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At least 181 records · Page 10Linked to original sources
PubMed1993

Upper extremity disorders in performing artists.

Studies in the past decade have shown that a significant proportion of instrumentalists report musculoskeletal problems severely affecting their musical performance. Musicians endure daily intensive use of their upper extremities, frequently placing them in bizarre positions. Their training schedules are rigorous and long term Predisposing factors to, and treatment for, overuse syndromes, tendinitis, and tendon trauma commonly encountered by musical performers are discussed at length. Nerve entrapment has also surfaced as a major problem in musicians, and the means of evaluation and treatment and the role of surgery are put forth. Techniques for studying and analyzing the difficulties faced by instrumentalists are summarized.

Arm↗
PubMed1986

Herniation of the abdominal wall in pregnant mares.

Abdominal wall hernia was detected in 4 pregnant mares. Antemortem diagnosis of the specific abdominal wall lesion was difficult. Ventral deviation of the abdomen, associated abdominal wall edema, and pain indicated rupture of the prepubic tendon. Three mares examined at necropsy did not have a rupture of the prepubic tendon but did have herniation of the abdominal wall. Abdominal pain was severe and was compounded by incarceration or entrapment of viscus.

Animals↗
PubMed1999

Tendon and nerve sonography.

The refinement of high frequency transducers has improved the ability of ultrasound (US) to detect fine textural abnormalities of tendons and nerves and to identify a variety of pathologic conditions. Characteristic echotextural patterns, closely resembling the histologic ones, are typically depicted in these structures using high US frequencies. In tendon imaging, US can identify tendon dislocations, degenerative changes, differentiate partial from complete tears and determine whether the patient has to be treated surgically or conservatively. A spectrum of findings in inflammatory conditions, including paratendonitis and tenosynovitis, and tendon tumors also can be detected. In nerve imaging, US can support clinical and electrophysiologic testing for detection of compressing lesions caused by nerve entrapment in a variety of osteofibrous tunnels of the limbs and extremities. Nerve tears and tumors also can be diagnosed. Overall, US is an effective technique for imaging tendons and nerves.

Humans↗
PubMed1996

Magnetic resonance imaging of the musculoskeletal system: Part 3. The elbow.

Magnetic resonance imaging provides clinically useful information in assessing the elbow joint. Superior depiction of muscles, ligaments, and tendons as well as the ability to directly visualize nerves, bone marrow, and hyaline cartilage are advantages of magnetic resonance imaging relative to conventional imaging techniques. Ongoing improvements in surface coil design and newer pulse sequences have resulted in higher quality magnetic resonance images of the elbow. Traumatic and degenerative disorders of the elbow are well seen with MR imaging. The sequelae of medial traction and lateral compression from valgus stress include medial collateral ligament injury, common flexor tendon pathology, medial traction spurs, ulnar neuropathy, and osteochondritis dissecans. These conditions as well as lateral collateral ligament injury and lateral epicondylitis may be characterized with magnetic resonance imaging. Posttraumatic osseous abnormalities well seen by magnetic resonance imaging include radiographically occult fractures, stress fractures, bone contusions, and apophyseal avulsions. Magnetic resonance imaging also can be used to assess cartilaginous extension of fractures in children. Intraarticular loose bodies can be identified with magnetic resonance imaging, especially if fluid or contrast material is present within the elbow joint. Biceps and triceps tendon injuries can be diagnosed and characterized. Magnetic resonance imaging also can provide additional information regarding entrapment neuropathies about the elbow. Magnetic resonance imaging is perhaps most useful when patients have not responded to conservative therapy and therefore surgery and additional diagnoses are being considered.

Elbow↗
PubMedDate not supplied

Traumatic simulated Brown's syndrome: a case report.

A case report of a simulated Brown's tendon sheath syndrome is presented which masks as an orbital floor fracture with entrapment. Despite a positive forced traction test, additional diagnostic information such as a normal tomographic exam of the orbital floor, vertical saccadic up gaze velocity measurements consistent with edema and hemorrhage, greater limitation to elevation in adduction than abduction, and tenderness and soft tissue injury in the region of the trochlea, persuaded us to conservatively manage this case. It behooves the ophthalmologist to consider a temporary superior restrictive phenomenon produced by edema prior to any surgical approach to improve elevation of the globe.

Adult↗
PubMed2002

Synovial entrapment: a complication of posterior stabilized total knee arthroplasty.

