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At least 1,423 records · Page 79Linked to original sources
PubMed1994

Endoscopic carpal tunnel release.

OBJECTIVE: To assess the efficacy and safety of a new technique for carpal tunnel release. DESIGN: A single-group prospective cohort study. SETTING: A referral-based hand-surgery university practice. PATIENTS: Ninety-five consecutive adults; 1 patient was excluded (35 men, 59 women). They underwent 108 surgical procedures. No patients were lost to follow-up. INTERVENTIONS: Endoscopic carpal tunnel release. Outpatient surgery with neuroleptic anesthesia. Two-portal Chow technique of release. MAIN OUTCOME MEASURES: Symptom relief, return to work, medication use and complication rate. RESULTS: The average preoperative duration of symptoms was 3.9 years. Nerve conduction studies were positive in 101 of the 108 hands. Only two patients required open release. Only eight patients complained of intraoperative pain. Six patients failed to obtain relief of symptoms; two of them required secondary open release owing to persistent symptoms. Of the 61 patients who were employed, 52 returned to their previous jobs without restriction. The mean time for return to work was 36.4 days for patients who were Workers' Compensation Board cases and 19.5 days for patients who were not (p < 0.01). Men returned to work in 17.7 days and women in 24.7 days (p < 0.05). Complications occurred in four patients (3.8%). No nerve injury, vascular injury or reflex sympathetic dystrophy was noted. Patients who had undergone previous contralateral open release noted less pain and earlier return to work after endoscopic carpal tunnel release. CONCLUSIONS: Endoscopic carpal tunnel release was effective in relieving symptoms and had a low complication rate. The technique was associated with early return to work and minimal palmar pain.

Adult↗
PubMed1993

Bone scintigraphy: Part 2. Orthopedic bone scanning.

Bone scanning provides a functional assessment of skeletal pathology not available with conventional radiography or special radiographic techniques such as CT and MRI. Bone scanning detects osteoblastic activity associated with many forms of orthopedic skeletal disease. Several of the more common orthopedic applications of bone scanning have been described above, while equally important topics such as prothesis loosening, avascular necrosis, and the reflex sympathetic dystrophy syndrome were not considered. Thus, for a great range of benign skeletal pathology, bone scanning can provide the orthopedic surgeon with practical information concerning the cause of the patient's pain, the true significance of otherwise questionable radiographic findings, the extent of disease and the results of orthopedic surgical treatment.

Arthrodesis↗
PubMed1993

Noncemented, porous ingrowth knee prosthesis: the 3- to 8-year results.

OBJECTIVE: To determine the principal long-term problems encountered in noncemented total knee replacement. DESIGN: A cohort of 252 consecutive cases of total knee replacement with no exclusions. Follow-up ranged from 3 to 8 years. SETTING: A university-affiliated institution specializing in orthopedic surgery. PARTICIPANTS: All 252 patients had arthritis of the knee, mainly osteoarthritis. All agreed preoperatively to prolonged postoperative follow-up. INTERVENTION: Noncemented total knee replacement with the Tricon M prosthesis, which has a metal-backed patella. MAIN OUTCOME MEASURES: The Hospital for Special Surgery rating system for clinical results and the radiologic results, including reasons for revision surgery. RESULTS: Thirty-five prostheses were revised: 11 prostheses because of patellar wear only; in 13 prostheses the tibial component (mainly a 6-mm unit) and patella were revised because of wear; 6 prostheses were revised for sepsis, 4 for reflex sympathetic dystrophy and 1 only for sinkage of the tibial component. Of the remaining 217 prostheses, 88% scored good or excellent, 6% fair and 6% poor. CONCLUSIONS: The single most common cause of failure was polyethylene wear. This was associated with the metal backing of the patella and the use of thin, polyethylene tibial components.

Adult↗
PubMed1993

Magnetic resonance imaging of the foot and ankle.

