Asociación Mexicana De Cirugía de Mano

una publicación de Asociación Mexicana De Cirugía de Mano.

Asociación Mexicana De Cirugía de Mano

Asociación Mexicana De Cirugía de Mano

una publicación de Victor Ravens.

FUENTE:
http://www.bjj.boneandjoint.org.uk/content/93-B/3/364.abstract

Use of quantitative intra-operative electrodiagnosis during partial ulnar nerve transfer to restore elbow flexion

THE TREATMENT OF EIGHT PATIENTS FOLLOWING A BRACHIAL PLEXUS INJURY

1. O. Suzuki, MD, PhD, Assistant Professor1; 
2. T. Sunagawa, MD, PhD, Professor2; 
3. K. Yokota, MD, PhD, Assistant Professor1; 
4. Y. Nakashima, MD, PhD, Orthopaedic Surgeon1; 
5. R. Shinomiya, MD, PhD, Orthopaedic Surgeon1; 
6. K. Nakanishi, MD, PhD, Assistant Professor1; and 
7. M. Ochi, MD, PhD, Professor1

+Author Affiliations

1. 1Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences
2. 2Department of Locomotor System Dysfunction, Graduate School of Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.

1. Correspondence should be sent to Professor O. Suzuki; e-mail:osami@hiroshima-u.ac.jp

Abstract

The transfer of part of the ulnar nerve to the musculocutaneous nerve, first described by Oberlin, can restore flexion of the elbow following brachial plexus injury. In this study we evaluated the additional benefits and effectiveness of quantitative electrodiagnosis to select a donor fascicle. Eight patients who had undergone transfer of a simple fascicle of the ulnar nerve to the motor branch of the musculocutaneous nerve were evaluated. In two early patients electrodiagnosis had not been used. In the remaining six patients, however, all fascicles of the ulnar nerve were separated and electrodiagnosis was performed after stimulation with a commercially available electromyographic system. In these procedures, recording electrodes were placed in flexor carpi ulnaris and the first dorsal interosseous. A single fascicle in the flexor carpi ulnaris in which a high amplitude had been recorded was selected as a donor and transferred to the musculocutaneous nerve. In the two patients who had not undergone electrodiagnosis, the recovery of biceps proved insufficient for normal use. Conversely, in the six patients in whom quantitative electrodiagnosis was used, elbow flexion recovered to an M4 level.

Quantitative intra-operative electrodiagnosis is an effective method of selecting a favourable donor fascicle during the Oberlin procedure. Moreover, fascicles showing a high-amplitude in reading flexor carpi ulnaris are donor nerves that can restore normal elbow flexion without intrinsic loss.

• Received February 9, 2010.
• Accepted November 10, 2010.

• © 2011 British Editorial Society of Bone and Joint Surgery

Asociación Mexicana De Cirugía de Mano

una publicación de Victor Ravens.

Endoscopic Carpal Tunnel Release (ECTR)

http://doctorsvideos.blogspot.mx/2012/09/endoscopic-carpal-tunnel-release-ectr.html

http://www.youtube.com/watch?v=rp9HwTGroXY

28 years old, 8 months pain wrist, no trauma, restriction of wrist movement , manual labour, low income, what to do further?

una publicación de Victor Ravens.

http://www.condroprotectores.es/premios-semergen-i-lesiones-en-la-practica-profesional-de-la-guitarra/

BECAS Y PREMIOS

Viernes 22 de noviembre de 2013 | 11:58

Premios Semergen (I): lesiones en la práctica profesional de la guitarra

Conocer la incidencia de lesiones en la práctica profesional de la guitarra y determinar las posibles causas que contribuyen a su aparición. Este fue el objetivo de un estudio descriptivo realizado por la Dra. Milagros Lucas, Médico Residente de Medicina Familiar y Comunitaria del Centro de Salud San Fernando de Badajoz. El trabajo ha sido premiado con una de las becas a la investigación en artrosis y condroprotección que Semergen otorgó durante su congreso nacional el pasado mes de octubre.

