Biomedical subjects

G R Sennwald

Publications and source records attributed to G R Sennwald.

29 records · Page 2Linked to original sources

PubMed1994

The anatomy of the palmar scaphotriquetral ligament.

The palmar ligaments of the wrist were dissected in 15 adult cadaver wrists and demonstrated by MRI in three. Ten fetal wrists (10 to 19 weeks' gestation) were studied in histological sections. The palmar scaphotriquetral ligament was found in them all. Its attachment to the triquetrum is substantial but that to the scaphoid is thin and fan-shaped, its fibres interdigitating with those of the radioscaphocapitate ligament. The contribution of the ligament to carpal stability has yet to be studied, but it may help to support the head of the capitate when the wrist is dorsiflexed.

Adult↗

PubMed1993

[Cervico-brachialgias, a delicate differential diagnosis: apropos of a patient with recurrent loss of consciousness in herniated disk].

A protrusion of a intervertebral disc can be the cause of a painful hand-shoulder syndrome. Such a situation can be difficult to interpret particularly if it is associated with repeated (recurrent?) loss of consciousness. The presented patient illustrates the complexity of this syndrome and emphasizes the importance of the history and clinical examination. One should not be reluctant to repeat these investigations, in particular the examination of reflexes. The value of nuclear magnetic resonance studies in the diagnostic approach is outlined. A cervical disc protrusion is part of the differential diagnosis of unconsciousness of undetermined cause. Its pathogenesis remains to be elucidated. In the presented patient the causal relation is unquestionable since symptoms subsided after surgery. It is an example over our limited knowledge about the pathophysiology of peripheral nervous-system diseases.

Cervical Vertebrae↗

PubMed1993

Kinematic analysis of relative motion within the proximal carpal row.

The motions of the scaphoid and triquetrum relative to the lunate have been studied on cadaver specimens. The helical axis concept was applied. The wrist motions performed were flexion-extension and radial-ulnar deviation. The results showed increased relative motion of the scaphoid towards terminal extension, and to a lesser amount in the case of the triquetrum, towards terminal flexion. The lunate might be considered as a keystone in the proximal carpal row when wrist stability is considered. It is doubly intercalated: longitudinally and transversely. Wrist ligaments co-ordinate the positioning of the bones in the mid-range of carpal motions, and restrict further motion in extreme positions of the wrist joint.

Cadaver↗

PubMed1993

The value of scapho-trapezio-trapezoid arthrodesis combined with "de la Caffinière" arthroplasty for the treatment of pan-trapezial osteoarthritis.

13 patients, 12 female and one male (mean age 63) with pan-trapezial osteoarthritis were treated by a "de la Caffinière" arthroplasty of the first carpometacarpal joint, combined with a scapho-trapezio-trapezoid (STT) arthrodesis. 11 could be reviewed at least 3 years after surgery (average 3 years and 8 months). Non-union of the arthrodesis occurred twice, once when no internal stabilization was used, once with the use of the staplizer. No impingement syndrome was recorded, and there was no correlation between the angular position of the scaphoid and mobility of the wrist. Two out of 11 "de la Caffinière" implants had to be removed. Loosening of the stem is unusual, but the cup remained only perfectly in place in two cases. There was no correlation between radiological and clinical findings and the overall result was good or excellent in 8 out of 13 (62%) of the cases. The grip and pinch strength were comparable to the results of the literature. This method cannot be further recommended because of the high rate of re-operation and the risk to the trapezium which has to be further evaluated.

Aged↗

PubMed1993

Kinematics of the wrist and its ligaments.

Precise anatomic dissections of unembalmed physiologically intact cadaver specimens were carried out before proceeding with the kinematic investigations on further specimens. Carpal flexor and extensor tendons were used to move the wrist. The analysis of the carpal bone movements was performed according to the finite helical axis motion concept for increments of 10 degrees for each main carpal motion. Separate axes of rotation for each of the bones in the proximal carpal row were found; however, the axes for the lunate and triquetrum bones were close, and the magnitudes of rotation and translation almost equal. One finding was that the axes of rotation of the bones in the proximal carpal row often cross at some particular point. Because the axes of the scaphoid are differently oriented than those of the lunate and triquetrum, shear might occur during wrist motion. This indicates also that the scaphoid and lunate cannot be considered rigidly coupled elements. We also assume that the individual bones of the proximal carpal row self-align themselves as long as they are not constrained by torsion. Several potential mechanisms of flexion motion of the proximal carpal row during radioulnar deviations of the hand were considered. The ligament function is still an unsolved problem. Compensation mechanisms may mask clear correlations between a lesion and the instability pattern associated with it. The proximal carpal row should be studied as one system.

Cadaver↗

PubMed1993

[Fascination of the hand and wrist].

