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Biomedical subjects

H Gellman

Publications and source records attributed to H Gellman.

At least 55 records · Page 3Linked to original sources
PubMed1990

Functional range of motion of the joints of the hand.

Active ranges of motion of the joints of the hand are well documented, but there is little data reporting the functional ranges of motion required to perform activities of daily living. Electrogoniometric and standard methods were used to measure both active and functional ranges of motion of the metacarpalphalangeal and interphalangeal joints during 11 activities of daily living. In the fingers, only a small percentage of the active range of motion of the joints was required for functional tasks. Functional flexion postures averaged 61 degrees at the metacarpalphalangeal joint, 60 degrees at the proximal interphalangeal joint, and 39 degrees at the distal interphalangeal joint. In the thumb, functional flexion postures averaged 21 degrees at the metacarpalphalangeal joint and 18 degrees at the interphalangeal joint using only 32% of the available flexion. Active thumb metacarpalphalangeal joint motion was found to be bimodal in the study group.

Activities of Daily Living↗
PubMed1990

Results of dorsal wrist synovectomies in the rheumatoid hand.

Seventy-eight patients with rheumatoid arthritis had 102 dorsal wrist tenosynovectomies, intraarticular synovectomies, and Darrach resection from 1962 to 1982. Follow-up after surgery averaged 11 years, with a range from 3 to 20 years. Pain was diminished in all but 17 wrists and motion decreased an average of 13 degrees. Synovitis recurred in 16 wrists and x-ray evidence of progressive intraarticular destruction was seen in 45 wrists. Revision surgery was necessary in 28 wrists.

Adolescent↗
PubMed1990

Anatomy of the juncturae tendinum of the hand.

Three distinct morphologic types of juncturae tendinum of the extensor tendons were identified in the dissection of 40 cadaver hands. Type 1 juncturae consists of filamentous regions within the intertendinous fascia that attached to the extensor tendons on either side of the intermetacarpal space in a transverse or oblique direction. The second type, consists of much thicker and well-defined connecting bands. Type 3 juncturae consist of tendon slips from the extensor tendons and were subclassified into "y" or "r" subtypes depending on shape. Type 1 juncturae were present in 88% of the second intermetacarpal spaces and in 28% of the third intermetacarpal spaces. Type 2 juncturae were present in 40% of the third intermetacarpal spaces and in 23% of the fourth intermetacarpal spaces. Type 3 juncturae were present in 33% of the third intermetacarpal spaces and in 80% of the fourth intermetacarpal spaces. Juncturae were absent in all of the first intermetacarpal spaces and in 12% of the second intermetacarpal spaces; they were present in all other spaces. The extensor indicis proprius did not receive a junctural connection, whereas extensor digiti quinti tendons did receive junctural connections. Intertendinous fascia was present between all extensor digitorum communis tendons regardless of presence of juncturae.

Connective Tissue↗
PubMed1990

The dorsal branch of the ulnar nerve: an anatomic study.

The dorsal branch of the ulnar nerve was dissected in 24 cadavers. The nerve arose from the medial aspect of the ulnar nerve at an average distance of 6.4 centimeters from the distal aspect of the head of the ulna and 8.3 centimeters from the proximal border of the pisiform. Its mean diameter at origin was 2.4 millimeters. The nerve passed dorsal to the flexor carpi ulnaris and pierced the deep fascia. It became subcutaneous on the medial aspect of the forearm at a mean distance of 5.0 centimeters from the proximal edge of the pisiform. The nerve gave an average of five branches with diameters between 0.7 and 2.2 millimeters. A better understanding of the anatomy of this nerve may help prevent nerve injury during surgical procedures, and can help in locating the nerve for repair of lacerations or administration of local anesthetics for regional nerve blocks.

Adult↗
PubMed1990

Total elbow arthroplasty.

