Search PubMed⌕ Search

Biomedical subjects

E Akelman

Publications and source records attributed to E Akelman.

At least 37 records · Page 2Linked to original sources
PubMed1995

Carpal tunnel syndrome. Etiology and endoscopic treatment.

Carpal tunnel syndrome involves classic symptoms of numbness and paresthesias in the radial three and one-half digits, most frequently nocturnal, with pain associated with this anatomic distribution. Thenar weakness and autonomic dysfunction occurs late in these patients and are usually seen in advanced cases. The wrist flexion test and local percussion sensitivity tests done on physical examination can be helpful in determining and confirming the diagnosis of carpal tunnel syndrome. The likelihood that operative treatment will be required for resolution of symptoms is heightened if the patient is involved in daily manual repetitive activities of the hand or wrist. Surgical decompression can be accomplished by either a limited open or new endoscopic carpal tunnel release techniques. Currently, the advantages and disadvantages present in both procedures and careful controlled studies conducted in a prospective and randomized fashion will be required to further delineate the indications for either procedure. Carpal tunnel release remains an operative procedure with the most predictable outcome with relief of symptoms for the patient.

Arthroscopy↗
PubMed1995

Nonmelanotic malignant skin tumors of the hand.

Squamous cell and basal cell carcinomas, the common nonmelanotic skin tumors, are the most frequent malignancies to occur in the hand. In spite of a rising incidence, these tumors are only occasionally seen by the hand surgeon because of their overall rarity. Untreated lesions are locally destructive and may cause functional deficits and death by way of metastasis. Appropriate treatment consists of timely diagnosis, surgical excision with a margin of normal tissue, lymph node dissection for clinically positive nodes or in special circumstances, and careful follow-up for recurrence, metastasis or metachronous lesions. The aggressive nature of some of the rare nonmelanotic skin tumors that may occur in the hand underlines the importance of proper diagnosis of unknown hand tumors.

Basal Cell Carcinoma↗
PubMed1995

Lumbar spinal stenosis: a review.

Lumbar spinal stenosis can usually be identified after a thorough history and physical examination. Most individuals with this condition are successfully treated by non-operative means. Invasive radiologic studies and surgery are reserved for those patients who fail to respond to conservative measures. In these select cases, predictably good results can be expected from lumbar decompression.

Aged↗
PubMed1994

Treatment of de Quervain's disease.

This study compared the use of a mixed steroid/lidocaine injection alone, an immobilization splint alone, and the simultaneous use of both in improving symptoms in de Quervain's disease. Ninety-three wrists were included in the study, with an average follow-up examination of 13 months. Complete relief of symptoms was noted in 28 of 42 wrists receiving an injection alone, 8 of 14 wrists receiving both an injection and splint, and 7 of 37 wrists receiving a splint alone. No significant difference was noted between the injection alone and injection plus splint groups. A significant difference was seen between the injection alone and splint alone groups and the injection/splint and splint alone groups. Twenty of 45 wrists that underwent operative release demonstrated a septum at the first dorsal compartment. When the need for operative release was used as an outcome result for treatment failure, the injection alone and splint alone groups demonstrated significance. We recommend the use of a mixed steroid/lidocaine injection alone as the initial treatment of choice in this condition. No additional benefit is appreciated by the addition of splint immobilization and, in fact, patients are less restricted with a lower financial burden without its use.

Adolescent↗
PubMed1994

The management of dog bites and dog bite infections to the hand.

Dog bites account for approximately one of 200 emergency room visits. The majority of bites are from dogs known to the victim. Due to the numerous small compartments and the thin covering of soft tissue over the bones and joints, bite wounds to the hand are more likely to become infected that are bites to the arm, leg, or face. Improper management can result in significant morbidity and prolonged treatment. This article discusses the microbiology of dog bite wounds, antibiotic selection, and proper wound management.

Animals↗
PubMed1994

The surgical approach in non-border digit complex dislocations of the metacarpophalangeal joint.

Complex dislocations of the metacarpophalangeal (MCP) joint of the hand are uncommon. Most are irreducible by closed means and require open reduction. The structure most frequently blocking reduction is the volar plate, which is often interposed between the metacarpal head and the base of the proximal phalanx by the partially torn deep transverse metacarpal ligaments and MCP collateral ligaments. A review of the literature reveals controversy concerning which surgical approach, dorsal or volar, should be used to reduce these dislocations. We present an unusual case of a closed dorsal complex dislocation of the middle finger MCP joint to advocate the dorsal approach.

Adult↗
PubMed1994

Radioulnar synostosis.

Radioulnar synostosis is a rare condition that exists in two forms: congenital and post-traumatic. Although both may involve either a bony or a fibrous union between the radius and ulna, they differ considerably in their etiologies, treatment, and prognosis. This article explores both of these conditions.

Humans↗
PubMed1994

Cubital tunnel syndrome. Part II: Treatment.

Conservative management has been successful for mild cases of cubital tunnel syndrome. If conservative treatment fails and clinical signs of nerve dysfunction or electrophysiologic abnormalities are present, surgical decompression should be considered. The indications for and results of simple decompression, anterior transposition (subcutaneous, submuscular, or intramuscular), and medial epicondylectomy, as well as associated complications, are reviewed.

Denervation↗
PubMed1994

Propane thermal injuries: case report and review of the literature.

