1/61. Post-traumatic distal nerve entrapment syndrome.Eleven patients with paralysis of muscle groups in the upper or lower extremity were clinically diagnosed after previous proximal direct trauma to the corresponding peripheral nerves, without complete nerve disruption. patients were seen within an average of 8 months after trauma (minimum 3 months and maximum 2 years after). Nerve lesions were caused either by gunshot, motor-vehicle accident, and other direct trauma or, in one case, after tumor excision. All patients presented with complete sensory and motor loss distal to the trauma site, but demonstrated a positive Tinel sign and pain on testing over the "classic" (distal) anatomic nerve entrapment sites only. After surgical release through decompression of the nerve compression site distal to the trauma, a recovery of sensory function was achieved after surgery in all cases. Good-to-excellent restoration of motor function (M4/M5) was achieved in 63 percent of all cases. Twenty-five percent had no or only poor improvement in motor function, despite a good sensory recovery. Those patients in whom nerve compression sites were surgically released before 6 months after trauma had an improvement in almost all neural functions, compared to those patients who underwent surgery later than 9 months post trauma. A possible explanation of traumatically caused neurogenic paralysis with subsequent distal nerve compressions is provided, using the "double crush syndrome" hypothesis.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/61. Burn due to misuse of an acetylene gas burner: a case report.A rare case of deep penetrating burn injury caused by misuse of a high-pressure acetylene burner is reported. A 35 year old man was admitted with second and third degree burns involving the right arm cubital area and a subcutaneous burn on his right arm caused by a high-pressure acetylene gas flame. Early surgical debridement and secondary skin grafting using a preserved subcutaneous vascular network skin graft (PSVNSG) proved effective in this patient. skin contracture was prevented and function was recovered. The basis of PSVNSG is that the vascular system existing in the graft is used as a permanent vascular system without degeneration. This case shows that, in this kind of burn injury, subcutaneous tissue damage should be suspected and that it is important to perform surgical debridement early after admission.- - - - - - - - - - ranking = 0.12964915141702keywords = area (Clic here for more details about this article) |
3/61. The shaking trauma in infants - kinetic chains.The findings in three children who died as a consequence of shaking and those in another child who survived are presented. In the three fatal cases, a combination of anatomical lesions were identified at autopsy which appear to indicate the sites where kinetic energy related to the shaking episodes had been applied thus enabling the sequence of events resulting in the fatal head injury to be elucidated. Such patterns of injuries involved the upper limb, the shoulder, the brachial nerve plexus and the muscles close to the scapula; hemorrhages were present at the insertions of the sternocleidomastoid muscles due to hyperextension trauma (the so-called periosteal sign) and in the transition zone between the cervical and thoracic spine and extradural hematomas. Characteristic lesions due to traction were also found in the legs. All three children with lethal shaking trauma died from a subdural hematoma only a few hours after the event. The surviving child had persistant hypoxic damage of the brain following on massive cerebral edema. All the children showed a discrepancy between the lack of identifiable external lesions and severe internal ones.- - - - - - - - - - ranking = 70.252622175111keywords = plexus (Clic here for more details about this article) |
4/61. Treatment of painful neuromas: a case report.The authors report a 15-year history of management of multiple recurrent neuromas in a patient with an amputated arm. Various surgical modalities were employed, including burying the nerve ends in muscle and bone. In addition, they also treated successfully one of the neuromas in this patient by capping the transected nerve with an extended autologous vein graft. This application of the extended autologous venous nerve conduit may be a novel alternative in the treatment of this challenging problem.- - - - - - - - - - ranking = 4keywords = pain (Clic here for more details about this article) |
5/61. The voluntary control of motor imagery. Imagined movements in individuals with feigned motor impairment and conversion disorder.The ability to volitionally control motor imagery was investigated by comparing the chronometry of real and imagined movements in a patient (AB) with conversion disorder who presented with paralysis of the left arm and hand and in a patient (MM) with an actual injury to the left arm. Control experiments investigated voluntary control of motor imagery in a group of healthy individuals who feigned a motor impairment with one limb and in one group who were instructed to move carefully and slowly. The visually guided pointing task was used to investigate the speed for accuracy trade-offs that occur as target size is varied for both real and imagined performance. In the healthy individuals, the speed for accuracy trade-off for both real and imagined performance on the motor task conformed to Fitts' law provided both the speed and accuracy of movements was emphasised. In MM, real and imagined performance was also within normal limits despite considerable pain and discomfort. In AB and in subjects feigning a motor impairment, motor task performance with the affected limb was slow and did not conform to Fitts' law. However, although imagined performance with the affected limb was generally slower than with the unaffected limb, it did conform to Fitts' law. These results suggest subjects cannot anticipate the effects of an actual limb injury. Furthermore, while they are able to control the general duration of imagined movements they have little voluntary control over their relative timing.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
