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Biomedical subjects

H K Watson

Publications and source records attributed to H K Watson.

At least 73 records · Page 4Linked to original sources
PubMed1987

Instabilities of the wrist.

Carpal instability is the result of ligamentous injury to the wrist. Although any ligament may be injured, certain recurring patterns are frequently seen. Common to the treatment of all instability patterns is the need to transfer load from the capitate to the radius: reliably, without stressing normal joints, and while preserving functional motion. Limited wrist arthrodesis fulfills these needs. The radius and carpal bones are shaped so that in their "normal" position, they are preloaded. Were it not for complex ligamentous systems, the bones would immediately assume unloaded "neutral anatomic" positions. Because the shape of the wrist bones tends to displace them with significant forces, current ligamentous reconstructions are inadequate. Common radial side instabilities invariably lead to degenerative arthritis.

Arthrodesis↗
PubMed1987

Scapholunate gap with scaphoid nonunion.

Ten of 64 patients reviewed with scaphoid nonunion were found to have scapholunate gaps (SLG). A roentgenographic study of the entire group who were symptomatic, but had no prior surgery, showed the SLG. The SLG indicated severe ligamentous injury and instability, and was always associated with the presence of Doral Intercalated Segment Instability (DISI) and an increased scapholunate angle. Instability was progressive and associated with the early onset of arthritis. In the entire group of nonunions, high frequency of arthritis occurred with a predictable sequence of radioscaphoid and midcarpal degenerative changes. Terminal wrist arthritis in scaphoid nonunion developed in the scapholunate articulation, as a manifestation of rotary subluxation of the distal scaphoid fragment.

Adult↗
PubMed1987

SSMB syndrome. Symptomatic supernumerary muscle belly syndrome.

Supernumerary muscle bellies (SMBs) of the forearm, common anatomic variant, are usually asymptomatic but can produce a debilitating pain syndrome that is secondary to a tendon-muscle shear phenomenon. This shear phenomenon seems to occur when a SMB is attached to another muscle and the excursion of the two units are different, thus parts of a muscle unit are prevented from migrating proximally on contraction of the entire muscle. The anomalous muscle may have either greater excursion, as in an anomalous palmaris longus attached to the flexor digitorum superficialis, or less excursion, as in an anomalous superficialis muscle attached to the carpus. The shear at the interface between different muscle-tendon units produces a burning pain that usually is localized to the distal one-third of the forearm. Surgical excision of the abnormal restricting muscle or tendon component relieves the symptom complex and restores the ability to apply full power. Observation on typical cases, diagnostic methods, operative technique, and results of the syndrome suggest that SSMB may be responsible for undiagnosed and untreated instances of distal forearm complaints.

Adolescent↗
PubMed1986

Saddle deformity. Posttraumatic interosseous-lumbrical adhesions: review of eighty-seven cases.

Trauma to the hand can result in adhesions between the interosseous and lumbrical muscles with subsequent painful impingement on the deep transverse metacarpal ligament during intrinsic contraction. If these adhesions also develop between the intrinsic muscles and the deep transverse metacarpal ligaments or metacarpophalangeal capsule, discomfort may be produced by stretching of the intrinsic tendons. Release of these adhesions, partial resection of the ligament, and early mobilization can produce relief of the symptoms. Eighty-seven cases are reviewed with respect to causes, diagnosis, and treatment.

Adolescent↗
PubMed1986

Matched distal ulnar resection.

Painful disorders of the distal radioulnar joint severely limit the work capability of the hand. Until recently, the standard treatment for this problem has been transverse resection of the distal ulna, as originally proposed by Darrach. A technique for a "matched" resection arthroplasty of the distal ulna, leaving the ulnar shaft--styloid axis along with the triangular fibrocartilage complex and the distal ulnar ligamentous attachments intact, has been used since 1967. This procedure resects the distal ulna in a long, smooth, convex curve, matching the opposing surface of the concave radial metaphysis in three dimensions. Forty-four wrists were followed for an average of 6.5 years and showed that the procedure is reliable and relieves pain while retaining a more normal ulnocarpal, radioulnar, and radiocarpal alignment, with painless pronation averaging 80.5 degrees and supination of 88.5 degrees.

Adolescent↗
PubMed1986

Limited triscaphoid intercarpal arthrodesis for rotatory subluxation of the scaphoid.

