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Biomedical subjects

J L Goldner

Publications and source records attributed to J L Goldner.

At least 37 records · Page 2Linked to original sources
PubMed1989

Chronic peroneal tendon subluxation produced by an anomalous peroneus brevis: case report and literature review.

Although congenital anomalies of the peroneal muscles have been well documented from anatomical studies, only a single clinically symptomatic case has been previously reported. In the present report, a previously unreported variation of the peroneus brevis, a bifid peroneus brevis, is described. This variation contributed to chronic subluxation of the peroneal tendons. Diagnosis was made at the time of operation, and resection of the duplicated tendon and reinforcement of the peroneal retinaculum relieved the symptoms of the patient.

Ankle Joint↗
PubMed1989

Neuralgic amyotrophy.

Neuralgic amyotrophy is an infrequent neuromuscular anomaly involving the shoulder girdle and upper extremity. Its course is highlighted by the sudden onset of severe pain followed by sensory deficits, muscle weakness, and severe atrophy. The diagnosis is based on the history and physical findings and is corroborated with electromyography. The prognosis is excellent. Treatment is supportive, using analgesics and physical therapy.

Analgesics↗
PubMed1988

Immediate and delayed neurorrhaphy in a rabbit model: a functional, histologic, and biochemical comparison.

The effect of timing of neurorrhaphy on neuromuscular function was studied. The extensor digitorum longus neuromuscular units of 51 rabbits were used, with repairs performed immediately, 3 weeks, 3 months, and 6 months after nerve transection. Neuromuscular function was assessed 3 months after nerve repair, as was histology, histochemistry, and muscle hydroxyproline content. Force generated by immediately repaired units was 93% of unoperated controls. All functional delayed repairs produced approximately 50% of control force. Mild endomysial and perimysial fibrosis was present in the immediate neurorrhaphy group. Fibrosis was mild to moderate in the functional delayed repairs and moderate to severe in the nonfunctional repairs. Total and regional hydroxyproline content correlated to both function and timing of nerve repair. The data demonstrate that immediate repair of peripheral nerve lacerations gives the best functional recovery in this rabbit model. If immediate repairs are not performed in the rabbit, approximately 50% to 75% of normal function can be obtained when repairs are delayed for periods of 3 weeks to 6 months.

Animals↗
PubMed1988

Surgical reconstruction of the upper extremity in cerebral palsy.

This article discusses surgical treatment of the upper extremity in cerebral palsy. Such treatment should provide a balanced grasp and release, a reasonable range of pronation and supination of the forearm, and should maintain sufficient strength for hand function.

Arm↗
PubMed1988

Strengthening of the partially paralyzed shoulder girdle by multiple muscle-tendon transfers.

Strength and stability of the shoulder girdle affect function of the entire upper extremity. Isolated muscle weakness may be compensated for by adjacent muscles; however, profound weakness of the deltoid muscle, for example, affects not only placement of the extremity, but also strength and endurance of the forearm and hand. Orthotic substitutes for weakened muscles are not successful. If the muscle weakness is nonprogressive and stable, then surgical treatment will improve glenohumeral stability, increase endurance, and provide more uniform strength for many activities of daily living.

Brachial Plexus↗
PubMed1987

Neurorrhaphy, nerve grafting, and neurotization: a functional comparison of nerve reconstruction techniques.

This study examines the efficacy of three methods of peripheral nerve reconstruction: neurorrhaphy, nerve grafting, and neurotization. The extensor digitorum longus (EDL) neuromuscular unit of 63 New Zealand rabbits was used as the experimental model. Neuromuscular function was examined after 2, 4, and 6-month recovery periods. Variable recovery was seen after 2 months of recovery. At 6 months postoperatively, nerve grafting and neurorrhaphy were not statistically different from the unoperated control neuromuscular units. Neurotization grafting demonstrated a recovery of function of no greater than 50% at 6 months.

Animals↗
PubMed1987

Traumatic horizontal deviation of the second toe: mechanism of deformity, diagnosis, and treatment.