Magnetic resonance imaging (MRI) of the foot and ankle is useful for the diagnosis and staging as well as the surgical planning of multiple disorders: first, for osseous injury, particularly stress fractures and occult fractures, which appear like bone bruises but behave more like fractures. Then, for the Achilles tendon, MR is useful for staging the chronicity and extent of damage, as well as whether the tendon can be surgically repaired or reconstructed. For the diagnosis of posterior tibialis tendon tears and injuries, MR is an important tool in surgical planning. Often, MR is helpful for the diagnosis of peroneal tendon injury, including dislocations and peroneal splits, two entities that are seen to affect only the peroneal tendons. MR helps in the evaluation of avascular necrosis in any bone secondary to various systemic causes, particularly following talus fractures. MR has also been utilized to assess ankle sprains with complications, such as the ankle impingement syndrome, the sinus tarsi syndrome, and chronic instability, and to diagnose osteomyelitis (since the typical patient also has neuropathic disease bone, scintigraphy is invariably abnormal). MR is promising for the evaluation of reflex sympathetic dystrophy and is as useful for the evaluation of bone and soft tissue tumors as it is elsewhere in the skeleton. MR helps to characterize the biological aggressiveness of the tumor as well as its extent and therefore aids in surgical planning.

Ankle↗
PubMed1994

Endoscopic carpal tunnel release. Use of the modified Chow technique in 215 cases.

OBJECTIVE: To present my experience using the modified Chow two-portal technique of endoscopic carpal tunnel release. PATIENTS: Two hundred and fifteen patients with a clinical diagnosis of carpal tunnel syndrome of more than three months' duration, unresponsive to conservative treatment. Only those few with the specific contraindications of recurrence, a florid flexor tenosynovitis or an acute crush injury were excluded. INTERVENTION: The operation used the modified Chow two-portal endoscopic method of carpal tunnel release. The original Chow method was used in another 15 patients. MAIN OUTCOME MEASURE: Symptomatic relief of pain and paraesthesia. RESULTS: Most patients made a rapid and dramatic recovery, with an early return to work, when compared with both my and patients' previous experience of open carpal tunnel release. Complications were few--two cases of mild reflex sympathetic dystrophy, two of unrelieved symptoms, and no permanent nerve or tendon injury. CONCLUSION: The modified Chow two-portal technique of endoscopic release of the carpal tunnel is effective, with a rapid recovery and few complications--provided that it is done by a surgeon experienced in this method.

Adolescent↗
PubMed1993

Bone scintigraphy in skeletal trauma.

This article emphasizes the usefulness of radionuclide bone imaging (RNBI) throughout the clinical spectrum of osseous trauma and relates RNBI to the other imaging modalities available. Acute, stress, insufficiency, avulsion, and occult fracture detection are discussed and illustrated. Other traumatic lesions including the bone bruise, shin splints, tendinitis and epiphyseal injuries are included. Biomechanical lesions, the result of more chronic low level repetitive stress are discussed in detail, as is the use of RNBI in the detection of post-traumatic sequela such as the reflex sympathetic dystrophy syndrome. Technical aspects of RNBI are considered in the context of producing the quality of diagnostic images necessary for clinically complete consultative reporting.

Bone Diseases↗
PubMedDate not supplied

The use of the Varney brace for subluxating shoulders in stroke and upper motor neuron injuries.

Applying the Varney shoulder brace for painful subluxating shoulders in stroke and head injury patients with or without spasticity has proved to be an extremely effective means of reducing the subluxed shoulder. Other causes for painful shoulders in these patients must be ruled out. Not every shoulder which subluxes with or without spasticity is painful. Correct diagnosis of the etiology of the pain is essential to help the patient. Rotator cuff tendinitis, reflex sympathetic dystrophy, glenohumeral arthritis, shoulder contracture, pain due to central nervous system origin (thalmic pain) and other intrinsic causes of referred pain must be ruled out. Once the subluxed shoulder is proven to be the cause of pain, the Varney brace is an excellent orthosis for the reduction and maintenance of position. Pain usually subsides completely within 5 to 7 days.

Braces↗
PubMed1993

Imaging techniques for distal radius fractures and related injuries.

