Degenerative Arthrosis Research Articles

Tumors and diseases of the joint

A variety of different diseases affect the synovium, including infection, noninfectious immunologic inflammatory conditions, degenerative arthroses, crystal deposits, trauma, and tumors. Tumors of the synovium are relatively uncommon. Any mesenchymal tumor may arise in the synovium, but most recapitulate its normal counterpart including synoviocytes, blood vessels, fat, and fibrous tissue. These tumors can arise in any synovial lined structures both within joints and in extraarticular locations. Most synovial tumors are benign. Malignant tumors are rare but important to recognize because many are aggressive and must be treated appropriately. Among common nonneoplastic conditions that affect the synovium and surrounding structures are crystal deposits such as monosodium urate crystals, calcium pyrophosphate dihydrate crystals, and hydroxyapatite crystals. These crystal deposits may be asymptomatic or cause severe pain or chronic joint destruction. Their accurate identification is important to guide appropriate therapy.

Latent Pisotriquetral Arthrosis Unmasked Following Carpal Tunnel Release

The causes of persistent wrist pain following carpal tunnel release include scar tenderness and pillar pain. The goal of this study was to evaluate latent pisotriquetral arthrosis as a source of ulnar-sided wrist pain following open carpal tunnel release. Seven hundred consecutive carpal tunnel releases were reviewed, looking for postoperative presentation of pisotriquetral arthrosis, as well as management and outcome. Fourteen patients with long-standing postoperative pain at the base of the hypothenar eminence had clinical and radiographic signs of pisotriquetral degenerative arthrosis, which conceivably had existed preoperatively and been unmasked thereafter. In 6 patients with persistent symptoms despite conservative measures, excision of pisiform was curative. Altered isometric stresses over the pisotriquetral articulation as a result of releasing the transverse ligament, which constitutes a major radial static stabilizer of this joint, seems to cause articular maltracking, and consequently aggravates a preexisting asymptomatic pisotriquetral arthrosis. Long-standing discomfort is characteristically associated with loss of grip strength and dexterity. Pisotriquetral dysfunction and arthrosis should always be considered in the differential diagnosis of persistent wrist pain following either open or endoscopic carpal tunnel release that does not respond to nonoperative measures. Clinical scrutiny, adequate clinical inspection, and radiographic evaluation readily establish the diagnosis. Conservative treatment includes immobilization, nonsteroidal anti-inflammatory drugs, and intra-articular injection of corticosteroids under fluoroscopic control. The corticosteroid injection combined with a local anesthetic also serves as a diagnostic test. Excision of the pisiform is indicated where conservative treatment has failed.

Tratamiento con acupuntura y moxibustión del síndrome poslaminectomía. Caso clínico

Failed back surgery syndrome is a common post-surgical complication which leads to chronic low back pain with great clinical and financial repercussions. The treatment possibilities include a great variety of techniques and drugs, despite this being one of the main causes of a very difficult to treat lumbar pain. There is increasing solid evidence that acupuncture may be a useful complement to conventional treatment for treating low back pain. A case is presented of a 37 year-old patient surgically intervened 2 years ago for L4-L5 arthrodesis, with subsequent intervention 1 year ago to remove the osteosynthesis material. There was a persistent uncontrolled post-laminectomy syndrome with a dysesthetic scar despite treatment with weak opiates and anticonvulsants, which was treated adequately with sessions of acupuncture and moxibustion. A magnetic resonance imaging scan was performed as a complementary test, in which post-surgical changes could also be seen in the posterior lumbar region, disc dehydration in L5-S1, and degenerative arthrosis of the small interapophyseal lumbar joints. An electro-neurophysiological study showed a change in the somesthetic evoked potentials performed in the left lateral femoral-cutaneous nerve, compatible with an axonal neuropathy of that nerve. Treatment was given in 10 sessions over 5 weeks, in with a biphasic treatment of 40 min being performed in each of them. The scar area was treated first and then the low back pain, moxibustion was performed on both with Artemis smoke and a pecking technique. The pain was controlled, going from a initial VAS score of 8 to 0 at the end of treatment. At the follow-up review at 6 months it was still 0 on the VAS scale.

