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H Assmus

Publications and source records attributed to H Assmus.

At least 19 recordsLinked to original sources
PubMed2006

[The iatrogenic carpal tunnel syndrome--case report].

An inadequate indication for a carpal tunnel revision procedure may be followed by disastrous sequelae for the patient. So it may be justified to talk of iatrogenic CTS. A patient suffering from bilateral CTS is presented who had been operated on six times in all. The following techniques had been used by an orthopedic surgeon, a neurologist, a neurosurgeon and a hand surgeon: microsurgical neurolysis, epineurectomy, neuroma resection, tenosynovectomy and finally a hypothenar fat flap. Initial cause for this fatal series was scar tenderness following lesion of the muscular and palmar branches of the median nerve in the first or second operation. Since sensory nerve conduction was normal after decompression had been performed, there would have been no indication for further surgery of the median nerve. Resection of the neuromas of the two injured branches was not followed by any relief for the patient nor did wrapping the nerve in a fat flap help. Such courses may lead to high costs in health care and occupational disability. They can be avoided by competent neurological and electrophysiological examination, correct interpretation of findings as well as critical consideration of the indication for revision procedures.

Carpal Tunnel Syndrome↗
PubMed2006

[Reoperations for CTS because of recurrence or for correction].

BACKGROUND: With an increasing number of operative procedures for CTS, the number of reoperations is increasing too. These procedures are not in general performed because of recurrence, other reasons may play a role for the failure of the initial operation or recurrent symptoms. METHODS AND CLINICAL MATERIAL: Revision procedures performed in 57 patients in the practice for peripheral neurosurgery from January to September 2004 were analyzed for incision, intraoperative findings, method of operation, electrophysiological findings, and revised diagnosis. Moreover, the data were compared with 185 revision procedures performed in the years from 1986 up to 1994. RESULTS: 2.4 % of all CTS operations were revision procedures (in the former time period 1.5 %). In 59 % of revision operations (former 50 %) an incomplete release of the transverse ligament was found, in 27 % (former 31 %) typical recurrence, in 5 % (former 6 %) nerve lesions, and in 9 % (former 13 %) no abnormalities so that other reasons for complaints of mainly radicular lesions must be assumed. In cases of incomplete release of the transverse ligament, only in 16 % of the patients were normal skin incisions seen, but in 56.3 % there were small incisions (i.e., short or mini-incisions). Typical CTS recurrence occurred mainly in hemodialysis patients, nerve lesions were seen mainly when endoscopic procedures were performed. CONCLUSION: Diagnostic problems because of incomplete or misinterpreted ENG findings may lead to delayed or useless primary as well as revision operations. Too small incisions but also endoscopic procedures used by less experienced surgeons are accompanied with an increased risk for avoidable revisions and nerve lesions. Not only for forensic reasons but also in view of quality management, procedures for correction (of operative failure) should be distinguished from those for recurrence.

Ambulatory Surgical Procedures↗
PubMed2005

[Recurrences of carpal tunnel syndrome in long-term haemodialysis patients].

BACKGROUND: Multiple recurrences of carpal tunnel syndrome and increased malfunction of the hand caused by tendopathies and arthropathies occur in long-term (20 - 30 years) haemodialysis and are mainly influenced by beta2-microglobulin amyloidosis. METHOD AND CLINICAL MATERIAL: 18 patients undergoing haemodialysis for an average of 29 years had been operated on 96 times for bilateral CTS and recurrent CTS during a mean observation period of 12.6 years. In nine patients (12 hands), removal of the thickened flexor digitorum superficialis tendons III and IV had been performed. All but two patients suffered from amyloidosis, 17 of them suffered from additional tendo- and 13 from additional arthropathies. All procedures were performed under local anaesthesia, and in half of them a tourniquet was used. The outcome was evaluated both clinically and with nerve conduction studies. RESULTS: 77 procedures for CTS-recurrences were performed. The first recurrence was observed after an average of 6.1 years (SD 2.8), the second after 4.6 (SD 3.1) and the third after 3.8 (SD 1.9) years. Whereas in case of a first (occasionally second or extremely seldom in a third) recurrence, another re-opening of the carpal tunnel with or without synovectomy, was sufficient to improve symptoms in the majority of patients, this was occasionally the case with a second but rarely with the third recurrence. In these latter patients, only resection of thickened superficial flexor tendon bundles, showing marked amyloid-deposits histologically, resulted in improvement of pain, as well as finger mobility in one third of the patients. The distal motor latency of the median nerve recovered after the primary operation in 86 %, and after the second (first recurrence) only in 53 %. After the third operation (second recurrence), the results after tendon removal were better than in cases after synovectomy alone. CONCLUSION: In long-term (more than 20 - 30 years) haemodialysis patients suffering from arthropathies, tendopathies and recurrent carpal tunnel syndrome, removal of the flexor digitorum superficial tendons should be considered for the second recurrence to improve pain and finger mobility.