Para el estudio se realizó una encuesta ad hoc para los participantes de uno de los Concursos Internacionales realizados en Extremadura en 2012. Los resultados mostraron que:

- El 88% de los encuestados había presentado alguna enfermedad relacionada con la práctica musical, predominando la patología a nivel de columna vertebral.

- El 40% realizaba estiramientos antes de tocar, el 32% a veces y el 28% nunca.

- Solamente el 64% consultó con un profesional sanitario (un 82% a su médico de atención primaria y un 36% a un fisioterapeuta).

Por todo ello, el estudio recomienda la realización de estiramientos previos a la interpretación musical desde la infancia, así como la adopción de posiciones adecuadas al toca, para evitar posibles lesiones músculo esqueléticas.

Si os ha interesado este tema, os recomendamos visitar este blog sobre la Salud del Guitarrista.

Resultados de la osteotomía extraarticular para el tratamiento de la consolidación en mala posición del radio distal

http://revistaiberoamericanamano.org/images/revistas/2013-vol1/Articulo2.pdf

una publicación de Victor Ravens.

Mas de anatomía...

Anatomía de la mano

Dolor en la muñeca...

una publicación de I.P.C Physical Therapy.

Victor Ravens ha compartido la foto de Asociación Mexicana De Cirugía de Mano.

una publicación de Victor Ravens.

XXV Congreso Mexicano de Ortopedia y Traumatología, México, 2014

Utilidad de las inyecciones de esteroides en los pacientes con el síndrome del túnel carpiano -> Proporcionan alivio a corto plazo del dolor del túnel carpiano, pero no alivian los síntomas a largo plazo en la mayoría de los pacientes. El 75% de los pacientes recurrió a la cirugía el plazo de 1 año para aliviar el dolor persistente.

Ann Intern Med, 03/09/2013 "Methylprednisolone Injections for the Carpal Tunnel Syndrome: A Randomized, Placebo-Controlled Trial"

Antecedentes: Las inyecciones de esteroides se utilizan en el síndrome del túnel carpiano idiopático (STC), pero la evidencia de la eficacia más allá de 1 mes es deficiente. Objetivo: Evaluar la eficacia de las inyecciones de metilprednisolona locales del STC. Diseño: Ensayo aleatorizado, controlado con placebo. ( ClinicalTrials.gov : NCT00806871 ). Marco: Departamento de ortopedia de referencia regional en Suecia. Pacientes: Pacientes de 18 a 70 años con el STC, pero sin inyecciones de esteroides anteriores. Intervención: Tres grupos (37 pacientes cada uno) recibieron 80 mg de metilprednisolona, 40 mg de metilprednisolona o placebo. Los pacientes y los cirujanos que tratan estaban cegados. Medidas: Los puntos finales primarios fueron el cambio en los síntomas del STC, las puntuaciones de gravedad a las 10 semanas (rango, 1 a 5) y la tasa de cirugía al 1 año. A tres pacientes les faltaban datos de 10 semanas. Todos los pacientes tenían datos del 1 año. Resultados: Los resultados de mejora de los síntomas de gravedad del STC a las 10 semanas fue mayor en los pacientes que recibieron 80 mg de metilprednisolona y 40 mg de metilprednisolona que en los que recibieron placebo (diferencia en cambio desde el inicio, -0,64 [ IC del 95%, -1,06 a - 0,21, p = 0,003 ] y -0,88 [IC, -1,30 a -0,46 , p < 0,001 ], respectivamente ), pero no hubo diferencias significativas al año. Las tasas de cirugía al año fueron de 73 %, 81 % y 92 % para de 80 mg de metilprednisolona, 40 mg de metilprednisolona y placebo, respectivamente. En comparación con los pacientes que recibieron placebo, los que recibieron 80 mg de metilprednisolona fueron menos propensos a tener una cirugía (odds ratio, 0,24 [IC , 0,06 a 0,95 ], p = 0,042). Con el tiempo de la cirugía incorporado, tanto el grupo de 80mg de metilprednisolona como el de 40 mg tuvieron menor probabilidad de cirugía (razón de riesgo, 0,46 [IC, 0,27 hasta 0,77 , p = 0,003 ] y 0,57 [IC , 0,35 a 0,94 , p = 0,026 ], respectivamente ). Limitación: El estudio se realizó en 1 centro y las férulas de muñeca habían fracasado previamente para todos los pacientes. Conclusión: Aunque las inyecciones de metilprednisolona durante STC tienen beneficios significativos en el alivio de los síntomas a las 10 semanas y reducen la tasa de cirugía al año después del tratamiento, 3 de cada 4 pacientes fue operado el plazo de 1 año.

