Biomedical subjects
Publications and source records attributed to Ghazi M Rayan.
The Microsurgery Tranining Card is a useful, practical, economic, easily assembled and used device, and provides a valuable tool for basic microsurgical training, especially for residents and fellows in teaching programs.
PLC syndrome is a spectrum that encompasses PLC instability and ends with PTA. Early recognition and treatment of PLC instability may disrupt its progression to PTA. The pisiform tracking test is a provocative maneuver that aids in diagnosing PLC syndrome. Pisiformectomy with preservation of the soft tissue confluence remains the treatment of choice for severe PLC syndrome that does not respond to nonoperative treatment.
PURPOSE: To examine anatomically and radiographically the ligaments stabilizing the pisotriquetral (PT) joint and to determine the contribution of each ligament to the stability of this joint. METHODS: Twelve cadaver arms were used. The study had 3 components: (1) anatomic dissection of the PT joint ligaments and patterns of degenerative changes, (2) biomechanical sequential sectioning of the supporting ligaments, and (3) radiographic assessment of PT joint motion in several planes both before and after ligament sectioning. RESULTS: The ligaments that attached to the pisiform were the pisometacarpal (PM), pisohamate (PH), radial PT, ulnar PT, and transverse carpal ligament. The PH ligament was shorter, wider, and thicker than the PM ligament. The transverse carpal ligament attachment in the pisiform was insubstantial. In 10 limbs degenerative changes were present, most of them peripheral. Biomechanical testing showed that the primary stabilizers of the PT joint were the PM, PH, and ulnar PT ligaments and that these were responsible for resisting proximal, ulnar, and radial forces, respectively. The PH distance increased along with the pisiform sagittal motion during wrist flexion on oblique x-rays after transection of the PM and ulnar PT ligaments. Concomitantly this distance decreased on the anteroposterior x-rays during radial deviation. The PH distance increased along with the pisiform frontal motion after transection of the PH and radial PT ligaments. CONCLUSIONS: The pisiform ligament complex has primary and secondary stabilizers to the PT joint. The primary stabilizers are the PH, PM, and ulnar PT ligaments. The transverse carpal and radial PT ligaments are secondary stabilizers. Injuries of the primary stabilizers of the PT joint may lead to instability that predisposes to degenerative joint disease.
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We report a case of hamulus (hook of hamate) fracture nonunion and secondary flexor digitorum profundus tendon rupture caused by repetitive wrist hyperextension sustained during clay shotgun shooting. The hyperextension caused avulsion of the hamulus by the pisohamate ligament. The hamulus was excised and a flexor digitorum profundus tendon transfer of the ring to small finger side to side was performed with satisfactory outcome.
We evaluated the results of revision surgery for persistent cubital tunnel syndrome after failed surgical treatment. Eighteen patients were evaluated with an average age of 44 years. The majority of the primary procedures were subcutaneous transpositions (15 patients). The average follow-up time was 34 months. All patients were treated with a submuscular transposition of the ulnar nerve and Z-lengthening of the flexor-pronator origin. The most common operative findings were perineural scarring (16), retained medial intermuscular septum (10) and common flexor aponeurosis (9). Pre-operative and post-operative data were compared. The majority of patients improved their postoperative grade and their ability to do daily activities or work and stated that the surgery met some or all of their expectations. Most patients had partial relief of their pain and the satisfaction rate was 78%. Our study suggests that although these results are less favorable than those for the primary procedure, submuscular transposition is a useful technique for revision of failed cubital tunnel syndrome surgery.
PURPOSE: To study the anatomy of the septa of Legueu and Juvara and interpalmar plate ligaments (IPPLs) of the hand. MATERIALS: Eleven cadaver hands were dissected. The number, attachments, dimensions, and relationships of the septa and IPPLs to other structures were determined. RESULTS: Eight septa were identified radial and ulnar for each digit. The radial were longer than the ulnar septa. The septa attached to the transverse ligament of the palmar aponeurosis superficially and to the soft-tissue confluence deeper and distally. They formed 7 compartments of 2 types flexor septal canals that contained the flexor tendons and web space canals that contained common digital nerves and arteries and lumbrical muscles. Grossly and histologically the septa were thicker and consisted of organized collagen distally but not proximally. Three IPPLs were identified: radial, central, and ulnar. These formed the floors of the second, third, and fourth web space canals. The IPPLs were more substantial, thicker, and had more fibrous appearance from radial to ulnar. The fibers of the radial and central IPPLs were oriented transversely, whereas those of the ulnar IPPL were oriented obliquely. CONCLUSIONS: Awareness of the anatomy of deep retinacular structures of the hand is important for surgical exposure in this area and possible involvement in conditions such as Dupuytren's disease.
