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PubMedDate not supplied

Spinal cord stimulation for chronic pain management.

This article outlines the role of spinal cord stimulation in contemporary chronic pain management. The anatomical and neurophysiological correlates of stimulation of the intraspinal structures are discussed. The most common indications are presented, including failed back syndrome, reflex sympathetic dystrophy, neurogenic thoracic outlet syndrome, and spinal cord injury, etc. The most common complications are presented, including paralysis, infection, electrode migration, cerebrospinal fluid leak, and pain. Spinal cord stimulation is one of the most effective techniques available in the management of severe chronic pain that has been refractory to other more conservative modalities.

Chronic Disease↗
PubMed1995

A comparison of different surgical techniques in treating degenerative arthrosis of the carpometacarpal joint of the thumb. A retrospective study of 98 cases.

Between March 1977 and December 1991, 98 surgical procedures on 85 patients were performed at SOS Main Strasbourg for osteoarthrosis of the carpometacarpal joint of the thumb. The mean age was 56 and 90% were female; 13 were operated on bilaterally. 40% had Swanson arthroplasties (group 1), 15% Ashworth-Blatt hemiarthroplasties (group 2), and 45% had soft tissue arthroplasties (group 3). 62 cases were reviewed at an average follow-up of 5 years. Normal thumb range of motion was obtained in all cases, regardless of the technique used. Complete pain relief was achieved in 77% of the cases in group 1, 37.5% in group 2 and 71% in group 3. 15% of group 1 and 50% of group 2 required surgical revision, either for displacement or fracture of the implants. No revision was necessary in group 3. One case of silicone synovitis requiring secondary surgery was noted 6 years after surgery, accounting for 2.9% of the total number of silicone implants reviewed, but radiological signs of silicone synovitis were much more common (56%). Proximal metacarpal migration in group 3 averaged 38% of the initial arthroplasty space, and was not related to the type of ligamentoplasty used, or presence or absence of an "anchovy". The migration increased to 68% of the space if an associated MP joint arthrodesis was carried out at the same time. Complications included reflex sympathetic dystrophy (4% in group 1 and 14% in group 3). The Ashworth-Blatt hemiarthroplasty failed to gain satisfactory results, but both silicone arthroplasty and soft tissue arthroplasty proved to be useful procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Wrist arthrodesis using a dynamic compression plate.

In order to determine the effectiveness of wrist arthrodesis using dynamic compression plating and bone grafting, we reviewed 18 consecutive procedures in 17 patients performed using a standardized technique over a 6-year period. Fourteen patients had previously undergone an average of 2.1 operations prior to arthrodesis. Mean follow-up was 48 months. All but one patient reported considerable pain relief and were satisfied with their results. Grip strength remained limited compared to the contralateral wrist. Complications were limited to one case of reflex sympathetic dystrophy and metacarpophalangeal joint contracture, and minor problems related to the bone graft donor site.

Adult↗
PubMed1997

Day care surgery for advanced Dupuytren's contracture.

Seventy-six consecutive patients suffering from advanced Dupuytren's contracture were analysed in order to evaluate the safety of day care surgery. The complication rates for haematoma, necrosis, infection and reflex sympathetic dystrophy were acceptable, but we found an unacceptably high percentage of nerve lesions. Day care treatment was achieved in all but seven cases. We concluded that advanced Dupuytren's contracture can be treated by day care surgery but the operations should be performed by surgeons who are skilled in hand surgery, and individual selection of patients with recurrence seems advisable.

Ambulatory Surgical Procedures↗
PubMed1999

Does endoscopic carpal tunnel release have a higher rate of complications than open carpal tunnel release? An analysis of published series.

The purpose of this study was to evaluate the reported rate of complications after endoscopic carpal tunnel release by means of an analysis of 54 publications, reporting a total of 9516 endoscopic and 1203 open releases. Endoscopic release was comparable to open release in the rate of irreversible nerve damage (0.3% and 0.2% respectively) but case reports may indicate a small risk of unacceptable complications with endoscopy, such as transection of the median nerve. Reversible nerve problems were more common after endoscopic release. Tendon lesions were extremely rare (0.03%) and the rate of other complications (reflex sympathetic dystrophy, haematoma, wound problems, etc.) was about the same with endoscopic as with open release.

