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PubMed2005

[Treatment of AO type C2-C3 fractures of the distal end of the radius with external fixation].

OBJECTIVES: We evaluated the results of combined treatment with closed reduction, grafting, K-wires, and external fixation in patients with fractures of the distal end of the radius. METHODS: Of 24 patients (15 males, 9 females; mean age 34 years; range 21-73), 16 patients had C2, eight patients had C3 fractures according to the AO classification. Three patients had open fractures, and four patients had signs of median nerve compression. Treatment included closed reduction, autologous grafting (16 cases) followed by fixation with 2 to 5 K-wires, and an external fixator. Clinical and radiographic results were assessed according to the Gartland-Werley's and Stewart's criteria, respectively, and degenerative changes to the Knirk-Jupiter's criteria. The mean follow-up was 35 months (range 25 to 52 months). RESULTS: All of the 19 patients who were employed returned to preinjury working conditions in a mean of 3.5 months. Radial length was preserved to a great extent. The mean amount of collapse of the joint surface was 1.4 mm. The mean loss was 6.7% in radial inclination, and 17.6% in the volar tilt. According to the Stewart's criteria, the results were good, moderate, and poor in 12, nine, and three patients, respectively. Flexion-extension (75%), supination-pronation (70%), and radial-ulnar deviation (75%) were preserved to a great extent. Grip force amounted to 70% of the healthy side. According to the Gartland-Werley criteria, three patients had excellent, eight patients had good, 10 patients had moderate, and three patients had poor results. According to the Knirk-Jupiter's criteria, degenerative changes were slight in 11 patients, moderate in six patients, and severe in one patient. Six patients had no signs of degeneration. Complications included pin track infections (n=4), early transient reflex sympathetic dystrophy (n=2), and hypoesthesia along the superficial branch of the radial nerve (n=2). CONCLUSION: Treatment of the distal end fractures of the radius (AO type C2-C3) with a combination of external fixation, grafting, and percutaneous K-wires provides almost normal radiologic and clinical parameters.

Adult↗
PubMed1992

Deep-venous thrombosis of the upper extremity after traumatic brain injury.

Deep-venous thrombosis (DVT) of the lower extremity occurs frequently in a variety of patients, including those with traumatic brain injury (TBI), during their rehabilitation. Thrombosis of the major veins of the upper extremity is believed to be relatively rare, although it has increased in recent years due to the routine use of indwelling percutaneous central venous catheters. Upper extremity pain and swelling in a TBI patient is commonly attributed to heterotopic ossification, reflex sympathetic dystrophy, or occult fracture. Clinicians may not consider DVT in the differential diagnosis. No longer regarded as a benign disorder, we report the successful outcome in a 27-year-old with TBI who developed an upper extremity DVT after subclavian catheterization. The diagnostic findings, as well as treatment recommendations are reviewed.

Adult↗
PubMed2005

[The musculoskeletal system in diabetic patients].

In this review, musculoskeletal manifestations in diabetic patients are presented. Late complications of diabetes mellitus (neuropathic arthropathy and diabetic muscle infarction), consequences of metabolic derangement inherent to diabetes (diffuse idiopathic skeletal hyperostosis, osteopenia, and osteoporosis), syndromes that may share etiologic mechanisms with changes of collagen and microvascular disease (limited joint mobility syndrome (cheiroarthropathy), palmar flexor tenosynovitis (trigger finger), Dupuytren's disease, adhesive capsulitis of the shoulder, and reflex sympathetic dystrophy) are described. Moreover, carpal tunnel syndrome, gout, osteoarthritis and their probable association with diabetes mellitus are discussed.

Bone Diseases, Metabolic↗
PubMed2006

An electrophysiological approach to the evaluation of regional sympathetic dysfunction: a proposed classification.

