| 1. |
- Buijze, Geert A., et al.
(författare)
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Diagnostic Performance of Radiographs and Computed Tomography for Displacement and Instability of Acute Scaphoid Waist Fractures
- 2012
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 94A:21, s. 1967-1974
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fracture displacement is the most important factor associated with nonunion of a scaphoid waist fracture. We evaluated the performance characteristics of radiographs and computed tomography (CT) in the diagnosis of intraoperative displacement and instability of scaphoid waist fractures using wrist arthroscopy as the reference standard. Methods: During a six-year period (2004 to 2010) at two institutions, forty-four adult patients with a scaphoid waist fracture underwent arthroscopy-assisted operative fracture treatment at a mean of nine days (range, two to twenty-two days) after injury. Subjects included all of those with a displaced scaphoid fracture seen on radiographs and a selection of patients with a nondisplaced scaphoid fracture. All patients had preoperative radiographs and CT. Arthroscopy with up to 5 kg of traction was the reference standard for fracture displacement and instability. Results: The reference standard (arthroscopy) led to a diagnosis of twenty-two displaced fractures (all unstable) and twenty-two nondisplaced fractures (seven unstable). Displacement was diagnosed in eleven patients (25%) with the use of radiographs and in twenty (45%) with CT. The sensitivity, specificity, and accuracy for diagnosing intraoperative displacement were 45%, 95%, and 70%, respectively, with the use of radiographs and 77%, 86%, and 82%, respectively, with CT. The sensitivity, specificity, and accuracy for diagnosing intraoperative instability were 34%, 93%, and 55%, respectively, with the use of radiographs and 62%, 87%, and 70%, respectively, with CT. Assuming a 10% prevalence of fracture displacement and instability among all scaphoid waist fractures, the positive and negative predictive values for displacement were 53% and 94%, respectively, with the use of radiographs and 39% and 97% with CT whereas the positive and negative predictive values for instability were 36% and 93%, respectively, with radiographs and 34% and 95% with CT. Conclusions: Radiographs and CT scans cannot be relied on to accurately diagnose intraoperative scaphoid fracture displacement or instability compared with arthroscopic examination. The influence, with regard to the risk of nonunion, of intraoperative instability of a scaphoid fracture that is seen to be nondisplaced on radiographs or CT is currently unknown.
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| 2. |
- Buijze, Geert A, et al.
(författare)
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Factors Associated With Arthroscopically Determined Scaphoid Fracture Displacement and Instability.
- 2012
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 37A:7, s. 1405-1410
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To identify factors associated with arthroscopically diagnosed scaphoid fracture displacement and instability. METHODS: This was a secondary use of data from 2 prospective cohort studies. The studies included 58 consecutive adult patients with a scaphoid fracture who elected arthroscopy-assisted operative fracture treatment: some for displacement, some as part of a prospective protocol, and others to avoid a cast. All patients had preoperative computed tomography with reconstructions in planes defined by the long axis of the scaphoid. RESULTS: Arthroscopy revealed 38 unstable fractures (movement between fracture fragments; 66%), 27 of which were also displaced. All arthroscopically determined displaced fractures were unstable, and 11 of the 31 arthroscopically determined, nondisplaced fractures were unstable. There was a significant correlation between radiographic comminution (more than 2 fracture fragments) and arthroscopically determined displacement and instability. CONCLUSIONS: Radiographic comminution is associated with displacement and instability as determined by arthroscopy.
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| 3. |
- Cederlund, Ragnhild, et al.
(författare)
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Activity limitations before and after surgical carpal tunnel release among patients with and without diabetes.
- 2012
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Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 44:3, s. 261-267
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate activity limitations before and after carpal tunnel release among patients with and without diabetes, to explore differences between genders and the influence of grip strength on activity limitations. DESIGN: Prospective case-control study. PATIENTS: Thirty-three patients with diabetes and carpal tunnel syndrome (CTS) were age and gender matched with 30 patients without diabetes having idiopathic CTS. METHODS: Activity limitations were assessed pre-operatively, 3 and 12 months after surgery, with the self-administered Evaluation of Daily Activities Questionnaire (EDAQ) containing 102 activity items in 11 dimensions and 3 additional male-activity-oriented dimensions including 22 items. RESULTS: For all dimensions the mean score was higher for patients with diabetes compared with patients without diabetes. This indicates a more pronounced activity limitation for patients with diabetes. However, no statistical differences between the two groups could be demonstrated. In general, females have significantly higher activity limitation scores than males. CONCLUSION: CTS creates a broad variety of activity limitations for affected patients. After carpal tunnel release a significant alleviation of these limitations occurs within the first 3 months. Activity limitations seem not to be related to diabetes, but were more pronounced in women than in men, probably due to reduced grip strength.
