1/31. Silastic interposition arthroplasty for osteoarthrosis of the carpometacarpal joint of the thumb.We performed Ashworth's (1977) silastic interposition arthroplasty for painful osteoarthrosis of the carpometacarpal (CM) joint of the thumb. Recently, however, some unsuccessful cases treated by this method have been reported. We therefore reviewed the results of patients treated by Ashworth's method. We reviewed 16 patients operated on according to the original Ashworth method for osteoarthrosis of the first CM joint. The cases consisted of 8 males and 8 females, ranging in age from 32 to 76 years (average, 59.6 years). The patients were grouped according to Eaton's classification as follows: 1 patient was stage II, 6 were stage III, and 9 were stage IV. All patients were followed postoperatively for 1 to 12.5 years (average, 4.5 years). Twelve patients did not complain of any pain but 3 patients felt slight pain when moving their thumb. However, the degree of pain was much less than that experienced preoperatively. Only one patient complained of severe pain 2 years after the first operation. Her implant ruptured and required additional surgery. All except one showed either an increase or no change in grip strength. The range of motion (ROM) was full in all patients. Implants showed sinking in 3 patients, a partial rupture of the implant edge in 5 patients and a whole body failure in only 1 implant, roentogenographically. In spite of these troubles, only 3 patients complained of an unpleasant feeling and 2 reported slight pain. Implant trouble did not always cause the symptoms. The clinical results of this method were mostly satisfactory.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/31. Dynamic magnetic resonance imaging technique for the study of the temporomandibular joint.AIMS: Echo planar imaging (EPI) is an ultrafast magnetic resonance imaging (MRI) technique that can scan a single frame in less than a second. The aim of this study was to use the EPI technique to develop a new dynamic MRI protocol for the temporomandibular joint (TMJ). methods: Basic fast-field echo and EPI pulse sequences were used for dynamic studies of the TMJ. The subjects were instructed to perform spontaneous, continuous, slow opening/closing movements without visual or audio feedback. Different scanning parameter settings were explored to optimize the results. RESULTS: With an opening/closing movement of approximately 6 to 7 seconds per cycle, the proposed protocol yielded a good insight into the relative motion between condyle and disc. It was also possible to see the deformation of the disc during movement. CONCLUSION: The EPI technique is a non-invasive technique that can be used for dynamic imaging study of a slow but continuous, uninterrupted jaw movement.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/31. Elastofibroma in shoulder osteoarthritis: a theoretical concept of the etiology.A case of unilateral, subscapular elastofibroma dorsi secondary to degenerative osteoarthritis in the ipsilateral glenohumeral joint is presented. A 69-year-old woman had experienced symptoms of osteoarthritis in the right shoulder since contracting septic arthritis when she was 7 years old. The patient noticed a soft tissue mass in the right subscapular region when she was 65 years old. The range of motion of the glenohumeral joint was severely restricted. Histopathologic examination of the excised mass revealed elastofibroma. The authors think the excessive scapulothoracic motion was important in formation of the lesion. This case indicates that elastofibroma is not a true neoplasm but a reactive lesion formed by repetitive minor trauma.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
4/31. Case challenges in shoulder surgery: what would you do?The management of complex shoulder issues was discussed in an interactive case presentation session. Patient scenarios discussed included reoperation of a rotator cuff repair with a subscapularis tear; uncemented hemiarthroplasty presenting with pain and osteolysis; severe osteoarthritis with all nonoperative options exhausted; rheumatoid arthritis with pain and diminished function; and significant pain, limited motion, and weakness in an active patient.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/31. Ulnohumeral arthroplasty: results in primary degenerative arthritis of the elbow.Our results with the ulnohumeral arthroplasty are presented. Seventeen patients were evaluated at an average followup greater than 36 months (range, 24-50 months). The average age of the patients was 52 years (range, 40-74 years). At final followup, 15 patients had complete pain relief at end ranges of motion whereas two patients had moderate pain after prolonged activity. Extension and flexion were improved by a mean of 12 degrees and 20 degrees, respectively, with a mean range of motion 14 degrees to 118 degrees. Postoperative radiographs showed a correctly placed drill hole with complete osteophyte resection. There were no neurologic or other complications and good stability of the elbow was observed in all patients. We think ulnohumeral arthroplasty is a good procedure for active patients with primary degenerative joint disease of the elbow.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
