Excision of the ulnar head in patients with rheumatoid arthritis

In 40 patients with rheumatoid arthritis 43 operations for excision of the ulnar head were performed. A follow-up study was performed after 35 months. In 38 patients wrist pain had disappeared completely or almost completely. The function in use, supination and pronation of the wrists, and wrist strength had all much improved. The stability of the radiocarpal joint was good after operation. Only minor complications were seen.

The hand in the child with juvenile rheumatoid arthritis

Clinical examination of 100 children showed frequent loss of wrist extension and ulnar deviation. Loss of flexion and radial deviation in the metacarpophalangeal joint is more frequent than in the adult. Statistical review of charts and roentgenograms of 200 patients showed all had ulnar shortening up to 9 mm but there was no correlation with ulnar deviation or netacarpophalangeal radial deviation. Conservative treatment is reviewed; surgery is rarely indicated.

Two methods of measuring muscle tone applied in patients with decerebrate rigidity

Two methods were used to measure muscle tone in patients with decerebrate rigidity. In the first method forces of square waveform were applied and the calculated compliance of the joint was used as an index of rigidity. Oscillatory transients were seen at the same frequency as the physiological tremor. The range of normal variation in compliance was large and the values measured in the patients flucuated markedly which limited the value of this index. In the second method, where forces of sinusoidal waveform were employed, the resonant frequency of the joint was measured and used as an index of rigidity. This index proved reliable and reproducible.

Clinical features of paralytic claw fingers

A study of 221 claw fingers of fifty-one leprosy patients with ulnar or combined ulnar and median-nerve paralysis showed that the severity of the deformity was determined mostly by the completeness of paralysis of intrinsci muscles, and to a lesser extent by the duration of paralysis. There was no predilection for severe deformity in any one finger. Recurrent dislocation of the extensor tendon from the knuckle of the metacarpophalangeal joint was observed mostly in fingers that were completely deprived of all intrinsic muscles. No satisfactory explanation could be found for this. Flexing the wrist facilitated opening of the claw finger, but the effect was more evident at the metacarphophalangeal joint than at the proximal interphalangeal joint.

Serial nerve conduction studies in carpal tunnel syndrome secondary to rheumatoid arthritis: preliminary study

Twenty patients with definite rheumatoid arthritis fulfilling the criteria of the American Rheumatism Association were examined for clinical and electrodiagnostic evidence of carpal tunnel syndrome. Of the 40 wrists studied, 8 (20%) had evidence of carpal tunnel syndrome. All wrists were followed up with serial electrodiagnostic, clinical, and laboratory studies at intervals of 4 months over a period of a year. All patients were seen by a rheumatologist and were put on effective anti-inflammatory drug therapy. At each visit serum drug level and sedimentation rate were estimated. Two of the wrists were splinted. In the 4 affected patients (8 wrists) the drugs were used were aspirin in 3 and gold in 1. All 8 wrists showed a decrease in the abnormally prolonged median sensory latencies. This finding paralleled clinical improvement of rheumatoid disease as shown by symptomatic relief of paresthesia, reduced swelling of joints (including wrists), absence of Tinel sign at the median nerve, and fall of sedimentation rate. The study strongly suggests that serial electrodiagnostic studies should be used as 1 parameter in the follow-up of carpal tunnel syndrome secondary to rheumatoid arthritis. The study also indicates that good anti-inflammatory therapy and splinting can control carpal tunnel syndrome in rheumatoid arthritis. None of the wrists involved needed surgery during the period of study.

Wrist arthrodesis

Arthrodesis of the wrist is an excellent procedure indicated only in carefully selected and evaluated cases. Eleven patients with various pathological lesions were treated by a modification of standard surgical techniques. Good stability and bone graft placement was secured by an easily removed internal fixation device. External immobilization was required for minimal periods of time. The end results were satisfactory.

[Biomechanical tests of various operative techniques for recurrent inferior radioulnar dislocation (author's transl)]

Among the great number of operative techniques for stabilization of the distal end of the ulna by grafts in recurrent inferior radioulnar dislocation 6 different methods were tested biomechanically and compared among each other. Those techniques which permit successful treatment of the dislocation are pointed out.

