Biomedical subjects

A N Ertel

Publications and source records attributed to A N Ertel.

3 recordsLinked to original sources

PubMed1989

Flexor tendon ruptures in rheumatoid arthritis.

Flexor tendon ruptures in rheumatoid arthritis are caused by either attrition on bone spurs or by direct invasion of the tendon by hypertrophic tenosynovium. All attrition ruptures occur within the carpal canal and represent the most common cause of tendon rupture. Removal of the causative bone spur is imperative in the treatment of this condition. Ruptures due to invasive tenosynovitis also are frequently found within the carpal canal. These ruptures may be unanticipated, and may be discovered as an incidental finding during flexor tenosynovectomy. Ruptures due to invasive tenosynovitis within the digit carry an unfavorable prognosis. The prognosis for restoring flexion in the event of a flexor tendon rupture is determined by the location of the rupture, the etiology, the degree of articular involvement from the rheumatoid disease, and to a lesser extent, by the number of ruptured tendons. In general, isolated or double ruptures within the carpal canal due to attrition have a better prognosis than those caused by invasive tenosynovitis since the condition of the tendons is more favorable for reconstruction; however, as the number of ruptures increases, the prognosis in both conditions worsens. Rupture of both tendons within the digital sheath is quite difficult to treat, with ruptures in zone 2 carrying the worst prognosis for the restoration of flexion. The severity of the patient's rheumatoid arthritis and articular disease has a great effect on the outcome of the reconstructive surgery. Prevention of tendon ruptures by early tenosynovectomy and the removal of bone spurs should be the goal of the surgeon.

Arthritis, Rheumatoid↗

PubMed1988

Flexor tendon ruptures in patients with rheumatoid arthritis.

One hundred fifteen flexor tendon ruptures were reviewed in 43 hands with rheumatoid arthritis, one hand with psoriatic arthritis, and one hand with lupus erythematosis. Ninety-one tendons were ruptured at the wrist, four ruptures occurred at the palm, and 20 ruptures occurred within the digits. At the wrist level, 61 ruptures were caused by attrition on a bone spur and 30 were caused by direct invasion of the tendon by tenosynovium. All ruptures distal to the wrist were caused by invasion of the tendon by tenosynovium. Patients whose ruptures were caused by attrition regained better motion than those whose ruptures were caused by invasion by tenosynovitis; however, motion overall was poor. Patients with isolated ruptures in the palm or at the wrist had the best functional results. Those patients with multiple ruptures within the carpal canal had a worse prognosis. Ruptures of both tendons within the fibro-osseous canal had the worst prognosis. The severity of the patient's disease and the degree of articular involvement had a great effect on the outcome of surgery. Prevention of tendon ruptures by early tenosynovectomy and removal of bone spurs should be the cornerstone of treatment.

Adult↗

PubMed1978

Cervical-spine instability in children with Down syndrome (trisomy 21).

Eighty-five children with Down syndrome, between sixteen months and eighteen years old, were evaluated for instability of the cervical spine at the atlanto-axial joint. The mean atlas-odontoid process interval was three millimeters in flexion and two millimeters in extension. Ten patients (12 per cent) exhibited abnormal intervals (4.5 millimeters or more) during either flexion or extension. The configuration of the odontoid process was considered normal in eighty patients and abnormal in another five patients (6 per cent). The correlation between the thickness of the interval and the degree of ligament laxity was statistically significant, as was the correlation between ligament laxity and age. Of the ten patients with an increased atlas-odontoid process interval, neurological deficit (hyperreflexia and clonus) developed in only one after a one-year follow-up.

Adolescent↗