Dupuytren's contracture is associated with sprouting of substance P positive nerve fibres and infiltration by mast cells.
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Adult↗
Biomedical subjects
N Borisch
Publications and source records attributed to N Borisch.
[Necrosis of the carpal scaphoid after chemotherapy. Case report].
Preiser's disease--first described by Preiser in 1910--presents the rare avascular necrosis of the carpal scaphoid. There is no consensus with regard to cause and therapeutic procedure to this day. The initially postulated idiopathic origin of the disease is controversial and rare. It is mainly caused by trauma or repetitive microtrauma, but can also occur as a complication of drug therapy. The rare occurrence of necrosis of the carpal scaphoid following chemotherapy is presented. The treatment was resection of the scaphoid and mediocarpal arthrodesis. Clinical appearance, diagnostic work-up, and therapy of the disease are discussed.
Antineoplastic Agents↗
[CRPS type I psychological origin-case report].
The complex regional pain syndrome type I (CRPS I)-formerly named Sudeck's atrophy or reflex sympathetic dystrophy (RSD)-describes a complex of symptoms with chronic, poorly controllable pain, autonomic, sensomotor and trophic alterations. It is mainly caused by trauma or surgery. We describe the rare case of a spontaneous manifestation of a CRPS I in an adolescent patient with typical clinical and radiological findings and the recurrence of symptoms after a one-year symptom-free interval. Symptoms were resolved by an intense multimodal therapy concept. The likely psychosocial origin in this case is discussed. Clinical appearance, diagnostic means and therapy of the CRPS are described.
Adolescent↗
The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb.
We report the results of a new bone-tendon ligamentoplasty for the reconstruction of chronic injuries of the ulnar collateral ligament at the metacarpophalangeal joint of the thumb. The mean follow-up period was 36 months. Using the Glickel grading system, seven patients had excellent results and one patient had good results. The mean loss of pinch strength was 10% compared with the contralateral thumb. The mean loss of motion at the MP joint was 8%. This technique successfully restores the desired long lasting stability while maintaining mobility of the thumb's metacarpophalangeal joint.
Adult↗
[The caput-ulnae-syndrome. Pathogenesis, clinic and therapy].
The ulnar head has a central function in stabilizing the wrist. In the treatment of caput ulnae syndrome, the radiocarpal joint must, therefore, always be considered. The integrity of the ulnar head and TFCC are of major importance for the rheumatoid wrist. Therefore, surgical treatment should be carried out early, and is indicated for drug-resistant synovitis and monarthritis of the wrist. Early synovectomy of the radiocarpal and distal radioulnar joint (DRUJ) can be done as an open procedure or, when extensor tendon synovitis is absent, as an arthroscopic procedure. In most cases, however, treatment of manifest caput ulnae syndrome, sometimes even with rupture of the extensor tendons, is necessary. In these cases, resection of the ulnar head together with a dorsal wrist stabilization is indicated. Less often, arthrodesis of the DRUJ with segmental resection of the ulna or an arthroplasty are indicated. When choosing the procedure, the type and stage of wrist changes have to be considered. The DRUJ usually has to be treated together with the radiocarpal joint. Its isolated treatment is rarely indicated.
Arthritis, Rheumatoid↗
[Unusual complication of silicon synovitis in the rheumatoid wrist].
Silicone synovitis is an important clinical entity recognized in rheumatoid patients after arthroplasties with silicone implants. It is a foreign body reaction to particulate material (silicone elastomer) characterized clinically by the re-occurrence of pain, stiffness and swelling at the site of arthroplasty after initial relief of symptoms. Whereas silicone synovitis is a rare complication in metacarpophalangeal implants, it is an important one in the wrist implant. Long-term follow-up studies have revealed that the rates of fracture and subsidence are high and that the implants deteriorate with time necessitating operative revisions in up to 50% of cases. Indications should therefore be restricted to a painful wrist in the elderly, very low demand patient with insufficient bone stock to permit total wrist arthroplasty with a metal-on-plastic design. Severe preoperative deformity and the need for use of ambulatory aids may further limit the indication. The unusual case of direct perforation of silicone particles from the wrist into the tendon sheath of the M. flexor pollicis longus inducing a tumor-like synovitis and a secondary carpal tunnel syndrome is presented. The importance of silicone synovitis and the indication at present for implantation of a silicone wrist spacer in the rheumatoid patient are discussed.
