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PubMed1989

Pathophysiology of navicular syndrome.

Navicular syndrome is a degenerative disorder of the distal half of the flexor surface of the proximal sesamoid bone that is predisposed by faulty foot conformation. In horses that become symptomatic, the faulty conformation results in sustained application of nonphysiologic pressure by the deep digital flexor tendon against the flexor cortex of the bone. This force stimulates an intense bone remodeling response in order to attenuate the pressure. An unfortunate sequela of this response is active hyperemia and edema formation in the medullary cavity of the bone. The edema is organized by fibrous tissue resulting in venous entrapment, venous hypertension, vascular bone pain, and the onset of clinical signs.

Animals↗
PubMedDate not supplied

MRI of the wrist.

In the past, the diagnostic imaging algorithm for evaluating the painful wrist included initial plain radiographic examination followed by arthrography, tomography, bone scintigraphy, or computed tomography. In recent years, magnetic resonance imaging (MRI) has been proven efficacious for diagnosing a number of maladies of the bones, ligaments, and soft tissues. MRI can be of aid in evaluation of carpal instability, disorders of the triangular fibrocartilage, ulnar impaction syndrome, distal radioulnar joint (DRUJ) instability, fracture, avascular necrosis (AVN), tendinopathy, nerve entrapment syndromes, synovial abnormalities, and soft tissue masses.

Carpal Bones↗
PubMed2001

Muscular buttonholing: An unusual cause of irreducible knee dislocation.

In cases of irreducible knee dislocation, all the medial joint structures have been reported to be the obstructing tissue. The case presented, the first in the English-language literature, is buttonholing of the femoral condyle through the vastus medialis muscle. Entrapment of the muscle bundle was diagnosed preoperatively using magnetic resonance imaging scans. The joint could be reduced easily, following sectioning of the muscle bundle.

Achilles Tendon↗
PubMed1993

[Recurrent acute occlusions of the popliteal artery before age 50: popliteal entrapment syndrome?].

Compression of the popliteal artery by the medial head of the gastrocnemius muscle is termed "Popliteal Artery Entrapment". The anatomical course of the artery can be normal or abnormal. The entrapment can cause occlusion of the artery or peripheral embolism. This syndrome is an important differential diagnosis in younger patients with recurrent peripheral arterial ischemia. Diagnosis is made by history, clinical findings, arteriography and CT-scan of the knees. All cases of popliteal artery entrapment, whether the artery is occluded or not, should be operated on.

Adult↗
PubMed2006

The treatment of disc-herniation-induced sciatica with infliximab: one-year follow-up results of FIRST II, a randomized controlled trial.

STUDY DESIGN: A randomized controlled trial. OBJECTIVES: To evaluate the long-term efficacy of infliximab, a monoclonal antibody against tumor necrosis factor alpha (TNF-alpha), in patients with acute/subacute sciatica secondary to herniated disc. SUMMARY OF BACKGROUND DATA: The results of experimental studies and our open-label trial support the use of infliximab in sciatica. Here we report the 1-year results of a randomized controlled trial (FIRST II, Finnish Infliximab Related STudy) evaluating the efficacy and safety of a single infusion of infliximab for sciatic pain. METHODS: Inclusion criteria were unilateral sciatic pain with a disc herniation concordant with the symptoms and signs of radicular pain. Patients had to be candidates for discectomy. Criteria for discectomy included (in addition to a symptomatic disc herniation on MRI) neural entrapment (straight leg raising [SLR] < or =60 degrees ) with either a short-term (2-4 weeks) severe or long-term (4-12 weeks) moderate leg pain. Forty patients were allocated to a single intravenous infusion of either infliximab 5 mg/kg or placebo. Differences in the clinical examination parameters (straight leg raise [SLR], muscle strength, sensory defects, tendon reflexes), patient-reported symptoms (leg and back pain using a visual analog scale [VAS], Oswestry disability, quality-of-life [RAND-36]), sick leaves, number of discectomies, and adverse effects between the two treatment groups over the 1-year follow-up were compared using Mann-Whitney U test or Student's t test, repeated-measures analysis, or Cox proportional hazards model. Logistic regression was used to assess the predictors of good response. RESULTS: Sixty-seven percent of patients in the infliximab group reported no pain at 52 weeks compared with 63% in the control group (P = 0.72). Similar efficacy was observed between treatment groups for other outcomes. Eight patients in each group required surgery. Three nonserious adverse reactions were encountered in the infliximab group. The response (irrespective of the treatment) was significantly better with shorter symptom duration and less SLR restriction at baseline. Patients in the infliximab group appeared to especially benefit in cases of a L4-L5 (or L3-L4) herniation and if a Modic change was colocalized at the symptomatic level. CONCLUSIONS: Although the long-term results of this randomized trial do not support the use of infliximab compared with placebo for lumbar radicular pain in patients with disc herniation-induced sciatica, further study in a subgroup of patients with L4-L5 or L3-L4 herniations, especially in the presence of Modic changes, appears to be warranted.