BACKGROUND: We observed a complication of posterior stabilized total knee arthroplasty involving hypertrophy of tissue proximal to the patella associated with pain during active knee extension from 90 degrees of flexion. The purpose of this paper was to describe synovial entrapment and to determine if design features of the prosthesis predispose patients to the complication. METHODS: Between April 1990 and June 1999, we performed 459 consecutive posterior stabilized primary total knee arthroplasties using three prosthetic designs with different femoral intercondylar geometries. We identified twenty-six patients (twenty-seven knees) in whom arthroscopic débridement of the knee or open arthrotomy with débridement of the knee had been subsequently performed because of a diagnosis of synovial entrapment. We reviewed the records of these patients to identify the knee components that had been used and the symptoms and conditions that necessitated additional treatment. RESULTS: Symptoms (grating, crepitation, and pain with active knee extension from 90 degrees) necessitating subsequent débridement occurred in 13.5% (nineteen) of 141 knees treated with the Anatomic Modular Knee-Congruency implant, 3.8% (eight) of 212 treated with the Anatomic Modular Knee-Posterior Stabilized implant, and none of the 106 treated with the Press Fit Condylar Sigma-Posterior Stabilized implant. All patients had difficulty rising from a chair and climbing stairs; however, none had symptoms when standing or walking. No patient had a patellar clunk. The symptoms occurred at a mean of seven months after the arthroplasty in the patients with an Anatomic Modular Knee-Congruency implant and at a mean of twenty months after the arthroplasty in those with an Anatomic Modular Knee-Posterior Stabilized implant. Débridement of the frond-like hypertrophic synovial tissue at the distal aspect of the quadriceps tendon alleviated symptoms in all patients. No nodules were identified during the arthroscopy. CONCLUSIONS: Synovial entrapment is characterized by hypertrophic synovial tissue at the superior pole of the patella. Use of a posterior stabilized femoral component with a proximally positioned or wide femoral box is more likely to result in this complication.

Aged↗
PubMed2001

Ultrasound of tendons and nerves.

Tendons and nerves represent probably one of the best application of musculoskeletal US due to the high lesion detection rate and accuracy of US combined with its low cost, wide availability, and ease of use. The refinement of high-frequency broadband linear-array transducers, and sensitive color and power Doppler technology, have improved the ability of US to detect fine textural abnormalities of these structures as well as to identify a variety of pathological conditions. Characteristic echotextural patterns, closely resembling the histological ones, are typically depicted in these structures using high US frequencies. In tendon imaging, US can assess dislocations, degenerative changes and tendon tears, including intrasubstance tears, longitudinal splits, partial and complete rupture, inflammatory conditions and tendon tumors, as well as postoperative findings. In nerve imaging, US can support clinical and electrophysiological testing for detection of compressing lesions caused by nerve entrapment in a variety of osteofibrous tunnels of the limbs and extremities. Congenital anomalies, nerve tears, and neurogenic tumors can also be diagnosed. Overall, US is an effective technique for imaging tendons and nerves. In most cases, a focused US examination can be performed more rapidly and efficiently than MR imaging.

Arthritis, Rheumatoid↗
PubMed1980

[Radial nerve compression syndrome at the elbow with reference to radiohumeral epicondylosis--clinico-anatomic studies].

Compression of the radial nerve in the angle of the elbow can manifest itself clinically as "epicondylosis" ("tennis elbow"). Operative findings and systematic necropsy studies point to four specific areas in which a compression of the radial nerve occurs: 1. Occasionally, firm connective tissue fibers running between the brachialis and brachioradialis extend over the radial nerve in the proximal part of the radial tunnel. 2. Blood vessels may cross the nerve in the angle of the elbow and cause compression. 3. The profundus branch of the nerve may be compressed by the tendon of the extensor carpi radialis brevis when the origin of the muscle is located far medially, and 4. by the tendon of the superficial part of the supinator (arcade of Frohse). These structures can lead to an entrapment neuropathy of the radial nerve, and thereby to an epicondylosis humeri radialis. In patients with clinical symptoms of "epicondylitis" feeling pain along the radial nerve upon application of pressure, the nerve should be exposed to that compressing structures may possibly be released operatively.

Elbow Joint↗
PubMed2006

A case of an accessory brachialis muscle.

Functionally, the brachialis muscle serves a critical role as the primary flexor of the arm at the elbow. However, few reports exist in the literature, which describe variations of this muscle. We present a case of an accessory brachialis muscle (AcBr), found during routine dissection at Harvard Medical School during 2003. The AcBr originated medially from the mid-shaft of the humerus and the medial intermuscular septum. During its course medially, toward the elbow, the AcBr crossed both the brachial artery and the median nerve. The distal tendon split to surround the median nerve before inserting into the common tendon of the antebrachial flexor compartment muscles. Embryological origins and clinical considerations including median nerve entrapment are considered.

