Showing papers in "Journal of Hand Surgery (European Volume) in 1987"
TL;DR: Results of this study show that if their lengths and diameters are correct, the Semmes-Weinstein monofilaments produce application forces that are repeatable within a predictable range.
Abstract: Forty-one filament kits were measured for filament application force, single and multitester application force repeatability, and comparison of filament repeatability with that of other hand held instruments Results of this study show that if their lengths and diameters are correct, the filaments produce application forces that are repeatable within a predictable range All hand held instruments vary in application force The Semmes-Weinstein monofilaments vary relatively little and are a controlled reproducible force stimulus for use in clinical testing
440 citations
TL;DR: It was found that the load through the ulna increased from 21% to 67% of the total load as the angulation of the distal radial fragment increased from 10 degrees of palmar tilt to 45 degrees of dorsal tilt.
Abstract: In an attempt to explain disability in dorsally angulated malunited distal radius fractures, an experiment was designed to evaluate load patterns about the wrist with varying degrees of dorsal angulation of the distal radius. Osteotomies were made in the distal radius of fresh cadaver arms after a modified external fixator was applied to the radius and load cells applied to the proximal radius and ulna. Pressure-sensitive film was inserted into the radioulnar carpal joint. After a predetermined load was applied to the wrist it was found that the load through the ulna increased from 21 % to 67 % of the total load as the angulation of the distal radial fragment increased from 10° of palmar tilt to 45° of dorsal tilt. The pressure distribution on the ulnar and radial articular surfaces changed in position and became more concentrated as dorsal angulation increased.
297 citations
TL;DR: The measurements for two-point discrimination obtained with the protocol employed in this study were found to have an interobserver reliability at the p less than 0.00001 level.
Abstract: Both moving and static two-point discrimination are valid measurements of functional sensibility in the hand. The present study investigated the interobserver variability of these measurements when two observers used the same testing instrument and the same definition of the testing procedure's end point. In testing 30 nerve-injured patients, interobserver variability was found to vary within 1 mm, or less, for moving two-point discrimination in 93.3% of the measurements and for static two-point discrimination in 86.8% of the measurements. In only two of the 30 measurements of moving two-point discrimination and in four of the measurements for static two-point discrimination were interobserver differences equal to 2 mm. Measurements for both moving and static two-point discrimination were analyzed statistically by linear regression and correlation co-efficient techniques. The measurements for two-point discrimination obtained with the protocol employed in this study were found to have an interobserver reliability at the p less than 0.00001 level.
260 citations
TL;DR: A retrospective radiographic analysis of 64 patients with symptomatic scaphoid nonunions without previous surgical treatment showed a high frequency of degenerative changes occurring in a predictable sequence and Instability was progressive and associated with an earlier onset of arthritis.
Abstract: A retrospective radiographic analysis of 64 patients with symptomatic scaphoid nonunions without previous surgical treatment was accomplished. The results showed a high frequency of degenerative changes occurring in a predictable sequence. For nonunions of 4 years duration, 75 % of patients had radioscaphoid changes, and for those of 9 years duration 60 % of the patients had midcarpal changes. The pattern of arthritis in scaphoid nonunion is that of scapholunate advanced collapse (SLAC) wrist resulting from rotary subluxation of the distal scaphoid fragment. The radius-proximal scaphoid fragment joint and the radiolunate joint were consistently spared from degenerative changes, even with severe arthritis. Instability was progressive and associated with an earlier onset of arthritis. Patients with symptomatic scaphoid nonunions appear to have a significant likelihood of arthritis developing.
254 citations
TL;DR: A bone graft, taken from the medial part of the radial epiphysis can be pedicled on the radial branch of the volar carpal arch, freed back to its origin, which permits the treatment of chronic pseud-arthrosis of the scaphoid where a Matti-Russe operation has failed.
Abstract: A bone graft, taken from the medial part of the radial epiphysis can be pedicled on the radial branch of the volar carpal arch, freed back to its origin. The graft can be transferred into the proximal row of the carpus to fill up a loss of bony substance or to provide vascularised bone. This permits the treatment of chronic pseud-arthrosis of the scaphoid where a Matti-Russe operation has failed. In the first three cases operated upon, favourable results have been obtained.
