PubMed · 14339977
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A GLAUBER. 1965. [HABITUAL ELBOW DISLOCATION].. https://pubmed.ncbi.nlm.nih.gov/14339977/
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Focal demyelinating lesions typically occur within a 1-cm segment of a nerve. In electrodiagnostic studies, measurements over longer distances decrease the chance of detecting such lesions, but measurements over shorter distances result in greater experimental error. Our objective was therefore to determine the optimal screening distance for ulnar neuropathy at the elbow (UNE) incorporating previously derived experimental errors for calculating nerve conduction velocity (NCV). Using a lesion model wherein prolongation of 0.4 ms was added to the expected latency of a 1-cm nerve segment, new NCVs were derived for distances between 1 and 10 cm for nerves normally conducting between 40 and 65 m/s. Lesion detection, or sensitivity, was defined as the likelihood of calculating a decrease of 10 m/s from the normal NCV while including the experimental error. Specificity was related to the likelihood of an inadvertent calculation of such a decrease in NCV in a segment without a lesion. Sensitivity and specificity were derived at multiple distances with varying NCVs. The total percentage error was the sum of the false-negative and false-positive percentages. The least total percentage error occurred at 3-4 cm, 4-6 cm, and 6-8 cm for nerves normally conducting at 40-50 m/s, 50-60 m/s, and 60-65 m/s, respectively. We conclude that the optimal distance for screening UNE, considering both sensitivity and specificity, is significantly less than 10 cm, perhaps as low as 4-6 cm; considering in addition the likely locations of focal lesions, the best distance is 6-8 cm.
PURPOSE: Various surgical repair techniques for distal biceps tendon ruptures have been reported, however, the optimal technique is unknown. METHODS: Over a 4-year period 19 distal biceps tendon ruptures were repaired: 9 using a single anterior incision and 10 using a modified 2-incision Boyd and Anderson technique. The patients were followed-up prospectively and independently reviewed. RESULTS: Patient-rated elbow evaluation and Short Form-36 (SF-36) scores improved with time independent of surgical technique. At 1 year the 1-incision group regained more flexion (142.8 degrees vs 131.1 degrees ) than the 2-incision group. There was no difference between groups in supination motion, supination strength, or flexion strength, although recovery of flexion strength was initially more rapid for the 2-incision group. Complications were encountered in 44% of cases treated with a 1-incision technique and in 10% of cases treated with the 2-incision technique; however, most of these were minor transient paresthesias. CONCLUSIONS: The differences between the 2 groups were relatively minor with the Morrey 2-incision technique showing a slightly more rapid recovery of flexion strength and fewer complications as compared with the 1-incision technique.
BACKGROUND: Only few studies have tested different ergonomic aspects of the working posture assumed by laparoscopic surgeons. Although no experimental data are available for a laparoscopic setting, a working posture with a horizontal forearm or an elbow angle 90 degrees to 120 degrees has been recommended for performing minimally invasive surgery (MIS). The comparison of electromyogram (EMG) activities in different muscles provides information about the force developed by each muscle and allows assessment of its contribution to a functional movement. The current study aimed to investigate whether certain handles do not support this posture. METHODS: For this study, 12 volunteers were postured in two different standardized arm positions, defined by elbow angles of 90 degrees and 120 degrees. They were manipulating a 0.1-N and a 2.5-N microswitch with four different types of instrument handle design: axial handle, ring handle, shank handle, Hirschberg handle. During the test, the EMG activities of five forearm muscles were recorded and normalized with respect to the maximum voluntary activity of the respective muscle. RESULTS: Virtually no significant difference in EMG activity was found between the two elbow angles in any of five forearm muscles for a simple grasping maneuver. Thus, the muscle activity required to manipulate different types of MIS handles is similar for the elbow angles of 120 degrees and 90 degrees. CONCLUSIONS: The current study did not show relevant differences between the two elbow angles for any of the four handles during a simple grasping maneuver with respect to the force required in the main forearm muscles.