6/61. Vitamin deficiency in a toddler reluctant to use her arm.Children frequently present to accident and emergency departments with limb pain, usually following trauma. An unusual cause of atraumatic limb pain in a toddler is described in this report. rickets should be added to the differential diagnosis of atraumatic limb pain in this age group. The possibility of acute bony injury (following unwitnessed trauma) not apparent on X-ray needs to be considered in this case. Suspicion of rickets, based on clinical features and radiographic findings, can be confirmed by biochemical assays.- - - - - - - - - - ranking = 3keywords = pain (Clic here for more details about this article) |
7/61. Complex regional pain syndrome (type I) after electrical injury: a case report of treatment with continuous epidural block.A 26-year-old man presented with severe complex regional pain syndrome type I of the affected limb after a work-related electrical injury. He suffered causalgia-like pain with no electrodiagnostic evidence of nerve injury. Early steroid and analgesic regimens did not adequately relieve these symptoms. His symptoms were temporarily relieved several times with stellate ganglion blocks. The patient underwent a cervical epidural block with a local anesthetic as well as a narcotic agonist over a 4-day period, which resulted in prompt, remarkable pain relief. Vocational rehabilitation was instituted as the pain subsided.- - - - - - - - - - ranking = 8keywords = pain (Clic here for more details about this article) |
8/61. Partial rupture of the distal biceps tendon.We report on 7 cases of partial rupture of the distal biceps tendon. The mean patient age was 52 years (range, 38-58 years). There were 5 men and 2 women. The dominant arm was affected in all 7 patients. pain was the chief complaint in all patients. immobilization and physiotherapy were attempted in all patients, and 4 had at least 1 local steroid injection. No patient improved from the conservative treatment. All patients eventually underwent surgical debridement and reattachment of the biceps tendon with use of a 1-incision technique with suture anchors. After a mean follow-up of 31 months (range, 25-44 months), all patients reported a significant decrease in their pain. No complications were noted.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
9/61. Vascular surgery of the upper limb: the first year of a new vascular service.Upper limb vascular reconstruction represents a small part of the vascular surgical workload (5%). The aim of this study was to assess the incidence of upper limb vascular reconstruction in a Regional Hospital. During the first year of a new vascular surgical service in Waterford Regional Hospital, upper limb vascular problems were prospectively analysed. Upper limb vascular reconstruction comprised seven of the total 92 major vascular procedures performed. Three cases were emergencies and four elective. There was one case of penetrating injury, two injuries due to blunt trauma, three patients with thoracic outlet syndrome (TOS) and one chronic ischaemia. The male:female ratio was 4:3 and the mean age was 42 years. Six of the cases were arterial in nature only, and one was both venous and arterial. Two of the cases were associated with upper limb fractures and multiple trauma. Three patients had interposition reversed cephalic vein grafting. One patient had an embolectomy and endarterectomy. Procedures for TOS included excision of a cervical rib in two patients (one bilateral) and scalenectomy alone in one patient. Of these, one patient also had thrombolysis and thrombectomy of the axillary and brachial artery. All of the patients made a good functional recovery and all arteries remained patent but the patient with the brachial plexus injury is awaiting repair abroad. Upper limb vascular problems form a small but significant part (8%) of the workload. Many cases present as emergencies and maybe associated with multiple trauma. This emphasises the need for an emergency vascular surgery service in all trauma units.- - - - - - - - - - ranking = 70.252622175111keywords = plexus (Clic here for more details about this article) |
10/61. brachial plexus injury after transfer of free latissimus dorsi musculocutaneous flap.Free latissimus dorsi muscle transfer is widely used for functional reconstruction of flexion of elbow and fingers after brachial plexus injury at later stage, as well as for soft tissue coverage because of its large size and long and reliable pedicle with adequate vessel diameter. Common complications recorded in literatures are hematoma and muscle atrophy due to a compartment syndrome. We treated a patient with soft tissue avulsion at forearm using free latissimus dorsi muscle transfer for soft tissue coverage in our hospital. Unfortunately during the transfer the patient's brachial plexus was injured. After timely treatment, he recovered completely.- - - - - - - - - - ranking = 421.51573305067keywords = plexus (Clic here for more details about this article) |
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