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Biomedical subjects

D Elliot

Publications and source records attributed to D Elliot.

At least 19 recordsLinked to original sources
PubMed2006

Relocation of painful end neuromas and scarred nerves from the zone II territory of the hand.

This paper reports the results of treatment by proximal relocation of 46 painful end-neuromas or scarred nerves in 33 patients from the pre-defined Zone II of the hand. The relocated nerves included four palmar cutaneous branches of the median nerve, 17 dorsal branches of the ulnar nerves and 25 digital nerves. If no pain at the original site and no pain or only mild pain at the relocation site are considered an adequate treatment of these difficult problems, these relocation procedures achieve complete control of spontaneous baseline pain, complete control of spontaneous spikes of pain, 93% control of direct pressure pain, complete control of movement pain (excluding the extremes of movement of the wrist into extension, supination and, less frequently, pronation) and 96% control of hypersensitivity of the overlying skin.

Adolescent↗
PubMed2006

The results of immediate re-repair of zone 1 and 2 primary flexor tendon repairs which rupture.

This study reports the outcome of immediate re-repair of primary flexor tendon repairs in zones 1 and 2 of the fingers which had ruptured. Between June 1989 and May 2003, a total of 62 fingers in 61 patients presented with ruptured flexor tendon repairs within 48 hours from rupture. Immediate re-repair and rehabilitation was carried out in 44 fingers (71%) in 43 (70%) patients. Thirty-six patients completed the 8-week therapy programme after re-repair in 37 fingers. Nine (24%) had excellent, 10 (27%) good, 5 (14%) fair and 13 (35%) had poor results when assessed by the original Strickland method. Five fingers in five patients ruptured the re-repair. Poor results and second ruptures were particularly common after re-repair of ruptured tendon repairs in the little finger. In the light of these findings, a policy for dealing with ruptured primary flexor tendon repairs in the fingers is suggested.

Adolescent↗
PubMed2006

The potential role of nerve growth factor (NGF) in painful neuromas and the mechanism of pain relief by their relocation to muscle.

Painful neuromas have been successfully treated by surgical procedures including relocation to muscle, but the underlying molecular mechanism remains unclear. Nerve growth factor (NGF) is secreted by tissues and promotes the expression of ion channels and neuropeptides in sensory neurons involved in pain transmission. We hypothesised that excess of NGF may lead to pain in neuromas and that the efficacy of surgical relocation results from deprivation of NGF, i.e. translocation from NGF-rich regions, particularly sub-cutaneous structures associated with injury or inflammation, to NGF-poor structures such as muscle or bone. Using immunohistological methods with primary antibodies to rhNGF, we report that NGF levels were elevated in 13 painful neuromas in comparison with six control nerves. However, in four painful neuromata re-located into muscle with pain relief, the NGF level was similar to that of controls. NGF levels suggest an explanation for the development of painful neuromas and the efficacy of relocation.

Adult↗
PubMed2005

Squamous cell carcinoma of the lateral nail fold.

The digital nail complex is occasionally involved by squamous cell carcinoma. The published literature has either been indiscriminating of the site of origin of this tumour within the nail complex or has concentrated attention on the nail bed as the site of pathology. Tumours originating in the lateral nail fold can be clearly differentiated from those of the nail bed itself. This study identifies six cases of squamous cell carcinoma arising in the lateral nail fold. While surgical convention remains to amputate the digital tip for squamous cell carcinoma of any part of the nail complex, the dermatological literature identifies that local surgery can be curative for these tumours, when presenting early and without bone involvement, although offering no discussion of reconstruction. Reconstruction is desirable and methods of achieving this following local excision of lateral nail fold tumours are illustrated in this series.

Adult↗
PubMed2005

The significance of extensor tendon tethering and dorsal joint capsule tightening after injury to the hand.

This paper examines the clinical problem of extensor tendon tethering and/or dorsal joint capsule tightening secondary to hand injury. One hundred and forty-one patients were examined 13 to 51 months after hand injuries of varying severity. Fifty-six patients (40%) had suffered simple and eighty-five patients (60%) complex injuries. Seventy-four (52%) of the 141 patients had no extensor tendon tethering and/or dorsal joint capsule tightening. In 30 (21%), the extensor tendon tethering and/or dorsal joint capsule tightening was considered to be "obvious" in that it was easily seen on examination using various commonly used clinical tests of finger flexion and extension. In 37 (26%), the extensor tendon tethering and/or dorsal joint capsule tightening was considered to be of "lesser degree" because it was only evident on application of specific tests which are described in this paper. Of the 37, 21 (56%) described themselves as being unable to make a "proper" fist with the injured hand, 33 (89%) had pain or discomfort on the dorsum of the injured hand and/or fingers on gripping (P < 0.01) and 25 (70%) had weakness of power of gripping (P < 0.01). Thirty-two (87%) complained of functional problems at work, with activities of daily living or with the pursuit of their hobbies.