The results of 36 total elbow arthroplasties in 32 patients are presented. The follow-up period ranged from 3 to 12 years. The preoperative diagnosis was rheumatoid arthritis in 27 patients and posttraumatic degenerative joint disease in 5. There were 23 women and 9 men. Unconstrained prostheses (London) were implanted in 6 elbows, semiconstrained prostheses (MAYO, AMC, and triaxial) in 26, and constrained prostheses (GSB, Schlein) were used in 4. There were five perioperative fractures (14%) that were successfully treated nonoperatively. Three ulnar nerve neuropraxias occurred (8%), one of which required surgical exploration and repeat anterior transfer of the nerve. Two superficial postoperative infections (6%) responded to nonoperative treatment. Major complications necessitating revision surgery occurred in 18 (50%). Loosening of the prostheses occurred in nine (25%); two were treated by reimplantation, with prosthetic removal in the others. Deep infections in four (11%) and dislocations occurring in two (6%) necessitated prosthetic removal. Traumatic fractures occurred in two (6%); one was successfully treated by internal fixation, while the other failed internal fixation, requiring prosthetic removal. Radiolucent lines were seen in 20 (56%).

Adult↗
PubMed1990

Malignant tumors of the upper extremity in children.

Of the 422 primary malignant tumors of bone and soft tissue treated at one institution between 1968 and 1988, the 29 found in the upper extremity in children are reviewed. In the latter group, there were 13 patients with osteosarcoma; one was lost to follow-up shortly after diagnosis, one was alive and disease free four years after surgery, two are currently being followed, and nine are dead. All of the four patients with Ewing's sarcoma died. Three patients had chondrosarcoma; one was lost to follow-up after surgery, and the other two were disease free at four and 14 years' follow-up. Two of the nine patients with soft-tissue sarcomas died as a result of their tumors.

Adolescent↗
PubMed1990

Transfer of the pronator teres tendon to the tendons of the flexor digitorum profundus in tetraplegia.

In eleven patients who had traumatic tetraplegia, the pronator teres tendon was transferred to the flexor digitorum profundus tendons to restore active flexion of the fingers. At the same time, in ten of these patients the tendon of the brachioradialis was transferred to the tendon of the flexor pollicis longus, and in the eleventh patient the brachioradialis tendon was transferred to the tendon of the flexor digitorum superficialis of the small finger, to restore pinch. The average time between injury and operation was thirty-four months. The average length of follow-up after operation was thirty-four months. Ten patients gained functional active flexion of the fingers, and they reported improved performance of activities of daily living. When the wrist was in 30 degrees of extension, the average active grasp strength was twenty-one millimeters of mercury and the average key-pinch strength was 2.2 kilograms. The average active flexion of the fingers from the resting position, measured from the tip of the finger to the distal palmar crease, was 1.5 centimeters. Only one patient did not gain active flexion of the fingers. Of the entire group, this patient had the least function of the hand on preoperative evaluation; retrospectively, he seemed to be a poor candidate for operation, since the strength of the pronator teres muscle and the sensibility of the hand were insufficient for useful function. We concluded that, in selected tetraplegic patients, transfer of the pronator teres tendon to the flexor digitorum profundus tendons provides useful active flexion of the fingers.

Adult↗
PubMed1990

Management of fractures of the humerus in patients who have an injury of the ipsilateral brachial plexus.

Twenty-one adults who had a fracture of the middle of the humeral shaft and an injury of the ipsilateral brachial plexus were followed for an average of twenty-eight months. Only two of these patients showed evidence of neurological improvement. Of the eleven patients who had an associated traumatic injury to the brain, eight were treated non-operatively and three, operatively. The presence of a fracture of the humerus in a flail extremity has been found to delay rehabilitation markedly and to result in prolonged hospitalization. Eleven fractures were treated non-operatively with a brace or cast, and there were five non-unions, two delayed unions, and two malunions. Of the ten fractures that were treated operatively, three that were treated by compression-plating all united. Two fractures were treated by external fixation; one had a delayed union and one, a malunion. In the remaining five patients, who were treated with an intramedullary rod, there were two non-unions, one delayed union, and one malunion.

Adolescent↗
PubMed1989

Surgical management of spastic thumb-in-palm deformity in adults with brain injury.

