Biomedical subjects
Publications and source records attributed to P E Higgs.
To delineate a hamate hook fracture, a radiograph was obtained with maximal radial deviation of the wrist and maximal abduction of the thumb. This view is easy and cost-effective to obtain, and it may prove helpful in diagnosing suspected hamate hook fractures or locating the cause of unexplained ulnar wrist pain.
Ninety-three workers having undergone carpal tunnel decompression were assessed 16 to 100 months after surgery. The results of outcomes pertaining to symptoms of numbness, nocturnal awakening, and pain as well as job status were compared to the patients' preoperative nerve conduction study findings. Significant differences in preoperative nerve-conduction values (NCVs) were found between groups reporting poor results and those reporting good results. These differences were such that those reporting poor results had more normal NCVs. Those reporting job changes because of carpal tunnel syndrome also had more normal preoperative nerve-conduction results. Data indicate that those with terminal latencies 1 ms greater than the testing facility normal value or with sensory conduction velocity 10 ms less than the facility norm were more likely to benefit from surgery. This study suggests the need for caution when considering carpal tunnel surgery in workers with normal or near normal nerve-conduction results.
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Wrist pain secondary to injury or disease is a common cause of morbidity and disability. The results of treatment are influenced strongly by promptly determining a correct diagnosis. We have found that a systematic, structured approach consisting of a detailed history and a thorough physical examination supplemented by the proper use of a variety of imaging modalities will establish accurately the diagnosis in almost all patients. Using such an algorithmic approach can greatly minimize medical costs and time lost from work as well as assist the surgeon in diagnosing the cause of wrist pain as quickly as possible. Even when this type of systematic approach is used in the evaluation of patients presenting with wrist pain, it is important for surgeons to remember that several imaging modalities, such as bone scans and arthrography, frequently demonstrate abnormal or atypical findings for which no pathologic correlate exists. If a firm diagnosis cannot be made even after a positive test result, it is unwise to perform surgery based solely on the findings of a test in the hope that wrist pain will thereby be relieved. In such cases, a trial of immobilization for 3 weeks is perhaps the best and most cost-effective way to verify that the pain is caused by an actual bone or joint abnormality that will respond to surgery.
The relationship between work activities and the diagnostic entities discussed in this article is poorly understood, but their development is probably multifactorial. The enormous cost to industry and society is driving many investigators to study the causes and pathologic manifestations of CTDs, and this research should lead to improved strategies for treating and preventing work-related injuries. Prevention, however, will work only if both management and labor participate in preventive efforts. When a task force approach can be implemented and senior management gives it the power to make effective changes, CTDs often can be reduced dramatically, as has been shown in numerous studies illustrating the success of this approach. It is unfortunate that many in senior management are reluctant to permit such task forces due to fear of increased injury claims. Our worry is that, in the end, the solution to problems believed to be associated with repetitive trauma at work may be shaped more by regulatory bodies and attorneys rather than scientists. Hand surgeons, who see patients with complaints that are perceived to be work related, often find themselves in the middle of this complicated problem, being asked to determine whether a patient's symptoms are caused by the performance of job tasks. To treat our patients with hand and wrist symptoms, we must stay abreast of the current understanding of CTDs and be familiar with the diagnosis and management of recognized disease entities such as those reviewed in this article. In most cases, a diagnosis of a specific clinical condition can be established that is based on strict criteria. If this is not possible and the picture is unclear, it is important not to guess at a diagnosis. Labeling a patient with a diagnosis such as thoracic outlet syndrome or nonspecific tendonitis without clear-cut and objective clinical signs can have lasting economic and employment consequences. For this reason, diagnosis of a specific clinical entity should be made only when the findings of the history, physical examination, and ancillary tests firmly support it.
One hundred thirteen workers' compensation and 53 non-workers' compensation patients who had undergone open carpal tunnel release were queried about job status and the presence or absence of residual symptoms of numbness, pain, or nocturnal awakening an average of 42 months postoperatively. Thirty-nine non-workers' compensation subjects were at their original jobs as compared to only 53 workers' compensation subjects. Seventeen of the workers' compensation subjects were unemployed versus two non-workers' compensation subjects. These differences were significant. Of patients changing jobs, 39 workers' compensation subjects and 2 non-workers' compensation subjects attributed their job change to symptoms of carpal tunnel syndrome. Residual symptoms were significantly more common in workers' compensation compared to non-workers' compensation subjects, with 92 of the former and 26 of the latter subjects reporting some residual symptoms.