Acute Disease↗
PubMed2003

MT1-MMP-dependent, apoptotic remodeling of unmineralized cartilage: a critical process in skeletal growth.

Skeletal tissues develop either by intramembranous ossification, where bone is formed within a soft connective tissue, or by endochondral ossification. The latter proceeds via cartilage anlagen, which through hypertrophy, mineralization, and partial resorption ultimately provides scaffolding for bone formation. Here, we describe a novel and essential mechanism governing remodeling of unmineralized cartilage anlagen into membranous bone, as well as tendons and ligaments. Membrane-type 1 matrix metalloproteinase (MT1-MMP)-dependent dissolution of unmineralized cartilages, coupled with apoptosis of nonhypertrophic chondrocytes, mediates remodeling of these cartilages into other tissues. The MT1-MMP deficiency disrupts this process and uncouples apoptotic demise of chondrocytes and cartilage degradation, resulting in the persistence of "ghost" cartilages with adverse effects on skeletal integrity. Some cells entrapped in these ghost cartilages escape apoptosis, maintain DNA synthesis, and assume phenotypes normally found in the tissues replacing unmineralized cartilages. The coordinated apoptosis and matrix metalloproteinase-directed cartilage dissolution is akin to metamorphosis and may thus represent its evolutionary legacy in mammals.

Animals↗
PubMed1986

A rare human variation: the relationship of the axillary and inferior subscapular nerves to an accessory subscapularis muscle.

A case of bilateral occurrence of a variant subscapularis muscle is reported. The superior lateral aspect of each subscapularis muscle presented a small accessory muscle with an accompanying tendon that inserted into the lesser tubercle of the humerus along with the primary tendon of the subscapularis muscle. Each accessory subscapularis muscle was separated from the primary subscapularis muscle by the axillary and inferior subscapular nerves. No branches of the axillary or inferior subscapular nerves supplied the primary subscapularis muscle or the accessory muscle while the nerves passed through the myotendinous tunnel. The relationship of the nerves with the variant subscapularis muscles has clinical significance with regard to entrapment neuropathy.

Axilla↗
PubMed1992

[A case of malignant rheumatoid arthritis with corticosteroid-reactive subacute myelopathy and multiple peripheral neuropathy].

We reported a 64-year-old man who had malignant rheumatoid arthritis (MRA) and developed subacute myelopathy and peripheral neuropathy. He had suffered from seropositive rheumatoid arthritis for 4 years, and developed weakness of four limbs, dysuria and constipation two months before the admission. Neurological examination revealed the diffuse muscle wasting and weakness in four limbs. Deep tendon reflexes were hyperactive in four limbs, but not in jaw jerk. Babinski sign was positive bilaterally. Deep sensation was decreased in four limbs and superficial sensation was decreased below the neck. Dysuria and constipation were noted, but anal and bulbocavernosus reflexes were present. On laboratory examination, RF and RAHA increased markedly. Serum complements decreased and immune complexes were positive. Nerve conduction study demonstrated multiple entrapment neuropathy in addition to mononeuritis multiplex. Histological examination of the biopsied sural nerve disclosed the obliterating endarteritis in the epineurium, and marked decrease in number of myelinated fibers. No compressive lesions were seen in the spinal canal by spine X-ray and MRI. Assuming that inflammatory process induced cervical myelopathy, corticosteroid therapy (predonisolone 60 mg/day) was administered and alleviated neurological symptoms, in accordance with the improvement of serological abnormalities. Therefore, an inflammatory process associated with MRA was supposed to damage the spinal cord as well as peripheral nerves in the present case.

Acute Disease↗
PubMed1997

Escalator-related injuries in children.