"Burn-like" propane thermal injury is produced by evaporative heat loss causing damage to vital structures. Acute appearance is that of heat burn with progressive vascular compromise. Histopathologic study demonstrates epidermal and dermal necrosis followed by vascular thrombosis. Physicians should be aware of this injury and its consequence in light of the widespread use of pressurized propane storage.

Adult↗
PubMed1994

Cubital tunnel syndrome. Part I: Presentation and diagnosis.

Cubital tunnel syndrome is the second most common entrapment neuropathy after carpal tunnel syndrome. This condition may arise without an obvious compression injury or may be secondary to nerve enlargement or narrowing of the cubital tunnel. Clinical symptoms, radiographic and electrophysiologic findings, and the differential diagnosis of cubital tunnel syndrome are reviewed.

Biomechanical Phenomena↗
PubMed1993

An experimental model of femoral condylar defect leading to osteoarthrosis.

The acute treatment of articular step-off injuries is based largely on reduction criteria, because the presence of residual incongruity has been correlated with the development of posttraumatic arthrosis (PTA). However, this association has not been demonstrated on a prospective basis. Using the rabbit femoral condyle, we developed a surgical model of articular condylar defect without sacrificing the axial alignment or inherent stability of the knee joint. Twenty weeks after the creation of 5-mm femoral condylar defects, progressive osteoarthritic changes were confirmed by radiographic, histological, and biochemical parameters. Osteophytes were observed on the medial aspect of operated knee joints in 67% of cases. Femoral and tibial articular cartilage at the site of the condylar defect exhibited fibrillation, hypocellularity, and severe loss of safranin-O staining. Focal areas of cartilage were denuded or replaced by pannus. In no case was femoral congruity restored by cartilage repair. Statistically significant decreases in proteoglycan content were demonstrated for cartilage sampled from the weight-bearing region of the condylar defect and from the tibial surface directly beneath it. These changes resemble those arising from previously reported models of osteoarthrosis. We present the model as a valid tool for the study of articular condylar defect and its role in the development of PTA.

Animals↗
PubMed1992

Acute open reduction and rigid internal fixation of proximal interphalangeal joint fracture dislocation.

We report the application and results of a technique of open reduction and rigid internal fixation of dorsal fracture/dislocation of the proximal interphalangeal joint with an interfragmentary screw in two cases. Articular congruity was restored, and the proximal interphalangeal joint was stabilized. This technique permitted immediate range-of-motion exercises. Excellent results were obtained in both cases. Previous descriptions have not detailed the indications, the surgical approach, or the results of this technique.

Adolescent↗
PubMed1992

Carpal tunnel syndrome: a review.

Carpal tunnel syndrome involves classic symptoms of numbness and paresthesias in the radial 3-1/2 digits, most frequently nocturnal, and pain associated with this distribution. Thenar weakness and autonomic dysfunction rarely are seen in this syndrome except in advanced cases. Provocative tests on physical examination such as the wrist flexion test and the local percussion sensitivity test over the median nerve can be extremely helpful in determining and confirming the diagnosis. Nerve conduction velocity and electromyographic studies of the median nerve and its compression can be helpful especially in difficult cases involving a complex differential diagnosis. It has been clearly documented that a negative NCV/EMG study by itself, does not exclude the possibility of carpal tunnel syndrome. The hallmark of the diagnosis remains the history and a careful physical examination. Treatment initially consisting of wrist splint immobilization and steroid injection into the carpal canal can provide initial relief and elimination of symptoms on a long-term basis in several patient groups. Patients without any resolution of symptoms after two to three months of conservative treatment or those with symptoms of greater than one year's duration generally can be considered candidates for surgical decompression of the carpal canal. The likelihood of operative treatment being required for resolution of symptoms is heightened if the patient is involved in daily manual repetitive activities of the hand and/or wrist. Surgical decompression can be accomplished by either a limited open technique or the new endoscopic released technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Carpal Tunnel Syndrome↗
PubMed1990

A patient registry for orthopedic surgery.

Identification of patient subpopulations for retrospective clinical studies, documentation of residents' clinical experience, and other administrative purposes can be difficult and time consuming. The problem of identification is exacerbated when a teaching program involves several hospitals or when the desired subpopulation is not adequately defined by standard diagnosis or procedure codes used by the institution. A useful patient registry system is reported here for the storage and retrieval of data on orthopedic patients treated by surgical residents at a major teaching hospital and its affiliates. The registry uses a simple, yet powerful encoding scheme to describe patient entries. In addition to a multidimensional encoded description based on SNOMED, the system supports the entry of free text to provide greater detail. This combination gives the patient registry both power and versatility.

Hospital Information Systems↗
PubMed1989

Fascial implant arthroplasty for treatment of radioscaphoid degenerative disease.

Twenty patients were evaluated up to 9 years (average, 3.8 years) after a hemiscaphoid fascial arthroplasty. All were men. Twelve had a chronic scaphoid nonunion, six had radioscaphoid arthritis from chronic scapholunate advanced collapse deformity, and two had irreducible transscaphoid perilunate dislocations. The degenerated or impinging portion of the scaphoid was replaced by a slightly oversized fascial implant; 4 being constructed of autograft and 16 of allograft fascia. Postoperative motion included a 30 degree or 73% gain in extension and a 19 degree or 38% gain in flexion, producing an overall 140 degree average arc motion. Grip strength increased 17% after operation. Pain was completely or dramatically relieved in all but one patient. All other patients returned to their preoperative occupations.

Adult↗