Osteoarthritis of the Wrist: Pathology, Radiology, and Treatment

2021 ◽  
Vol 25 (02) ◽  
pp. 294-303
Author(s):  
Jan-Peter Grunz ◽  
Carsten Herbert Gietzen ◽  
Georgios Christopoulos ◽  
Jörg van Schoonhoven ◽  
Florian Goehtz ◽  
...  
Keyword(s):  
Load Distribution ◽  
Synovial Joint ◽  
Close Collaboration ◽  
Degenerative Arthritis ◽  
Specific Patient ◽  
Rapid Disease Progression ◽  
Joint Surfaces ◽  
Osteoarthritis Of The Wrist ◽  
Advanced Stages ◽  
Asymmetric Load

AbstractOsteoarthritis (OA) is a degenerative disease that can manifest in any synovial joint under certain conditions. It leads to destruction of articular cartilage and adjacent bone, as well as formation of osteophytes at the edges of afflicted joint surfaces. Regarding the wrist, typical degenerative arthritis affects particular joints at a specific patient age, due to asymmetric load distribution and repetitive microtrauma. However, in the presence of instability or systemic diseases, early-onset degeneration can also impair the range of motion and grip strength in younger patients. Although advanced stages of OA display characteristic signs in radiography, the detection of early manifestations frequently requires computed tomography or magnetic resonance imaging (in some cases with additional arthrography). If a wrist becomes unstable, timely diagnosis and precise treatment are essential to prevent rapid disease progression. Therefore, close collaboration between radiologists and hand surgeons is obligatory to preserve the carpal function of patients.

scholarly journals A Complete Digital Workflow for Planning, Simulation, and Evaluation in Orthognathic Surgery

2021 ◽  
Vol 10 (17) ◽  
pp. 4000
Author(s):  
Sang-Jeong Lee ◽  
Ji-Yong Yoo ◽  
Sang-Yoon Woo ◽  
Hoon Joo Yang ◽  
Jo-eun Kim ◽  
...  
Keyword(s):  
Orthognathic Surgery ◽  
Image Data ◽  
The Other ◽  
Close Collaboration ◽  
Digital Workflow ◽  
Linear Discrepancy ◽  
Specific Patient ◽  
Bimaxillary Orthognathic Surgery ◽  
The Absolute ◽  
Simulation And Evaluation

The purpose of this study was to develop a complete digital workflow for planning, simulation, and evaluation for orthognathic surgery based on 3D digital natural head position reproduction, a cloud-based collaboration platform, and 3D landmark-based evaluation. We included 24 patients who underwent bimaxillary orthognathic surgery. Surgeons and engineers could share the massive image data immediately and conveniently and collaborate closely in surgical planning and simulation using a cloud-based platform. The digital surgical splint could be optimized for a specific patient before or after the physical fabrication of 3D printing splints through close collaboration. The surgical accuracy was evaluated comprehensively via the translational (linear) and rotational (angular) discrepancies between identical 3D landmarks on the simulation and postoperative computed tomography (CT) models. The means of the absolute linear discrepancy at eight tooth landmarks were 0.61 ± 0.55, 0.86 ± 0.68, and 1.00 ± 0.79 mm in left–right, advance–setback, and impaction–elongation directions, respectively, and 1.67 mm in the root mean square direction. The linear discrepancy in the left–right direction was significantly different from the other two directions as shown by analysis of variance (ANOVA, p < 0.05). The means of the absolute angular discrepancies were 1.43 ± 1.06°, 0.50 ± 0.31°, and 0.58 ± 0.41° in the pitch, roll, and yaw orientations, respectively. The angular discrepancy in the pitch orientation was significantly different from the other two orientations (ANOVA, p < 0.05). The complete digital workflow that we developed for orthognathic patients provides efficient and streamlined procedures for orthognathic surgery and shows high surgical accuracy with efficient image data sharing and close collaboration.

scholarly journals Current State of the Art in the Adjuvant Systemic Treatment of Premenopausal Patients With Early Breast Cancer

2020 ◽  
Vol 14 ◽  
pp. 117955492093181
Author(s):  
Francesca Parisi ◽  
Maria Grazia Razeti ◽  
Eva Blondeaux ◽  
Luca Arecco ◽  
Marta Perachino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Systemic Treatment ◽  
Premenopausal Women ◽  
Specific Patient ◽  
Adjuvant Systemic Treatment ◽  
Current State ◽  
Age Related ◽  
Advanced Stages ◽  
Premenopausal Patients

Breast cancer is the most frequent malignancy diagnosed in premenopausal women. In this age group, breast tumors tend to be diagnosed at more advanced stages and to harbor more aggressive biological features. In addition, specific age-related issues including genetic counseling, fertility preservation, impact on social and couple relationships, working life, and management of long-term side effects should be considered highly relevant when managing early breast cancer in premenopausal women. Therefore, the care of these patients is particularly complex and a multidisciplinary approach is mandatory. The present review summarizes the current state of art in the adjuvant systemic treatment of premenopausal women with early breast cancer focusing on the optimal chemotherapy, endocrine therapy, and targeted therapy approaches in this specific patient population.