Rotatory subluxation of the scaphoid is a well known lesion that is relatively common and results in instability of the wrist. It has been well accepted that because of the subluxation of the scaphoid, degenerative changes in the wrist may develop rapidly, and for that reason correction of the subluxation in its early stages is indicated. Over the past thirteen years, many cases of rotatory subluxation of the scaphoid in various stages of the pathological process have been successfully treated with a triscaphoid arthrodesis of the wrist (fusion of the scaphoid, trapezium, and trapezoid) at the Connecticut Combined Hand Surgery Service. A follow-up of thirty patients with an average length of follow-up of three years and eleven months is described. From this experience, a classification system and treatment plans for each type of rotatory subluxation of the scaphoid have evolved.

Adolescent↗
PubMed1986

Evolution of arthritis of the wrist.

Degenerative arthritis of the wrist follows very specific patterns from onset to terminal severe bone and joint destruction. About 95% of them occur as periscaphoid area problems: SLAC (scapholunate advanced collapse pattern) wrist (55%), triscaphe arthritis (26%), and a combination of the two (14%). In SLAC wrist, the repeating sequence of degenerative change is based on and caused by articular alignment problems between the scaphoid and the radius. Changes then progress between the capitate and the lunate that are secondary to carpal collapse. In triscaphe arthritis, the degenerative change is limited to between the trapezium, trapezoid, and distal scaphoid. SLAC procedure (fusion of the capitate, lunate, hamate, and triquetrum along with silastic scaphoid implant) for SLAC wrists and triscaphe arthrodesis (fusion of the scaphoid, trapezium, and trapezoid) for triscaphe arthritis, are designed to make maximum use of undamaged structures and to maintain full-power, painless, mobile human wrists.

Bone Nails↗
PubMed1985

An approach to Kienböck's disease: triscaphe arthrodesis.

Sixteen patients with Kienböck's disease were treated with triscaphe arthrodesis (fusion of the scaphoid, trapezium, and trapezoid) with or without silicone rubber lunate arthroplasty. This approach removes compressive stress from the diseased lunate and treats the accompanying rotary subluxation of the scaphoid. Five patients were treated with triscaphe arthrodesis together with silicone rubber lunate arthroplasty. Three patients, who were symptomatic, after receiving silicone rubber lunate arthroplasty elsewhere, were treated with triscaphe arthrodesis. Eight patients were treated with triscaphe arthrodesis alone, without silicone rubber lunate arthroplasty. Two of these eight patients later required silicone rubber lunate arthroplasty. Radial styloidectomy and small lunate fragment excision were performed later on one patient. After an average follow-up of 20.5 months, relief of pain was satisfactory in all 16 patients. There was neither nonunion nor surgical infection. We believe that triscaphe arthrodesis with a silicone rubber lunate provides a means for load transference and heavy stress use capability of the hand. Triscaphe arthrodesis alone may suffice to bear the wrist load and can be used in an effort to preserve the diseased lunate. A silicone rubber lunate can easily be added at a later date if necessary.

Adolescent↗
PubMed1985

Rheumatoid wrist reconstruction utilizing a fibrous nonunion and radiocarpal arthrodesis.

Rheumatoid arthritic involvement of the wrist severely limits the functional status of the upper extremity. Total wrist arthrodesis, while providing pain relief and reestablishing support, compromises the functional capacity of the hand because of lack of wrist motion. Wrist arthroplasties allow motion, but have not found wide acceptance because of instability and the recurrence of deformity. A technique for establishing an intentional fibrous nonunion between the carpus and the radius was devised 17 years ago. This fibrous hinge gives wrist stability with or without radiocarpal wrist arthrodesis while allowing painless motion at the fibrous radiocarpal hinge and at the less severely involved midcarpal joint. Twenty-three patients have been followed for more than 7 years. All patients whose wrists achieved nonunion had no pain. Twelve of the 19 wrists in which radiocarpal arthrodesis occurred had no pain, and seven had mild pain that did not limit use.

Adolescent↗
PubMed1985

Posttraumatic sesamoid arthritis of the metacarpophalangeal joint of the thumb.

The articular interface between the radial sesamoid and the radial condyle of the metacarpal head, which is the radial subsesamoid joint, is the most frequently involved area of abnormality in the metacarpophalangeal joint complex. More than 85% of all adult cadavers demonstrate degenerative arthritis of the radial subsesamoid joint. Confusing this condition with degenerative arthritis of the metacarpophalangeal joint may lead to unnecessary joint fusions. The predisposition of the radial subsesamoid to degenerative arthritis is related to the asymmetry of the palmar condyles of the metacarpal. The ulnar sesamoid has a flatter and broader condyle compared with the radial sesamoid, which rides on a high, narrow ridge. Thirty-six patients with symptomatic sesamoiditis have been treated by sesamoidectomy since 1978. Twenty-one of these patients were available for follow-up examination between 1 and 5 years after surgery, and 19 had relief of proximal thumb pain after sesamoidectomy.