PURPOSE: The purpose of this study was to examine the anatomy of the terminal tendon (TT) and its relationship to adjacent structures. MATERIALS: The extensor tendons of 56 cadaveric digits (52 fresh-frozen and 4 formalin-preserved) underwent anatomic dissection. RESULTS: The TT is a segment between the convergence of the lateral bands proximally and the bony insertion in the phalanx distally. The ulnar lateral bands were thicker than the radial bands. The average distance from the TT insertion to the germinal matrix of the nail bed was 1.4 mm. The triangular ligament (TL) is a thin layer of transverse fibers between the lateral bands proximal to the TT. The dimensions of the TT and the TL vary relative to the size of the digit with the largest often occurring in the middle, followed by the ring, index, and small finger. The transverse retinacular ligament (TRL) had a dorsal attachment to the lateral bands and was much more defined and distinct than the oblique retinacular ligament. The ulnar TRL often was thicker than the radial TRL. CONCLUSIONS: The TT is the primary structure responsible for extending the distal interphalangeal (DIP) joint. The function of the adjacent retinacular structures is to provide stability to the TT. The thin nature and proximity of the TT to the nail matrix must be kept in mind during surgery. Knowledge of the TT anatomy is necessary for further study of its kinematics and pathology and for diagnosis and management of its disorders.
PURPOSE: To conduct kinematic analyses of both intact and sectioned terminal tendon (TT) of multiple fingers in the hand. METHODS: The TTs of 36 fresh-frozen cadaveric digits were used in this study. TT excursion was assessed along with the influence on proximal joint motion. The influence of TT lengthening and shortening on distal interphalangeal (DIP) joint motion were investigated. RESULTS: TT excursion averaged 1 mm at the DIP joint and was influenced by the proximal interphalangeal (PIP) joint but not the position of other joints in the hand and wrist. The greatest degree of DIP joint motion averaged 86 degrees when the PIP joint was in full flexion, whereas the least motion averaged 45 degrees when this joint was in neutral position. Lengthening of the TT resulted in angular deformity at the DIP joint. Average flexion deformities reached 25 degrees at 1 mm, 36 degrees at 2 mm, 49 degrees at 3 mm, and 63 degrees at 4 mm of lengthening. The middle finger showed the greatest flexion deformity, followed by the ring, small, and index fingers. Shortening the TT by as little as 1 mm resulted in difficult tendon repair because of excessive tension and minimal or no DIP joint flexion was obtained. CONCLUSION: Only DIP and PIP joints affect TT excursion; hence these are the main joints to be immobilized to protect TT repair. The middle finger TT showed the least tolerance to lengthening with potential for mallet deformity. Joint flexion deformity is proportional to tendon lengthening. Only 1 mm of TT lengthening results in approximately 25 degrees of DIP joint extension lag, and 4 mm of TT lengthening results in DIP joint flexion deformity greater than 60 degrees . Even 1 mm of TT shortening will seriously restrict DIP joint flexion.
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BACKGROUND: We studied the complications of peripheral intravenous (i.v.) catheters in the hand and forearm in a teaching hospital over a 3-year period. METHODS: The records of 67 patients who developed i.v. catheter-related complications were reviewed. RESULTS: The most common sites for developing complications in order of frequency were the forearm, hand, wrist, and antecubital fossa. There were 56 minor and 11 major complications. More than 50% of minor complications occurred in the hand and wrist, and more than 50% of major complications occurred in the hand. In 68% of minor complications, the patients were aged 50 years or older and 68% were women. Minor complications comprised 26 intravenous infiltrations, 23 cases of thrombophlebitis, and 7 cases of cellulitis. Ninety percent of major complication patients were aged 50 or older and 82% were women. Major complications included septic thrombophlebitis in three; hematomas resulting in skin necrosis in two; and infiltration related complications in six, resulting in skin necrosis in two, compressive nerve lesions in two, digital stiffness in one, and compartment syndrome in one. Ten patients with major complications were over the age of 50 years and nine were women. Two patients receiving anticoagulation developed large dorsal subcutaneous space hematomas. Chemotherapeutic agents contributed to two minor complications and one major complication. CONCLUSION: The hand is a common site for minor and major i.v. catheter complications. Women and older patients are more susceptible to these complications. Peripheral i.v. line complications are not uncommon and can result in morbidity and increased health care costs from prolonged hospitalization, extended use of i.v. antibiotic therapy, and surgical intervention.
