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Öğe Digital Neuropathy of the Median and Ulnar Nerves Caused by Dupuytren's Contracture Case Report(LIPPINCOTT WILLIAMS & WILKINS, 2009) Guney, Figen; Yuruten, Betigul; Karalezli, NazimIntroduction: Digital neuropathy is a pure sensory neuropathy of a digital nerve. It may be caused by acute or chronic local trauma or pressure, or accompany systemic illnesses such as rheumatoid disease, leprosy, Raynaud disease, dysproteinemia, or diabetes mellitus. We describe an extraordinary case of digital neuropathy of the median and ulnar nerves caused by Dupuytren contracture. Case Report: A 56-year-old right-handed man was presented with numbness and tingling of the little finger of the right and ring finger of the left hand. The clinical and EMG findings in this patient were consistent with a lesion of the median and ulnar palmar digital nerves of the right and left ring and little fingers. Conclusion: Dupuytren tissue usually affects: the palmar fascia, superficial to the digital nerves, and it may rarely affect the spiral cord in the digits. A spiral cord may cause sensory loss due to impingement of digital nerves or Dupuytren tissue may have been compressing the palmar digital nerves against the relatively inelastic deep transverse metacarpal ligament. As a result, digital neuropathy can develop in those with Dupuytren's contracture, and nerve conduction studies should also be performed to determine the condition. New Studies are needed to provide better diagnostic criteria for the condition.Öğe The Effects of Electrocautery on Peripheral Nerve: An Experimental Study(THIEME MEDICAL PUBL INC, 2016) Karalezli, Nazim; Koktekir, Ender; Yildirim, Serhat; Toy, Hatice; Oz, Mehmet; Yuceturk, AydinBackground The aim of this study was to assess the usability of an electrocautery device as nerve stimulator and to investigate histopathologically the adverse effects of electrocautery at low power on rat sciatic nerves. Methods A total of 36 female Sprague-Dawley albino rats were divided into six groups according to the power applied to their sciatic nerves (1, 2, 3, 4, 5 and 6 W, respectively). Pathologic changes were studied by microscopic examination and scored (no change = 0, mild = 1, moderate = 2, severe = 3). Multiple comparisons were provided for all groups by the Bonferroni test (one-way analysis of variance). A p value < 0.05 was accepted as statistically significant. Results The average scores were 2.66 +/- 0.51, 3.66 +/- 0.51, 5.83 +/- 1.83, 10.0 +/- 1.78, 11.0 +/- 1.54, and 13.8 +/- 0.89 in groups 1 to 6, respectively. Significant differences were found between all groups (p < 0.01), except between groups 1 and 2, groups 2 and 3, and groups 4 and 5 (p > 0.05) Variable motor responses and foot deformities were observed at the different power levels. Conclusion Although electrocautery devices provoke motor responses if getting in contact with peripheral nerves as do nerve stimulators, their use induces histopathologically adverse effects even at the lowest power. Their use around peripheral nerves should be avoided.Öğe Evaluation of Three-Dimensional Motion Analysis of the Upper Right Limb Movements in the Bowing Arm of Violinists Through a Digital Photogrammetric Method(SCIENCE & MEDICINE INC, 2009) Yagisan, Nihan; Karabork, Hakan; Goktepe, Ayhan; Karalezli, NazimViolin is one of the most widely taught string instruments in the world. The positions of the right tipper arm, elbow, and wrist and the vertical inclinations of the arm and forearm differ among violin players. The objective of this study was to measure the angular changes in the wrist and elbow joints, as well as the vertical inclinations of the arm, forearm, and hand, which are active in basic bow drives in violin playing, by using digital photogrammetric methods. In this way, we could determine the angular changes of the joints during bow drives, allowing Lis to incorporate this information into reaching proper bow techniques as well as preventing possible problems due to excessive force. This study involved nine Male University violin players. Certain anatomic areas were marked oil the players for measurement. The wrist and elbow joints of the right upper extremity were filmed on a calibrated test field using a metric camera, and images were transferred to the computer for photogrammetric evaluation using Pictran software (Technet GmbH, Germany). The angles of the elbow and wrist as well as the vertical inclinations of the arm, forearm, and hand of the right arm were ascertained from these marks on the photographs. The study showed that there are significant interindividual differences in the angular changes and inclinations on the E string and in the vertical inclinations on all strings among the different players. Med Probl Perform Art 2009; 24: 181-184.