Síndrome de mano diabetica / Diabetic hand

La diabetes mellitus (DBT) es un desorden metabólico producto de una deficiencia absoluta o relativa de insulina. Este trastorno tiene consecuencias de importancia en varios órganos y sistemas del cuerpo. Es bien conocido que la DBT está asociada con una cantidad de manifestaciones cutáneas y osteoarticulares. La más común de estas características afecta al pie (síndrome de pie diabético); sin embargo, similares lesiones se pueden observar en la mano (síndrome de mano diabética), generalmente asociadas a una larga evolución de la enfermedad, malos controles glicémicos y complicaciones microvasculares. En este artículo se realiza una revisión de la literatura para actualizar el diagnóstico y la terapéutica de manifestaciones musculo-esqueléticas en la mano de pacientes con DBT: movilidad articular limitada, contractura de Dupuytren, tenosinovitis del flexor (dedo en gatillo), infección por síndrome de mano diabética tropical, ulceración neuropática periférica, síndrome del túnel carpiano, neuropatía cubital y neuropatía en piel y uñas.

Diabetes mellitus (DBT) is a metabolic disorder caused by absolute or relative deficiency of insulin. This disorder has importance consequences in various organs and systems. It is well known that DBT is associated with cutaneous and osteoarticular manifestations; the most common of these complications affects the foot (diabetic foot syndrome). However, similar lesions can be observed in the hand (diabetic hand syndrome), usually associated with long standing disease, poor glycemic control and microvascular complications. This article makes a review of the literature to update diagnosis and therapy ofmusculoskeletal manifestations in patients with diabetic hand syndrome: limited joint mobility, Dupuytren’s contracture, trigger finger, tropical diabetic hand, peripheral neuropathic ulceration, carpal tunnel syndrome, cubital neuropathy, and skin and nail changes.

Ulnar Nerve Palsy Following Closed Fracture of the Distal Radius: A Report of 2 Cases

Ulnar nerve palsy subsequent to a fracture of the distal radius is extremely rare compared to a median nerve injury. The lesion tends to occur in younger patents with a high-energy mechanism of injury and a severe injury pattern consisting of wide displacement, comminution, combined distal ulnar fracture and open fracture. The mechanism of injury can contribute to a direct contusion and traction, compression secondary to prolonged edema and tissue fibrosis, intraneural fibrosis and laceration. We report 2 cases of progressive ulnar nerve palsy subsequent to closed fractures of the distal radius. The neurological symptoms recovered in all cases who underwent nerve decompression and neurolysis at 2 or 3 months after the trauma. It is recommended that cases with high-energy, widely displaced or comminuted fractures of the distal radius be evaluated carefully for ulnar nerve as well as median nerve injury.

A randomized clinical trial of oral steroids for ulnar neuropathy in type 1 and type 2 leprosy reactions / Ensaio clínico sobre o tratamento com esteróides via oral da neuropatia ulnar em reação tipo 1 e tipo 2 da hanseníase

BACKGROUND: Steroids regimens in leprosy neuropathies are still controversial in botth types of reactions. METHOD: For this trial, 21 patients with ulnar neuropathy were selected from 163 leprosy patients, 12 with type 1 reaction (T1R) and nine with type 2 (T2R). One experimental group started with prednisone 2 mg/kg/day and the control group with 1 mg/kg/day. A clinical score based on tests for spontaneous pain, nerve palpation, sensory and muscle function was used. Neurophysiological evaluation consisted on the motor nerve conduction of the ulnar nerve in three segments. Student "t" test for statistical analysis was applied on the results: before treatment, first week, first month and sixth month, between each regimen and types of reaction. CONCLUSION: In both reactions during the first month higher doses of steroids produced better results but, earlier treatment with lower dose was as effective. Short periods of steroid, 1 mg/Kg/day at the beginning and,tapering to 0,5 mg/Kg/day or less in one month turned out to be efficient in T2R.

INTRODUÇÃO: O tratamento da neuropatia da hanseníase com esteróides é ainda controverso nos dois tipos de reações. MÉTODO: Neste ensaio, de 163 pacientes foram selecionados 21 com neuropatia ulnar, 12 com reação tipo 1 e 9 com tipo 2. Um grupo experimental iniciou com 2 mg/kg/dia e o grupo controle com 1 mg/kg/dia. Foi composto um escore clínico pela avaliação da sensação dolorosa espontânea, palpação de nervos e funções sensitiva e motora. Realizou-se a condução nervosa motora do nervo ulnar em três segmentos. Aplicaram-se os estudos estatísticos com o teste t de Student nos resultados: antes do tratamento, primeira semana, primeiro mês e sexto mês. CONCLUSÃO: Em ambas as reações dosagens mais elevadas iniciais produziram melhores resultados, mas a dose menor quando administrada precocemente foi igualmente efetiva. Períodos curtos com doses efetivas, 1 mg/Kg/dia no início e reduzindo-se para 0,5 mg/Kg/dia ou menos em um mês foram eficientes na reação tipo 2.

Outcome of supracondylar fractures of the humerus in children treated by closed reduction and percutaneous pinning.