What Proportion of Patients Need Extensive Surgery After Failure of the Ponseti Technique for Clubfoot?

In 1948, Professor Ignacio Ponseti began a nonoperative management form of treatment for severe talipes equinovarus. This method of manipulative treatment became attractive because long-term outcomes demonstrated the majority of feet were pain-free, plantigrade, and functioning at a high level of activity without evidence of degenerative arthrosis. We retrospectively reviewed the charts of 51 children (31 boys and 20 girls; 72 feet) with idiopathic clubfeet deformity treated with the Ponseti method from January 5, 2002, to January 5, 2007. The median age at treatment was 2 weeks (95% confidence limit, 1-2 weeks); there was no difference in age at presentation between boys and girls. The minimum followup was 4 months (mean, 19.8 months; range, 4-48 months). A total of 288 casts were applied (mean, 5.5; standard deviation, 0.92). Successful treatment was defined as a plantigrade foot with a normal hindfoot, midfoot, and forefoot on clinical examination. Correction was achieved and maintained in 90% (65 of 72) of the feet; 10% (seven of 72) of the treated feet did not improve and needed subsequent surgery. There was no difference in the proportion of children who had tenotomy or previous treatment among those who presented with residual deformity or recurrence or had surgery. However, patients who tolerated bracing had lower recurrence rates and underwent less surgery. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Anatomic variations in a cleft hand of an elder cadaveric specimen

Cleft hand is a rare and complex malformation in which the central part of the hand is missing. Since the nineteenth century, a very small number of dissections in cleft hand have been reported and very few reports describe the soft-tissue abnormalities. We report a case of an elderly cadaveric specimen with bilateral cleft hand. X-ray, CT-scan with 3D reconstruction and dissection were performed on the right hand and forearm. On both the sides, we noted the absence of the index, middle and ring finger. Malformation and degenerative arthrosis at the carpal bones level have been identified. The flexor and extensor tendons of the absent fingers fuse with one another over the end of the remaining carpal bones, forming a radial and an ulnar tendinous plexus and two tendon loops. Data concerning intrinsic muscles, vessels and nerves are entirely recorded. Soft-tissue abnormal distribution is due to the abnormal bony configuration. Correction of the bone abnormalities does not resume the surgical treatment of a cleft hand. Hand surgeons need to be aware of the soft-tissue disorders and their surgical implications.

Technique and Outcomes of Opening Wedge High Tibial Osteotomy

High tibial osteotomy (HTO) is a surgical procedure that involves cutting the proximal tibia in an attempt to change the weight bearing axis from the medial to the lateral compartment of the knee. It is particularly suited to young and middle age active patients, who have a primary degenerative arthrosis involving the medial compartment in a malaligned limb causing pain and functional limitation. HTO has been often presented as a possible alternative to prosthetic joint replacement. However the indications depend on the stage of the degenerative cartilage changes and on the patient's profile and typically differ from the indications for uni or total knee replacement. Over the last 10 years the indication for a HTO have expanded to include patients with cartilage damage that can be treated with one of the new cartilage repair techniques and patients with chronic ligament deficiency associated with varus malalignment. The opening wedge HTO is a relatively new technique and it will be illustrated here in a step by step approach. This technique differs from Coventry's lateral closing wedge osteotomy by obtaining the correction of the varus deformity by adding a wedge medially. It is based on a special dedicated system of instruments and plates (Arthrex, Naples, FL).

A Prospective Outcomes Study of Four-Corner Wrist Arthrodesis Using a Circular Limited Wrist Fusion Plate for Stage II Scapholunate Advanced Collapse Wrist Deformity

