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C Sokolow

Publications and source records attributed to C Sokolow.

17 recordsLinked to original sources
PubMed2001

Anatomy and histology of the scapholunate ligament.

The scapholunate ligament links the scaphoid to the lunate. It runs transversally at its posterior aspect and obliquely at its anterior aspect, allowing significant relative motion between the two bones. From the neutral position to the full extension position, the lunate rotates by 28 degrees and the scaphoid by 30 degrees; from the neutral position to the full flexion position, the lunate rotates by 30 degrees, whereas the scaphoid rotation is 60 degrees because of the motion of the scaphoid around the capitate. The ligament's dorsal part is shorter and more resistant than the anterior part, allowing a pseudodissociation during flexion. Kauer described an additional movement of the scapholunate pair attributable to differences in the shapes of the scaphoid and lunate proximal poles. The scaphoid curve is more important and the scaphoid needs to glide on the lunate to maintain radioscaphoid congruity. As a result, there is sagittal ligament torsion. This can be a partial explanation for failure of scapholunate arthrodesis. This description of the scapholunate ligament is of interest to understand the relative importance of the three parts of this ligament. It can, in particular, explain the failure of ligamentous reconstruction that considers the scapholigament as a homogeneous structure. In addition, the three parts do not have the same tensile strength. The posterior part is the most resistant to tear forces and needs more than a 300 N tensile stress to fail. The anterior part fails with 150 N stress and the intermediary portion can withstand only a 25 N to 50 N stress. In comparison, the triquetrolunate ligament (which is also divided in three parts--anterior intermediate, and posterior) has failure coefficients opposite those of the scapholunate ligament: The anterior part is more resistant (300 N) than the posterior (150 N); the intermediate part has the same tensile strength as the scapholunate intermediate part. These biomechanical studies demonstrate the importance of the scapholunate ligamentous posterior part in controlling flexion and extension motion and the anterior part for rotational control. Both parts of the ligament are necessary for an harmonious functioning of the scapholunate pair.

Biomechanical Phenomena↗
PubMed2000

[Ligament repair and/or capsulodesis in scapholunate instability].

We have reviewed 37 patients with scapholunate instability, operated in Paris between 1979 and 1995 7 months after the injury. There were 12 partial and 18 complete ligament ruptures, but also 4 distensions. The repair was a secondary suture in 16 cases (7 direct, 1 transosseous, 1 combined, 5 anchor, 2 transosseous with anchor). A capsulodesis was performed 7 times as an isolated and 8 times as a combined procedure. 6 previous cases have been treated by ligamentoplasty. We present the results after a mean postoperative follow-up of 27 months, with good results on pain and grip, maintaining a satisfactory range of motion.

Adolescent↗
PubMed1999

Soft tissue stabilization in the management of chronic scapholunate instability without osteoarthritis. A 15-year series.

Management of chronic scapholunate instability without osteoarthritis remains controversial. Some surgeons favor partial wrist arthrodesis; others, soft tissue stabilization. Many techniques for soft tissue repair have been described but with few or unpredictable results. We reviewed all our cases of scapholunate instability without osteoarthritis treated by soft tissue stabilization. Since 1979, 37 soft tissue stabilization procedures have been performed to correct dynamic (25) or static (12) scapholunate instability without osteoarthritis. The average time from injury to surgical treatment was 7.2 mos. (range 0.25 to 36 mos.). Three cases were treated within the first month of injury. The choice of repair was determined intraoperatively. The scaphoid shift must be easily reducible to make the case eligible for soft tissue repair. The scapholunate ligament was usually disrupted from palmar to dorsal, and the average amount of disruption was 74%. When scapholunate ligament remnants were of sufficient quality, secondary repair was performed; but if not, ligament reconstruction using tendon grafts or capsulodesis was performed. The procedures used were secondary ligamentous repair in 16 (by direct suture, reinsertion using anchor and/or transosseous reattachment), ligament reconstruction using tendon grafts in 6, capsulodesis in 7 and a combination of these procedures in 8. The mean follow-up was 27 mos. (range 2 to 62 mos.). Postoperatively, there was an 83% decrease in pain. The average wrist motion was 60 degrees extension, 47 degrees flexion, 18 degrees radial deviation and 28 degrees ulnar deviation (92%, 84%, 106% and 88% of preoperative values and 88%, 75%, 78% and 76% of the uninvolved wrists, respectively), and the grip strength was 28 kg (117% of preoperative value and 78% of the uninvolved wrists). On roentgenograms, the mean static scapholunate distance was 4.2 mm (a 26% loss of reduction compared to the early postoperative gap), but scapholunate and radiolunate angles were within normal values (58 degrees and 9 degrees, respectively). At follow-up, one patient presenting a small zone of chondromalacia on the scaphoid at the time of secondary ligamentous repair developed severe radioscaphoid arthritis 15 months postoperatively. The results were further assessed according to the form of instability, delay before surgery, severity of disruption and type of repair. Patients with static instability showed worse clinical and radiological findings than those with dynamic instability. Surgical delay did not influence the outcome. The more severe the ligament disruption was, the poorer were the results. All types of repair had a comparable outcome except those treated by ligament reconstruction using tendon grafts. The results in the latter group were unsatisfactory in terms of motion, grip strength and radiological findings. This technique has been abandoned by the group. In conclusion, soft tissue stabilization is part of the armamentarium in the management of reducible chronic scapholunate instability without osteoarthritis. Ligament reconstruction using tendon grafts gave, in our hands, unsatisfactory results. Otherwise, all types of repair achieved a relatively pain-free wrist, with acceptable motion, grip strength, scapholunate and radiolunate angles but with a wider than normal static scapholunate distance. A longer follow-up is needed to assess the effect of this abnormal gap. Factors that favorably affected the outcome were: dynamic type of instability and partial disruption of the ligament.

