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A Rudisch

Publications and source records attributed to A Rudisch.

35 records · Page 2Linked to original sources
PubMed2002

[Distal radius fractures and concomitant lesions. Experimental studies concerning the pathomechanism].

Since Colles (1814) first described a distal radius fracture and the publication by Dupuytren (1834), the frequency of and problems surrounding these fractures were increasingly recognised. Not only the treatment but also the formation and type of fracture were repeatedly analysed. The various theories concerning the pathomechanism led to names such as: "tear fracture", "bend fracture", "thrust fracture", "compression fracture", "snap fracture" and others. In our experimental studies we attempted to simulate the pathomechanism of distal radius fractures and present them pictorially. With the help of a materials testing machine, 63 prepared cadaver arms were hyperextended in the wrist joint until a radius fracture occurred. The concomitant lesions were registered radiologically and by dissection. Moreover, additional cadaver arms were deep-frozen and examined by means of computer tomography and cryosection according to Kathrein. Through experimental hyperextension it was possible to generate dorsal, central, and palmar types of fractures. We produced 42 dorsal, 14 central and 7 palmar fractures. Fundamentally, it seems that the fracture depends on the extent in which the carpal bones of the proximal row are pressed against the dorsal, central or palmar part of the articular surface of the distal radius. The subsequent dissection showed in 40 cases (63 %) mostly multiple concomitant lesions and in 23 cases (37 %) none of these. The reason for concomitant lesions may be the proportion of bone stability to the strength of ligaments. Most frequently (27 cases, i.e. 43 %), we found a destabilisation of the articular disk with or without a bony avulsion fragment (fracture of the ulnar styloid). We also commonly found ruptures of the interosseous ligaments between scaphoid and lunate (20 cases, i.e. 32 %) and lunate and triquetrum (11 cases, i.e. 18 %). It is difficult to apply knowledge gained from experimental studies on preserved cadaver arms clinically. There are of course no physiological reflexes and the slow fracture process must be taken into consideration. This holds true not only for concomitant lesions but also for the type of fracture. On the other hand, in these experimental studies it was possible to generate many realistic types of fractures with their concomitant lesions.

Biomechanical Phenomena↗
PubMed2001

The short-term effect of stabilization-type splints on the local asymmetry of masseter muscle sites.

Patients with temporomandibular disorders (TMD) may present with a cluster of joint and muscle disorders characterized primarily by pain, joint sounds and irregular or deviating jaw function. Maxillary stabilization-type splints represent the best standard therapy, so the purpose of this study was to evaluate changes in local cross-sectional dimensions (LCSD) of masseter muscle sites associated with short-term application of 'splint therapy' using the diagnostic approach of high-resolution gray-scale ultrasonography. The study included 29 patients who had signs and symptoms of temporomandibular disorders. Ultrasonographic investigation was performed with a linear (B-scan) 7.5 MHz small-part transducer to visualize the antero-superior, antero-inferior, medio-superior, medio-inferior, postero-superior and postero-inferior sites of the masseter muscle. To assess local muscle asymmetry patterns and to evaluate the respective effect of occluding splints, the 'absolute asymmetry index (AAI)' was used, with the mean maximum muscle diameter of the respective right and left sides calculated from three consecutive measurements before and after splint therapy. Comparing the pre-treatment with the 2-month follow-up values revealed a significant decrease in the overall mean asymmetry indices at the anterior (P < 0.01), medial (P < 0.05) and posterior (P < 0.05) muscle sites. There was no significant change in LCSDs at the various muscle sites (P > 0.05). The results of this study suggest stabilization-type splints to be effective in reducing local muscle asymmetries. Further studies are warranted to evaluate muscle-site specific effects in patient and non-patient groups and to relate these effects to pre-treatment variables like bite force, preferred chewing side, facial morphology and occlusion.

Adult↗
PubMed2001

Relationship between temporomandibular joint pain and magnetic resonance imaging findings of internal derangement.