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| 4. |
- Dahlin, Lars B, et al.
(författare)
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Carpal tunnel syndrome and treatment of recurrent symptoms.
- 2010
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 1651-2073. ; 44, s. 41375-41375
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Carpal tunnel syndrome is the most common compression lesion of peripheral nerves with a prevalence of 4%. It is often treated by release of the flexor retinaculum, which may completely relieve the symptoms. Although such treatment is considered successful, there are probably many patients with persistent or recurrent symptoms. Recurrence implies that the patient's symptoms were initially relieved but recurred some time after the operation; this is a controversial field in which clear definitions, aetiology, diagnosis, and treatment seem uncertain. We describe recurrence of carpal tunnel syndrome and summarise possibilities for diagnosis and treatment of the condition.
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| 5. |
- Dahlin, Lars, et al.
(författare)
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Low myelinated nerve-fibre density may lead to symptoms associated with nerve entrapment in vibration-induced neuropathy.
- 2014
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Ingår i: Journal of Occupational Medicine and Toxicology. - : Springer Science and Business Media LLC. - 1745-6673. ; 9:1
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Forskningsöversikt (refereegranskat)abstract
- Prolonged exposure to hand-held vibrating tools may cause a hand-arm vibration syndrome (HAVS), sometimes with individual susceptibility. The neurological symptoms seen in HAVS are similar to symptoms seen in patients with carpal tunnel syndrome (CTS) and there is a strong relationship between CTS and the use of vibrating tools. Vibration exposure to the hand is known to induce demyelination of nerve fibres and to reduce the density of myelinated nerve fibres in the nerve trunks. In view of current knowledge regarding the clinical effects of low nerve-fibre density in patients with neuropathies of varying aetiologies, such as diabetes, and that such a low density may lead to nerve entrapment symptoms, a reduction in myelinated nerve fibres may be a key factor behind the symptoms also seen in patients with HAVS and CTS. Furthermore, a reduced nerve-fibre density may result in a changed afferent signal pattern, resulting in turn in alterations in the brain, further prompting the symptoms seen in patients with HAVS and CTS. We conclude that a low nerve-fibre density lead to symptoms associated with nerve entrapment, such as CTS, in some patients with HAVS.
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| 6. |
- Gilling, Mette, et al.
(författare)
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Biparental inheritance of chromosomal abnormalities in male twins with non-syndromic mental retardation
- 2011
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Ingår i: European Journal of Medical Genetics. - : Elsevier BV. - 1769-7212. ; 54:4, s. 383-388
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Tidskriftsartikel (refereegranskat)abstract
- In a monozygotic twin couple with mental retardation (MR), we identified a maternally inherited inversion and a paternally inherited translocation: 46,XY,inv(10)(p11.2q21.2)mat,t(9;18)(p22;q21.1) pat. The maternally inherited inv(10) was a benign variant without any apparent phenotypical implications. The translocation breakpoint at 9p was within a cluster of interferon a genes and the 18q21 breakpoint truncated ZBTB7C (zinc finger and BTB containing 7C gene). In addition, analyses with array-CGH revealed a 931 kb maternally inherited deletion on chromosome 8q22 as well as an 875 kb maternally inherited duplication on 5p14. The deletion encompasses the RIM2 (Rab3A-interacting molecule 2), FZD6 (Frizzled homolog 6) and BAALC (Brain and Acute Leukemia Gene, Cytoplasmic) genes and the duplication includes the 5' end of the CDH9 (cadherin 9) gene. Exome sequencing did not reveal any additional mutations that could explain the MR phenotype. The protein products of the above mentioned genes are involved in different aspects of brain development and/or maintenance of the neurons which suggest that accumulation of genetic defects segregating from both parents might be the basis of MR in the twins. This hypothesis was further supported by protein interaction analysis. (C) 2011 Elsevier Masson SAS. All rights reserved.