Aged↗
PubMed2005

[Carpal tunnel syndrome in haemodialysis patients: analysis of clinical and electrophysiological findings in 268 patients (395 hands)].

PURPOSE/BACKGROUND: Along with arthropathies, carpal tunnel syndrome (CTS) may occur in patients on chronic haemodialysis, its incidence is correlating with the duration of the haemodialysis treatment. To evaluate clinical and electrophysiological findings, relation of the disease to the side of the arteriovenous shunt, gender ratio, and a concurrent tendovaginosis stenosans (TVS), 268 haemodialysis-patients with CTS or recurrent CTS were retrospectively analyzed. METHODS AND (CLINICAL) MATERIAL: Over a period of ten years (1994 - 2003), 268 haemodialysis patients presented to our peripheral neurosurgery practice with CTS or recurrent CTS. Diagnosis was confirmed with clinical and electrophysiological findings. The patients were divided into three groups based on their severity of disease as follows: Patients with only intermittent paraesthesias (CTS I degrees ), with persistent numbness in the area supplied by the median nerve (CTS II degrees ), and with paresis of the thenar muscles (CTS III degrees ). The average distal motor latency (DML), loss of sensory nerve action potentials (SNAP), and/or motor action potentials (MAP) were used as electrophysiological parameters. RESULTS: During the above mentioned period, 395 primary CTS-operations were performed in 268 patients, and 83 operations of recurrent CTS in 53 patients, i.e. approximately 50 % of the patients had bilateral operations. A second recurrency of CTS was treated in 29 hands of 20 patients and a third recurrency in six hands of five patients. The ratio of women to men suffering from CTS was approximately 1 : 1. TVS occurred concurrent in 22 % of the patients in one hand and in 11.6 % in both hands. Decompression of the median nerve was performed more frequently on the shunt-side, or primarily on the shunt-side, if both hands were affected, as compared to the contralateral side. Recurrency of CTS, possibly a second or third recurrency, was found with increasing time of dialysis. The temporal interval from one operation to the other had a declining tendency. Whereas at the time of the primary operation in 27.4 % of the patients a CTS I degrees was found, patients suffered from CTS II degrees or III degrees in case of a second or third recurrency. Deterioration of clinical signs in CTS recurrency was reflected by the electrophysiological findings with an increasing loss of SNAP and MAP. CONCLUSION: CTS is a typical complication of chronic haemodialysis, and differs from idiopathic CTS by a gender ratio of 1 : 1, a high frequency of concurrent TVS, as well as a tendency to recur. Since compression of the median nerve was found preferentially on the shunt-side, haemodynamic factors may play a role in the pathogenesis of the disease in addition to amyloidosis. Haemodialysis patients complaining of paraesthesia in their hands should undergo electrophysiological examination, even if a successful CTS-operation was performed in the past.

Aged↗
PubMed2005

[Tennis elbow].

Explore the source record for details and available documents.

Adult↗
PubMed2004

[Postmastectomy lymphedema and carpal tunnel syndrome. Surgical considerations and advice for patients].

PURPOSE: Following surgery for breast cancer, an increased risk is assumed for development or worsening of lymphedema following hand surgery procedures. The aim of this study was to find out whether surgery performed with exsanguination using a pneumatic tourniquet has any disadvantages under these circumstances. There might result consequences for patients' information of possible risks as well as for performance of hand surgical procedures. METHOD: 52 patients who had undergone mastectomy were included in the study. In 47 of these, axillar lymph node biopsy or dissection had been performed. 41 patients had been advised not to allow measurement of blood pressure, drawing of blood or surgery to that arm. Surgical release of the retinaculum flexorum by using local anesthesia and exsanguination for a maximum of ten minutes was performed at an average of 7.5 (range from 1 - 26) years after the breast operation. RESULTS: Following release of the carpal ligament a temporary swelling of the arm or hand was found in four patients, which persisted for 2 - 3 months in one patient and disappeared within one week in the others. Three patients suffered from moderate lymphedema before surgery. It was unaffected by hand surgery in two patients and only temporarily worsened for several days in another patient. In all patients, neurological symptoms (paresthesia, numbness and pain) improved completely. Other complications, particularly infections, were not observed. CONCLUSIONS: 1. Exaggerated information of patients with breast surgery in their history does not seem to be indicated in minor hand surgical procedures. 2. The hand surgeon should inform the patients preoperatively that there may occur a transient swelling which can be avoided by loose dressings and early functional training. Using a pneumatic tourniquet has no adverse effect on existing lymphedema in short lasting procedures. 3. Since patients after mastectomy and/or axillary dissection often complain about arm pain and paraesthesia, not only brachial plexus pathology but also a carpal tunnel syndrome must be considered.