In terms of clinical decision-making in instances of temporomandibular disorders (TMD) and orofacial pain, there is controversy in the literature over the diagnostic significance of the temporomandibular joint (TMJ)-related variable disk-condyle relationship (DCR). The purpose of this study was to investigate whether in patients with TMJ-related pain, the variable of TMJ pain may be linked to magnetic resonance (MR) imaging findings of internal derangement (ID). The study comprised 163 consecutive TMJ pain patients. Criteria for including a patient were report of orofacial pain referred to the TMJ, and the presence of uni- or bilateral TMJ pain during palpation, during function, and/or during unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the prevalence of TMJ ID types. Analysis of the data revealed the presence of TMJ pain to be associated with significantly more MR imaging diagnoses of ID than an absence of ID (P<0.001), and disk displacement without reduction than disk displacement with reduction (P<0.001). Using chi-square analysis, the results showed a significant relationship between the presence of TMJ-related pain and the MR imaging diagnosis of TMJ ID (P=0.001), and TMJ ID type (P=0.000). Use of the Kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of ID (K=0.16). The results suggest that the clinical variable of TMJ pain may have a significant effect on the prevalences of MR imaging diagnoses of TMJ ID. The data confirm the biological concept of DCR as a diagnostic approach in patients with signs and symptoms of TMJ-related pain.

Adolescent↗
PubMed2001

Temporomandibular joint internal derangement type III: relationship to magnetic resonance imaging findings of internal derangement and osteoarthrosis. An intraindividual approach.

The purpose of this study was to investigate whether in patients with a clinical unilateral temporomandibular joint (TMJ)-related finding of internal derangement type (ID)-III (disk displacement without reduction) in combination with TMJ-related pain, the intraindividual variable of 'unilateral TMJ ID-III pain' may be linked to subject-related magnetic resonance (MR) imaging findings of TMJ ID, and TMJ osteoarthrosis (OA). The study comprised 48 consecutive TMJ pain patients, who were assigned a clinical unilateral TMJ pain side-related diagnosis of ID-III. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ ID and/or OA. Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ ID-III pain and the MR imaging diagnoses of TMJ ID (P=0.000) and TMJ ID type (P=0.000). There was no correlation between the clinical finding of TMJ ID-III pain and the MR imaging diagnosis of TMJ OA (P=0.217), nor between the MR imaging diagnosis of TMJ OA and that of TMJ ID (P=0.350). Regarding the diagnostic subgroups of TMJ ID, a significant relationship was found between the presence of TMJ OA and the MR imaging diagnoses of TMJ ID type(P=0.002). Use of the Kappa statistical test indicated a fair diagnostic agreement between the presence of TMJ ID-III pain and the MR imaging diagnosis of disk displacement without reduction (DDNR) (K=0.42). The results suggest that TMJ ID-III pain is related to TMJ-related MR imaging diagnoses of ID. Further, the data confirm the biological concept of 'DDNR and OA' as an underlying mechanism in the etiology of TMJ-related pain and dysfunction.

Adolescent↗
PubMed2001

High-resolution ultrasonography of the TMJ: helpful diagnostic approach for patients with TMJ disorders ?

PURPOSE: The purpose of this study was to investigate patients with a clinical diagnosis of internal derangement to determine the diagnostic value of static high resolution ultrasonography (HR-US) when compared with magnetic resonance imaging (MRI). PATIENTS: Sixty-six patients (132 temporomandibular joints [TMJs]) with a clinical diagnosis of internal derangement were investigated by HR-US and MRI. METHODS: MRI and HR-US investigations were performed by experienced radiologists. The sonograms were done with a real-time 12-Mhz linear-array scanner. The HR-US interpretation errors were re-evaluated retrospectively by the same radiologist knowing the MRI results by comparing these with the 'prospective' and 'retrospective' diagnoses. The prospective and retrospective diagnoses were also compared with each other. RESULTS: Eighty-seven of the 132 TMJs had a disc displacement proved by MRI in the closed-mouth position. At maximum mouth opening, 54 TMJs had a disc displacement. The prospective interpretations showed a sensitivity and specificity of 78% each, accounting for an accuracy of 78%. At maximum mouth opening, HR-US resulted in a sensitivity of 61%, a specificity of 88% and an accuracy of 77%. The retrospective interpretations yielded a sensitivity of 90%, a specificity of 84% and an accuracy of 88% in the closed-mouth position. At maximum mouth opening, HR-US showed a sensitivity of 73%, a specificity of 95% and an accuracy of 86%. CONCLUSION: HR-US is suitable for the detection of disc displacements in the TMJ. However, further studies may be warranted to reduce the proportion of false-positive interpretations, thereby avoiding the application of unnecessary treatment.

Adolescent↗
PubMed2001

Validity of clinical diagnostic criteria for temporomandibular disorders: clinical versus magnetic resonance imaging diagnosis of temporomandibular joint internal derangement and osteoarthrosis.