Spastic thumb-in-palm deformity was surgically treated in 27 adults with brain injury. Procedures included muscle lengthening, recession, or release, arthrodesis of the thumb interphalangeal joint, or Z-plasty of the thumb web space. At mean follow-up of 39 months, 23 of 27 had a satisfactory correction. Unsatisfactory results included two with inadequate correction and two with over-correction. Surgical treatment of this entity requires careful preoperative planning, addressing predominantly those spastic muscles responsible for the deformity.

Adolescent↗
PubMed1989

Analysis of pinch and grip strength after carpal tunnel release.

This study evaluates the time required for grip and pinch strength to return to preoperative levels after carpal tunnel release. Grip strength was 28% of preoperative level at 3 weeks; 73% by 6 weeks, and returned to the preoperative level by 3 months. At 6 months grip strength was found to increase to 116%. Pinch strength returned sooner being 74% of preoperative level at 3 weeks and 96% by 6 weeks. By 3 months an increase to 108% was seen and at 6 months an increase to 126% of preoperative levels was found. This data should prove useful in predicting when patients may be able to return to their previous level of occupational-related activity.

Adult↗
PubMed1989

Palmar shelf arthroplasty in the rheumatoid wrist. Results of long-term follow-up.

Sixty-three palmar-shelf arthroplasties (so-called pseudofusions of the wrist) that had been performed between 1970 and 1978 in forty-nine patients were evaluated. The length of follow-up averaged eighty-three months (minimum, twelve months for the wrists that fused and twenty-four months for those that did not). Preoperatively, all wrists were painful, with 96 per cent being moderately or severely so. Carpal subluxation was present in 79 per cent of the wrists. Postoperatively, pain recurred in 84 per cent of the wrists, but it was less severe (mild in 48 per cent, moderate in 35 per cent, and severe in 2 per cent). Sixty-eight per cent of the wrists fused spontaneously and were no longer painful. Of the twenty wrists (32 per cent) that did not fuse, 70 per cent were mildly or moderately painful. In patients who have rheumatoid arthritis, we found that palmar shelf arthroplasty was followed by a high rate of delayed spontaneous fusion and an unacceptably high rate of recurrent pain, although the pain was less severe.

Arthritis, Rheumatoid↗
PubMed1989

Comparison of short and long thumb-spica casts for non-displaced fractures of the carpal scaphoid.

A prospective study was undertaken of fifty-one patients who were randomly assigned to treatment with either a long or a short thumb-spica cast for a non-displaced fracture of the carpal scaphoid. The duration of follow-up was at least until union; the average follow-up was twelve months. Twenty-eight fractures were treated with a long thumb-spica cast and twenty-three, with a short thumb-spica cast. The hands that initially were treated with a long thumb-spica cast were placed in a short thumb-spica cast after six weeks. Fractures that initially were treated with a long thumb-spica cast united at an average of 9.5 weeks and those that were maintained in a short thumb-spica cast, at an average of 12.7 weeks. There were no non-unions and two delayed unions in the fractures that initially were treated with a long thumb-spica cast, compared with two non-unions and six delayed unions in those that had only a short thumb-spica cast. Fractures of the proximal or middle third of the carpal scaphoid had a significantly shorter time to union when they were treated initially in a long thumb-spica cast. Fractures of the distal third did well regardless of the type of immobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

An in vitro analysis of wrist motion: the effect of limited intercarpal arthrodesis and the contributions of the radiocarpal and midcarpal joints.

Radiocarpal and intercarpal arthrodeses were simulated in 12 fresh cadaver wrists by means of external fixation. Range-of-motion measurements were made before and after simulated arthrodesis and used to calculate the contribution of the midcarpal and radiocarpal joints to wrist motion, as well as the residual wrist motion after limited intercarpal arthrodeses. Relative contributions to wrist motion were as follows: wrist flexion: radiocarpal (RC) joint 63%, midcarpal (MC) joint 36%; wrist extension: RC joint 53%, MC joint 46%. The wrist motion remaining after simulated arthrodeses was as follows: capitate-hamate: flexion (Flx) 98%, extension (Ext) 92%, ulnar deviation (UD) 96%, radial deviation (RD) 90%; scaphoid-lunate: Flx 97%, Ext 91%, UD 90%, RD 91%; scaphoid-trapezium-trapezoid: Flx 86%, Ext 88%, UD 67%, RD 69%; scaphoid-lunate-triquetrum: Flx 91%, Ext 82%, UD 86%, RD 70%; capitate-lunate: Flx 70%, Ext 59%, UD 89%, RD 79%; capitate-hamate-triquetrum: Flx 88%, Ext 79%, UD 88%, RD 81%; hamate-triquetrum: Flx 90%, Ext 85%, UD 89%, RD 94%; scaphoid-trapezium-trapezoid-capitate: Flx 85%, Ext 77%, UD 64%, RD 57%.