Adolescent↗
PubMed1998

Management of true recurrent carpal tunnel syndrome: is it worthwhile to bring vascularized tissue?

Since 1989, 13 consecutive cases of true recurrent carpal tunnel have been operated on. Average delay before reoperation was 20 months (3 to 60 months). Intraoperative findings were univocal: extensive fibrosis with nerve adhesion to the roof of the carpal tunnel and a lack of nerve gliding. Surgery performed was: extensive external neurolysis from distal forearm to distal to carpal tunnel to allow a complete freedom of the nerve. A vascularized flap was never performed. Mean follow-up was 27.5 months (range 4 to 74 months). Results were: complete relief of symptoms in 75%; improvement with complete disappearance of nocturnal symptoms but persistent dysesthesia in 17%; no improvement in one patient (Sudeck's dystrophy). Interests of this study are: homogeneous population (only true recurrence), no bias from work compensation, consecutive cases, one surgeon, standardized surgical procedure and one independent observer. Results suggest that main factor for true recurrent carpal tunnel syndrome is lack of normal gliding of the nerve and that an extensive neurolysis helps to restore this gliding.

Adult↗
PubMed1995

Early results of conventional versus two-portal endoscopic carpal tunnel release. A prospective study.

The authors compare in a prospective, randomized study the early outcome of carpal tunnel release using either a conventional palmar open release (n = 40) or a two-portal endoscopic release (n = 56). Both groups were similar. No statistically significant differences were found regarding pain, disappearing of paraesthesiae or time to return to work. However, better recovery of grip strength was observed in the endoscopic group at 1 and 3 months. No surgical complications were observed in either group.

Adult↗
PubMed1995

[Articular necroses of the proximal interphalangeal joint. Treatment by resection-distraction using a multicentric MS3 fixator].

PIP joint necrosis occurs in multioperated patients with a history of a dorsal and palmar approach to their joint. Seven cases are reported. The surgical treatment consisted of articular resection followed by external distraction using the MS3 device. Four of the patients regained a painless range of movement (30 to 50 degrees): two of these patients had a clinodactyly of 20 degrees. The final range of movement was better when the extensor apparatus was not injured. Three patients were reoperated: a fusion was performed which healed, more rapidly than normal.

Adult↗
PubMed1995

Audiogram construction using frequency-specific auditory brainstem response (ABR) thresholds.

Brainstem evoked response audiometry (ABR) permits auditory pathway assessment without the need for voluntary response. Brainstem responses are unaffected by attention, drugs, and most other confounding conditions. Consequently, if ABR could be used to determine hearing threshold in the speech frequencies, it would have great value for patients who are unable or unwilling to respond accurately during behavioral audiometric testing. Utilizing broad band clicks, one can only estimate hearing sensitivity in the frequency range of 2,000 to 4,000 Hz. This is inadequate for medical or legal purposes in which hearing in the speech frequencies must be assessed. Consequently, we have developed a modified ABR technique that permits a more accurate determination of hearing threshold at 500, 1,000, 2,000 and 3,000 Hz, as illustrated in tests on 27 normal ears. This technique has great potential value for neonatal and mentally handicapped populations, as well as for individuals involved in hearing loss litigation.

Adult↗
PubMed1993

[Ulnar nerve disorders at the elbow. Etiologic approach. Apropos of 40 cases].

The authors analysed the medical records of 40 patients with isolated ulnar nerve entrapment at the elbow with a follow-up ranging between 7 months and 6 years. According to MacGowan's classification, there were 32.5% stage I, 25% stage II and 42.5% stage III. In 82.5% of cases, surgical decompression consisted of simple neurolysis by section of Osborne's arcade, while the other patients underwent transposition in the case of a local anatomical lesion (10%) or medial epicondylectomy (7.5%). The results in this series showed 50% very good, 15% good, 65% fairly good and 20% poor results, comparable to the results reported in other published series. The authors propose a classification into six groups which may have a prognostic significance, based on the mode of onset and the course of the paralysis: primary mononeuropathy (45% of cases in this series), compressions due to a local cause (10% of cases), postural compression (12.5% of cases), rapid-onset post-traumatic compression (10% of cases), sudden onset mononeuropathy (10% of cases) and mononeuropathy related to a systemic disease (10% of cases). The distribution according to MacGowan's classification was fairly homogeneous, but the postoperative results showed marked differences. A review of the literature showed that each author uses a particular technique and no other prognostic elements have been previously proposed.