208 citations
TL;DR: Good and satisfactory results all had adequate preoperative stretching, proper surgical technique, and postoperative brace compliance, but failure to adhere to outlined principles of soft tissue release and adequate centralization resulted in the unsatisfactory results.
Abstract: Sixty-four patients with 101 radial deficiencies form the basis of this review of anatomy, treatment, and long-term follow-up. Average follow-up was 8.6 years, with a range of 1 to 27 years. A radiologic classification of radial deficiencies is presented. The preferred method of treatment is centralization. The goal is to create a centralized, cosmetically and functionally improved hand, yet maintain wrist motion. There were 21 good, 20 satisfactory, and 10 unsatisfactory results. Good and satisfactory results all had adequate preoperative stretching, proper surgical technique, and postoperative brace compliance. Failure to adhere to outlined principles of soft tissue release and adequate centralization resulted in the unsatisfactory results.
206 citations
TL;DR: Data suggest that the risk of tendinitis among workers can be reduced by reduction of the repetitiveness and the forcefulness of the work, but this hypothesis has not yet been fully tested.
Abstract: The objectives of this article are to present (1) a historical perspective on hand and wrist tendinitis in workers, (2) new data that demonstrate a relationship between the repetitiveness and forcefulness of manual work and the prevalence of tendinitis, (3) possible biomechanical factors in tendinitis, and (4) possible job modifications for the prevention of tendinitis. Numerous studies during the last 100 years show that tendinitis is a major cause of worker suffering and workers' compensation in intensive hand work. Epidemiologic data show that the risk of hand and wrist tendinitis in persons who perform highly repetitive and forceful jobs is 29 times greater than in persons who perform jobs that are low in repetitiveness and force. A possible factor in this relationship is viscous deformation of the tendons and adjacent tissues. Although these data suggest that the risk of tendinitis among workers can be reduced by reduction of the repetitiveness and the forcefulness of the work, this hypothesis has not yet been fully tested.
197 citations
TL;DR: A survey of the members of the American Society for Surgery of the Hand determined whether a consensus exists concerning the treatment of carpal tunnel syndrome among surgeons who regularly treat hand problems.
Abstract: Carpal tunnel syndrome is one of the most common problems seen by the hand surgeon. In spite of its frequent occurrence there are several aspects of its treatment that remain controversial. A survey of the members of the American Society for Surgery of the Hand determined whether a consensus exists concerning the treatment of carpal tunnel syndrome among surgeons who regularly treat hand problems.
181 citations
TL;DR: The model developed in this study demonstrates that an initial loss of flexor tendon repair strength is not inevitable, and immediate constrained digital mobilization allows progressive tendon healing without an intervening phase of tendon softening.
Abstract: Profundus tendon lacerations were repaired in the central toes of 216 chickens, and the digits were either immobilized in a cast or allowed immediate constrained motion in a tethering splint. The effect of digital motion on the early phases of tendon healing was investigated by comparing the rupture strengths of the two groups during the first 40 days after repair. The repairs in immobilized digits showed marked decreases in strength during the first 20 days, while the tendons in mobilized digits showed immediate and progressive gains in strength through the time intervals studied. By 5 days, the difference in strength between the two groups was significant ( p
177 citations
TL;DR: A technique of isolation of the peroneal communicating branch for use as a nerve graft is described and may be useful as a source of nerve graft without complete sacrifice of the sural nerve.
Abstract: The anatomy of the sural nerve complex in 20 cadaveric limbs was determined by dissection. The nerve usually consists of four named components: the medial sural cutaneous nerve, the lateral sural cutaneous nerve, the peroneal communicating branch, and the sural nerve. In most instances (80%), the sural nerve is formed in the distal portion of the leg by the union of the medial sural cutaneous nerve and the peroneal communicating branch. In 20% of cases, the peroneal communicating branch is absent. In such cases, the sural nerve is derived from the medial sural cutaneous nerve alone. The lateral sural cutaneous nerve is laterally situated and usually divides into medial and lateral branches. In a few cases, its medial division may contribute to the sural nerve through the peroneal communicating branch. The peroneal communicating branch can be of substantial caliber and may be useful as a source of nerve graft without complete sacrifice of the sural nerve. We describe a technique of isolation of the peroneal communicating branch for use as a nerve graft.
