Orthopaedic review最新文献

A study was performed to analyze the efficacy of an instrumented carpal-compression device in the diagnosis of carpal tunnel syndrome. This device provides a direct measurement of the amount of applied pressure necessary to elicit symptoms of carpal tunnel syndrome. A positive test is indicated by the reproduction of numbness, tingling, or dysesthesia in the distribution of the median nerve within 30 seconds. The study group consisted of 30 patients in whom 48 hands had clinical symptoms and positive electrodiagnostic findings of carpal tunnel syndrome; 50 hands of 25 asymptomatic individuals were studied as controls. This study found that the instrumented carpal-compression test had an 89% sensitivity and a 96% specificity in diagnosing carpal tunnel syndrome. The instrumented device described in this study is lightweight and simple to use, and provides a rapid and inexpensive method of screening for carpal tunnel syndrome.

Treatment of atraumatic osteonecrosis of the femoral head is presently based not on disease prevention, but instead on the end-stage changes of bone associated with the necrotic lesion. Current diagnostic modalities are limited, by both cost and efficacy, in their ability to diagnose early-stage osteonecrosis. While many studies have assumed the cause of osteonecrosis is vascular occlusion, recent work suggests that alternate processes are primarily involved in the pathogenesis. By examining these concepts, a better understanding of osteonecrosis of the femoral head may lead to earlier diagnostic modalities and treatment protocols to prevent this devastating process from developing.

An athletic patient presented with a nontraumatic peroneal neuropathy that failed to resolve after a period of rest. A magnetic resonance image (MRI) showed a multilobulated mass in the course of the common peroneal nerve consistent with a plexiform neurofibroma. Surgical exploration revealed a mass, which coursed from the midthigh to the fibular neck, that was intimately involved with the fibers of the nerve bundle and had cystic degeneration with vesicles along its length. The authors recommend MRI as highly accurate in diagnosing unusual causes of peroneal neuropathy.

Physical examination of a woman with painful swelling about the ulnar side of her dominant right wrist but no history of trauma revealed a freely mobile soft-tissue mass on the ulnar aspect of the wrist. Radiographs of the wrist were normal. At surgery, a 1 cm x 1 cm ganglion immediately adjacent to the hypothenar muscles was dissected circumferentially and found to have a stalk originating from the ulnar aspect of the pisotriquetral joint. This report suggests that ganglions arising from the medial side of the pisotriquetral joint should be included in the differential diagnosis of ulnar wrist pain.

Transient regional osteoporosis of the ankle and foot is an uncommon clinical entity characterized by local tenderness over the involved area. Plain radiographs demonstrate osteopenia of the involved bone and technetium diphosphonate bone imaging shows increased tracer uptake at the same location. This disorder is benign and self-limiting, and treatment is conservative.

The following case describes the imaging and clinical findings of a condition of interest to the orthopaedic surgeon. Initial history, physical findings, and imaging examinations are presented here for your consideration. The final clinical diagnosis and relevant discussion can be found on the following pages.

Lyme disease is caused by the spirochete Borrelia burgdorferi and is transmitted by the Ixodes tick. Early diagnosis is difficult because the tick bite may go unnoticed and the distinguishing rash, erythema chronicum migrans, often does not occur. Serologic tests are both sensitive and specific in the later stages of the disease but not in stage 1. Thus diagnosis of Lyme disease remains clinical. Knowledge of the orthopaedic manifestations of Lyme disease may aid in early diagnosis and help differentiate from possible cases of juvenile rheumatoid arthritis and septic arthritis. If septic arthritis is suspected, appropriate antibiotic therapy should be initiated while awaiting serology for Lyme disease. Recurrence of Lyme arthritis following antibiotic treatment is rare. Lyme disease should be considered in any patient with arthritis and a history of rash, fever, or neurologic or cardiac abnormality.

Regional nerve block anesthesia has been less commonly used and less successful in surgery on the lower extremity than on the upper extremity because of anatomic difficulties associated with lower-extremity nerve blockade. The authors have developed a technique that combines two peripheral nerve blocks with a nerve stimulator. This has provided sufficient anesthesia for the performance of arthroscopic surgery on the knee. It simplifies earlier techniques by decreasing the discomfort associated with the procedure and increasing its accuracy. The technique has also facilitated rapid patient discharge from the same-day unit. No significant complications have been encountered.

An understanding of the anatomy and biomechanics of the lateral ankle ligaments is essential to make a proper diagnosis in patients with ankle sprains. Specific radiographic stress tests can aid in differentiating single-versus double-ligament injuries and in determining their severity. Inadequately treated ankle sprains can result in chronic pain, instability, and early osteoarthritis. Thus, the proper diagnosis and initial treatment are important. This paper reviews the essential features of the anatomy, biomechanics, diagnosis, and natural history of lateral ankle sprains.