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Biomedical subjects

R D Leffert

Publications and source records attributed to R D Leffert.

At least 19 recordsLinked to original sources
PubMed1992

Thoracic outlet syndromes.

TOS may arise in a variety of circumstances including trauma, but it may also be seen as a result of postural abnormalities that may be induced by different factors. Cervical ribs and other congenital anomalies are not necessary prerequisites for either the causation or diagnosis of TOS, although they are more common in the TOS population. More important than diagnostic tests are the history and physical examination of the patient. Double crush syndrome can complicate the diagnosis and treatment; however, proper selection of candidates for surgery can produce excellent and good results in a high percentage of cases. Perioperative complications can be significant, so that surgery should be restricted to only those patients who find their symptoms intolerable.

Diagnosis, Differential↗
PubMed1988

Clinical diagnosis, testing, and electromyographic study in brachial plexus traction injuries.

A system for evaluation of patients with brachial plexus injury is based on careful observation, including the patient's history and a physical examination, a radiographic assessment, and electrodiagnosis. The clinical history and physical examination remain the cornerstone of this evaluation and their documentation is vital. Traction injuries, wherein there is a possibility of root avulsion, were examined myelographically and electromyographically at one month. Although they must be considered, the limitations of these methods of evaluation do not vitiate their usefulness. Modification of the evaluation procedures should be made according to the requirements imposed by specific causal agents and circumstances.

Arm Injuries↗
PubMed1988

Tendon transfers for brachial plexus injury.

Brachial plexus injuries result in severe functional deficits in the upper limb. The authors review a group of 74 patients with brachial plexus injuries who underwent 160 tendon transfer operations, as well as 94 additional procedures, in an attempt to augment lost function. Following evaluation of functional recovery, 58 percent of the patients were rated Good, 34 percent Improved, and 8 percent Unimproved. The authors conclude that significant benefit can be obtained by peripheral reconstruction and tendon transfers in patients with brachial plexus injuries.

Arm Injuries↗
PubMed1987

Massive neurofibromatosis of the upper extremity with paralysis.

Tendon transfer and bulk reduction procedures are an alternative to amputation of the elephantoid enlarged limb with neurofibromatosis and paralysis. A patient with this progressive disease has been followed-up for 10 years and retains sufficient function to work as a computer operator.

Adolescent↗
PubMed1987

Rehabilitation of the patient with a brachial plexus injury.

The rehabilitation of patients with brachial plexus injury is a complex process that is dependent upon the understanding by the physician, and others involved in providing care, of the nature of the nerve injury, its natural history, and what measures are available to lessen the disability of such patients. In addition, the patients themselves must understand these same facts so that they can maximize the treatment they receive.

Arm↗
PubMed1987

Non-union of the clavicle. Associated complications and surgical management.

Twenty-three patients who had a clavicular non-union were treated operatively at the Massachusetts General Hospital from 1974 to 1985. Twenty-one non-unions were the result of fracture and two, secondary to osteotomy. Twenty non-unions were located in the middle third of the clavicle, while three were in the lateral third. Radiographically, eighteen non-unions were atrophic and three, hypertrophic. Two non-unions resembled pseudarthrosis. Of the etiological factors that were reviewed the extent of displacement of the original fracture was the most significant. Associated complications of the non-union included limited mobility of the shoulder in fourteen, neurological symptoms in eight, thoracic outlet syndrome in four, and arterial ischemia in one. Of the nineteen patients who were treated to obtain union, seventeen had a successful result at an average length of follow-up of 23.8 months. In sixteen (93.7 per cent) of the seventeen patients union was achieved by fixation with a plate; one patient required two procedures. Ancillary bone graft was used in eighteen patients, with three requiring a sculptured bicortical graft from the iliac crest to span a defect. Of the four other patients three were treated with a partial clavicular resection and one, with complete clavicectomy.

Adult↗
PubMed1987

The relationship between dead arm syndrome and thoracic outlet syndrome.

A relationship exists between anterior shoulder subluxation and thoracic outlet syndrome that is responsible for the more florid symptoms of dead arm syndrome (DAS) in some patients. This relationship was demonstrated in eight of 27 patients (30%) in a consecutive series of Bankart operations for treatment of subluxation. The mechanism is associated with a disturbance in the kinesiology of the shoulder-joint complex that alters the position of the scapula relative to the rib cage and neurovascular supply to the upper limb. Therapy is directed toward restoration of the stability of the glenohumeral joint so that normal biomechanics can be reestablished. In advanced stages of thoracic outlet syndrome, however, DAS may initially require surgical decompression of the nerves and vessels. Careful attention to postural mechanics is essential for rational diagnosis and treatment of DAS.