http://annals.org/article.aspx?articleid=1733275

Methylprednisolone Injections for the Carpal Tunnel Syndrome: A Randomized, Placebo-Controlled Trial

Isam Atroshi, MD, PhD; Magnus Flondell, MD; Manfred Hofer, BSc; and Jonas Ranstam, PhD

Background: Steroid injections are used in idiopathic carpal tunnel syndrome (CTS), but evidence of efficacy beyond 1 month is lacking.

Objective: To assess the efficacy of local methylprednisolone injections in CTS.

Design: Randomized, placebo-controlled trial. (ClinicalTrials.gov: NCT00806871)

Setting: Regional referral orthopedic department in Sweden.

Patients: Patients aged 18 to 70 years with CTS but no previous steroid injections.

Intervention: Three groups (37 patients each) received 80 mg of methylprednisolone, 40 mg of methylprednisolone, or placebo. The patients and treating surgeons were blinded.

Measurements: Primary end points were the change in CTS symptom severity scores at 10 weeks (range, 1 to 5) and rate of surgery at 1 year. Three patients had missing 10-week data. All patients had 1-year data.

Results: Improvement in CTS symptom severity scores at 10 weeks was greater in patients who received 80 mg of methylprednisolone and 40 mg of methylprednisolone than in those who received placebo (difference in change from baseline, −0.64 [95% CI, −1.06 to −0.21; P = 0.003] and −0.88 [CI, −1.30 to −0.46; P < 0.001], respectively), but there were no significant differences at 1 year. The 1-year rates of surgery were 73%, 81%, and 92% in the 80-mg methylprednisolone, 40-mg methylprednisolone, and placebo groups, respectively. Compared with patients who received placebo, those who received 80 mg of methylprednisolone were less likely to have surgery (odds ratio, 0.24 [CI, 0.06 to 0.95]; P = 0.042). With time to surgery incorporated, both the 80- and 40-mg methylprednisolone groups had lower likelihood of surgery (hazard ratio, 0.46 [CI, 0.27 to 0.77; P = 0.003] and 0.57 [CI, 0.35 to 0.94; P = 0.026], respectively).

Limitation: The study was conducted at 1 center, and wrist splinting had previously failed for all patients.

Conclusion: Methylprednisolone injections for CTS have significant benefits in relieving symptoms at 10 weeks and reducing the rate of surgery 1 year after treatment, but 3 out of 4 patients had surgery within 1 year.

Primary Funding Source: Region of Scania Research and Development Foundation and Hässleholm Hospital Organization.

Rheumatoid Arthritis of the hand - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing the condition of rheumatoid arthritis

http://www.youtube.com/watch?v=d6P0MCjz9T4&feature=share&list=TLsTRdLAr_7GAt3oO4qxxpQ9oj9YqiEvdI

http://www.youtube.com/watch?v=d6P0MCjz9T4&list=TL0U9lp95t9fjyJZ03DQ46xruzJecY6l7y

Rheumatoid Arthritis of the hand - Everything You Need To Know - Dr. Nabil Ebraheim

www.youtube.com

Educational video describing the condition of rheumatoid arthritis. Become a friend on facebook: http://www.facebook.com/drebraheim 

Four corner fusion

http://www.slideshare.net/vaikunthan/four-corner-fusion#!

