Martin Posner, M.D.

Benign extraosseous cartilage tumours of the hand and wrist
Christoforou, D; Strauss, E J; Abramovici, L; Posner, M A
2012 Jan;37(1):8-13, Journal of hand surgery, European volume
Benign extraosseous cartilage tumours of the hand and wrist comprise soft tissue chondromas, synovial chondromatosis and tenosynovial chrondromatosis. These tumours can significantly affect patients as they are often painful, functionally limiting and cosmetically displeasing. Although each tumour is generally considered to be a distinct entity, they share radiological and histopathological similarities. Occasionally, all three tumours may be seen in the same patient. This is an important consideration because of the risk of recurrence that may not necessarily occur at the same anatomical site but instead extend to different sites, such as a tendon sheath and/or joint
— id: 149795, year: 2012, vol: 37, page: 8, stat: Journal Article,

Restoration of opposition
Posner, Martin A; Kapila, Deepak
2012 Feb;28(1):27-44, Hand clinics
Opposition is not grasp but a preposition for grasp that involves 3 components of thumb movements: abduction, flexion, and pronation. Thumb opposition is usually lost with paralysis of the thenar muscles innervated by the median nerve. Many opposition transfers have been described that differ in the donor tendon, route of transfer, and method of attachment to the thumb. No one transfer is applicable for every clinical condition, and each transfer has its advantages and disadvantages. Many factors must be evaluated to decide if surgery is likely to be beneficial and then decide on the optimum treatment
— id: 141987, year: 2012, vol: 28, page: 27, stat: Journal Article,

Correlation of malrotation deformity in distal radius fractures with radiographic analysis: cadaveric study
Lee, Steve K; Shin, Robert; Zingman, Alissa; Loona, Justin; Posner, Martin A
2010 Feb;35(2):228-232, Journal of hand surgery (American volume)
PURPOSE: The radiographic parameters commonly used for evaluating distal radius fractures are radial length, palmar tilt, radial inclination, and articular congruity. Rotation of the distal fragment is not routinely evaluated after distal radius fractures. The purpose of this study was to define the appearance of distal fragment malrotation on conventional radiographs and to correlate varying degrees of malrotation with the corresponding radiographic findings. METHODS: Six distal radiuses from embalmed cadavers were cut and stabilized in 10 degrees, 20 degrees, and 30 degrees of pronated malrotation. Posteroanterior, lateral, and oblique (45 degrees pronated view) radiographs were taken and radiographic measurements were made of radial length, palmar tilt, radial inclination, and rotation. RESULTS: With malrotation, the visible cortical width of the distal fragment mismatched the visible cortical width of the proximal fragment. This was most evident on the oblique view (p < .05) and measured 2.2 mm for 10 degrees of rotation (standard deviation [SD] 0.6), 3.4 mm for 20 degrees of rotation (SD 0.8), and 5.3 mm for 30 degrees of rotation (SD 2.2). CONCLUSIONS: The radiographic parameter of rotation should be considered when evaluating distal radius fracture reduction. Malrotation is best seen on a 45 degrees oblique pronated radiographic view as a mismatch of the cortical width of the distal fragment compared with the cortical width of the proximal fragment. In the absence of radial shortening, a 5.3-mm mismatch is associated with 30 degrees of malrotation and is the upper limit of acceptability
— id: 107372, year: 2010, vol: 35, page: 228, stat: Journal Article,

Intraosseous and extraosseous attachments of flexor tendon to bone: a biomechanical in vivo study in rabbits
Green, Steven M; Posner, Martin A
2009 Nov;38(11):E170-E172, American journal of orthopedics (Belle Mead, NJ)
There are 2 popular methods of repairing flexor tendons to the distal phalanx and attaching a free tendon graft to bone: intraosseous, by implanting the tendon into a bony tunnel, and extraosseous, by suturing the tendon to the cortical surface after elevating the periosteum. An in vivo study was designed to determine whether one method is stronger than the other. The profundus flexor of the third and fourth toes of the hind paw of adult rabbits was divided and reattached to the middle phalanx using either an intraosseous tunnel or an extraosseous suture. Half the rabbits were killed after 3 weeks, the other half after 8 weeks. Repairs were then tested to failure, using an Instron device, and compared with the same tendons in the nonoperated limbs. The repaired tendons demonstrated similar strength 3 weeks and 8 weeks after surgery but were significantly weaker than the nonoperated tendons. The importance of this study is that it gives equal credence to these usual methods of tendon attachment
— id: 106105, year: 2009, vol: 38, page: E170, stat: Journal Article,