Two patients with a deviated overlapping second toe due to rupture of the dorsal lateral metatarsophalangeal (MTP) collateral ligament and the lateral interosseous tendon were diagnosed, analyzed, and treated. Athletic activities were responsible for the tendon-ligament ruptures and the ensuing medial deviation of the second toe. Pain occurred in the second MTP joint, and a dorsal corn formed over the proximal interphalangeal joint (PIP). Reconstructive procedures included lengthening of the interosseous-lumbrical tendons and the collateral ligament on the medial side of the joint; a dorsal capsule incision; repair of the lateral collateral ligament and interosseous tendon; transfer of the flexor digitorum longus to the extensor digitorum longus; and shortening of the proximal phalanx in one patient. These soft tissue reconstructive procedures and realignment joint congruity are essential to relieve pain and prevent traumatic arthrosis. The treatment completed on the two patients resulted in relief of pain, satisfactory function, and alignment of the digits involved.

Adult↗
PubMed1986

Computerized tomographic analysis of acute calcaneal fractures.

Computerized tomography (CT) of the hindfoot is introduced as an effective technique in the evaluation of acute, intra-articular calcaneal fractures. Thirty-two fractures in 30 patients have been reviewed, and common fracture characteristics identified. These included the presence of a sustentacular fragment, displacement and comminution of the lateral weightbearing surface, and lateral spread with loss of calcaneal height. Based on the improved understanding of fracture anatomy provided by the CT scan, treatment often can be determined more accurately.

Adult↗
PubMed1986

Computerized tomography of talocalcaneal tarsal coalition: a clinical and anatomic study.

Consistently accurate radiographic diagnosis of talocalcaneal tarsal coalitions is difficult because of the complex anatomy of the subtalar articulations. Standard techniques that include special radiographic views and plain tomography are useful but often inconclusive. In this study, computerized tomography (CT) was used to evaluate suspected talocalcaneal coalitions in patients with the clinical diagnosis of peroneal spastic flatfoot. CT demonstrated bony and nonbony coalitions in 14 of 22 patients studied. In the remaining eight patients, CT effectively ruled out the diagnosis of subtalar coalitions. If the coalition is obvious, CT will confirm it; if the clinical syndrome exists but standard radiographic procedures do not document the lesion, CT scan will be helpful in establishing a diagnosis. Anatomic studies of fresh cadaver feet compared CT, plain tomography, and plain radiographs for efficacy in visualizing the three subtalar facet joints. CT was superior to the other modalities for clearly identifying all aspects of the subtalar joint and talocalcaneal coalitions in patients and cadavers.

Adolescent↗
PubMed1986

Bilateral nontraumatic anterior acromioclavicular joint dislocation. A case report.

An incidental finding of bilateral nontraumatic anterior acromioclavicular joint dislocation was made in a 14-year-old boy with spastic hemiparesis. Acromial processes were dislocated anterior to the distal clavicles, with characteristic radiographic findings. The dislocation is termed "anterior" because the clavicle is anatomically more proximal than the acromion. Anterior acromioclavicular joint dislocation usually is associated with significant trauma. There was no history of trauma in this case. Localized laxity of the acromioclavicular and coracoclavicular ligaments was the presumed cause of this condition, because there was no visible osseous abnormality. Since the patient was asymptomatic, no treatment was indicated.

Acromioclavicular Joint↗
PubMed1985

Open fractures of the extremities. The case for open treatment.

Meticulous care of open wounds in open fractures is essential to prevent development of infection. Wounds should be treated by early excision and early delayed or secondary closure. Primary closure is not necessarily beneficial and can actually increase the risk of infection. Culture for aerobic and anerobic organisms should be obtained at initial examination, and antibiotic treatment should be started before wound excision. The experience at Duke University Medical Center, Durham, North Carolina, during the past 40 years has demonstrated that open treatment of open wounds is safe and highly successful in preventing gas gangrene and osteomyelitis.

Academic Medical Centers↗
PubMed1985

Foot and ankle injuries in theatrical dancers.