Activities of Daily Living↗
PubMed2005

Validity and responsiveness of the patient evaluation measure as an outcome measure for carpal tunnel syndrome.

The aim of this study was to assess the validity of the Patient Evaluation Measure questionnaire (PEM) as an outcome measure in carpal tunnel syndrome. The PEM was compared to the DASH questionnaire and to objective measurements of hand function. We also compared its responsiveness to changes following carpal tunnel release with that of the DASH score. Twenty-four patients completed the PEM and DASH questionnaires before and 3 months after open carpal tunnel release. Grip strength, static two-point discrimination and the nine-hole peg test were measured. There was a significant correlation between individual items of the PEM and the objective measures. There was also strong correlation between PEM and DASH scores. The PEM showed a greater responsiveness to change (effect size 0.97) than the DASH score (effect size 0.49). The PEM correlates well with objective measures of hand function and the DASH score when used in carpal tunnel syndrome. It is more responsive to change than the DASH score. It is very simple to complete and score and is an appropriate and practical outcome measure in carpal tunnel syndrome.

Adult↗
PubMed2005

Physical activity staging distribution: establishing a heuristic using multiple studies.

The purpose of this study was to identify the population prevalence across the stages of change (SoC) for regular physical activity and to establish the prevalence of people at risk. With support from the National Institutes of Health, the American Heart Association, and the Robert Wood Johnson Foundation, nine Behavior Change Consortium studies with a common physical activity SoC measure agreed to collaborate and share data. The distribution pattern identified in these predominantly reactively recruited studies was Precontemplation (PC) = 5% (+/- 10), Contemplation (C) = 10% (+/- 10), Preparation (P) = 40% (+/- 10), Action = 10% (+/- 10), and Maintenance = 35% (+/- 10). With reactively recruited studies, it can be anticipated that there will be a higher percentage of the sample that is ready to change and a greater percentage of currently active people compared to random representative samples. The at-risk stage distribution (i.e., those not at criteria or PC, C, and P) was approximately 10% PC, 20% C, and 70% P in specific samples and approximately 20% PC, 10% C, and 70% P in the clinical samples. Knowing SoC heuristics can inform public health practitioners and policymakers about the population's motivation for physical activity, help track changes over time, and assist in the allocation of resources.

Behavioral Research↗
PubMed2004

Tripier's innervated myocutaneous flap 1889.

A translation of Tripier's publication in 1889 is presented. This paper includes description of two bipedicled myocutaneous flaps based on the orbicularis oculi muscle and designed as 'bucket-handles'. The author intended that these flaps be a transfer of innervated and functioning muscle and designed the flaps with full awareness of the need to maintain the original muscle length and nerve supply to retain function. This paper was, perhaps, the first description of an innervated myocutaneous flap. A third and new variant of the Tripier flap is described and illustrated.

Blepharoplasty↗
PubMed2004

The use of Acufex wedge tag tissue anchors in hand surgery.

Over a period of 4 years, in various circumstances commonly seen in hand surgery, 100 patients underwent 127 soft tissue attachments to bone using the Acufex wedge tag system (Acufex Microsurgical, Inc, Mansfield, MA), a non-metallic bone anchor. No failures to maintain the attachment of the desired soft tissue to bone were identified. While less robust than the Mitek anchor, the other commonly available system of bone anchoring, and therefore possibly inappropriate for general orthopaedics, the Acufex wedge tag proved adequate for the smaller forces of hand surgery.

Adolescent↗
PubMed2004

Immediate repair and early mobilization of the extensor pollicis longus tendon in zones 1 to 4.