Quantitative synovial joint geometry and load distribution

1981 ◽  
Vol 14 (7) ◽  
pp. 489 ◽  
Author(s):  
R.W. Mann ◽  
P.D. Rushfeldt ◽  
W.H. Harris
Keyword(s):  
Load Distribution ◽  
Synovial Joint ◽  
Joint Geometry

Can a Polycarbonate-Urethane Meniscal Implant Protect Articular Cartilage? Histopathological Results in a Sheep Model

2009 ◽  
Author(s):  
Eran Linder-Ganz ◽  
Gal Zur ◽  
Jonathan Shani ◽  
Jonathan J. Elsner ◽  
Ori Brenner ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Knee Joint ◽  
Clinical Studies ◽  
Load Distribution ◽  
Degenerative Arthritis ◽  
Sheep Model ◽  
Polycarbonate Urethane ◽  
Fresh Frozen ◽  
Joint Biomechanics ◽  
Histopathological Results

The menisci play an important role in the knee joint biomechanics [1]. Clinical studies have shown that the loss of the meniscus leads to degenerative arthritis attributed to the changes in load distribution and the loss of proprioception [2]. Clearly, there is a substantial need to protect the articular cartilage by either repairing or replacing the menisci. There are many difficulties dealing with both fresh frozen or cryopreserved allograft menisci, and the complexities of meniscal repairs may contribute to uneven distribution of load, instability and recurrence of degenerative damage. Hence there is a need for the development of an artificial meniscus that is available at the time of surgery in several sizes that can accommodate most patients.

Equal Life Optimization of Shells Based on Kiln Axis Alignment

2013 ◽  
Vol 404 ◽  
pp. 257-262 ◽  
Author(s):  
Xiao Yan Yang ◽  
You Gang Xiao ◽  
Xian Ming Lei
Keyword(s):  
Fatigue Life ◽  
Life Expectancy ◽  
Load Distribution ◽  
Fuzzy Optimization ◽  
Remaining Life ◽  
Design Variables ◽  
Stress Spectrum ◽  
Axis Alignment ◽  
Asymmetric Load ◽  
Set Up

The crack of kiln shells was seen regularly due to axis deflection and asymmetric load distribution. It will be helpful to improve kiln performance if the remaining life of kiln shells can be kept the same. For this the formulae of stress spectrum and fatigue life of kiln shells are obtained. Taking the aligned values of axis deflections as design variables, equal fatigue life of shells and maximum axis deflection as the objective function, considering the fuzzy factors during axis alignment, the fuzzy optimization model of kiln axis alignment is set up. The results indicate that kiln axis can be aligned as direct as possible, and life expectancy of kiln shells can be optimized to keep near the same. Accordingly, the valuable production time of kiln can be increased greatly by such aligned method.

Sleep Impairment

2009 ◽  
Vol 14 (3) ◽  
pp. 7-10
Author(s):  
Craig Uejo ◽  
Stephen Demeter
Keyword(s):  
Rotator Cuff ◽  
Distal Clavicle ◽  
Rotator Cuff Disease ◽  
Degenerative Arthritis ◽  
Sixth Edition ◽  
Cuff Tear ◽  
Shoulder Region ◽  
Illness Causation ◽  
Traumatic Rotator Cuff Tear ◽  
Distal Clavicle Resection

Abstract In the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, distal clavicle resection (resection arthroplasty of the acromioclavicular joint [ACJ]) results in ratable impairment, but only a single diagnosis within a region may be rated. Therefore, if another impairing condition is present in the shoulder region (eg, impingement syndrome or rotator cuff disease) only that resulting in the greatest causally related impairment is rated. In the setting of an occupational or other compensable injury or illness, causation of the impairment often is a key issue because, typically, only impairment that is causally related to the injury can be rated. For example, assume that a lifting injury at work caused a tear in a rotator cuff tendon that was already attenuated by repetitive impingement on inferiorly projecting spurs from longstanding degenerative arthritis of the ACJ. If surgery was performed for a traumatic rotator cuff tear and the distal clavicle also was resected due to preexisting ACJ arthritis, the latter surgery is not considered to be related to the injury. In other words, because the ACJ arthritis was neither caused nor worsened by the injury, this condition is not rated. The distal clavicular resection may have been warranted to diminish pain due to ACJ arthritis and/or eliminate the distal clavicle as a source of impingement.