BACKGROUND: The importance to physicians of maintaining a level of understanding of illnesses and their treatment continues to reveal itself in a most striking fashion when it comes to the progressive interest recently directed to disorders of the autonomic nervous system (ANS). In particular, the relevance to pain practitioners of disease states which directly involve the sympathetic portion of the ANS has increased markedly following the international renaming of reflex sympathetic dystrophy (RSD) and causalgia to complex regional pain syndrome (CRPS) Type I and Type II respectively, as well as sympathetically maintained pain (SMP). Subsequently it has become better understood that many other forms of neuropathic pain also demonstrate local abnormalities of the sympathetic nervous supply to the skin within the painful territory, thereby increasing the diagnostic value of these (often subtle) cutaneous clinical signs. OBJECTIVES: The objectives of this presentation include (a) a concise review of laboratory tests that are currently used in the evaluation of the autonomic nervous system, (b) a discussion of those procedures that were developed for the assessment of sympathetic sudomotor function, (c) a review of the anatomic pathways subserving those electrophysiological methods for sudomotor testing, and (d) the current diagnostic classification for regional abnormalities of sympathetic sudomotor dysfunction. METHODS: Methods used in the preparation of this article have included a review of (a) historic clinical and laboratory articles (or translations thereof) regarding the medical importance of disorders of the autonomic nervous system, dating back to more than 155 years ago (b) anatomic and electrophysiological basis for electroneurodiagnostic sudomotor testing, and (c) the author's proposal for a diagnostic classification of regional sympathetic sudomotor dysfunction.

Autonomic Nervous System Diseases↗
PubMed1990

[Reflex syndromes in cervical osteochondrosis].

Clinical, biochemical, x-ray findings are available for 430 patients who demonstrated reflex syndromes of acute cervical osteochondrosis as well as evidence on functioning of peripheral and cerebral hemodynamics, neuromuscular and sympatheticoadrenal systems obtained at rheovasography, rheoencephalography, Doppler ultrasonography, electromyography, electroneuromyography, electroencephalography.

Acute Disease↗
PubMed1991

Patellar tendon bone grafting for patellectomized patients having total knee arthroplasty.

A technique for restoring the moment arm to improve quadriceps leverage after patellectomy has been developed and used in patients treated with total knee arthroplasty. Essentials of the technique involve use of a 2.5-cm diameter by 1-cm thick bone graft sewn into the previous anatomical position of the patella, using a subsynovial pouch for stabilization. Clinically, seven knees in six patients were treated with patellar tendon bone grafting during total knee arthroplasty. The final outcome of these patients was evaluated from 24 to 125 months (mean, 75.4 months). Good to excellent results were demonstrated in six of seven knees (85.7%) with sufficient extension power for normal gait in most cases. Failure to achieve painless, active extension was seen in one patient following revision knee arthroplasty complicated by chronic reflex sympathetic dystrophy of the knee. Patellar tendon bone grafting improves quadriceps leverage in previously patellectomized knees and is useful in restoring extensor function in such patients having primary or revision knee arthroplasty.

Adult↗
PubMed1990

[The concept of "ganglionitis" in the modern science of the autonomic nervous system].

The authors review the concept of vegetative "ganglionitis" formed in the Soviet literature in the 40-60s. Consider the etiological, clinical and diagnostic aspects thereof. Provide the modern concepts of the clinical manifestations related to the lesions of the paravertebral sympathetic ganglia. Relate some hypotheses concerning the origin of painful phenomena within the framework of the syndrome of reflex sympathetic dystrophy. Indicate that verified lesions of the sympathetic ganglia are associated with well-defined clinical symptoms which absolutely differ in their appearance from the reported descriptions of "ganglionitis", which are unjustifiedly widely used in the Soviet literature over the recent decades. The conclusion is made about the necessity of reviewing the outdated concepts of the pathology of the vegetative sympathetic ganglia from the standpoint of the modern concept of peripheral vegetative insufficiency.

Autonomic Nervous System Diseases↗
PubMed1990

[Intravenous sympatholysis in arterial occlusive diseases and acrosyndromes].

Regional intravenous injection of ismelin is a very common pain treatment in sympathetic reflex dystrophies. In view of the mode of action of ismelin, it would be interesting to use that technique in the symptomatic treatment of chronic obstructive arteriopathies and of Raynaud's phenomenon. Surprisingly, few papers deal with that subject, probably because of fear of aggravating ischemia. However, short-term results are satisfactory in terms of pain relief. Long-term follow-up is unfortunately never mentioned.

Arterial Occlusive Diseases↗
PubMed1989

Neurologic sequelae of minor electric burns.