OBJECTIVE: Escalator-related trauma is uncommon but can cause significant injury. This study reviewed escalator-related injuries in children to determine risk factors, types of injuries, medical interventions, and long-term outcomes. DESIGN AND SETTING: Retrospective clinical patient series, Municipal Hospital Pediatric Emergency Service. Participants. All children less than 18 years of age who presented to the Pediatric Emergency Service with an escalator-related injury from August 1990 through February 1995. METHODS: We reviewed the chart and interviewed the parent of each child by telephone. We collected the following information: age, gender, child's supervision and activity while on the escalator, escalator location, direction of motion, presence of escalator defects, nature and extent of injury, medical interventions, and outcome. RESULTS: Twenty-six children had escalator-related injuries. The average age was 6 years (range, 2-16). Thirteen children (50%) were 2 to 4 years old. There were 15 (57%) boys. Eighteen children (69%) were accompanied by an adult. All children 7 years and younger were accompanied by an adult; however, 50% were not holding the hand of their guardian. Eight children (31%) were injured while riding improperly, ie, walking, running, playing, or sitting on the escalator, and among these, all who were standing fell down before the injury. Six (23%) children were injured while stepping off the escalator. Of 9 children less than 4 years old, 7 (78%) were riding the escalator properly. Of 9 children 4 years or older, only 3 (33%) were riding properly. Circumstances of injury included falling down with subsequent blunt trauma, falling down with subsequent entrapment of an extremity, and entrapment of an extremity not related to falling down. Locations of entrapment were between two steps, between a step and the side-rail, and between the last step and the comb plate. Twenty-one (81%) injuries occurred in rail or subway stations. Eight escalators were reported to have functional or structural problems. Seventeen (65%) children sustained lower extremity injuries and 8 (31%) sustained upper extremity injuries. Injuries included lacerations, avulsions and degloving injuries of the extremities, tendon and nerve lacerations, and digit fractures and amputations. Thirteen (50%) children were admitted to the hospital for operative management; the average length of hospitalization was 13 days (range 1-29). Four children (15%) suffered significant functional loss, and 12 (46%) sustained permanent cosmetic deformities. CONCLUSION: Children are at risk for sustaining severe injuries on escalators. Young age, inadequate adult supervision, improper activity while riding on the escalator, and escalator-related mechanical problems all increase the risk of injury. Public and parent education directed toward escalator safety issues may help to reduce escalator-related injuries in children.

Accidents↗
PubMed1998

Brown's syndrome diagnosed following repair of an orbital roof fracture: a case report.

The upgaze deficit of Brown's syndrome differs from the upgaze deficit of an orbital floor fracture with entrapment. In Brown's syndrome, the upgaze limitation is most evident in adduction of the eye. This difference may be difficult to establish at times, particularly beneath the periorbital edema of an acute traumatic injury. Nevertheless, it is important to recognize this differentiation, since the approach to management of these two clinical entities is distinctly dissimilar. Brown's syndrome is produced by restriction of the superior oblique muscle tendon, usually in the region of the trochlea. In the course of describing a case of Brown's syndrome, recognized following the repair of an orbital roof fracture, issues related to etiology, diagnosis, and management are discussed. In the case presented, surgical repair of the left eye was performed.

Adult↗
PubMed1999

Insidious symptomatology and misleading physical findings in popliteal artery entrapment syndrome. A case report.

A patient presented with an ischemic right forefoot. She suffered rest pain but had relief on walking and on flexing her leg. Popliteal and pedal pulses were palpable. The underlying condition was popliteal artery entrapment. Compression of the popliteal artery occurred with extension of the knee and additional contraction of the gastrocnemius muscles only and was released with flexion. Distal embolizations into all three lower leg arteries had caused acute ischemia. As the emboli had travelled through both tibial vessels very distally pedal pulses were found to be normal. Treatment was operatively by resection of a tiny lateral portion of the medial gastrocnemic tendon which crossed the artery dorsally as the vessel pierced the tendon.

Adolescent↗
PubMed2001

SLAP lesions: current concepts.

The presence and significance of superior glenoid labral tears have received increasing attention in the 1990s. The symptoms associated with labral tears can be quite disabling to competitive and recreational athletes alike. Recent basic science and clinical studies have contributed much to the understanding of these injuries, including their association with suprascapular nerve entrapment. This article reviews the current basic science and clinical understanding of SLAP (superior labrum anterior and posterior) lesions in order to guide clinicians and promote further investigation.

Biomechanical Phenomena↗
PubMed1995

Pseudo-entrapment of extraocular muscles in patients with orbital fractures.

Diplopia is a prominent finding in patients who have suffered orbital fractures. If the patient's double vision or ocular motility restriction was caused by soft tissue entrapment into the fracture site, surgery is frequently performed in order to release this entrapment and restore normal eye movement. However, the presence of diplopia should not necessarily be an indication for surgery. Brief case reports are hereby presented to illustrate that the symptoms of diplopia and motility restriction are not always attributable to the presence of orbital fractures that require surgical repair. The purpose of this article is to describe other causes of abnormal ocular motility that are associated with orbital trauma but which are not caused by soft tissue entrapment.

