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Biomedical subjects

R M Braun

Publications and source records attributed to R M Braun.

At least 19 recordsLinked to original sources
PubMed1992

The distal joint of the radius and ulna. Diagnostic studies and treatment rationale.

Three areas of functional anatomy are present in the distal ulna. Each of these has a specific function in load bearing of the wrist, rotation of the forearm, and maintenance of the relationship between the radius and ulna. The distal portion of the ulna serves as a suspensory post for ligaments that stabilize the ulnar border of the wrist. The midportion of the distal ulna contains the load-bearing triangular fibrocartilage complex. The proximal portion of the distal ulna articulates with the radius at the sigmoid notch and participates in forearm rotation. Each of these areas is assessed in problems related to ligament instability, load bearing, and range of motion. Mechanical problems that affect the distal joint of the radius and ulna include the affects of trauma, degenerative change, and inflammatory disease. Each of these requires evaluation in the treatment of joint derangement. Diagnostic studies that relate to problems in the distal radioulnar joint area include standard roentgenographs, arthrograms, magnetic resonance (MR) scanning, and arthroscopy. Each of these studies has particular advantages and disadvantages in providing data for analysis of joint malfunction. A medical history, physical examination, and use of proper diagnostic studies will assist in an appropriate diagnosis of problems in the distal joint of the radius and ulna.

Adult↗
PubMed1991

Spontaneous bilateral median nerve compressions in the distal arm.

A case of bilateral median nerve compressions in the distal arm is described. The patient was seen initially with the spontaneous onset of paresis of the anterior interosseous nerve innervated muscles, as well as more proximal median nerve innervated muscles. There was no shoulder-girdle weakness or sensory abnormality. No systemic symptoms were identified. Surgical exploration in each extremity revealed enlarged communicating veins directly compressing the median nerve in the distal arms. Clinical improvement began 6 months after operation and was complete by 18 months.

Adult↗
PubMed1989

Provocative testing in the diagnosis of dynamic carpal tunnel syndrome.

This study measures the effects of provocative testing on a series of patients with latent symptoms of carpal tunnel syndrome. Forty patients were studied for change in hand volume and loss of sensibility after stress. Thirty-four patients demonstrated significant measurable increase in hand volume after a 7-minute stress test. In 17 of 34 patients impaired sensibility associated with swelling developed and they were considered to have dynamic carpal tunnel syndrome. Surgical treatment was effective in correcting symptoms and sensory defects in these 17 individuals despite postoperative hand swelling that continued after the operation when the hand was subjected to stress.

Adult↗
PubMed1989

Carpal tunnel syndrome: morphologic changes after release of the transverse carpal ligament.

We describe the morphologic changes that follow division of the transverse carpal ligament in patients with carpal tunnel syndrome. Fifteen hands in 12 patients with carpal tunnel syndrome were studied with magnetic resonance imaging before operation and for 6 weeks after operation. Eight hands were studied at 8 months after operation. Carpal arch width, anterior displacement of the carpal canal contents, and carpal canal volume were measured by use of multiplanar reformation and three-dimensional reconstruction of magnetic resonance images. There was a 24.2 +/- 11.6% increase in carpal canal volume 6 weeks after carpal tunnel release (p less than 0.001). This difference persisted at 8-month follow-up. There was an anterior displacement of carpal canal contents 3.5 +/- 1.9 mm from its original position 6 weeks after operation (p less than 0.001). This palmar displacement persisted at the 8-month follow-up. There was no statistically significant increase in carpal arch width 8 months after carpal tunnel release. We believe that division of the transverse carpal ligament restores median nerve function by increasing the volume of the carpal canal. This volumetric increase results from an anterior displacement of the newly formed transverse carpal ligament and not from a widening of the bony carpal arch.

Carpal Bones↗
PubMed1986

Distal interphalangeal joint involvement in rheumatoid arthritis.