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Trigger finger is uncommon among children and often caused by various lesions. We report a 5-year old girl who presented with chronic painless triggering of the right ring finger and normal X-ray. She underwent exploration of the finger flexor tendons and release of the A1 pulley. Lack of obvious pathology dictated further wound exploration which revealed a hidden osteochondroma of the proximal phalanx. We believe that adequate surgical wound exposure is necessary if no obvious cause of triggering could be seen in order to rule out an atypical osteochondroma even in the presence of normal X-rays.
PURPOSE: To report a congenital anomaly of the middle finger. METHOD: Nine patients (16 digits) are reported with congenital flexion deformity of the metacarpophalangeal (MCP) joint of the middle finger. Three patients (4 digits) had isolated deformities to the middle finger and in 6 the deformity was part of congenital ulnar drift (CUD) of the hand. Three patients had Freeman-Sheldon syndrome, 2 had nonsyndromic CUD, and 1 had arthrogryposis multiplex congenita. In CUD patients the middle finger had substantially greater flexion deformity of the MCP joint in comparison with other digits. Seven patients were treated surgically and 2 were treated nonsurgically. Five of the surgical patients had bilateral middle finger involvement. RESULTS: During surgery on 12 digits sagittal band hypoplasia of varying degrees was encountered in all patients and in all patients the extensor tendon of the middle finger was underdeveloped and often ulnarly displaced. Longitudinal imbrication of the remnants of the extensor tendon and centralizing the tendon if necessary by radial sagittal band reefing improved MCP joint flexion deformity. CONCLUSIONS: Congenital middle finger-in-palm deformity in our patients was caused by sagittal band and extensor tendon hypoplasia.
PURPOSE: To assess the longitudinal radiographic osseous changes of the wrist and hand other than interphalangeal joints in rheumatoid disease. METHODS: Serial wrist and hand x-rays in 96 patients with long-standing rheumatoid disease were reviewed. The average number of years between initial and most recent x-rays was 15.1. The Larsen scoring system was used to assess the degree and severity of joint involvement. We identified patterns of involvement in the wrist, thumb, and finger metacarpophalangeal (MCP) joints. RESULTS: The radioscaphoid and radiolunate joints had the earliest and most severe progression of all joints studied. Scaphoid erosions often were seen early (27%) and their presence was a predictor of progressive involvement. Ulnar styloid erosions commonly were seen as early isolated findings (25%). The distal radioulnar joint showed a rapid increase in Larsen score and was involved in 78% of patients on late x-rays. The thumb showed considerable late MCP joint disease that often led to boutonniere deformity and the trapeziometacarpal joint had the least rate of progression of all joints studied. The most severely and frequently involved MCP joints were the radial (index and middle), which also had the greatest increase in score over the span of the study. Finger MCP joint disease was observed to progress temporally in a predictable pattern: first radial MCP joints of the dominant hand, followed by the nondominant radial MCP joints, and last the ulnar MCP joints of the nondominant hand with small finger involvement preceding that of the ring finger. Of all MCP joints, the ring finger was least affected. CONCLUSIONS: This study clarified the longitudinal osseous radiographic changes of the wrist and hand (excluding interphalangeal joint) in rheumatoid disease.
We report a patient who sustained a hand injury while target shooting with a compound bow. An open metacarpal fracture occurred from the bow during the arming phase. This peculiar mechanism of injury has not been reported before. This report presents and discusses the mechanism of injury and reviews the literature on archery related injuries.
A patient is reported with a history of multiple tendon ruptures including biceps, flexor hallucis longus and achilles tendons. He presented with closed rupture of the flexor carpi radialis tendon following long standing tendonopathy and scapho-trapezio-trapezoid arthrosis. Non-operative treatment was elected because of low physical demands on the upper extremity. Early management of scapho-trapezio-trapezoid arthritis can prevent flexor carpi radialis tendon rupture.
A patient with Dupuytren's disease with involvement of the palmar fascial complex and digital contracture is described. A vertical cord had developed in the transverse ligament of the palmar aponeurosis fibers and the underlying septa of Legueu and Juvara. The cord was composed of a pretendinous band, transverse ligament of the palmar aponeurosis, and septum of Legueu and Juvara. The cord was attached deeply in the soft tissue confluence of the sagittal band, palmar plate, and interpalmar plate ligament. Involvement of the transverse ligament of the palmar aponeurosis and septa of Legueu and Juvara in Dupuytren's disease is rare. Understanding of the normal and pathologic fascial anatomy explains their simultaneous involvement and is necessary for complete ablation of the diseased tissue.