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G. S. I. Sulkers - One of the best experts on this subject based on the ideXlab platform.
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diagnosing carpal instabilities using wrist Cineradiography
2020Co-Authors: G. S. I. SulkersAbstract:The wrist is a complex joint, the stability of which is created by a balance between the bones of the wrist (carpal bones), the ligaments of the wrist and the tendons of the forearm. Carpal instability can be divided into three groups: carpal instability dissociative (CID), carpal instability non-dissociative (CIND), carpal instability combined (CIC). A well-known form of a CID is a scapholunar dissociation (SLD). An SLD can be further divided into three stages: predynamic, dynamic and static. As in dynamic and predynamic SLD the intercarpal relationships are not disrupted in the resting position, it is difficult to make an accurate diagnosis by means of a radiograph. It is important for the patient that an SLD should be diagnosed at the earliest stage possible in order to minimalize loss of function. Wrist Cineradiography is the only dynamic radiological investigation that is able to image the carpal bones in real time while the wrist is moved in several directions. This investigation provides good images of the carpal bones and enables the visualization of the movement between the scaphoid and the lunate bones (amongst others). In this way it is possible to diagnose both predynamic and dynamic SLD. In this doctoral thesis we will focus on the diagnosing of an SLD by using the wrist Cineradiography.
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wrist Cineradiography a protocol for diagnosing carpal instability
Journal of Hand Surgery (European Volume), 2018Co-Authors: G. S. I. Sulkers, Niels W. L. Schep, Simon D. Strackee, Mario MaasAbstract:Carpal instability is often related to ruptured or lax carpal ligaments. Wrist Cineradiography has been shown to be a good modality for diagnosing carpal instability. To create uniformity in obtain...
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intraobserver and interobserver variability in diagnosing scapholunate dissociation by Cineradiography
Journal of Hand Surgery (European Volume), 2014Co-Authors: G. S. I. Sulkers, Niels W. L. Schep, Mario Maas, Simon D. StrackeeAbstract:Purpose To evaluate the intraobserver and interobserver variability in diagnosing scapholunate dissociation (SLD) by wrist Cineradiography. Methods A musculoskeletal radiologist, hand surgeon, and trauma surgeon assessed the records of 50 consecutive wrist cineradiographies performed in 25 patients. Fluoroscopy was performed on the unaffected and affected wrist and consisted of radiographer-controlled passive flexion-extension and passive radial-ulnar deviation in both posteroanterior and lateral projections. To determine the intraobserver variability, the 3 reviewers reassessed all wrist cineradiographies 6 months after their first assessment. The kappa coefficient for interobserver agreement was calculated using the jackknife method. The Cohen kappa was used to assess intraobserver variability. Results The interobserver variability for diagnosing SLD by Cineradiography was excellent (κ = 0.84). The intraobserver variability for the hand surgeon was excellent (κ = 0.80), and was good for the radiologist (κ = 0.72) and the trauma surgeon (κ = 0.76). Conclusions Cineradiography is a promising and helpful, noninvasive tool for diagnosing SLD. It is widely available and has relatively low costs. Conventional radiographs remain essential in the primary workup for suspected SLD. However, we recommend Cineradiography when an SLD is clinically suspected. Type of study/level of evidence Diagnostic III.
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The diagnostic accuracy of wrist Cineradiography in diagnosing scapholunate dissociation
The Journal of hand surgery European volume, 2013Co-Authors: G. S. I. Sulkers, Niels W. L. Schep, Mario Maas, C. M. A. M. Van Der Horst, J.c. Goslings, Simon D. StrackeeAbstract:Ruptures of the scapholunate ligament (SLL) may cause carpal instability, also known as scapholunate dissociation (SLD). SLD may lead to osteoarthritis of the radiocarpal and midcarpal joints. The aim of this retrospective study was to determine the diagnostic value of wrist Cineradiography in detecting SLD. All cineradiographic studies made during a 24 year period were retrieved. All patients who underwent the confirmation method (arthroscopy and/or arthrotomy) and Cineradiography were included. In total, 84 patients met the inclusion criteria. Sensitivity, specificity, likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy for detecting SLD were calculated for radiography and Cineradiography. Cineradiography had a sensitivity of 90%, a specificity of 97%, and a diagnostic accuracy of 0.93 in detecting SLD. Radiography had a sensitivity of 81%, a specificity of 80%, and a diagnostic accuracy of 0.81. Cineradiography has a high diagnostic value for diagnosing SLDs. A positive Cineradiography markedly increases the post-test probability of SLD.
Simon D. Strackee - One of the best experts on this subject based on the ideXlab platform.
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wrist Cineradiography a protocol for diagnosing carpal instability
Journal of Hand Surgery (European Volume), 2018Co-Authors: G. S. I. Sulkers, Niels W. L. Schep, Simon D. Strackee, Mario MaasAbstract:Carpal instability is often related to ruptured or lax carpal ligaments. Wrist Cineradiography has been shown to be a good modality for diagnosing carpal instability. To create uniformity in obtain...
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intraobserver and interobserver variability in diagnosing scapholunate dissociation by Cineradiography
Journal of Hand Surgery (European Volume), 2014Co-Authors: G. S. I. Sulkers, Niels W. L. Schep, Mario Maas, Simon D. StrackeeAbstract:Purpose To evaluate the intraobserver and interobserver variability in diagnosing scapholunate dissociation (SLD) by wrist Cineradiography. Methods A musculoskeletal radiologist, hand surgeon, and trauma surgeon assessed the records of 50 consecutive wrist cineradiographies performed in 25 patients. Fluoroscopy was performed on the unaffected and affected wrist and consisted of radiographer-controlled passive flexion-extension and passive radial-ulnar deviation in both posteroanterior and lateral projections. To determine the intraobserver variability, the 3 reviewers reassessed all wrist cineradiographies 6 months after their first assessment. The kappa coefficient for interobserver agreement was calculated using the jackknife method. The Cohen kappa was used to assess intraobserver variability. Results The interobserver variability for diagnosing SLD by Cineradiography was excellent (κ = 0.84). The intraobserver variability for the hand surgeon was excellent (κ = 0.80), and was good for the radiologist (κ = 0.72) and the trauma surgeon (κ = 0.76). Conclusions Cineradiography is a promising and helpful, noninvasive tool for diagnosing SLD. It is widely available and has relatively low costs. Conventional radiographs remain essential in the primary workup for suspected SLD. However, we recommend Cineradiography when an SLD is clinically suspected. Type of study/level of evidence Diagnostic III.
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The diagnostic accuracy of wrist Cineradiography in diagnosing scapholunate dissociation
The Journal of hand surgery European volume, 2013Co-Authors: G. S. I. Sulkers, Niels W. L. Schep, Mario Maas, C. M. A. M. Van Der Horst, J.c. Goslings, Simon D. StrackeeAbstract:Ruptures of the scapholunate ligament (SLL) may cause carpal instability, also known as scapholunate dissociation (SLD). SLD may lead to osteoarthritis of the radiocarpal and midcarpal joints. The aim of this retrospective study was to determine the diagnostic value of wrist Cineradiography in detecting SLD. All cineradiographic studies made during a 24 year period were retrieved. All patients who underwent the confirmation method (arthroscopy and/or arthrotomy) and Cineradiography were included. In total, 84 patients met the inclusion criteria. Sensitivity, specificity, likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy for detecting SLD were calculated for radiography and Cineradiography. Cineradiography had a sensitivity of 90%, a specificity of 97%, and a diagnostic accuracy of 0.93 in detecting SLD. Radiography had a sensitivity of 81%, a specificity of 80%, and a diagnostic accuracy of 0.81. Cineradiography has a high diagnostic value for diagnosing SLDs. A positive Cineradiography markedly increases the post-test probability of SLD.
W A Weijs - One of the best experts on this subject based on the ideXlab platform.
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the functional anatomy of the shoulder in the virginia opossum didelphis virginiana
Journal of Zoology, 2009Co-Authors: Parish A Jenkins, W A WeijsAbstract:The activity of 14 shoulder muscles and the excursions of the shoulder girdle and forelimbs were studied by simultaneous electromyography and Cineradiography in nine opossums (Didelphis virginiana) walking on a treadmill at speeds of 0.52 m/sec to 0.95 m/sec. The relative magnitudes of vertical, propulsive, braking, and transverse forces engendered by the forelimb were measured by means of a force plate and correlated with skeletal postures determined by Cineradiography. This study provides basic functional-anatomical data on the shoulder of a generalized, noncursorial therian which bear on the interpretation of the structural evolution of the shoulder known from the fossil record of mammal-like reptiles and early mammals. The infraspinatus, supraspinatus, subscapularis, atlantoscapularis, rhomboid, triceps and the cervical part of the serratus ventralis usually begin activity during the swing phase and continue throughout most, but not all, of the propulsive phase. The thoracic part of the serratus ventralis, the posterior belly of the omohyoid, the pectoralis, and the posterior part of the latissimus dorsi are active principally during the propulsive phase; EMG signals begin after foot contact and terminate before the foot is lifted from the substrate. The teres major and the anterior part of the latissimus dorsi are active principally during the transition from propulsion to swing phase. The deltoid, posterior trapezius, and atlanto-acromialis are predominantly active during the swing phase, although variable and intermittent activity frequently occurs in the propulsive phase. Peak vertical forces engendered by the forelimbs are on the order of 57 % of body weight. During the propulsive phase the forelimb first exerts a braking and then a propulsive effect. Vectors representing vertical and longitudinal forces usually pass in front of the scapula during the initial part of the propulsive phase, through the scapula during mid-propulsion, and behind the scapula by the end of propulsion. Transverse forces engendered by the forefeet are principally lateral. During mammalian evolution, scapular structure was altered by the addition of a supraspinous fossa, loss of the procoracoid, reduction of the coracoid, and reorientation of the glenoid fossa. The activity patterns of the supraspinatus, infraspinatus, and other muscles support the hypothesis that the mammalian shoulder evolved compensatory stabilizing mechanisms at the same time that it specialized for mobility.
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the functional anatomy of the shoulder in the virginia opossum didelphis virginiana
Journal of Zoology, 2009Co-Authors: Parish A Jenkins, W A WeijsAbstract:The activity of 14 shoulder muscles and the excursions of the shoulder girdle and forelimbs were studied by simultaneous electromyography and Cineradiography in nine opossums (Didelphis virginiana) walking on a treadmill at speeds of 0.52 m/sec to 0.95 m/sec. The relative magnitudes of vertical, propulsive, braking, and transverse forces engendered by the forelimb were measured by means of a force plate and correlated with skeletal postures determined by Cineradiography. This study provides basic functional-anatomical data on the shoulder of a generalized, noncursorial therian which bear on the interpretation of the structural evolution of the shoulder known from the fossil record of mammal-like reptiles and early mammals. The infraspinatus, supraspinatus, subscapularis, atlantoscapularis, rhomboid, triceps and the cervical part of the serratus ventralis usually begin activity during the swing phase and continue throughout most, but not all, of the propulsive phase. The thoracic part of the serratus ventralis, the posterior belly of the omohyoid, the pectoralis, and the posterior part of the latissimus dorsi are active principally during the propulsive phase; EMG signals begin after foot contact and terminate before the foot is lifted from the substrate. The teres major and the anterior part of the latissimus dorsi are active principally during the transition from propulsion to swing phase. The deltoid, posterior trapezius, and atlanto-acromialis are predominantly active during the swing phase, although variable and intermittent activity frequently occurs in the propulsive phase. Peak vertical forces engendered by the forelimbs are on the order of 57 % of body weight. During the propulsive phase the forelimb first exerts a braking and then a propulsive effect. Vectors representing vertical and longitudinal forces usually pass in front of the scapula during the initial part of the propulsive phase, through the scapula during mid-propulsion, and behind the scapula by the end of propulsion. Transverse forces engendered by the forefeet are principally lateral. During mammalian evolution, scapular structure was altered by the addition of a supraspinous fossa, loss of the procoracoid, reduction of the coracoid, and reorientation of the glenoid fossa. The activity patterns of the supraspinatus, infraspinatus, and other muscles support the hypothesis that the mammalian shoulder evolved compensatory stabilizing mechanisms at the same time that it specialized for mobility.
Mario Maas - One of the best experts on this subject based on the ideXlab platform.
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wrist Cineradiography a protocol for diagnosing carpal instability
Journal of Hand Surgery (European Volume), 2018Co-Authors: G. S. I. Sulkers, Niels W. L. Schep, Simon D. Strackee, Mario MaasAbstract:Carpal instability is often related to ruptured or lax carpal ligaments. Wrist Cineradiography has been shown to be a good modality for diagnosing carpal instability. To create uniformity in obtain...
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intraobserver and interobserver variability in diagnosing scapholunate dissociation by Cineradiography
Journal of Hand Surgery (European Volume), 2014Co-Authors: G. S. I. Sulkers, Niels W. L. Schep, Mario Maas, Simon D. StrackeeAbstract:Purpose To evaluate the intraobserver and interobserver variability in diagnosing scapholunate dissociation (SLD) by wrist Cineradiography. Methods A musculoskeletal radiologist, hand surgeon, and trauma surgeon assessed the records of 50 consecutive wrist cineradiographies performed in 25 patients. Fluoroscopy was performed on the unaffected and affected wrist and consisted of radiographer-controlled passive flexion-extension and passive radial-ulnar deviation in both posteroanterior and lateral projections. To determine the intraobserver variability, the 3 reviewers reassessed all wrist cineradiographies 6 months after their first assessment. The kappa coefficient for interobserver agreement was calculated using the jackknife method. The Cohen kappa was used to assess intraobserver variability. Results The interobserver variability for diagnosing SLD by Cineradiography was excellent (κ = 0.84). The intraobserver variability for the hand surgeon was excellent (κ = 0.80), and was good for the radiologist (κ = 0.72) and the trauma surgeon (κ = 0.76). Conclusions Cineradiography is a promising and helpful, noninvasive tool for diagnosing SLD. It is widely available and has relatively low costs. Conventional radiographs remain essential in the primary workup for suspected SLD. However, we recommend Cineradiography when an SLD is clinically suspected. Type of study/level of evidence Diagnostic III.
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The diagnostic accuracy of wrist Cineradiography in diagnosing scapholunate dissociation
The Journal of hand surgery European volume, 2013Co-Authors: G. S. I. Sulkers, Niels W. L. Schep, Mario Maas, C. M. A. M. Van Der Horst, J.c. Goslings, Simon D. StrackeeAbstract:Ruptures of the scapholunate ligament (SLL) may cause carpal instability, also known as scapholunate dissociation (SLD). SLD may lead to osteoarthritis of the radiocarpal and midcarpal joints. The aim of this retrospective study was to determine the diagnostic value of wrist Cineradiography in detecting SLD. All cineradiographic studies made during a 24 year period were retrieved. All patients who underwent the confirmation method (arthroscopy and/or arthrotomy) and Cineradiography were included. In total, 84 patients met the inclusion criteria. Sensitivity, specificity, likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy for detecting SLD were calculated for radiography and Cineradiography. Cineradiography had a sensitivity of 90%, a specificity of 97%, and a diagnostic accuracy of 0.93 in detecting SLD. Radiography had a sensitivity of 81%, a specificity of 80%, and a diagnostic accuracy of 0.81. Cineradiography has a high diagnostic value for diagnosing SLDs. A positive Cineradiography markedly increases the post-test probability of SLD.
Takemi Kawara - One of the best experts on this subject based on the ideXlab platform.
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obstruction of st jude medical valves in the aortic position significance of a combination of Cineradiography and echocardiography
The Journal of Thoracic and Cardiovascular Surgery, 2000Co-Authors: Shigeaki Aoyagi, Masaru Nishimi, Hiroshi Kawano, Eiki Tayama, Shuji Fukunaga, Nobuhiko Hayashida, Hidetoshi Akashi, Takemi KawaraAbstract:Abstract Background: Obstruction of the St Jude Medical valve (St Jude Medical, Inc, St Paul, Minn) is a rare but serious complication. Methods: Cineradiographic and echocardiographic evaluations of aortic St Jude Medical valves were simultaneously performed on 54 patients, with no signs of prosthetic valve dysfunction late after surgery. Results: Although closing angles of the leaflets corresponded closely with the manufacturer data, restricted opening of the leaflets (opening angle ≥ 20°) was found in 16 (group D) of the 54 patients by means of Cineradiography. The opening angles were equal to or less than 14° in the other 23 patients (group N) and between 15° and 19° in the remaining 15 (group M). Doppler-derived transprosthetic pressure gradients were significantly higher ( P =.03) and the velocity index was significantly lower ( P =.003) in group D than in group N. However, no significant differences were found in those values between group N and group M. Replacement of the aortic St Jude Medical valves was performed in 5 of the 16 patients, and the remaining 11 have been followed up because of relatively low pressure gradients. The cause of restricted leaflet movement was pannus formation without thrombosis in 4 patients and valve thrombosis with pannus formation in one. Conclusions: Reduced valve orifice area and restricted opening of the leaflets resulting from excess growth of pannus probably led to obstruction of the aortic St Jude Medical valves. A combination of Cineradiography and echocardiography makes it possible to provide an accurate and detailed diagnosis of obstruction of the valve. (J Thorac Cardiovasc Surg 2000;120:142-7)
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obstruction of the st jude medical valve diagnostic and therapeutic values of Cineradiography
Thoracic and Cardiovascular Surgeon, 1993Co-Authors: Shigeaki Aoyagi, Takemi Kawara, Y Higa, S Matsuzoe, Y Nishi, K Tanaka, Atsushige Oryoji, K Kosuga, K OishiAbstract:Between 1984, and 1992, we observed 8 patients with an ob structed St. Jude Medical (SJM) valve. Of these, 1 had an ob structed SJM valve in the aortic Position, 3 in the mitral posi tion, and 4 in the tricuspid position. Diagnosis of obstruction of the SJM valve was made by Cineradiography combined with echocardiography in all 8 patients. Restriction or absence of movement of the leaflet of the SJM valve was observed by cin eradiography in all of the 8 patients. Normal range of leaflet mobility of the SJM valve was measured by conventional cin eradiography in 70 patients with a normal SJM valve, and the results were compared with the leaflet mobility obtained from the 8 patients with an obstructed SJM valve. In this study, lea flet function in the obstructed SJM valve was strikingly abnor mal, with both opening and closing angles, and leaflet motion clearly outside the normal range. Of the 8 patients, 4 under went urgent prosthetic valve replacements after cineradio graphy and echocardiography were carried out. Thrombolysis using Urokinase was performed in 4 patients, and this treat-ment was successful in 1 patient. Efficacy of thrombolytic therapy was evaluated by repeat Cineradiography. Three of the 4 patients who received thrombolysis showed no signifi cant improvement of leaflet mobility after at least 72 hours of thrombolytic therapy, and finally required surgical correction for the obstructed SJM valve. We believe that Cineradiography combined with echocardiography is the optimal method for the diagnosis of obstruction of the SJM valve, and to follow the effect of thrombolytic therapy on prosthetic valve function. Al though thrombolytic therapy is considered the first choice of treatment for obstructed SJM valve in selected patients, pa tients who do not respond to thrombolytic therapy within 48-72 hours should be referred for surgery. Es wird von uber 8 Patienten mit thrombotisch obstruierter St. Jude Medical Klappe (SJM) berichtet, von denen 4 notfall masig operiert und 4 einer Thrombolyse unterworfen wurden; diese war jedoch nur in 1 Fall an der Tricuspidalis erfolgreich, in den 3 anderen Fallen muste dann auch operiert worden. Viermal war die Tricuspidalklappe, dreimal die Mitralklappe und einmal die Aortenklappe betroffen. Die Diagnose wurde jeweils mittels Cineradiographie und Echokardiographie ge stellt. An 70 anderen Patienten mit einer normalen SJM-Klap pe wurde die Beweglichkeit der Klappenscheiben mittels kon ventioneller Cineradiographie ausgemessen und mit den 8 Pa tienten verglichen. Die Autoren betrachten die Kombination von Cineradiographie und Echokardiographie als die optimale diagnostische Methode zur Erkennung der Klappenobstruk tion, aber auch zur Uberprufung des Erfolgs einer thromboly tischen Behandlung.