In patients with distal radius fractures, routine roentgenographic examination in at least two or three planes should be performed first and is usually sufficient for correct diagnosis and adequate treatment. A careful examination of the soft tissues of the forearm and wrist on conventional roentgenograms may be key for correct diagnoses. Routine roentgenographic examination of the wrist, preferable in four views, should be performed in every patient with a distal radius fracture acutely as well as at follow-up. The technique is easy to perform, universally available, and inexpensive. Advanced imaging techniques such as radionuclide bone imaging, CT, or MR imaging should not be first choice modalities in patients with distal radius fractures and should be used only when conventional roentgenograms are inconclusive. Scintigraphy can be helpful for diagnosing occult fractures, for documenting fracture healing and ligamentous or cartilaginous post-traumatic disorders, as well as for diagnosis and follow-up of reflex sympathetic dystrophy. A disadvantage of scintigraphy is its poor specificity. Indications for CT include the confirmation of occult fractures suspected on the basis of the findings of physical examination and focally hot bone scintigrams when plain films are normal or inconclusive. In comparison with conventional radiography, CT is superior for the preoperative evaluation of complex comminuted distal radius fractures, depicting the distal radial articular surface and size and position of fracture fragments, as well as for the assessment of fracture healing. Additionally, CT is the imaging technique of choice for the correct diagnosis of subluxations of the distal radioulnar joint. Magnetic resonance imaging is an important diagnostic technique for the evaluation of suspected injuries of soft tissues related to distal radius fractures, such as to the flexor and extensor tendons or the median nerve, and for the early diagnosis of necrosis of the scaphoid or lunate. Other indications include identification of triangular fibrocartilage complex perforations, ruptures of carpal ligaments, and demonstration of contents of the carpal tunnel.

Follow-Up Studies↗
PubMed1993

[Analysis of the therapy of chronic pain. A comparison of previous therapy and specialized pain therapy].

In Germany patients with chronic pain are often undertreated. It is necessary to establish more specialized institutions for pain therapy. As pain therapy is time consuming and labor intensive the costs must be justified by quality and efficiency. METHODS. We analyzed the new patients who came to our pain clinic in 1990 and compared the previous nonspecialist pain-related treatment with our pain therapy. For each patient we recorded the duration of pain therapy in the past, the number of physicians involved in the treatment, the number and duration of hospital stays and the number of operations carried out to relieve pain. For our pain therapy we recorded the number of treatments on an outpatient basis, the number of patients who were hospitalized and the number of hospital days. The outcome of our pain therapy was determined on a visual analogue scale (VAS). Pain relief of more than 50% was defined as adequate pain therapy. RESULTS. In 1990 we treated 379 new patients in our pain clinic. The largest group (140, 37%) had pain of the muscle or skeletal system. A further 75 patients (18%) had neuropathic pain, 66 (17%) suffered from cancer pain, several types of headache were found in 57 patients (15%), 19 patients (5%) had phantom limb pain, 11 (3%) suffered from reflex sympathetic dystrophy, and we diagnosed psychogenic pain in 11 patients (3%). On average the patients had been treated for their pain over a period of 10 years by eight different physicians. Patients suffering from migraine had the longest duration of preliminary therapy (19.2 years), while patients with cancer pain were pretreated for 2, 3 years in the period before. 80% (n = 302) of all patients were hospitalized at least once. A total of 20,959 hospital treatment days was registered. At least one operation was performed in 34% of the patients (n = 130) to relieve the pain. For all patients the pain relief afforded by the preliminary therapy was insufficient. In our pain therapy the patients had on average 6.5 outpatient appointments. We hospitalized 45 patients (12%), for a mean of 11 days. During the observation period 74% of the patients (n = 280) obtained pain relief of more than 50% in comparison with the start of treatment. CONCLUSION. The findings of our retrospective study demonstrate that specialized pain therapy is evidently effective. If such therapy is instituted early enough, chronic pain can be prevented. Shorter duration of disease, fewer stays in hospitals and less absence from work could reduce the economic costs of chronic pain. It is necessary to make specialised pain therapy a regular component of clinical practice; this means redoubling our efforts concerning education and experimental and clinical studies. The efficiency of pain therapy must be documented in order to improve the care of patients with chronic pain.

Chronic Disease↗
PubMed1993

[Connective tissue massage].

