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Biomedical subjects

R S Richards

Publications and source records attributed to R S Richards.

34 records · Page 2Linked to original sources
PubMed1995

Combined central slip and volar plate injuries at the PIP joint.

PIP joint injuries are common. We describe an unusual injury in which an apparent volar plate avulsion injury was associated with a dorsal, central slip avulsion fracture. We postulate that the mechanism of injury would appear to have been forced flexion with the central slip being avulsed and the volar plate fracture occurring as a secondary impingement fracture. Our two cases were treated with full extension splinting with satisfactory results.

Adolescent↗
PubMed1995

Percutaneous A1 pulley release: a cadaveric study.

Percutaneous A1 pulley release was performed on 17 fresh-frozen cadaveric hands with a 14-gauge angiocath needle. Each hand was then explored to assess the adequacy of release and the degree of injury to adjacent structures. Complete release of the A1 pulley was obtained in 45 of the 66 fingers and in 10 of the 17 thumbs. Significant injury to the flexor tendons was observed in two digits. All tendon injuries occurred along the line of the fibers. There were no digital nerve injuries. The release was within 2 mm of a thumb digital nerve in seven hands and the little finger ulnar digital nerve in two. In the thumb, the close proximity of the digital nerves makes percutaneous trigger digit release potentially hazardous. With the little finger held in abduction the risk of digital nerve injury or inadequate release is reduced. Percutaneous trigger finger release can be safely performed in the index, long, and ring fingers.

Cadaver↗
PubMed1995

Arthroscopic treatment of triangular fibrocartilage tears.

Lesions of the TFCC are more frequently implicated as a cause of ulnar-sided wrist pain. Accurate diagnosis of TFCC pathology must be based on a thorough history and physical examination. Imaging modalities of particular use include plain radiographs, triple compartment arthrography, and MR imaging. The most sensitive and accurate diagnosis of the extent as well as the clinical significance of intra-articular pathology on the ulnar side of the wrist is by means of the arthroscope. With the advent of smaller and more elaborate arthroscopic instrumentation, the ability to perform arthroscopic surgery on the TFCC has dramatically increased over the past decade. The present arthroscopic treatment of traumatic central and radial lesions consists of debridement of unstable flaps, whereas dorsal and ulnar-sided lesions can be directly repaired. Centrally located degenerative perforations can be debrided in conjunction with an arthroscopic wafer procedure on the distal ulna.

Arthroscopy↗
PubMed1994

The palmar cutaneous branch of the median nerve and the palmaris longus tendon: a cadaveric study.

The purpose of this study was to determine the frequency with which the palmar cutaneous branch of the median nerve passes through the palmaris longus tendon. Fifty-two wrists (27 cadavers) were dissected. In three wrists the palmaris longus tendon was absent. The palmar cutaneous branch was seen to course through the fibers of the palmaris longus in two specimens (different cadavers). The nerve passed through the tendon 1 and 1.5 cm proximal to its insertion into the palmar aponeurosis. In the presence of this anomaly the palmar cutaneous branch of the median nerve is at risk of injury during harvesting of the palmaris longus tendon for grafts. To avoid injury, we recommend transecting the tendon 2 cm proximal to its insertion into the palmar aponeurosis.

Cadaver↗
PubMed1994

Simultaneous proximal row carpectomy and radius to distal carpal row arthrodesis.

We assessed the functional results of simultaneous proximal carpal carpectomy and radius to distal carpal row arthrodesis. A retrospective review of patients undergoing wrist arthrodesis for degenerative joint disease was performed. Patients with rheumatoid arthritis or spastic hemiplegia were excluded. Simultaneous proximal row carpectomy and radius to distal carpal row arthrodesis was performed in 38 patients using AO plates and 3.5 mm diameter screws. The mean follow-up time was 16 months, the fusion rate was 100%, and the average grip strength was 24 kg force or 79% of the contralateral hand measured at 10 degrees wrist extension. Patients with three or more screws placed in the metacarpal had significantly more plate-related complications and a higher rate of plate removal than those with two screws distally. Simultaneous proximal row carpectomy and radius to distal carpal row arthrodesis did not decrease the postoperative grip strength.