By 250 million years ago, the five-finger digit is established. In developmental terms, the human hand is both specialized and primitive. Man's hand is not a unique structure, it is only the way in which it is used that sets it apart from the other animals. Its value seems therefore to be correlated with the development of brain. The fact that skin and nervous system share the same ectoblastic origin may strengthen the symbiotic effect related to brain development. Since the wrist sustains and enables most of the capabilities of the hand, a deterioration of its function may give rise to challenging diagnostic problems. Therefore a classification of wrist disabilities in five main groups may be helpful in daily practice. An ulnar translocation, a SL-dissociation, a LT-disruption or a carpal collapse may be clearly diagnosed. When no clear pathology can be demonstrated, the physician is faced with the so-called normal group. In those cases a ganglion or an osteonecrosis on onset may explain the pain. In any case however, the physician has to recall the central and physiological aspect of the hand, an organ which has become the symbol of man and power.

Diagnosis, Differential↗

PubMed1993

[Post-traumatic pain in the wrist, a diagnostic challenge].

Hyperextension of the wrist may induce underestimated intrinsic and extrinsic ligamentous tears. Undetected scaphoid fractures show the importance of accurate primary diagnostic. Evaluation of the anatomic and functional integrity of the ligaments of the wrist remains challenging. It requires great experience, but in any case, radiology remains the basic diagnostic tool used by both the general practitioner and the specialist. Only the use of reproducible imaging techniques will allow for comparison between healthy and pathological side as well as for follow-up. Every one should master and use standardized techniques as described in this paper. The costs bound to appropriate imaging techniques are certainly lower than the consequences of misdiagnosed ligamentous damage or carpal bone fractures. Furthermore, standardized techniques will avoid repeating radiological sessions.

Carpal Bones↗

PubMed1993

[Diagnosis, etiopathogenesis and therapy of carpal tunnel syndrome].

This is a retrospective study analyzing the operation records of 637 patients cured for carpal tunnel syndrome. No statistical difference could be demonstrated between the mean age of female compared to male. However a highly significant statistical difference between age distribution in between sex could be demonstrated (p = 0.0015). 61.3% of the female (male: 47.6%) are affected by the disease between 40 and 65 years and only 16.4% (male 27.6%) later on. Under 40 years of age both sex are affected in the same proportion. This confirms that hormonal factors related to sex play a major role in the etiology of this disease affecting mainly women (71%). On the contrary, combined pathology as tendovaginitis, ulnaris neuropathy at the elbow, synovitis bound to rheumatoid arthritis and epicondylitis were equally distributed between sex.

Adult↗

PubMed1993

[Pathophysiology of perilunate dislocation].

The anatomy of the palmar scapho-triquetral ligament was studied: on 15 hand specimens by means of gross anatomical dissections and MR imaging; and on a further 10 foetal wrist specimens, microanatomically. This ligament allows us to present the proximal carpal row as a socket, consisting of an upper part (the triquetrum, distal part of the scaphoid, and the dorsal and palmar scapho-triquetral ligament), and a base (the concave parts of the lunatum and scaphoid, connected by the scapho-lunate ligament). With a hyperextension wrist injury the upper part follows the distal part of the carpus, while the base remains fixed at the radius. The upper part slips away from the base, consequently, injuring the ligamentous structure, or causing a scaphoid fracture. The luno-triquetral and the palmar scapho-triquetral ligaments are also frequently torn. The overall prognosis depends on the grade of ligament damage. The arthroscopy allows us to estimate the state of the ligament structures, therefore, it is indicated before any reconstructive operation.

Adult↗

PubMed1993

[Does the thoracic outlet syndrome exist?].

We reviewed fourteen patients suffering from thoracic outlet syndrome (TOS). This allowed a critical analysis of the diagnostic tools, especially the Adson and Allen tests, currently used. The value of arthrography and phlebography are discussed in relation to the supposed pathophysiology of the disease. The decision to operate on those patients has to be considered in relation to the possible mishaps related to the surgical procedure. Particular attention has to be paid to post-operative perineural fibrosis, a possible cause of definite disability. The psychological components seem to remain mostly underestimated, a fact that has to be stressed and which we were able to demonstrate in our small sample. However, pre-operative evaluation remains difficult. No definite objective sign enables the surgeon to assert the presence of a thoracic outlet syndrome. Therefore not only the decision making but also the analysis of the results remains debatable. In all cases, even in the presence of clear narrowing of the vessels, indication to operation should be restrictive.

Angiography↗

PubMed1990

Fasciectomy for treatment of Dupuytren's disease and early complications.

This review of 103 cases of hands operated on for treatment of Dupuytren's disease demonstrates the significant increase of postoperative stiffness as related to recurrences and staging of the disease, but not to sex. On the contrary, the frequency of reflex sympathetic dystrophy after fasciectomy is sex related affecting females. The protective effect of guanethidine may be a valuable therapeutic adjunct for female patients. We propose that the disease be staged on the basis of anatomic findings, inasmuch as staging based on degree of contracture alone is insufficient for comparative studies.

Dupuytren Contracture↗