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PubMedDate not supplied

Laser-assisted arthroscopic ulnar shortening.

The purpose of this study is to evaluate arthroscopic ulnar shortening with the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for the treatment of ulnocarpal abutment syndrome (UAS). This is a retrospective review of the experience of a single surgeon using this technique between 1994 and 2000. Unloading the ulnocarpal joint is the recognized treatment of UAS. Ulnar shortening via a diaphyseal osteotomy and plating (USO) has been used with good results; however, nearly 50% of patients will require hardware removal. Researchers have reported similar results between open distal ulnar resection (the wafer procedure) and USO for the treatment of UAS. Researchers have also reported similar results with mechanical arthroscopic distal ulnar resections (arthroscopic wafer distal ulnar resection [AWP]) for UAS. Eleven patients who underwent Ho:YAG laser-assisted arthroscopic distal ulnar resection were retrospectively evaluated. The average follow-up time was 31 months, with a range of 7 to 61 months. Evaluation using Darrow' s criteria revealed 64% excellent (7 of 11), 18% good (2 of 11), 9% fair (1 of 11), and 9% poor (1 of 11) results. The average return to work time was 4.7 months, with a range of 1.5 to 16 months. Complications included 1 repeat surgery for ulnocarpal scar formation, 2 cases of transient tendonitis, and 1 portal site erythema without drainage that was treated with antibiotics. One patient (the one with a poor result) has not returned to work for unrelated reasons. chi- square analysis (P <.05) was unable to identify a statistical difference between the reported results of arthroscopic wafer procedures, USOs, and open wafer procedures. We concluded that Ho:YAG laser-assisted arthroscopic ulna shortening procedures show similar results to those reported for arthroscopic wafer procedures, open wafer procedures, and USOs. Return to work times are similar to those reported by other researchers, as is the return to preoperative occupation rate. There is no need for late removal of hardware, as is sometimes associated with USO. Our experience has been that the Ho:YAG laser removes hyaline cartilage and subchondral bone rapidly and with little debris, and thus facilitates the ulna shortening procedure.

Adult↗
PubMedDate not supplied

Arthroscopic repair of dorsal radiocarpal ligament tears.

Various authors have highlighted the importance of the dorsal radiocarpal (DRC) ligament in normal carpal kinematics. It is a secondary stabilizer of the lunate and has a role in midcarpal stability. Disruption of the DRC ligament has been implicated in the development of static VISI and DISI deformities, prompting some authors to perform an open reattachment of the dorsal capsule if there is an associated scapholunate ligament tear. The management of these tears is still evolving. The contribution of a DRC ligament tear to the development of wrist pain remains uncertain when combined with additional wrist pathology. An isolated DRC ligament tear was responsible for chronic dorsal wrist pain in 2 patients. A previously undescribed inside-out repair method of the DRC ligament using a volar wrist portal was successful in relieving the pain. Recognition of this condition and further research into treatment methods is needed.

Adult↗
PubMed2003

Iliotibial band Z-lengthening.

Iliotibial band friction syndrome (ITBFS) is a common overuse injury reported to afflict 1.6% to 12% of runners. It results from an inflammatory response secondary to excessive friction that occurs between the lateral femoral epicondyle and the iliotibial band. Initial treatments include rest, anti-inflammatory medication, modalities (ice or heat), stretching, physical therapy, and possibly a cortisone injection. In recalcitrant cases of ITBFS, surgery has been advocated. This report describes a surgical technique of Z-lengthening of the iliotibial band in patients presenting with lateral knee pain localized to the iliotibial band at the lateral femoral epicondyle and Gerdy's tubercle who failed all nonoperative efforts.

Anti-Inflammatory Agents↗
PubMed2003

The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics.

PROLOGUE: Several years ago, when we began to question microinstability as the universal cause of the disabled throwing shoulder, we knew that we were questioning a sacrosanct tenet of American sports medicine. However, we were comfortable in our skepticism because we were relying on arthroscopic insights, clinical observations, and biomechanical data, thereby challenging unverified opinion with science. In so doing, we assembled a unified concept of the disabled throwing shoulder that encompassed biomechanics, pathoanatomy, kinetic chain considerations, surgical treatment, and rehabilitation. In developing this unified concept, we rejected much of the conventional wisdom of microinstability-based treatment in favor of more successful techniques (as judged by comparative outcomes) that were based on sound biomechanical concepts that had been scientifically verified. Although we have reported various components of this unified concept previously, we have been urged by many of our colleagues to publish this information together in a single reference for easy access by orthopaedic surgeons who treat overhead athletes. We are grateful to the editors of Arthroscopy for allowing us to present our view of the disabled throwing shoulder. Part I: Pathoanatomy and Biomechanics is presented in this issue. Part II: Evaluation and Treatment of SLAP Lesions in Throwers will be presented in the May-June issue. Part III: The "SICK" Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation will be presented in the July-August issue. We hope you find it thought-provoking and compelling.

