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Biomedical subjects

M L Kasdan

Publications and source records attributed to M L Kasdan.

At least 19 recordsLinked to original sources
PubMed2000

Reflex sympathetic dystrophy: misdiagnosis in patients with dysfunctional postures of the upper extremity.

The purpose of this case-control study was to assess the frequency of the inappropriate diagnosis of reflex sympathetic dystrophy (RSD) in patients who presented with dysfunctional postures of the upper extremity (n = 43). This group of patients with a dysfunctional posture was compared with a randomly selected control group of patients who presented with pain but no dysfunctional posture (n = 88). The patients underwent radiographic evaluation after review of previous medical records and history and physical examination. Patients with dysfunctional postures had a significantly higher frequency (63%) of a previous inappropriate diagnosis of RSD compared with the control group (6%). None of the patients in either group had objective findings consistent with a diagnosis of RSD. Patients presenting with dysfunctional postures of the upper extremity may be misdiagnosed as having RSD and rarely meet the criteria for this diagnosis.

Adolescent↗
PubMed1999

The nocebo effect: do no harm.

The nocebo effect creates negative expectations about symptoms and can have devastating influence on patient recovery. Just as the placebo effect works by making patients believe they will get better, the nocebo effect can serve to make patients worse. Two case histories are presented in which patients were assigned diagnoses without objective physical findings. This resulted in poor outcomes. Physicians should avoid assigning a diagnosis without objective physical evidence and thus avoid creating the nocebo effect in patients.

Adult↗
PubMed1998

Expanded profile of the SHAFT syndrome.

The SHAFT syndrome is a factitious disorder in which a patient manipulates the surgeon to perform operations to fulfill his or her psychological needs. The acronym describes patients who are sad, hostile, anxious, frustrating, and tenacious. A chart review from January 1990 to June 1996 was undertaken to provide a profile to aid in the recognition and diagnosis of the SHAFT syndrome. An analysis of 28 patients revealed characteristics supporting a definitive SHAFT profile. Patients with SHAFT syndrome seek physicians to perform invasive procedures. Their typical complaint is pain, usually without objective physical findings that would support a more definitive diagnosis. Such patients tend to be women, cry with pain, describe symptoms out of proportion to objective findings, and have a history of psychiatric care.

Adult↗
PubMed1998

Electrodiagnostic reports of median neuropathy at the wrist.

The diagnosis of carpal tunnel syndrome (CTS) is confirmed by electrodiagnostic testing. Practice parameters for electrodiagnostic testing of CTS have been defined in a summary statement published by the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. All members of the Industrial Injuries and Prevention Committee of the American Society for Surgery of the Hand provided electrodiagnostic reports from their office practices indicating an electrodiagnosis of CTS or median neuropathy at the wrist. One hundred consecutive reports were analyzed to determine how often these electrodiagnostic studies adhered to the standards and guidelines of the summary statement. Variability in the thoroughness of the studies, hence in the quality of information in the reports, was noted. The clinical implications of this survey are that some patients were diagnosed and treated for CTS who did not have median neuropathy at the wrist.

Carpal Tunnel Syndrome↗
PubMed1997

A case-control study of obesity as a risk factor for carpal tunnel syndrome in a population of 600 patients presenting for independent medical examination.

Pain, numbness, and tingling through the median nerve distribution, known as carpal tunnel syndrome (CTS), has been associated with many personal risk factors. Previous studies have implicated obesity as a risk factor for median neuropathy at the carpal tunnel. A case-control design was undertaken to explore the association between obesity and CTS. Six hundred patients presented with symptoms of upper-extremity disorders for independent medical examination related to a disability or compensation claim. The 300 patients with electrodiagnostic evidence of CTS were compared with 300 control subjects from the same initial population. All patients were categorized according to their body mass index. The analysis was stratified for the possible confounding factors of cervical spine abnormalities, Martin-Gruber interconnections, age, and sex. A statistically significant association was found between obesity and median neuropathy. The implications of such a relationship are discussed in light of the contemporary debate over the etiology of cumulative trauma disorders.

Adult↗
PubMed1996

Carpal tunnel syndrome. Effects of litigation on utilization of health care and physician workload.

We performed a study consisting of two parts to investigate the impact of litigation on patient recovery and physician workload. We received 556 replies from a questionnaire sent to hand surgeons and discovered that 98.20% of them felt that litigation increased the subjective complaints of patients. Most of these physicians (89.75%) also felt that litigation led to a worse result from treatment. Second, we undertook a retrospective chart review of 447 patients to see if there was a correlation between litigation, patient utilization of health care and physician workload. We found that workers' compensation patients with pending litigation went to the doctor's office more. They also had more letters, phone calls, and forms associated with their care, had more nerve conduction studies performed, and took longer to be discharged from care than patients with non-work-related carpal tunnel syndrome as well as workers' compensation patients who did not have pending litigation. These results indicated that litigation does affect patient utilization of health care and increases the workload on the physician.

Adult↗
PubMed1996

Occupational soft-tissue and tendon disorders.

Reports of work-related musculoskeletal disorders have increased. The cause of the problem has yet to be determined. Thus far, only cross-sectional case and controlled studies exist. It is important for the physician to develop a thought process to separate patients with subjective complaints and real objective findings from those with unreasonable subjective complaints and minimal or no findings.

Humans↗
PubMed1996

Trigger finger: not always work related.

A retrospective chart review of 516 patients with 719 trigger fingers was undertaken to determine the relationship between trigger finger and occupation. Of the 516 patients, 361 were employed. One hundred seventy-eight (34.5%) of the employed patients had trigger fingers related to heavy lifting and/or high force gripping activities. The decision of causation is arbitrary and not based on science.

Adult↗
PubMed1995

Upper extremity disorders: a literature review to determine work-relatedness.

The objective of this review is to establish whether the medical literature validates a causal relationship between upper extremity disorders and work activities. Selected articles were reviewed using a Diagnostic Medical Criteria. Articles meeting this criteria were further reviewed for validity. Only 14 of 52 reviewed articles were felt to encompass medical criteria. However, these articles also contained what appear to be major validity flaws. Very little of the written material dealing with the issue of work-related upper extremity conditions incorporates what are felt to be sound medical diagnostic criteria in the definition and identification of these conditions. None of the reviewed studies have established a causal relationship between distinct medical entities and work activities. Further research using well constructed studies that incorporate reliable epidemiologic and accepted diagnostic criteria is needed. In this manner, the best of the medical and epidemiologic fields can be applied to solving these problems.

Arm Injuries↗