Cold exposure injuries to the extremities
Golant, Alexander; Nord, Russell M; Paksima, Nader; Posner, Martin A
2008 Dec;16(12):704-715, Journal of the American Academy of Orthopaedic Surgeons
Cold exposure injuries comprise nonfreezing injuries that include chilblain (aka pernio) and trench, or immersion, foot, as well as freezing injuries that affect core body tissues resulting in hypothermia of peripheral tissues, causing frostnip or frostbite. Frostbite, the most serious peripheral injury, results in tissue necrosis from direct cellular damage and indirect damage secondary to vasospasm and arterial thromboses. The risk of frostbite is influenced by host factors, particularly alcohol use and smoking, and environmental factors, including ambient temperature, duration of exposure, altitude, and wind speed. Rewarming for frostbite should not begin until definitive medical care can be provided to avoid repeated freeze-thaw cycles, as these cause additional tissue necrosis. Rewarming should be rapid and for an affected limb should be performed by submersion in warm water at 104 degrees to 107.6 degrees F (40 degrees to 42 degrees C) for 15 to 30 minutes. Debridement of necrotic tissues is generally delayed until there is a clear demarcation from viable tissues, a process that usually takes from 1 to 3 months from the time of initial exposure. Immediate escharotomy and/or fasciotomy is necessary when circulation is compromised. In addition to the acute injury, frostbite is associated with late sequelae that include altered vasomotor function, neuropathies, joint articular cartilage changes, and, in children, growth defects caused by epiphyseal plate damage
— id: 96880, year: 2008, vol: 16, page: 704, stat: Journal Article,

Upper extremity replantations in Renaissance art
Posner, Martin A; Rinaldi, Elio
2008 Oct;33(8):1440-1441, Journal of hand surgery (American volume)
— id: 92679, year: 2008, vol: 33, page: 1440, stat: Journal Article,

Multiple neurilemomas in the upper extremity: a series of three cases
Vigler, Mordechai; Levine, Lewis J; Posner, Martin A
2008 ;66(1):61-64, Bulletin of the NYU Hospital for Joint Diseases
Neurilemomas are the most frequently arising benign nerve tumors of the upper extremity and are also called Schwannomas. Generally, they present as solitary tumors, although multiple tumors are common. Regardless of number, they are usually found on the lexor surface of the forearm and hand, and multiple tumors are almost always located within a single major nerve, its branches, or both. We present three patients who had multiple neurilemomas; two patients had tumors within a single major nerve and its branches, and the third patient had an unusual occurrence of one tumor in the ulnar nerve and a second tumor in a branch of the median nerve
— id: 79374, year: 2008, vol: 66, page: 61, stat: Journal Article,

A new technique for reconstruction of the ulnar collateral ligament of the thumb
Baskies, Michael A; Tuckman, David; Paksima, Nader; Posner, Martin A
2007 Aug;35(8):1321-1325, American journal of sports medicine
BACKGROUND: Several previous studies have described reconstructive methods for the treatment of an injury to the ulnar collateral ligament of the thumb. However, there are few biomechanical studies to date to analyze the strength of the surgical reconstruction. PURPOSE: To evaluate 2 reconstruction techniques with use of a cadaveric model: (1) reconstruction with the use of a free tendon graft placed in a figure-of-8 fashion through drill holes in the metacarpal and proximal phalanx of the thumb, and (2) reconstruction with the use of the Bio-Tenodesis Screw System. STUDY DESIGN: Controlled laboratory study. METHODS: Eight matched pairs of cadaveric specimens underwent removal of the proper and accessory ulnar collateral ligaments. One of the 2 reconstruction methods was performed, and specimens were mounted on a materials-testing machine. The specimens were subjected to valgus stress to failure at 30 degrees of flexion. Failure was defined as valgus laxity of 30 degrees at the metacarpophalangeal joint. RESULTS: The peak load to failure was 23.5 +/- 11.4 N for the figure-of-8 reconstruction and 24.3 +/- 12.3 N for the reconstruction using the Bio-Tenodesis Screw System. Comparing the 2 groups, there was no statistically significant difference in peak loads to failure (P = .88). CONCLUSION: There was no statistically significant difference between the peak loads to failure of the 2 reconstructions. CLINICAL RELEVANCE: The Bio-Tenodesis Screw System may provide another viable option for surgical reconstruction of the ulnar collateral ligament of the thumb
— id: 74299, year: 2007, vol: 35, page: 1321, stat: Journal Article,

Failed surgery for ulnar nerve compression at the elbow
Ruchelsman, David E; Lee, Steve K; Posner, Martin A
2007 Aug;23(3):359-71, vi, Hand clinics
Surgical procedures for the treatment of ulnar nerve compression at the elbow are well described. Studies have reported clinical outcomes after decompression of the nerve without transposition and decompression with transposition. Numerous preoperative, intraoperative, and postoperative factors contribute to failure of the surgical procedures. Although the techniques available for revision decompression of the ulnar nerve at the elbow are similar to those used in the primary setting, the results after repeat surgical intervention are less predictable
— id: 75372, year: 2007, vol: 23, page: 359, stat: Journal Article,

