MyMedR

Fulltext Spinal cord stimulation for treatment of failed back surgery syndrome--two case reports

Vijayan R, Ahmad TS

Med J Malaysia, 1999 Dec;54(4):509-13.

Severe, persistent back pain following back surgery is often referred to as Failed Back Surgery Syndrome (FBSS). Conservative measures such as physiotherapy, back strengthening exercises, transcutaneous electrical nerve stimulation and epidural steroids may be inadequate to alleviate pain. Spinal Cord Stimulators were implanted into two patients suffering from FBSS. Both patients responded successfully to spinal cord stimulation with reduction of pain and disability.

Use of a New External Fixator for the Correction of Fixed Flexion Deformity of the Fingers

Siow YS, Ahmad TS, Goh SY

Hand Surg, 1999 Dec;4(2):167-174.

PMID: 11089175

Three patients with severe fixed flexion deformity of the fingers caused by trauma were reported. As an alternative treatment, a new mini external fixator was used to correct the deformities. The use of this device has made treatment of contractures simpler and more predictable. Gradual distraction and straightening was applied to loosen and extend the joints, followed by a period of mobilisation while still on the device. In all the three patients, this experimental device and approach led to improvement of the fixed flexion deformities. With use of this device, surgical release may not be necessary.

Steroid injection versus NSAID injection for trigger finger: a comparative study of early outcomes

Shakeel H, Ahmad TS

J Hand Surg Am, 2012 Jul;37(7):1319-23.

PMID: 22721455 DOI: 10.1016/j.jhsa.2012.03.040

Stenosing tenosynovitis of the flexor tendon sheath of the digits of the hand results from a discrepancy between the diameter of the flexor tendon and its sheath at the A1 pulley. The treatment options for trigger digits include oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local NSAID applications, splintage, steroid injection, and percutaneous and open release of the A1 pulley. Injectable NSAID is used intramuscularly and locally in other sites. The hypothesis is that an injectable NSAID is as effective as the traditionally used steroid injection in the treatment of trigger digit, based on Quinnell grading, and that the treatment works as well in patients with diabetes as in those without diabetes.

Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial

Lee TG, Ahmad TS

Foot Ankle Int, 2007 Sep;28(9):984-90.

PMID: 17880872

The response of chronic plantar fasciitis to any treatment is unpredictable. Autologous blood might provide cellular and humoral mediators to induce healing in areas of degeneration, the underlying pathology in plantar fasciitis. This study compared the efficacy of intralesional autologous blood with corticosteroid injection for plantar fasciitis present for more than 6 weeks.

Fulltext A modified Blatt dorsal capsulodesis in the treatment of dynamic scapholunate instability

Azura L, Ahmad TS, Kamarul T

Med J Malaysia, 2006 Dec;61 Suppl B:51-4.

PMID: 17600993

We report a case of scapholunate dissociation which was initially missed and presented late. A modification of Blatt dorsal capsulodesis performed using dorsal intercarpal ligament (DICL) and extra tunnel appears not only to add to dorsal stability but also address the volar problem as well. This modification may be a better alternative to the current technique of using a single flap.

Fulltext Thumb Schwannoma : A Frequent Misdiagnosis

Mooi SS, Ahmad TS

Malays Orthop J, 2016 Mar;10(1):53-54.

PMID: 28435548 MyJurnal DOI: 10.5704/MOJ.1603.010

A 32 year-old Malay lady presented with a swelling over the dorsal surface of her right thumb for 6 months. The swelling was non-tender, smooth surfaced, mobile and nonfluctuating with no bony involvement. The provisional diagnosis was ganglion cyst. Excisional biopsy did not show features of ganglion cyst as it appeared to be wellencapsulated, multi-lobulated and yellowish in colour. Histopathological examination showed that it was a schwannoma. Schwannomas are relatively rare benign tumours which are frequently misdiagnosed. In this case, it was misdiagnosed both as a ganglion and a lipoma.

Simplifying four-strand flexor tendon repair using double-stranded suture: a comparative ex vivo study on tensile strength and bulking

Low TH, Ahmad TS, Ng ES

J Hand Surg Eur Vol, 2012 Feb;37(2):101-8.

