Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen
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Handchir Mikrochir Plast Chir · Aug 2005
Comparative Study[Peroneal nerve palsy caused by a recurrent proximal tibiofibular joint ganglion--a case report and review of the literature].
Compression of peripheral nerves is a well known complication of articular synovial cysts. The peroneal nerve is the most common site of intraneural ganglia (pseudocysts) originating from the proximal tibiofibular joint. The neurological deficit associated with these cysts is often severe due to delayed diagnostic and surgical treatment. Therefore, recurrence is very often seen and recovery is incomplete. ⋯ This entity needs careful, prompt preoperative evaluation to avoid neurological damage. Surgical treatment includes microsurgical decompression and complete resection of the cyst and also ligation of the ganglion stem. Early diagnosis and treatment is required to ensure recovery.
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Handchir Mikrochir Plast Chir · Jun 2005
[Carpal tunnel syndrome in haemodialysis patients: analysis of clinical and electrophysiological findings in 268 patients (395 hands)].
Along with arthropathies, carpal tunnel syndrome (CTS) may occur in patients on chronic haemodialysis, its incidence is correlating with the duration of the haemodialysis treatment. To evaluate clinical and electrophysiological findings, relation of the disease to the side of the arteriovenous shunt, gender ratio, and a concurrent tendovaginosis stenosans (TVS), 268 haemodialysis-patients with CTS or recurrent CTS were retrospectively analyzed. METHODS AND (CLINICAL) MATERIAL: Over a period of ten years (1994 - 2003), 268 haemodialysis patients presented to our peripheral neurosurgery practice with CTS or recurrent CTS. Diagnosis was confirmed with clinical and electrophysiological findings. The patients were divided into three groups based on their severity of disease as follows: Patients with only intermittent paraesthesias (CTS I degrees ), with persistent numbness in the area supplied by the median nerve (CTS II degrees ), and with paresis of the thenar muscles (CTS III degrees ). The average distal motor latency (DML), loss of sensory nerve action potentials (SNAP), and/or motor action potentials (MAP) were used as electrophysiological parameters. ⋯ CTS is a typical complication of chronic haemodialysis, and differs from idiopathic CTS by a gender ratio of 1 : 1, a high frequency of concurrent TVS, as well as a tendency to recur. Since compression of the median nerve was found preferentially on the shunt-side, haemodynamic factors may play a role in the pathogenesis of the disease in addition to amyloidosis. Haemodialysis patients complaining of paraesthesia in their hands should undergo electrophysiological examination, even if a successful CTS-operation was performed in the past.
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Handchir Mikrochir Plast Chir · Jun 2005
[Recurrences of carpal tunnel syndrome in long-term haemodialysis patients].
Multiple recurrences of carpal tunnel syndrome and increased malfunction of the hand caused by tendopathies and arthropathies occur in long-term (20 - 30 years) haemodialysis and are mainly influenced by beta2-microglobulin amyloidosis. ⋯ In long-term (more than 20 - 30 years) haemodialysis patients suffering from arthropathies, tendopathies and recurrent carpal tunnel syndrome, removal of the flexor digitorum superficial tendons should be considered for the second recurrence to improve pain and finger mobility.
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Handchir Mikrochir Plast Chir · Apr 2005
Comparative Study Clinical Trial Controlled Clinical Trial[Wrist lesions in MRI arthrography compared with wrist arthroscopy].
Wrist arthroscopy is routinely used for diagnosis of ligamentous lesions to the wrist. Although it is very sensitive and specific, it is also more invasive than other available diagnostic techniques. ⋯ Though sensitivity of MRI arthrography approaches that of arthroscopy, it cannot replace it at the moment. However, it is a potent additional tool for wrist diagnosis if intraarticular contrast is used. It can facilitate diagnosis and indications for surgery of the wrist. It may make arthroscopic and more invasive interventions for diagnostic purposes avoidable in future.
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Handchir Mikrochir Plast Chir · Apr 2005
Comparative Study[Functional results after proximal row carpectomy (PRC) in patients with SNAC-/SLAC-wrist stage II].
The proximal row carpectomy (PRC) is a motion preserving procedure which creates a new joint without arthrosis. It is a frequently used procedure in stage II of a posttraumatic degenerative arthrosis of the wrist after scaphoid nonunion or scapholunate ligament instability (SNAC-/SLAC-wrist). In this retrospective analysis the functional postoperative results of this operation are compared in light of a homogenous indication (SNAC-/SLAC-wrist stage II). ⋯ However, our follow-up time is relatively short and we cannot make any conclusion about the long-term outcome. PRC is a technically straightforward procedure for treatment of carpal collapse. For stage II of the SNAC-/SLAC-wrist we consider the resection of the proximal carpal row an alternative procedure to the midcarpal arthrodesis particularly in patients who require less grip strength and when a shorter postoperative immobilization is reasonable.