Cortico-medullary continuity in bizarre parosteal osteochondromatous proliferation mimicking osteochondroma on imaging
Rybak, Leon D; Abramovici, Luigia; Kenan, Samuel; Posner, Martin A; Bonar, Fiona; Steiner, German C
2007 Sep;36(9):829-834, Skeletal radiology
Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora's lesion, is an unusual surface-based lesion of bone found most commonly in the hands and feet. In the original description of the lesion and in all publications that followed, one of the key imaging characteristics used to define this entity was the lack of cortico-medullary continuity with the underlying bone. The authors present 4 unique cases of pathologically proven BPOP in which cortico-medullary continuity with the underlying bone was demonstrated on imaging. It is believed that florid reactive periostitis, BPOP and turret osteochondroma may reflect points along the same continuum with trauma the likely inciting event. The authors suggest that, given this continuum, it may be possible to have BPOP lesions demonstrating overlapping imaging features with osteochondroma. If this is the case, strict adherence to the standard imaging criterion of lack of continuity between the lesion and the underlying bone may lead to misdiagnosis of these unusual cases of BPOP as osteochondromas
— id: 78630, year: 2007, vol: 36, page: 829, stat: Journal Article,

Wrist arthroscopy
Elkowitz, Stuart J; Posner, Martin A
2006 ;64(3-4):156-165, Bulletin of the NYU Hospital for Joint Diseases
— id: 72407, year: 2006, vol: 64, page: 156, stat: Journal Article,

Safety and efficacy of the infraclavicular nerve block performed at low current
Keschner, Mitchell T; Michelsen, Heidi; Rosenberg, Andrew D; Wambold, Daniel; Albert, David B; Altman, Robert; Green, Steven; Posner, Martin
2006 Jun;6(2):107-111, Pain practice
It has recently been suggested that peripheral nerve or plexus blocks performed with the use of a nerve stimulator at low currents (<0.5 mA) may result in neurologic damage. We studied the infraclavicular nerve block, performed with the use of a nerve stimulator and an insulated needle, in a prospective evaluation of efficacy and safety. During a one-year period, 248 patients undergoing infraclavicular nerve block were evaluated for block success rate and incidence of neurologic complication. All blocks were performed with the use of a nerve stimulator and an insulated needle at < or =0.3 mA. Success rate was 94%, which increased to 96% with surgical infiltration of local anesthetic. There were no intraoperative or immediate postoperative complications noted. After one week, only one patient had a neurologic complaint, and this was surgically related, referable to surgery performed on the radial nerve. We conclude that infraclavicular nerve blocks performed at low currents (< or =0.3 mA) are safe and effective
— id: 71211, year: 2006, vol: 6, page: 107, stat: Journal Article,

Malignant tumors of the hand and wrist
Plate, Ann-Marie; Steiner, German; Posner, Martin A
2006 Nov;14(12):680-692, Journal of the American Academy of Orthopaedic Surgeons
Malignant tumors in the hand and wrist compose a wide variety of lesions involving skin, soft tissues, and bone. Although these lesions are found elsewhere in the body, many have unique characteristics at this anatomic location. Skin tumors predominate; the most common are squamous cell carcinomas, followed in frequency by basal cell carcinomas and malignant melanomas. Other soft-tissue malignancies are less common but may present more difficult diagnostic problems. They often appear as painless masses that sometimes have been present for months or even years and deceptively appear to be benign. A missed or delayed diagnosis of these tumors can have devastating consequences. Bone malignancies involve both primary lesions, of which chondrosarcomas are the most common, and metastatic lesions. Regardless of cell type, treatment of malignant tumors in the hand and wrist requires special considerations because of the important function of these structures. Orthopaedic surgeons should be familiar with the spectrum of these tumors, the work-up necessary to arrive at a precise diagnosis, and the treatment that will achieve the most favorable outcome
— id: 70027, year: 2006, vol: 14, page: 680, stat: Journal Article,

An unusual rupture of the flexor carpi radialis tendon: a case report
Polatsch, Daniel B; Foster, Lawrence G; Posner, Martin A
2006 Mar;35(3):141-143, American journal of orthopedics (Belle Mead, NJ)
We present the unusual case of a flexor carpi radialis tendon that ruptured after extended strenuous physical activity by a patient with paralysis of the opposite limb secondary to poliomyelitis
— id: 66696, year: 2006, vol: 35, page: 141, stat: Journal Article,