172 citations
TL;DR: The results suggest that injury to this structure significantly changes carpal motion especially between the scaphoid and lunate.
Abstract: Although the scapholunate interosseous ligament has been studied anatomically and functionally by several investigators, its exact role in wrist kinematics is still controversial. We designed and executed an experimental study with four cadaver specimens to compare various carpal motions before and after section of this ligament. Our results suggest that injury to this structure significantly changes carpal motion especially between the scaphoid and Innate.
TL;DR: Seventeen male patients with a fourth metacarpal fracture and fifth carpometacARPal joint injury were treated and distinct patterns of injury were recognized and in each case fell into one of three categories.
Abstract: Seventeen male patients with a fourth metacarpal fracture and fifth carpometacarpal joint injury were treated. Distinct patterns of injury were recognized and in each case fell into one of three categories. Type IA lesions were characterized by subluxation or dislocation of the fifth carpometacarpal joint without hamate avulsion fracture. Type IB lesions were identical to type IA lesions except for the appearance of a small dorsal rim hamate avulsion fracture. Type II lesions were distinguished by subluxation or dislocation of the fifth carpometacarpal joint and comminution of the dorsal hamate rim. Finally, type III lesions exhibited coronal splitting of the hamate.
TL;DR: The treatment program is based on active "stress loading," which consists of active traction and compression exercises that provide stressful stimuli to the extremity without joint motion that are effective, simplicity, safety, and noninvasiveness.
Abstract: Reflex sympathetic dystrophy (RSD) is a syndrome characterized by pain out of proportion to injury, vasomotor and trophic changes, stiffness, and decreased function. It is important to separate the active disease process of RSD from its resultant state of contracture and fibrosis. Our treatment program is based on active "stress loading," which consists of active traction and compression exercises that provide stressful stimuli to the extremity without joint motion. Fifty-two patients with RSD were treated during a 3-year period. Their results and long-term follow-up on 41 patients are presented. The "stress loading" program has been used consistently during the past 20 years. The advantages of the program are its effectiveness, simplicity, safety, and noninvasiveness.
TL;DR: In over 16% of cases, a tumor of the hand was the first manifestation of a primary tumor elsewhere, and the lung is the chief source, followed by the breast and the kidney.
Abstract: A review of the world literature shows 163 cases of tumors metastatic to the hand; we report three additional cases. The incidence of primary tumors elsewhere metastasizing to the hand is a little more than 0.1%. In over 16% of cases, a tumor of the hand was the first manifestation of a primary tumor elsewhere. The lung is the chief source, followed by the breast and the kidney. The terminal phalanges are the most frequent site of metastasis, followed by the metacarpals and the proximal phalanges. The mechanism of dissemination remains obscure.
TL;DR: Pressure-sensitive film was used to study the contact areas, scaphoid-lunate area ratios, average high pressures, centroid positions, and intercentroid distances of five wrist joints under a uniform load of 103 Newtons (N) in 36 different positions.
Abstract: A static positioning frame allows the positioning of unembalmed human upper extremities in any combination of wrist flexion/extension, radio/ulnar deviation, and pronation/supination. Pressure-sensitive film (Fuji) was used to study the contact areas, scaphoid-lunate area ratios, average high pressures, centroid positions, and intercentroid distances of five wrist joints under a uniform load of 103 Newtons (N) in 36 different positions. The contact areas accounted for only 20.6% of the available joint surface. They shift from a primarily palmar location to a primarily dorsal location when the wrist changes from flexion to extension. Overall the scaphoid contact area was 1.47 times that of the lunate and was generally greatest with the wrist in ulnar deviation. The scapho-lunate contact area ratio increased as wrist position changed from radial to ulnar deviation and/or from flexion to extension. For the constant load of 103 Newtons the high pressure averaged 3.17 megapascals (MPa). The scaphoid and Innate high pressure centroids shifted palmar when wrist position changed from 20° of flexion to 20° of extension and then shifted dorsal with further extension of the wrist. The intercentroid distance averaged 14.91 mm and ranged from 10 to 20 mm.
TL;DR: In a prospective study, 87 carpal and digital ganglions were aspirated, multiply punctured, and digitally ruptured and immobilization significantly improved the results of treatment of dorsal carpal ganglion.
