The plantaris tendon graft: an ultrasound study.

To assess the value of ultrasound in imaging the plantaris tendon, ultrasounds were done on 26 legs in 25 patients who had a variety of surgical procedures on the posterior leg. Eighteen ultrasounds were done and interpreted before operation and eight after operation by a radiologist. The sonographic results were compared with the status of the plantaris as determined at surgery. The plantaris was present in 21 of 23 patients for a prevalence of 91%. Eighteen plantaris tendons were well visualized on ultrasound for a sensitivity of 86%. Of the three false-negative results, two occurred with thinned plantaris tendons that were less than 2 mm thick and hence considered inadequate for grafting. Therefore, the sensitivity for detecting a tendon suitable for grafting was 95%. All patients with positive studies had a plantaris tendon present for a specificity of 100%. A learning curve for the radiologist was demonstrated. Ultrasound appears to be effective in the preoperative imaging of the plantaris tendon.

Interposition of extensor digitorum tendon in distal radius fracture mimicking a compartment syndrome.

A 14-year-old boy sustained a dorsally displaced Salter-Harris Type II fracture of the distal radius. A single attempt at closed reduction failed. After this closed reduction, the patient was unable to passively or actively extend or flex his fingers. He had increasing pain and compartment pressures were abnormally elevated. Dorsal fasciotomy was done, and during the open reduction, entrapment of the dorsal extensor retinaculum and extensor digitorium communis within the fracture was found. After removal of these structures, fracture reduction was easily accomplished and his fingers had a full range of motion. Postoperative recovery was uneventful.

Phantom pain: a lesson in the necessity for careful clinical research on chronic pain problems.

Recent findings suggest that major misunderstandings concerning the prevalence, characteristics, etiology, and treatment effectiveness of phantom pain have led to the widespread mismanagement of amputees throughout the history of modern medicine. For years it has been believed that phantom pain is relatively rare, is of unknown etiology, and probably has a psychological basis. Research results over the last few years, however, suggest that phantom pain is widely prevalent among individuals with amputations and most likely has a physiological basis. Although many different treatments have been introduced recently, few, if any, have yet been documented as effective due to lack of rigorous follow-up studies. Future progress in clinical treatment and increased scientific understanding of phantom pain will require an examination of some of the factors that have led to past confusion regarding scientific research on and clinical treatment of phantom pain.

Thermographic correlates of chronic pain: analysis of 125 patients incorporating evaluations by a blind panel.

Series of thermograms from 125 sequential participants were analyzed to determine the usefulness of thermography as a tool for evaluating chronic pain. The stability and symmetry of thermographic patterns over time among both healthy subjects and subjects whose pain remained at the same intensity across several recordings were found to be both high and consistent. This was true only if sensitivity was limited to no greater than 0.5C per color band. Greater sensitivity resulted in the creation of inconsistent asymmetrical patterns among healthy and pained subjects. Thermograms were evaluated by the authors' statistical analysis of the heat patterns and by a ten-member panel of scientists. They found thermography an excellent tool for monitoring changes in pain related to variations in near surface blood flow, such as those occurring during a sympathetic block. It was excellent for relating changes in near surface blood flow to changes in phantom limb pain intensity. There was a good relationship between changes in pain intensity and changes in symmetry of heat patterns for most of the disorders examined. Thermography had mixed usefulness in differentiating pain-free from pained subjects reporting knee pain (test efficiency, 98%), leg pain, and back pain (efficiency, 56%). It consistently indicated painful areas among patients with spinal cord injury.