MR imaging in the diagnosis of carpal tunnel syndrome.

Diagnosis of carpal tunnel syndrome (CTS) is usually made on the basis of clinical and electrophysiologic data. Other tests, however, such as ultrasound and CT, have enabled us to acquire additional information regarding the anatomical definition of the structures inside the carpal tunnel. The superior quality of MRIs soft-tissue definition led us to employ it in cases of median nerve compression at the wrist in order to determine its true diagnostic value. We compared the preoperative electrophysiologic and MRI findings in 23 cases of CTS which had undergone surgical decompression of the median nerve at the wrist. Exact correspondence with the intraoperative findings confirmed the reliability of the anatomical information provided by MRI, yet the same comparison revealed that correct "functional" information could be provided only by the electrophysiologic tests.

Rotational disorders in intramedullary fixation of the lower limbs.

The routine employment of intramedullary fixation in fractures of the femur and tibia has led the authors to thoroughly evaluate malunions. With the aid of CT scan, precise multilevel quantification of residual rotational deformity was possible by comparison with the contralateral limb after fracture healing. The results of this study confirm the effectiveness of the method, filling an interpretative gap in the literature.

A case of monolateral duplication of the Achilles tendon due to an anomaly of the medial gastrocnemius muscle.

The authors describe the chance finding of a congenital morphological anomaly in the Achilles tendon, characterized by monolateral duplication as a result of anomalous differentiation of the medial gastrocnemius muscle. This may be added to the previous congenital deformities described in the literature (shortness of the Achilles tendon, its duplication as a result of the lack of fusion of the aponeurosis of the soleus and of the gastrocnemii, the presence of a supplementary medial gastrocnemius).

Camurati-Engelmann's disease. A case report.

Camurati-Engelmann's syndrome is a rare congenital disease characterised by hyperostosis and sclerosis with a predilection for the long bones of the lower limbs. The authors report a case in an adult with a family history of the disease, and multiple localisations in the diaphyses of the long bones. The site of pain and greatest involvement of the disease was the right tibia and fibula. The affection was treated by drilling and reaming the medullary canal with drills of increasing diameter. This method is easy to carry out, causes little trauma, and has undoubted advantages in greatly reducing the period of bedrest and aiding functional recovery.

Domed high tibial osteotomy: the long-term results in tibiofemoral arthritis with and without malalignment of the extensor apparatus.

The authors confirm the role of high tibial osteotomy in the correction of valgus and varus anomalies, which are frequently associated with imbalance of the extensor apparatus and with torsional defects of the tibia. This has encouraged the authors to adopt a curvilinear osteotomy capable of correcting anomalies in the various planes. The results are evaluated in subjects with monocompartmental arthritis associated with valgus or varus, as well as for those with associated malalignment of the extensor apparatus. The review is based on 38 operated knees, followed up for 17 to 78 months (average 39 months) after operation.

[Short-term study of proglumetacin]. / Studio a breve termine della proglumetacina.

Twenty-five patients with joint rheumatoid pain were treated as outpatients during 15 days with 450 mg/day fo proglumetacin. Efficacy was "good" or "very good" in 64% of the patients. No case of clinically significant side-effects was observed.

Biochemical changes in the articular cartilage of the patella and femoral condyles in the lateral hyperpatellar syndrome.

The biochemical changes in the articular cartilage of the femoral condyles and the patella were studied during the earliest stage of patello-femoral arthrosis, with particular reference to chondromalacia of the patella in the "lateral hypertension syndrome", with the object of comparing them with the results obtained by Boni et al. (1977) in the initial phases of experimental arthrosis induced in rabbits by means of vitamin A. The biochemical determinations were done on samples of cartilage removed at operation from the medial and lateral femoral condyles and the medial and lateral patellar articular facets in ten patients. The biopsy samples were fixed in 80% alcohol and dried in the oven at 50 degrees C for twenty-four hours. The hexosamine and hydroxyproline content was then determined. This investigation demonstrated significant biochemical changes in this syndrome in the four areas examined. The data obtained indicate that only the mucopolysaccharide component of the joint cartilage is involved at this stage. The most interesting finding was marked diminution in the galactosamine/glucosamine ratio, which was markedly diminished - the opposite of what occurs in established arthrosis. These data appear to be identical with those found in the early phases of vitamin A induced arthrosis in experimental rabbits. The diminution of hexosamine content and the diminished galactosamine/glucosamine ratio were more marked in the femoral condyles, which appeared to have few lesions macroscopically. These changes were also present in both articular facets of patella, but were less marked, probably because the degeneration was more advanced in those areas, thus more closely resembling frank arthrosis.