chemo extravasation

http://www.uic.edu/classes/pmpr/pmpr652/Final/bressler/extrainj.html

http://www.jhandsurg.org/article/S0363-5023(11)01243-3/fulltext

flaps

http://www.msdlatinamerica.com/ebooks/HandSurgery/sid806116.html

stsg

http://cdn.intechopen.com/pdfs/18924/InTech-Split_thickness_skin_grafts.pdf

hook test biceps

The Hook Test for Distal Biceps Tendon Avulsion

1. Shawn W. O’Driscoll, PhD, MD†,*, 
2. Lucas B. J. Goncalves, MD‡, and
3. Patricio Dietz, MD§

+Author Affiliations

1. From the ^†Mayo Clinic, Rochester, Minnesota, ^‡Hospital Madre Teresa, Belo Horizonte, Brazil, and ^§Hospital Base Osorno, Osorno, Chile

1. Address correspondence to Shawn W. O’Driscoll, PhD, MD, Mayo Clinic, 200 1st Street SW, MSB 3-69, Rochester, MN 55905 (e-mail: odriscoll.shawn@mayo.edu).

Abstract

Background: Complete biceps tendon avulsions are frequently missed on clinical examination, suggesting the need for a reliable diagnostic test.

Hypothesis: Complete distal biceps avulsions can be reliably detected with the Hook test.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: The hook test was performed by a single surgeon in a cohort of 45 patients undergoing surgical exploration of the distal biceps tendon. While the patient actively supinates with the elbow flexed 90°, an intact hook test permits the examiner to hook his or her index finger under the intact biceps tendon from the lateral side. With an abnormal hook test, indicating distal avulsion, there is no cord-like structure under which the examiner may hook a finger.

Results: Thirty-three patients had an avulsion and 12 had a partial tear. The hook test was abnormal in 33 of 33 (100%) patients with complete biceps avulsions, and intact in 12 of 12 with partial detachments. However, it was painful in 9 of those 12. In the noninjured contralateral arms, which served as the normal control group, 45 of 45 (100%) had a normal hook test. Magnetic resonance imaging (MRI) diagnosed a complete tear in 11 of 12 patients with partial tears and in 11 of 13 with complete lesions. The sensitivity and specificity were both higher with the hook test (both 100%) than with MRI (92% and 85%, respectively).

Conclusions: The hook test is a highly sensitive and specific test for assessment of distal biceps tendon avulsions.

Keywords:

• biceps
 
• tendon
 
• avulsion
 
• rupture
 
• elbow

Footnotes

• No potential conflict of interest declared.
• Copyright 2007 by American Orthopaedic Society for Sports Medicine

tendon relative strengths

. With the FCR muscle as the reference it is well known that the relative strengths of the FCU, flexor pollicis longus, each of the digital flexors, extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, and each of the digital extensors are 2, 1, 0.5, 1, 1, 1, and 0.5, respectively.⁸ When one takes the ratio of all the flexors to all the extensors the flexion/extension ratio is essentially 8 divided by 6 and is approximately 1.33 based on the cross-sectional area of the muscle bellies, suggesting that the total flexion force generated will be greater than the extension force.

Elbow instability

http://www.bonepit.com/Lectures/Elbow%20instability%20Matthew%20James%20Sharp.pdf

cp

macs

TABLE 1. Summary of the MACS

MACS Level	Description
I	Handles objects easily and successfully.
II	Handles most objects but with somewhat reduced quality or speed of achievement.
III	Handles objects with difficulty; needs help to prepare or modify activities.
IV	Handles a limited selection of easily managed objects in adapted situations.
V	Does not handle objects and has severely limited ability to perform even simple actions.

house

TABLE 2. House Functional Classification

Grade	Designation	Activity Level
0	Does not use	Does not use
1	Poor passive assist	Uses as stabilizing weight only
2	Fair passive assist	Can hold on to object placed in hand
3	Good passive assist	Can hold on to object and stabilize it for use by the other hand
4	Poor active assist	Can actively grasp object and hold it weakly
5	Fair active assist	Can actively grasp object and stabilize it well
6	Good active assist	Can actively grasp object and then manipulate it against other hand
7	Spontaneous use, partial	Can perform bimanual activities easily and occasionally uses the hand spontaneously
8	Spontaneous use, complete	Uses hand completely independently without reference to the other hand