Fixation of tendon grafts for collateral ligament reconstructions: a cadaveric biomechanical study
Lee, Steve K; Kubiak, Erik N; Liporace, Frank A; Parisi, Debra M; Iesaka, Kazuho; Posner, Martin A
2005 Sep;30(5):1051-1055, Journal of hand surgery (American volume)
PURPOSE: To compare the biomechanical properties of 4 methods of fixation of tendon grafts to bone as used for ligament reconstructions. METHODS: Thirty-two metacarpals were harvested from fresh-frozen cadavers and stripped of soft tissue. Flexor tendons were harvested from the same cadavers and cut into 2-mm-wide strips. Each tendon was fixed to a metacarpal head at the site of origin of a collateral ligament. Four different methods of fixation were tested. In group 1 the tendon was fixed to the bone with a 4.0-mm Arthrex bio-tenodesis interference screw (Arthrex, Inc., Naples, FL). In group 2 the tendon was passed through a bone tunnel and fixed with a 3.2-mm mini-Acutrak screw (Acumed, LLC, Hillsboro, OR) that was inserted in interference mode. In group 3 the tendon was passed through a bone tunnel and fixed with sutures tied over a polyethylene button. In group 4 the tendon was fixed with a mini-Mitek bone suture anchor (Mitek Worldwide, Norwood, MA). All specimens were clamped into a linear loading machine and loaded until failure. Statistical analysis was performed by 1-way analysis of variance testing. RESULTS: The differences in maximal tensile strength and stiffness were statistically significant when comparing any 2 groups. The Arthrex biotenodesis interference screw was the strongest and stiffest fixation method, followed by the Acutrak screw inserted in interference mode. Next was the suture tied over a button method. The mini-Mitek bone suture anchor was the weakest. CONCLUSIONS: Interference screw fixation of tendons to bone has statistically significant higher pullout strength and stiffness than 2 other commonly used fixation methods. The use of interference screws for fixation of tendon grafts to bone for hand ligament reconstructions is a promising new surgical technique
— id: 61261, year: 2005, vol: 30, page: 1051, stat: Journal Article,

Refining the diagnoses of inattention and overactivity syndromes: A reanalysis of the Multimodal Treatment study of attention deficit hyperactivity disorder (ADHD) based on ICD-10 criteria for hyperkinetic disorder
Santosh, PJ; Taylor, E; Swanson, J; Wigal, T; Chuang, S; Davies, M; Greenhill, L; Newcorn, J; Arnold, LE; Jensen, P; Vitiello, B; Elliott, G; Hinshaw, S; Hechtman, L; Abikoff, H; Pelham, W; Hoza, B; Molina, B; Wells, K; Epstein, J; Posner, M
2005 DEC ;5(5-6):307-314, Clinical neuroscience research
There are large differences between nations in the diagnosis and management of children with marked impulsiveness and inattention. The differences extend to the names and definitions of disorder and the extent to which medication should be used. This paper uses data from a large randomized clinical trial of pharmacological and psychosocial treatments, conducted in North America, to clarify its implications for other parts of the world. A diagnostic algorithm was applied to 579 children, diagnosed with ADHD-Combined Type in the MTA trial, to generate the ICD-10 diagnosis of 'hyperkinetic disorder' (HD); only a quarter met these more stringent criteria. HD was a moderator of treatment response. The superiority of medication to behavioral treatment was greater for children with HD. Children with ADHD but not HD also showed some improvement with medication. The results provide evidence for the validity of HD as a subgroup of those presenting ADHD; and suggest that treatment with stimulants is a high priority in children with HD. Results also suggest that some children with other forms of ADHD will respond better to medication than to psychosocial intervention, and therefore that European guidelines should extend their indications.
— id: 61375, year: 2005, vol: 5, page: 307, stat: Journal Article,

Bizarre parosteal osteochondromatous proliferation (Nora's lesion) in the hand
Michelsen, Heidi; Abramovici, Luigia; Steiner, German; Posner, Martin A
2004 May;29(3):520-525, Journal of hand surgery (American volume)
PURPOSE: The purpose of this study was to review our experience with a benign surface bone lesion referred to as bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion, named for the pathologist who described it in 1983. The lesion may be confused with a variety of tumors, particularly solitary osteochondromas, which are rare. METHODS: The files in the Department of Pathology at the Hospital for Joint Diseases were reviewed over a 21-year period for all surface bone lesions involving the tubular bones in the hand. There were a total of 10 cases of BPOP compared with only a single case of an osteochondroma. RESULTS: Radiographs generally showed a well-marginated uniformly dense mass arising from the surface of the affected bone without any disruption in its bony architecture. Surgical excision is the definitive treatment and included the fibrous pseudocapsule over the lesion, any periosteal tissue beneath the lesion, and any area of the cortex of the host bone that appeared abnormal. Although in the medical literature the recurrence rate for BPOP is high, we had only one recurrence in our series. CONCLUSIONS: BPOP is a benign surface bone lesion that may be confused with benign and malignant tumors. Although there is a cleavage plane between the lesion and host bone, we recommend excising the pseudocapsule over the lesion, any periosteal tissue beneath the lesion, and decorticating any abnormal-appearing areas in the underlying host bone. This may explain the low recurrence rate in our series
— id: 79376, year: 2004, vol: 29, page: 520, stat: Journal Article,