Adolescent↗
PubMed1984

A centralization procedure for radial clubhand.

A modified centralization procedure for radial club hand caused by partial or total absence of the radius is presented. This technique differs from the methods presently used in that no carpal bones are resected. Adequate release of the wrist from the fibrotic radial anlage is provided through two Z-plasty incisions to allow the hand to move easily to the new position. Stabilization is then obtained with a Kirschner wire placed via the lunate and capitate into the long finger metacarpal and then directed in a retrograde fashion into the ulna. A total of 12 centralization procedures with the above technique have shown very good results. Long-term follow-up results demonstrate remodeling of the ulna, which becomes broad in its distal end, resembling a radius.

Carpal Bones↗
PubMed1984

Synovial chondromatosis of the distal radioulnar joint.

This case presentation of synovial chondromatosis describes a rare lesion in the distal radioulnar joint. The distal radioulnar joint was locked and damaged by an impinging chondral body. Use of standard resection principles produced an asymptomatic wrist.

Adult↗
PubMed1984

Midcarpal instability caused by malunited fractures of the distal radius.

Thirteen patients with malunited fractures of the distal radius developed symptoms of pain and instability of the midcarpal joint. In six cases, a recurrent voluntary midcarpal subluxation was also present during ulnar deviation. These symptoms were first noticed several weeks, and at times several months, after all immobilization for the treatment of the original fracture had been discontinued. We believe that the loss of the normal palmar tilt of the distal articular surface of the radius prepositions the carpus in a dorsal collapse alignment, which enables this instability to develop. Although the instability is localized to the midcarpus , it is treated best, in our opinion, by a corrective osteotomy of the distal radius. In nine patients, osteotomies resulted in relief of preoperative symptoms and correction of midcarpal instability. In one patient, osteotomy of the radius was deemed unnecessary because the loss of palmar tilt of the radius was minimal. Instead the midcarpal ( triquetrohamate ) joint was stabilized by ligament reconstruction. Only transient correction was obtained, with later recurrence of the voluntary midcarpal subluxation.

Adolescent↗
PubMed1984

The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis.

Four thousand wrist x-ray films were reviewed to establish the pattern of sequential changes in degenerative arthritis of the wrist. After eliminating all other arthritides, we studied 210 cases of degenerative arthritis. The most common pattern (57%) was arthritis between the scaphoid, lunate, and radius; 27% of cases occurred between the scaphoid, trapezium, and trapezoid; a combination of these two patterns occurred in 15%. Twenty operations were performed on 19 patients with the scapholunate advanced collapse pattern. Eighteen of 19 patients had less pain postoperatively and none required pain medication. Flexion-extension and radial-ulnar deviation motions showed considerable improvement after the operation.

Adult↗
PubMed1984

Hyposensitization in hay fever with grass pollen extracts: a three-year study comparing a dialysed alum adsorbed extract with allpyral.

Immunotherapy with a dialysed aqueous extracted alum absorbed extract of grass pollens and with undialysed pyridine extracted alum precipitated extract of grass pollens (Allpyral) was compared in 58 patients with hay fever over a three year period in a randomized open study. Both types of treatment resulted in similar immunological responses as measured by changes in grass specific serum IgE and IgG. The dialysis of the grass pollen material did not decrease or increase the stimulation of specific immunoglobulins. The incidence of both local and systemic side effects was similar in both treatments. More injection site granulomata occurred in patients treated with the new alum adsorbed extract, although the difference did not achieve statistical significance. Symptom-medication data showed that patients who received the conventional pyridine extracted materials obtained a better clinical response, but all treatments gave continuing clinical benefit in each successive year.

Adolescent↗
PubMed1984

Degenerative disorders of the carpus.

Degenerative arthritis of the human wrist follows specific patterns. The patterns do not change with time. Degenerative arthritis progresses within the framework of these patterns. Specific therapeutic approaches have been developed for the treatment of degenerative arthritis of the wrist, with an emphasis on maintaining painless range of motion and power function capability.

Arthrodesis↗