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| 7. |
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| 8. |
- Jørgsholm, Peter, et al.
(författare)
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The benefit of magnetic resonance imaging for patients with posttraumatic radial wrist tenderness.
- 2013
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 38:1, s. 29-33
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Tidskriftsartikel (refereegranskat)abstract
- To describe fractures revealed by magnetic resonance imaging (MRI) in a series of skeletally mature patients with radial wrist pain after an acute injury and clinically suspected to have a scaphoid fracture. Additionally, we attempted to assess the diagnostic value of radiographs and computed tomography (CT) in patients with scaphoid and other carpal fractures verified by MRI.
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| 9. |
- Jørgsholm, Peter, et al.
(författare)
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The incidence of intrinsic and extrinsic ligament injuries in scaphoid waist fractures.
- 2010
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 35:3, s. 368-374
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To determine the incidence of associated intrinsic and extrinsic ligament injuries in patients with a nondisplaced or displaced scaphoid waist fracture. METHODS: During a 3-year period, a study of all scaphoid fractures was performed at our institution. Diagnosis was confirmed by plain radiographs, computed tomography, and magnetic resonance imaging. A 3-part anatomic classification was used to categorize the scaphoid fractures. The study population comprised 40 patients with 41 scaphoid waist fractures who had wrist arthroscopy for treatment and evaluation of the scaphoid fracture and associated carpal injuries. RESULTS: We observed fresh intrinsic ligament injuries in 34 of 41 wrists. In 29 cases, the scapholunate ligament was injured, with complete rupture occurring in 10 wrists. The lunotriquetral ligament was injured in 8 wrists, and the triangular fibrocartilage complex was injured in 11 wrists. Statistically, the number of intrinsic ligament injuries did not differ between nondisplaced and displaced scaphoid fractures (p> .30). CONCLUSIONS: In this study of acute scaphoid waist fractures, the overall incidence of associated ligament injuries was surprisingly high, at 34 of 41 wrists. Complete scapholunate ligament rupture was found in 10 of 41 wrists. This incidence is higher than previously reported and emphasizes the need for careful assessment of the intrinsic and extrinsic ligaments, particularly the scapholunate ligament, before deciding on treatment.
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| 10. |
- Mojaddidi, Moaz A., et al.
(författare)
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Molecular and pathological studies in the posterior interosseous nerve of diabetic and non-diabetic patients with carpal tunnel syndrome
- 2014
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 57:8, s. 1711-1719
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis We sought to establish the molecular and pathological changes predisposing diabetic and non-diabetic patients to the development of carpal tunnel syndrome (CTS). Methods The posterior interosseous nerve (PIN) was biopsied in 25 diabetic and 19 non-diabetic patients undergoing carpal tunnel decompression for CTS. Detailed morphometric and immunohistological analyses were performed in the nerve biopsy. Results In diabetic patients median nerve distal motor latency was prolonged (p < 0.05 vs non-diabetic patients), PIN myelinated fibre density (p < 0.05), fibre area (p < 0.0001) and axon area (p < 0.0001) were reduced, the percentage of unassociated Schwann cell profiles (p < 0.0001) and unmyelinated axon density (p < 0.0001) were increased and the axon diameter was reduced (p < 0.0001). Endoneurial capillary basement membrane area was increased (p < 0.0001) in diabetic patients, but endothelial cell number was increased (p < 0.01) and luminal area was reduced (p < 0.05) in non-diabetic patients with CTS. There was no difference in the expression of hypoxia-inducible factor 1 alpha between diabetic and non-diabetic patients with CTS. However, the expression of vascular endothelial growth factor A (VEGF) (p < 0.05) and its receptors VEGFR-1 (p < 0.01) and VEGFR-2 (p < 0.05) was significantly increased in diabetic patients, particularly those with type 1 diabetes, and related to the severity of nerve fibre pathology. Conclusions/interpretation This study demonstrates increased nerve fibre and microvascular pathology in relation to enhanced expression of VEGF and its receptors in a non-compressed nerve in diabetic compared with non-diabetic patients with CTS. It therefore provides a potential molecular and pathological basis for the predisposition of diabetic patients to the development of CTS.
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