Data Trace Editor – if cuff is not repairable, then debride the tendon edges, it remove any further source of impingement; – bony trough: – classically an osteotome is used to create a 4-5 mm wide and 25 mm long in the space between greater tuberosity and articular surface; … Read more
– Discussion: – Cx & Gram’s staining are obligatory when infection is suspected. – Definitive diagnostic test is either the demonstration of bacteria by Gram’s stain, usually best seen on a concentrated sediment of centrifuged synovial fluid, or the recovery of bacteria from the synovial-fluid culture; – Gram’s stains are positive … Read more
– Post Op Care: – following surgery, the wrist is splinted in neutral or slight extension; – this avoids anterior displacement of median nerve w/ entrapment between divided margins of the TCL; – some believe early motion (with in days … Read more
– See: Nerve Entrapment – Discussion: – cubital tunnel serves as major contraint for the ulnar nerve as it passes behind elbow; – the syndrome occurs most commonly between 30 to 60 years, and is exceptionally uncommon in children under 15 years; – inciting events: – symptoms may appear several years after trauma (hence tardy … Read more
– Discussion: – note carrying angle of the elbow (for cubitus valgus); – r/o subluxation: – palpate the nerve in the cubital tunnel and note its mobility; – it is essential to know whether ulnar nerve subluxation is present; – motor … Read more
– Discussion: – w/ flexion the cubital tunnel becomes taunt, and with extension the cubital tunnel becomes lax; – sharp freee margin of aponeurosis is stretched tightly over nerve during flexion; – volume of the cubital tunnel decreases, and extrinsic pressure increases during … Read more
– Discussion: – in the presence of H.O. the nerve should be placed in the subcutaneous position, since H.O. forms between muscle layers; – sub-muscular transposition (or subQ transposition) is also indicated to relieve tension following ulnar nerve repairs; – is often indicated in revision cubital tunnel surgery; … Read more
– See: Baumann’s Angle – Discussion: – cubitus varus is the most common complication following supracondylar frx, – orginally, etilogy of cubitus varus was thought to occur because of growth disturbance of distal humeral epiphysis; – this may be true but is uncommon; … Read more
– Discussion: – careful exam to identify crystals in synovial fluid can establish a dx early and avoid unnecessary hospital admissions for treatment of suspected infectious arthritis. – presence of crystals does not exclude infection, esp since abnormalities such as Gout may increase likelihood of septic arthritis; – cultures … Read more
– Discussion: – plain x-rays may fail to demonstrate dorsal angulation of proximal pole-lunate complex and the concomitant flexion of distal pole; – CT scan is indicated w/ any hint of foreshortening due to angulation is suspected; – scaphoid may be well visualized w/ 6-8 CT sections made along true longitudinal axis; … Read more