OKOJ, Volume 7, No. 9

Ulnar Nerve Palsy

Paralysis of the ulnar nerve causes substantial functional impairment of the hand. Based on the level of injury, there is a relatively consistent pattern of motor and sensory deficits. The greatest motor disability results from paralysis of the dorsal and volar interossei, abductor digiti minimi, and deep head of flexor pollicis brevis. Paralysis of these muscles, in turn, results in a claw deformity (flattening of the transverse metacarpal arch and longitudinal arches with hyperextension of the metacarpophalangeal joints and flexion of the proximal interphalangeal and distal interphalangeal joints), difficulty with fine motor pinch and grasp, and diminished precision and fine motor coordination. A variety of reconstructive options are available for ulnar nerve palsy in the form of tendon transfers and soft-tissue rearrangements (flexor pulley advancement, fasciodermadesis, volar capsulodesis), which are designed to restore motor function and correct the secondary deformity. All surgical interventions require dedicated intensive postoperative rehabilitation.

    • Keywords:
    • ulnar nerve paralysis

    • ulnar nerve injury

    • ulnar nerve compression

    • ulnar nerve entrapment

    • high ulnar nerve palsy

    • low ulnar nerve palsy

    • cubital tunnel syndrome

    • tendon transfer

    • Subspecialty:
    • Hand and Wrist

Duchenne Muscular Dystrophy

Duchenne muscular dystrophy is an X-linked recessive disease characterized by progressive muscle weakness caused by an absence of the protein dystrophin. Diagnosis and subsequent management of the patient with Duchenne muscular dystrophy may be challenging and requires input from and collaboration with multiple medical and ancillary providers. In most instances, diagnosis of Duchenne muscular dystrophy is relatively straightforward because of the relatively classic presentation and laboratory confirmation. Musculoskeletal care should be focused on maximizing the patient's upright status as late in life as possible, as well as maintaining the function and comfort of the patient when ambulation is no longer possible. There is some evidence that medical management using steroid protocols may be beneficial in this regard, but these medications have significant inherent short- and long-term problems. The one orthopedic intervention that has demonstrated utility with respect to improving quality, if not quantity, of life is early posterior spinal fusion. This will improve upright sitting status and function of wheelchair-dependent patients and appears to have some positive effect on maintaining, or at least slowing, the relentless progression of pulmonary deterioration characteristic of this disease.

    • Keywords:
    • Duchennes muscular dystrophy

    • DMD

    • Becker muscular dystrophy

    • BMD

    • childhood muscular dystrophy

    • Subspecialty:
    • Pediatric Orthopaedics

Ankle Arthroscopy

Arthroscopy is a useful tool in the treatment of a variety of foot and ankle disorders. Multiple indications for ankle arthroscopy exist today, and more than likely these will be expanded in the future. Ankle problems that can be managed arthroscopically include soft-tissue and osseous impingement, loose bodies, adhesions, synovitis, and osteochondral defects of the talus. These conditions can be approached with the use of anterolateral and anteromedial portals and, if necessary, accessory portals. Arthroscopic ankle fusion can also be performed through the use of anterior portals for patients with arthritis of the ankle who do not respond to conservative management. Complications of ankle arthroscopy involve neurologic problems more often than arthroscopy elsewhere in the body. Damage to the branches of the superficial peroneal nerve as well as to the sural nerve makes up most of the complications. A thorough knowledge of the topographic anatomy of the foot and ankle plus use of the"nick and spread technique"can help avoid most of these complications.

    • Keywords:
    • osteochondral lesions of the talus

    • anterior ankle impingement

    • loose bodies

    • anterior osteophytes

    • degenerative arthritis

    • ankle arthrodesis

    • posterior ankle impingement

    • Subspecialty:
    • Sports Medicine