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Biomedical subjects

M S Pinzur

Publications and source records attributed to M S Pinzur.

90 records · Page 5Linked to original sources
PubMed1987

Triceps spasticity in traumatic hemiplegia: diagnosis and treatment.

Three patients with adult-acquired hemiplegia are described with the unusual dynamic deformity of spasticity of the triceps muscle. This deformity produces motor imbalance with the triceps overpowering the elbow flexors, thus impeding volitional elbow flexion. The nature of the deformity was defined by electromyography of the muscle groups about the elbow, which demonstrated out-of-phase inhibitory electrical activity of the triceps muscle. Treatment consisted of V-Y lengthening of the triceps muscle to achieve agonist-antagonist motor balance. The operation improved hand placement for all three patients.

Adult↗
PubMed1987

Gait changes in adult onset hemiplegia.

Multiple parameters of gait were evaluated in 50 adult acquired hemiplegic patients and 30 control patients with no history of gait abnormality and no deviation from normal gait by observational analysis. Findings in the hemiplegic group include: 1) increase in the proportion of the gait cycle spent in stance and double-limb support phases in both the normal and affected limb; 2) consistent deviation from normal gait pattern by observation and objective pattern analysis; 3) abnormal phasic activity of specific muscles and muscle groups in the affected limb; and 4) a consistent electrogoniometric deviation from normal joint ankle progression in the affected hip, knee and ankle. These data lend credence to the hypothesis that gait deviation in adult acquired hemiplegia follows a consistent pattern varying with the severity of central nervous system involvement. These data also provide a baseline from which to measure therapeutic intervention in this complex patient population.

Adult↗
PubMed1986

Early post-surgical prosthetic fitting with a pre-fabricated plastic limb.

Early prosthetic fitting and independent ambulation are major goals in the rehabilitation of amputees with early walking being extremely valuable in the physical and psychosocial rehabilitation of the amputee. With early resumption of weight bearing and ambulation, deterioration of postural reflexes can be prevented and the residual limb (stump) can be shaped for definitive prosthetic fitting. A new temporary prosthesis was evaluated in its use on new below-knee amputees. The prosthesis is a plastic, hollow form which fits over the conventional rigid, plaster postoperative dressing. It comes in one size and is cut to fit the patient. The prosthesis is readily available, needs little training for its application, can be re-used, and is inexpensive. Twenty-two consecutive patients treated at Hines Veteran's Administration Hospital and Loyola University Medical Center underwent below-knee amputations. All were determined to be potential walkers. The average age at surgery was 61 years with a range of 17 to 74 years. Amputation was performed for trauma in two patients and gangrene in the other 20. All wounds were dressed with conventional rigid, plaster dressings with cast changes five days postoperatively. The prefabricated temporary prosthesis was applied at the second cast application at an average of 8.1 days postoperatively with permanent prosthetic fitting at 7.7 weeks. There were no complications related to the use of the plastic temporary prosthesis. The use of a new plastic temporary prosthesis has been found to be advantageous in the early rehabilitation of below-knee amputees.

Adolescent↗
PubMed1986

Diabetic neuro-osteoarthropathy. Rehabilitation of a patient with both ankle joints involved and associated skin problems.

Neuro-osteoarthropathy in diabetes mellitus is not rare. The case of a 53-year-old diabetic with involvement of both ankle joints and multiple associated skin problems complicating rehabilitation management is discussed. By applying a team approach, closely monitoring the patient's skin and joint problems, and treating them at an early stage by adaptive shoes and orthoses, we found that function could be sustained at an optimal level for a prolonged period. In addition to prevention of ulceration, modifying the weight bearing or temporarily non-weight bearing is the treatment of choice. Amputation is to be considered only as a last resort.

Ankle Joint↗
PubMed1986

Temporal gait monitoring: a new device.

A new device that provides continuous recording of gait and gait events is presented. It can be used with motor point electromyography to perform walking electromyography, an electrogoniometer to continuously record joint position, or other measuring devices to record events or activities related to phase of gait. The major advantages of this system as compared with available systems are ease of use, decreased patient encumbrance, potential for portability, potential for digitizing the signal for minicomputer compatibility, and greatly reduced expense.

Adult↗
PubMed1986

Biceps tenodesis for painful inferior subluxation of the shoulder in adult acquired hemiplegia.

Painless inferior subluxation of the shoulder is a common finding following stroke and is a manifestation of the adynamic nature of the disorder. The weight of the limb is not counterbalanced by shoulder musculature. This is a preliminary report of a simple tenodesis procedure performed in six patients with uniformly successful reduction of the subluxation. The tenodesis is performed through a short deltopectoral approach. The tendon of the long head of the biceps is looped over the coracoid process of the scapula and secured with a barbed staple, thus reducing the subluxation. The indications were painful inferior subluxation of a flail shoulder and failure of multiple orthotic attempts to relieve discomfort. Follow-up evaluation ranged from ten to 42 months with no instances of pain or recurrent subluxation in five cases. The one failure was in a patient whose pain was thought to be thalamic in origin. The subluxation was reduced, but the pain persisted.

Adult↗
PubMed1986

Adult-onset hemiplegia: changes in gait after muscle-balancing procedures to correct the equinus deformity.

