Biomedical subjects
Publications and source records attributed to C D Kerr.
A case of insulinoma is presented which highlights the need for the physician to be alert and non-judgmental, and the importance of performing basic, simple and appropriate investigations. In this case a fasting blood glucose provided the evidence for the diagnosis.
We believe that this is the first reported case of concomitant ipsilateral perilunate dislocation of the wrist with an associated posterior radial head dislocation. The case presented involves both injuries occurring during a single traumatic episode. Recognition is the key to reducing the morbidity associated with each dislocation.
This article reviews the results of endoscopic carpal tunnel release surgery. Comparison with a matched population of patients undergoing standard open carpal tunnel release was performed with respect to safety and return to work times. The newer technique was found to be safe because no surgical complications were noted in the study group. Patients undergoing the endoscopic technique with private insurance returned to work 15.6 days sooner than their open counterparts. Patients with workers' compensation claims returned to work at the same time regardless of the technique used.
This study was undertaken to determine the presence or absence of tenosynovitis in persons with idiopathic carpal tunnel syndrome. Eight hundred thirty-five consecutive operations for carpal tunnel syndrome were retrospectively reviewed, and 625 cases of idiopathic carpal tunnel syndrome were identified. Of these 96% (601) had a synovial tissue histologic diagnosis of benign fibrous tissue without inflammation, 4% (23) showed chronic inflammation, and 0.2% (1) revealed evidence of acute inflammation. We believe that tenosynovitis is not a part of the pathophysiologic process in chronic idiopathic carpal tunnel syndrome. Further histologic analysis of the flexor synovium for pathologic changes other than inflammation is needed.
From November 1984 to February 1989, 13 extensor indicis proprius tendon transfers were performed for various reasons. Nine patients with a total of ten transfers were available for follow-up, at an average of 29 months. Active range of motion was measured (both dependently and independently) at the metacarpophalangeal joints of both the involved and the uninvolved index finger. There was no extensor lag of the metacarpophalangeal joint during dependent extension, and only an average of 2.1 degrees of extensor lag during independent extension. Measurement of total active motion showed that the dependent and independent range of motion of the involved index finger was 95% of that of the uninvolved index finger. The obvious concerns with using the extensor indicis proprius tendon for transfer is the possible theoretical loss of complete extension and independent extension of the index finger. We found these concerns not to be a problem.
Review of the notes of 46 extensor tendon repairs in 21 patients treated by post-operative dynamic traction without an M.P. flexion block, no tendon ruptures or extensor lag and only one digit without full flexion after a mean follow-up of seven weeks. Re-examination of 26 treated repairs in nine patients for this study demonstrated a mean T.A.M. of 259 degrees at an average 14 months follow-up. No bow-stringing occurred because the extensor retinaculum was not excised, and no tenolyses were necessary.
A patient was referred to the hand service for treatment of a ganglion of his left distal volar forearm. History and examination revealed the mass to be an aneurysm of the left radial artery. At surgery, a false aneurysm was resected and a vein graft interposed. This case illustrates arterial aneurysms, although uncommon, must be included in the differential diagnosis of masses about the hand and wrist.