The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · May 2004
Low-back pain following surgery for lumbar disc herniation. A prospective study.
Lumbar disc herniation often causes sciatica. Although surgery may provide relief of sciatic pain, it is uncertain how surgery affects the relief of low-back pain. The purpose of the present prospective study was to assess the efficacy of discectomy in the treatment of low-back pain associated with lumbar disc herniation. ⋯ Excision of a herniated disc for relief of sciatica provided rapid relief of sciatica and low-back pain. The findings of the present small study suggest that lumbar disc herniation might be a possible cause of low-back pain.
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This prospective study was performed to determine which clinical and imaging tests were most helpful for diagnosing acromioclavicular joint pain. ⋯ The highly sensitive tests had low specificity, and the highly specific tests had low sensitivity. However, the combination of a positive Paxinos test and a positive bone scan predicted damage to the acromioclavicular joint as the cause of shoulder pain with a high degree of confidence.
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Management of compartment syndrome in the modern era involves not only avoiding the sequelae of a missed diagnosis but also minimizing the risk of a malpractice claim. Little information is available on the legal aspects of compartment syndrome. ⋯ While malpractice claims involving compartment syndrome were uncommon, they resulted in a high rate and amount of indemnity payments. Early fasciotomy not only improves patient outcome but is also associated with decreased indemnity risk.
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J Bone Joint Surg Am · Apr 2004
Case ReportsSelective neurotization of the median nerve in the arm to treat brachial plexus palsy. An anatomic study and case report.
The current method for treatment of median nerve palsy after a brachial plexus injury is unpredictable. On the basis of an anatomic study of the median nerve in the arm, we present a new method of selective neurotization of the median nerve. ⋯ The typical arrangement of the fascicular groups of the median nerve in the arm favors the technique of selective neurotization, which has been used effectively in one patient to date.
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J Bone Joint Surg Am · Apr 2004
Randomized Controlled Trial Comparative Study Clinical TrialTreatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study.
Epidural steroid injection is a low-risk alternative to surgical intervention in the treatment of lumbar disc herniation. The objective of this study was to determine the efficacy of epidural steroid injection in the treatment of patients with a large, symptomatic lumbar herniated nucleus pulposus who are surgical candidates. ⋯ Epidural steroid injection was not as effective as discectomy with regard to reducing symptoms and disability associated with a large herniation of the lumbar disc. However, epidural steroid injection did have a role: it was found to be effective for up to three years by nearly one-half of the patients who had not had improvement with six or more weeks of noninvasive care.