Adult↗
PubMed1992

[Dorsal tenolysis and arthrolysis of the proximal interphalangeal joint. 19 cases].

18 patients suffering from PIP stiffness in extension were treated by dorsal teno-arthrolysis. PIP joint stiffness was due to 3 cases of fracture of P1, 2 cases of fracture of P2, 2 cases of extensor tendons, 8 fractures of P1 associated with section of the extensor tendon, 2 cases of PIP closed trauma (1 sprain, 1 dislocation), and 2 crush injuries of the extensor tendon at the PIP joint. The surgical technique combined a dorsal sinuous approach, tenolysis of the extensor tendon on the dorsum of first phalanx dorsal capsulotomy, and more rarely (3 cases), section of collateral ligaments. The mean pre-operative active flexion was 44 degrees and the mean post operative active flexion was 78 degrees, which represents a gain of 34 degrees of active movement. Thanks to a classification which incorporates the range of active flexion in PIP joint, and the lock of active extension we rated 3 results as excellent, 4 as good, 8 as useful and 4 as insufficient. We therefore improved the range of movement in 15 out of 19 cases, which seams very encouraging.

Adolescent↗
PubMed1992

[Contribution of gradient-echo MRI in the study of subacromial pathology: correlation between surgery and arthrography].

30 asymptomatic volunteer subjects and more than 400 patients with suspected rotator cuff lesions were examined by MRI at 0.5 T using T2*-PD weighted gradient echo (T2-GEI) sequences. Its superiority over T2 spin echo imaging was established in previous studies. The results were compared to those of surgery in 87 cases and arthrography in 233 cases (associated with CT arthrography in 70 cases). In the operated patients, T2-GEI and arthrography correctly diagnosed 49 complete ruptures (CR). T2-GEI was found to be superior to arthrography for defining the real extent of the rupture, the degree of tendon retraction and the local muscular trophicity, essential information to define the therapeutic indications. In contrast, among 22 lesions of the long biceps tendon, correctly demonstrated by arthrography or CT arthrography, 5 intracapsular lesions were not detected by MRI. MRI was able to detect 8 lesions of the anterior labrum associated with a CR not demonstrated by arthrography. Lastly, among the 18 cases of partial inferior rupture (PIR), 6 partial superficial ruptures and 14 cases of inflammatory changes, correctly diagnosed by MRI, only 8 PIR were also demonstrated by arthrography. For the non-operated patients investigated by the two modalities (146 cases), T2-GEI and arthrography were concordant in 43 cases. In contrast, 103 intact cuffs on arthrography showed features on T2-GEI compatible with tendinopathy without rupture, bursitis and degenerative changes. In the absence of very fine surgical or histological correlations for these small lesions, it is impossible, at the present time, to determine the real sensitivity and specificity of MRI.

Arthrography↗
PubMed1990

[Cold sensitivity after median or ulnar nerve injury based on a series of 82 cases].

Cold sensitivity often occurs after upper limb nerve injuries. 82 patients were reviewed retrospectively with an average follow-up of 42 months. Cold sensitivity occurred after 50% of median nerve injuries and after 75% of ulnar nerve injuries. Symptoms are localized to the damaged sensory nerve territory, and are related to the level of the lesion after median nerve injury. They are increased by associated arterial damage even when it is repaired. The less attened is the two-point discrimination lest, the less severe are the disorders. The origin is not really known, but we think that cold sensitivity is related to a disturbance of sympathetic and sensory fibers.

Adolescent↗
PubMed1989

[Results of the primary repair of 28 isolated median nerve injuries in the wrist].

Based on the study of a homogeneous series of twenty-eight isolated median nerve injuries at the wrist, sutured as an emergency procedure, the authors determined the course and sequelae of this type of nerve lesion with no associated tendon involvement. Repair was associated with epi-perineural suture performed with an operating microscope, immobilisation in slight flexion of the wrist for three weeks and rehabilitation of sensation. 60.7% of patients obtained a good or very good results with better motor recovery than sensory recovery. Nerve contusion, loss of nerve substance with suture under tension and work accidents were factors of poor prognosis.

Adolescent↗
PubMed1987

Bacterial flexor tenosynovitis in the hand. A series of 68 cases.

The authors report 68 cases of bacterial tenosynovitis (BT) that is the largest international series dealing with this pathology since the introduction of antibiotics. Their study stresses the connection between the quality of the final result and the stage at which the condition is treated. The speed at which the tenosynovitis becomes established depends on the mechanism of infection. One can dissociate BT by direct inoculation with violation of the tenosynovial sheath, from the BT by diffusion through an undamaged sheath. The former progress within a few hours to a few days, the latter slowly in a few days to a few weeks, with a slower onset masked by the clinical signs of the initial infection. They propose a new classification which allows the choice of proper surgical therapy taking into account the type of onset of the BT and the intraoperative findings.

Adult↗