Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 1977
Functional anatomy of the deep motor branch of the ulnar nerve.
Our presently inadequate knowledge of the functional anatomy of the deep branch of the ulnar nerve handicaps our management of ulnar nerve lesions. The extensive anatomical variations in the distribution of this nerve preclude adherence to a textbook pattern of innervation. ⋯ Afferent fibers arise from muscle, joints, deep subcutaneous tissues and even skin. These findings suggest that it is unwise to look at any nerve as purely motor or having a set innervation pattern, and emphasize the pressing need for objective preoperative and/or intraoperative functional assessment in peripheral nerve surgery.
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Hemophilia produces severe destruction of the knee joint resulting frequently in intractable pain. Total knee replacement with synovectomy can be safely performed with the proper use of blood concentrates. Four Modular knee replacements were performed on three patients without complications, and at follow up of two years or more, the patients were pain free but one had an occasional recurrence of bleeding in the joint.
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Clin. Orthop. Relat. Res. · May 1977
The external compression syndrome of the ulnar nerve at the cubital tunnel.
Diagnosis of the cubital tunnel external compression syndrome, and subsequent avoidance of further external pressure, minimizes the possibility of progressive crippling of the hand. The usual clinical features are local tenderness over the cubital tunnel, often accompanied by distal paresthesias, and neurological deficit in the ulnar nerve distribution with sparing of the flexor digitorum profundus and flexor carpi ulnaris muscles; the elbow flexion test, described by the author, awaits evaluation in the diagnosis of the syndrome. Clinicians and others concerned with positioning patients on the operating room table or caring for patients in the ward should be aware of the syndrome. ⋯ Surgical treatment is sometimes indicated, at least to halt progression of the palsy. A classification of the cubital tunnel syndrome is proposed: physiological, acute and subacute due to external pressure (both forming the cubital tunnel external compression syndrome) and chronic (space-occupying lesions and loss of volume due to lateral shift of the ulnar as a consequence of childhood injury to the capitular epiphysis). Nerve conduction studies may be helpful in the diagnosis of the doubtful cubital tunnel syndrome, particularly when there is definite impairment of power or sensation in the hand.
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Clin. Orthop. Relat. Res. · Jan 1977
Review Case Reports Clinical TrialChymopapain--past and present, future?
Clinical experience with Chymopapain casts doubts upon the reported results of the limited double blind studies done mainly by surgeons and their residents, relatively inexperienced in the disc injection technique. Chymopapain is a useful drug when used properly for lumbar disc disease and has the potential of eliminating three-fourths of lumbar disc surgery. ⋯ In the mean-time the drug is available in Canada and England but not in the U. S.
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A 73-year-old housewife with enlargement of her distal right humerus and especially the medial epicondyle due to Paget's disease developed an ulnar nerve palsy. Transposition of her ulnar nerve anterior to her elbow completely relieved her symptoms. A similar case of ulnar nerve palsy associated with expansion of the distal humerus due to Paget's disease seems not to have been previously reported.