The theatrical dancer is a unique combination of athlete and artist. The physical demands of dance class, rehearsal, and performance can lead to injury, particularly to the foot and ankle. Ankle sprains are the most common acute injury. Chronic injuries predominate and relate primarily to the repeated impact loading of the foot and ankle on the dance floor. Contributing factors include anatomic variation, improper technique, and fatigue. Early and aggressive conservative management is usually successful and surgery is rarely indicated. Orthotics play a limited but potentially useful role in treatment. Following treatment, a structured rehabilitation program is fundamental to the successful return to dance.

Achilles Tendon↗
PubMed1985

Recurrent dislocation of the patella treated by the modified Roux-Goldthwait procedure. A prospective study of forty-seven knees.

We studied the results in forty-seven knees in thirty-seven patients - ten male and twenty-seven female - who had recurrent dislocation of the patella and were treated by a modified Roux-Goldthwait procedure (lateral retinacular release, medial transfer of the lateral patellar tendon without advancement, plication of the medial retinaculum, and advancement of the vastus medialis). Ten of the female patients had bilateral dislocation. The results were analyzed after follow-ups ranging from 3.0 to 16.3 years (average, 5.8 years). The study confirmed that a tangential radiograph of the patellofemoral joint, made with the knee in 20 degrees of flexion, is reliable in determining patellar displacement. The results were excellent in twelve knees, good in thirty-one, fair in one, and poor in three. The fair and poor ratings were due to pain caused by severe chondromalacia patellae. The patient with a fair result had had recurrent dislocations after the Roux-Goldthwait procedure due to a very lax synovial and capsular sac. Reoperation with tightening of the sac medially and laterally eliminated hypermobility of the patella in this patient and established straight patellar tracking. There was one serious complication, a large subcutaneous hematoma with necrosis of a skin flap. The patients with mild chondromalacia improved and showed no progressive patellofemoral arthritis after simple realignment, while those with severe chondromalacia were not improved by shaving, drilling, and realignment. Preliminary results indicated that a modified Maquet procedure, in addition to realignment, may be indicated for patients with severe chondromalacia. This study demonstrated that the modified Roux-Goldthwait procedure, without advancement of the tibial attachment of the patellar ligament, can stabilize the patella without increasing patellofemoral compression. The procedure does not relieve the symptoms of severe chondromalacia of the patella but realignment is the first step in treatment of any form of patellofemoral arthrosis.

Adolescent↗
PubMed1984

Recovery of skeletal muscle after laceration and repair.

Few data are available regarding structural and functional recovery of lacerated skeletal muscle after repair. This study used the extensor digitorum longus muscle of rabbits to document recovery after laceration and repair and a healing period of 12 weeks. Completely lacerated muscles recovered approximately 50% of their ability to produce tension but were able to shorten to 80% of normal. Partially lacerated muscle bellies recovered approximately 60% of their ability to produce tension and normal ability to shorten. Histologic specimens revealed that the lacerations did not cause necrosis of either segment. After the recovery period, histologic and histochemical sections revealed that the distal segment initially isolated from the nerve supply showed histologic changes of fiber atrophy and size variability, increased fibrosis, and nuclear centralization suggestive of denervation. Dense scar separated the two fragments. Data show that skeletal muscle can recover useful but not normal function after laceration and repair.

Animals↗
PubMed1984

Isolated cold stress testing in the assessment of symptoms in the upper extremity: preliminary communication.

Isolated cold stress testing is introduced as a method for quantification of thermoregulatory capacity of the upper extremities. Ninety-six patients with pain, numbness, or cold intolerance were studied. All diagnoses were confirmed by operation, arteriography, or dynamic radionuclide imaging. Patients were prospectively evaluated, and the observed response patterns were correlated with pathologic processes. Three characteristic temperature-response curves were identified. Isolated cold stress testing is a safe and effective technique that provides useful information about vasomotor tone and areas of arterial compromise and competency that is unavailable with static-state testing.

Adolescent↗
PubMed1984

Median nerve compression lesions. Anatomical and clinical analysis.

The motor and/or sensory zones of the median nerve may be compressed at one or more points along its course from the cervical roots to the common digital nerves. If sensory and/or motor deficiencies persist, the compressive lesion should be localized, defined by clinical and electro-diagnostic studies, and treated either nonsurgically or surgically, depending on the fundamental pathological process.

Adult↗