Adult↗
PubMed2002

[Glomus tumours of the extremities: localisation and operative treatment in 36 cases].

Glomus tumours are rare lesions and perhaps for that reason they often pose diagnostic difficulties. They are benign tumours first described by Masson in 1924, and they are derived from the glomus body responsible for blood and temperature regulation. In this study, 36 cases were reported out of a total of more than 35 000 operations in an eleven-year period. Among them were 23 women (average age 51 years) and 13 men (average age 52 years). They were diagnosed correctly after a mean period of eight years from onset of symptoms until surgery. In women, glomus tumours occurred almost always in the distal phalanx, especially in the subungual area, in men without any predisposing localisation. Two third of the patients presented with local pain and cold intolerance, and 50 percent of the patients with subungual localisation had a bluish discoloration beneath the nail. In three patients without visible or palpable signs additional MRI confirmed the diagnosis. All patients were operated upon in local anaesthesia and in a bloodless field. In the cases with subungual localisation, we mostly used a transungual triangular incision with good cosmetic results. In 94 % of the patients the lesion has been cured, in one case symptoms persisted, and in another case recurrence occurred. Conclusion. In patients with severe local pain, especially in the distal phalanx, glomus tumours should be considered. In cases where no clinical signs can be found, MRI - although not specific - may be helpful in establishing the correct diagnosis. The operation can be performed in local anaesthesia, bloodless field and in subungual localisation through a triangular incision. Recurrences may occur.

Adult↗
PubMed2002

[Neurological examination methods of the hand].

Handsurgeons are normally more interested in clinical tests evaluating sensory and movement disorders of hand. Since these are often unprecise and require a cooperative (and intelligent) patient, neurologists and neurosurgeons prefer precise diagnostic procedures. For this reason they use electrophysiological techniques to evaluate and localize peripheral nerve lesions, i.e. electromyography, sensory and motor nerve conduction velocity and somatosensory-evoked potentials (SEP), by which most nerves of the arm and hand (median, ulnar and radial nerves including their major branches) can be easily assessed. Insufficient technique (submaximal stimulation, no temperature control, stimulation of a neighbouring nerve) and mis- or overinterpretation are sources of error, which can best be avoided when the diagnosis is made in context with the clinical picture--especially when the surgeon is familiar with electrophysiological techniques.

Electromyography↗
PubMed2000

[Surgical treatment of carpal tunnel syndrome in pregnancy: results from 314 cases].

A total of 314 hands of patients suffering from carpal tunnel syndrome (CTS) in pregnancy or puerperium were treated by carpal tunnel release. In 53% of these cases, other members of the family were also affected, usually the mother. Ninety-seven patients were operated upon at both hands. One hundred thirty-three operations were performed during pregnancy, mostly in the last trimester, and 181 during puerperium. In four patients, the operation was performed on both hands simultaneously. There were also 12 cases of associated De Quervain's tenosynovitis and ten trigger fingers. Severe night pain and/or permanent hypoesthesia was experienced by 93% of the patients. All patients were operated on with local anesthesia and in a bloodless field. The distal motor latency was 7 +/- 1.5 ms in cases with hypoesthesia and 4.9 +/- 1.75 ms without sensory loss. Of the patients, 98% reported good or excellent results of the operation during pregnancy via questionnaires. Since symptoms are often very severe in pregnancy and puerperium and the operation is well-tolerated by pregnant women and without risk to either mother or child, we recommend surgery, especially when sensory loss is present and motor latency is more than 5 ms.

Adolescent↗
PubMed2000

[Tendovaginitis stenosans: a frequent complication of carpal tunnel syndrome].

Of 1310 patients surgically treated for carpal tunnel syndrome (CTS), 134 (10.2%) were observed to have one or more trigger fingers or de Quervain's disease. Of a total of 205 fingers, the middle finger was affected 75 times, the ring finger 50 times, the thumb 47 times, the small finger 17 times, and the index finger 16 times. Chronic nonspecific synovitis is commonly suspected as the cause of both diseases. In all cases of carpal tunnel syndrome, the patient should therefore be examined for symptoms of concomitant trigger finger and vice versa. Both can be cured surgically under local anesthesia and bloodless field in a single session.

Adult↗
PubMed1996

[Correction and reintervention in carpal tunnel syndrome. Report of 185 reoperations].