Scapholunate advanced collapse wrist deformity is a common pattern of degenerative arthrosis of the wrist. This study prospectively evaluated a series of patients who underwent four-corner fusion using a circular plate internal fixation technique. Patients with symptomatic stage II scapholunate advanced collapse wrist deformity were treated with scaphoid excision and four-corner fusion using the Spider Limited Wrist Fusion Plate (KMI, San Diego, Calif.). Patients were prospectively evaluated at 6 months and 1 year using a standard study protocol with radiographs, functional tests, and an outcomes questionnaire. Outcomes were compared with those of historical series from the literature. Eleven patients were enrolled and 10 patients completed their 1-year follow-up. Grip strength, lateral pinch strength, and Jebsen-Taylor test scores at 1 year were not significantly different from preoperative values. Mean active range of motion was 87 degrees preoperatively and 74 degrees at 1-year follow-up (p = 0.19). The Michigan Hand Outcomes Questionnaire showed no significant improvement in function, activities of daily living, work, pain, or patient satisfaction. The mean pain scores decreased from 54 preoperatively to 42 1-year postoperatively (p = 0.30), indicating persistent wrist discomfort. Three patients had broken screws: one was asymptomatic, one required 3 months of strict wrist immobilization, and one was reoperated for symptomatic nonunion. Four-corner fusion using the first-generation Spider plate technique has the advantage of earlier mobility and more patient comfort from absence of protruding Kirschner wires; however, patients continued to have disabling pain, functional limitations, work impairment, and low satisfaction scores postoperatively. Although limited by a small patient sample, this series presents outcomes data that may be useful in counseling patients who are contemplating four-corner fusion using this internal fixation device. Further investigation is necessary to evaluate the biomechanical properties of the Spider plate. The data suggest that better implants should be designed to avoid implant failure, which occurred in three of the 11 patients in this series.

Why lateral meniscectomy is more dangerous than medial meniscectomy. A finite element study

Total meniscectomies are commonly thought to cause progressive degenerative arthrosis pathology in articular cartilage in a period of a few years because of alteration of the biomechanical environment including increased joint instability. This concern has lead to a preference for partial meniscectomies, although lateral partial meniscectomies sometimes lead to catastrophic results. We performed a three-dimensional finite element model of the human tibiofemoral joint to examine the effect of lateral meniscectomy on knee biomechanics. The results were compared to those from modeling a medial meniscectomy. Under axial femoral compressive loads, the peak contact stress and maximum shear stress in the articular cartilage increased 200% more after a lateral than a medial meniscectomy. These increased stresses could partly explain the higher cartilage degeneration observed after a lateral meniscectomy.

Funktionelle Ergebnisse nach Entfernung der proximalen Handwurzelreihe bei SNAC- und SLAC-Wrist Stadium II

The proximal row carpectomy (PRC) is a motion preserving procedure which creates a new joint without arthrosis. It is a frequently used procedure in stage II of a posttraumatic degenerative arthrosis of the wrist after scaphoid nonunion or scapholunate ligament instability (SNAC-/SLAC-wrist). In this retrospective analysis the functional postoperative results of this operation are compared in light of a homogenous indication (SNAC-/SLAC-wrist stage II). In 38 patients PRC was performed for a stage II SNAC- (n = 29) or SLAC-wrist (n = 9) between June 1994 and March 2002. Postoperative examination included range of motion and grip strength. Pain was assessed using a visual analogue scale (VAS 0 - 100). The DASH questionnaire (disability of the arm, shoulder and hand) was used to evaluate the disabilities in activities of daily living (ADL). Thirty patients (79 %) with a mean age of 39 years (23 - 59) were evaluated with a mean follow-up of 27 months (6 - 100). Mean extension and flexion of the wrist reached 75 degree which was 57 % of the contralateral hand. Mean radial and ulnar deviation was 33 degree corresponding with 52 % of the contralateral hand. The average grip strength was 50 % of the unaffected side. The postoperative DASH score was 27.4. Pain with strenuous activity was reduced by 40 %, resting pain by 77 %. Three patients showed radiological signs of a radiocapitate arthrosis, one patient needed conversion into a complete wrist arthrodesis. Our results are in concordance with the literature. However, our follow-up time is relatively short and we cannot make any conclusion about the long-term outcome. PRC is a technically straightforward procedure for treatment of carpal collapse. For stage II of the SNAC-/SLAC-wrist we consider the resection of the proximal carpal row an alternative procedure to the midcarpal arthrodesis particularly in patients who require less grip strength and when a shorter postoperative immobilization is reasonable.

"Hallux rigidus"--a global problem?