A meta-analysis of the literature on distal radius fractures: review of 615 articles
Paksima, Nader; Panchal, Anand; Posner, Martin A; Green, Steven M; Mehiman, Charles T; Hiebert, Rudi
2004 ;62(1-2):40-46, Bulletin (Hospital for Joint Diseases)
A structured meta-analysis of the available literature was performed to evaluate the outcome of the treatment of displaced intra-articular fractures of the distal radius. A comprehensive search of Medline using the key words 'radius' and 'fracture' revealed over 4,000 articles. After limiting the search to clinical trials in English and excluding pediatric and geriatric age groups as well as biomechanical and animal studies, 615 abstracts were identified in the period from 1976 to May 1998. Thirty-one articles met the inclusion and exclusion criteria. These included two prospective randomized comparative trials, two non-randomized comparative trials, one half prospective case series and half historical control, and 27 papers on case series. Four papers dealt with external fixation versus closed reduction and cast treatment and one paper looked at open reduction internal fixation with or without additional external fixation. There was insufficient data to perform a scientific meta-analysis because of the poor quality of the studies and lack of a uniform method of outcome assessment. However, the data from the comparative trials showed that external fixation was favored over closed reduction and casting. Additionally, comparing the results of the case series showed that external fixation was superior to internal fixation
— id: 47335, year: 2004, vol: 62, page: 40, stat: Journal Article,

Demyelinating focal motor neuropathy of the ulnar nerve masquerading as compression in Guyon's canal: a case report
Dhillon, Manjit S; Chu, Mary Lynn; Posner, Martin A
2003 Jan;28(1):48-51, Journal of hand surgery (American volume)
Ulnar nerve-innervated intrinsic muscle weakness, in the absence of sensory complaints or deficits, usually is the result of compression at the ulnar nerve in zone II of Guyon's canal. In rare instances the problem is not caused by a compressive neuropathy but by a demyelinating focal motor neuropathy. Demyelinating neuropathies have been well documented in the neurologic literature but they have received little attention in the hand surgery literature. We report on one such case and the importance of differentiating the 2 neuropathies. Although surgery often is necessary for a compressive neuropathy it is contraindicated for a demyelinating neuropathy
— id: 43245, year: 2003, vol: 28, page: 48, stat: Journal Article,

Tumorlike lesions and benign tumors of the hand and wrist
Plate, Ann-Marie; Lee, Steven J; Steiner, German; Posner, Martin A
2003 Mar-Apr;11(2):129-141, Journal of the American Academy of Orthopaedic Surgeons
A broad spectrum of tumorlike lesions and neoplasms can occur in the hand and wrist, although with somewhat less frequency than in other parts of the body. A thorough understanding of the differential diagnosis of these lesions and a comprehensive strategy for evaluation are central for effective care. Plain radiographs are diagnostic for most bony lesions, whereas magnetic resonance imaging may be necessary to help differentiate a benign soft-tissue lesion from the rare malignant neoplasm. In spite of the complex anatomy, adherence to proper oncologic principles most often will lead to a satisfactory outcome
— id: 36173, year: 2003, vol: 11, page: 129, stat: Journal Article,