Repetitive motion injuries have presented clinicians with a significant challenge over the past two and a half decades. Acceptable treatment of inflammatory disorders is well established, but compressive neuropathies and nonspecific complaints of numbness, tingling, and discomfort in the upper extremity present vexing dilemmas. Current research and experience point to multilevel problems, including posturally induced muscular imbalance. Although surgical solutions to these problems are sometimes indicated, conservative approaches successfully treat many individuals and have narrowed the scope and indications for surgical intervention. These approaches include ergonomic changes at the workstation, postural changes, and muscle stretching and strengthening to correct imbalance.
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BACKGROUND: Upper extremity cumulative trauma disorders (CTDs) are among the most prevalent and costly occupational injuries. These disorders include nerve compression syndromes, tenosynovitis, epicondylitis, tendinitis, and arthritis. These have been related in the past to repetitive use of the upper extremity. The expected increase in the age of the American work force and the assumption that older workers are more susceptible to the disorders prompted this investigation of the relationship of age to signs and symptoms of upper extremity impairment. METHODS: A battery measuring seven objective signs and four reported symptoms of upper extremity cumulative trauma disorders was administered to two stratified random samples of workers. One group (n = 157) processed cooked poultry and the second group (n = 118) performed data entry at VDT terminals. Workers were separated into three age groups (younger: 20-35 years, middle-aged: 36-50 years, and older: 51-71 years). RESULTS: A series of analyses of variance were computed to determine whether the older workers were more impaired. No significant age differences were found for sign, symptom, or total scores in either sample, and no significant Age x Gender interaction was present. Older workers were more impaired for vibratory sensation, cutaneous pressure, and motor latency. CONCLUSIONS: The results support the hiring of older workers for general tasks in the workplace without significant worry of increased susceptibility to CTDs.
Ulnar artery thrombosis is well reported but treatment recommendations still vary. We report the 10-year follow-up of a vein graft used to treat a patient with ulnar artery thrombosis. The graft remained patent until the tenth year, when the patient sustained a blunt hyperextension injury to the involved wrist and developed a pseudoaneurysm of the vein graft. The pseudoaneurysm was found to be in the graft itself and not at the anastomosis. The vein graft thrombosed and was successfully treated with resection of the thrombosed vessel, embolectomy of the superficial palmer arch, and replacement with a new vein graft.
All the applicants to plastic surgery residency programs who participated in the residency matching program for 1992 were reviewed. Data were collected on age, sex, race, nationality, place of birth, undergraduate education, medical education, postgraduate training, research activity, and evaluation scores. Findings indicate that applicants interested in academic careers are significantly more likely to have published research and are generally rated higher in categories of intellectual curiosity, performance, and intelligence by evaluators. Women and some minorities were underrepresented when compared with recent medical school graduating classes. We recommend a longitudinal study of applicants to correlate career achievement with applicant characteristics. We also recommend some changes in the application and evaluation process and in efforts to interest women and minorities in the specialty.
Giant lipomas of the upper extremity are infrequently reported. They can alter function by restricting motion or producing compressive neuropathies. This report of four cases of giant lipoma in the hand and forearm illustrates these functional losses. The role of MRI and CT in preoperative evaluation of these lesions is discussed and a report of an anterior interosseous syndrome caused by a giant lipoma is presented.
The sciatic nerve in 60 rats was transected and repaired with 9-0 nylon under magnification. The repairs were tested for bursting strength at 2, 3, 6, 9, and 12 weeks and expressed as a percentage of the bursting strength of a paired control from the opposite leg. The mean percent bursting strength was 25, 42, 53, 45, and 62, respectively. There was no statistically significant gain in bursting strength from the third to the ninth week after nerve repair. However, there was a significant difference in bursting strength at 3 weeks and 12 weeks after repair. A similar experiment was performed in monkeys. At 4 weeks, the repaired nerves had regained 77% of the bursting strength of the normal median and ulnar nerves. These studies call into question earlier claims that repaired nerves regain normal bursting strength within 3 to 4 weeks of repair.
This study evaluates a youth subject-directed smoking prevention and cessation program titled Breathe Easy! The program was delivered at two sites and a control group was recruited from two additional sites. Surveys were administered prior to the program and either 1 month or 6 months after completion at the exposure sites. The same survey administration procedure was used as the control. After controlling for invalid responses and including only those that completed both surveys, 251 exposure subjects and 159 control subjects remained for analysis. At sites with 1-month follow-up, no significant difference was noted between intervention and control groups. At the sites with 6-month follow-up, prevalence dropped from 18.7% to 8.9%, which is statistically significant, while at the control site prevalence changed from 14.1% to 9.4%, which is not significant. Additional outcomes examined in the exposed group showed trends toward smoking cessation and prevention at higher rates than those of the unexposed group.