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Biomedical subjects

T L Greene

Publications and source records attributed to T L Greene.

At least 37 records · Page 2Linked to original sources
PubMed1987

Treatment of unstable metacarpal and phalangeal fractures with tension band wiring techniques.

The techniques of tension band fixation are applied in the treatment of metacarpal and phalangeal fractures. The technique uses standard, readily available materials. The variability of the fixation techniques allows for secure fixation of virtually any long bone fracture in the hand, even when other methods are not applicable. Nonunion, malunion, loss of fixation, infection, or tendon rupture have not occurred. The technique allows for early active motion and return to full activity usually within for to six weeks. Most patients achieve full painless motion in that time.

Adult↗
PubMed1986

Scaphoid-trapezium-trapezoid fusion in the treatment of chronic scapholunate instability.

Limited intercarpal arthrodesis for chronic scapholunate instability has been the subject of several recent publications. We have followed nine patients, who had scapho-trapezio-trapezoidal (S-T-T) fusion for scapholunate instability. All nine patients were re-examined recently after an average follow-up period of 19 months (range, 12 to 25 months). Six of the nine patients believed that their symptoms were significantly improved. The postoperative range of wrist motion (ROM) was decreased in all directions of motion. The pinch strength averaged 86% on the treated side and the grip strength averaged 74% of the unoperated side. Review of follow-up x-ray films showed radiographic evidence of union in eight of nine patients. We conclude that, with careful patient selection and close attention to operative detail, S-T-T fusion can be an effective treatment for scapholunate instability. However, the results are not uniformly predictable, and neither range of motion nor strength is normal after the procedure.

Adolescent↗
PubMed1985

Digital nerve grafting using the dorsal sensory branch of the ulnar nerve.

The dorsal sensory branch of the ulnar nerve has been found to have the appropriate size and sufficient length for use as a digital nerve graft. This donor nerve was utilised fifteen times in twelve patients for the bridging of defects in thirteen digital nerves of the fingers. After an average follow-up of 23.2 months, only one patient failed to achieve any two point discrimination in the area supplied by the involved digital nerve. The other eleven patients had an average two point discrimination of 9.5 mm with a range of 5 to 18 mm. Painful neuroma formation or loss of hand function related to the use of the dorsal sensory branch of the ulnar nerve as a donor for digital nerve grafts was not encountered.

Adolescent↗
PubMed1985

Carpal tunnel release: analysis of suboptimal results.

The results of carpal tunnel release are generally good, but not all patients obtain complete and long lasting relief. Persistence of signs and symptoms after adequate decompression of the median nerve is uncommon. Forty-seven suboptimal results in thirty-four patients have been evaluated to determine the reasons for failure. Thirty-eight of the suboptimal results (81%) were associated with the persistent neck pain and/or abnormal cervical radiographs (typically narrowing of C5-6 and/or C6-7 disc spaces). This retrospective review supports a "double crush" phenomenon that influences both the manifestations of carpal tunnel syndrome and the outcome of its treatment.

Adult↗
PubMed1985

Lipofibromas of the median nerve: long-term follow-up of four cases.

Four cases of lipofibromatous infiltration of the median nerve with long-term follow-up (average 11 years) are reported. Progressive compromise of median nerve function has been noted. Initial treatment considerations should be directed toward biopsy and alleviation of the compression neuropathy. The role of microsurgical debulking procedures remains unclear at this time.

Adolescent↗
PubMed1985

The upper extremity and psychiatric illness.

Thirty-three patients who had various conversion reactions manifested by signs and symptoms involving the upper extremities were seen over a 13-year period. Factitious lymphedema, factitious ulcers, clenched fists, as well as other dysfunctional postures of the hand and upper extremity, were the most frequently recognized patterns of illness. Denial of knowledge of the cause of the physical problem and a lack of insight into the illness are major parts of the disease process. Twenty-nine of the 33 patients in this study had work-related and therefore compensable injuries. The physical signs and symptoms resolved in four of the patients when compensation was withdrawn. The average follow-up in this study was 4 1/2 years. Unfortunately, the long-term follow-up of these patients revealed that this disease process was chronic and most frequently failed to resolve. Various efforts at treatment have been unsuccessful, including extensive psychotherapy. Confrontation with the patient is contraindicated.

Adolescent↗
PubMed1985

Fluoroscopic and arthrographic evaluation of carpal instability.

The efficacy of a diagnostic protocol involving videotape fluoroscopy of carpal motion and radiocarpal arthrography was evaluated in patients with wrist pain unexplained by physical examination and conventional radiographs. Videotape fluoroscopy was performed as the first study in 68 consecutive cases and was positive in 44 (66%). Radiocarpal arthrography was performed after videotape fluoroscopy in 39 of the cases (57%), including the 24 in which videotape fluoroscopy was normal and 15 others in which further information was desired in spite of positive videotape fluoroscopy. The addition of radiocarpal arthrography to videotape fluoroscopy increased the diagnostic yield to 52 (76%) of the 68 cases and excluded significant anatomic or dynamic abnormality in the others. The diagnosis was proven surgically in 25 cases. This protocol was efficacious for ligament tears of the proximal carpal row, triangular fibrocartilage tears, and proximal and midcarpal instability. Videotape fluoroscopy should be the primary method of evaluating patients with unexplained wrist pain, and arthrography should be done in those cases in which fluoroscopy is either normal or does not fully explain physical findings.

Adolescent↗
PubMed1985

Complications of carpal tunnel surgery.