Abstract: In a prospective study, 87 carpal and digital ganglions were aspirated, multiply punctured, and digitally ruptured. Fifty percent of wrists and digits were immobilized for 3 weeks and 50% were mobilized early. Mean follow-up was 22 months. Thirty-six percent (31/87) of all ganglions treated showed a successful outcome. Twenty-seven percent (16/60) of dorsal carpal, 43% (6/14) of palmar carpal, and 69% (9/13) of palmar digital ganglions did not recur. Immobilization significantly improved the results of treatment of dorsal carpal ganglions. Forty percent (12/30) of those in the immobilization group and 13% (4/30) of those in the early mobilization group had a successful outcome ( p
TL;DR: Eight hundred twenty-one median nerves were retrospectively and prospectively reviewed for variations during operations to treat carpal tunnel syndrome and the combined incidence of anomalies at operation was 9.8% and in the cadaver series 18%.
Abstract: Eight hundred twenty-one median nerves were retrospectively and prospectively reviewed for variations during operations to treat carpal tunnel syndrome. Ninety-two cadaver median nerves were also dissected to document the incidence of variations within the carpal canal. The combined incidence of anomalies at operation (Lanz groups 1 to 4) was 9.8% and in the cadaver series 18%. The discrepancy reported by Poisel, 54% in the Lanz group 1 series, versus ours of 1.42% cannot be explained.
TL;DR: In the intact specimen, ulnaloading increased with wrist extension and ulna deviation and decreased with flexion and radial deviation, while after the surgical procedures there was no significant change in ulna loading with wrist position.
Abstract: To evaluate the effect of silicone replacement of the distal ulnar, hemiresection arthroplasty and the Darrach procedure on ulnar support of the carpus, changes in force transmission to the radius and ulnar were measured using load cells in axially loaded cadaver arms. Testing of the intact specimens in neutral position showed that an average of 17% of the axial load was borne by the ulna whereas the load decreased to 3.6% after silicone arthroplasty, to 2.4% after hemiresection arthroplasty, and to 1.0% after the Darrach procedure. Only by placing the silicone cap on the ulna to lengthen it by 4 mm did the ulna load become within 75% of that in the intact specimen. In the intact specimen, ulna loading increased with wrist extension and ulna deviation and decreased with flexion and radial deviation, while after the surgical procedures there was no significant change in ulna loading with wrist position.
TL;DR: Twenty-one cases of vascularized fibula transfer for upper limb reconstruction are reviewed, and the most favorable results were achieved in cases of forearm bone reconstruction and for long-bone reconstruction after tumor resection.
Abstract: Twenty-one cases of vascularized fibula transfer for upper limb reconstruction are reviewed. Recipient sites included the humerus in 11 patients, radius in five, ulna in three, and clavicle in two. Overall, primary bone union occurred in 15 patients (71.4%), and eventual union was achieved in 17 patients (81%). Two of the patients in whom there was failure to unite are minimally symptomatic, with stable fibrous nonunions. The most favorable results were achieved in cases of forearm bone reconstruction (100% union) and for long-bone reconstruction after tumor resection (83% union).
TL;DR: Fifteen patients had culture proven Mycobacterium marinum infections of the hand; 11 had injured their hands while fishing in water around Long Island, and a combination of surgery and tetracycline provided effective treatment.
Abstract: Fifteen patients had culture proven Mycobacterium marinum infections of the hand; 11 had injured their hands while fishing in water around Long Island. No patient had type I lesions (verrucal), six patients had type II lesions (subcutaneous granulomas), and nine patients had type III lesions (deep). Histologic examination showed noncaseating granulomas in all cases. A specific defect in the patients' lymphocytes ability to respond to M. marinum antigens was identified. A combination of surgery and tetracycline provided effective treatment. Follow-up averaged 2 1/2 years.
TL;DR: Thirty aneurysms in the upper extremity in 28 patients over the last 10 years are reviewed and it was showed that false aneuryms develop from penetrating trauma, while true aneurYSms tend to arise in parts of the arterial tree exposed to blunt trauma.