The diagnosis "hallux rigidus" is used for limitation of great toe motion, which is particularly painful at push-off during gait. The underlying condition is often degenerative arthrosis of the first metatarsophalangeal joint. Radiographs show no abnormality initially, later degeneration sets in at the dorsal aspect of the joint. Conservative treatment mainly consists of local anti-inflammatory applications and orthopaedic appliances to decrease load at the metatarsophalangeal joint. With progression of the arthrosis, joint preserving procedures such as cheilectomy are used. With this technique, the degenerated dorsal part of the first metatarsal head is resected. In complete destruction of the joint space, arthrodesis is the technique of choice in the mostly active, younger patients. Resection arthroplasty is a simple technique which is used in elderly, less active patients. The results of first metatarsophalangeal joint replacement are inferior to arthrodesis.

Artropatía ocronótica: utilidad diagnóstica de la gammagrafía ósea en la alcaptonuria

We report the case of a 62 year old man diagnosed of alkaptonuria who was referred to our department to undergo bone scintigraphy for polyarthralgia. The patient had a history of pain in lumbar and thoracic spine, right shoulder and left knee. Bone scintigraphy showed multiple joint disease with increased uptake in both shoulders, knees and spine. Higher uptake stood out in painful right shoulder and left knee joints. Ochronotic arthropathy that is developed in alkaptonuric patients is a degenerative joint disease. X-ray studies in this patient showed marked degenerative arthrosis in knees and shoulders, without more intense involvement in the symptomatic joints. Lumbar spine X-rays showed intervertebral disk calcification with disk collapse and fusion of the vertebral bodies with relative sparing of sacroiliac joint, which is a classic feature of ochronotic arthropathy.This case highlights the utility of bone scintigraphy in the evaluation of joint involvement as well as its correlation with clinical course and potential usefulness in the follow-up of this disease.