Arthroscopy↗
PubMed2003

Can complex regional pain syndrome be painless?

While spontaneous and stimulus-evoked pain are the hallmarks of complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy, autonomic abnormalities, motor dysfunction, and trophic changes in the affected limb are additional clinical characteristics distinguishing this syndrome. Even though the exact underlying mechanisms of the syndrome remain obscure, a recent hypothesis suggests that the abnormal response of neural nociceptive tissue plays a major role in the pathogenesis of CRPS via the mechanism known as 'neurogenic inflammation'. The group of patients presented here exhibited all the clinical characteristics of CRPS but had no pain, thereby indicating that ongoing or evoked pain is not a necessary condition for CRPS to be maintained. We suggest the term complex regional painless syndrome to describe this syndrome.

Adolescent↗
PubMed2004

Maldaptation of the link between inflammation and bone turnover may be a key determinant of osteoporosis.

Currently the etiology of osteoporosis is attributed to various endocrine, metabolic, and mechanical factors. We hypothesize that many cases of osteoporosis are also partially attributable to a maladaptation of the link between inflammation and bone turnover. We explore the spatial and temporal link between inflammation and osteoporosis in conditions such as aging, menopause, reflex sympathetic dystrophy, HIV, pregnancy, transplantation, and steroid administration. While nutritional and mechanical factors clearly play a role in many of these situations, the spatial and temporal concordance of osteoporosis and inflammation is buttressed by emerging molecular evidence. Modern bone biology of humans may reflect dual functional legacies of mineral storage and structural support. Osteoporosis may result from disequilibrium between structural demand for key minerals and their biologic demand during maladaptive states of inflammation.

Bone Remodeling↗
PubMed1995

Matched hemiresection interposition arthroplasty of the distal radioulnar joint.

Since 1986 the senior author has performed a matched hemiresection with retinacular/capsular interposition for patients with painful disorders of the distal radioulnar joint. A retrospective review of 55 wrists was performed by an independent hand surgeon and hand therapist. Forty-nine of 54 wrists in the surviving patients were clinically and radiographically reviewed with an average follow-up interval of 36 months. Subjective assessment included a visual analog rating of pain improvement and satisfaction with treatment. Objective assessment included examination of range of motion, strength, stability, and standardized functional testing with the Jebsen and Minnesota Rate of Manipulation tests. Thirty-five patients reported pain improvement and 41 patients were satisfied. The range of supination and pronation increased from 54 degrees and 67 degrees, respectively, to 72 degrees and 72 degrees. Functional ability as measured by the Jebsen test was similar to the contralateral wrist. Patients had most difficulty turning large objects. The clinical, objective, functional, and x-ray films results correlated poorly with pain improvement and patient satisfaction. Complications included one infection, one reflex sympathetic dystrophy, one neuroma of the dorsal sensory branch of the ulnar nerve, and four cases of ulnar-carpal impaction. Pain relief was the primary determinant of patient satisfaction and should be considered the indication for surgery.

Adolescent↗
PubMed1979

Carpal tunnel release under local anesthesia: evaluation of the outpatient procedure.

In 100 consecutive cases of carpal tunnel release done under local anesthesia in an outpatient ambulatory care operating room, 93 had satisfactory results at 6 months without any complications. Two patients developed a neuroma of the palmar cutaneous branch of the median nerve, and five showed early signs of reflex sympathetic dystrophy. These complications are discussed, as well as the prevention of other complications of this procedure.

Ambulatory Surgical Procedures↗
PubMed1985

Partial dorsal wrist denervation: resection of the distal posterior interosseous nerve.

Chronic dorsal wrist pain limits hand function. This article details preoperative diagnostic nerve block and patient selection criteria, operative technique for partial dorsal wrist denervation, and results of nonoperative as well as operative treatment for pain transmitted via the distal posterior interosseous nerve. More than 90% of the patients treated with the partial dorsal wrist denervation procedure achieved subjective relief of pain and objective improvement in wrist function, with 83% returning to work. Function did not improve in the group with fractures associated with reflex sympathetic dystrophy, and three of the four patients with rotary subluxation of the scaphoid subsequently required wrist fusion.