Medical history of carpal tunnel syndrome
Michelsen, Heidi; Posner, Martin A
2002 May;18(2):257-268, Hand clinics
The anatomical configuration of the carpal tunnel is that of an inelastic channel. Consequently, any increase in its volume or alteration in shape will usually result in a significant increase in interstitial pressure. At a pressure threshold of 20 mm Hg to 30 mm Hg, epineurial blood flow is compromised. When that pressure is sustained, the symptoms and physical findings associated with CTS appear. Typically, patients present with intermittent pain and paresthesias in all or part of the median nerve distribution of their hand(s). As weeks and months pass, symptoms progressively increase in frequency and severity. Eventually, thenar muscle weakness develops that initially manifests itself as 'fatigue,' or 'tiredness.' The progressive increase in symptoms and physical findings, usually accompanied by a progressive deterioration in electrodiagnostic studies, facilitates the classification of the condition into early, intermediate, and advanced stages. The increase in interstitial pressure in the carpal tunnel is in the vast majority of cases idiopathic (spontaneous). It can also be caused by a myriad of other conditions that can be classified into three other categories: intrinsic factors that increase the volume of the tunnel (outside and inside the nerve), extrinsic factors that alter the contour of the tunnel, and repetitive/overuse conditions. In addition, there is another category of neuropathic factors that affect the nerve without increasing interstitial pressure. In rare situations CTS can present as an acute problem. Far less common than the chronic form of the condition, it can follow acute wrist trauma, rheumatologic disorders, hemorrhagic problems, vascular disorders affecting a patent median artery, and high pressure injection injuries. Prompt recognition is important, followed in most cases by urgent surgical decompression of the median nerve
— id: 79377, year: 2002, vol: 18, page: 257, stat: Journal Article,

Boxer's Knuckle
Stracher, Michael; Posner, Martin A
2002 Dec;6(4):196-199, Techniques in hand & upper extremity surgery
Tear of the dorsal capsule of a finger metacarpophalangeal joint is an uncommon injury that should be differentiated from an injury to the sagittal fibers of the extensor hood. While the latter injury can often be treated nonoperatively, a dorsal capsular injury usually requires surgery, particularly in athletes who are disabled by the injury
— id: 79375, year: 2002, vol: 6, page: 196, stat: Journal Article,

Intratendinous rupture of a flexor tendon graft many years after staged reconstruction: a report of three cases
Eshman, S J; Posner, M A; Green, S M; Meals, R A
2000 Nov;25(6):1135-1139, Journal of hand surgery (American volume)
Three cases of rupture of a flexor tendon graft many years after surgery are presented. Two cases occurred 12 years after reconstruction and the third case occurred 21 years after reconstruction. Each rupture was intratendinous, just proximal to the flexor tendon sheath in 2 cases and at the proximal edge of the transverse carpal ligament in the third case. Active digital flexion was restored by transfer of the flexor digitorum superficialis from an adjacent finger to the distal tendon stump or by direct end-to-end repair of the rupture site reinforced with an onlay autogenous patch graft. Patients undergoing tendon grafting should be alerted to the possibility of rupture, even many years later
— id: 145551, year: 2000, vol: 25, page: 1135, stat: Journal Article,

Compressive neuropathies of the ulnar nerve at the elbow and wrist
Posner MA
2000 ;49:305-317, Instructional course lectures (American Association of Orthopaedic Surgeons)
Compressive neuropathy of the ulnar nerve in the upper limb is a common problem that frequently results in severe disabilities. At the elbow, Lundborg concluded that the nerve was 'asking for trouble' because of its anatomic course through confined spaces and posterior to the axis of elbow flexion. Normally, the ulnar nerve is subjected to stretch and compression forces that are moderated by its ability to glide in its anatomic path around the elbow. When normal excursion is restricted, irritation ensues. This results in a cycle of perineural scarring, further loss of excursion, and progressive nerve damage. Initial treatment for the acute and subacute neuropathy at the elbow is nonsurgical. Rest and avoiding pressure on the nerve may suffice, but if symptoms persist, splint immobilization of the elbow and wrist is warranted. For chronic neuropathy associated with muscle weakness, or neuropathy that does not respond to conservative measures, surgery is usually necessary. A variety of surgical procedures have been described in the medical literature, and deciding on the most effective procedure can be difficult considering the excellent results claimed by proponents for each. Unfortunately, there is a paucity of information based on prospective randomized clinical studies comparing the different surgical methods. Dellon attempted to provide some guidelines by reviewing the data in 50 articles dealing with nonsurgical and surgical treatment of ulnar neuropathies at the elbow. In order to provide uniform data, he re-interpreted the data in these articles using his own system for staging nerve compression. He reported that treatment was most successful for mild neuropathies, a conclusion few would challenge. Excellent results were also achieved in 50% of patients with mild neuropathies that were treated nonsurgically and in more than 90% treated by surgery, regardless of the procedure. For moderate neuropathies, nonsurgical treatment was generally unsuccessful, as were decompressions in situ. Medial epicondylectomies were effective in only 50% of cases and they had the highest recurrence rate. Regarding ulnar nerve transpositions, each method has its proponents, usually based on the training and experience of the surgeon. Subcutaneous transposition is the least complicated. It is an effective procedure, particularly in the elderly and in patients who have a thick layer of adipose tissue in their arms. It is the procedure of choice for repositioning the nerve during surgical reductions of acute fractures, arthroplasties of the elbow, and secondary neurorrhaphies. Intramuscular and submuscular transpositions are more complicated procedures. Although proponents of intramuscular transposition report favorable results, the procedure can result in severe postoperative perineural scarring. Submuscular transposition has a high degree of success and is generally accepted to be the preferred procedure when prior surgery has been unsuccessful. I also prefer it as the primary procedure for most chronic neuropathies that require surgery. Compressive neuropathies of the ulnar nerve in the canal of Guyon are less common, but they can also result in significant disabilities. Compression can occur in 1 of 3 zones. Zone 1 is in the most proximal portion of the canal, where the nerve is a single structure consisting of motor and sensory fascicles, and zones 2 and 3 are distal where the ulnar nerve has divided into motor and sensory branches. The clinical picture correlates with the zone in which compression occurs
— id: 11680, year: 2000, vol: 49, page: 305, stat: Journal Article,