Abstract: Thirty aneurysms in the upper extremity in 28 patients over the last 10 years are reviewed. Analysis showed that false aneurysms develop from penetrating trauma, while true aneurysms tend to arise in parts of the arterial tree exposed to blunt trauma. Penetrating injury to vessels should be thoroughly explored and repaired. Arterial aneurysm should be included in the differential diagnosis of masses in the upper extremity, especially after trauma. Three-phase radionuclide scanning is a useful tool for evaluating lesions of the distal arterial tree. When an aneurysm is suspected, early treatment is advised. Treatment options of resection and ligation versus reconstitution of vessel flow should be based on preoperative and intraoperative evaluation of circulatory status.
TL;DR: The effects of scaphoid malunion on wrist motion were simulated in a cadaveric study and it was found that the loss of wrist extension is proportional to the angular deformity.
Abstract: A scaphoid malunion results when a scaphoid fracture heals in a flexed position or when a scaphoid nonunion with carpal collapse is grafted without correction of the angular deformity. The effects of scaphoid malunion on wrist motion were simulated in a cadaveric study. It was found that the loss of wrist extension is proportional to the angular deformity. Loss of radiocarpal extension occurred at 15° of angulation and loss of midcarpal extension occurred at 30° of angulation.
TL;DR: The extensor digitorum brevis manus muscle (EDBM) was found in 17 out of 559 dissected hands of 286 cadavers and was considered to be a variant of the extensor indicis proprius muscle.
Abstract: The extensor digitorum brevis manus muscle (EDBM) was found in 17 (3.0%) out of 559 dissected hands of 286 cadavers. The anatomy of the EDBM was classified into three types. The EDBM frequently arose on the distal margin of the radius, but without direct attachment to the carpal bones. The insertion of the EDBM was the same as that of the extensor indicis proprius. The EDBM and the extensor indicis proprius were often joined and had the same nerve and arterial supply. The EDBM muscle was considered to be a variant of the extensor indicis proprius muscle. Clinically five of 29 patients with an EDBM were treated.
TL;DR: Reconstructive procedures were performed to treat tendon rupture in 60 patients with rheumatoid arthritis, finding that single or double tendon ruptures responded successfully to a variety of tendon transfers.
Abstract: Seventy-six reconstructive procedures were performed to treat tendon rupture in 60 patients with rheumatoid arthritis. Tendon rupture commonly occurred in the extensors to the ring and small fingers. However, ruptures of extensors and several flexor tendons were also encountered. Single or double tendon ruptures responded successfully to a variety of tendon transfers. Reconstruction for multiple tendon ruptures is a salvage procedure that is often associated with extensor lag and impairment of overall function. Early aggressive treatment of distal radioulnar joint derangements in the rheumatoid wrist is recommended to forestall many cases of tendon rupture.
TL;DR: Three tourniquet sizes and the inflation pressure required to eliminate flow to the upper extremity using an ultrasonic Doppler device to monitor blood flow in the radial artery of ten normal subjects were investigated.
Abstract: Previous recommendations for use of pneumatic tourniquets in extremity surgery suggest parameters for maximum pressure and time limits without regard for optimum cuff width. Wide cuffs produce lower readings of blood pressure relative to narrow cuffs, presumably because the wide cuffs arrest flow at lower inflation pressure. We investigated three tourniquet sizes and the inflation pressure required to eliminate flow to the upper extremity using an ultrasonic Doppler device to monitor blood flow in the radial artery of ten normal subjects (arm circumference 24.5 to 37 cm). Arterial flow was always eliminated at the lowest pressure using the widest tourniquet cuff. Significantly lower inflation pressures will eliminate blood flow if wider tourniquet cuffs are used; therefore, use of a wider tourniquet cuff may result in a reduced incidence of tourniquet complications.
TL;DR: In almost all cases with total ankylosis, the forearm had compensatory movement around the wrist, the mean arc being from 76.3 degrees of pronation to 42.9 degrees of supination.
Abstract: In order to make clear the clinical features of congenital radio-ulnar synostosis, compensatory rotation around the wrist and functional results after rotation osteotomy, 40 cases of congenital radio-ulnar synostosis have been analysed. The mean pronation of the ankylosed forearm in those who complained of disabilities in daily life was 60.7° and that in patients without complaints was 21.2°. In almost all cases with total ankylosis, the forearm had compensatory movement around the wrist, the mean arc being from 76.3° of pronation to 42.9° of supination. 13 limbs in 11 patients treated by transverse rotational osteotomies through the fusion mass have followed up for over two years. The functional results after surgery were satisfactory in all patients. Rotational osteotomy of the forearm is a useful and reliable treatment for congenital radio-ulnar synostosis.