Current concepts in meniscus surgery: resection to replacement

More recently, increasing attention has been turned toward the preservation and restoration of the medial and lateral menisci of the knee. The literature is replete with studies that cite the important biomechanical roles that the menisci play in shock absorption and load distribution across the knee in addition to contributing to stability, joint congruence, articular cartilage nutrition, lubrication, and proprioception. 1 Kettlekamp D. Jacobs A. Tibiofemoral contact area Determination and implications. J Bone Joint Surg Am. 1972; 54: 349-356 PubMed Google Scholar , 2 Walker P. Erkman M. The role of the menisci in force transmission across the knee. Clin Orthop. 1975; 109: 184-192 Crossref PubMed Scopus (814) Google Scholar , 3 Levy M. Torzilli P. Warren R. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am. 1982; 64: 883-888 PubMed Google Scholar , 4 Radin E. de Lamotte F. Maquet P. The role of the menisci in the distribution of stress in the knee. Clin Orthop. 1984; 185: 290-294 PubMed Google Scholar , 5 Shoemaker S. Markolf K. The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate deficient knee Effects of partial versus total excision. J Bone Joint Surg Am. 1986; 68: 71-79 PubMed Google Scholar , 6 Beaupre A. Choukroun R. Guidouin R. Knee menisci Correlation between microstructure and biomechanics. Clin Orthop. 1986; 208: 72-75 PubMed Google Scholar , 7 Baratz M. Fu F. Mengato R. Meniscal tears The effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med. 1986; 14: 270-275 Crossref PubMed Scopus (647) Google Scholar Published data supports that meniscal attrition after subtotal meniscectomy could be associated with degenerative processes in adjacent articular cartilage surfaces. 7 Baratz M. Fu F. Mengato R. Meniscal tears The effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med. 1986; 14: 270-275 Crossref PubMed Scopus (647) Google Scholar , 8 Johnson R. Kettelkamp D. Clark W. Factors effecting late results after meniscectomy. J Bone Joint Surg Am. 1974; 56: 719-729 PubMed Google Scholar , 9 Jorgensen U. Holm S. Lauridsen F. Long term follow-up of meniscectomy in athletes A prospective longitudinal study. J Bone Joint Surg Br. 1987; 69: 80-83 PubMed Google Scholar , 10 Bolano L. Grana W. Isolated arthroscopic partial meniscectomy. Functional radiographic evaluation at five years. Am J Sports Med. 1993; 21: 432-437 Crossref PubMed Scopus (152) Google Scholar , 11 Osti L. Liu S. Raskin A. Merlo F. Bocchi L. Partial lateral meniscectomy in athletes. Arthroscopy. 1994; 10: 424-430 Abstract Full Text PDF PubMed Scopus (50) Google Scholar , 12 Hede A. Larsen E. Sandberg H. Partial versus total meniscectomy. J Bone Joint Surg Br. 1992; 74: 118-121 PubMed Google Scholar , 13 Anderson-Molina H. Karlsson H. Rockborn P. Arthroscopic partial and total meniscectomy Long-term follow-up study with matched controls. Arthroscopy. 2002; 18: 183-189 Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar , 14 Schimmer R. Brulhart K. Duff C. Glinz W. Arthroscopic partial meniscectomy A 12-year follow-up and two-step evaluation of the long-term course. Arthroscopy. 1998; 14: 136-142 Abstract Full Text PDF PubMed Scopus (118) Google Scholar Despite this body of work, arthroscopic meniscectomy remains one of the most commonly performed orthopaedic procedures. The development of an increasingly more sophisticated and scientific understanding and approach to knee problems and, in particular, the natural history of the meniscectomized knee has raised concern for the risk of late degenerative arthrosis. Multiple other factors have continued to heighten interest in meniscal surgery, including the trend in our society for all age groups to place greater emphasis on fitness and remaining active. This has raised the demand for normalizing knee function, not only after injury, but also at extended follow up. Patients, the media, and clinicians alike all focus more attention on the treatment as well as the prevention of osteoarthritis. Furthermore, as more advanced technical capability has evolved as far as knee surgery is concerned, there is an increasing tendency to carry out more comprehensive arthroscopic and reconstructive surgical methods. Expanding surgical indications and demand now exists for anterior cruciate ligament (ACL) reconstruction, articular cartilage biologic resurfacing, and correction of axial malalignment as well as meniscal preservation or replacement surgery. Interest in the meniscus continues to remain in the forefront of basic scientific work, clinical study, and novel technology development. The purpose of this publication is to review the current and potential future approaches to meniscal pathology, including decision-making and indications for meniscal resection versus repair, and to report on several of newest devices and methods for repairing meniscal tears and replacing and transplanting meniscal tissue.

Proximal row carpectomy in carpal collapse

Proximal row carpectomy (PRC) is a generally accepted procedure in the treatment of an advanced radiocarpal arthrosis. The aim of this retrospective study was the evaluation of individual, functional and radiological results after proximal row carpectomy. Seventeen patients (15 male, two female) who had undergone proximal row carpectomy between 1991 and 1999, were reviewed. The most common indication was degenerative arthrosis secondary to carpal collapse associated with chronic scaphoid nonunion (SNAC), scapholunate advanced collapse (SLAC) deformity, late Kienböck's disease or perilunate dislocations. Clinical and subjective results were assessed using different scores (DASH-, modified Mayo wrist-score) and evaluating the individual wrist range of motion. Anteroposterior and lateral X-rays were obtained for radiological analysis. At follow-up evaluation (mean 65.4 months), the majority of patients reported pain relief and a significant increased range of motion for the operated wrist. Radiographical analysis showed degenerative changes at the radiocapitate articulation in ten patients. The intermediate-term results of this review would suggest that proximal row carpectomy is an effective procedure providing pain relief and a satisfactory range of motion in a variety of pathologic wrist disorders. Because of eventual radiocapitate arthrosis, we suggest PRC only in patients without significant degenerative changes at the proximal pole of the capitate or the lunate fossa.

MR arthrography of postoperative knee: for which patients is it useful?