During a 12-year period, the authors treated 25 patients with 26 complications of previous carpal tunnel surgery. Twenty-four of these patients were referred following initial surgery elsewhere. The most frequent complication identified was neuroma of the palmar cutaneous branch of the median nerve in 14 of the cases. Other complications were hypertrophic scars, dysesthesias after multiple procedures to release the carpal tunnel, joint stiffness, failure to relieve symptoms, and neuromas of the dorsal sensory branch of the radial nerve. All of these complications are potentially preventable. With a properly placed incision, exposure carried out under magnification, and surgery under direct vision the majority of these complications may be prevented. It is further noted that the technique of transverse incision at the wrist for release of the carpal tunnel is potentially dangerous and should be abandoned.

Adult↗
PubMed1984

Fibroma of tendon sheath.

Fibroma of tendon sheath is a benign soft tissue tumor that has a predilection for the hand. It is histologically distinct from giant cell tumor of tendon sheath, a lesion with which it is commonly confused. A case is reported in a 35-year-old man whose tumor, which extended the whole length of the index finger, had been present for 6 years. This particular tumor is probably more common than has been previously recognized.

Adult↗
PubMed1984

Evaluation of normal values for stationary and moving two-point discrimination in the hand.

Stationary and moving two-point discrimination were tested in a normal population stratified by age and sex. The 467 subjects tested consisted of 202 females and 265 males whose ages ranged from 4 years to 92 years. Statistical analysis of the data revealed the following: (1) Moving two-point values were of lesser magnitude than stationary two-point values in all areas tested; (2) test values for median innervated areas were lower by both methods than values for ulnar innervated areas; (3) there was a gradual increase in the magnitude of the test values for both methods with advancing age; (4) female subjects consistently tended to discriminate at shorter distances when compared with male subjects at corresponding sites; and (5) the absolute values obtained were dependent upon the individual examiner, but the statistical significance applied to the data of all of the examiners.

Adolescent↗
PubMed1984

Traumatic upper arm defect treated with latissimus dorsi muscle transposition.

Transfer of the latissimus dorsi muscle was useful in restoring contour and function to a child's acutely injured upper extremity. The procedure provided protection for exposed vital structures. A split-thickness skin graft covered the exposed muscle. Transposition of the latissimus dorsi insertion was not necessary to obtain adequate elbow flexion.

Arm Injuries↗
PubMed1984

Capitate-lunate instability: recognition by manipulation under fluoroscopy.

Videotape fluoroscopy was used to diagnose a previously undescribed carpal dissociation, the capitate lunate instability pattern. In eight patients with midcarpal pain and clicking, the examiner simultaneously applied pressure to the scaphoid tuberosity while applying longitudinal traction and flexion to the wrist under fluoroscopic control. This maneuver revealed dorsal subluxation of the proximal carpal row and capitate lunate subluxation in each of the eight patients. Plain radiography and arthrography were not helpful in the diagnosis. All eight cases were managed conservatively. Videotape fluoroscopy is the best radiologic method of diagnosing capitate-lunate instability.

Adolescent↗
PubMed1980

Calcifying tendinitis in the hand.

Two cases of acute calcification in the hand are presented with a review of the clinical presentation, pathological findings, differential diagnosis, and treatment. The value of radiographic study is emphasized. A variety of conservative, non-operative treatments have been successfully utilized in the past and are reviewed. The importance of differentiating this infrequent problem from an acute infectious process is emphasized, inasmuch as hospitalization and surgical drainage may be indicated for an acute infection but not for cases of calcifying tendinitis.

Acute Disease↗
PubMedDate not supplied

Back pain and vertebral changes simulating Scheuermann's disease.

Nineteen adolescent patients who presented with mechanical-type back pain and vertebral changes consisting of intravertebral disc herniation, disc space narrowing, and minimal wedge deformity are described. The symptoms and signs were primarily located at the dorsolumbar junction. A specific strenuous activity or traumatic event was clearly associated with the onset of symptoms in 16 of the 19 patients. Spondylolysis or spondylolisthesis (grade I or II) at L5-S1 was also found in 32% of the patients. Most patients responded well to a program of rest, exercises, salicylates, and temporary avoidance of the particular activity involved. Some required orthoses to obtain relief. No patient had a progressive kyphotic deformity during the follow-up period. The relationship of this condition to increased stresses applied to the immature spine, particularly in a preflexed posture, is emphasized.

Adolescent↗
PubMedDate not supplied

Nonepiphyseal ossification and pseudoepiphysis formation.

Direct ossification extending from the metaphysis into the epiphysis preceded and continued to be more mature than formation and expansion of the typical epiphyseal ossification center at the opposite end of each longitudinal bone of the hand and foot. Direct metaphyseal to epiphyseal ossification usually started centrally and expanded hemispherically, replacing both physeal and epiphyseal cartilage simultaneously. When remnants of the "physis" were retained, however, while juxtaposed epiphyseal cartilage was replaced, a pseudoepiphysis formed. Three basic patterns of pseudoepiphysis formation were evident: (a) a central osseous bridge, (b) a peripheral osseous bridge, and (c) multiple bridging. In each condition, the remnant of the "physis" lacked typical cell columns capable of contributing to the postnatal longitudinal growth of the involved bone. Pseudoepiphyses were well formed by 4-5 years and coalesced with the rest of the bone months to years before skeletal maturation was attained at the opposite epiphyseal end.

Adolescent↗