Öğe The fascial band from semitendinosus to gastrocnemius: the critical point of hamstring harvesting(TAYLOR & FRANCIS INC, 2007) Tuncay, Ibrahim; Kucuker, Hudaverdi; Uzun, Ibrahim; Karalezli, NazimBackground Arthroscopically-assisted reconstruction of the anterior cruciate ligament with hamstring tendons has achieved widespread acceptance; however, the anatomy of these tendons may cause technical problems at harvesting. Methods We studied the anatomy of the fascial band between semitendinosus and gastrocnemius and the distance between the semitendinosus insertion and the origin of this band in 23 knees from cadavers (17 male). The length of the semitendinosus tendon and the width of the fascial band were also recorded. Results Fascial attachment was detected in all cadavers except 1. The mean width of the band was 2.6 (1 - 4) cm. The mean distance from the insertion of the semitendinosus to the fascial band was 7 (6 - 8) cm. The mean length of the semitendinosus tendon was 22 (18 - 26) cm. Interpretation A better understanding of the anatomy of the hamstring tendons will reduce the risk of a disappointing complication right at the start of the operation.Öğe Formation of osteocartilaginous exostosis resulting from the raising of a lateral supramalleolar flap(INFORMA HEALTHCARE, 2012) Keskin, Mustafa; Karalezli, Nazim; Tosun, Zekeriya; Savaci, NedimAn osteocartilaginous exostosis developed in a 4-year-old boy in whom a distally-based lateral supramalleolar adipofascial flap had been used to cover a defect in the dorsum of the foot. The bony exostosis was first noticed four months after the operation. It was excised with no complications and there has been no recurrence after two years follow-up. The exostosis was thought to result from stripping the perichondrium over the epiphyseal plate while the flap was being raised. This unique complication has not to our knowledge been reported after harvest of a flap before.Öğe The pain associated with intraarticular hyaluronic acid injections for trapeziometacarpal osteoarthritis(SPRINGER, 2007) Karalezli, Nazim; Ogun, Tunc Cevat; Kartal, Senay; Saracgil, Sacide Nur; Yel, Mustafa; Tuncay, IbrahimTrapeziometacarpal osteoarthritis predominantly affects middle-aged women. Most cases with rhizarthrosis can be managed successfully by conservative means. The purpose of this prospective study was to evaluate pain and tolerability of viscosupplementation therapy with hyaluronic acid (HA) for trapeziometacarpal osteoarthritis. Groups A and B consisted of eight patients each with Eaton stage 3 or 4 rhizarthrosis, who underwent one cycle of three injections of (one per week) 0.3 cm(3) sodium hyaluronate. The injections for group A were under fluoroscopy control, but fluoroscopy was not used in group B. Pain and tolerability of both groups A and B were measured and compared. The patients of the groups were also asked to evaluate the tolerability of the treatment. The results suggested that HA injection in the carpometacarpal joint is a tolerable procedure but the patients complained of pain and discomfort during the injections. The pain in group A was much greater than in group B. Viscosupplementation for the treatment of trapeziometacarpal osteoarthritis is a viable treatment option for stages 3 and 4 patients when they do not want to be operated on. It is a tolerable but not a painless procedure especially when it is done without fluoroscopy control. We recommend giving injections under fluoroscopy control.Öğe Pull-in suture technique for the treatment of mallet finger(LIPPINCOTT WILLIAMS & WILKINS, 2006) Ulusoy, M. Gurhan; Karalezli, Nazim; Kocer, Ugur; Uysal, Afsin; Karaaslan, Onder; Kankaya, Yuksel; Aslan, CaferBackground: Mallet finger deformity is a common disability that causes discomfort and inconvenience to the patient. Although numerous operative techniques have been described, surgical management remains controversial. Methods: Between 2002 and 2004, 19 patients with an unsuccessful splinting reg. imen history, chronic deformities of tendinous origin (> 3 months after the injury), or fractures involving 30 percent or more of the articular surface underwent surgical treatment. In 11 patients, chronic mallet finger deformity with tendinous origin was present, whereas eight patients presented with mallet fractures involving more than 30 percent of the articular surface. Open reduction with internal "pull-in" sutures and distal interphalangeal joint immobilization with Kirschner wire was accomplished. Active motions of the proximal interphalangeal and metacarpophalangeal joints were not restricted. After removal of the Kirschner wire at week 6, active flexion exercises were commenced immediately, and daily activities were not restricted. Full activity was allowed at day 7. Goniometric measurements, radiographs, and patient satisfaction were evaluated during the follow-up period. Results: The mean follow-up period of the patients was 16 months (range, 4 to 28 months). Mean extensor lag of the distal interphalangeal joint was 2 degrees (range, 0 to 6 degrees). The mean flexion of the distal interphalangeal joint was 74 degrees (range, 60 to 90 degrees). According to Crawford's evaluation criteria, 14 excellent and five good results were obtained. Apart from radiologically documented mild degenerative changes or joint narrowing in six patients, no complication was encountered. Conclusion: The pull-in technique allows accurate realignment of the tendon-bone unit without any specific instrumentation or intraoperative fluoroscopic imaging methods.