Supracondylar fractures of humerus in children are common injuries. Displaced fractures are inherently unstable. Conservative treatment results in malunion. Open reduction and internal fixation (ORIF) is more invasive and recovery is prolonged. From September 2004 to September 2005, 102 displaced supracondylar fractures of humerus, aged between one and half year to 13 years, were treated using close reduction and percutaneous Kirschner (K) wire fixation under c-arm fluoroscopy. Seventy nine patients were treated by cross K-wires and in twenty three cases lateral two K-wires were put. Above elbow plaster of paris back slab was applied in all cases for at least four weeks. Back slab, K-wires were removed after four weeks and elbow range of motion exercise was started. Results were analyzed using Flynn's criteria. All patients were followed up to 14th week postoperatively. In cross K-wire group(N=79) 70.8% had excellent, 22.7% good, 3.8% fair and 2.5% had poor results at eight weeks follow up which was improved to 91.1% excellent, 6.3 good, 1.2% fair and 1.26% poor results at 14 weeks follow up. In lateral K-wire group (N=23) 70% had excellent, 21.7% good, 4.3% fair and 4.3% had poor result at eighth week which was improved to 91.3% excellent, 4.3% good, 4.3% fair and no poor result at 14th week follow up. Eight patients got superficial pin tract infection and seven patients sustained ulnar nerve injury post operatively. We recommend this procedure for displaced supracondylar fractures in children as it is safe and cost effective procedure with acceptable complication rates.

Electrodiagnosis in the evaluation of ulnar neuropathy in Benghazi

To study the causes, clinical presentation and the findings of electrophysiological examination in patients with ulnar nerve neuropathy due to entrapment or traumatic disorders, Prospective study of patients with ulnar neuropathy referred for neurophysiological studies [nerve conduction and electromyography studies]. Cases included people aged between 15-75 years, who had ulnar nerve neuropathy and referred for electrodiagnosis in Benghazi, between March 2003 and September 2006. There were 53 patients with ulnar neuropathy, 32 were male and 21 were females. The mean age was 36 +/- 13.5 [SD] yeas [range 15-75 years]. The common clinical manifestations were weakness, sensory disturbances and pain in the ulnar nerve territory. Twenty-seven [51%] patients had traumatic ulnar neuropathy, while the other 26 [49%] patients had idiopathic compression neuropathy of the ulnar nerve at the elbow [cubital tunnel syndrome]. Axonal damage on electrophysiological examination was established in 25 [93%] cases of patients who had traumatic neuropathy. Segmental demyelination and conduction delay were observed in 20 patients with the cubital tunnel syndrome, while axonal injury was recorded in 6 patients of whom 3 were diabetic patients. Additional carpal tunnel syndrome was found in 7 patients of this group. The present study was comparable with previous reports. The obtained data were similar for male predominance, clinical and electrophysiological findings. However, the study reveals a high prevalence of stab wound injury of the ulnar nerve among young men,. This suggests that preventive strategies are indicated to prevent and combat this rising problem and hence, the devastating consequences, of functional disability

Ulnar neuropathy at Jordan University Hospital

To study the causes, clinical and electromyography/nerve conduction study [EMG/NCS] findings and treatment modalities in Jordanian patients with ulnar neuropathy [UN] observed in a tertiary care referral center and compare the findings with those from Western literature. The case notes of 20 patients with UN referred to the neurophysiology department at Jordan University Hospital, Amman, Jordan, between January 2002 and January 2004 were reviewed. The clinical presentation, causes, EMG/NCS and treatment modalities were registered. Among the 20 patients, 18 were male and 2 female with a mean age of 39 years [range 14-68 years]. Ten cases were traumatic UN while the other 10 were presumably idiopathic cubital tunnel syndrome [CTS]. The most common clinical manifestations were paresthesiae of 4th/5th digits and weakness/atrophy of small hand muscles. All 10 cases of traumatic UN were axonal on EMG/NCS while among the other 10 with CTS, 3 diabetics had axonal injury and 6 out of 7 nondiabetics had a demyelinating injury, 3 sensorimotor and 3 pure sensory. Additional carpal tunnel syndrome was found in 5 patients. Needle EMG was abnormal only in cases of abnormal ulnar sensory action potential. Nine out of 10 with traumatic UN had surgery while only 3 out of 10 with CTS had cubital tunnel release. Compared to previous studies from Western literature, our study shows a similar male predominance as well as comparable clinical and neurophysiological findings and treatment modalities

Reconstructive surgery in upper limbs in leprosy.

Of all the deformities in leprosy, 80% require minor surgery and the rest major surgery. Upper and lower limbs and face are mainly affected by deformities. Either the median or ulnar nerve and rarely the radial nerve are involved in isolation or in combination. Tendon transfer is the only option available in cases of deformities like simian hand, ulnar claw hand, wrist drop and failure to the metacarpals. The only motor function to be restored in median nerve palsy is opponensplasty. For radial nerve palsy standard FCU transfer, FDS transfer and FCR transfer are the reconstructive methods. For ulnar nerve palsy, an intrinsic minus hand function is restored by the motors PL, ECRL, FDS, EIP or EDM extended by four tail fascia lata graft onto lateral or ulnar bands of fingers. When ulnar nerve is part of much more extensive paralysis, reducing the availability of suitable motors, static mathods of conection of claw hand are done.