OBJECTIVES: Research is needed to assess the validity of clinical decision criteria for the diagnoses of temporomandibular disorders. The objective of this study was to assess the reliability of clinical diagnoses in predicting magnetic resonance imaging diagnoses of temporomandibular joint internal derangement and osteoarthrosis in a patient pain group with temporomandibular disorders. METHODS: One clinician used the Clinical Diagnostic Criteria for Temporomandibular Disorders to classify 163 consecutive patients with temporomandibular disorders on physical diagnosis. The radiologist subsequently performed magnetic resonance imaging on 326 temporomandibular joints. Diagnostic agreement was determined for the diagnostic categories of absence of internal derangement, disk displacement with reduction, disk displacement without reduction, and osteoarthrosis. RESULTS: Use of the Kappa statistic test indicated a poor diagnostic agreement between the clinician and the radiologist. CONCLUSIONS: The classification system of the Clinical Diagnostic Criteria for Temporomandibular Disorders provides insufficient reliability for determination of the presence of temporomandibular joint internal derangement and osteoarthrosis. It should be supplemented by evidence from cross-sectional and longitudinal investigations to assess decisive differences in the areas of pathogenesis, treatment, and prognosis.

Adolescent↗
PubMed2001

Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain.

OBJECTIVES: The purpose of this study was to investigate the relationship between the presence of temporomandibular joint (TMJ) pain and the magnetic resonance (MR) imaging findings of internal derangement (ID) and effusion. STUDY DESIGN: The study was comprised of 41 consecutive patients with TMJ pain. Criteria for including a patient were report of unilateral pain near the TMJ, with the presence of unilateral TMJ pain during palpation, function, and/or unassisted or assisted mandibular opening, and the absence of a specific clinical TMJ-related diagnosis of disk displacement with or without reduction. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ ID or effusion, or both. RESULTS: Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ ID (P =.001), and TMJ effusion (P =.004). Furthermore, there was a significant relationship between the MR imaging diagnosis of TMJ ID and TMJ effusion (P =.000). Use of the kappa statistic test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of TMJ ID (kappa = 0.34), TMJ effusion (kappa = 0.32), and TMJ ID and effusion (kappa = 0.27). CONCLUSIONS: The study's findings suggest that although clinical pain is correlated with TMJ-related MR imaging findings, clinical pain in and of itself is not reliable for predicting the presence of TMJ ID or effusion, or both. Therefore, MR imaging appears to be a warranted and necessary supplement to the clinical findings.

Adolescent↗
PubMed2001

Diagnosing TMJ internal derangement and osteoarthritis with magnetic resonance imaging.

BACKGROUND: The authors conducted a study to investigate the relationship between the presence of temporomandibular joint, or TMJ, pain and magnetic resonance imaging, or MRI, findings of internal derangement, or ID, and arthritis, or OA. METHODS: The authors studied 131 consecutively seen TMJ pain patients. Their criteria for including a patient in the study were report of unilateral orofacial pain referred to TMJ and the presence of unilateral TMJ pain during palpation, function, and unassisted or assisted mandibular opening. The authors took bilateral sagittal and coronal MRIs to establish the presence or absence of TMJ ID, OA or both. RESULTS: When the authors compared TMJ side-related data from all subjects, they found a significant relationship between the clinical findings of TMJ pain and the MRI diagnoses of TMJ ID (P = .000) and TMJ OA (P = .013). They also found a significant relationship between the MRI diagnosis of TMJ ID type and that of TMJ OA (P = .000). The authors used the kappa statistical test and found poor diagnostic agreement between the presence of TMJ pain and the MRI diagnosis of TMJ ID (kappa = 0.21), TMJ OA (kappa = 0.15), and TMJ ID and OA combined (kappa = 0.18). CONCLUSIONS: The study's findings suggest that while clinical pain is related to TMJ-related MRI findings, the presence of clinical pain is not a reliable predictor of TMJ ID, OA or both. CLINICAL IMPLICATIONS: Using MRI to supplement clinical findings of TMJ pain appears warranted and necessary to establish the presence or absence of TMJ ID.

Adolescent↗
PubMed2000

Effect of arthrocentesis and hydraulic distension on the temporomandibular joint disk position.