To assess which postoperative patients benefit most from MR arthrography of the knee. One hundred consecutive MR arthrograms obtained in patients who had previous knee surgery underwent retrospective review in consensus by three radiologists after prospective reading by one of the three radiologists. Criterion on MR arthrograms for a retear was abnormal tracking of an intraarticular dilute gadolinium-based contrast material and saline mixture into the substance of a meniscus. Patients were separated into three groups: those with more than 25% meniscal resection, those with less than 25% meniscal resection, and those with meniscal repair. All 100 patients had preoperative MR images to review directly in conjunction with the postoperative MR images. Fifty-seven of these 100 patients underwent second-look arthroscopy. Nine patients had MR findings consistent with avascular necrosis. Nineteen patients had marked degenerative arthrosis in the area of previous surgery. Seven patients had chondral defects or injuries. Twenty-nine patients had clear MR evidence of a meniscal retear without any contrast material injected into the joint. In 32 of the 100 patients, intraarticular contrast material was useful in demonstrating a retear. Of these 32 patients, 22 had MR arthrographic evidence of a retear, while 10 had no clear MR arthrographic finding to explain postoperative pain. Four additional patients had no clear MR imaging or MR arthrographic abnormality. All patients with meniscal repair (n = 16) needed MR arthrography to diagnose a residual or recurrent meniscal tear. No patient with less than 25% meniscal resection (n = 23) needed MR arthrography to demonstrate a residual or recurrent meniscal tear. Sixteen of 61 patients with more than 25% meniscal resection needed MR arthrography to demonstrate a residual or recurrent meniscal tear. All patients with meniscal repair required MR arthrography. All patients with meniscal resection of more than 25%, who did not have severe degenerative arthrosis, chondral injuries, or avascular necrosis required MR arthrography. Patients with less than 25% meniscal resection did not need MR arthrography.

The Short-Term Efficacy of Hyaluronic Acid Injections for the Treatment of Degenerative Arthrosis of the Shoulder (SS-15)

The Short-Term Efficacy of Hyaluronic Acid Injections for the Treatment of Degenerative Arthrosis of the Shoulder (SS-15)

Biomechanics of the Spine

Biomechanics of the spine is a vast area of research that has generated numerous studiesin recent years on the part of doctors (mainly orthopaedic surgeons), bioengineers and physicists. This paper is a short introduction to some of the topics of major interest in spine biomechanics. The first topic is the development of the spine with a “mechanical” explanation of the physiological curvatures. As the spine is a multiarticular complex structure, understanding the mechanism responsible for its dynamics requires in-depth knowledge of the spine's basic components: the vertebrae and their architecture, the intervertebral joints, the ligaments and muscles. A short morphofunctional description of each of these anatomical parts is given mentioning their biomechanical features. Of particular interest, in relation to spinal trauma, is the architecture of the cancellous bone of the vertebrae responsible for most resistance to compressive weight loads. This specific characteristic is gradually lost over the years either due to disease or to a progressive resorption of the horizontal lamellae and thinning of the vertical columns typical of osteoporosis. Numerous studies have been conducted in vivo and in vitro to shed light on the mechanisms leading to particular traumatic lesions or degenerative arthrosis. These have given rise to various theories formulated to account for the distribution of loads and strength in the elements making up the functional spinal unit. These theories include the old “two vertical columns” theory, subsequently replaced by the “three columns theory”, and the latest “four columns” model which divides the spine longitudinally depending on carrying strength. The latest theory was formulated in the wake of in vivo CT studies using an axial loading device which allows axial loads to be applied even though patients are in a supine position. A short mention is made of the possible biomechanical applications of neuroradiological techniques, namely cine-MR scans, which allow detailed study of the ligaments, muscles and disc, especially the cervical spine under dynamic conditions. Lastly, the controversial concept of spinal stability and instability is discussed. Further studies are necessary to establish appropriate criteria for treatment of traumatic or degenerative lesions since an impairment to spine statics can result in permanent neurological damage.