Sixty-two patients with seropositive rheumatoid arthritis (RA) were evaluated radiographically for distal interphalangeal (DIP) joint involvement and were compared with 50 age- and sex-matched control subjects. The frequency of DIP erosions was 37% in the patients versus 14% in the controls; these erosions were mild and were not related to disease duration. Erosions elsewhere in the hand and wrist were of all degrees of severity and were related in part to disease duration. Osteophytes occurred frequently in both the RA group (71%) and the control group (60%). However, joint space narrowing occurred more frequently in RA patients (77%) than in the controls (46%) (P less than 0.009). The findings from this study suggest that in RA patients, DIP erosions occur frequently, do not occur in isolation, and are not simply a marker for severe global erosive disease in the hand and wrist. The high frequency of osteophytosis and joint space narrowing in both groups probably represents the overlap of osteoarthritis and RA that occurs in many patients.

Arthritis, Rheumatoid↗
PubMed1985

Dynamic compression for small bone arthrodesis.

A technique providing dynamic compression for arthrodesis of the small joints in the hand uses a longitudinal wire for alignment and two 0.045 Kirschner wires and methyl methacrylate cement for continuous dynamic compression. Thirty-one joints, 12 metacarpophalangeal and 19 interphalangeal, were arthrodesed by this method. There were no angular malunions or nonunions. The technique is recommended as an alternative to current fixation methods in the hand for small joint arthrodesis.

Arthrodesis↗
PubMed1985

Total joint arthroplasty at the carpometacarpal joint of the thumb.

A series of 50 cases of total joint arthroplasty at the carpometacarpal joint of the thumb demonstrate surgical procedure and cement technique. Most patients showed a full range of motion within four weeks of suture removal and continue to demonstrate good long-term results. Less motion is anticipated in patients with contractures or systemic disease. Five patients showed clinical or radiographic evidence of loosening. Revision procedures document the retrieval potential of a failed implant. The author's ten-year experience with this system indicates that the concept is viable. Future modifications are discussed.

Carpal Bones↗
PubMed1979

Iatrogenic compression of the thoracic outlet.

Arterial injury and brachial plexus nerve compression have been reported in association with surgical procedures in the area of the thoracic outlet. An initial report of iatrogenic injury was related to the operative correction of Sprengel's deformity, which required lowering of the scapula in a child. Compression of the neurovascular bundle between the clavicle and the first rib occurred during this surgical migration. The developmental anatomy of the costo-clavicular area and the descent of the upper limb from its initial cervical position are reviewed. This relationship between the clavicle and the first rib may also be altered by surgical procedures carried out on adults. Two cases of the iatrogenic injury to the brachial plexus are reported in association with operations performed in the area of the clavicle. Correction of these injuries resulted when the costoclavicular space was re-established.

Adult↗
PubMed1978

Injury to the brachial plexus as a result of diagnostic arteriography.

Six cases of brachial plexus injury within the brachial sheath are reported following axillary-brachial arteriography. Direct compression resulted from leakage of arterial blood into the space formed by the fascial sheath. In one, hemorrhage occurred several days after arteriotomy. Early decompression and arteriorrhaphy resulted in restoration of normal function. Permanent nerve damage resulted when surgical decompression was delayed.

Aged↗
PubMed1978

Palmaris longus tendon transfer for augmentation of the thenar musculature in low median palsy.

The palmaris tendon may be lengthened by a distal strip of palmar fascia and transferred subcutaneously to the tendon of insertion of the abductor pollicis brevis for augmentation of thumbs elevation from the palm. The transfer attempts to duplicate abductor brevis function in the complex act of opposition. The palmaris has appropriate strength, excursion, and direction for this purpose. It is properly phased for pinch activity and requires minimal retraining. Twenty-eight cases of transfer have been performed successfully and without difficulty. The uses of the transfer have included cases of carpal tunnel syndrome with thenar atrophy, injury to thenar muscles, and direct trauma to the median nerve in the forearm.

Adult↗