Adult↗
PubMed1985

The frozen shoulder.

The clinical entity of frozen shoulder has been the subject of considerable controversy concerning pathogenesis and treatment. This is a review and interpretation of the literature against the background of my personal experience and a formulation of a treatment algorithm based on a practical synthesis of these sources. The separate stages of the disease are clearly definable and must be considered in prescribing treatment for the purpose of compressing the natural history and morbidity of this self-limited though disabling condition.

Diagnosis, Differential↗
PubMed1983

Hand difficulties among musicians.

We describe our experience with 100 musicians in whom occupation-related difficulties developed. The majority, pianists, experienced hand difficulties in midcareer (average age, 31 years). These were described as "pain, tightening, or weakness" of the right hand or arm or drooping of the fourth or fifth fingers. These difficulties led to loss of control (34%) or diminished facility (18%), endurance (18%), or speed (18%) while playing trills, arpeggios, or octaves requiring fast, forte finger movements. Most commonly found were inflammatory disorders of tendon or joint (45%) or disorders of motor control (24%). Less likely were entrapment of peripheral nerves and noninflammatory tendon or joint disorders.

Adolescent↗
PubMed1982

Anterior submuscular transposition of the ulnar nerves by the Learmonth technique.

Thirty-eight patients with progressive posttraumatic ulnar neuropathy at the elbow underwent anterior submuscular transposition of their nerves. Multiple mechanical causes of neuropathy were identified. Fourteen patients had undergone previous surgery for ulnar neuropathy, while 24 had not. Postsurgical follow-up averaged 23.1 months. The operative technique is described and illustrated in detail. Complications attributable to surgery were minimal. No absolute prognostic factors could be identified, and even those patients with significant muscular atrophy or time delay before operation were generally benefited. If prior surgery had induced significant scarring and neural damage, the prognosis for recovery was considerably worse, as it also was for patients who had severe preoperative dysesthesia or pain. Four patients thought to represent examples of double crush or compression syndrome were identified.

Adolescent↗
PubMed1981

Distraction-fixation in the primary treatment of metacarpal bone loss.

Nine patients seen in civilian practice with severe open injuries of the hand, including loss of portions of some or all of the metacarpals, were treated by primary restoration of metacarpal length and alignment by distraction-fixation with the use of transverse intermetacarpal Kirschner wires. An external fixation device was added in two of the nine patients. Severe associated soft tissue injuries were present in all but one patient. Two injuries were caused by firearms, and the other seven by heavy machinery. Contractures of the joints were prevented by the use of a second set of wires to position the metacarpophalangeal joints in 70 degrees of flexion and the first metacarpal in abduction and pronation. Staged closure of wounds by local or distant flaps and secondary reconstructions by bone, nerve, and tendon grafts or transfers were necessary in all and required an average of almost 2 years until treatment was completed. All except the one child and the one most recently injured patient have returned to employment or vocational retraining. Follow-up was 24 to 78 months from injury.

Accidents, Occupational↗
PubMed1978

Technical problems with ulnar nerve transposition at the elbow: findings and results of reoperation.

Ten patients who had persistent or recurrent paresthesias, muscular weakness, or sensory loss following transposition of the ulnar nerve at the elbow were explored. Operative findings included compression of the nerve at the intermuscular septum or at the entrance to the cubital tunnel, dense scarring after intramuscular transposition, and constriction by fascial slings. The average interval from the previous operation to re-exploration was 13 months. All patients were improved following neurolysis and submuscular transposition. Recovery was incomplete in nine patients. The average follow-up was 14.5 months.

Adolescent↗
PubMed1976

Patterns of neuromuscular activity following tendon transfer in the upper limb: a preliminary study.

Early results of a continuing study of the electrical activity of muscles after transfer, with an integrated system of electromyographic and video tape recording, recorded motions of the simple voluntary type, mostly with isometric contractions. A triceps-to-biceps transfer showed activity in the new motion one day after operation. A partial transfer of the pectoralis major (Clark) demonstrated isolated activity of the transfer after one year. A superficialis transfer to clawed ring and little fingers functioned to flex the metacarpophalangeal joints and to extend the interphalangeal joints. Transfer of superficialis to finger extensors showed that antagonists acted to provide unresisted extension. The original phasic activity of a muscle was retained in a study of extensor indicis proprius to thumb for opposition. New phasic activity was shown in transfer of extensor carpi radialis longus to digital flexors. In two instances of transfer of spastic wrist flexors to wrist extensors, the original phasic activity was retained, but in only one was the function assumed by the transfer even though wrist extension was improved.

Adult↗