Adolescent↗
PubMed1999

Psychometric assessment of patients with chronic upper extremity pain attributed to workplace exposure.

Upper extremity pain attributed to workplace exposure is a growing concern in medicine today. This study was undertaken to investigate the psychological findings in patients with chronic upper extremity pain attributed to workplace exposure. Sixty-three consecutive patients were evaluated. All patients underwent a history and physical examination by a hand surgeon and a psychological evaluation by a licensed psychologist, including a Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Physical and psychological findings were then compared. Forty-one patients (65%) showed abnormalities on MMPI-2 examination (t score > 70 = 97% confidence). This result is far above what generally would be expected in medical patients. When physical findings were grouped with psychological findings, 5 distinct groups were identified: 1 patient had normal physical and psychological results, 6 patients had normal physical findings but abnormal psychological assessments, 21 patients had abnormal physical findings but normal psychological assessments, 28 patients had both abnormal physical and psychological findings, and 7 patients had abnormal physical results but invalid MMPI-2 evaluations due to purposeful attempts to deny psychological symptoms. Identification of these groups may have diagnostic, prognostic, and treatment value. In addition, identification of these groups may help clarify several aspects of the debate over the role of psychosocial factors in the development and maintenance of chronic upper extremity pain that patients attribute to workplace exposure.

Arm↗
PubMed1999

The effect of legal representation on functional recovery of the hand in injured workers following carpal tunnel release.

A group of 225 patients who underwent surgical release for carpal tunnel syndrome, considered causally related to their jobs, were compared on the basis of one variable: representation by an attorney. Postoperative functional recovery measurements for the represented and the unrepresented workers were reviewed. There is no difference in the functional recovery rates or final functional values in these two groups of workers. We concluded that an attorney representing an injured worker did not influence the functional recovery of the hand in these patients, nor did it affect the medical decision-making process.

Adult↗
PubMed2001

The implication of repeated versus continuous strain on nerve function in a rat forelimb model.

We studied the effect of repeated and continuous nerve strain using a rat forelimb model to investigate whether an innocuous level of strain applied continuously affects nerve function when applied repeatedly. We used the rat medial cord of the brachial plexus and assessed the effects of strain by studying nerve histology (blood-nerve barrier), function (grasping strength), and electrophysiology. Continuous stretching was applied to the rat forelimb for 1 hour at 2 N. After this strain neither histologic analysis, grasping strength, nor electrophysiologic analysis revealed any effect. We then applied repeated strain at both 60 and 120 times per hour; after the latter strain abnormalities in histology, grasping strength, and nerve conduction were identified. There results suggest that a small nerve strain applied repeatedly results in nerve dysfunction. Our data may help explain the cause of nonspecific neural symptoms in the upper extremities of patients with no objective findings.

Animals↗
PubMed1999

Hypothenar hammer syndrome. Retrospective study of nine cases.

The hypothenar hammer syndrome is an uncommon lesion of the ulnar artery caused by repetitive trauma to the ulnar portion of the hand. It characteristically occurs in the dominant hand of middle-aged craftsmen, but also in athletes practising various types of sports. We present a retrospective study of nine patients between 1988 and 1999. The follow-up ranged from 1 to 10 years. We recommend surgical treatment, by resection of the involved arterial segment and revascularization either by direct anastomosis or by means of a venous interpositional graft.

Adult↗
PubMed2001

Arm pain without physical findings: medicine vs. the law?

Arm pain without physical findings occurring in association with light repetitive work has been with us from the time man developed factories but has become controversial since a number of reported cases in Australia in 1983. It remains a highly contentious and medically confused area. Claims for compensation for the condition against employers have been firmly rejected by courts in Australia and the USA, but large awards continue to be made in UK courts. The reason for this difference lies in recent changes in British Law and court procedure and British courts now seem to recognize this nebulous clinical condition as representing a compensable injury. In this situation, therefore, physicians must be meticulous in their examinations and record keeping. In addition, they must only use specific diagnoses when irrefutable clinical signs or confirmatory special investigation results are present and must be guarded in loose talk or discussion about "causation".

Arm↗
PubMed2001

The use of ultrasound imaging to demonstrate reduced movement of the median nerve during wrist flexion in patients with non-specific arm pain.