Connective tissue massage deals with the skin and the subcutaneous tissue. It focuses on definite regions of the body, assigned in segmental order to inner organ systems and structures of the locomotor system (spinal cord, joints, muscles). In case of acute disease, oedematous swelling of a generally soft tissue consistency can be observed in circumscribed areas. Persisting symptoms may result in induration of such tissues, associated with reduced rheology and epicritic pain if manipulated mechanically. Eventually, chronic conditions may progress to atrophy. The name "connective tissue massage" is based on the concept that corresponding physiological events take place in connective tissue structures and the segmentally associated organ. With regard to the pathophysiology of such zones, mechanisms which are comparable to sympathetic reflex dystrophy are discussed at present. Analysis of such changes has contributed to general diagnosis. Connective tissue massage is considered to be an important element of physiotherapy. The clinical data on the efficacy of connective tissue massage are reviewed.

Chronic Disease↗
PubMedDate not supplied

The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach. A prospective study of 1,000 consecutive patients.

BACKGROUND AND OBJECTIVES: The present study was performed at the Crystal Clinic Surgery Center, an outpatient free-standing surgicenter specializing in orthopedic surgery, to determine the incidence of both neurologic and vascular sequelae associated with exclusive use of a transarterial approach to axillary brachial plexus block in order to assess the technique's safety and efficacy. METHODS: The prospective consecutive study involved 1,000 adult patients scheduled for surgery using axillary brachial plexus block. The transarterial approach was performed on all patients using a medium-bevel 24-gauge Jelco 1-5-inch needle. Data tabulated included the incidence of neurovascular complications and the outcome of successful axillary brachial plexus anesthesia. RESULTS: Two patients presented with a sensory paresthesia (0.2%) in the distribution of the ulnar nerve and the musculocutaneous nerve that most likely occurred during supplementation of an incomplete block. Three patients presented with upper-arm myalgias (0.3%) related to tourniquet injury. After the operation, two patients developed reflex sympathetic dystrophy, which responded to stellate ganglion blocks. Vascular complications, including transient arterial spasm in 10 of 996 (1%), unintentional intravascular injection in 2 of 996 (0.2%), and small (0-2 cm) hematoma formation in 2 of 996 (0.2%), were recognized but did not require any intervention other than close observation. The study revealed a complete block in 88.8% of cases, an incomplete block requiring supplemental local anesthesia in 10% of cases, and a complete block failure in 1.2%. CONCLUSIONS: This study demonstrated the safety and efficacy of the transarterial technique in achieving brachial plexus block.

Adult↗
PubMed1996

Scintigraphy in the evaluation of arthropathy.

Significant progress has been made in radionuclide imaging of bones and joints. This largely is owing to advances in radiopharmaceuticals, particularly the antibodies, and in technology, particularly in the introduction of new computers and multiheaded camera systems resulting in improved imaging. These techniques have applied to the evaluation of articular and para-articular diseases including rheumatoid arthritis, septic arthritis, osteoid osteoma, transient osteoporosis, reflex sympathetic dystrophy, avascular necrosis, and facet joint syndrome. This article reviews scintigraphy in these conditions.

Citrates↗
PubMed1996

The transaxillary approach for treatment of thoracic outlet syndromes.

The diagnosis and management of thoracic outlet syndromes is based on the surgical management of more than 3,000 patients, 800 of which have had recurrent thoracic outlet syndromes. Accurate diagnosis for peripheral nerve compression is based on measurement of the ulnar and median nerve conduction velocities across the thoracic outlet. For sympathetic maintained pain syndrome or causalgia, a stellate ganglion block is helpful. Arteriography and venography are critical to show vascular compression. Conservative management is successful in most cases (70%) initially. For arterial reconstruction, the supraclavicular-infraclavicular approach is recommended. For the Paget-Schroetter syndrome (effort thrombosis of the axillary subclavian vein), prompt thrombolysis followed by transaxillary first rib resection is mandatory. No long-term anticoagulants are necessary. For hyperhidrosis, causalgia, sympathetic maintained pain syndrome or reflex sympathetic dystrophy, transaxillary dorsal sympathectomy with first rib resection or thoracoscopy is the preferred management when conservative therapy fails. For recurrent thoracic outlet syndrome and sympathetic maintained pain syndrome, a high thoracoplasty posterior approach is preferable with neurolysis of the nerve roots and brachial plexus as well as a dorsal sympathectomy. The technique of transaxillary first rib resection with or without dorsal sympathectomy is presented. The use of the thoracoscope expedites the procedure and improves the teaching capability.