Arthritis, Rheumatoid↗
[Adaptive patterns of the rheumatoid wrist after radiolunate arthrodesis].
OBJECTIVE: The aim of this study was the analysis of long-term carpal changes after radiolunate arthrodesis. METHODS: Pre- and postoperative X-rays of 91 wrists in 78 patients with rheumatoid arthritis, who were treated for carpal instability with a radiolunate arthrodesis, were examined concerning the midcarpal joint and the Larsen grade. The mean follow-up was 60 months. RESULTS: After radiolunate arthrodesis the midcarpal joint space remained unchanged in 28%. In 35% secondary arthritis and in 37% further arthritic destruction occurred. The mean Larsen grade increased from 3.2 to 3.8. Six wrists needed complete arthrodesis 25 to 87 months after the primary procedure and one was treated by total wrist replacement. Adaptive changes of the carpus during progressive disease and in secondary arthritis were recognized. Three types of joint lines could be identified: in 35% of the wrists a "perilunar", in 22% a "radio-midcarpal" and in 3% a purely "midcarpal" joint line. In 40% no specific joint line could be identified. CONCLUSION: After radiolunate arthrodesis the carpus remains unchanged in the long run in nearly a third of cases. But even if secondary arthritis or further arthritic destruction occurs as in the remaining cases, the carpus shows an amazing capacity for adaptation. A new intracarpal joint line may develop or the midcarpal joint re-establishes itself.
Arthritis, Rheumatoid↗
A comparison of two indices for ulnar translation and carpal height in the rheumatoid wrist.
The indices for ulnar translation described by Chamay et al. (1983, Annales de Chirurgie de la Main, Vol. 2, pp. 5-17), and Bouman et al. (1994, Journal of Hand Surgery Vol. 19B, pp. 325-329), and for carpal height described by Youm et al. (1978, Journal of Bone and Joint Surgery, Vol. 40A, pp. 423-431) and Bouman et al. (1994) were compared in pre- and postoperative wrist X-rays of 91 patients with rheumatoid arthritis undergoing radiolunate arthrodesis. Both indices described by Bouman had a higher applicability and sensitivity than the Chamay and Youm indices and are recommended for use with the rheumatoid wrist. However false-negative values may result when the Bouman index for ulnar translation is used to follow up radiolunate arthrodesis.
Arthritis, Rheumatoid↗
[Complex regional pain syndrome type I (CRPS I). Pathophysiology, diagnostics, and therapy].
Complex regional pain syndrome type I (CRPS type I)--formerly termed Sudeck's atrophy or reflex sympathetic dystrophy (RSD)--causes chronic, poorly controllable pain, autonomic, sensorimotor disorders,and serious trophic alterations in the later stages. It develops in the distal extremities mostly after minimal trauma or surgical intervention and rarely spontaneously. The severity of symptoms is disproportionate to the causative event. The latest scientific findings show that the previously called reflex sympathetic dystrophy (RSD), which was supposed to be a result of a hyperreactive autonomic nervous system,is a very complex syndrome that occurs on different integration levels of the nervous system. Sympathetically maintained pain (SMP) may be facultatively characteristic, but is not to be misunderstood as an underlying mechanism. A neurogenic inflammation reaction has recently been discussed, just as had been postulated by Paul Sudeck long before. That was the reason why the International Association for the Study of Pain (ISAP) introduced the more descriptive term "complex regional pain syndrome" (CRPS) type I in 1994. Due to the complexity of the process necessitating qualified knowledge, it is important to immediately refer patients to a specialized pain OPD or clinic. The diagnosis of CRPS type I is based upon a carefully taken case history and a clinical examination by an experienced practitioner. Imaging diagnostic tools and laboratory findings are of no or only low predicative value. The question of whether SMP exists after diagnosing CRPS type I is eminent for therapy planning. Therefore, diagnostic regional anesthetics are still important in spite of their uncertain prognostic relevance. Physical therapy, occupational therapy, medical treatment, and psychotherapy play an important role in the primary treatment of CRPS type I as noninvasive procedures. Despite heavy criticism, invasive sympathetic block, subsequent to adequate diagnostics, is an important part of the therapeutic concept. A multimodal therapeutic concept, which includes all available possibilities, is absolutely necessary to avoid grave permanent disabilities caused by insufficient or failed therapy. Nevertheless, already established as well as new treatment modalities have to be critically observed by further randomized, prospective control trials.
