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Biomedical subjects

H Nigst

Publications and source records attributed to H Nigst.

At least 37 records · Page 2Linked to original sources
PubMed1980

[Reoperation after surgery of flexor tendons].

After stabilizing operations such as tenodesis or arthrodesis used for lesions of flexor tendons in the hand, secondary operations to achieve more suitable angulation are mainly needed when there is elongation of the tenodesis. Complications are more frequent after mobilizing operations such as reinsertion, advancement, Z-lengthening, primary suture, tendon graft or tendon transfer. Tenolysis, the operation most frequently used, since contractures may occur after all the prementioned procedures, is treated in a separate paper. Tendon rupture, for instance after reinsertion or advancement operations may require repetition of the primary procedure. More often another procedure will be indicated, for instance a graft after rupture of a primary suture. Pulley reconstruction is necessary when correction of bow-stringing is the aim. Synovitis after the first stage of HUNTER's tenoplasty, a consequence of mechanical or chemical irritation from the silastic rod, is best treated by a short period of immobilisation. Tardy, secondary contractures after tendon graft are a real problem. If conservative treatment using splints is ineffective, either the hook-deformity has to be accepted or the finger amputated.

Contracture↗
PubMed1980

[Reinterventions after surgery of the extensor tendons].

Tenolysis, tendon grafts or tendon transfer are the main procedures to be considered for secondary repair in zone 6. Tenolysis is also indicated when adhesions prevent gliding in zone 5. Here interposition of the extensor retinaculum may provide protection against deep scar tissue. In zone 4, particularly in the presence of supernumerous tendons of abductor pollicis longus, mismatching of tendon ends may have occurred. In such cases the right connections have to be reestablished. Lesions of the hood which have not been recognized primarily will sometimes, when causing dislocation of the extensor tendon over the metacarpal head, be an indication for secondary repair of the hood and adhesions in this region for tenolysis or tendon lengthening. Button-hole deformity following primary repair for lesions of the extensor apparatus in zone 2 has the same indications for repair as old untreated lesions. From the many methods recommended to deal with this difficult lesion the author prefers the FOWLER, MATEV, and PIEPER procedures. Failure after primary repair in zone 1 due to rupture of the extensor apparatus calls for either secondary suture, some form of tendon-plasty or a PULVERTAFT tenorrhaphy.

Hand↗
PubMed1979

Syndromes of compression of the median nerve in the proximal forearm (pronator teres syndrome; anterior interosseous nerve syndrome).

Entrapment of the median nerve in the proximal forearm is seen in two forms: the pronator teres syndrome, and the anterior interosseous nerve (or Kiloh-Nevin) syndrome. Both syndromes are rare, and they comprised approximately 1% of the compression syndromes of the upper limb which were treated operatively by the authors. The symptoms, signs, etiologies, and intraoperative findings are discussed. It is pointed out that certain of the clinical features may resemble those of irritation of the median nerve by a supracondylar process or Struthers' ligament. Although both proximal median entrapment syndromes have a favorable prognosis when treated non-operatively, the authors recommend operative treatment in cases in which there is no perceptible improvement following 8 weeks of non-operative treatment, since this is likely to speed and enhance recovery. Nine cases of the pronator teres syndrome (8 treated successfully by operation, 1 failure) and 2 cases of the anterior interosseous nerve syndrome (both fully recovered) are added to the cases reported previously in the literature.

Adult↗
PubMed1976

[Ulnar nerve neuropathy in the elbow region: surgical findings and conclusions about the etiologic mechanism and indications for surgery].

The operative findings of 191 cases of so-called tardy ulnar neuritis are demonstrated. They may be divided into 2 groups, neuropathies associated with (67 cases) and without dislocation or subluxation of the nerve (124 cases). Cases of ulnar neuritis associated with dislocation of the nerve showing no other pathologic changes indicate that dislocation of the nerve alone may account for clinical signs. The next step is the formation of adhesions followed at a later date by formation of a pseudoneuroma. As this condition is mostly of congenital origin an additional factor is needed for including clinical manifestations such as direct or chronic professional trauma. Not enough importance has been attached to the strong triceps, with large muscle mass reaching far down to the olecranon, which might cause irritation of the nerve by pressing it against the wall of the sulcus or dislocating it over the epicondyle. In cases of neuropathy without dislocation/subluxation there is always a pathological finding even when there is no pseudoneuroma. The m. epitrochleoanconaeus is found in this category (14 cases, 11%). The cubital tunnel syndrom of OSBORNE in a very large sense (all possible causes of compression distal to the sulcus) has been found 28 times. Therapeutic measures aim at taking the nerve away from the causative irritation (anterior transposition) or at erradicating the cause (resection of the epicondyle, section of the arcus tendineus, excision of a tumor etc.). OSBORNE's operation has been performed only thrice. Subluxation or dislocation of the nerve may follow this procedure or the nerve is left more exposed to pressure than before. Deep submuscular transposition is preferred in patients less than 50 years old but other factors may determine the choice between deep and subcutaneous transposition such as the cause of the neuropathy, arthritis of the elbow joint, strength of the flexor muscle mass etc.

Adult↗
PubMed1976

[Ulnar nerve neuropathy in the wrist region: surgical findings].

The author describes the operative findings in 20 cases of compression of the ulnar nerve at the wrist. Adhesions with or without compression of the nerve, neuroma formation and compression by a ganglion are the most frequent findings. In some cases an enlarged artery is compressing the nerve. In one case a loose pisiform bone was causing the irritation. Despite clinical and electromyographical symptoms there was no pathological finding in 2 cases.

Humans↗
PubMed1976

[Transaxillary approach for the resection of the first rib in costo-clavicular compression syndrome].

80 operations for decompression of the thoracic outlet were performed on 70 patients. Clinical follow-up examinations with phono-angiograms were obtainedin 60 cases. The majority of patients with total relief of symptoms were found after transaxillary resection of the first rib combined with scalenotomy. The phono-angiographic controls of postoperative results were in accordance to signs and symptoms.

Clavicle↗
PubMed1975

[Reconstruction and Replacement of the grip function in the maimed hand (author's transl)].

The minimum requirement for a functional hand is the presence of one or more fingers to which a sensitive, mobile thumb separated from them by a deep cleft can be opposed. Of the reconstructive techniques available for the hand, those for the thumb are the most numerous, and they are usually applied at a secondary operation. Reconstruction can only be performed at primary surgery if the state of the hand and the resources available in terms of surgical facilities and personnel are ideal, which is of the bony structure as possible, to be used as a base for reconstruction later.

Adult↗
PubMed1975

[Luxations and subluxations of the scaphoid bone].

The rare occurrence and the difficulties in diagnosis make partial and total luxations of the scaphoid to a problematic chapter in hand surgery. The main part in diagnosis lies in the correct interpretation of the X-ray pictures from which the different formes of displacement may be recognized. These include isolated luxations of scaphoid in palmar, radial or dorsal directions, varying degrees of scapho-lunate subluxations and luxations and the special type of isolated subluxation of the scaphoid bone. In the first part of the paper the diagnostic criteria and in particular the radiologic signs are described. Most important is the recognition of the alteration in the shapes of the scaphoid bone due to its tilting on several axes and the overlapping of its outline with that of the adjacent bones. The displacement of the whole carpal region can extend as far distal as the metacarpals. A diastasis of the scaphoid and lunate is typically due to rupture of the ligaments between these bones and the radius.

Arthrodesis↗