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Biomedical subjects

H Russwurm

Publications and source records attributed to H Russwurm.

8 recordsLinked to original sources

Neurophysiology not required before surgery for typical carpal tunnel syndrome.

Sixty-eight patients with typical carpal tunnel syndrome underwent neurophysiological investigations preoperatively, but these were not assessed until the end of the study. Open carpal tunnel release was performed and the clinical diagnosis of carpal tunnel syndrome was considered as confirmed when there was a prompt resolution of the preoperative symptoms. Sixty-three of the 68 patients responded well to surgery, three had equivocal outcomes and two did not improve, and thus were considered not to have carpal tunnel syndrome. The neurophysiological tests were normal in these two patients, but were also normal in 14 of the 63 patients who improved with carpal tunnel surgery. Preoperative neurophysiology might therefore have led to up to 14 of the 63 cases of carpal tunnel syndrome being turned down for surgery. We conclude that neurophysiological studies contribute little to the diagnosis in typical cases of carpal tunnel syndrome, and are more often confounding than of assistance.

Adult↗

No advantage from splinting the wrist after open carpal tunnel release. A randomized study of 82 wrists.

To study the value of postoperative splinting after open carpal tunnel surgery, we randomly selected 82 wrists for 4 weeks of postoperative immobilization or no immobilization. The distributions of scar discomfort or pain and "pillar pain" were equal in the two groups both at 6 weeks and 6 months. Median sick leave was 6 weeks in both groups. Median VAS values for persistent discomfort and pain at 2 weeks, 6 weeks and 6 months were similar in the two groups. Grip strength was reduced compared to preoperative values by about 20% and keypinch strength by about 10% in both groups at 6 weeks and had returned to normal by 6 months. Pinch between the thumb and the tips of fingers 4 and 5 was considerably reduced postoperatively, but similar in both groups. We conclude that 4 weeks of postoperative immobilization confers no detectable benefit.

Absenteeism↗

Tendon interposition arthroplasty for basal joint arthrosis. 38 thumbs followed for 4 years.

We reviewed 38 thumbs (35 patients) operated with a modified Burton procedure for basal joint arthrosis. There were 3 pintrack infections and 9 patients reported severe discomfort during the postoperative period in a plaster of Paris. After a follow-up of 4 (1-7) years, 28 patients rated the overall result as excellent, while 1 would not have consented to the operation if she had known the result in advance. Activities of daily living were markedly improved. Compared to the nonoperated hand, the key pinch was moderately reduced and grip strength was almost the same. The postoperative scaphometacarpal gap was 6 mm.

Activities of Daily Living↗

Metacarpal lengthening after traumatic amputation of the thumb.

In nine patients of median age 34 years who had sustained an amputation of the thumb at a median 24 (5 to 131) months previously, we lengthened the first metacarpal by 30 (17 to 36) mm. Seven amputations had been through the proximal phalanx and two through the metacarpal. The first two patients had autogenous grafting at a second stage, but the other seven had callotasis alone. In these patients the external fixators were removed at a median 189 (115 to 271) days after osteotomy. In six cases the adductor pollicis tendon was transferred proximally and the first web deepened. There was late fracture or palmar flexion of the callus in five patients, but this required further surgery in only one. Treatment was complete at 326 (140 to 489) days after osteotomy. The extended thumb retained its sensitivity; both grasp and key-pinch strength were satisfactory and only one patient felt that the result did not warrant the long course of treatment. Metacarpal lengthening by this method is a prolonged procedure, but provides a valuable alternative to more complex reconstructions.

Adult↗

Lumbar intervertebral disc herniation in the young.

A survey of 37 young patients, 10 to 18 years of age, with lumbar intervertebral disc herniation is presented. Local physical findings and limitation in straight-leg raising are often more marked in the young than in adults, whereas pain may be slight or even absent. Neurological findings were normal in 40 per cent of the cases, and when deficits were found, they were usually of a minor nature. Herniated disc syndrome in children and adolescents is characteristic and should not be difficult to recognize. With surgical treatment good results were obtained in nearly all cases.

Adolescent↗