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Biomedical subjects

M Vastamäki

Publications and source records attributed to M Vastamäki.

At least 19 recordsLinked to original sources
PubMed1996

Iatrogenic serratus anterior paralysis. Long-term outcome in 26 patients.

STUDY OBJECTIVE: To evaluate the treatment, extent of recovery, and residual disability in 26 iatrogenic cases of serratus paralysis. PATIENTS AND STUDY DESIGN: Seventeen cases of serratus anterior paralysis had occurred following a local invasive procedure along the course of the long thoracic nerve, including seven first-rib resections, four mastectomies with axillary dissection, two scalenotomies, two surgical treatments of spontaneous pneumothorax, and two infraclavicular plexus anesthesia. Eight cases of paralysis had occurred after general anesthesia for patients who had undergone surgery for diverse clinical reasons. One case of paralysis occurred after spinal anesthesia. The length of sick leave, treatment with a shoulder brace, amount of physical therapy, long-term symptoms, and residual disability were evaluated from the medical records and from the questionnaire sent to the patients on average 6 years (range, 2 to 11 years) after the onset of the paralysis. RESULTS: Despite comprehensive and lengthy treatment, all but one had residual symptoms, as well as limitations in the use of the affected limb. Twenty-one (81%) of the patients could not lift or pull heavy objects, 15 (58%) could not play sports, such as tennis or golf, and 14 (54%) found it impossible to work with hands above shoulder level. CONCLUSION: Serratus anterior paralysis, following anesthesia or local invasive procedures on the anterolateral aspect of the thorax, may cause considerable and long-term dysfunction of the shoulder girdle and affect the function of the whole upper limb.

Adolescent↗
PubMed1995

Cardiovascular functional disorder and distress among patients with thoracic outlet syndrome.

Cardiovascular functional stability of 11 women with thoracic outlet syndrome (TOS; mean age 34.5) and nine female controls (mean age 35.1) was studied using an orthostatic test, a deep breathing test, Valsalva manoeuvre and hand-grip test. The heart rate at rest was significantly higher in TOS patients. The TOS group showed significant accentuation in T wave vacillation in the orthostatic test. The rise in diastolic blood pressure of the TOS group during a hand-grip test was significantly less than that of the control group. TOS patients experienced significantly more distress according to the modified somatic perception questionnaire (MSPQ) than the control group. Pain was correlated with the score of MSPQ, the resting heart rate and increase in diastolic blood pressure in a hand-grip test. The results suggest that TOS patients' symptoms often reflect a wider disturbance than merely anatomical compression in the thoracic outlet. It seems possible that sympathetic tone is higher in TOS patients than in controls. In addition to possible operative treatment, it may be necessary to provide psychological help, relaxation and endurance training.

Adult↗
PubMed1994

Long-term results of primary scalenotomy in the treatment of thoracic outlet syndrome.

A total of 107 patients with thoracic outlet syndrome were reviewed an average of 4.1 years (range 2-11 years) after primary scalenotomy. The sample included 86 women and 21 men, and the mean age at surgery was 41.9 years (range 16-59 years). The three most disturbing pre-operative symptoms were pain at rest (87%), numbness (66%) and lack of power (55%). The post-operative success rate diminished from 71% 1 month after operation to 63% at follow-up. The retirement frequency increased from 6% up to 33% during the follow-up time. It was highest among factory workers at 60%. Of the patients older than 45 years at surgery, 68% were retired at follow-up. The importance of careful selection for operation is emphasized, and also the need to consider vocational rehabilitation before resorting to surgical treatment of thoracic outlet syndrome. We recommend surgical treatment for this disabling disorder, especially for younger patients with clear evidence of thoracic outlet syndrome who are engaged in occupations demanding little repetitive work. The best results have occurred in this group.

Adolescent↗
PubMed1993

The results of secondary microsurgical repair of radial nerve in 33 patients.

