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Central Cord Syndrome
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
The most significant deficit is clearly in the upper limbs with almost normally preserved power in the lower limbs. The upper extremity motor scores are more than 10 Medical Research Council (MRC) points lower than the lower extremity motor scores and therefore qualifies as a central cord injury. The hyperextension injury suggested in the history is typical in the elderly population. Hyperextension causes buckling of the ligamentum flavum, cord compression and axonal injury.
Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Thumb carpometacarpal (CMC) or scaphotrapezial-trapezoid joints (or both): Patients with CMC arthritis present with varied complaints of localized pain, or vague complaints such as throbbing or burning in the radial aspect of the hand. Advanced osteoarthritis often has adduction contracture thumb and a compensatory MCP joint hyperextension. These patients may show laxity of the joint in hyperextension. A grinding test and joint subluxation test evaluate thumb carpometacarpal joint arthritis. Grinding test: The examiner faces the patient and rests his/her hand on the examination table. Once the wrist is stabilized with the other hand, an axial load is applied to the thumb axis to elicit pain as well as crepitus seen in degenerative arthritis (Video 3.4).CMC subluxation test: The test is similar to the grinding test where the examiner gently forces the CMC joint to subluxate and note the pain and crepitus.
Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
A few degrees of hyperextension at the knee is normal in view of the stability achieved in standing. Pathological hyperextension is encountered in conditions such as Ehlers–Danlos syndrome, ligamentous injury, etc. The knee flexion should preferably be measured with the hip flexed to avoid any restriction by a tight rectus femoris and vice versa; full flexion at the hip should be avoided during measurements of knee extension to avoid interference by the hamstring muscles. The variable axis of flexion and extension is determined by the shape of the medial femoral condyle. As the leg moves the full arch from full flexion to extension, the peculiar elongated shape of the medial femoral condyle ensures that the tibia glides as well as rotates on the femur, and as a result, the tibia rotates outwards with respect to the femur (assuming the thigh is fixed and the leg moves) (Figure 10.8).
The shark flap: a modified internal mammary artery perforator flap for composite defects in head and neck reconstruction
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Anna Scarabosio, Alessandro Tel, Filippo Contessi Negrini, Roberta Albanese, Massimo Robiony, Piercamillo Parodi
At the end of dissection time no venous congestion of the flap occurred, allowing to rotate it of 90 degrees to restore entirely the skin surface of the neck [12]. Therefore it may be fully considered a propeller flap. The donor area of the chest was sutured directly. The ‘fin’ of the shark flap was rotated clockwise in the safest direction and sutured to wound margins to close the defect (Figures 2 and 3). The flap was then accurately sutured following the natural linings of the patient, in particular the ‘fin’ was place right underneath the chin perpendicularly to the major axis of the neck. This placement guaranteed a tension-free closure. Post-operatively neck mobility was fully limited and a light hyperextension was maintained for almost a week, then gradually restored. In two weeks time the patient had no mobility restrictions.
Surfer’s myelopathy: A review of etiology, pathogenesis, evaluation, and management
Published in The Journal of Spinal Cord Medicine, 2021
Jason Gandhi, Min Yea Lee, Gunjan Joshi, Sardar Ali Khan
SM is hypothesized to be caused by hyperextension of the spine thus leading to vascular damage and ischemia to the distal spinal cord segment.1 As novice surfers generate excessive force by maneuvering the surf boards and surrounding waves, tension on both the spinal cord and its vasculature increases. While most studies suggest this acute hyperextension is a predictor of SM, a study by Freedman et al. has posited alternative etiologies.7 The authors proposed that inferior vena cava compression or embolization within the spinal arteries, both secondary to prolonged hyperextension, are the root causes. This may explain why the lower spinal cord and conus medullaris may be vulnerable to arterial insufficiency.6 An alternative explanation is that affected patients have a thin body habitus concomitant with weak musculature, dehydration, and long distance travel.1
Functional passive range of motion of individuals with chronic cervical spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2020
Sara Kate Frye, Paula Richley Geigle, Henry S. York, W. Mark Sweatman
ROM analysis: Absolute ROM assessment revealed notable differences between individuals with cervical SCI and the general population normative data (Tables 1 and 2). Upper Limb: Shoulder extension was greater in this study population than the general able-bodied population. Elbow extension limitations were prevalent, but of those who could achieve full extension, hyperextension was observed in 10 participants. Wrist extension was greater in the sample population than the general population. Lower Limb: Straight leg raise (SLR) hip flexion, abduction, and internal rotation fell short of the documented ranges for the able-bodied population. Ankle plantarflexion contractures were ubiquitous with the mean being over 10 degrees less than neutral and 23 participants unable to achieve a neutral position in one or both ankles.