Thesis (PhD)--University of South Australia, 2002.

Dissertation (Ph.D.)--Auburn University, 2006. / Abstract. Vita. Includes bibliographic references (p.89-95).

Book Summary: The New Edition provides the latest, essential information on the symptoms, diseases, treatments, and procedures most commonly encountered in everyday practice. It features step-by-step clinical guidance for more than 320 common diseases and disorders, as well as explicit guidelines for over 60 office procedures. An organ-system organization, extensive alphabetical index, and cross references within the individual chapters make the information easy to find.

Book Summary: The 451 chapters in this introductory text are organized by organ system, and provide data on 318 specific diseases and disorders - including their aetiology, symptoms, clinical findings, laboratory tests, differential diagnosis, treatment and follow-up. Nearly 60 office procedures are described in detail, with discussions of indications, contraindications, preparation, equipment, anaesthesia, precautions, technique and follow-up. A complete list of procedures and ICD-9 codes is also included.

Yes / In relation to wrist imaging, the accepted requirement is two orthogonal projections obtained at 90°, each with the wrist in neutral position. However, the literature and anecdotal experience suggests that this principle is not universally applied. Method: This multiphase study was undertaken across eight different hospitals sites. Compliance with standard UK technique was confirmed if there was a change in ulna orientation between the dorsi-palmar (DP) and lateral wrist projections. A baseline evaluation for three days was randomly identified from the preceding three months. An educational intervention was implemented using a poster to demonstrate standard positioning. To measure the impact of the intervention, further evaluation took place at two weeks (early) and three months (late). Results: Across the study phases, only a minority of radiographs demonstrated compliance with the standard technique, with an identical anatomical appearance of the distal ulna across the projections. Initial compliance was 16.8% (n = 40/238), and this improved to 47.8% (n = 77/161) post-intervention, but declined to 32.8% (n = 41/125) within three months. The presence of pathology appeared to influence practice, with a greater proportion of those with an abnormal radiographic examination demonstrating a change in ulna appearances in the baseline cohort (p

As fraturas da extremidade distal do rádio são muito comuns em nosso meio, sendo a mais freqüente do punho. Inúmeras pesquisas já foram realizadas sobre o tema e é conhecida a importância da redução anatômica das fraturas intra-articulares; porém, a causa de insucesso no seu tratamento pode ser a associação de outras lesões, envolvendo partes moles e cartilagem. O objetivo foi realizar uma avaliação artroscópica para analisar a incidência das lesões ligamentares e condrais associadas às fraturas intraarticulares da extremidade distal do rádio, correlacionado-a com classificação AO/ASIF. Trinta pacientes, com idade entre 20 a 50 anos, portadores de fratura fechada dos grupos B e C da classificação AO/ASIF foram selecionados. Todos eles foram submetidos à artroscopia do punho, para abordar as lesões intra-articulares e para redução e osteossíntese da fratura. Observou-se uma alta incidência de lesões intra-articulares, sendo que 76,7% deles apresentavam lesão do complexo da fibrocartilagem triangular, 36,6% do ligamento intrínseco escafo-semilunar, 6,6% do ligamento intrínseco semilunar-piramidal e 33,3% com lesão da cartilagem articular maior que três milímetros. Pacientes portadores de fraturas tipo C da classificação AO/ASIF apresentam uma incidência maior de lesões ligamentares associadas. Não houve relação entre a presença de lesão cartilaginosa e a classificação AO/ASIF das fraturas nesta casuística. / Fractures of the distal end of the radius are very frequent in our country and the most common is that of the wrist. Much research was carried out on the subject and the importance of the anatomical reduction of intra-articular fractures is well known, however the cause of unsuccessful treatment may be the association of other injuries involving soft tissues and cartilage. The purpose here was to perform an arthroscopic evaluation to analyze the incidence of ligament and chondral injuries associated to intra-articular fractures of the distal end of the radius, for correlation with the AO/ASIF classification. Thirty patients ranging from 20 to 50 years of age, bearers of closed fractures of groups B and C of the AO/ASIF classification were selected. They were submitted to wrist arthroscopy to treat the intra-articular injuries for fracture reduction and osteosynthesis. A high incidence of intraarticular injuries was noted, 76.7% of them presenting injury of the triangular fibrocartilage complex, 36.6% of the intrinsic scapholunate ligament, 6.6% of the intrinsic lunotriquetral ligament and 33.3% of an injury of the articular cartilage larger than three millimeters. Patients bearers of a type C fracture in the AO/ASIF classification present with a higher incidence of associated ligament injuries. No relation between presence of cartilage injury and AO/ASIF Classification was found in this casuistry.