Aged↗
PubMed1987

[Compression syndromes in the popliteal area].

In young, active patients with intermittent or sudden-onset ischemic pain in the lower leg, the presence of an entrapment syndrome of the popliteal artery must be considered. This compression syndrome can be clinically and angiographically verified by an interruption in the continuity of the middle segment of the artery. As irritation of the arterial wall can lead to complete occlusion of the artery, all cases of entrapment syndrome within the popliteal fossa--even those causing few symptoms or none at all--require surgical revision. A dorsal approach should be used, and the anatomical variations of the artery listed elsewhere must be considered. The surrounding musculature on the fibrous structures causing compression must be incised or resected; in some cases vascular reconstruction is necessary. In the relatively rare soleus syndrome, there is entrapment of nerves and veins as well as of the artery. In such cases, the tendon of the soleus muscle must be split to obtain adequate decompression of the vascular nerve bundle.

Constriction, Pathologic↗
PubMed1996

[Weber fibular ligament-plasty with plantar tendon with Segesser modification].

UNLABELLED: Ankle joint injuries are one of the most frequently diagnosed sports injuries. In our clinic we observed between 1981-92 18% ankle joint injuries in 11.350 patients. The acute injury was generally handled conservatively by functional treatment with a special shoe; only comminute injuries like fractures, luxations or tendon injuries would lead to the decision to perform surgery. The ratio of acutely performed surgery compared to late surgery was decreasing: 1981 1:3, compared to 1992 1:50. Reconstructive surgery of the lateral ligament complex is indicated under the following conditions: patient suffering from recurrent trauma and feeling of instability and/ or in case of comminuted overuse injuries caused by instability like the entrapment of the tibial nerve in the tarsal tunnel, achilodynia caused by instability of the rearfoot or luxation of the peroneal tendons. Reconstruction of the lateral ligaments of the ankle should be done anatomically, operations with effect of tenodesis should be avoided. TECHNIQUE: We modified the technique of Weber to reconstruct the lateral ligaments. An autograft (plantaris tendon) is used for this procedure. The plantaris tendon is removed through a medial sided minimal incision on the injured leg with a special stripper. Through the lateral incision on the lateral malleolus drill wholes are made at the anatomical ligament insertions of the calcaneus, talus and fibula. The graft is passed through the drill wholes this way the Lcf and Ltfa are anatomically reconstructed. The tendon sheat of the peroneal tendons will be closed if needed with residual plantaris tendon. The postoperative treatment is the same as conservative treatment with full-weight-bearing in a special shoe three days after surgery with 30 degrees (10-0-20) range of motion. ROM will be increased to 50 degrees after three weeks. For the first three weeks the leg will be positioned in a 90 degrees splint over night. Two series of patients altogether 584 patients in the time from 1981-1991 were operated. The difference of the two groups lied in the technique of surgery (in group 2 the calcaneofibular ligament was reconstructed as well as the peroneal tendon sheat) as well as the postoperative treatment was altered (group one removable cast for the first three weeks versus functional treatment after surgery in group 2 as described in the postop treatment). RESULTS: 443 (76%) out of 584 operated patients were followed at least one year after OP. Working ability: 19% (group 1)/25% (group 2) of the patients after two weeks, 31/42% after 2-4 weeks and 79/88% after 4-6 weeks. Full sports activity to previous sport 8/17% after 4-6 weeks, 26/38% after 6-8 weeks, 65/70% after 8-12 weeks. The group 2 achieved full sports activity and working ability on average two weeks before the patients of group one. Personal evaluation: 88/90% felt their ankle joint to be more stable postoperatively, 10/9% as stable as before and 2/1% described it as less stable. Clinical evaluation: The modified Benedetto score showed in 76/81% very good results, in 9/7% good and 13/8% bad results. In conclusion the described reconstruction of the fibular ligaments without damaging the active stabilizing muscles is a valid technique. The reconstruction of the calcaneofibular ligament improved the long term results of surgery. The functional postoperative rehabilitation (special shoe and night brace) does shorten the time for the patients working ability as well as the return to full sports activity. The long term results on the other hand appeared to be similar for both groups. The advantage of our technique using the plantaris tendon as a graft. The use of autograft material having the same tensile strength as the original ligaments anatomically reconstructed. Surgery with tenodesis effects should be abandoned. The good results occurring while performing late surgery leave the chance for primary conservative treatment of lateral ligament injuries.

Adult↗
PubMed1999

Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis.

