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At least 379 records · Page 21Linked to original sources
PubMed1998

Complete dorsal dislocation of the metacarpophalangeal joint of the thumb.

In the pathology of simple complete dislocation involving the metacarpophalangeal joint of the thumb, whether or not the palmar plate is interposed within the joint is controversial. Nine cases of complete dorsal dislocation of the joint were reviewed, and cadaver dissection was performed to study the pathology of this injury. Eight of the nine patients were seen within 4 days of injury and treated successfully by closed manipulation. One patient treated 7 days after the injury required open reduction. We were able to reproduce the pathological anatomy of the dislocation, wedging of the palmar plate in the joint of the cadaver. In this cadaver and in all clinical cases, radiographs showed a complete dislocation with an increased distance between the palmar edge of the base of the proximal phalanx and the metacarpal head, indicating an interposition of the palmar plate. Our study suggests that in simple complete dislocations of this joint, the palmar plate is interposed between the displaced bones.

Adolescent↗
PubMed2000

The treatment of pulled elbow: a prospective randomized study.

To evaluate the effectiveness in decreasing recurrence of cast application after manual reduction of pulled elbow. Sixty-four children with pulled elbow were randomized into two treatment groups: Group A underwent manipulative reduction followed by splinting the elbow in a flexed and supinated position for 2 days; group B underwent manipulative reduction only. Both groups were examined 2, 5, and 10 days later. None of the 33 patients in group A had a pulled elbow at follow-up. Four (13%) of 31 patients in group B had a pulled elbow 2-5 days later. Immobilizing the elbow for 2 days after manipulative reduction improves the success of treatment of a pulled elbow.

Child↗
PubMed2000

Simultaneous double interphalangeal dislocation in one finger.

Isolated dislocation of the proximal or distal interphalangeal joint of a finger is common, but simultaneous dislocation of both joints is rare. Three cases of simultaneous dislocations of both interphalangeal joints in the same finger are reported. Closed reduction was easily achieved in all cases.

Adult↗
PubMed1999

Management of simple elbow dislocations. Does the period of immobilization affect the eventual results?

METHODS: Forty-five patients with a simple elbow dislocation were re-examined at an average time of 61 months after injury. All patients were treated by means of closed reduction. Only patients with minor associated injuries were included in the study. The Morrey score was used to evaluate pain, limitation of motion, instability, and daily activities. The overall results were good or excellent with regard to pain and function. The most common finding was a loss of terminal extension. Nine percent of all patients had a lack of extension up to 30 degrees, while 36% had a flexion contracture of less than 10 degrees. Periarticular ossification was seen in 28 patients, but did not lead to loss of motion. For further analysis, the patients were divided into three groups of immobilization: group I, less than 2 weeks, group II, 2-3 weeks, and group III, more than 3 weeks. RESULTS: We encountered better results from those in groups I and II with regard to pain and score results without any statistical significance. CONCLUSION: Our results suggest that splintage of the reduced elbow for 2 weeks enhances patient comfort and does not adversely affect the eventual outcome. Splintage for over 3 weeks may result in worse function.

Adolescent↗
PubMed1998

Vertigo in patients with cervical spine dysfunction.

To our knowledge, quantitative studies on the significance of disorders of the upper cervical spine as a cause of vertigo or impaired hearing do not exist. We examined the cervical spines of 67 patients who presented with symptoms of dizziness. Prior to the orthopaedic examination, causes of vertigo relating to the field of ENT and neurology had been ruled out. Fifty patients of the above-mentioned group were studied. They followed the outlined treatment protocol with physical therapy and were available for 3 months of follow-up. Thirty-one patients, hereinafter referred to as group A, were diagnosed with dysfunctions of the upper cervical spine. Nineteen patients, hereinafter referred to as group B, did not show signs of dysfunction. Cervical spine dysfunctions were documented as published by Bischoff. In group A dysfunctions were found at level C1 in 14 cases, at level C2 in 6 cases and at level C3 in 4 cases. In seven cases more than one upper cervical spine motion segment was affected. Dysfunctions were treated and resolved with mobilising and manipulative techniques of manual medicine. Regardless of cervical spine findings seen at the initial visit, group A and B patients received intensive outpatient physical therapy. At the final 3-month follow-up, 24 patients of group A (77.4%) reported an improvement of their chief symptom and 5 patients were completely free of vertigo. Improvement of vertigo was recorded in 5 group B patients (26.3%); however, nobody in group B was free of symptoms. We concluded that a functional examination of motion segments of the upper cervical spine is important in diagnosing and treating vertigo, because a non-resolved dysfunction of the upper cervical spine was a common cause of long-lasting dizziness in our population.

Adult↗
PubMed1999

Management of the stiff shoulder.