OBJECTIVE: Recent studies have suggested arthrocentesis and hydraulic distension as an effective treatment modality in patients demonstrating clinical findings consistent with the diagnosis of disk displacement without reduction, normal range of motion thereby being restored and pain of the temporomandibular joint reduced. In view of the fact that only a few studies have been performed to verify the biologic concept of disk displacement without reduction as a diagnostic and therapeutic approach in patients with "closed-lock" symptoms, the purpose of this study was to investigate whether temporomandibular joint-related variable disk position might be linked to cessation of related signs and symptoms associated with the performance of arthrocentesis and hydraulic distension. STUDY DESIGN: The study compared 15 patients, each of whom was assigned a clinical unilateral temporomandibular joint-related diagnosis of internal derangement (ID) type III (disk displacement without reduction) in combination with capsulitis/synovitis. Clinical diagnoses were made according to the Clinical Diagnostic Criteria for Temporomandibular Disorders. Bilateral sagittal and coronal magnetic resonance images were obtained immediately preoperatively and at 2-month follow-up to establish the presence or absence of associated types of ID. Temporomandibular joint-related pain, level of function, and mandibular range of motion were assessed preoperatively and the data were compared with the respective 2-month follow-up findings. RESULTS: Comparison of the pretreatment temporomandibular joint side-related data revealed the temporomandibular joint side with an ID-III in combination with capsulitis/synovitis to be associated with significantly more magnetic resonance imaging diagnoses of ID than of an absence of ID (P <.001) and with significantly more disk displacement without reduction than disk displacement with reduction (P <.001). At the 2-month follow-up, clinical evaluation showed a significant reduction in temporomandibular joint-related pain during function (P <.001), a significant reduction in the prevalence of temporomandibular joint-related diagnoses of capsulitis/synovitis (P <.001) and ID-III (P <.01), and a significant increase in mandibular range of motion (P <.01). There was no change in the prevalence rates of associated temporomandibular joint side-related IDs. CONCLUSIONS: The results confirm the concept of disk displacement as a diagnostic approach but not as a therapeutic approach for patients presenting with signs and symptoms of unilateral ID-III in combination with capsulitis/synovitis. In terms of clinical decision-making in temporomandibular disorder-related instances of ID, magnetic resonance imaging may be used as a diagnostic method for identifying the diagnostic validity of the variable "disk-condyle relationship."

Adolescent↗
PubMed2000

Temporomandibular joint pain: relationship to internal derangement type, osteoarthrosis, and synovial fluid mediator level of tumor necrosis factor-alpha.

OBJECTIVES: The purpose of this study was to investigate whether patients with temporomandibular joint (TMJ)-related pain classified as capsulitis/synovitis may be linked to magnetic resonance imaging (MRI) findings of internal derangement, osteoarthrosis, or the synovial fluid aspirate findings of tumor necrosis factor-alpha (TNF-alpha) level. STUDY DESIGN: The study comprised 23 patients with temporomandibular disorders (TMD), who had nonchronic pain (pain onset < or =6 months) and a unilateral TMJ-related diagnosis of capsulitis/synovitis. Bilateral sagittal and coronal magnetic resonance images were obtained to establish the presence or absence of internal derangement, osteoarthrosis, or both. TMJ synovial fluid aspirates were obtained from the pain and contralateral nonpain sides to determine the TNF-alpha level. RESULTS: Comparison of the TMJ side-related data showed a significant relationship between the clinical TMD diagnosis of capsulitis/synovitis and the MRI diagnoses of TMJ internal derangement (P =.002) and of TMJ internal derangement type (P =.04). The mean TNF-alpha level in synovial fluid aspirates from TMJs assigned a clinical TMD diagnosis of capsulitis/synovitis was significantly higher than in those obtained from contralateral nonpain sides (P =.001). There was no correlation between the clinical diagnosis of capsulitis/synovitis and the MRI diagnosis of TMJ osteoarthrosis (P =.13) or between the MRI diagnosis of TMJ osteoarthrosis and that of TMJ internal derangement (P =.70) or TMJ internal derangement type (P =.33). CONCLUSIONS: The results suggest that the TMJ pain condition of capsulitis/synovitis is related to TMJ-side specific MRI diagnoses of internal derangement and internal derangement type, and synovial fluid aspirate findings of TNF-alpha level. The data confirm the concept of elevated mediator level as a diagnostic approach for patients presenting with TMJ-related pain. MRI and synovial fluid aspirates may be used as diagnostic methods for evaluating TMJ-related pain conditions.

Adolescent↗
PubMed1999

Diagnosis of digital flexor tendon annular pulley disruption: comparison of high frequency ultrasound and MRI.

