1/8. Microsurgical combined scapular/parascapular flap for reconstruction of severe neck contracture: case report and literature review.OBJECTIVE: The reconstruction for severe neck contracture is difficult, because it may include not only the necessity the use of a large flap but also the ability for three-dimensional movement of the neck. methods: A 41-year-old woman sustained a severe neck contracture with retraction of the lower lip and limited range of neck motion after a chemical burn. We used the combined scapular/parascapular flap to reconstruct the soft-tissue defect in the neck after excision of hypertrophic scar and release of contracture. The scapular portion was transferred to cover the defect vertically, and the parascapular portion was transferred to cover the transverse portion of the neck. This kind of design would allow the patient to move her neck more easily. RESULTS: Postoperatively, the range of motion of the neck was full in the vertical and horizontal directions after 6 months of rehabilitation. Also, the patient was satisfied with the final aesthetic results. CONCLUSION: The microsurgical combined scapular/parascapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during surgery, is a good option for reconstruction of the severe neck contracture. We classify the inset of the combined scapular/parascapular flap into three types with six subtypes, according to the location of defects and the relation of the parascapular flap to the scapular flap.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/8. Incomplete decapitation of a motorcyclist from hyperextension by inertia: a case report.This is a rare case involving a motorcyclist. A 57 year old motorcycle rider wearing a full face type helmet, suffered incomplete decapitation. The autopsy findings revealed a wide lacerated wound accompanied by extension marks in the front neck, atlanto-occipital dislocation and complete transection of the brainstem. According to the police traffic report, the man's head was stationary at the moment of impact and the remainder of the body continued in a backward motion. We concluded that the inertia of the torso caused hyperextension of the neck and subsequent incomplete decapitation.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/8. A clinical guide to surface-EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation.Therapeutic stretching is a vital component of chronic musculoskeletal pain rehabilitation for increasing range of motion and counteracting the effects of physical deconditioning. Surface EMG biofeedback is currently being used to facilitate movement and to maximize effective stretching with patients in an interdisciplinary chronic pain rehabilitation program for disabled workers. A clinical protocol with case examples is presented.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
4/8. Novel treatment of basilar invagination resulting from an untreated C-1 fracture associated with transverse ligament avulsion. Case report and description of surgical technique.The authors describe the case of a traumatic C-1 ring fracture and transverse ligament injury in an otherwise healthy adult woman; the lesion was essentially untreated for 3 months and resulted in basilar invagination. On presentation 3 months postinjury, the patient complained of severe increasing suboccipital pain and a grinding sensation in her upper neck. Axial computerized tomography (CT) scans revealed a C-1 ring fracture, basilar invagination with the dens abutting the clivus, and significant lateral splaying of the C-1 lateral masses. Flexion-extension radiography demonstrated abnormal motion at the atlantoaxial junction. A unique surgical technique was used to address simultaneously the C1-2 instability, the displaced C-1 fracture, and basilar invagination without having to perform occipital fixation. The authors believe that an understanding of the mechanism of the cranial settling in this case (further splaying of the C-1 lateral masses and downward migration of the occipital condyles) permitted full reduction of the deformity; this was accomplished by performing a horizontal reduction of the C-1 lateral masses, using direct C-1 lateral mass screws, a rod compressor, and a cross-link. Postoperative CT scanning confirmed the success of reduction. The results in this report highlight a rare but important complication of untreated C-1 fracture and ligament disruption, and the authors describe a novel treatment technique with which to restore vertical alignment and preserve occipital C-1 motion. A variation of this technique may also be used to treat Type II transverse ligament injuries associated with C-1 ring fractures as an alternative to halo immobilization.