Bilateral traumatic dislocation of the distal radioulnar joint, ulna dorsal: case report and review of the literature

Bilateral dislocation of the distal radioulnar joint seems not to have been reported in the literature. This is a report of a 22-year-old man successfully treated with closed reduction and immobilization in long arm casts. Limited forearm rotation and wrist pain after a twisting injury are typical findings. In ulna dorsal dislocation the patient's forearm is locked in pronation. In ulna volar dislocation the wrist appears narrow and the forearm is locked in supination. The mechanism of injury for dorsal dislocations is hyperpronation; for volar dislocations it is hypersupination. Dislocation of the distal radioulnar joint injures the triangular disk and/or fractures the ulnar styloid. Suspicion is important in making the diagnosis. Fifty per cent of unilateral cases reported in the literature were missed initially or were diagnosed late. The acute case is easily treated by closed reduction under local anesthesia and immobilization in a long arm cast. Treatment of the chronic dislocation includes various soft tissue reconstructions or resection of the distal ulna depending on the degree of arthrosis.

Total wrist arthroplasty: a preliminary report

Evaluation of 26 Meuli total wrist arthroplasties in 22 patients 7 to 17 months after operation revealed that 92 percent (24 wrists) were relieved of pain. Postoperative motion averaged 32 degrees of dorsiflexion. 27 degrees of palmar flexion, 2 degrees of radial deviation, and 23 degrees of ulnar deviation. Failure of the prosthetic design to place the center of rotation properly in the capitate resulted in a tendency toward flexion and ulnar deviation deformities. Reoperation was required in nine (35 percent) of the 26 wrists. After reoperation of these nine wrists, 77 percent (20 wrists) of the total group had good or excellent results, 11.5 percent (three wrists) fair, and 11.5 percent (three wrists) poor.

Kienböck's disease in cerebral palsy

Five cases of Kienböck's disease occurring in a group of fifty-three adults with cerebral palsy are described. The increased incidence of the disease is attributed to the flexed posture habitual in the affected wrist and to an effect on the pattern of blood supply to the lunate.

Hypertension in relation to musculoskeletal disorders

Generalized osteoarthrosis was found to be significantly more common in older males with high than with low diastolic blood pressure. The excess of osteoarthrosis in those with hypertension was mainly in the hips, knees, carpometacarpal and metacarpophalangeal joints, and was independent of obesity in the hypertensive group. It was not associated with a higher cholesterol or uric acid level in the serum. Radiological evidence of avascular necrosis was present in 36% of males with osteoarthrosis of the hips and diastolic blood pressure above 100 mmHg, in 20% with a diastolic pressure of 81-100 mmHg, but was found in none of those with osteoarthrosis and blood pressure of 80 mmHg or below. Only those with osteoarthrosis and a diastolic pressure above 100 mmHg had significantly more avascular necrosis that expected. Osteoarthrosis of the knee in female was more frequent in the hypertensive groups independent of obesity. It is concluded that vascular disorders are involved in this form of generalized osteoarthrosis.

Assessment of surgery of the rheumatoid wrist

A series of 314 wrist operations performed on 227 patients with rheumatoid arthritis is presented. In 266 hands various wrist operations were undertaken with the object of synovial debridement and in 48 hands the wrist was also arthrodesed. The mean age at the time of surgical treatment was 51 years and the mean period of observation 4.2 years. This study shows that the main benefits of synovectomy are related to a constant and marked pain relief and prevention of tendon ruptures. The hope that synovectomy might arrest or prevent skeletal destruction was not realized and progression of X-ray changes was found in 74%. The very low recurrence rate in the present series as judged by clinical signs is probably not very significant and it is concluded that the X-ray findings are the most reliable criteria reflecting the real activity in a rheumatoid joint. In several wrists where prophylactic ulnar head resection had been performed through a small ulnar incision, an active dorsal tenosynovitis with tendon invasion developed later. These and other findings at the operation indicate that the erosive effect of the distal end of the ulna is certainly not the sole cause of tendon rupture in this area and that a complete exposure and decompression of the tendons should regularly be performed. Finally, arthrodesis of the wrist was so successful that it can be highly recommended.