Fifty-four adult patients with acquired spastic equinus and equinovarus deformity were treated with lengthening of the Achilles tendon, lateral transfer of the anterior tibial tendon, and appropriate muscle releases. All patients had preoperative dynamic electromyography and electrogoniometry performed in order to assist in planning the surgical procedures and to provide a baseline assessment of the dynamic deformities. Preoperatively, the stance and double-support phases of gait were prolonged. Throughout the stance phase, the gait of these patients was characterized by equinus deformity of the ankle, decreased flexion of the knee (hyperextension in the most severely involved patients), and increased flexion of the hip (which also varied with the severity of the equinus deformity of the ankle and hyperextension of the knee). In all patients, the operation was performed at least one year after onset of the hemiplegia. Clinical follow-up at an average of thirty months (range, twenty-four to sixty-two months) showed that the equinus deformity was corrected in all patients and that 59 per cent of them were brace-free. Two patients had a superficial infection that healed uneventfully, and two had pull-out of the tendon that required reoperation. Postoperative analyses of gait, performed at least one year after surgery for twenty-seven of the patients, showed that the stance and double-support phases of gait (which had been prolonged before surgery) approached the findings in normal control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Surgery to achieve dynamic motor balance in adult acquired spastic hemiplegia: a preliminary report.

Reconstructive surgery of the upper limb was performed in an attempt to restore dynamic motor balance in 55 patients with adult-acquired spastic hemiplegia. An eight-level grading system was developed to determine the level of functional capacity. Because this system proved useful in predicting the results of surgery, it was utilized for operative planning. A two-level increase in functional grade was necessary for patients to obtain a meaningful increase in function. The average improvement after surgery was 2.10 functional levels. A two-level increase was achieved in 73.2% of the patients. No patient decreased in grade, and only one remained unchanged. In selected patients with upper limb spasticity, a predictable improvement in functional capacity can be obtained with dynamic motor balancing surgery.

Adolescent↗
PubMed1985

Modified moberg opponensplasty in acquired spastic hemiplegia.

Loss of the transverse arch of the hand and decreased thumb opposition has heretofore been an unreported deformity in the adult acquired spastic hemiplegic upper extremity. Based on Moberg's experience in quadriplegic patients, 11 patients underwent release of the annular ligament at the base of the thumb. This procedure allows the flexor pollicis longus tendon to bowstring and substitute for thumb opposition. All 11 had increased prehension capacity following the surgery. In carefully selected adult acquired spastic hemiplegic patients, release of the annular ligament at the base of the thumb can functionally restore the transverse arch of the hand, improve thumb opposition and improve prehensile capacity.

Adult↗
PubMed1984

Ray resection in the dysvascular foot. A retrospective review.

Twenty-nine ray resection amputations of the lower extremity were performed in 25 dysvascular patients during a four-year period. The indications for amputation were localized gangrene, resistant localized osteomyelitis of a metatarsal, or both. Specific criteria included: (1) foot Doppler pressure of 70 mm Hg, (2) ankle-arm Doppler arterial pressure ratio of at least 0.5, (3) lateral ray resection only when healthy tissue margins could easily be produced, and (4) central ray resection only for persistent deep infection resistant to local treatment. Only 31% healed without further amputation or ulceration. Analyzed retrospectively, the results demonstrate that ray resection has a poor potential for success in the presence of "localized" gangrene and is only moderately successful in the treatment of chronic resistant localized infection.

Amputation, Surgical↗
PubMed1984

Qualitative and quantitative gait phase analysis by continuous monitoring of inter-ankle distance.

A new device is presented that is able to provide a temporal recording of gait as well as a continuous qualitative monitoring of gait events. It can be used with motor-point electromyography to perform walking electromyography, with an electrogoniometer to record joint position, or with other measuring devices to record events relative to phase of gait. The major advantages of this system as compared with available systems are ease of use, decreased patient encumbrance, potential for portability, greatly reduced expense, and the potential for digitizing the signal for computer compatibility. Preliminary data are comparable to available accepted norms.

Adult↗
PubMedDate not supplied

Clostridial myonecrosis in a patient undergoing oxacillin therapy for exacerbation of chronic foot ulcers and osteomyelitis. A case report.

Gas gangrene developed from a chronic foot ulcer in the absence of periferal vascular disease or diabetes mellitus in a hospitalized patient undergoing parenteral antibiotic therapy. Within a 6 hour period the patient developed profound toxemia necessitating emergency and life saving leg amputation. Classically clostridial myonecrosis is diagnosed by the clinical course and the gram stain. In this case, 2 preoperative gram stains failed to show gram-positive rods. At the time of surgery, frank fasical and muscle necrosis in the peroneal compartment dictated extending the below knee amputation to above the knee. In retrospect demonstration of clostridial species and myonecrosis in the pathological specimen confirmed the clinical impression. The identified organism, Clostridium sporogenes has rarely been implicated as a cause of gas gangrene.

Chronic Disease↗
PubMedDate not supplied

Complete posterior dislocation of the talus. Case report and discussion.

Complete dislocation of the talus is an injury that is produced by a great magnitude of force, producing severe soft tissue injury, frequently vascular compromise, often with subsequent avascular necrosis. Complete posterior dislocation of the talus seems not to have been reported previously. The treatment in a 39-year-old man was designed on the basis of experience with antero-medial dislocation. Treatment ranges from attempted anatomical reduction to early arthrodesis of one or all of the articulations of the talus, with and without talectomy. No one method has shown to be superior to the others. Oen reduction is often unsuccessful, probably because of ankle malalignment. Avascular necrosis of the talus without collapse is not necessarily painful. In the present case talectomy and tibio-calcaneal fusion was performed one year after injury. The symptomatic results were good. Accurate anatomical reduction should be the aim of initial therapy. Definitive therapy can be designed to fit the requirements of the individual case.

Accidents, Traffic↗