PURPOSE: The objective of this study is to assess accuracy of ultrasound (US) and MRI to diagnose completely disrupted annular pulley ligaments (APL) of the flexor tendons of the fingers. PATIENTS AND METHODS: In a prospective study 32 patients (all males 18-42 years, mean age 25 years) with clinically suspected annular pulley disruption were studied with US and MRI. As a control group we investigated 40 fingers of 10 healthy volunteers and a non-injured finger of the patients with US. A 10 MHz linear array was used for US examinations and a 1.5 Tesla unit for MRI. Imaging was performed between the accident and surgical repair within 6 weeks. Examinations were performed in an extended and forced flexed finger position. RESULTS: Complete disruption of the APL was diagnosed by US and MRI in 14 cases confirmed by surgery. The typical sign of disruption was a marked volar displacement of the flexor tendon in the area of the torn annular pulley during forced flexion. A distance between tendon and bone at the area of the ruptured pulley of 3 mm during extension and a distance of 5 mm at flexion was typical for complete disruption. CONCLUSION: Both diagnostic modalities, US and MRI are valuable techniques in diagnosing complete disrupted annular pulleys of the flexor tendons.

Adult↗
PubMed1999

Vascularized bone graft from the iliac crest for the treatment of nonunion of the proximal part of the scaphoid with an avascular fragment.

BACKGROUND: It was hypothesized that nonunion of the proximal third of the scaphoid associated with avascular necrosis could be treated successfully with a free vascularized bone graft obtained from the iliac crest. METHODS: Fifteen patients who had a nonunion of the proximal part of the scaphoid that had been present for an average of two years and three months (range, nine months to seven years) were managed with use of a free vascularized bone graft obtained from the iliac crest. Avascularity of the scaphoid, as assessed on preoperative radiographs, was characterized by loss of trabecular structure, collapse of subchondral bone, and formation of bone cysts. The results of the procedure were assessed in terms of osseous union, pain, active motion of the wrist, and osteoarthritis. Postoperatively, vascularity of the scaphoid was evaluated with use of magnetic resonance imaging and color Doppler ultrasonography. The average duration of follow-up was six years and one month (range, two years and one month to eight years and one month). RESULTS: Preoperatively, one patient had had pain with any movement of the wrist and fourteen had had pain after strenuous manual labor or sports activity. The average pain score, derived with use of a 10-point visual analog scale, was 2.4 points (range, 1.0 to 6.7 points). Postoperatively, union was achieved in twelve patients; six were pain-free, and six had occasional pain during strenuous manual labor or sports activity, or both. The average pain score for these twelve patients was 1.1 points (range, 0.0 to 4.2 points) on the visual analog scale. Preoperatively, osteoarthritis was limited to the region between the radial styloid process and the distal part of the scaphoid in fourteen patients and to the radioscaphoid region in one patient. Postoperatively, the degree of osteoarthritis remained unchanged in seven of the twelve patients who had union and progressed to the radioscaphoid region in five. Vascularity, as seen on the imaging studies, was restored in all twelve patients who had union. The nonunion persisted in three patients, all of whom had progressive osteoarthritis leading to carpal collapse. CONCLUSIONS: The index procedure was successful in twelve of the fifteen patients who had a symptomatic nonunion of the proximal part of the scaphoid associated with avascular necrosis and osteoarthritis that was limited to the radioscaphoid joint.

Adult↗
PubMed1998

Metallic artifacts in magnetic resonance imaging of patients with spinal fusion. A comparison of implant materials and imaging sequences.

STUDY DESIGN: Devices for spinal fusion were compared with respect to their influence on magnetic resonance images. In addition, different magnetic resonance pulse sequences were evaluated to elicit their susceptibility to imaging artifacts. OBJECTIVES: To determine the implants with the least imaging artifacts as a recommendation for the spine surgeon and to assess the best imaging strategy for the radiologist. SUMMARY OF BACKGROUND DATA: For patients who have had surgical spinal fusion with instrumentation, magnetic resonance imaging is the most favorable diagnostic method. Unfortunately, metallic implants lead to severe degradation of image quality. These artifacts depend on the material of the implant and on the choice of the pulse sequence. METHODS: The fusion devices were mounted on a simple plastic phantom in various combinations and were imaged on 1.5-T magnetic resonance units. Frequently used types of plates and screws made of titanium or steel in various alloys were examined on the phantom with routinely used pulse sequences. The results of these examinations were compared with those in patient studies involving the same implants as well as the same pulse sequences. RESULTS: The least imaging artifacts were caused by titanium implants, especially when using shorter screws, wider screw placement, and thinner titanium plates. Nevertheless, there were distinct image distortions that could lead to erroneous image interpretation. The best images were acquired by spin echo (T1), turbo spin echo (T1, T2), and half Fourier single shot turbo spin echo (HASTE) sequences. Sequences containing any gradient echo components (gradient echo or turbo gradient and spin echo sequence or frequency-selective fat saturation techniques) resulted in the highest amount of image degradation. CONCLUSION: By choosing appropriate spinal fusion devices as well as pulse sequences, postoperative magnetic resonance imaging examinations can give acceptable results, in spite of the presence of metallic implants.