Adult↗
PubMed1994

Endoscopic carpal tunnel release.

OBJECTIVE: To assess the efficacy and safety of a new technique for carpal tunnel release. DESIGN: A single-group prospective cohort study. SETTING: A referral-based hand-surgery university practice. PATIENTS: Ninety-five consecutive adults; 1 patient was excluded (35 men, 59 women). They underwent 108 surgical procedures. No patients were lost to follow-up. INTERVENTIONS: Endoscopic carpal tunnel release. Outpatient surgery with neuroleptic anesthesia. Two-portal Chow technique of release. MAIN OUTCOME MEASURES: Symptom relief, return to work, medication use and complication rate. RESULTS: The average preoperative duration of symptoms was 3.9 years. Nerve conduction studies were positive in 101 of the 108 hands. Only two patients required open release. Only eight patients complained of intraoperative pain. Six patients failed to obtain relief of symptoms; two of them required secondary open release owing to persistent symptoms. Of the 61 patients who were employed, 52 returned to their previous jobs without restriction. The mean time for return to work was 36.4 days for patients who were Workers' Compensation Board cases and 19.5 days for patients who were not (p < 0.01). Men returned to work in 17.7 days and women in 24.7 days (p < 0.05). Complications occurred in four patients (3.8%). No nerve injury, vascular injury or reflex sympathetic dystrophy was noted. Patients who had undergone previous contralateral open release noted less pain and earlier return to work after endoscopic carpal tunnel release. CONCLUSIONS: Endoscopic carpal tunnel release was effective in relieving symptoms and had a low complication rate. The technique was associated with early return to work and minimal palmar pain.

Adult↗
PubMed1993

Functional outcome of upper limb tendon transfers performed in children with spastic hemiplegia.

Children with spastic hemiplegia often present with upper limb muscle imbalance. The purpose of this paper was to determine whether reconstructive surgery improved their functional ability. 17 children under the age of 16 years with spastic hemiplegia underwent reconstruction that included tendon transfers, tendon lengthenings and thumb metacarpophalangeal fusion. They were assessed pre-operatively and at an average follow-up period of 2.6 years. Children's abilities were classified according to House's functional rating scale. Tendon transfers improved functional grading by two grades, from good passive assist to fair active assist. Improvement in the arc of wrist motion and forearm rotation was also seen. Parental satisfaction was high. Reconstructive surgery improved the functional abilities in this group of children with spastic hemiplegia.

Adolescent↗
PubMed1993

Ulnar artery palmar to palmaris brevis: cadaveric study and three case reports.

Three cases in which the ulnar artery was palmar to the palmaris brevis muscle at the level of the wrist are described and the results of a cadaveric study are presented. The anomaly was confined to the level of Guyon's canal with a normal position of the artery proximally in the forearm and distally in the palm. In spite of its superficial location, the artery was patent in all patients and no symptoms referable to the ulnar artery were present. The ulnar nerve was found dorsal to the palmaris brevis in Guyon's canal in all three patients. An accessory muscle was found in one patient, but no other anatomic anomalies were seen. A cadaveric study of 43 limbs revealed a similar anomaly of the ulnar artery in 1 cadaver. In the presence of this anomaly the ulnar artery may be at increased risk during surgical exploration of Guyon's canal. Exposure of the artery in the forearm prior to exploration of Guyon's canal is recommended.

Cadaver↗
PubMed1993

Use of the external fixation apparatus for percutaneous insertion of pins in the distal one-third of the radius: an anatomic study.