Adult↗
PubMed1988

Staged flexor tendon reconstruction in the fingers and hand.

A two-stage tendon-grafting technique was used to reconstruct 130 fingers in 101 patients between 1973 and 1984. Eighty-nine patients with 117 fingers that had undergone operation were evaluated 6 months or longer after stage II surgery. Sixty-five percent of the patients were in the Boyes salvage group before operation. Overall, 54% had good or excellent results by the total active motion (TAM) as a percentage of total passive motion (TPM) method, although only 19% had final TAM of greater than 180 degrees. Complications included infection in 15%, rupture in 4%, amputation in 4%, and reflex sympathetic dystrophy in 1% of the patients. Sixteen percent of the patients required tenolysis after stage II surgery. Factors associated with a poor result included zone I or II injury and patients who were less than 10 years of age. Factors associated with a better result included zone IV or V injury and all postoperative therapy under the direct supervision of the treating surgeon.

Adolescent↗
PubMed1998

Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance.

Twenty-five patients with triangular fibrocartilage complex (TFCC) tears associated with ulnar positive variance who did not respond to conservative management were treated by ulnar shortening. The follow-up period averaged 35 months. All patients complained of pain, restricted forearm rotation, and weakness of grip. Arthroscopy was performed in 23 of 25 wrists to assess the status of the TFCC and the degree of the degenerative change of the proximal aspect of the lunate and triquetrum. Arthroscopic findings consisted of 15 class 1 and 8 class 2 tears according to Palmer's classification. When the TFCC showed a traumatic flap tear, only the torn flap was removed arthroscopically. Ulnar shortening averaged 3 mm. Transverse osteotomies healed in all patients at a mean postoperative time of 7 weeks. Twenty-three patients had either complete relief or occasional mild pain of the wrist. Two patients with persistent pain had additional procedures performed. Postoperative x-ray films revealed slight degenerative changes at the distal radioulnar joint in 7 patients. Complications included 1 reflex sympathetic dystrophy and 2 fractures through the osteotomy site after early plate removal. Ulnar shortening is a useful procedure for TFCC tears associated with ulnar positive variance.

Adolescent↗
PubMed1997

Questions of the handsurgeon to the radiologist--a survey on the most common lesions in the hand and the implications of diagnostic tools on their therapy.

By the rapid development of imaging techniques, a significant gap developed between the knowledge of the radiologists and that of the hand surgeons on specific indications of the different technical possibilities. The problems to be solved by both specialties together are analyzed. Examples of the most common lesions in the hand like trauma, reflex sympathetic dystrophy, congenital malformation, infection, tumour, rheumatoid and other degenerative processes, nerve compression syndromes etc., are given, and the implications of diagnostic tools on their therapy are discussed.

Hand↗
PubMed1998

Sports injuries in the pelvis and hip: diagnostic imaging.

We discuss the role of imaging techniques in examining the athletes with sports injuries involving the pelvis and the hip. Pelvis and hip pain is of difficult clinical clarification because of the various athletic injuries which may affect the bone or soft tissues at different anatomic sites. Moreover, the symptoms of pelvis and hip injuries are similar in most cases and they are often diffuse and atypical. Diagnostic imaging can play an essential role because treatment success depends on a correct diagnosis and these techniques can actually differentiate the most frequent causes of pelvis and hip sports injuries such as groin strain, osteitis pubis, ischial intersection syndrome, snapping hip, stress fractures, hernias and avulsion fractures. Finally, we discuss the role of magnetic resonance imaging in detecting the causes of hip pain other than sports injuries, such as avascular necrosis, reflex sympathetic dystrophy syndrome, herniation pit, acetabular labrum injuries. To conclude, diagnostic imaging techniques currently permit the direct and noninvasive depiction of pelvis and hip conditions. Particularly, magnetic resonance imaging is very helpful in detecting injury site, extent and characteristics; it can also predict the time period an athlete will be disabled and help define the best treatment planning.