Apportionment of Impairment from Meniscal Tears and Knee Arthritis

2013 ◽  
Vol 18 (5) ◽  
pp. 1-10 ◽  
Author(s):  
Charles N. Brooks ◽  
James B. Talmage
Keyword(s):  
Medial Meniscus ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Detailed Knowledge ◽  
Meniscal Tears ◽  
Knee Arthritis ◽  
Degenerative Arthritis ◽  
Study Results ◽  
Physical Findings ◽  
Causation Analysis

Abstract Meniscal tears and osteoarthritis (osteoarthrosis, degenerative arthritis, or degenerative joint disease) are two of the most common conditions involving the knee. This article includes definitions of apportionment and causes; presents a case report of initial and recurrent tears of the medial meniscus plus osteoarthritis (OA) in the medial compartment of the knee; and addresses questions regarding apportionment. The authors, experienced impairment raters who are knowledgeable regarding the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), show that, when instructions on impairment rating are incomplete, unclear, or inconsistent, interrater reliability diminishes (different physicians may derive different impairment estimates). Accurate apportionment of impairment is a demanding task that requires detailed knowledge of causation for the conditions in question; the mechanisms of injury or extent of exposures; prior and current symptoms, functional status, physical findings, and clinical study results; and use of the appropriate edition of the AMA Guides. Sometimes the available data are incomplete, requiring the rating physician to make assumptions. However, if those assumptions are reasonable and consistent with the medical literature and facts of the case, if the causation analysis is plausible, and if the examiner follows impairment rating instructions in the AMA Guides (or at least uses a rational and hence defensible method when instructions are suboptimal), the resulting apportionment should be credible.

Evaluating Shoulder Impairment

1998 ◽  
Vol 3 (5) ◽  
pp. 1-3
Author(s):  
Richard T. Katz ◽  
Sankar Perraraju
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Sensory Loss ◽  
Motor Deficits ◽  
Nerve Lesion ◽  
Fourth Edition ◽  
Specific Patient ◽  
Industrial Medicine ◽  
Shoulder Motion ◽  
Upper Extremity Impairment

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, offers several categories to describe impairment in the shoulder, including shoulder amputation, abnormal shoulder motion, peripheral nerve disorders, subluxation/dislocation, and joint arthroplasty. This article clarifies appropriate methods for rating shoulder impairment in a specific patient, particularly with reference to the AMA Guides, Section 3.1j, Shoulder, Section 3.1k, Impairment of the Upper Extremity Due to Peripheral Nerve Disorders, and Section 3.1m, Impairment Due to Other Disorders of the Upper Extremity. A table shows shoulder motions and associated degrees of motion and can be used in assessing abnormal range of motion. Assessments of shoulder impairment due to peripheral nerve lesion also requires assessment of sensory loss (or presence of nerve pain) or motor deficits, and these may be categorized to the level of the spinal nerves (C5 to T1). Table 23 is useful regarding impairment from persistent joint subluxation or dislocation, and Table 27 can be helpful in assessing impairment of the upper extremity after arthroplasty of specific bones of joints. Although inter-rater reliability has been reasonably good, the validity of the upper extremity impairment rating has been questioned, and further research in industrial medicine and physical disability is required.

Nonsurgical Therapies for Hepatocellular and Cholangiocellular Carcinoma

Swiss Surgery ◽  
1999 ◽  
Vol 5 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Schmassmann
Keyword(s):  
Current Trend ◽  
Percutaneous Ethanol Injection ◽  
Cholangiocellular Carcinoma ◽  
Multidisciplinary Therapy ◽  
Term Survival ◽  
Ethanol Injection ◽  
First Choice ◽  
Tumor Stages ◽  
Choice Of Treatment ◽  
Advanced Stages

Surgical resection is the first choice of treatment for patients with hepatocellular (HCC) and cholangiocellular carcinomas. Prolongation of survival is, however, the only realistic goal for most patients, which can be often achieved by nonsurgical therapies. Inoperable patients with large or multiple HCCs are usually treated with transarterial chemoembolization (TACE) with lipiodol in combination with a chemotherapeutic drug and gelfoam. Three-year survival depends on the stage of the disease and is about 20%. Patients with earlier tumor stages (one or two tumor nodules less than 3cm in size) are suitable for treatment with percutaneous ethanol injection (PEI) alone or in combination with TACE. Several studies have shown that in these early stages, the 3-year survival rate is approximately 55%-70% in the actively treated patients which is significantly higher than in untreated patients. In advanced stages of the disease, TACE and PEI have no effect on survival and should not be performed. Some of these patients have been successfully treated with octreotide. Patients with inoperable cholangiocellular carcinoma are treated by endoscopic or percutaneous stent placement. If stenting does not achieve adequate biliary drainage, multidisciplinary therapy including internal / external radiotherapy or photodynamic therapy should be considered in patients with potential long-term survival. In conclusion, nonresectional therapies play an essential role in the therapy of inoperable hepato- and cholangiocellular carcinomas as they lead to satisfactory survival. Multidisciplinary therapy appears to be the current trend of management.

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