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Biomedical subjects

V R Masear

Publications and source records attributed to V R Masear.

16 recordsLinked to original sources
PubMed1998

Triggering of the lesser toes at a previously undescribed distal pulley system.

We have treated five patients with metatarsalgia and triggering of the lesser toes. This paper describes a mechanism of triggering that involves a previously undescribed flexor pulley system in the toes that is very similar to the pulley system in the fingers. The specific anatomy of the toe flexor pulleys is described based upon the dissections of 50 fresh-frozen cadaver toes. These pulleys were composed of transverse to obliquely oriented fibrous bands within the flexor sheaths from the metatarsal heads to the distal phalanges. We found a system of pulleys in the lesser toes and the great toe, analogous to that found in the hand. Trigger toe is a rare entity and is only briefly described in the literature. We believe it is more common than is now recognized and may be an important underdiagnosed cause of metatarsalgia. The diagnosis is made when active plantarflexion causes the toes to catch in flexion and the patient is then unable to extend them. Nonsurgical therapy consisting of steroid injection, NSAIDs, or changing footwear may be effective, otherwise surgical release of the A1 pulley may be required.

Adult↗
PubMed1996

Rupture of the extensor pollicis longus tendon.

Rupture of the extensor pollicis longus (EPL) tendon after nondisplaced fracture of the distal radius is a known complication, but can also occur in nonrheumatoid patients without a history of fracture. This study is a retrospective analysis of seven patients treated between 1985 and 1992. Five EPL ruptures occurred with nondisplaced Colles' fractures. Two involved a chronic tenosynovitis of the second dorsal extensor compartment of the wrist. The age of the patients ranged from 29 years to 68 years (mean, 42 years). Length of follow-up ranged from 6 weeks to 62 months (mean, 30 months). Rupture occurred at a median of 7 weeks (range, 2 weeks to 11 months) from the time of the distal radius fracture. Three extensor indicis proprius tendons and four free palmaris longus tendon grafts were performed. At final follow-up, six patients had an extensor lag < 10 degrees or normal thumb interphalangeal joint motion. One patient had a 25 degrees extensor lag. The causes of EPL rupture include mechanical irritation, attrition, and vascular impairment leading to delayed rupture. Synovitis of the extensor carpi radialis due to repetitive use may invade the EPL tendon and lead to rupture. Extensor indicis proprius transfer or free palmaris longus grafts yield good results after EPL rupture.

Adult↗
PubMed1996

The treatment of epineural scarring with allograft vein wrapping.

Painful scarring around peripheral nerves is a difficult treatment dilemma. Many previously recommended treatment options have resulted in recurrence of pain. The authors describe the technique of allograft vein wrapping with preserved human umbilical vein. To date, 119 vein wrappings of peripheral nerves have been performed. Good or excellent results were obtained in 79% of the patients. The most common complication has been deep infection (in two patients) and a draining sinus tract (in seven patients). The majority of patients have had significant relief from their chronic pain, and the authors have found the results, at an average follow-up of 25 months, to be very encouraging.

Cicatrix↗
PubMed1994

Efficacy of direct repair to partial arterial lacerations.

These are differences of opinion as to the best method of reconstituting flow following partial laceration of a small artery. This study was undertaken to determine how narrowing of a small vessel by direct repair affects patency rates. Partial arterial lacerations of varying widths were made in both femoral arteries of 30 Sprague-Dawley rats. The vessels were randomized to groups of longitudinal and transverse partial lacerations. Flow was reestablished in experimental vessels with direct repair (with reduction of vessel cross-sectional area ranging from 22% to 62%). In control vessels, resection and end-to-end repair or resection with vein grafting was performed. Two weeks postoperatively all vessels were explored to confirm patency and calculate flow. Immediately after repair all vessels were patent. At 2 weeks all direct and end-to-end repairs remained patent, while two of seven vein grafts had thrombosed. Immediately following repair there were no significant hemodynamic differences between repair groups. The final flow rate measured distal to the repair site averaged 2.5 mm2KHz for vessels with resection and either end-to-end repair or vein grafting (control group) versus 2 mm2KHz for vessels with direct repair of the laceration (experimental group); however, comparisons for specific groups showed no significant velocity or flow differences between control and experimental vessels. Direct repair of a partial arterial laceration with up to 62% narrowing of cross-sectional area gives patency rates equal to or better than those of alternate methods; however, blood flow rates may be altered distal to such a repair site.

Animals↗
PubMed1992

Strain-gauge evaluation of lunate unloading procedures.

A biomechanical study was undertaken to determine which procedure(s) most effectively relieve load from the lunate. Strain gauges were mounted on the lunates of 20 preserved cadaveric limbs. Three types of procedures were performed: scaphotrapeziotrapezoid arthrodesis, capitohamate arthrodesis, and ulnar lengthening. Load testing was performed both before and after the simulated fusions and ulnar lengthenings. Ulnar lengthening of 3 mm was the most effective method of lunate strain reduction. Capitohamate arthrodesis decreased compressive strain but increased shear strain. Scaphotrapeziotrapezoid fusion significantly increased both compressive and shear strain in the lunate. Of the three procedures that were tested, ulnar lengthening to create a neutral variance is the most reliable means of unloading the lunate.

Analysis of Variance↗
PubMed1992

Endoscopic carpal tunnel release: a cadaveric study.

Five surgeons performed endoscopic (Dyonics) carpal tunnel releases on 24 fresh cadaver wrists. In 50% of the specimens, transection of the transverse carpal ligament was incomplete. The average amount of incomplete release was 31% (range, 0% to 53%). Three types of incomplete release were noted: (1) release of Guyon's canal release--one, (2) incomplete distal ligament release--five, and (3) incomplete central or superficial release--six. Other technical errors were noted in nine of 24 specimens. There were no nerve lacerations. Endoscopic carpal tunnel release is either a technically demanding procedure, commonly results in incompletely released ligaments, or both. Proper training, followed by practice on several cadaver specimens before its clinical use, is recommended.