33 patients with injuries to the radial nerve were reviewed, on average, 12.1 (5-20) years after secondary repair. 24 were male and nine female, with a mean age of 29.8 (7-54) years. Most of the nerve lesions were blunt (17) or sharp (14) injuries. Division was total in 24 cases and they were mostly injured at the upper arm level (21 cases). The average interval between injury and repair was 6.0 (1-19) months. The procedures used were fascicular grafting in 21 and direct suture in 12 cases. Motor and sensory recovery were evaluated quantitatively. Useful results were obtained in 65.0% and useless in 25.0%. Fascicular grafting restored a useful level of motor function in only 8/21 cases (38.1%). Pre-operative delay had a significant influence. Associated lesions proved to be the critical factor for restoration of radial nerve function.

Adolescent↗
PubMed1993

The results of secondary microsurgical repair of ulnar nerve injury.

110 patients with injuries to the ulnar nerve were assessed, on average, 12.7 (3-20) years after secondary repair. 89 were male and 21 female, with a mean age of 27.9 years. Most of the nerve lesions were sharp (63) or blunt (41) injuries. Division was total in 76 cases and most were at the forearm level. The average delay from the injury to the operation was 10.1 (1-48) months. Secondary repair was performed in 34 cases and fascicular grafting in 76 cases. The mean graft length was 5.4 (1-30) cm. Four factors of motor and sensory function were assessed and the quantitative evaluation was compared with the MRC classification. Useful results were obtained in only 51.8% and poor in 30.9%. The age of the patient, the width of contusion, the pre-operative delay, and the level of the injury influenced the results significantly.

Adolescent↗
PubMed1993

An analysis of the results of late reconstruction of 132 median nerves.

132 patients with injuries to the median nerve were assessed on average 10.4 years after repair. There were 106 males and 26 females, with a mean age of 28.4 years. Most of the nerve lesions were sharp (76) or blunt (47) injuries. Division was total in 87 cases, and most were at the wrist level. Secondary repair was performed in 34 cases and fascicular grafting in 98 cases. The average gap was 5.8 cm. A quantitative evaluation and grading according to the MRC classification was created to reflect sensory and motor recovery. Excellent or good results were obtained in only 49.2%. The age of the patient, the width of contusion, the pre-operative delay, the length of grafting and the level of the injury influenced the results significantly. The result of nerve repair was poor in patients aged over 54 years, when the level of the injury was more than 56 cm proximal to the finger tip, if the pre-operative delay was more than 24 months, or if the graft length was more than 70 mm.

Adult↗
PubMed1993

Suprascapular nerve entrapment.

Fifty-four patients with suprascapular nerve entrapment were evaluated on an average of 5.6 years (range, 2-9 years) after surgical release. There were 32 males and 22 females. Supposed causative factor was exertion at work or vacation in 36 cases. Sixteen patients had an atrophy of the supraspinatus and 26 of the infraspinatus muscle. Conduction time to the supraspinatus muscle was 4.5 ms (range, 2.2-14.4 ms), and to the infraspinatus, 8.6 ms (range, 2.5-43.6 ms). The mean time from the onset of the symptoms to surgery was 2.8 years (range, three months to 14 years). The mean age at operation was 38.4 years (range, ten to 61 years). Two patients were operated on bilaterally within two and four years. All but two patients were operated on at the suprascapular notch. A new cranial approach is advocated. The most dramatic effect of the operation was prompt disappearance of the pain in 24 cases and marked diminishing in 15 cases (72%). At the follow-up evaluation, a moderate atrophy of the supraspinatus muscle was found only in one patient but that of the infraspinatus in 11 patients. There were ten poor long-term results, some of them presumably operated on after wrong diagnoses and some at a wrong region.

Adolescent↗
PubMed1989

Operation for old sternoclavicular dislocation. Results in 12 cases.