Compressive ulnar neuropathies at the elbow: I. Etiology and diagnosis
Posner MA
1998 Sep-Oct;6(5):282-288, Journal of the American Academy of Orthopaedic Surgeons
Ulnar nerve compression at the elbow can occur at any of five sites that begin proximally at the arcade of Struthers and end distally where the nerve exits the flexor carpi ulnaris muscle in the forearm. Compression occurs most commonly at two sites-the epicondylar groove and the point where the nerve passes between the two heads of the flexor carpi ulnaris muscle (i.e., the true cubital tunnel). The differential diagnosis of ulnar neuropathies at the elbow includes lesions that cause additional proximal or distal nerve compression and systemic metabolic disorders. A complete history and a thorough physical examination are essential first steps in establishing a correct diagnosis. Electrodiagnostic studies may be useful, especially when the site of compression cannot be determined by physical examination, when compression may be at multiple levels, and when there are systemic and metabolic problems
— id: 57328, year: 1998, vol: 6, page: 282, stat: Journal Article,

Compressive ulnar neuropathies at the elbow: II. treatment
Posner MA
1998 Sep-Oct;6(5):289-297, Journal of the American Academy of Orthopaedic Surgeons
Initial treatment of most compressive neuropathies at the elbow is nonoperative, consisting of rest, avoidance of elbow flexion, and, when necessary, temporary immobilization of the elbow and wrist. If symptoms persist, particularly when accompanied by muscle weakness, surgery is usually indicated. Operative procedures include decompression without transposition of the nerve (in situ or by means of medial epicondylectomy) and decompression with transposition of the nerve carried out in a subcutaneous, intramuscular, or submuscular fashion. The indications, advantages, disadvantages, and surgical technique of each operative procedure are discussed
— id: 57327, year: 1998, vol: 6, page: 289, stat: Journal Article,

The role of MR imaging in the management of elbow problems
Eshman SJ; Posner MA; Hochwald N; Rosenberg ZS
1997 Aug;5(3):443-450, Magnetic resonance imaging clinics of North America
In the past several years, the role of MR imaging in diagnosing pathologic conditions of the elbow has dramatically increased. Aside from imaging soft-tissue tumors, it can accurately visualize partial and complete tears of tendons and ligaments, as well as displacement of epiphyseal fractures in children. Its role in identifying loose bodies, particularly when they are nonosseous, and areas of osteochondritis dissecans has also increased. The use of MR imaging for diagnosing neuropathies, particularly when electrodiagnostic studies are negative, offers exciting possibilities as additional technical improvements are developed
— id: 56942, year: 1997, vol: 5, page: 443, stat: Journal Article,

Simultaneous rupture of both flexor tendons in a finger [see comments]
Backe H; Posner MA
1994 Mar;19(2):246-248, Journal of hand surgery (American volume)
— id: 7107, year: 1994, vol: 19, page: 246, stat: Journal Article,

New method of limb deformities correction in children
Atar D; Lehman WB; Grant AD; Strongwater A; Frankel VH; Posner M; Golyakhovsky V
1992 Nov;68(4):447-469, Bulletin of the New York Academy of Medicine
A new 'bloodless' technique (Ilizarov) was used to correct 36 limb deformities in 29 children. There were six leg length discrepancies, five achondroplasias, four deformed feet, five joint contractures, one rotational deformity of tibia, and in three the apparatus was used as an external fixator after corrective osteotomy. Lengthening was accomplished in 15 of the 16 procedures (93%). Average increase in femur length was 10 cm (32%), in tibial length 7.5 cm (30%), in humerus 11 cm (40%). Bony union was achieved in two out of five pseudoarthroses. Four deformed feet were fully corrected. Joint contractures were corrected in four out of five. The complication rate is as high as in other methods but with the Ilizarov apparatus, longer segments of bone were lengthened and more complex deformities were treated. Complications lessened as experience was gained
— id: 35487, year: 1992, vol: 68, page: 447, stat: Journal Article,