Öğe Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence(HINDAWI LTD, 2013) Karalezli, Nazim; Kutahya, Harun; Gulec, Ali; Toker, Serdar; Karabork, Hakan; Ogun, Tunc C.Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1) the transverse carpal ligament and the distal forearm fascia intact, (2) only the transverse carpal ligament incised, (3) the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand.Öğe Triggering of the Digits After Carpal Tunnel Surgery(LIPPINCOTT WILLIAMS & WILKINS, 2015) Acar, Mehmet Ali; Kutahya, Harun; Gulec, Ali; Elmadag, Mehmet; Karalezli, Nazim; Ogun, Tunc CevatIntroduction Carpal tunnel syndrome (CTS) and trigger finger may be seen simultaneously in the same hand. The development of trigger finger in patients undergoing CTS surgery is not rare, but the relationship between these conditions has not been fully established. The aims of this prospective randomized study were to investigate the incidence of trigger finger in patient groups undergoing transverse carpal ligament releasing (TCL) or TCL together with distal forearm fascia releasing and to identify other factors that may have an effect of these conditions. Materials and Method This prospective randomized study evaluated 159 hands of 113 patients for whom CTS surgery was planned. The patients were separated into 2 groups: group 1 (79 hands of 57 patients) undergoing TCL releasing only and group 2 (80 hands of 56 patients) undergoing TCL and distal forearm fascia releasing together. The age and gender of the patients, dominant hand, physical examination findings, visual analogue scale (VAS), and electromyography (EMG) results were recorded. Follow-up examinations were made at 1, 3, 6, 12, and 24 months for all patients. We noted development of trigger finger in the surgical groups, and its location and response to treatment. Results The incidence of trigger finger development was statistically significantly different between group 1 and group 2 (13.9% and 31.3%, respectively). The logistic regression analysis of factors affecting the development of trigger finger posttreatment found that the surgical method and severity of EMG were significant, whereas the effects of the other factors studied were not found to have any statistical significance. Conclusion There was an increased risk of postoperative trigger finger development in patients undergoing TCL and distal forearm fascia releasing surgery for CTS compared to those undergoing CTL only. There is a need for further studies to support this result and further explain the etiology.Öğe Wrist tourniquet: The most patient-friendly way of bloodless hand surgery(LIPPINCOTT WILLIAMS & WILKINS, 2007) Karalezli, Nazim; Ogun, Cemile Oztin; Ogun, Tunc Cevat; Yidirim, Serhat; Tuncay, IbrahimBackground: The literature is scarce on wrist tourniquets. In this study, three well-established locations of tourniquet setting including upper arm, proximal forearm, and wrist were compared on the same limb using both clinical as well as biochemical variables in paramedical volunteers. Methods. Twenty unmedicated, healthy, paramedical, right-hand dominant volunteers participated in the study. The left upper arms were used for monitoring. Blood pressures and heart rates were monitored and recorded before (baseline) and immediately after the application of the tourniquet, every 5 minutes, and at the time the patient requested deflation. An intravenous cannula (22 G) was placed on the right hand to obtain samples, which were taken at baseline and immediately after deflation of the tourniquet to evaluate the levels of pO(2), pCO(2) O-2 saturation, pH, bicarbonate, blood sugar, lactate, hematocrit, and electrolytes. The tourniquets were applied to the right upper arm, forearm, and wrist of each subject with 5-day intervals between each trial. Subjective discomfort and tourniquet pain levels were recorded. For each trial, tourniquet tolerance and details of discomfort were recorded. Statistical analysis was performed as appropriate. Results: Twenty volunteers aged 20 to 44 years were included. For each trial, in the first 10 minutes after inflation of the tourniquet, the heart rate and systolic blood pressure were increased compared with baseline values. Diastolic blood pressure was elevated immediately after inflation and remained so until deflation in each trial. Diastolic blood pressure values were higher in the upper-arm tourniquet group compared with wrist. Then pH, pO(2), and O-2. saturation values were de-creased and pCO(2) and lactate levels were increased compared with baseline values in each trial. Blood sugar was decreased significantly in the arm group. The decrease in pH, pO(2), O-2 saturation, and blood sugar in the upper arm group was significantly higher compared with wrist and forearm groups. The lactate value was higher in the upper arm group compared with wrist. Visual analog scale and numerical rating scores were lower in the wrist group compared with others at all times. The longest tourniquet tolerance was in the wrist group. In the wrist group, curling was observed in all subjects but the fingers could easily be extended. Conclusion: The wrist tourniquet is the most comfortable technique of bloodless surgery for procedures limited to the hand region.
