OKOJ, Volume 7, No. 11

Median Nerve Palsy

Median nerve palsy is caused by deep, penetrating injuries to the arm, forearm, or wrist area, and occasionally from blunt force trauma or neuropathy. Injuries to the median nerve can be separated into high and low median nerve palsies, depending on the level of injury. Patients with low median nerve palsy—for example, because of a lesion at the wrist—lack the ability to abduct and oppose the thumb due to paralysis of the thenar muscles. They will also have sensory loss in the thumb, index finger, long finger, and the radial aspect of the ring finger. In contrast, patients with high median nerve palsy (lesion at the elbow and above) have weakness in forearm pronation and wrist and finger flexion, in addition to lack of thumb opposition. A variety of tendon transfers are available to restore motor function and improve functional outcome in patients with median nerve palsy.

    • Keywords:
    • median nerve injury

    • median nerve trauma

    • brachial plexus injury

    • high median nerve palsy

    • low median nerve palsy

    • entrapment neuropathy of median nerve

    • anterior interosseous nerve

    • tendon transfers

    • muscle transfers

    • Bunnell opponensplasty

    • Huber opponensplasty

    • abductor digiti minimi transfer

    • flexor carpi ulnaris transfer

    • flexor digitorum superficialis transfer

    • Camitz transfer

    • extensor indicus proprius transfer

    • Subspecialty:
    • Hand and Wrist

Rheumatoid Arthritis: Spinal Manifestations and Surgical Treatment

Rheumatoid arthritis affects an estimated 1.3 million persons in the United States. It can be an extremely morbid disease, with cervical spine involvement leading to significant disability and even mortality. We describe the current diagnostic modalities and treatment algorithm for rheumatoid arthritis of the cervical spine. New antirheumatic drugs allow for marked improvement of joint involvement for all joints affected by rheumatoid arthritis. The three forms of cervical instability secondary to rheumatoid arthritis are atlantoaxial instability, atlantoaxial impaction (vertical settling), and subaxial subluxation. Surgery is considered for patients with intractable neck pain, neurologic deficits, and specific radiographic criteria. Both anterior and posterior surgical techniques are viable options depending on the surgical pathologic findings involved. Many studies have shown that patients with lower Ranawat scores have better long-term outcomes after surgical stabilization. Early intervention in patients with neurologic deficits in the setting of cervical spine instability provides the best chance for improved neurologic function.

    • Keywords:
    • spinal arthritis

    • spinal rheumatoid arthritis

    • spinal RA

    • rheumatoid cervical spondylitis

    • atlantoaxial subluxation

    • atlantoaxial impaction

    • subaxial subluxation

    • basilar invagination

    • Subspecialty:
    • Spine

Advanced Techniques in Labral Repair

The labrum is the gasket or seal of the hip joint and provides force dissipation, socket deepening, and subsequent stability. Additionally, a functional labrum allows the hip to maintain negative pressure, which further adds to the stability of the hip joint. It is important, therefore, to preserve as much functional labrum as possible. This article discusses advanced techniques for arthroscopic acetabular labral repair and describes in detail a technique for reconstructing the acetabular labrum with an iliotibial band autograft in patients with a calcified or unrepairable labrum.

    • Keywords:
    • wave sign

    • chondrolabral dysfunction

    • cam-type impingement

    • FAI

    • femeroacetabular impingement

    • dysplastic hip

    • IT band autograft

    • hip dial test

    • leg-roll test

    • labral tear

    • arthroscopy

    • arthroscopic assessment

    • Subspecialty:
    • Sports Medicine