Adolescent↗
PubMed1997

The diagnostic value of ultrasonography to determine the temporomandibular joint disk position.

OBJECTIVE: Temporomandibular joint (TMJ) arthrography and magnetic resonance imaging are the imaging techniques of choice in patients presenting with signs and symptoms of TMJ disorders suggesting soft tissue pathosis. With the disadvantage of arthrography as an invasive procedure and magnetic resonance imaging posing a problem in clinical availability and cost, the purpose of this study was to determine whether ultrasonography could be used to assess the presence or absence of disk displacement in patients with TMJ disorders. STUDY DESIGN: In 17 patients, 100 TMJ positions were investigated by static and dynamic ultrasonography to analyze the disk-condyle relationship. To compare the respective findings with those of a diagnostic method offering high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. RESULTS: With static ultrasonography showing a sensitivity of 0.41 and a specificity of 0.70 and dynamic ultrasonography a sensitivity of 0.31 and a specificity of 0.95, the data revealed that static and dynamic ultrasonography are marginal in detecting the presence of disk displacement, but dynamic ultrasonography is sensitive in detecting the absence of disk displacement. However, with a positive predictive value of 0.61 and a negative predictive value of 0.51 for static ultrasonography, and a positive predictive value of 0.88 and a negative predictive value of 0.55 for the dynamic technique, the results indicate that both modalities are insufficient in establishing a correct diagnosis for the presence or absence of disk displacement. CONCLUSION: In view of the fact that dynamic ultrasonography proved to be a reliable diagnostic aid for the detection of normal disk position, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.

Adolescent↗
PubMed1996

[Rupture or stress injury of the flexor tendon pulleys? Early diagnosis with MRI].

Eighteen extreme rock climbers underwent primary clinical and MRI examination because of recent closed injuries to the flexor tendon pulleys. Follow-ups were after approximately 36 months on the average. The recent injuries, which are difficult to diagnose clinically, could be ascertained by means of MRI: This type of injury seems to occur more frequently than is currently diagnosed. Eight patients with overuse syndrome and eight patients with a short pulley rupture were treated conservatively. In two patients with long pulley rupture, the pulleys were reconstructed by means of a tendon graft using Kleinert's technique. Clinically manifest bowstringing or flexion contracture after treatment could not be ascertained on any one of the patients. All except for one showed an almost normal range of motion. By means of control MRI it was, however, possible to ascertain minor bowstringing and scars in most patients. Clinically, this partial instability manifested by lasting swelling. What was most disturbing, however, was reduced strength and the subjective feeling of insecurity during climbing.

Adolescent↗
PubMedDate not supplied

Disruption of the finger flexor pulley system in elite rock climbers.

We treated 13 elite rock climbers for isolated disruptions of the pulleys of the long fingers. Diagnosis and treatment were based on the clinical finding of bow-stringing, which was confirmed by magnetic resonance imaging. Eight patients had bowstringing indicating incomplete disruption of the major pulley A2 and were treated nonoperatively (group A). Five patients showed bowstringing indicating complete disruption of the pulley A2. After failed nonoperative treatment, the pulleys were reconstructed (group B). The mechanism of injury and clinical and subjective results were evaluated. At a 31-month follow-up (range, 18 to 43 months), loss of extension in the proximal interphalangeal joint measured 5.6 degrees (range, 0 degree to 10 degrees) in group A and 4 degrees (range, 0 degree to 10 degrees) in group B. Circumference of the finger section was increased 4.2 mm in group A (range, 0 to 10 mm) and 4.8 mm in group B (range, 0 to 10 mm). Grip strength decreased 20 N in group A (range, 10 to 50 N) and 12 N in group B (range, 10 to 30 N). Four patients in group A and one in group B had bowstringing at clinical evaluation. On follow-up magnetic resonance images, bowstringing remained unchanged in group A but was reduced in all patients in group B. Good subjective results were seen in both groups.

Adult↗