OBJECTIVE: To assess the risk of soft-tissue injury during percutaneous placement of external fixation pins in the proximal radius. DESIGN: An anatomic study with embalmed cadaver limbs. SETTING: Hand and upper limb centre at a university-affiliated hospital. INTERVENTIONS: Two 4-mm Hoffman half pins were percutaneously placed along the dorsoradial ridge of the radius, four finger breadths proximal to the radial styloid process. MAIN OUTCOME MEASURES: Injuries to soft tissues including tendons, nerves and vessels were noted. RESULTS: Nerve or tendon injuries occurred in 7 of 26 forearms. Three pins transfixed either the superficial branch of the radial nerve or lateral antebrachial cutaneous nerves. Tendon injuries included the brachioradialis in two forearms, the extensor carpi radialis brevis in three forearms, and the extensor carpi radialis longus and the abductor pollicis longus in one forearm each. CONCLUSIONS: Percutaneous pin placement in the distal radius is unsafe. The authors recommend open pin placement for fractures of the distal radius.

Bone Nails↗
PubMed1992

Microsurgical free flap transfer in sickle cell disease.

A patient with sickle cell anemia and recurrent ankle ulceration is presented. Multiple previous skin grafts did not resolve the painful ulcers. A radial forearm free flap was attempted. Despite preoperative transfusions to reduce her hemoglobin S levels, postoperative thrombosis occurred. The true risk of free flap failure in sickle cell anemia is unknown and there is still debate about the exact nature of the hypercoagulable state that exists in this disease. We recommend, however, that consideration is given to the use of prophylactic anticoagulation in patients undergoing complex procedures or in whom other risk factors have been identified.

Adult↗
PubMed1986

Prostatic carcinoma: 5-year followup of patients with surgically staged disease undergoing extended field radiation.

We analyzed all patients who had undergone pre-radiation staging pelvic lympadenectomy from 1969 to 1979. Of 70 patients with a minimum followup of 5 years 33 had positive and 37 had negative nodes. Three of the 33 patients with positive lymph nodes were alive without disease at the time of our study, compared to 20 of 37 with negative lymph nodes. Our review suggests that extended field radiation has minimal or no impact on the natural history of prostatic carcinoma in patients with positive nodes. Patients with stages T1 and T2 lesions, and negative nodes do well with external beam therapy.

Carcinoma↗
PubMedDate not supplied

Patient rating of wrist pain and disability: a reliable and valid measurement tool.

OBJECTIVE: The goal of this study was to develop a reliable and valid tool for quantifying patient-rated wrist pain and disability. DESIGN: Survey, tool development, reliability, and validity study. SETTING: Upper extremity unit. PARTICIPANTS: One hundred members of the International Wrist Investigators were surveyed by mail to assist in development of the scale. Patients with distal radius (n = 64) or scaphoid (n = 35) fractures were enrolled in a reliability study, and 101 patients with distal radius fractures were enrolled in a validity study. INTERVENTION: Information from the expert survey, biomechanical literature, and patient interviews was used as a basis for item generation and definition of structural limitations for a scale that would be practical in the clinic. Patients with distal radius or scaphoid fractures completed the Patient-Rated Wrist Evaluation (PRWE) on two occasions to determine test-retest reliability. Patients with distal radius fractures (n = 101) completed the PRWE and the SF-36 and were tested with traditional impairment measures at baseline and at two, three, and six months after fracture to determine construct and criterion validity. MAIN OUTCOME MEASURES: Reliability coefficients (ICCs) and validity correlations (Pearson product moment correlations). RESULTS: Patient opinions on pain and on ability to do activities of daily living and work were thought to be the most important dimensions to include in subjective outcome tools. Brevity and simplicity were seen as essential in the clinic environment. A fifteen-item questionnaire (the PRWE) was designed to measure wrist pain and disability. Test-retest reliability was excellent (ICCs > 0.90). Validity assessment demonstrated that the instrument detected significant differences over time (p < 0.01) and was appropriately correlated with alternate forms of assessing parameters of pain and disability. CONCLUSIONS: The PRWE provides a brief, reliable, and valid measure of patient-rated pain and disability.

Activities of Daily Living↗