Fifteen centers for orthopaedic treatment of the foot and ankle participated in a prospective randomized trial to compare several nonoperative treatments for proximal plantar fasciitis (heel pain syndrome). Included were 236 patients (160 women and 76 men) who were 16 years of age or older. Most reported duration of symptoms of 6 months or less. Patients with systemic disease, significant musculoskeletal complaints, sciatica, or local nerve entrapment were excluded. We randomized patients prospectively into five different treatment groups. All groups performed Achilles tendon- and plantar fascia-stretching in a similar manner. One group was treated with stretching only. The other four groups stretched and used one of four different shoe inserts, including a silicone heel pad, a felt pad, a rubber heel cup, or a custom-made polypropylene orthotic device. Patients were reevaluated after 8 weeks of treatment. The percentages improved in each group were: (1) silicone insert, 95%; (2) rubber insert, 88%; (3) felt insert, 81%; (4)stretching only, 72%; and (5) custom orthosis, 68%. Combining all the patients who used a prefabricated insert, we found that their improvement rates were higher than those assigned to stretching only (P = 0.022) and those who stretched and used a custom orthosis (P = 0.0074). We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.

Adult↗
PubMedDate not supplied

US of the shoulder: non-rotator cuff disorders.

The most common indication for shoulder ultrasonography (US) is the diagnosis of rotator cuff disease. However, there is a spectrum of non-rotator cuff abnormalities that are amenable to US examination, including instability of the biceps tendon, glenohumeral joint, and acromioclavicular joint; arthropathies and bursites (inflammatory diseases, degenerative and infiltrative disorders, infections); nerve entrapment syndromes; and space-occupying lesions. Many of these conditions may be overlooked clinically or can even mimic rotator cuff tears, and US can help redirect the diagnosis if a complete shoulder examination rather than a simple rotator cuff assessment is performed. In addition, US can be remarkably helpful in guiding either needle aspiration procedures or local injection therapy in patients with synovial processes. Although radiography, magnetic resonance (MR) imaging, and computed tomographic and MR arthrography are effective modalities for the evaluation of non-rotator cuff disorders, US is both less costly and less invasive and will likely be used more frequently in this setting as experience increases. Once adequate radiographs have been obtained to exclude apparent bone disorders, high-resolution US should be the first-line imaging modality in the assessment of non-rotator cuff disorders of the shoulder, assuming the study is performed with high-end equipment by an experienced examiner.

Arthritis↗
PubMed1996

Conservative treatment of bilateral sural nerve entrapment in an ice hockey player.

Midway through the season, an intercollegiate ice hockey player experienced bilateral numbness in the posterior aspect of the leg along the area of the calcaneal tendon. This numbness corresponded with the distribution of both sural nerves. While obtaining a history of the condition, the athlete admitted that he routinely spiraled his ice hockey laces tightly around the proximal portion of each ice hockey boot before finally tying the laces off. A complete neurological examination was negative except for the bilateral numbness. Based upon this information, a diagnosis of bilateral sural nerve entrapment was made. In addition to frequent follow-up examinations, nonoperative treatment consisted of changing the way the athlete laced his ice hockey skates. The athlete was able to complete the season and, after approximately 4 months, was asymptomatic. Although this appears to be an isolated incident, athletic trainers should be cautious when evaluating patients with paraesthesia in this region. If symptoms such as those described develop, entrapment of the sural nerve should be considered as a possible cause.

Journal Article↗
PubMed2004

Variant of the coracobrachialis muscle with a tunnel for the median nerve and brachial artery.

This case report documents a variation in the insertion of the coracobrachialis muscle of the right arm of an adult male cadaver of unknown age. In addition to the normal insertion of the coracobrachialis muscle into the middle of the medial border of the humerus, an additional slender tendon passed inferiorly, crossing anterior to the median nerve and brachial artery before attaching to the medial epicondyle of the humerus. Most of the proximal part of the tendon gave rise to an aponeurotic expansion that inserted into the distal medial border of the humerus. The tendinous insertion and aponeurotic expansion may represent a variant of the coracobrachialis longus (Wood's) muscle and the internal brachial ligament, respectively. The median nerve and brachial artery traversed a tunnel bounded by the additional tendon and aponeurotic expansion as well as the usual humeral insertion of the coracobrachialis muscle. The clinical implication of this variation is that it may be a cause of median nerve entrapment and brachial artery compression.

Adult↗
PubMed1993

Basketball injuries of the foot and ankle.

Foot and ankle injuries in basketball are discussed in three unrelated categories in this article. This includes a practical differential diagnosis of ankle sprains, acute conditions of the mid and hindfoot, overuse syndromes of nerve entrapment, fascial strain, synovitis, joint subluxation, and inflammation resulting from repetitive stress. The diagnosis and treatment of tendon inflammation of the extrinsic foot musculature is also reviewed.

Ankle Injuries↗