Twelve patients were operated upon after unsuccessful conservative treatment for complete dislocation of the sternoclavicular joint. Three methods were used; stabilisation using fascial loops, reconstruction with a tendon graft, and resection of the sternal end of the clavicle. The results were good in only four patients, three treated with a tendon graft and one by fascial loops. Another four patients had fair results, but all four treated by resection of the medial end of the clavicle had poor results, with pain and weakness of the upper extremity. In our opinion resection of the sternal end of the clavicle should not be used in old traumatic dislocation.

Adolescent↗
PubMed1987

Median nerve as free tendon graft.

Four patients are described, all of whom had tendon injuries in which the median nerve was used as a free tendon graft. Three cases involved the repair of a flexor tendon injury, and one the repair of an extensor tendon. In all cases, reconstruction of the median nerve was performed with a free sural nerve graft. The difficulty was that the palmaris longus tendon was missing in all cases. The importance of preoperative clinical testing for the presence of the palmaris longus tendon is emphasized.

Adult↗
PubMed1987

Silicone implant arthroplasty in Kienböck's disease.

Fifty-five patients with malacia of the carpal lunate treated by Swanson's silicone implant arthroplasty were reexamined. The follow-up period averaged 3 years. The operation had a favorable effect on pain, but the range of motion and the grip strength remained impaired. Arthrosis progressed in half the cases, and there were five dislocations of the implant and 11 cases of cystic changes of carpal bone.

Adult↗
PubMed1987

Shoulder arthrodesis for paralysis and arthrosis.

Twenty-three patients with a mean age of 35 years (11 males and 12 females) were reexamined 6 years after shoulder fusion. Indication for the operation was shoulder paralysis in 14 cases and arthrosis in 9. In 4 patients the operation had to be repeated because of nonunion. Eighteen patients had improved function, particularly in bringing the hand to the midline of the body, to the face, and to the side pocket. However, bringing the hand to the back and the anal region often deteriorated. One third of the patients, mainly those with arthrosis, had considerable shoulder pain at the follow-up.

Adult↗
PubMed1986

Factors influencing the operative results of rotator cuff rupture.

This paper reports the conclusions from a clinical, radiological and mathematical analysis of 126 patients with rotator cuff ruptures who were treated by operation. There were 83 men and 43 women. The mean age was 53.4 years and the average follow-up period was 3.5 years. According to a new method of scoring, an acceptable result was achieved in 78% of cases (excellent in 29%, good in 23%, and fair in 26%). The chi-square and the two tailed t-tests indicated that the following preoperative or operative variables influenced the results significantly: time away from work before operation (p less than 0.001); operative delay (p less than 0.001); the number of operations on the rotator cuff (p less than 0.001); atrophy of the spinati muscles (p less than 0.001); degenerative changes of the greater tuberosity (p less than 0.001); the heaviness of the patient's work (p less than 0.005); the extent of the resection of the acromion (p less than 0.005) and indication for operation (pain, lack of motion or both) (p less than 0.025). According to regression and covariance analyses, these factors independently influenced the final outcome. The following variables did not significantly predict or influence the operative result: age of the patient; sex; conjoined lesions; the size of the rupture; the site of the rupture or detachment of the deltoid.

Disability Evaluation↗
PubMed1986

Decompression for peroneal nerve entrapment.

I reviewed 24 patients after decompression for peroneal entrapment neuropathy; in 3 cases the lesion was bilateral. There were 15 males and 9 females; mean age 44 (12-72) years. The etiology was an operation around the knee in 12, a tibial fracture in 2, a slight compression in 1, an ankle sprain in 2, excessive climbing in 2, sitting in a cross-legged position in 4, and in 4 cases no reason was found. There was foot drop in 15 and ankle instability in 12 cases. The nerve was decompressed after an average period of 17 months (4 days-8 years). Immediate relief of symptoms was achieved in 14 cases, slower relief in 10, and in 3 cases there was no recovery. In peroneal neuropathy, decompression should be considered after 2 months without recovery and after 4 months when recovery is slow.

Adolescent↗