Cooperativity of neutralizing antibodies directed against the V3 and CD4 binding regions of the human immunodeficiency virus gp120 envelope glycoprotein
Thali, M; Furman, C; Wahren, B; Posner, M; Ho, D D; Robinson, J; Sodroski, J
1992 ;5(6):591-599, Journal of acquired immune deficiency syndrome
Human immunodeficiency virus type 1 (HIV-1) infection elicits neutralizing antibodies directed against two discrete regions of the gp120 exterior envelope glycoprotein: the third variable (V3) loop and the CD4 binding region. Monoclonal antibodies directed against these two regions demonstrated additive or, in some cases, weakly synergistic neutralization of HIV-1 infection. Cooperativity in virus neutralization was also observed for some gp120 mutants that, in the absence of anti-V3 loop antibodies, were relatively resistant to neutralization by antibodies directed against the CD4 binding region. Although the binding of some anti-V3 region monoclonal antibodies increased the recognition of the multimeric envelope glycoproteins by anti-CD4 binding antibodies, this enhanced binding was not predictive of the degree of cooperativity observed in virus neutralization. These results suggest that elicitation of both types of neutralizing antibodies should increase the efficacy of vaccine preparations
— id: 108016, year: 1992, vol: 5, page: 591, stat: Journal Article,

Ilizarov technique in treatment of congenital hand anomalies. Two case reports
Atar D; Lehman WB; Posner M; Paley D; Green S; Grant AD; Strongwater AM
1991 Dec;(273):268-274, Clinical orthopaedics & related research
An Ilizarov apparatus was successfully used in the treatment of a six-year-old child with a radially deviated hand caused by congenital pseudoarthrosis of the distal radius after previous traditional surgery failed. The limb length was restored, the pseudoarthrosis healed, and the deviated hand corrected. A second child, five years old, with Poland's syndrome, had a 90 degrees flexion contracture of the wrist that was treated with the Ilizarov apparatus. The flexion contracture was gradually corrected. It seems that the Ilizarov apparatus can be an important tool in the treatment of complex limb deformities
— id: 61310, year: 1991, vol: , page: 268, stat: Journal Article,

Treatment of enchondromas of the hand with allograft bone
Bauer RD; Lewis MM; Posner MA
1988 Nov;13(6):908-916, Journal of hand surgery (American volume)
We investigated whether cortico-cancellous allograft obtained from cadaveric banked bone is effective in the treatment of enchondroma of the hand. Twelve patients had 15 operations on 19 enchondromas using allograft bone. These patients were compared with 16 patients with enchondroma treated with autogenous iliac cancellous bone. The distribution of tumors was similar in both groups. There was no significant difference in the patient's age, their occupations, or whether the operation involved the dominant hand. In both groups, immobilization was maintained until clinical union was obtained. The duration of immobilization for both groups was identical. There were no recurrences, refractures, or complications in patients treated with allograft bone. The grafts incorporated and remodeled in all patients. We concluded that a allograft cortico-cancellous bone can be used effectively in the treatment of enchondromas of the hand. It is especially useful in the treatment of patients with multiple tumors
— id: 10911, year: 1988, vol: 13, page: 908, stat: Journal Article,

Intratendinous aponeurotic fibroma
Moskovich R; Posner MA
1988 Jul;13(4):563-566, Journal of hand surgery (American volume)
Juvenile aponeurotic fibroma is a distinctive fibroblastic tumor usually found in young children. The tumor has a predilection for the palms and soles, although it can occur elsewhere, either superficially in subcutaneous tissues or in deeper musculofascial and paraskeletal tissues. In this case the tumor occurred in an adult within the substance of the flexor pollicis longus tendon, a location not previously reported in the literature. Because of the unique location of the tumor, it was excised without sacrificing the tendon. Since recurrence of these lesions is common, continued observation was necessary. Magnetic resonance imaging in this patient 26 months after the operation showed restoration of the normal tendon contour
— id: 35857, year: 1988, vol: 13, page: 563, stat: Journal Article,

Compartment syndrome caused by a traumatized vascular hamartoma
Joseph FR; Posner MA; Terzakis JA
1984 Nov;9(6):904-907, Journal of hand surgery (American volume)
A case report is presented of a traumatized vascular hamartoma producing a forearm flexor compartment syndrome; such a case has not been reported previously. The role of minor trauma in this case was important. There is a need for a high degree of suspicion in order to make an early, accurate diagnosis. Delayed surgical decompression and resection of the pathologic muscle resulted in a dramatic improvement in sensibility and digital mobility
— id: 22804, year: 1984, vol: 9, page: 904, stat: Journal Article,