur as an isolated phenomenon after scaphoid-trapezium-trapezoid arthrodesis.
Adult↗
Recognizable dysfunction syndromes.
Many presentations of dysfunctional postures of the upper extremity have been described in the literature. Attempts have been made to differentiate these situations by describing their physical and pathophysiologic circumstances. Unfortunately, these attempts to define and differentiate the various conditions that are recognizable patterns of upper-extremity dysfunction syndromes have not been entirely successful. This failure is perhaps because hard and firm diagnostic criteria that would specifically delineate each of these circumstances are wanting. At best, it can be said that there are patients who will present with pain as their primary complaint and who present with physical findings that would best support a diagnosis of reflex sympathetic dystrophy. There are others who present with dysfunctional postures in which pain is not a primary presenting complaint. In addition, are those in an intermediate zone, where pain and dysfunction are intermixed, and where prolonged observation may help to place them in one category or the other. Recent evidence has suggested that patients with painless dysfunctional syndrome benefit from the attentions of psychically oriented providers. The timing and appropriateness of such interventions require further study. The literature of the behavioral scientists and that of the practitioners of the medical arts is bereft of concrete explanations for causation and specific definitive solutions.
Adolescent↗
Embryologic development and variations in the anatomy of the ulnocarpal ligamentous complex.
Eighteen fetal hand specimens were reviewed in an effort to clarify variations in reports of the ligamentous anatomy of the ulnar side of the wrist. Sizes ranged from 45 mm crown-rump length (CRL) to 325 mm CRL. Representative coronal sections from the 2779 sections available were reviewed. Significant variations in size of triquetral attachment and thickness and consistency of the ulnocarpal ligamentous complex (UCLC) were observed. Each of the specimens exhibited one of four UCLC variations: (1) 5 of 18 (28%) with an average CRL of 187 mm had a dense, thin UCLC, with a focal triquetral attachment; (2) 7 of 18 (39%) with an average CRL of 209 mm had a focal, dense attachment of a thick UCLC to the triquetrum; (3) 5 of 18 (28%) with an average CRL of 220 mm exhibited a thick, dense UCLC with a broad attachment to the triquetrum; and (4) 1 of 18 (5%) with a CRL of 166 mm was unique, with a loose, areolar UCLC broadly attached to the triquetrum.
Embryonic and Fetal Development↗
Perineural hemangiomas of the upper extremity: report of four cases.
Perineural hemangiomas in the upper extremity have been the subject of few reports. We found only eight such cases reported in the literature. We report four additional cases in which there were neurologic symptoms. The specific diagnosis of cavernous hemangioma was not made preoperatively in any of the patients. The greater the extent of intrafascicular involvement, the more difficult is total eradication of the hemangioma.
Adolescent↗
Triceps avulsion fracture in a weightlifter.
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Adult↗
Neurofibrosarcomas of the upper extremity.
A retrospective review of all malignant hand tumors seen at the University of Michigan from 1950 to 1987 demonstrated six biopsy-proven cases of neurofibrosarcoma involving the upper extremity. There were four male and two female patients; average age at presentation was 37 years and ages ranged from 15 to 63 years. All patients had a history of von Recklinghausen's disease. Three patients were seen initially with painful enlarging masses, one with a painful mass with a neurological deficit, and two with painless enlarging masses. Three patients had radical excisions requiring upper extremity or forequarter amputation, and three patients received limited or no surgical treatment. Five patients died of metastases an average of 3 years after diagnosis. One patient remains alive 18 years after upper extremity amputation despite an early local recurrence. Early diagnosis and radical surgical excision offer the best chance of long-term survival from this highly lethal cancer.
Adult↗
Ramazzini and occupational diseases.
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History, 18th Century↗
Evolving concerns relating to occupational disorders of the upper extremity.
Occupational disorders of the upper extremity have become a problem of increasing concern around the world. The management of these problems must be understood in light of current social trends that influence patient management. Workers' compensation is one of these continually developing trends. This article describes the historical aspects of compensation and bodily injury or loss occurring in the work place. Changes in workers' attitudes during the development of workers' compensation have been observed since the turn of the century. The influence of the legal system in this regard is also noteworthy. The modern surgeon is faced with these confounding influences when treating a patient with a work-related injury or cumulative trauma disorder.
Arm Injuries↗
Ischemia-reperfusion in humans. Appearance of xanthine oxidase activity.
We evaluated effluent blood from extremities of human patients undergoing reconstructive surgical treatment, which is routinely accompanied by upper-extremity exsanguination and application of a tourniquet, resulting in total interruption of arterial blood flow to one upper extremity. After tourniquet release (reperfusion), there were immediate increases in the plasma levels of xanthine oxidase activity, uric acid, and histamine in the ipsilateral limb and much smaller increases, if any, in levels of the same materials in plasma obtained from the contralateral extremity. There was no detectable xanthine dehydrogenase activity in plasma from either limb. Plasma also contained evidence of products consistent with the formation of oxygen-derived free radicals, namely, the appearance predominantly in the reperfused limb of hemoglobin and fluorescent compounds. These data indicate for the first time in humans that ischemia-reperfusion events are associated with the appearance of xanthine oxidase activity and its products in the plasma effluent.
Adult↗