Humans↗
PubMedDate not supplied

Successful use of epidural blood patch for postdural puncture headache following lumbar sympathetic block.

BACKGROUND AND OBJECTIVES: A 21-year-old man was scheduled for a diagnostic lumbar sympathetic block for reflex sympathetic dystrophy of the right lower extremity. METHODS: The patient experienced paresthesias with possible puncture of a dural sleeve during needle placement under fluoroscopy. After discharge, the patient developed a positional headache, which increased in intensity over 48 hours. An epidural blood patch was subsequently performed. RESULTS: The patient obtained complete relief from the headache. CONCLUSION: Postdural puncture headache resulting from leakage of cerebrospinal fluid through a punctured dural sleeve may be successfully treated with an epidural blood patch should more conservative treatments fail.

Adult↗
PubMed1996

Three-phase bone scan in osteomyelitis and other musculoskeletal disorders.

The three-phase bone scan is very sensitive and is the study of choice in the evaluation of patients with suspected osteomyelitis and normal radiographs. If the underlying bone pathology, such as a healing fracture or degenerative disease, is detected on radiographs of the bone, the indium-111-labeled autologous leukocyte scan is the most cost-effective second study. When fracture of the long bones is clinically suspected but radiographs are normal and a delay in definitive diagnosis is acceptable, it is practical and economical to take follow-up films in 10 to 14 days. In cases requiring prompt diagnosis or when follow-up radiographic films are not diagnostic, the three-phase bone scan is the most cost-effective study. The three-phase bone scan is also used in the evaluation of occupational and sports injuries, including shin splints, stress and occult fractures, enthesiopathies and reflex sympathetic dystrophy.

Athletic Injuries↗
PubMed1996

[Management of severe pain after extended maxillectomy in a patient with carcinoma of the maxillary sinus].

We treated a 65 year-old man with severe facial pain after extended maxillectomy due to carcinoma of maxillar sinus. He had been suffering from pain at rest, on mastication, or at treatment of surgical wound. Various kinds of analgesics had been tried, but his pain did not disappear. At 17 weeks after the operation, he came to our pain clinic. Because his pain was thought to be due to reflex sympathetic dystrophy (RSD), stellate ganglion blocks (SGB) were performed. After 5 administrations of SGB, pain was reduced markedly but the pain at treatment of wound persisted. We thought that persistent pain would need trigeminal nerve block. Then Gasserian ganglion block was performed directly through an open wound after the operation. After the Gasserian ganglion block, the pain was diminished remarkably. He could tolerate procedures for facial prosthesis. Pain control after the operation in this patient was very efficient to improve his quality of life. Serum concentrations of catecholamines, serotonin and substance P were measured. The levels of norepinephrine and serotonin are related to the mechanism of pain as seen in this patient.

Aged↗
PubMed1995

Decision making in distal radius fractures.

In distal radius fractures, function follows restoration of preinjury anatomic landmarks. The allowable deviation from these measurements is relatively small if optimal results are to be achieved, particularly in younger individuals. A hierarchy of treatment options--characterized by increasing invasiveness--exists for treating these injuries. As this hierarchy is ascended, treatment-related complications increase. It appears reasonable to select the least invasive treatment option capable of achieving satisfactory anatomic alignment. Hand and extremity function must be addressed early, and a conscientious effort must be exerted to avoid residual stiffness or the development of reflex sympathetic dystrophy.

Colles' Fracture↗
PubMed1996

Epidemiology of rheumatic disease in children.

Major problems associated with interpreting and comparing epidemiologic studies on chronic arthropathies in children include the diversity of classification criteria and selection bias. A new set of classification criteria for peripheral arthritis in children, aiming toward defining biologically homogeneous subgroups, was recently proposed and should be further tested. Descriptive studies from all over the world are now emerging on childhood rheumatic diseases, increasing the potential for comparing the impact of genetic and environmental factors on disease frequency and manifestations. Awareness about pain syndromes in children, such as juvenile primary fibromyalgia and reflex sympathetic dystrophy, has increased, and this population now forms a substantial portion of clinic visits in pediatric rheumatology. The impact of the rheumatic diseases in children on disability and quality of life during childhood and in adult life is still to a large extent unknown and must be further studied in an epidemiologic context.

Arthritis, Infectious↗