PMID: 21636621 DOI: 10.1177/1753193411409840

We have compared a simple four-strand flexor tendon repair, the single cross-stitch locked repair using a double-stranded suture (dsSCL) against two other four-strand repairs: the Pennington modified Kessler with double-stranded suture (dsPMK); and the cruciate cross-stitch locked repair with single-stranded suture (Modified Sandow). Thirty fresh frozen cadaveric flexor digitorum profundus tendons were transected and repaired with one of the core repair techniques using identical suture material and reinforced with identical peripheral sutures. Bulking at the repair site and tendon-suture junctions was measured. The tendons were subjected to linear load-to-failure testing. Results showed no significant difference in ultimate tensile strength between the Modified Sandow (36.8 N) and dsSCL (32.6 N) whereas the dsPMK was significantly weaker (26.8 N). There were no significant differences in 2 mm gap force, stiffness or bulk between the three repairs. We concluded that the simpler dsSCL repair is comparable to the modified Sandow repair in tensile strength, stiffness and bulking.

Pain relief for reduction of acute anterior shoulder dislocations: a prospective randomized study comparing intravenous sedation with intra-articular lidocaine

Cheok CY, Mohamad JA, Ahmad TS

J Orthop Trauma, 2011 Jan;25(1):5-10.

PMID: 21164304 DOI: 10.1097/BOT.0b013e3181d3d338

The aim was to compare the effectiveness of intra-articular lidocaine (IAL) versus intravenous Demerol and Diazepam (IVS) in reduction of acute anterior shoulder dislocation.

A preliminary study of the effects of glucosamine sulphate and chondroitin sulphate on surgically treated and untreated focal cartilage damage

Kamarul T, Ab-Rahim S, Tumin M, Selvaratnam L, Ahmad TS

Eur Cell Mater, 2011 Mar 15;21:259-71; discussion 270-1.

PMID: 21409755

The effects of Glucosamine Sulphate (GS) and Chondroitin Sulphate (CS) on the healing of damaged and repaired articular cartilage were investigated. This study was conducted using 18 New Zealand white rabbits as experimental models. Focal cartilage defects, surgically created in the medial femoral condyle, were either treated by means of autologous chondrocyte implantation (ACI) or left untreated as controls. Rabbits were then divided into groups which received either GS+/-CS or no pharmacotherapy. Three rabbits from each group were sacrificed at 12 and 24 weeks post-surgery. Knees dissected from rabbits were then evaluated using gross quantification of repair tissue, glycosaminoglycan (GAG) assays, immunoassays and histological assessments. It was observed that, in contrast to untreated sites, surfaces of the ACI-repaired sites appeared smooth and continuous with the surrounding native cartilage. Histological examination demonstrated a typical hyaline cartilage structure; with proteoglycans, type II collagen and GAGs being highly expressed in repair areas. The improved regeneration of these repair sites was also noted to be significant over time (6 months vs. 3 months) and in GS and GS+CS groups compared to the untreated (without pharmacotherapy) group. Combination of ACI and pharmacotherapy (with glucosamine sulphate alone/ or with chondroitin sulphate) may prove beneficial for healing of damaged cartilage, particularly in relation to focal cartilage defects.

The role of wrist anthropometric measurement in idiopathic carpal tunnel syndrome

Lim PG, Tan S, Ahmad TS

J Hand Surg Eur Vol, 2008 Oct;33(5):645-7.

PMID: 18662961 DOI: 10.1177/1753193408093326

Anthropometric wrist measurement ratios were examined for an association with idiopathic carpal tunnel syndrome (CTS). Wrist measurements were recorded in 67 patients with CTS and in a matched control group of 67 healthy volunteers. The Wrist Ratio (WR) (wrist anterior to posterior dimension/wrist medial-lateral dimension) and the Wrist Palm Ratio (wrist anterior to posterior dimension/palm length) were calculated for each case. We found that a WR of > or =0.70 and a Wrist Palm Ratio of >0.342 were significantly associated with idiopathic CTS.

Fulltext Quantitative and qualitative evaluation of sural nerve graft donor site

Ng SS, Kwan MK, Ahmad TS

Med J Malaysia, 2006 Dec;61 Suppl B:13-7.

