Hand elevation test for assessment of carpal tunnel syndrome.

The Hand Elevation test is a new provocative test for the diagnosis of carpal tunnel syndrome. We have investigated the sensitivity and specificity of this test in 48 patients with a clinical diagnosis of carpal tunnel syndrome and compared it to Tinel's and Phalen's tests. The Hand Elevation test was found to be 88% sensitive and 98% specific. This test is a simple, reproducible provocative test which is easily employed in conjunction with other known tests to assist in the diagnosis of carpal tunnel syndrome.

Radial nerve entrapment by the lateral intermuscular septum after trauma.

Radial nerve palsy is associated with humeral shaft fractures, usually occurring at the time of injury but sometimes occurring later. We report on a case in which a progressive radial nerve palsy occurred three months after a fracture; on exploration, the nerve was found to be trapped by the lateral intermuscular septum. It is important to recognize progressive radial nerve palsies or late presentations, because they often represent chronic compression and a delay in exploration may be detrimental to the return of nerve function.

Intracapsular chondroma of the elbow producing a posterior interosseous nerve palsy.

We present a case report of a patient who presented with posterior interosseous nerve paralysis caused by an intracapsular chondroma arising within the elbow joint. We review the literature and discuss problems associated with making the diagnosis preoperatively.

Candida infection of a silicone metacarpophalangeal arthroplasty.

Fungal infections following joint arthroplasty are extremely rare. Only 16 cases of Candida prosthetic infections have been reported, involving the hip, knee or shoulder joints. We report a case of a silicone metacarpophalangeal joint replacement complicated by a Candida albicans infection.

Poor results of Darrach's procedure after wrist injuries.

Darrach's procedure was performed for post-traumatic symptoms in the inferior radio-ulnar joint in 36 patients, who were reviewed after a mean follow-up of 6 years. Only 18 of the patients had a satisfactory clinical result. Poor outcome was associated with osteoarthritis of the wrist, the occurrence of algodystrophy and a short ulnar remnant.

Cervical myelography of nerve root avulsion injuries using water-soluble contrast media.

Eight cases of cervical nerve root avulsion injury are presented which were investigated by cervical myelography using a water-soluble contrast medium. The previous literature describes the appearances of this lesion using an oil-based agent and has resulted in emphasis being placed on looking for a traumatic meningocele rather than an abnormality of the roots themselves. The excellent definition of the nerve rootlets and axillary pouch that are obtained with a water-soluble contrast medium resulted in more root lesions per patient being detected than with an oil-based medium. There was complete correlation with the surgical findings at all but one root level explored. The appearances of root avulsion injuries and the advantages of using a water-soluble contrast medium are discussed.

Female victims of assault. A study of hospital attenders.

During the first six months of 1986, 294 consecutive victims of assault were examined to determine the patterns of injury. Forty-three victims were women aged 15-46 years (mean: 25 years). In comparison with the hospital catchment population, the unemployed were over-represented and the greater than 40 age range under-represented. Facial injury, especially bruising, was extremely common, affecting 88% of women and 84% of men. Some 56% of women had sustained a fracture compared to only 26% of men but facial lacerations were uncommon in female victims. Assailants were known to 75% of female victims, but only 25% of men, and females were four times more likely to be assaulted at home. 33% of women reported previous assault in comparison with 44% of men. Oral and maxillofacial staff should understand the likely social implications and be able to organise management of assault victims of which women form an important subgroup. Management may involve social workers and psychiatrists as well as other members of the family.

Assault: characteristics of victims attending an inner-city hospital.

To characterize victims of assault attending a district general hospital, 294 consecutive patients were interviewed and examined. The group included 249 men (median age 23 years, range 13-62 years) and 45 women (median age 23 years, range 15-46 years). The 15-30 years age group, single males, and the unemployed were over-represented (P = less than 0.001). Fewer than expected were professionals or aged 10-15 years or over 50 years. The ethnic background was not significantly different from the Bristol population. Facial injury was extremely common; 89 per cent of fractures, 70 per cent of wounds and 56 per cent of haematomas affected the face. Only 32 per cent of patients were assaulted within their home ward (13 per cent at home) and most assaults took place in the city centre on Fridays and Saturdays, between 11 p.m. and 1 a.m. and in or near public houses and clubs or in the street. Only 29 per cent of assaults were claimed to be unprovoked. Alcohol intake immediately preceding injury was reported by 73 per cent of victims (range 1-34 units) and blood ethanol levels corresponded with this intake. Victims reported police involvement in 54 per cent of cases, but police lists of 'woundings' included only 23 per cent of patients assaulted in central Bristol. Admission of victims was 17 per cent.

Orthopaedic undergraduate assessment.

The multiple choice, viva voce and consultant marks from 327 students in the Orthopaedic Undergraduate Course at the University of Bristol were compared. The assessments were based on 84 questions in the multiple choice questionnaire, 30 questions in the viva voce and four questions in the consultant assessment. The consultant assessment correlated least well with the other two marks. It is suggested that in short courses consultant grades be supplemented by objective examinations.

A prospective study of deep vein thrombosis of the leg in children on halo-femoral traction.

This prospective study was performed to determine the true incidence of deep vein thrombosis of the lower limb in children who had undergone halo-femoral traction to correct scoliosis before operation. Bilateral ascending phlebography of the lower limbs was performed on 54 children two days before spinal fusion and Harrington rod instrumentation. Two patients developed clinical evidence of thrombosis whilst on traction. This diagnosis was confirmed by phlebography. The other 52 children had no clinical evidence of thrombosis and their venograms were normal. The incidence of thrombosis was 3.7 per cent and clinically silent thrombosis did not occur.

The fractured carpal scaphoid. Natural history and factors influencing outcome.

The scaphoid fracture is commonest in young men in the age group 15 to 29 years, who have the highest incidence of non-union, take the longest time to unite, lose more time from work, and spend the longest time as outpatients. A union rate of 95 per cent can be achieved using standard simple treatment. All but a few fractures are visible on the first radiograph, and failure of visualisation at this stage is not associated with a bad outcome. The postero-anterior and semipronated views are the most important to scrutinise. Crank-handle injuries have a particularly bad prognosis when they produce a transverse fracture of the waist of the scaphoid. Poor prognostic factors are displacement during treatment, the fracture line becoming increasingly more obvious, and the presence of early cystic change. The severity of trauma is an important factor to elicit from the history.