Shoulder stiffness occurs as a result of (1) contractures of the intraarticular capsule or muscle-tendon units or (2) adhesions within the extraarticular humeroscapular or scapulothoracic motion interface. These contractures or adhesions may occur independently or in combination. A thorough history and physical examination usually reveal the diagnosis (idiopathic frozen shoulder or posttraumatic stiff shoulder) and the anatomical locations of fibrosis that is causing stiffness, and identifies other treatable conditions associated with shoulder stiffness (such as diabetes). A gentle home program of passive stretching is effective in most patients. When the home program is not effective, a manipulation or surgical release may be indicated. If manipulation is not effective, capsular contractures are best released arthroscopically as this allows circumferential release without damaging the rotator cuff and thus allows rehabilitation without the need to protect the rotator cuff. The humeroscapular motion interface adhesions can be released either open or arthroscopically, but we believe that an open release combined with an arthroscopic capsular release is quicker and does not interfere with rehabilitation. When necessary, operative management coupled with an aggressive rehabilitation program can provide significant relief of pain and restoration of shoulder motion. Approximately 90% of patients can expect a good result with this treatment algorithm.

Algorithms↗
PubMed2001

Cervicogenic headache: manual and manipulative therapies.

This article reviews current literature on the role of manual medicine in the diagnosis and treatment of cervicogenic headache. Manual diagnostic procedures and treatment procedures are described for the cervical spine. Emphasis is placed on accurate diagnosis using a biomechanical model and precise localization of forces. Muscle energy technique is suggested as a safe and effective treatment when somatic dysfunction of the cervical spine is found in association with the diagnostic criteria for cervicogenic headache. Lastly, a suggested clinical approach to this problem from a manual medicine perspective is given.

Cervical Vertebrae↗
PubMed1993

Thalamic infarction secondary to cervical manipulation.

Vertebrobasilar infarction is a well documented complication of cervical manipulation. A commonly proposed pathogenesis is an intimal tear of the vertebral artery leading to cerebellar and other posterior fossa lesions. However, there have been no cases of thalamic infarct reported. This case demonstrates a thalamic infarction concurrent with brainstem and cerebellar infarction secondary to cervical manipulation and intimal tearing of the vertebral artery. Immediately following manipulation, the patient developed nystagmus, quadriparesis, and a speech deficit. After an aggressive course of in-patient rehabilitation, the patient progressed to a community ambulator with deficits in speech and perception. This case demonstrates one of the inherent risks associated with repetitive forceful cervical manipulation.

Adult↗
PubMed1979

Nasal injuries: their pathogenesis and treatment.

The treatment of a fractured nose by manipulation is criticised. A "perfect" result was achieved in only one-third of 40 cases, a finding mirrored in the literature. The anatomy of nasal fractures produced experimentally in 15 cadavers is described. A recurring pattern of septal fracture and displacement is identified as the cause of the poor results of manipulation. Release of locked septal displacement by a defined local submucous resection, as part of the primary treatment, has given greatly improved results.

Adult↗
PubMed1975

Unusual traumatic anterior dislocation of the hip.

Four interesting cases of traumatic anterior dislocation of the hip are presented. All were easily reduced by closed manipulation, including one complicated by a subtrochanteric fracture of the same femur. Early reduction and mobilization have resulted in good early results, though the risk of late change in the shape of the femoral head still exists in one of the cases. Another case confirmed that an abduction force on the flexed hip can produce anterior dislocation of the hip.

Accidents, Traffic↗
PubMed1976

Central fractures of the acetabulum.

A series of 26 patients with central fractures of the acetabulum is presented with a follow-up of 3-13 years. Three patients had undisplaced fractures. In the remaining 23, long-term results of treatment by traction in 15 and by primary open reduction in 8 have been compared. A numerical grading system has been used for assessment. Results in the non-operative group were generally poor, only 2 being satisfactory. Some of the poorest scores in this group were associated with initial roof damage. Three patients required secondary salvage procedures because of severe pain and disability approximately 2 years after injury. Of the open reduction patients, all with roof damage, 4 had satisfactory results. Reasons for failure is the remaining 4 patients are discussed. Galloping degeneration due presumably to irreversible intra-articular cartilage damage at the initial injury, developed in 2 patients in the non-operative group and in one in the operative group.

Acetabulum↗
PubMed1977

Displaced radial neck fractures in children.

Forty-eight children with displaced fractures of the radial neck were studied. Five types of injury were seen, that associated with a valgus strain being the most common. Good results were obtained in just over one-half of the cases. It is concluded that treatment of these fractures should be by closed means whenever possible. It is generally unwise to attempt operative correction unless the radial head remains displaced or the residual angulation approaches 45 degrees. Open reduction should be checked by intraoperative radiographs. Internal fixation is seldom necessary and has its complications. Late manipulation of the fracture causes additonal trauma and the results are bad. Avascular necrosis and radio-ulnar synostosis were the two most disabling complication encountered.

Adolescent↗
PubMed1977

The operative management of the difficult supracondylar fracture of the humerus in the child.

A series of supracondylar fractures of the humerus in children is presented. The majority was reduced by closed manipulation. The difficult fractures were defined as those in which adequate reduction either could not be achieved by manipulation or was not maintained, or those in which neurological or vascular complications occurred. Such cases were treated by open reduction and internal fixation. The results were assessed with regard to loss of elbow movement, deformity and symptoms. The results of the operative series were comparable with those achieved by closed manipulation in the easier cases. No secondary corrective procedures were necessary. It is concluded that closed manipulation should be used routinely as the method of treatment for supracondylar fractures of the humerus in children, except in the difficult case, for which operative treatment should be undertaken. Stiffness or deformity does not follow open reduction and internal fixation.

Adolescent↗