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MANAGING PARALYSIS OF INTRINSIC MUSCLES OF THE THUMB
F. Chaise 1.2.3, Ph. Bellemere 1.2, B. Chabaud 3.4. | MO n°165
June 2007 |  Paralysis of the intrinsic muscles of the thumb will change the opposition function which is the result of a movement made up of three components: extension, adduction and pronation. The full movement of opposition is only possible if all the local anatomic structures are functional. A thumb with paralysis of the intrinsic muscles will be dependent on the extrinsic muscles which will progressively lead to major functional imbalance with the final result being a thumb stiffened in adduction and retroposition with an interphalangeal joint fixed in flexion. Early medical care must be undertaken before these complications arise because their treatment is difficult, the results uncertain and often disappointing. Re-education, fitting of prosthesis and physiotherapy must all be an essential part of this protocol prior to any surgical reconstruction. ...
F. Chaise 1.2.3, Ph. Bellemere 1.2, B. Chabaud 3.4. |
PALLIATIVE TREATMENT FOR PARALYSIS OF INTRINSIC MUSCLES OF THE FINGERS
Ph. Bellemere 1.2, F. Chaise 1.2.3, B. Chabaud 2.4. | MO n°165
June 2007 |  Paralyses of the intrinsic muscles of the fingers are the result of nerve damage, infectious nerve diseases (leprosy, polio) or degenerative diseases affecting at least the ulnar nerve. These paralyses cause deformity of the fingers and functional disability due to imbalance between the intrinsic and extrinsic muscle apparatus of the fingers. The deformity is a clawing of the fingers which is typically seen during active extension of the fingers with hyperextension of the first phalanx because the metacarpophalangeal joints are not stabilised while the 2nd and 3rd phalanges remain in flexion . This attitude only concerns the 4th and little finger in the case of isolated ulnar nerve paralysis because the lumbrical muscles of the 2nd and 3rd fingers, innervated by the median nerve, can suffice to prevent deformation in these fingers. The claw ...
Ph. Bellemere 1.2, F. Chaise 1.2.3, B. Chabaud 2.4. |
ARTHROSCOPY OF THE WRIST: Use and technical possibilities
Ch. Dumontier | MO n°119
December 2002 |  The wrist is a frequent source of pain, the clinical and radiographic investigation of which remains difficult (See Maîtrise Orthopédique n°49). Accordingly, arthroscopic diagnosis is still indicated in some cases. However, as in other joints, wrist arthroscopy is, above all, a therapeutic act. Although its use is not yet widespread in France, probably because of the material cost, wrist arthroscopy is an ever-growing part of the therapeutic arsenal of hand surgeons. In certain indications, the results of arthroscopic treatment are now superior to those of open techniques. At present, the number of patients in published series and follow-up are sufficiently extensive for arthroscopy of the wrist to warrant more widespread attention. Even if you have few indications in your practice, this short article is designed to illustrate what one sees ...
Ch. Dumontier |
COMPOSITE TISSUE ALLOTRANSPLANTATION AND RECONSTRUCTIVE SURGERY: The first clinical applications
F. Petit | MO n°111
February 2002 |  On September, 1998, a 48-year old man with a right-hand amputation received a forearm transplant harvested from a 41-year old man in cadaveric (brain dead) status . This first human hand transplantation was performed in Lyon, France by a team directed by J.-M. DUBERNARD. The procedure was not considered by all as an advance in hand surgery , but it will be remembered as a major step in the history of Man, as were the first kidney (Murray, 1954) and heart transplantations (Barnard, 1967). Dispute over whether or not the procedure was justified has already taken place in many publications . Despite the contention, more hand transplants have been performed and other anatomic areas have been transplanted that recently have entered the scope of " composite tissue allotransplantation " (C.T.A.) - so called by its promoters - in the field of clinical ...
F. Petit |
Treatment of scaphoid nonunion with a vascularized bone graft harvested from the volar aspect of the radius
Ch. Mathoulin | MO n°105
June 2001 |  The choices of treatment of scaphoid nonunion are numerous, varied, and often controversial. The use of a bone graft associated with an osteosynthesis has proved to be very efficient and enables union more frequently than when these two treatments were used separately.Due to the technical difficulties encountered, vascularized bone grafts were usually reserved for when standard techniques failed. In 1965 Judet, with Roy-Camille, was the first to suggest using a bone graft harvested from the palmar aspect of the radius and vascularized by pronator quadratus fibers . This technique was then used by Braun and more recently has been used by Kawai with excellent results which showed union in all the cases in their series. Judet modified his technique in 1972 because the graft harvested from the palmar aspect of the radius did not enable a long ...
Ch. Mathoulin |
Carpal instability
Ph. Saffar | MO n°73
April 1998 | There is no muscular attachment to the proximal carpal row. It is an intercalated segment stabilized only by ligaments. Proximal carpal row motion is the consequence of movements of the distal carpal row and forearm bones. The intracapsular wrist volar ligamentous plane is thick and strong : stretching of this structure is difficult to assess but probably plays a role in carpal instability. The dorsal ligamentous plane is thinner and less important for carpal stability.Description of the “carpal instability” entity is more than 25 years old (Linscheid et Dobyns, 1972). It was defined as carpal malalignment on X-rays or by carpal ligamentous tears and controversy still exists regarding this definition. We have been interested in pathology of carpal instability since it was described. New imaging techniques for the carpus have helped ...
Ph. Saffar |
Upper limb disorders in musicians
R. Tubiana | MO n°69
December 1997 | Orthopaedists are seeing this type of problem more and more frequently in their clinics. The problems themselves are not a new phenomenon, but for a long time they were played down both by doctors, who had no treatment to offer for a set of poorly-defined symptoms which were often regarded as psychosomatic, for want of a more accurate diagnosis; and by professional musicians themselves, who were very concerned for their career and their future.An extraordinarily large number of people play a musical instrument these days, many of them self-taught; and this has led to a considerable increase in the number of cases of these disorders. As a result, epidemiological studies have been carried out, which have confirmed that there is a serious problem. Thus, in 1986, Fishbein et al. performed a study among 4,000 orchestral musicians in the United ...
R. Tubiana |
Physical examination of wrist instabilities
C. Dumontier | MO n°49
December 1996 | This version is an update of the original version as Lou A. Gilula was very kind to correct the grammatical as well as the orthographic mistakes of the text. He also took of his time to partly rewrite this text. His advices and comments were very useful and I want to deeply thank him for his contributions. Some remarks have also been made by David M. Lichtman who sent me more details on the performance of the midcarpal shift test that he described. His drawings were not included in the original version of this work published in French in the number 49 of Maîtrise Orthopédique.Although 35 years ago McLaughlin stated that wrist sprains were rare injuries, Linscheid and Dobyns's publication of 1972 was the beginning of an enormous number of publications reporting either experimental or clinical work on wrist ligamentous injuries. Most of these ...
C. Dumontier |
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