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Diabetic Neuropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Common signs and symptoms of cranial neuropathy depend on the nerve affected. In an oculomotor palsy, there will be double vision on lateral and upward gaze with drooping of the eyelid of the affected eye. If the cell body of the third nerve has been affected, bilateral ptosis may also be appreciated. Involvement of the trochlear nerve leads to double vision on vertical gaze and a compensatory head tilt. A diabetic facial nerve palsy leads to loss of the ability to raise the eyebrow, close the eye, raise the corner of the mouth, change in hearing on the affected side, and a loss of taste.
Surgery of the Elbow
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Alan Salih, David Butt, Deborah Higgs
A systematic approach is essential if pathology is not to be missed. To distend the capsule, 15–25 mL of fluid is instilled into the joint through the direct lateral portal using an 18G needle. Backflow of fluid confirms correct placement. The anterolateral portal is established (see earlier) and the arthroscope and cannula inserted. The capsule medial to the articulation is examined first. Medial laxity can be assessed by supinating the forearm and applying valgus stress to the elbow in varying degrees of flexion. Flexing and extending the elbow allows the trochlea to be viewed. The radioulnar articulation is observed as the forearm is rotated and, for coronoid impingement, as the elbow is fully flexed.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The elbow consists of three joints all within the same joint capsule. The major articulation of the elbow is the hinge joint between the humerus of the upper arm and the ulna of the forearm. This ulnohumeral joint is responsible for flexion-extension of the elbow joint. Mediolateral movement at the joint is prevented by its bony structure (see planes and axes of movement). The distal end of the humerus, the trochlea, sits in the trochlear notch at the proximal end of the ulna. The second joint at the elbow is between the radius of the forearm and the humerus. This radiohumeral joint is not constrained by its bony structure. It is the articulation between the capitulum and the head of the radius. The radiohumeral joint would be susceptible to dislocation if the thick annular ligament, which forms a ring around the proximal end of the radius, was not present to stabilize it. The third joint at the elbow, the proximal radioulnar joint, between the radial head and the ulnar notch, enables pronation-supination of the forearm and, therefore, repositions the hand about the long axis of the upper limb.
A Large Segmental Mid-Diaphyseal Femoral Defect Sheep Model: Surgical Technique
Published in Journal of Investigative Surgery, 2022
David S. Margolis, Gerardo Figueroa, Efren Barron Villalobos, Jordan L. Smith, Cynthia J. Doane, David A. Gonzales, John A. Szivek
In patients, an intramedullary device can be placed in an antegrade or retrograde fashion to treat mid-diaphyseal femur defects. An antegrade nail is typically performed in this scenario to avoid penetrating the knee joint. Preliminary studies in our lab demonstrated that the sheep sciatic nerve was draped in the saddle between the femoral head and trochlea, medial to the trochanter. This precluded access of the central axis of the femur in an antegrade fashion using a straight intramedullary nail. The trochanter of the sheep is too lateral to the central axis of the femur to use a trochanteric entry nail. The sheep stifle joint has anatomy similar to humans with differences that do not prevent passage of a retrograde nail into the femur [21]. The axis of the femur needed for nailing passes through the trochlea in a bare cartilaginous area that is not engaged by the patella until the stifle is placed in high flexion, similar to a human, and there are no ligaments at risk [21].
Particulated juvenile articular cartilage allograft transplantation for osteochondral lesions of the knee and ankle
Published in Expert Review of Medical Devices, 2020
Colleen M. Wixted, Travis J. Dekker, Samuel B. Adams
Surgical treatment options available for osteochondral lesions of the knee closely resemble those available for OLTs. The patellofemoral joint contains the thickest articular cartilage, and injury to this area most often results in osteochondral lesions affecting the patella and trochlea [37,38]. Over the last 5 years, use of newer generation ACI and MACI techniques to treat these lesions has increased while the use of conventional microfracture has decreased. ACI and MACI require two procedures: the first to obtain a cartilage biopsy that is placed in cryopreservation and the second to implant the cultured chondrocytes. For MACI, the chondrocytes are delivered on a pre-seeded collagen membrane that is sized according to the defect rather than in a cell suspension. Extensive clinical evidence demonstrates favorable long-term outcomes for both of these techniques, providing a safe and durable means of cartilage repair with an 86% survival rate after 10 years[39]. Randomized controlled trials that compare ACI/MACI to microfracture have been contradictory since studies of smaller lesions and studies with shorter follow-up have not observed a clinically significant difference in outcomes [40–43]. However, as was seen with OLTs, studies of larger lesions and studies with longer follow-up noted superior outcomes with ACI and MACI compared to microfracture [44–47]. Although the downside to both ACI and MACI is the need for two procedures, they result in the development of hyaline-like cartilage rather than fibrocartilage.
Evaluation and Management of V pattern Strabismus in Craniosynostosis
Published in Journal of Binocular Vision and Ocular Motility, 2020
Abdelrahman M. Elhusseiny, Elisah M. Huynh, Linda R. Dagi
V pattern strabismus in patients with craniosynostosis usually presents with overelevation and underdepression of the adducting eye, and in more severe cases is accompanied by limitation of elevation in abduction. The pathogenesis of V pattern can be multifactorial. Retro-positioning of the trochlea results in a shortened SO course increasing laxity of this muscle.13,16,17 Retro-positioning of trochlea is common in uni- or bicoronal synostosis because of retro-positioning of the superior orbital rim and shallowing of the orbit.13,16,18 In some cases, it may be iatrogenic secondary to fronto-orbital advancement.19 During this procedure, the orbital bandeau is removed, the periorbita is exposed and sequestered and the trochlea is disinserted from the notch. Once the cranial vault is reconfigured and the orbital bandeau replaced, there is passive re-insertion of the trochlea. Although it may return to its original anatomical position, it sometimes slides posteriorly increasing superior oblique tendon laxity, and nearly eliminating the horizontal trajectory of the tendon toward the “notch”, thereby reducing the ability of the superior oblique to incyclotort the globe and infraduct the eye in adduction.19