Anthropometry↗
PubMed1991

Rotational step-cut osteotomy for treatment of metacarpal and phalangeal malunion.

Metacarpal and phalangeal malunion after fracture or replantation frequently causes rotational deformities with scissoring during digital flexion. Transverse osteotomy at the metacarpal base has been advocated for derotation, but this only partially corrects scissoring resulting from phalangeal malunion. We describe the results of rotational step-cut osteotomies at the site of malunion. There were twenty-three osteotomies in eighteen patients; seven metacarpal and sixteen in the proximal phalanx. The value of the technique is supported by the results; speedy healing of bone, satisfactory alleviation of deformity, and a useful gain in range of motion in many patients.

Adult↗
PubMed1991

Painful syndromes of the foot: diagnosis and management.

The human foot is subjected to a large number and variety of stresses. Consequently, virtually every person will at one time or another experience a painful disorder of the foot. The first line of treatment is normally footwear modification and relief from the inciting event or cause. When this is unsuccessful, various surgical procedures may often be of benefit.

Foot Diseases↗
PubMed1990

Triggering of the thumb with de Quervain's stenosing tendovaginitis.

Triggering with de Quervain's stenosing tenosynovitis has rarely been mentioned since de Quervain's original description. Either or both the abductor pollicis longus and extensor pollicis brevis tendons may be responsible. Without detailed examination testing specifically for triggering, the entity may be overlooked. We have encountered nine patients with triggering in the first dorsal compartment. The five with surgical release had complete resolution of symptoms; the four treated nonoperatively have improved but still have symptoms. Triggering may represent a more severe form of de Quervain's tendovaginitis.

Adult↗
PubMed1989

Surgical anatomy of the medial antebrachial cutaneous nerve.

In standard anatomy textbooks the course and distribution of the medial antebrachial cutaneous nerve and its branches are glossed over in a vague fashion as if they are of little importance. There are, however, clinical circumstances in which a knowledge of the anatomy of this nerve is invaluable. Sacrifice of the posterior branch in a medial approach to the elbow or cubital tunnel surgery can lead to annoying numbness over the olecranon and a symptomatic neuroma. The medial antebrachial cutaneous nerve is also frequently used in nerve grafting, especially in brachial plexus reconstruction, in which it is beneficial to know the available length and size of donor nerve. Fifty fresh cadaveric arms were dissected to define the course, distribution, size, and branches of the nerve.

Arm↗
PubMed1989

Degenerative arthritis of the carpus associated with congenital hypoplastic thumb.

The case history of a young man with bilteral congenital hypoplastic thumbs and early degenerative arthritis involving the base of the thumb and scaphotrapeziotrapezoid joints is reported. To our knowledge this association has not been previously made. Limited intercarpal arthrodesis and/or trapezium arthroplasty may be required at a relatively early age in patients with thumb dysplasia. We believe the hypoplastic thenar musculature may lead to instability and excessive shear stresses on the radial side of the carpus, causing the early arthritic changes.

Adolescent↗
PubMed1988

Ulnar compression neuropathy secondary to the anconeus epitrochlearis muscle.

The treatment of the five arms of four patients with ulnar neuropathy at the elbow and an associated anconeus epitrochlearis muscle is presented. Two of these patients had unilateral involvement, one had bilateral neuropathy and bilateral anconeus epitrochlearis muscles, and one had bilateral symptoms, with an anconeus epitrochlearis muscle on the side that was treated by operation. All patients were treated with excision of the anconeus epitrochlearis muscle and cubital tunnel release without anterior transposition of the nerve. All five arms were clinically normal at follow-up 16 to 29 months after operation. Postoperative electrodiagnostic studies on four arms at an average of 9 months after operation showed marked improvement in conduction velocities across the elbow. We recommend simple excision of the anomalous anconeus epitrochlearis muscle when no other cause of ulnar nerve neuropathy at the elbow is identified. Anterior transposition of the nerve seems unnecessary.

Adult↗
PubMed1986

An industrial cause of carpal tunnel syndrome.

A retrospective study was done to determine why a meat packing plant in Illinois had such an unusually high incidence of carpal tunnel syndrome. In the past 12 years, 14.8% of employees at this plant have had a carpal tunnel release. Only two of 117 patients remained unimproved at an average follow-up of 37.4 months. The most consistent result after release was relief of the paroxysmal attacks of burning pain and paresthesia. Weakness of grip was the most significant postoperative complaint in 78%. Highly repetitive motions involving extreme wrist positions, especially flexion and ulnar deviation while grasping, are predominant in meat cutting and probably contribute to the development of carpal tunnel syndrome in this industry. Previous reports of industrial carpal tunnel syndrome have not approached the incidence identified in this study. Patient awareness and Workers' Compensation benefits may account for the high numbers seeking treatment.

Adult↗
PubMedDate not supplied

Avulsion fracture of the tibial eminence associated with severe medial ligamentous injury in an adolescent. A case report and literature review.

In the presence of open physes, tibial eminence fractures are usually isolated injuries. However, adults sustaining a fracture of the tibial eminence are more likely to have other associated injuries, most commonly a tear of the medial collateral ligament. A case of an adolescent with a tibial eminence fracture and a complete tear of the medial collateral ligament is reported. Review of the literature revealed two similar cases in adolescents. If medial instability is demonstrated on valgus stress of the knee in an adolescent with tibial eminence fracture, we believe stress roentgenograms of the knee should be obtained to distinguish between physeal injury and collateral ligament tear.

Adolescent↗