ABSTRACT
ABSTRACT Robert Wartenberg was a renowned 20th century neurologist who contributed greatly to our understanding of the neurological examination. This article aims to illustrate his legacy by highlighting five seminal neurological signs.
RESUMO Robert Wartenberg foi um renomado neurologista do século XX que contribuíu enormemente para o entendimento do exame neurológico. Este artigo tem como objetivo principal ilustrar seu legado, ressaltando cinco sinais neurológicos seminais.
Subject(s)
Humans , History, 20th Century , Neurologic Examination/history , Neurologic Examination/methods , Neurology/history , Palpation , Thumb/physiopathology , Vibration , Wrist/physiopathology , Accessory NerveABSTRACT
OBJECTIVE: To evaluate the prognostic value of absent thumb pain sensation in newborns and young infants with birth brachial plexopathy. METHODS: We evaluated 131 patients with birth brachial plexopathy with less than two months of age. Pain sensation was evoked by thumb nail bed compression to evaluate sensory fibers of the upper trunk (C6). The patients were followed-up monthly. Patients with less than antigravity elbow flexion at six months of age were considered to have a poor outcome. RESULTS: Thirty patients had absent thumb pain sensation, from which 26 showed a poor outcome. Sensitivity of the test was 65% and specificity was 96%. CONCLUSION: Evaluation of thumb pain sensation should be included in the clinical assessment of infants with birth brachial plexopathy.
OBJETIVO: Avaliar o valor prognóstico da hipoestesia dolorosa no polegar em recém-nascidos e lactentes jovens com plexopatia braquial obstétrica. MÉTODOS: Avaliamos 131 pacientes com plexopatia braquial obstétrica com menos de dois meses de idade. A sensação dolorosa foi provocada pela compressão do leito ungueal do polegar para avaliar fibras sensitivas do tronco superior (C6). Os pacientes foram seguidos mensalmente. Prognóstico desfavorável foi atribuído aos pacientes sem força antigravitacional para flexão do cotovelo aos seis meses de idade. RESULTADOS: Trinta pacientes apresentaram hipoestesia dolorosa do polegar, dos quais 26 tiveram prognóstico desfavorável. A sensibilidade do teste foi de 65% e a especificidade 96%. CONCLUSÃO: A avaliação da sensibilidade dolorosa do polegar deve ser incluída na avaliação clínica de pacientes com plexopatia braquial obstétrica.
Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Birth Injuries/physiopathology , Brachial Plexus Neuropathies/diagnosis , Brachial Plexus/injuries , Hypesthesia/diagnosis , Pain Threshold/physiology , Thumb/physiopathology , Birth Injuries/complications , Brachial Plexus Neuropathies/physiopathology , Brachial Plexus/physiopathology , Elbow Joint/physiology , Prognosis , Range of Motion, Articular , Sensitivity and SpecificityABSTRACT
Although extensor tendon rupture often occurs after volar plating for a distal radius fracture, a flexor tendon rupture is extremely rare. Most reported instances of flexor tendon ruptures after volar plating have involved improper placement of the plate, increased prominence of the distal edge of the plate because of collapse of the fracture site, use of custom-made plates, current steroid use by the patient, or a history of tendon injury. We report a case of delayed rupture of the flexor pollicis longus tendon 40 months after volar plating with a 3.5-mm T-locking compression plate for which the distal edge was located at the transverse ridge level of the distal radius. If symptoms such as tendon irritation occur in this situation, surgeons should consider removing the plate as soon as possible after bony union is achieved.