The outcome of 185 reoperations between 1986 and 1995 could be grouped into three categories: 1. In 91 cases (49.2%) the retinaculum was not fully divided (in most cases distally) or was completely intact. Most of these patients presented atypical incisions and deterioration of distal motor latency as well as worsening of the clinical symptoms. 2. In 58 cases (31.4%) true recurrences were present. Forty-five of these patients received chronic haemodialysis. 3. In 36 cases (19.5%) the reoperation proved unnecessary. In ten of them iatrogenic nerve damage was found. Five patients were assumed to have spontaneous intraneural bleeding following decompression of the highly compressed nerve with prolonged recovery. Other cases presented additional symptoms of radicular compression ("double crush syndrome"), especially when the electroneurographic findings were discrete or could not be compared with preoperative values. With regard to these experiences, reoperation is indicated when symptoms of median nerve compression persist, especially when an atypical incision is present and distal motor and sensory latency has increased. True recurrences are rare, except in patients undergoing chronic haemodialysis. Reoperation has proved to be less successful in patients presenting atypical signs and symptoms, e.g. dysaesthesia following the first operation, which is rather typical for nerve damage, or a double crush syndrome. Exploration is also not indicated in patients suffering from tender scars. Since additional intraneural neurolysis is unnecessary, reoperations can be performed under local anaesthesia in bloodless field.

Adult↗
PubMed1994

[Simple decompression of the ulnar nerve in cubital tunnel syndrome with and without morphologic changes. Report of experiences based on 523 cases].

The transposition of the ulnar nerve has proved to be an effective therapy in ulnar neuritis at the elbow but has also many risks and technical problems. In contrast the simple decompression or release of the nerve within the cubital tunnel which was first described by Osborne and Feindel and Stratford is an operation which is free of complications and postoperative morbidity and can be performed in local anesthesia. According to the results of a former study of 139 cases and this follow-up study of further 523 cases the simple decompression proved to be an efficacious and almost entirely substitute for the more complicated and extensive procedure of volar transposition-not only for the "idiopathic" cubital tunnel syndrome but also for the "symptomatic" forms as tardy ulnar palsy, luxation of the ulnar nerve or other abnormalities i.e. epitrochleoanconeus muscle, ganglia, lipomas, bursitis. Depending on the severity of nerve damage and duration of symptoms but widely independent from etiology the electroneurographic follow-up study indicated a significant improvement of conduction velocity in about 90% of cases and was therefore a good indicator for successful decompression. It is suggested to give up the concept of different etiologies especially the widely used "sulcus-ulnaris-syndrome" and to replace it by the term "cubital tunnel syndrome" (with or without morphological alterations). Most important for the outcome of surgery is an early operation. Once muscle atrophy has developed the prognosis will be poor. This is also true for cases with concomitant polyneuropathy. Anterior transposition may be restricted to very few cases of extreme cubitus valgus.

Adolescent↗
PubMed1994

[Morton metatarsalgia. Results of surgical treatment in 54 cases].

This syndrome, which involves nerve compression, is probably often overlooked and is, therefore, more frequent than supposed. It is characterized by pain of the forefoot, especially the 3rd and 4th toe, and is induced by pressure of the intermetatarsal space, or extension of the metatarsophalangeal joints. Results of the present study suggest that it can be successfully treated by surgery. Fifty-four patients--mostly women in midlife--had undergone operation by dorsal excision of the "neuroma" which had been performed under local anaesthesia in a bloodless field. Forty of the patients (74.1%) had recovered completely within an observation period of 1-6 years. Four (7.4%) demonstrated significant, and another 4, only slight improvement. In 6 cases (11.1%), surgery failed. The 6 unsuccessful cases had not exhibited any preoperative disturbance to the sensibility of the 4th toe. They showed, rather, symptoms of conversion disorder with depressive features, e.g. increased nocturnal suffering which is atypical for Morton's metatarsalgia. It is concluded that the accuracy of diagnosis according to strict criteria is decisive for surgical outcome.

Adult↗
PubMed1987

[Post-traumatic carpal tunnel syndrome].

In the course of a ten months study on 508 patients with CTS a trauma as a possible causal factor was observed in 22 cases. In none of these cases did the other hand show normal electroneurographic parameters. The mean values of distal motor latency were among 5.5 ms (3.7-9.2 ms) on the injured side and 4.6 (3.5-6.7 ms) on the other. The relatively seldom occurrence of CTS in connection with a trauma requires therefore strict criteria for the evaluation of the casual context. A traumatic etiology can only be recognised if a close temporal relation exists (beginning of the symptomatology during immobilisation or after removal of the cast) or a special tendency to swelling or a dislocation as well as a clear difference in electroneurographic values of the two sides can be observed. Depending on the degree of this difference in latency one can maintain criteria for evaluating the question of causality or of transient or permanent deterioration. Finally in case of CTS the treatment should be given primary importance ahead of reimbursement for the injury.

Adult↗