Autonomic Nervous System↗
[Imaging in rheumatoid arthritis of the elbow].
Early specific radiologic changes of rheumatoid arthritis can usually be detected in the hands and feet. Later stages of the disease process show a typical centripetal spread of the affected joints, i.e., shoulder, elbow, and knee. For prognostic assessment of cubital rheumatoid arthritis, conventional radiography still remains the gold standard. X-rays allow objective scoring and thus classification into standardized stages. A concentric destruction of the rheumatic joint as compared to deformity in the degenerative joint is the typical radiologic symptom to look for. For soft tissue assessment, ultrasound (US) should be the diagnostic tool of choice. Due to the thin surrounding soft tissue layer, as well as the advanced high-resolution technology, bony structures can also be well demonstrated in any plane. In the early arthritic stages, particularly the small changes, e.g., minimal erosions of the cortical area, are very well detectable by US. The use of "color" allows good evaluation of the synovial inflammatory status. Modern imaging methods such as computer- assisted tomography (CAT) scan and magnetic resonance imaging (MRI) are restricted to a few set indications and should not be chosen for routine examination. More invasive methods such as arthrography are no longer indicated for assessment of cubital rheumatoid arthritis.
Arthritis, Rheumatoid↗
Neurophysiological recovery after open carpal tunnel decompression: comparison of simple decompression and decompression with epineurotomy.
Two hundred and seventy-three patients with carpal tunnel syndrome without advanced neurophysiological changes (distal motor latency below 11 ms) were randomized to treatment by open carpal tunnel release with, or without, epineurotomy. Patients were examined clinically and by nerve conduction studies preoperatively and at 3, 6 and 12 months postoperatively. We found no statistically significant difference between simple decompression and decompression combined with epineurotomy with regard to either the clinical or the neurophysiological outcome.
Carpal Tunnel Syndrome↗
[The rheumatoid wrist. Pathobiomechanics and therapy].
A stable and pain-free wrist is a prerequisite for normal hand function. Since the wrist joint is involved early in rheumatoid disease and progress is rapid, operative treatment is of major importance. It is indicated not only for treatment of established osseous changes with instability, deformation, and extensor tendon ruptures but for early treatment of drug-resistant synovitis and monarthritis of the wrist.A considerable number of operative procedures is available: arthroscopic or open synovectomy of the radio- and midcarpal as well as the distal radioulnar joint, possibly with resection of the ulna head, partial arthrodeses, complete arthrodeses,and arthroplasty. When choosing the procedure, type and stage of wrist changes as well as the pathobiomechanic situation have to be considered. The individual course of the disease and patient requirements have to be taken into account.Thus, for long periods of time a pain-free stable wrist can be preserved, albeit sometimes with only limited but functional mobility.
Adult↗
Radiolunate arthrodesis in the rheumatoid wrist: a retrospective clinical and radiological longterm follow-up.