Abducens Nerve Injury↗
PubMed1986

The unreduced carpal dislocation. A method of treatment.

Unreduced lunate, perilunate, and transscaphoid perilunate dislocations present a difficult and challenging surgical problem. The authors feel that all efforts should be made to obtain a reduction of the old dislocation. They support a combined dorsal and palmar approach, open reduction, and internal fixation of scaphoid with a Herbert screw to obtain midcarpal stability. A carpal tunnel decompression should be performed if symptoms suggest median nerve entrapment. When the dislocation is unable to be reduced, the authors favor limited wrist arthrodesis or a proximal row carpectomy in the absence of significant arthritis.

Adolescent↗
PubMed1995

[The Achilles tendon in sports].

Achillodynia is a generic term for various types of ailments in the region of the Achilles tendon. For adequate therapy a specific diagnosis is absolutely necessary. Besides an accurate anamnesis and the right choice of terrain and shoes, as well as a clinical examination where one has to specifically keep an eye on muscular imbalance between the gastrocnemius and the soleus muscle and disorders of the ligamentous control of the calcaneus caused by fibular ligament instabilities, a procedure such as radiology, ultrasound, and MR imaging is inevitable. From the differential diagnosis point of view a distinction between peritendinitis, mechanically triggered bursitis (calcaneal and subachilles), bony alterations of the calcaneus (calcaneus spur, Haglund exostosis persistent nucleus of the apophysis, fatigue fracture, etc) and a partial or total rupture (a one-time occurrence or multiple occurrences) has to be made. Occasionally, entrapment of the ramus calcaneus of the sural nerve causes calcaneal pain. If clinically not confirmed, lumbar pain ought to be taken into consideration (discopathy, Bechterew disease, etc). Metabolic disorders (especially uric acid) and underlying rheumatic diseases must be excluded. The therapy of achillodynia includes local and peroral antiphlogistic medication as a concomitant measure. More important is the causal influence of etiological factors, i.e., the correction of muscular imbalance, ensuring control of the calcaneus through bandages and adjustment of sport shoes, changes in training buildup and exercise intensity, just to mention a few. If necessary, surgically splitting the peritendineum, sanitation of a partial rupture, bursectomy and removal of mechanically obstructive exostosis must be done.

Achilles Tendon↗
PubMed1997

Neuropathic symptoms and musculoskeletal pain in carpal tunnel syndrome: prognostic and therapeutic implications.

BACKGROUND: Repetitive activities in the workplace can not only jeopardize the median nerve across the carpal tunnel but also the musculoskeletal structures, such as the ligaments, synovia, tendons and muscles producing pain, and local tenderness at the wrist, elbow, and shoulder. The occurrence of this latter condition can dominate the overall clinical picture and affect the outcome of treatments for this very common condition. METHODS: A clinical evaluation of 30 patients who previously underwent a successful and uncomplicated carpal tunnel release surgery was conducted. These patients were referred back for another electrodiagnostic study to consider the possibility of persistent or recurrent nerve entrapment. These patients all had musculoskeletal pain and local tenderness at the wrist, elbow, and shoulder as their primary and disabling symptoms; and neuropathic symptoms as their less disabling complaints. RESULTS: All patients reported significant resolution of their neuropathic symptoms following surgery but their musculoskeletal symptoms persisted preventing them from returning to their original occupation. Fifty percent showed mild to moderate improvement in their electrophysiologic abnormalities but none had complete normalization of nerve conduction. Few patients developed symptoms of sympathetic nerve overactivity. CONCLUSIONS: Some patients suffering from carpal tunnel syndrome may present with a disabling musculoskeletal pain and local tenderness in the upper extremities that can persist following surgery despite resolution of neuropathic symptoms. These two symptom complexes, although both sequelae of repetitive activities, have fundamental clinicopathologic differences that must be recognized because of their therapeutic, prognostic, and medico-legal implications.

Adult↗
PubMed1986

Nonosseous athletic injuries of the elbow, forearm, and hand.

This article deals with soft-tissue injuries of the upper extremity incurred by competitive athletes. The authors describe the pathophysiology, conservative and operative management of musculotendinous elbow injuries, entrapment neuropathy, tendinous disorders, vascular injuries, and dermatologic conditions in athletes. Protective gear for many of the aforementioned injuries are also described.

Athletic Injuries↗