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Biomedical subjects

T G Wadsworth

Publications and source records attributed to T G Wadsworth.

At least 19 recordsLinked to original sources
PubMed1993

Prosthetic replacement of the arthritic elbow.

According to the recent literature, overall, results appear to be improving with elbow prosthetic surgery for severe arthritic problems, most cases being due to rheumatoid disease. However, a significant challenge remains: although data is accumulating, longer-term follow-up and greater numbers of patients need to be assessed before this area of surgical reconstruction emerges from the clinically experimental stage. It can be seen from the literature reviewed here that prosthetic loosening within bone, displacement of the articular surface of the implant, infection, and neurologic deficit, particularly of the ulnar nerve, can be unfortunate sequelae of prosthetic replacement of the elbow for severe arthritis. Osteoarthritis of the elbow is a good deal less common than rheumatoid disease of this joint, and the severe case is sometimes dealt with by prosthetic replacement; an alternative, in well selected cases, is the somewhat less challenging procedure of lower humeral fenestration arthroplasty. Revision of a failed elbow prosthesis can be a difficult challenge for the surgeon; the alternatives in this unfortunate situation are the use of an external brace, resection arthroplasty, or arthrodesis, all of them far from ideal. Many rheumatoid patients who undergo elbow prosthetic surgery have very significant shoulder involvement. Because of painful restriction of rotation of the gleno-humeral articulation, in particular, added forces are brought to bear on the elbow, making this one of the important factors in loosening of fully constrained prostheses. So far, there has been no long-term report of combined elbow and shoulder prosthetic replacement in such individuals, which is at present typically performed on separate occasions.

Arthritis↗
PubMed1979

A modified posterolateral approach to the elbow and proximal radioulnar joints.

A modified posterolateral approach is useful for extensive exposure of the elbow and proximal radioulnar joints. The patient is placed prone and the elbow flexed over a padded support: a pneumatic tourniquet is placed proximally on the arm. The laterally curved skin incision extends from the center of the posterior surface of the arm, at the upper limit of the triceps tendon, to the back of the lateral epicondyle and thence to the posterior border of the ulna 3 finger-breadths distal to the tip of the olecranon. The large medial and smaller lateral flaps are secured with sutures. The ulnar nerve is exposed and protected. A distally based tongue of triceps tendon is fashioned and retracted downwards. The anconeus is separated from the extensor carpi ulnaris muscle and retracted medially with the underlying capsule. The common extensor origin and the lateral collateral ligament, with the adjacent capsule, are partially reflected from the humerus. Excellent exposure of the elbow and proximal radioulnar joints is easily achieved and visualization can be increased by putting a varus strain on the elbow.

Elbow Joint↗
PubMed1977

The external compression syndrome of the ulnar nerve at the cubital tunnel.

Diagnosis of the cubital tunnel external compression syndrome, and subsequent avoidance of further external pressure, minimizes the possibility of progressive crippling of the hand. The usual clinical features are local tenderness over the cubital tunnel, often accompanied by distal paresthesias, and neurological deficit in the ulnar nerve distribution with sparing of the flexor digitorum profundus and flexor carpi ulnaris muscles; the elbow flexion test, described by the author, awaits evaluation in the diagnosis of the syndrome. Clinicians and others concerned with positioning patients on the operating room table or caring for patients in the ward should be aware of the syndrome. Avoidance of a position of the elbow which predisposes to external compression of the cubital tunnel is mandatory and active elbow movement should be encouraged in bedridden and chair-bound patients. Surgical treatment is sometimes indicated, at least to halt progression of the palsy. A classification of the cubital tunnel syndrome is proposed: physiological, acute and subacute due to external pressure (both forming the cubital tunnel external compression syndrome) and chronic (space-occupying lesions and loss of volume due to lateral shift of the ulnar as a consequence of childhood injury to the capitular epiphysis). Nerve conduction studies may be helpful in the diagnosis of the doubtful cubital tunnel syndrome, particularly when there is definite impairment of power or sensation in the hand.

Acute Disease↗
PubMed1976

Screw fixation of the olecranon after fracture or osteotomy.

For 10 years prior to the availability of the Olecranon Screw described in this article, oblique fixation using a regular Sherman bone screw was employed for displaced fractures (with a suitable fragment) by engaging the anterior ulnar cortex. Internal fixation was supplemented by a split for 3 weeks. The reason for a special olecranon screw is to eliminate the necessity for additional fixation and permit early motion. No instance of non-union or important restriction of motion or serious complication has been encountered.

Adult↗
PubMed1973

Cubital tunnel external compression syndrome.

External compression of the cubital tunnel comprises the acute and subacute forms of ulnar nerve compression at the elbow. Subacute compression is often seen in hospital practice and sometimes results in partial crippling of the hand. Prognosis for complete recovery is poor. Avoidance of a position of the elbow which predisposes to external compression of the ulnar nerve within the cubital tunnel is advised when a patient is on the operating table, in bed or in an armchair. Prolonged severe elbow flexion in these circumstances should also be avoided. The patient suffering from the syndrome should be instructed to avoid further pressure so that worsening of the palsy is minimized. A compressed nerve is likely to be more sensitive than a normal nerve to ischaemia produced by subsequent pressure. Surgical treatment is sometimes indicated at least to halt progression of the palsy.

Acute Disease↗