A retrospective study was performed to investigate the clinical and radiological results of radiolunate arthrodesis in the rheumatoid wrist. Ninety-one wrists in 78 patients were assessed at a mean follow-up of 60 months. Most patients were pain-free and content with the overall result. In 68 wrists the carpus had been repositioned or maintained in neutral or slightly ulnar alignment and no further translation occurred. Midcarpal dislocation occured in ten and midcarpal rotation in 13 wrists. The midcarpal joint underwent further arthritic destruction in 34 wrists and secondary arthrosis in 32 wrists. In 25 wrists the midcarpal joint space remained unchanged. Radiolunate arthrodesis can successfully be performed in wrists even with advanced destruction. In cases with fixed carpal collapse, anatomical repositioning of the lunate and restoration of carpal height should not be attempted as this causes midcarpal dislocation or rotation or precipitates secondary arthrosis.
Adult↗
[Problems of the musculoskeletal system in amateur orchestra musicians under special consideration of the hand and wrist].
Studies on professional orchestra musicians have shown a high incidence of physical problems mainly on the level of the musculoskeletal system. At the same time, the individual instrument groups differ in the types and patterns of complaints. So far, no study on amateur orchestra musicians has been conducted. We therefore interviewed the 130 members of the "Bayerisches Arzteorchester", all members being amateur musicians. The complaints were documented and compared with those of professional orchestra musicians. 84 % of the musicians had physical problems, 74 % involving the musculoskeletal system. The high string players suffered mainly from shoulder-neck problems, cellists and bassists complained of neck and lumbar spine problems. Wind players suffered at the spine and woodwind players at individual digits. The hand was affected in 39 % of the musicians. The complaints voiced by amateur musicians are essentially identical with those found in professional musicians.
Adult↗
[Interest in early active controlled mobilization and flexion following flexor tendon repair in zone 2].
INTRODUCTION: Primary repair of flexor tendons in zone II of the hand and early post-operative rehabilitation is no longer challenged. However, early rehabilitation methods vary from one unit to another. Although currents techniques such as of Kleinert's and Duran's have brought considerable improvements in functional outcomes, they do not allow early active motion of repaired flexor tendons. METHODS: A promising method of active controlled mobilization has been proposed by the Bordeaux Hand Unit and adopted by our rehabilitation unity since 1995. The aims of this method are: to avoid of proprioceptive inhibition linked to passive methods and prevention of adhesions. This method has been assessed by a prospective study of 22 consecutive patients with average follow-up of 11.8 months. RESULTS: Our rating was based on the Strickland scoring technique. 81% of good and excellent results were observed. Our score rates confirm the results published by others authors who have applied the same active protocols. The results observed in our series tend to confirm the advantages of early controlled active mobilization techniques and lead us to pursue their application in the future.
Adolescent↗
Bone-tendon ligamentoplasty for chronic ulnar instability of the thumb metacarpophalangeal joint: an anatomic reconstruction of the ulnar collateral ligament.
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Journal Article↗
Proximal fractures of the fifth metacarpal: a retrospective analysis of 25 operated cases.
The clinical and radiological outcomes of 25 surgically treated fractures of the proximal third of the fifth metacarpal were retrospectively analysed. Many different methods of osteosynthesis were used. At follow-up after a mean of 3.3 years, 15 of 25 patients had no pain. Most patients regained a nearly full range of motion in the adjacent joints and more than 90% of the contralateral grip strength. X-ray signs of degenerative arthritis in the metacarpohamate joint were observed in 10 of 25 patients. Pain was found to be directly correlated with the presence of degenerative changes.
Adolescent↗
[Treatment of a radio-ulnar synostosis by resection and interposition of a septofascial flap--a case report].
Posttraumatic bone formation between radius and ulna can limit forearm rotation considerably. Recurrence after resection of synostoses is likely to develop if the bony surfaces are not covered by gliding soft tissue that is well vascularised. The interposition of a fascial forearm flap pedicled on the septal vessels of the posterior interosseous artery is suitable for this particular purpose. We report on the case of a spontaneous radioulnar synostosis by cartilaginous exostoses and its treatment by resection and interposition of a vascularised fascial flap. Forearm rotation was restored to normal. Until two years postoperatively there has been no recurrence of the synostosis.
Adolescent↗