Following clinical screening, we examined movement of the median nerve at the wrist using high-resolution (10-22 MHz) ultrasound in 16 controls and 12 patients with non-specific arm pain (also referred to as repetitive strain injury). Imaging was performed just proximal to the carpal tunnel with the wrist in neutral, 30 degrees of extension and 30 degrees of flexion. In control subjects the position of the median nerve was 4.8 (SE=0.4) mm more radial with the wrist flexed than with the wrist extended. In the twelve arm pain patients the average change was only 1.2 (SE=0.5) mm. It appears that ultrasound imaging may be helpful in diagnosing non-specific arm pain, a condition for which there are no well-defined diagnostic tests at present. The reduced nerve movement seen with ultrasound imaging confirms previous work with magnetic resonance imaging.

Adolescent↗
PubMed2001

Miners' Nystagmus.

Explore the source record for details and available documents.

Arm Injuries↗
PubMed1999

[Chronic compartment syndrome of the first dorsal interosseous muscle: 2 case reports].

Chronic exercise-induced compartment syndrome of the first dorsal interosseous muscle of the hand is a rare condition. The presented complaint is a dull muscle pain which can be increased by hyperextension of the index metacarpo-phalangeal joint and by repetitive key grip. Two patients complaining of these symptoms could successfully be treated by simple fasciotomy of the first dorsal interosseous compartment.

Adolescent↗
PubMed2000

[Hypothenar hammer syndrome: causes, sequelae and diagnostic aspects].

PURPOSE: To investigate the reasons and disease course of Hypothenar Hammer Syndrome. INTRODUCTION: Occlusion of the ulnar artery at the level of the hamate bone due to repetitive trauma to the hypothenar eminence is implicated as the cause of the rarely diagnosed hypothenar hammer syndrome (HHS). The thrombotic occlusion and the formation of an aneurysm of the ulnar artery and the superficial palmar arch with possible peripheral embolism of the digital arteries are a direct cause of the chronic damage to the vessel wall. Generally, HHS is diagnosed too late for recanalization to be a viable therapeutic option. METHODS: From 1996 to 1998 the diagnosis of an HHS was made in 8 patients at our hospital. Etiology, clinical settings and disease course were assessed. RESULTS: Our analysis suggests that HHS may be caused by a single severe trauma in addition to repetitive injuries. The pathogenesis of the syndrome is dependent on the vascular anatomy of the individual hand. Interindividual variations in the arterial supply of the affected hand influences the clinical symptomatology with possible masking of arterial occlusions. CONCLUSION: An exact investigation concerning the pathogenesis of HHS is a precondition for treating the disease and may help to establish HHS as an occupational disease. MR-angiography may be a new approach for assessing HHS.

Adult↗
PubMed2000

[Injuries and overuse syndromes due to rock climbing on artificial walls].

The purpose of this study was to obtain an overview of acute injuries and chronic overuse syndromes due to rock climbing on artificial climbing walls. Strategies for prevention should then be developed based on these experiences. From October 1995 to December 1996 314 climbers of both sexes and all degrees of climbing abilities were individually interviewed at five different indoor climbing arenas with the help of a special questionnaire. Type, quantity and cause of typical injuries and overuse syndromes on artificial climbing walls were determined. Injuries (n = 204) as well as overuse syndromes (n = 266) increased with the performance level. Experienced climbers often suffered from injuries to the finger flexor tendons (n = 42) and the finger flexor pulleys (n = 37) while holding small grips. Beginners sustained skin injuries (n = 26) and joint distortions (n = 22) of the lower limb while falling. Reasons are a lack of experience in the techniques of belaying and falling as well as incomplete covering of the ground with crash mats. Chronic overuse syndromes mainly presented as swelling and pain in the finger joints (n = 140) and as epicondylitis in the elbow (n = 30). Especially knee problems (n = 12) were caused by new climbing techniques used on artificial climbing walls. Referring to injuries as well as to overuse syndromes climbing on artificial climbing walls is a very safe sport, compared to climbing on natural rock. Further prevention could be provided by a well-based instruction of beginners, especially in techniques of belaying and falling. The ground of climbing walls should always be completely covered by sufficient crash mats. More experienced climbers should minimize harmful climbing techniques, like using very small holds with a cling grip, long distance reaches and inside rotation of the leg under pressure.

Adolescent↗
PubMed2001

[Orthopaedic examination of gymnasts].

A gymnast is prone to catch specific acute and overload injuries as well. Those injuries are concentrated at the spine due to the fact, that high load is administered to the growing apophyseal elements. Preventive X-ray examinations are useless in this respect, because the gymnasts training starts at the age of 5-6 years and apophyseal ossification nuclei develop not before the age of about 11-13 years. On the other hand regular performed preventive clinical examinations seem to be important for preventive reasons. For this purpose we developed specific clinical tests which allow early recognition of overuse injuries while they are in a latent phase and while the athlete does not complain any pain. Furthermore staging of the injury is possible and healing response can be controlled.

Adolescent↗