Aktuelles Therapiekonzept zur Behandlung des fortgeschrittenen karpalen Kollapses nach Skaphoidpseudarthrose (SNAC-Wrist)

Veraltete Kahnbeinpseudarthrosen führen langfristig zu einem karpalen Kollaps (SNAC-Wrist [Scaphoid Nonunion Advanced Collapse] bzw. zur Handgelenksarthrose. Die Arthrose wird entsprechend der Ausdehnung im Handgelenk in 3 Stadien unterteilt (SNAC-Wrist I-III), für welche stadiengerechte operative Verfahren zur Verfügung stehen. Eine Rekonstruktion des Skaphoids ist nur im Stadium I sinnvoll, im Stadium II haben sich die bewegungserhaltenden Verfahren der mediokarpalen Teilarthrodese und der Entfernung der proximalen Handwurzelreihe (PRC) etabliert, während im Stadium III die mediokarpale Teilarthrodese allein das Standardverfahren darstellt. Eigene Erfahrungen zeigen gleichermaßen zufrieden stellende Ergebnisse nach mediokarpaler Teilarthrodese oder Entfernung der proximalen Handwurzelreihe in der Behandlung des karpalen Kollapses. Bei beiden Verfahren kann postoperativ eine Beweglichkeit von ca. 60 % im Vergleich zur Gegenseite erreicht werden. Die Grobkraft liegt nach mediokarpaler Teilarthrodese bei etwa 65 % der Gegenseite, nach PRC bei ca. 50 %. Die Schmerzreduktion liegt bei beiden Verfahren bei etwa 50 % im Vergleich zur präoperativen Situation. Aufgrund der guten Resultate sollten bewegungserhaltende Operationen immer den Vorzug gegenüber einer Handgelenksversteifung beim SNAC-Wrist erhalten.

Upper-extremity Problems in Musicians Related to Age

This is a review of 140 musicians referred to a specialist hand therapy department in London, England. Musicians are referred from different sources and represent a fair cross-section. The musicians were analyzed in three different age groups: under 25 years of age, 25–40 years of age, and over 40 years of age; and by three different pathological groups: “trauma,” “degenerative,” and “non-specific arm and hand pain.” The results highlight three points: 1) Musicians of all ages are injured in coincidental accidents (“trauma”). 2) As musicians age, they are more likely to develop “degenerative” upper limb conditions such as Dupuytren’s contracture, nerve compression syndromes, or degenerative arthrosis in critical joints. 3) Non-specific arm and hand pain is overwhelmingly prevalent in young musicians and music students but is much less prevalent in the older age groups. This last point is the most worrisome statistic and perhaps the most preventable.

Operative Management of Patellofemoral Pain With Degenerative Arthrosis

Operative Management of Patellofemoral Pain With Degenerative Arthrosis

Complete superficial replacement of the middle finger joint--long-term outcome and surgical technique

Pain, weakness, malalignment and limited range of motion (ROM) at the PIP joint following arthrosis (degenerative or post-traumatic) or rheumatoid arthritis frequently require surgical treatment. PIP joint fusion or implantation of a prosthetic device are options. The purpose of this study was to report our long-term results with a surface replacement PIP arthroplasty (SR PIP arthroplasty) and the description of our operative technique. 82 prostheses were done in 60 patients between 1980 and 1999. All patients were reexamined, the average follow up was 64 months (12 to 260 months); average age was 57 years. 48 patients were operated on the right hand, 12 on the left hand. 44 patients were female, 16 were male. All patients complained of pain preoperatively. Patients were divided into three groups: A degenerative arthrosis, B posttraumatic arthrosis and C inflammatory arthritis. Active range of motion of all fingers of the operated hand, grip-strength, pain relief, joint stability or deformity and comprehensive radiographic assessment were studied. The subjective impressions of the patients were measured in four grades: very satisfied--satisfied--dissatisfied--very dissatisfied. Finally the investigators divided the overall results in: good--fair--poor. The average flexion arc was 31 degrees (maximum 15 degrees hyperextension to 95 degrees flexion) preoperatively and 47 degrees (maximum 14 degrees hyperextension to 90 degrees flexion) postoperatively. Over 70% of the patients had complete pain relief. In 12 fingers secondary procedures were necessary, usually related to soft tissue deformity and extensor tendon function. No arthrodesis was performed as a following operation. In 40 fingers a good result was achieved (49%), 25 had a fair (30%) and 17 (21%) a poor result. Our results of resurfacing PIP arthroplasty are encouraging and provide equal and usually improved motion in comparison with other joints. With experience and refinements of the operative technique our confidence in surface replacement arthroplasty has increased. For this reason we prefer this procedure for posttraumatic or degenerative arthrosis as against PIP joint fusion or silastic implants.