Medical Blog

Flexor Tendon Lacerations

Introduction

Injuries to the flexor tendons of the hand are common. Each specific movement of the hand relies on the finely tuned biomechanical interplay of intrinsic and extrinsic musculotendinous forces. Considering the hand’s role in labor, entertainment, art, literature, and passion, hand surgeons should fully define the normal and pathologic boundaries in each patient examined. With injuries that involve flexor tendons, fully defining the pathology is especially important. In this article, the management of the flexor tendon injuries is addressed specifically, with emphasis on history, physical examination, surgical repair, and rehabilitation. (Also, see the eMedicine article Hand, Tendon Lacerations: Flexors.) For excellent patient education resources, visit eMedicine’s Hand, Wrist, Elbow, and Shoulder Center. Also, see eMedicine’s patient education articles Hand Injuries and Finger Injuries. Read more…

Elbow and Above-Elbow Amputations

Introduction

Upper extremity amputations largely follow the same basic principles as those of any amputation. This article highlights the special considerations involved in acquired amputations at or above the elbow. Below-elbow amputations are discussed in separate articles (see Wrist and Forearm Amputations and Digital Amputations). Although acquired amputations in children are discussed (because pediatric patients deserve special consideration), patients with congenital limb amputations and deficiencies are beyond the scope of this article. Read more…

Dupuytren Contracture

Introduction
Problem

Dupuytren contracture, a disease of the palmar fascia, results in the thickening and shortening of fibrous bands in the hands and fingers. This disease entity belongs to the group of fibromatoses that include plantar fibromatosis (Ledderhose disease), penile fibromatosis (Peyronie disease), and fibromatosis of the dorsal proximal interphalangeal (PIP) joints (Garrod nodes or knuckle pads). Guillaume Dupuytren received recognition for the condition that came to be associated with his name because of his expertise on the clinical findings, pathogenesis, prognosis, and treatment of this disease; however, Plater and Cline respectively provided the earliest known records of Dupuytren contracture and its surgical treatment (Verheyden, 1983). Read more…

Distal Humerus Fractures

Introduction

The elbow joint coordinates movements of the upper extremity, facilitating the execution of activities of daily living in areas such as hygiene, dressing, and cooking. When the distal humerus is injured, elbow joint function can be impaired. The goal of open reduction and internal fixation is restoration of normal anatomy. Distal humerus fractures continue to provide challenging reconstructive problems for the orthopedic surgeon.

For excellent patient education resources, visit eMedicine’s Breaks, Fractures, and Dislocations Center. Also, see eMedicine’s patient education articles Broken Arm and Broken Elbow.

History of the Procedure

Many physicians once believed that optimal recovery for complex distal humerus fractures could be achieved through conservative treatment. In 1937, Eastwood described the “bag of bones” technique, which involved compressive manipulation of the distal fragments with collar-and-cuff support and the elbow in flexion.1 After a 2-week period in which the elbow was immobilized at 120 º of flexion, extension was gradually increased. Better outcomes were observed in elderly patients, with ulnohumeral motion averaging 116 º after 2.5 years of follow-up. However, Evans observed that despite the functional range of motion, the final outcome often was a weak and unstable elbow.2 Read more…

Capitellar Fracture

Introduction

Fractures of the capitellum are rare. The complete capitellar fracture pattern was first described in the 19th century (1853) by doctors Hahn and Steinthal; the eponym for this fracture pattern includes their names. Later, doctors Kocher and Lorenz described an additional variation of this fracture pattern; a classification system includes their names.
Problem Read more…

Bicipital Tendon Injuries

Introduction

Bicipital tendon injuries of the elbow most commonly occur in the dominant extremity of men aged 40-60 years. Injuries range from tendonitis to partial tears to complete ruptures. A rupture usually occurs at the insertion of the tendon to the radial tuberosity, resulting in pain and deformity about the elbow, as well as weakness, especially with supination. Most surgeons agree that the best results are obtained with early surgical intervention and reattachment of the tendon to the radial tuberosity.
History of the Procedure

Boyd and Anderson first described a modified 2-incision approach for repair of a distal biceps tendon in 1961. The original approach involved subperiosteal dissection on the ulna. This led to an increased incidence of synostosis and heterotopic bone formation. Read more…

Tarsal Tunnel Syndrome

Introduction

Tarsal tunnel syndrome is a condition that is caused by compression of the tibial nerve or its associated branches as the nerve passes underneath the flexor retinaculum at the level of the ankle or distally.
History of the Procedure

Tarsal tunnel syndrome is analogous to carpal tunnel syndrome of the wrist. In 1962, Keck and Lam first described the syndrome and its treatment.
Problem Read more…

Tarsal Coalition

Introduction

Tarsal coalition is a condition in which 2 or more bones in the midfoot or hindfoot are joined. The most common types of coalitions are those between the calcaneus and either the talus or the navicular bones. Patients with this congenital condition usually present during late childhood or adolescence, but presentations in adulthood have been reported. The condition usually presents as recurrent sprains and pain in the midfoot and has been associated with peroneal spastic flatfoot, fixed flatfoot, and other abnormalities of the foot (also see the eMedicine article Acquired Flatfoot and the Medscape article Flat Feet). Radiographic evaluation has been revolutionized by the use of CT scanning. Early treatment usually involves conservative modalities, including immobilization, while surgical intervention includes resection of the coalition or arthrodesis of degenerated painful joints.1,2  Read more…

Recurrent Ankle Sprains

Introduction

Ankle sprains, especially of the lateral ligaments, are extremely common injuries in the athletic population. Despite the vast amount of research in this area, recurrences remain common. The recurrence rate for lateral ankle sprains has been reported to be as high as 80%.1 In one study, 75% of the ankle sprains in professional soccer players were in ankles with previous sprains or instability.2 In another study, the incidence of developing chronic ankle instability was 20-40% of those who had previously sustained an acute ankle sprain.3 Neuromuscular and proprioceptive deficits are thought to be related to chronic ankle instability, including functional and mechanical insufficiencies.4 Read more…

Plantar Fasciitis

Background

Plantar heel pain is a common problem in adults. The most common cause of heel pain is inflammation to the dense tissue extending from the calcaneus to the metatarsal region, thus the descriptive term plantar fasciitis. Though not all cases of plantar heel pain are due to plantar fasciitis, an inflamed or damaged fascia may contribute to painful conditions caused by nerve injury or soft-tissue inflammation in local muscle and the fat pad. With the Internet and an increasing public awareness of plantar fasciitis comes greater demand for treatment when time and home remedies do not alleviate pain. The nature of upright human activity is repetitive tensile and compressive stress of the fascia that has a cumulative ability to damage or transform the tissue. Longer lifespans and greater recreational expectations of working adults also are contributing to the volume of patients seeking attention for plantar fasciitis.
Pathophysiology Read more…