As fraturas da extremidade distal do rádio são muito comuns em nosso meio, sendo a mais freqüente do punho. Inúmeras pesquisas já foram realizadas sobre o tema e é conhecida a importância da redução anatômica das fraturas intra-articulares; porém, a causa de insucesso no seu tratamento pode ser a associação de outras lesões, envolvendo partes moles e cartilagem. O objetivo foi realizar uma avaliação artroscópica para analisar a incidência das lesões ligamentares e condrais associadas às fraturas intraarticulares da extremidade distal do rádio, correlacionado-a com classificação AO/ASIF. Trinta pacientes, com idade entre 20 a 50 anos, portadores de fratura fechada dos grupos B e C da classificação AO/ASIF foram selecionados. Todos eles foram submetidos à artroscopia do punho, para abordar as lesões intra-articulares e para redução e osteossíntese da fratura. Observou-se uma alta incidência de lesões intra-articulares, sendo que 76,7% deles apresentavam lesão do complexo da fibrocartilagem triangular, 36,6% do ligamento intrínseco escafo-semilunar, 6,6% do ligamento intrínseco semilunar-piramidal e 33,3% com lesão da cartilagem articular maior que três milímetros. Pacientes portadores de fraturas tipo C da classificação AO/ASIF apresentam uma incidência maior de lesões ligamentares associadas. Não houve relação entre a presença de lesão cartilaginosa e a classificação AO/ASIF das fraturas nesta casuística. / Fractures of the distal end of the radius are very frequent in our country and the most common is that of the wrist. Much research was carried out on the subject and the importance of the anatomical reduction of intra-articular fractures is well known, however the cause of unsuccessful treatment may be the association of other injuries involving soft tissues and cartilage. The purpose here was to perform an arthroscopic evaluation to analyze the incidence of ligament and chondral injuries associated to intra-articular fractures of the distal end of the radius, for correlation with the AO/ASIF classification. Thirty patients ranging from 20 to 50 years of age, bearers of closed fractures of groups B and C of the AO/ASIF classification were selected. They were submitted to wrist arthroscopy to treat the intra-articular injuries for fracture reduction and osteosynthesis. A high incidence of intraarticular injuries was noted, 76.7% of them presenting injury of the triangular fibrocartilage complex, 36.6% of the intrinsic scapholunate ligament, 6.6% of the intrinsic lunotriquetral ligament and 33.3% of an injury of the articular cartilage larger than three millimeters. Patients bearers of a type C fracture in the AO/ASIF classification present with a higher incidence of associated ligament injuries. No relation between presence of cartilage injury and AO/ASIF Classification was found in this casuistry.

Many epidemiological studies have named pinching, deviated wrist postures, and repetitive motion as ergonomic risk factors in the development of carpal tunnel syndrome (CTS). Evidence suggests that hypervascularization of the median nerve and increased intraneural blood flow proximal to the carpal tunnel result in response to ergonomic risk factors (finger pressing and deviated wrist postures). The purposes of this study were to 1) determine the effect of a pinch posture, with and without force exerted by the finger, thumb, or both and 2) determine the effect of repetitive wrist flexion and extension on intraneural blood flow velocity in the median nerve proximal to the carpal tunnel. Eleven healthy and eleven CTS symptomatic individuals participated in this study and completed three components: 15 pinch posture force trials, 3 repetitive wrist motion trials, and 3 static wrist posture trials. Intraneural blood flow was measured using pulse wave Doppler during each trial. Main effects of pinch posture force (F4,80 = 21.397, p < 0.001) and wrist posture (F2,40 = 14.545, p < 0.001) were observed. Trials where force was applied by the finger (2.21 cm/s), thumb (2.22 cm/s) or both (2.34 cm/s) produced higher intraneural blood flow velocities than trials with no force (1.79 cm/s) or relaxed hand (1.89 cm/s). Trials performed in flexion (2.24 cm/s) were greater than neutral (2.06 cm/s) and extension (1.97 cm/s). No interactions or main effects of time were found in response to repetitive wrist motion. These results suggest that at low force levels (6 N) it’s not how the force is applied but rather that the force is being applied that has an effect on the median nerve. Additionally these results suggest that the contribution of repetitive motion to the development of CTS may not be directly to the median nerve. / Thesis / Master of Science (MSc)

No description available.

As computational power has increased, computational modeling has become a very promising tool to model the biomechanics of complex joint systems. Musculoskeletal computational models have become more complex when compared to original iterations which utilized a number of simplifications. This thesis utilized a three-dimensional computational model of the wrist joint structure to investigate scapholunate kinematics. The model accurately represented the bony anatomy of the wrist and hand and represented soft tissue structures such as ligaments, tendons, and other surrounding tissues. Creation of the model was done using commercially available computer-aided design and medical image processing software, and utilized the rigid body modeling methodology. It was validated for scapholunate kinematics against a cadaver study and then utilized to investigate further measures and surgical procedures. The simulations performed by the model demonstrated an accurate anatomical response of wrist function. As better understanding of the biomechanics of the wrist joint is achieved, this model could prove to be an important tool to further investigate wrist mechanics.