Although neurologic pathology is a well-documented sequela of major electric burns, there are few reports of complications arising from less extensive electrically induced trauma. Two cases of patients with significant disease subsequent to minor electric burns are presented. In one patient with a 2% superficial partial-thickness burn of the right forearm, nerve conduction studies, electromyography, and somatosensory evoked potential studies were consistent with right median mononeuropathy at the wrist and a distal slowing of the right ulnar nerve. The second patient presented with persistent numbness, hyperpathia, and burning in his left hand after an electric shock in a telephone booth. He had a creatine phosphokinase of 2000m mu/mL but no surface burn. A left stellate ganglion block provided complete resolution of his symptoms and established a diagnosis of minor reflex sympathetic dystrophy.

Adult↗
PubMedDate not supplied

Early continuous passive movement in hand surgery.

For many conditions CPM can provide better results than good surgical technique alone. CPM was first used for flexor tendon repairs. More recently, its use has been extended to operations on extensor tendons, tenolysis, joint reconstruction, and the treatment of intraarticular fractures, burned hands, reflex sympathetic dystrophy, and crush injuries of the hand. New portable CPM machines have permitted an increase in the effective therapy time patients may receive. This article compared three different CPM machines and described two treatment protocols for early passive movement of the hand after operations on the tendons.

Hand↗
PubMed1989

Surgical complications of the patellofemoral articulation.

The complications associated with surgery on the extensor mechanism of the knee were reviewed. These complications may be avoided by being mindful of the importance of patient selection, establishing specific diagnoses, and then carrying out proper surgical procedures. Also reviewed were the complications associated with the extensor mechanism in total knee arthroplasty. Patellofemoral complications are the most common complications of total knee arthroplasty. The importance of precise surgical technique in aligning the extensor mechanism was emphasized. Caution is probably advisable in the use of metal-backed patellar components for the time being. Lastly, the relatively rare, but important, complications of reflex sympathetic dystrophy, infrapatellar contracture syndrome, and patella infra were reviewed.

Arthroplasty↗
PubMed1989

The electrodiagnosis of the carpal tunnel syndrome.

The carpal tunnel syndrome is one of the most commonly discussed subjects among the public, as well as the medical community, these days. Even though this is a rather simple nerve compression, which can be easily corrected, the carpal tunnel syndrome can induce further complications, sometimes leading to total disability of the patient. Early, proper diagnosis and treatment is very vital. Unfortunately, the exact pathomechanism and proper diagnosis is yet to be seen. As electromyographers, the authors would like to re-visit this debatable carpal tunnel syndrome emphasizing the electrodiagnosis. Among the electrodiagnostic tests, comparison of distal motor or sensory latency of the median nerve to the ulnar nerve along with amplitude of the response, was found to be the most sensitive test. Also, the C6 cervical radiculopathy and the pronator syndrome can present similar clinical pictures and require a differentiation. After successful surgery many patients still complain of subjective residual symptoms. The electrophysiologic findings do not correspond to the clinical progress in many cases. The authors also experienced that most of the victims, following successful surgery, still would benefit from a proper exercise program including instruction for proper body mechanics before they return to their previous activities, to lessen the undesirable complications including the reflex sympathetic dystrophy.

Carpal Tunnel Syndrome↗
PubMed1989

Autonomic mechanisms in oral sensations.

Sympathetic fibres reach the oro-facial region by several routes, the main one being via the carotid nerve and the trigeminal or facial nerves. Sensory receptors in this region may be affected non-specifically by activity in these fibres as a result of, for example, changes in local blood flow or contraction of pilo-erector muscles. There is evidence that the responses of intradental receptors and periodontal mechanoreceptors may change during stimulation of the cervical sympathetic trunk, but these effects are probably not due to specific modulatory mechanisms. There is no evidence that the parasympathetic nervous system affects the properties of oral receptors. Patients with Horner's syndrome appear to have no sensory abnormalities, apart from pain which is sometimes associated with the onset of the condition. Reflex sympathetic dystrophy seems to be rare in the oro-facial region.

Dental Pulp↗
PubMed1986

[Algoneurodystrophy].

The authors consider the extensive literature concerning a quite frequently observed clinical picture, that has been named in different way by each researcher. Algoneurodystrophy is the name used in this analysis. They make a review of the most important works appeared in literature. It points the contrasting aspects of the research made till now. Therefore, in authors' opinion, it's necessary for them to investigate with further studies various aspects of the disease (etiological, pathogenetic, clinical, therapeutic ones, etc.) associated with a prevention of the secondary and tertiary damage the earliest as possible.

Feedback↗
PubMed1988

[Possibilities of neural therapy in internal medicine].