Four corner fusion from Vaikunthan Rajaratnam

DId You Know: Hands and fingers are the most-often injured body parts!

una publicación de Victor Ravens.

Fractura de Escafoides (Boxeador)

una publicación de ESCOLA TECNICA DE RADIOLOGIA CULTURAL.

Distal Radius Fractures

una publicación de Victor Ravens.

DEFORMIDADE DE MADELUNG

una publicación de Victor Ravens.

Dupuytren's Contracture Facts

una publicación de I.P.C Physical Therapy.

XXXII CONGRESO NACIONAL DE ORTOPEDIA Y TRAUMATOLOGÍA. 59° REUNIÓN ANUAL, MÉXICO, 2014

una publicación de Victor Ravens.

Cirugía de los síndromes de compresión nerviosa de la muñeca

una publicación de Victor Ravens.

57 years old female, history of RTA

una publicación de Victor Ravens.

LUXAÇAO SEMILUNAR / Luxación del semilunar

una publicación de ESCOLA TECNICA DE RADIOLOGIA CULTURAL.

https://www.researchgate.net/publication/258035583_Medical_Student_Perceptions_of_Plastic_Surgeons_as_Hand_Surgery_Specialists?goback=%2Egde_3804094_member_5801245045575135236

Role of platos surgeons in acute hand trauma?

Medical Student Perceptions of Plastic Surgeons as Hand Surgery Specialists. researchgate.net

Plastic surgeons are often not perceived as hand surgery specialists. Better educating medical students about the plastic surgeon's role in hand surgery may improve the understanding of the field...

Medical Student Perceptions of Plastic Surgeons as Hand Surgery Specialists.

Jayant P Agarwal, Shaun D Mendenhall, Paul N Hopkins

From the *Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, Salt Lake City, UT; †The Institute for Plastic Surgery, School of Medicine, Southern Illinois University, Springfield, IL; and ‡Study Design and Biostatistics Center, School of Medicine, University of Utah, Salt Lake City, UT.

Annals of plastic surgery (Impact Factor: 1.29). 10/2013; DOI:10.1097/SAP.0b013e3182583f3b

Source: PubMed

ABSTRACT Plastic surgeons are often not perceived as hand surgery specialists. Better educating medical students about the plastic surgeon's role in hand surgery may improve the understanding of the field for future referring physicians. The purposes of this study were to assess medical students' understanding of hand surgery specialists and to analyze the impact of prior plastic, orthopedic, and general surgery clinical exposure on this understanding.
An online survey including 8 hand-related clinical scenarios was administered to students at a large academic medical center. After indicating training level and prior clinical exposure to plastic surgery or other surgical subspecialties, students selected 1 or more appropriate surgical subspecialists for management of surgical hand conditions.
A response rate of 56.4% was achieved. Prior clinical exposure to plastic, orthopedic, and general surgery was reported by 29%, 43%, and 90% of fourth year students, respectively. Students generally chose at least 1 acceptable specialty for management of hand conditions with improvement over the course of their training (P = 0.008). Overall, students perceived orthopedic surgeons as hand specialists more so than plastic and general surgeons.Clinical exposure to plastic surgery increased the selection of this specialty for nearly all scenarios (22%-46%, P = 0.025). Exposure to orthopedic and general surgery was associated with a decrease in selection of plastic surgery for treatment of carpal tunnel and hand burns, respectively.
Medical students have a poor understanding of the plastic surgeon's role in hand surgery. If plastic surgeons want to continue to be recognized as hand surgeons, they should better educate medical students about their role in hand surgery. This can be achieved by providing a basic overview of plastic surgery to all medical students with emphasis placed on hand and peripheral nerve surgery.

The effect of a Galeazzi fracture on the strength of pronation and supination two years after surgical treatment

una publicación de Victor Ravens.