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/8. Clinical evaluation of traumatic central cord syndrome: emphasis on clinical significance of prevertebral hyperintensity, cord compression, and intramedullary high-signal intensity on magnetic resonance imaging.BACKGROUND: We evaluated the prognostic and clinical value of radiological findings including prevertebral hyperintensity (HI), cord compression, intramedullary high-signal intensity (IMHSI) and instability in patients with traumatic central cord syndrome without evidence of fracture and dislocation. methods: The radiological and clinical findings of 23 patients who had undergone surgery between 1996 and 2002 were reviewed retrospectively. All of the patients underwent dynamic motion study and magnetic resonance (MR) imaging after trauma. Neurologic status was evaluated with American Spinal Injury association motor score pre- and postoperatively and compared with the radiological findings. Anterior decompression and fusion were performed in 12 patients with 1- or 2-level lesions, and posterior decompression was done for 11 cases of multilevel lesions. RESULTS: Prevertebral HI was found in 17 patients. Among them, instability was revealed in 11 patients. There was significant correlation between prevertebral HI and instability (P = .014). Cord compression was found in varying degrees in all patients on MR imaging. Intramedullary high-signal intensity was found preoperatively in 19 (83%) of 23 patients, and it was revealed at the most compressed level of the spinal cord in all cases. The neurologic level was consistent with the level of instability (100%), IMHSI (95%), and cord compression (87%). Mean American Spinal Injury association motor scores in patients with instability were lower than in those without instability (P < .05). CONCLUSIONS: The presence of prevertebral HI, IMHSI, and cord compression influenced the neurologic status of the patients. The instability was significantly associated with poor prognosis for neurologic outcome. Prevertebral HI on T2 MR imaging may be a possible indicator of instability in patients with central cord syndrome after hyperextension injury.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
6/8. Burn scars treated by pinhole method using a carbon dioxide laser.Many patients with burn injuries have various complications and emotional problems due to scars. Although various modalities to improve burn scars have been attempted, such as excision of scars, skin grafts, laser abrasion and silicone product usage, the cosmetic outcomes have not been satisfactory for a large portion of patients. Herein, we describe two cases which showed satisfactory cosmetic results after treatment of burns scars with the pinhole method using a carbon dioxide (CO(2)) laser that allowed us to make deep, closely set holes reaching down to the upper dermis. A 20-year-old female patient with a scar on her neck and a 25-year-old female patient with a scar on her right forearm after burn injuries are presented. As early as only a few weeks after the treatment, the scars showed relaxation of contracture, reduction of wrinkles and improvement of texture and color compared to before the treatment. Treatment of burn scars with the pinhole method can be easily performed and results in dramatic improvement in scar quality with only a few side-effects.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
7/8. Posttraumatic torticollis.We report six cases of torticollis precipitated by neck trauma. The dystonia began 1 to 4 days after the trauma and differed clinically from idiopathic torticollis by marked limitation of range of motion, lack of improvement after sleep ("honeymoon period"), and absence of geste antagonistique. Worsening with action was not present; nor was there improvement with support as seen with idiopathic torticollis. Onset of pain immediately after the trauma and marked spasms of the paracervical muscles were other predominant features. Anticholinergic therapy was without benefit; however, some improvement occurred with botulinum toxin injection. It is concluded that torticollis can be caused by peripheral trauma and that it has unique clinical characteristics.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
8/8. Posttraumatic cervical dystonia.Posttraumatic cervical dystonia has been described as a distinct syndrome with some similarities to idiopathic nontraumatic cervical dystonia (torticollis). We describe five patients in whom cervical dystonia developed immediately after relatively mild trauma to the neck. Four of the five patients had persistent contractions of all cervical muscles including the trapezius muscles, which almost completely prevented motion of the neck and resulted in muscle hypertrophy. The condition persisted unabated in all patients for the entire period of follow-up (duration, 1 1/2 to 3 years). Pharmaceutical interventions, which had been used previously for idiopathic nontraumatic cervical dystonia, failed to benefit these patients. Two patients who received injections of botulinum toxin had no more than mild benefit. Selective denervation was inapplicable because of the widespread involvement of all cervical muscles in all but one patient. Physical therapy was essentially ineffective. Because of the unusual features and possible medicolegal setting, clinicians may tend to diagnose this condition as a psychogenic disorder or litigation-oriented behavior. The clinical picture, however, is consistent with an organic dystonia that may render the patient functionally and occupationally disabled.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |