[Aama-cases] AAMA/MARF Case Sharing Info

[boxwood at aol.com]

I would explore the tendon and relieve the mechanical problem.
?Post-op consider Luo Yuan Shunt of TH/MH, with Ba Xie if needed, with Inverse and Contrary points if needed.

Dein Shapiro MD


-----Original Message-----
From: JDOWDEN at prodigy.net
To: aama-cases at lists.olympus.net
Sent: Thu, 3 Apr 2008 9:03 pm
Subject: [Aama-cases] AAMA/MARF Case Sharing Info



On 04/03/2008, the following Case Sharing Info was submitted to AAMA/MARF:

Name of Physician:  David Gibson, MD

Diagnosis/Symptom:  traumatic hand injury; finger amputation

Age and Sex of Patient: 

Current Medications:    none

Tounge & Pulse: 

Response to previous therapies: Scar infiltration with lidocaine attempted but 
discontinued due to pain and hypersensitivity.

Brief Medical History:  Right hand dominant male s/p traumatic (farm machinery) 
hand injury 8/2007 with palmar laceration from thenar area to prox. phalanx of 
middle finger with resulting flexor tendon laceration (middle finger)which has 
been functionally repaired and resulting flexion contracture of middle finger 
primarily over MCP and PIP, amputation of right ring finger(#4) at PIP, and 
amputation of little finger in the middle of middle phalanx.  More specifically 
surgical repair of right middle finger flexor digitorum profundus in zone 2, 
repair of middle finger flexor digitorum superficialis in zone 2, and repair of 
middle finger ulnar digital nerve. Well healthed scars. Has been dedicated with 
hand therapy.

Main Patient Complaint: 1)flexion contracture of middle finger which can be 
improved with slow progressive stretching through aggressive manual assisted 
hand therapy but can not be maintained. 
2)He can't flex at little finger PIP. Little finger flexion is intact at MCP; 
proximal and middle phalanx will move as a single unit with result being MCP 
flexion and mid phalanx "sticking out" in line with prox. phalanx, though 
passively there is good/normal motion at little finger PIP.  

He has been offered the option of exploration of palmar flexor tendon laceration 
and "cleaning up the adhesions".

Questions or Comments on the Case:  
Recommendations to improve middle finger ROM consistently and possibly PIP 
motion at little finger (though I realize this could be due to lack of tendon 
reapproxiamtion to mid phalanx little finger).

Submitter/Poster:
-----------------------
Name:   David Gibson
Address:    
Phone Number:   919.742.6032
Email Address:  david_gibson at med.unc.edu
AAMA number:    16252

This information comes directly from a form on the AAMA Website.  
The submitter may not be a member of the aama-cases list.  Please respond
to this submission with a copy to david_gibson at med.unc.edu as well as the 
aama-cases list.

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