Neural therapy is the diagnostic-therapeutic application of local anaesthetics, in order to be able to treat functional, painful, reversible diseases, disturbed regulations including inflammations. The results of the cure are to be explained by complex neurophysiologic, electrophysiologic, molecularbiologic, immunologic, humoral and thus cybernetic courses of reaction. Neural therapy is to be used under two complexes. Firstly, symptomatically in the segment as weal, in trigger points, on and in joint structures, in vessels, muscular and tendon attachments, sympathetic-parasympathetic ganglia in order to cause a regulating effect, for instance by interruption of nociceptive afferences, blocking of sympathetic efferent reflexes in the sense of the sympathetic reflex dystrophy. Secondly, causally at the focus of disturbance or in the peripheral irritation centre, which may be a scar, the nasopharyngeal space, the abdomen, the spine and other things, in order to eliminate the cause of the disturbance. From the variety of the effects of the local anaesthetics, like membrane stabilizing, antihistaminic, catecholamine-decreasing, choline receptor inhibiting, antiarrhythmic at the cardiac muscle results their multifarious use, also in internal medicine. The neural therapy is effective, economic, poor in side effects, closes therapeutic gaps and is well to be combined with other successful medical treatments, especially of reflex-therapeutic kind. Exact clinical diagnostics, good knowledge in anatomy, technical ability of the therapeutist as well as theoretical basic knowledge are prerequisite for the use of the neural therapy.

Anesthetics, Local↗
PubMed1988

Finger pain.

The local, systemic, and referred causes of finger pain are generally recognizable by historical features and physical examination findings, although radiographs and laboratory evaluation are often required to support the diagnostic impression. Most minor traumatic causes of finger pain require only conservative management, including immobilization followed by exercise. Infectious causes of finger pain include cellulitis, tendinitis, paronychia, felon, and infectious emboli, which generally require antibiotics with or without drainage. Certain patients with finger pain resulting from infection should be referred to a hand surgeon. Vascular and ischemic causes of finger pain represent true emergencies, because tissue viability is dependent on prompt intervention. Whereas any sensory neuropathy may present with finger pain, carpal tunnel syndrome is among the most common. Systemic rheumatic disease, such as rheumatoid arthritis or vasculitis, may begin with finger pain. In addition, such pain may be the first manifestation of a serious systemic illness, as in hypertrophic pulmonary osteoarthropathy. Reflex sympathetic dystrophy is an example of referred pain, presumably by way of neural mechanisms. Certain infectious, traumatic, and ischemic causes of finger pain must be diagnosed promptly to avoid significant morbidity; depending upon the cause of the symptoms, referral to a hand surgeon, rheumatologist, or neurologist may be appropriate. Symptomatic and functional improvement may also be hastened by the input of an occupational therapist.

Diagnosis, Differential↗
PubMed1988

Subluxation of the first rib: a possible thoracic outlet syndrome mechanism.

Twenty-two cases of both the thoracic outlet syndrome (TOS) and reflex sympathetic dystrophy (RSD) are described, four in detail. Each case had a hypomobile first rib on the painful side. A simple test was used to evaluate the first rib mobility. After isometric exercises of the scalene muscles, the mobility of the first rib was restored and the symptoms completely relieved in 13 patients. We concluded that the subluxation of the first rib may irritate the neural network and the stellate ganglion in the neighborhood of the first costotransverse joint. This in turn can cause the radiating pain and RSD symptoms.

Adult↗
PubMed1987

A rational approach for the recognition and treatment of Colles' fracture.

The approach to Colles' fracture, as recommended in this article, is derived from understanding the mechanism of injury. Fractures that are inherently unstable can be recognized by observing the depth of comminution presented on the lateral postreduction radiography. These unstable fractures demand a more vigorous approach to achieve the result our patients have come to demand. External fixators, percutaneous pinning, and bone grafting have all been successfully used to achieve a satisfactory result. Fortunately, the majority of Colles' fractures are stable and can be treated by accurate closed reduction and immobilization in plaster. If the fracture results in loss of containment of the carpus, a chronically weak and sometimes painful wrist will result. This event can be remedied surgically. The final emphasis I would like to impart is the prevention of sympathetic reflex dystrophy. Early involvement by the patients in their rehabilitation process is essential in minimizing this condition. Understanding and application of the principles I have presented will result in patients pleased with the result of their care and, consequently, with their physician.

Arthritis↗