TL;DR: One patient has shown progressive degenerative radiocarpal changes and may become a candidate for a limited or formal wrist arthrodesis.
Abstract: Ulnar translation of the carpus is a rare posttraumatic carpal instability pattern, in which the entire carpus is displaced ulnarward on the radioulnar surface. No previous formal reports of this problem have been located although it has been described in general discussions of wrist instability. Seven men and one woman were diagnosed with this condition although the diagnosis was delayed from 2 to 23 months, an average of 7.3 months. Three patients were treated surgically before diagnosis; the other five patients were treated conservatively before diagnosis. At the time of definitive diagnosis the radiographs showed an ulnar translation of the carpus, which was quantified on the radiographs in all eight patients by the method of Chamay. Four patients had an attempt to repair the radiolunate and radiocapitate ligaments. One patient had a ligamentous augmentation of the radiocapitate ligament complex. Two patients had ligamentous repairs of a scapholunate dissociation; one of these had simultaneous radiocarpal ligamentous augmentation. The eighth patient had a radiolunate arthrodesis. Follow-up averaged 32 months. Three patients had formal wrist arthrodeses at 10, 13, and 26 months after initial ligamentous repair, which were considered treatment failures. In the remaining five patients, four had partial recurrent ulnar shift, which was seen radiographically. Of these, three patients rated the result as good, with near normal strength and returned to full activities while two obtained fair results, with minimal pain but decreased range of motion and decreased strength. One patient has shown progressive degenerative radiocarpal changes and may become a candidate for a limited or formal wrist arthrodesis.
TL;DR: The best radiographic features for correlation with loss of motion and grip strength were the lunate deformation quotient and, to a lesser extent, the carpal index.
Abstract: Radiographic and clinical findings were reviewed in 50 patients with Kienbock's disease. In 40 patients the clinical and radiographic findings were complete enough to allow correlation of findings. Measurements were made from radiographs in an attempt to quantify the anatomic substrate of Kienbock's disease and to determine which radiographic measurements might be helpful in predicting the course and prognosis of the disease. The measurements included ulnar variance, radial slope, carpal index, carpal angle, combined cortical thickness, optical density, radial slant, scapho-lunate angle, lunate deformation quotient, and the radiographic stages modified from Stahl. These measurements were correlated with patient's history, age at onset of disease, range of motion, and grip strength. Relevant anatomic factors were ulnar variance and the radial slope. The best radiographic features for correlation with loss of motion and grip strength were the Innate deformation quotient and, to a lesser extent, the carpal index. None of the radiographic measurements were very strongly correlated with the clinical findings.
TL;DR: A prospective study has shown that aspiration treatment of ganglion cysts of the wrist and hand can safely remove 85% of these tumors if one, two or three separate treatments are administered.
Abstract: A prospective study has shown that aspiration treatment of ganglion cysts of the wrist and hand can safely remove 85% of these tumors if one, two or three separate treatments are administered. There is a decided cost savings when this treatment is compared with surgical excision, even when the expense of surgical excision for aspiration treatment failures is added to the equation.
TL;DR: Although in general, the goal of treatment should be palliation, in some patients long disease-free intervals can be provided by wide excision of the metastatic focus.
Abstract: During a 43-year period, 18 patients with 22 lesions metastatic to the hand were treated at our institution. Twelve lesions were located in the distal phalanges, and the remainder were found in the carpus, metacarpals, proximal phalanges, and soft tissues of the hand. The primary tumor was in the lung in five cases and in the kidney in five cases. Treatment consisted of local excision or radiation for proximal lesions and amputation for distal lesions. Although the median survival was only 5 months, five patients lived longer than 2 years, including two who had no further evidence of malignant disease. In two patients, hand metastasis was the first sign of malignant disease. Metastatic malignancy should be considered in the differential diagnosis of inflammatory lesions of the hand. Although in general, the goal of treatment should be palliation, in some patients long disease-free intervals can be provided by wide excision of the metastatic focus.