6/31. "Broken heart syndrome" after separation (from OxyContin).We describe a 61-year-old woman with "broken heart syndrome" (Takotsubo-like cardiomyopathy) after abrupt postsurgical withdrawal of OxyContin. Her medical history was remarkable for long-term opiold dependence associated with the treatment of multi-Joint degenerative osteoarthritis. The patient presented to the emergency department 1 day after discharge from the hospital following total knee arthroplasty revision with acute-onset dyspnea and mild chest pain. She had precordial ST-segment elevation characteristic of acute myocardial infarction and elevated cardiac biomarkers. Emergency coronary angiography revealed no major coronary atherosclerosis. However, the left ventricular ejection fraction was severely decreased (26%), and new regional wall motion abnormalities typical of broken heart syndrome were noted. In addition to resuming her opioid therapy, she was treated supportively with bilevel positive airway pressure, diuretic therapy, morphine, aspirin, metoprolol, enalaprilat, intravenous heparin, nitroglycerin infusion, and dopamine infusion. Ventricular systolic function recovered completely by the fourth hospital day. To our knowledge, broken heart syndrome after opioid withdrawal has not been reported previously in an adult. Our case illustrates the importance of continuing adequate opiate therapy perioperatively in the increasing number of opioid-dependent patients to prevent potentially life-threatening complications such as broken heart syndrome.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/31. periprosthetic fractures in patients with total knee arthroplasties.Ten patients with total knee arthroplasties sustained periprosthetic fractures. Nine of these were supracondylar fractures, and one occurred in the middle one-third of the tibia. These patients were treated with conservative methods in two cases and internal fixation with plate and screws in three cases. The remaining five patients were treated with intramedullary fixation using a specially designed revision prosthesis with long intramedullary stems. The best results wer achieved through the revision arthroplasty, based on walking ability, range of motion, and early rehabilitation.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/31. Arthroscopic debridement of the arthritic knee.Arthroscopic debridement was carried out in 49 knees of 44 patients. These patients, who had a primary diagnosis of arthritis, were older than 50 years of age. Two-thirds had roentgenographic evidence of severe arthritis. Age, weight, compartment location of arthritis, and presurgical range of motion did not affect surgical results. Symptoms of long duration, arthritic severity as evidenced by roentgenograms, and malalignment predicted poor results. Conversely, shorter duration of symptoms, mechanical symptoms, mild to moderate roentgenographic changes, and crystal deposition correlated with improved results. Surgery offered no benefit for 39% of the patients. Another 9% had temporary improvement, averaging 15 months, but were judged failures at the final follow-up examination. Good or excellent results were achieved in 52% of the patients and maintained through the final follow-up examination in 40% of the patients. Of these, two-thirds had no visible deterioration within a 33-month average follow-up period.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/31. The importance of the meniscus in unstable knees. A comparative study.This study analyzes differences in knee function in ACL deficient knees with different meniscus status. Eighty patients, 12 women and 68 men, were matched in four groups according to sex, age, knee injuries, and follow-up time. Group I had two intact menisci; Group II, one meniscus successfully repaired; Group III, one meniscus removed; and Group IV, both menisci removed. The ACL was repaired acutely or reconstructed later in most cases and other significant ligament injuries were treated. All patients were reexamined clinically 6 to 8 years after injury. Knee function was recorded using the Lysholm knee function score. Activity level before injury and at followup was rated with the Tegner scale. Stability was tested and weightbearing roentgenograms were taken. There was a higher frequency of ACL reconstructions in Groups I and II, but instability was the same in all groups. No difference was found in Lysholm score (range, 86 to 92). The activity level was higher in Group IV at followup. A lower frequency of motion impairment was found in Group III, (20% versus 50%). Subjective evaluation was similar and positive in all groups. Group I had six meniscus ruptures during the follow-up period. In Group II three of the repaired menisci were removed, as were two of the contralateral menisci in Group III. Roentgenograms, available in 55 of 80 cases, showed osteoarthritis in 65%. There were no differences in the frequency of osteoarthritis among the first three groups, but Group IV had a higher incidence of osteoarthritic changes. osteoarthritis did not result in lower knee function, poorer subjective evaluation, or increased impairment of motion.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
10/31. The need for integrating TMJ therapy with implant prosthodontic cases.In this paper, guidelines for TMJ diagnosis and treatment were reviewed, and a case history was presented demonstrating the need for the integration of TMJ therapy. The case history presented is just one of many cases in the author's practice where the implant candidate also presented with a CM-TMJ disorder. The author emphasizes the incorporation of a CM-TMJ disorder screening exam and history to complement the initial consultation by all practitioners. This should include: 1) check for pops, clicks, in front of ears, (opening, closing, protruding); 2) range of motion (three fingers opening); 3) headaches; 4) grind or brux (night or day); 5) palpate key masticatory muscles of the head and neck; 6) tooth interferences; and 7) bite feels off. The author understands that not all practitioners have access to various diagnostic instrumentation, but emphasizes that this should not prevent the practitioner from diagnosing and treating CM-TMJ disorders or referring for such treatment. The literature has not indicated the overall benefits of implant prosthodontics other than allowing mastication of food and a feeling of self-esteem; but the benefits also allow the treatment and relief of CM-TMJ disorders via a stable occlusion.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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