Subject(s)
Female , Humans , Middle Aged , Bone Plates , Fracture Fixation, Internal/methods , Radius Fractures/complications , Rupture , Tendon Injuries/etiology , Thumb/physiopathologyABSTRACT
Esta es una serie de 7 enfermos con 10 casos de osteoartritis de la articulación trapecio-metacarpiana del pulgar, 6 del sexo femenino, con edad promedio de 56 años. Se trataron mediante resección parcial o total del hueso trapecio y plastía por interposición del tendón transpuesto del palmar menor. Después de la cirugía el dolor despareció en el 70 por ciento de las manos; los arcos de movimiento se incrementaron en el 80 por ciento y el 20 por ciento restante permanecieron sin cambios. La fuerza de la prensión permaneció igualmente sin cambios. El resultado se consideró excelente en 7 manos y buenos en 3
Subject(s)
Humans , Male , Female , Middle Aged , Osteoarthritis/therapy , Thumb/surgery , Thumb/physiopathology , ArthroplastyABSTRACT
For correction of instability of the carpometacarpal joint (CMC joint) of the thumb in combined paralysis of ulnar and median nerves in leprosy bone fusing procedures have been used, but they are not desirable and can often be avoided. A procedure analogous to the "Extensor pollicis brevis deviation graft operation" for the correction of instability of the metacarpophalangeal joint of the thumb is described here. The new procedure appears to be useful to correct and stabilize the subluxated carpometacarpal joint of the thumb actively during the use of the hand. When thumb web contracture has occurred and the passive range of movement needed for successful opponents replacement of thumb is not available, this new procedure helps to prepare such a severe deformed thumb for correction at earlier time.
Subject(s)
Adolescent , Adult , Joint Dislocations/surgery , Female , Hand Deformities, Acquired/etiology , Humans , Joint Instability/etiology , Leprosy/complications , Male , Median Nerve/physiopathology , Middle Aged , Tendon Transfer/methods , Thumb/physiopathology , Ulnar Nerve/physiopathology , Wrist Joint/physiopathologyABSTRACT
Paciente masculino de 36 años con un carcinoma espinocelular en el lecho ungueal del pulgar izquierdo de 8 meses de evolución, tratado quirúrgicamente con amputación parcial y cierre primario del muñón
Subject(s)
Adult , Humans , Male , Carcinoma/diagnosis , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Thumb/physiopathology , Thumb/surgeryABSTRACT
Los procesos degenerativos de la articulación basal del pulgar ocasionan problemas funcionales en un gran número de personas. Se presenta una revisión de 14 pacientes con 15 pulgares operados en que se realizó artroplastia de interposición con fascia para tratar la panartrisis del trapecio. Los resultados fueron calificados con base en la fuerza, estabilidad, movilidad y dolor en el pulgar. De los 15 pulgares, 12 tuvieron un resultado excelente y tres, bueno. La artroplastia fascial es una alternativa de tratamiento para estos pacientes, ya que se logra un pulgar estable, fuerte e indoloro, sin los inconvenientes de las artroplastias sintéticas.
Subject(s)
Humans , Male , Female , Middle Aged , Arthroplasty , Arthroplasty/rehabilitation , Thumb/surgery , Thumb/physiopathology , Metacarpophalangeal Joint/surgery , Metacarpophalangeal Joint/physiopathology , Osteoarthritis/surgery , Osteoarthritis/physiopathology , Surgical Procedures, Operative , Surgical Procedures, Operative/rehabilitation , Hand Deformities, Acquired/surgery , Hand Deformities, Acquired/rehabilitation , Bone Transplantation , Bone Transplantation/rehabilitationABSTRACT
A partir de un planteo biomecanico como es el de postular la existencia de cuplas musculares estabilizadores de la articulacion trapecio-metacarpiana, proponemos un proceso fisiopatologico de desequilibrio para la subluxacion y artrosis adducta del pulgar. La revision de la bibliografia sobre el tema que se comenta en la introduccion de este trabajo nos enseña acerca de la complejidad que la profundizacion depara a aquellos que se han preocupado por aumentar su conocimiento. Revisamos 42 casos operados con diversas tecnicas, haciendo hincapie en la necesidad de retrotraer los elementos estabilizadores activos a la situacion de equilibrio para la obtencion de resultados cercanos a la situacion normal. Realizamos el comentario del uso de una u otra tecnica y analizamos pros y contras de cada una de ellas. Los factores de exitos y fracasos en su utilizacion y las posibles mejoras tecnicas que sugerimos. Insistimos en la necesidad de tratar la patologia de todas las articulaciones involucradas en el proceso: trapecio-trapezoideo-bimetacarpiana y metacarpo-falangica. Aportamos finalmente los elementos que nos parecen importantes para la correcta formulacion de planteos terapeuticos y tacticas operatorias