Athletic Injuries↗
PubMed2002

Complications related to carpal tunnel release.

Complications of operative carpal tunnel release continue to occur in the clinical practice of hand surgery. Anatomic localization of nerve injury has been reviewed in the area of the palmar cutaneous nerve, the median motor branch, and in the combined sensory/motor median nerve itself. Diagnosis and appropriate treatment plans have been reviewed to facilitate early appropriate treatment which usually diminishes disability. General complications have also been discussed including recurrent scar formation which is probably the most commonly encountered complication following carpal tunnel release. Possible neurovascular complications involving the development of reflex sympathetic dystrophy have received some attention in this presentation in order to alert the clinical surgeon to the possibility of this entity providing further disability to an already injured median nerve.

Brachial Plexus Neuropathies↗
PubMed1988

Complications in arthroscopic surgery performed by experienced arthroscopists.

Twenty-one experienced arthroscopists participated in a prospective, 19-month study to analyze complications in arthroscopic surgery of the knee and other joints. Participants responded to a monthly questionnaire that provided information on a case-by-case basis for the duration of the study. A total of 63 specific procedures were studied. A total of 10,262 procedures were recorded. Procedures performed on the knee joint were most prevalent in the study (8,741 or 86%). Complications were placed in one of 11 descriptive categories for analysis; 173 complications occurred and the overall complication rate was 1.68%. The types of complications recorded in order of frequency were hemarthrosis, 60.1%; infection, 12.1%; thromboembolic disease, 6.9%; anesthetic complications, 6.4%; instrument failure, 2.9%; reflex sympathetic dystrophy, 2.3%; ligament injury, 1.2%; and fracture and neurologic injuries, 0.6% each. The remainder were miscellaneous complications, 6.9%. No vascular injuries were reported. The two most frequent procedures reported were medial meniscectomy (2,468) with a complication rate of 1.78%, and lateral meniscectomy (1,149) with a complication rate of 1.48%. Overall, there was a lower incidence of complications in meniscal repair (1.29%), including both inside-out and outside-in techniques, than in meniscectomy (1.69%). In-depth information was gathered on each complication. In addition, profiles on surgical techniques and surgical equipment were obtained from each of the contributing surgeons. The complication rate in arthroscopic surgery was found to be higher than had been previously found in retrospective surveys. With further analysis oft he complication data and profiles of the surgeons, protective techniques can be further identified to help reduce the incidence of complications in arthroscopic surgery.

Arthroscopy↗
PubMed1996

Neurological complications of ankle arthroscopy.

A retrospective review of the first 612 patients undergoing consecutive ankle arthroscopy in the practices of two experienced arthroscopists was under-taken. All inpatient records, outpatient charts, and operative reports were reviewed. Indications for surgery included pain, swelling, locking, and instability that failed to respond to nonoperative management. The results of our investigation revealed an overall complication rate of 9.0% (55 complications). There were 27 neurological complications (4.4% of all arthroscopies) accounting for 49.1% of the complications noted. Specifically, the superficial peroneal nerve was injured in 15 cases, the sural nerve in 6, the saphenous nerve in 5, and the deep peroneal nerve in 1. All nerve injuries occurred through direct injury by portal or distractor pin placement. No cases of neurological injury caused by tourniquet compression or compartment syndrome were seen. Also, 1 case of reflex sympathetic dystrophy was identified.

Adolescent↗
PubMed1994

[The role of posterior bracket plate osteosynthesis in the treatment of compression-extension fractures of the distal end of the radius].

Osteosynthesis without immobilisation of compression-extension fractures by means of a posterior plate was studied in prospective series with a minimum follow-up of six months (first group: 73 patients) and a minimum follow-up of one year (second group: 63 patients). The clinical results were evaluated and showed several complications (no infection, but reflex sympathetic dystrophy, paresthesia, unsightly scars). The clinical and radiological findings (radio-ulnar index) could improve with several technical devices, now used.

Adolescent↗