We present the results of repair and early mobilization of 100 extensor pollicis longus (EPL) tendon injuries in zones 1 to 4 in 100 patients using a dynamic outrigger splint which controlled metacarpophalangeal joint movements but allowed free movement of the interphalangeal joint. Eighty-two were complete divisions of the tendon and 18 were 80% to 99% tendon divisions. Analysis of measurements obtained routinely at 8 weeks showed 81% excellent and good results using the TAM system. There were 90% excellent and good results in the 72 patients, who were followed-up and received therapy for 12 weeks. Except on the rare occasion when the repair rupture, loss of thumb extension was not a common functional problem, but scar tethering of the repaired tendon could result in loss of thumb flexion. While loss of metacarpophalangeal joint flexion appeared to have little functional importance, loss of interphalangeal joint flexion and slowing of the movements of this joint could cause functional problems. When interphalangeal joint hyperextension is present before the injury, it is frequently lost but this generally goes unnoticed by the patients. The problems of analysing the EPL injury using the methods of assessment available are discussed.

Adolescent↗
PubMed2004

Treatment of end-neuromas, neuromas-in-continuity and scarred nerves of the digits by proximal relocation.

This paper reports the results of treatment by proximal relocation of 104 painful nerves in 57 digits in 48 patients. These included 86 digital nerves and 18 terminal branches of the superficial radial nerve and the dorsal branch of the ulnar nerve. Eighty-three were end-neuromas and 14 were neuromas-in-continuity, of which nine followed nerve repair and five occurred following a closed crush injury. Seven were painful as a result of tethering in scarred tissue. Eighty nerves (77%) required a single relocation and 24 (23%) required more than one operation. Ninety-eight per cent of nerve relocations achieved complete pain relief at the primary site. One patient had mild pain on pressure at the primary site after relocation of two nerves from this site. Over 90% of the nerves had no spontaneous pain, pain on movement or hypersensitivity of the overlying skin at the final site of relocation. However, the incidence of mild or no pain on direct pressure at the site of nerve relocation was lower at 83% as relocated nerves, although traumatized less often at the sites chosen for relocation, can still be painful on direct pressure.

Adult↗
PubMed2004

Early active mobilization of primary repairs of the flexor pollicis longus tendon with two Kessler two-strand core sutures and a strengthened circumferential suture.

This study reports our treatment of divided flexor pollicis longus (FPL) tendons by primary repair from 1999 to 2002. Forty-eight FPL repairs were performed using two Kessler two-strand repairs with a cross-linked Silfverskiold circumferential suture. All were rehabilitated by early active mobilization. Excellent or good results were observed in 73/77% of cases (White/Buck-Gramcko assessments, respectively). No patients (0%) ruptured their repair as a result of early active mobilization. Two patients (4%) developed post-operative infections with wound and tendon dehiscence. This combination of repairs addresses the problem of rupture of FPL during early mobilization which we experienced in previous studies. Its problems and alternatives are discussed.

Adolescent↗
PubMed2004

Specific flaps for the thumb.

This article illustrates the use of local and distant flaps for the reconstruction of the thumb. The flaps available for thumb reconstructions, particularly of small defects, are often similar to those used in the fingers. However, they are rarely identical and have usually required modification to the particular needs of the thumb. These flaps and their modifications are, perhaps, as important as the few classic flaps used in larger thumb reconstructions, as many defects of the thumb are small and only a few are large. This article attempts to address all of these needs of thumb reconstruction, indicating when small flaps are suitable and when more extensive reconstructions are necessary.

Journal Article↗
PubMed2003

Local anaesthetic infusion for postoperative pain.

The role of continuous bupivacaine infusion either into the wound or as a local nerve block, following hand surgery was investigated in 100 patients. After excluding six patients with complex pain problems in whom neither the bupivacaine infusion nor any other conventional analgesic techniques provided adequate analgesia post-operatively, 86 of 94 (91%) patients were adequately treated for post-operative pain by this system during the first night after surgery when pain is presumed to be greatest. This system also provided adequate on-going analgesia for up to 1 week after surgery, controlling nerve pain and allowing mobilization of tendons after tenolysis. Continuous bupivacaine infusion is of particular use in these two groups of patients and after major hand injuries, when considerable pain can be anticipated. Pain during the first night was not controlled adequately by the bupivacaine infusion system in eight of the 94 patients (8%). All eight had a technical failure of the system, which was rectified in six cases to restore adequate analgesia by the infusion system. Two patients developed infection at the infusion cannula insertion site, which occurred only after 1 week and was successfully treated by removal of the cannula and oral antibiotics.

Adult↗