Arthrodesis↗
PubMed1988

Internal vascularity of the scaphoid in cadavers after insertion of the Herbert screw.

This article describes the effects of various operative exposures for insertion of the Herbert screw on the internal vascularity of the scaphoid. Vessels supplying the proximal 70% to 80% of the scaphoid were intact in all specimens except one, which had a combined palmar and dorsal. approach. Vessels supplying the tubercle and the distal 20%-30% were disrupted in five of 18 specimens undergoing the palmar approach. The palmar approach did not disrupt the significant dorsal blood supply, and the dorsal approach was safe provided care was taken to preserve the visible dorsal vascular leash.

Bone Screws↗
PubMed1988

Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate.

The outcome of delayed treatment of an unreduced transscaphoid, transtriquetral, perilunate fracture dislocation of the carpus is unpredictable. Long-term follow-up observations in a 22-year-old man treated three months postinjury showed changes in the lunate consistent with avascular necrosis at the time of open reduction and internal fixation. Early resolution of this was evident by nine months, and complete resolution was seen at the follow-up examination (four years and two months). Despite delay in treatment, this patient had full, pain-free wrist motion. Consequently, avascular changes of the carpus following wrist dislocation do not preclude a good result. Anatomic reduction of the scaphoid, as well as the midcarpal joint, and restoration of the articular surface of the lunate, are most important in determining prognosis.

Adult↗
PubMed1988

Carpal tunnel syndrome in paraplegic patients.

Thirty-eight (49 per cent) of seventy-seven paraplegic patients whose level of injury was at or caudad to the second thoracic vertebra were found to have signs and symptoms of carpal tunnel syndrome. The prevalence of carpal tunnel syndrome was found to increase with the length of time after the injury. In the eighteen patients in whom manometric studies were done, the carpal tunnel pressures when the wrist was in the neutral position were higher than those that have been reported in non-paraplegic patients who did not have carpal tunnel syndrome but were lower than the values in non-paraplegic patients who did have the syndrome. When the wrist was in flexion, the pressures were similar to the values that have been reported for non-paraplegic patients. However, in the paraplegic patients, regardless of whether or not they had carpal tunnel syndrome, the pressures that developed when the wrist was in extension were significantly higher than those in non-paraplegic patients, regardless of whether or not they had carpal tunnel syndrome. Most of the activities of daily living of paraplegic patients, including the maneuver to relieve ischial pressure that consists of arising from the seated position using the extended arms, are performed with the wrists locked in maximum extension. The pressure that develops in the carpal canal during this forced extension of the wrist, probably combined with the repetitive trauma to the volar aspect of the extended wrist while propelling a wheelchair, contributes to the high frequency with which carpal tunnel syndrome is found in paraplegic patients.

Activities of Daily Living↗
PubMed1988

Reflex sympathetic dystrophy in cervical spinal cord injury patients.

Sixty consecutive patients admitted to the spinal cord injury unit at a Downey, California medical center were evaluated for hand and upper extremity pain. Patients averaged nine months postinjury and had an average age of 37 years. Seven patients (11.7%) complained of diffuse hand pain, swelling, and stiffness. All patients with complaints were evaluated with three-phase radionuclide scintigraphy. Six of those seven patients had scintigrams consistent with reflex sympathetic dystrophy (RSD), an overall incidence of 10%. Three of these six patients were treated with stellate ganglion blocks, which gave relief of symptoms and allowed return to their rehabilitation program. An awareness of RSD as a cause of pain in spinal cord injured patients should lead to earlier recognition and treatment.

Adult↗