An unusual cause of spinal cord injury: case report and discussion.

Traumatic spinal cord injury is a devastating condition that alters every aspect of the victim's life. Motor vehicle accidents cause about half of the cases, whereas others are the result of falls, recreational and sporting accidents, or acts of violence. We report a case of a C3 spinal fracture with a resultant Brown Sequard syndrome, which occurred in a unique manner and could have easily been prevented. There is a need for the medical community to play a more active role in educating the public to prevent accidents that lead to these catastrophic injuries.

Obesity. A risk factor for knee dislocation.

Complete dislocation of the knee joint is a severe injury that is commonly the result of high-velocity injuries and often associated with disruption of the popliteal artery. We report two cases in which obesity appeared to be the principal cause of knee dislocation with vascular compromise. Preventive measures in extremely obese patients are recommended.

The shoulder abduction relief sign in cervical radiculopathy.

A patient with C6 cervical radiculopathy reported that sustained shoulder abduction significantly diminished this upper extremity pain. The patient was instructed to adopt this position for prolonged periods during rest and at work. Pain relief was temporary and lasted as long as the arm was in abduction. Relief of pain, induced by arm abduction, may be observed in cervical radiculopathy in which the lower cervical roots are involved. Reduced tension at the nerve root is the probable underlying mechanism that leads to pain relief. Shoulder abduction can be used not only as a diagnostic sign but also may be incorporated in the conservative management of patients suffering from cervical radiculopathy affecting the lower cervical roots.

Vertebral artery damage complicating cervical manipulation.

Cervical manipulation may result in serious neurologic injury arising specifically from trauma to the vertebrobasilar system. The vertebral arteries are susceptible to trauma at three locations: in the transverse foraminae, at the atlantoaxial joint, and at the occipitoatlantal joint. Because of frequent inequality in the size of the two vertebral arteries, damage to the larger artery may lead to ischemia of the brain stem. Vertebral artery obstruction may be produced by extension with rotation, even within normal ranges of motion. Neurologic injury following manipulation requires accurate diagnosis and prompt manipulation requires accurate diagnosis and prompt anticoagulant therapy.

Spine fractures in ankylosing spondylitis.

Patients with ankylosing spondylitis are susceptible to spine fracture, usually in the cervical spine. Less frequently, the thoracic and lumbar spine is affected. The fracture line may involve anterior and posterior elements. Frequently, it extends through the entire width of the spine. As a result the fracture tends to be unstable and may cause neurologic damage. Prompt immobilization and reduction of the dislocated spine followed by stabilization may prevent neurologic damage. We report a 45-year-old man who fell and sustained a fracture dislocation of L2 vertebra. The patient was operated and stabilized with Harrington rods. A deep wound infection developed, which did not respond to antibiotic therapy and led to removal of the rods. In spite of bed immobilization with a body jacket the fracture remained unstable and dislocated. As a result the patient sustained severe neurologic damage. Many fractures in patients with ankylosing spondylitis occur following minor trauma. We feel that a very important aspect of ankylosing spondylitis management is prevention of these fractures. Alerting patients of their spine fragility and teaching then how to evade situations leading to spinal trauma may help in avoiding this situation.

Carpal tunnel syndrome: median nerve stress test.

The purpose of this study was to determine the effect of wrist position on distal sensory and motor latencies of the median nerve. An orthosis was devised to maintain the wrist either in extension or in flexion while measuring these latencies. Fourteen patients with presumptive carpal tunnel syndrome (CTS) and 12 control subjects were evaluated following extension or flexion of the wrist for 5 and 10 minutes. Results showed an increase in distal latencies for both groups; the highest increment was found among CTS patients following 5 minutes of wrist flexion. Since it is not uncommon for patients to present with classical CTS symptoms but without electrodiagnostic findings in support of such diagnosis, it is suggested that such patients be reevaluated after 5 minutes of wrist flexion (median nerve stress) test.

Hemicorporectomy for functional rehabilitation.

Hemicorporectomy is usually performed as a last resort for life-threatening diseases. A case is reported in which this deforming traumatic procedure was performed in a 66-year-old man for functional and rehabilitation reasons rather than life-saving indications. The indications for the procedure, the patient's decision-making, the preoperative preparation of the patient, both physically and psychologically, the preparation of the family and the rehabilitation procedures are summarized.