PMID: 17600987

This study is designed to evaluate twenty patients after sural nerve harvest using the single longitudinal incision method. The area of sensory loss to pin prick was assessed by the authors at different intervals. Donor site factors, scar cosmesis, functional status and complications were assessed using a questionnaire. The mean area of anaesthesia at one month was 65 cm2 and it had reduced by 77% to 15 cm2 at one and a half years. The mean area of reduced sensation was 49 cm2 at one month and it increased by 18% to 58 cm2 over the same period. Therefore, the total area of sensory deficit was reduced by 36% from 114 cm2 at one month to 73 cm2 at one and a half years. Subjective patient evaluation indicated moderate level of pain during immediate post surgical period, which reduced significantly at one month. A low level of neuroma symptoms was recorded throughout the study period. At a mean follow-up period of two years, there was no area of anaesthesia in 50% of the patients. Mean area of anaesthesia for all patients was 12 cm2 and mean area of reduced sensation was 55 cm2. Subjective patient evaluation indicated a low level of pain, neuroma symptoms and numbness over the sural nerve sensory distribution. Twenty five percent of the patients were not satisfied with the scar appearance. Function and daily activities were not affected significantly. No surgical complications were observed.

Fulltext A novel and improved method of predicting hand grip strength in the adult Malaysian population

Kamarul T, Ahmad TS, Loh WY

Med J Malaysia, 2006 Dec;61 Suppl B:37-44.

PMID: 17600991

Hand grip strength measurement is a recognized part of hand function assessment. The standard measurement using the Jamar dynamometer and comparing these results to the recommended normal values suggested by the manufacturers of the Jamar was questioned as these values were based on Western population. A study comparing a novel method of predicting grip strength using our software was conducted on 25 normal subjects using the LIDO kinetic workset (Group A and B ). These results were then compared against our predictive software (Group A) and the expected values supplied together with the Jamar Dynamometer (Group B). In another group, 22 normal subjects were tested using the Jamar (Group C and D) and then matched against the predicted values using their recommended chart (Group C). The last group (Group D) was tested using the Jamar but the values attained were compared to the results from our software. In group A, the predictability of our predictive method was 100% (both R & L) as compared to (R = 64%, L = 68%) in group B, (R = 27.3%, L = 59.1%) in group C and (R = 81.8%, L = 86.4%) in group D. The differences between the predictability of both methods were statistically significant. The data collected using both the Jamar and the LIDO kinetic workset correlated well to the data from our software but not to the values suggested by the manufacturers of Jamar. We conclude that our method of predicting hand grip values are superior to that suggested by the manufacturers of dynamometers. The standard reference for hand grip strength provided by the manufacturers is less accurate in predicting the grip strength of our local population.

Fulltext Reconstruction of the heel defect with in-step island flap. A report of four cases

Kwan MK, Marican AM, Ahmad TS

Med J Malaysia, 2005 Jul;60 Suppl C:104-7.

PMID: 16381293

Soft tissue loss of the heel is difficult to treat as it may cause significant morbidity particularly recurrent ulceration and subsequent chronic osteomyelitis. Reconstruction of such defect with local flap can provide good result. We report our experience in treating four patients with heel defect using the in-step island flap. The flap, which is based on the medial plantar neurovascular pedicle, provides a sensate durable tissue required for weight-bearing and normal gait.

Hand grip strength in the adult Malaysian population

Kamarul T, Ahmad TS, Loh WY

J Orthop Surg (Hong Kong), 2006 Aug;14(2):172-7.

PMID: 16914783

To measure the hand grip strength of Malaysians aged 18 to 65 years.

The use of an aberrant flexor carpi ulnaris tendon with an ulnar artery island forearm flap for reconstruction of a dorsal defect of the hand

Jeyaratnam TS, Ahmad TS, Kassim NM

Hand Surg, 2001 Jul;6(1):99-102.

PMID: 11677671

A review of free flap failures in the University Hospital, Kuala Lumpur

Ahmad TS, Musa G, Lee JK

Ann Acad Med Singap, 1997 Nov;26(6):840-3.

PMID: 9522989

Sixty-one free flaps performed in 59 patients from April 1983 to April 1995 were analysed. Various factors that might have affected the outcome of the surgery were studied. These included the patient's age, history of smoking, pre-existing medical problems such as hypertension and diabetes mellitus, the type of free flaps, flap infection, use of postoperative anticoagulation, postoperative anaemia and re-exploration. The infection rate was 16.4% and this had a strong correlation with the free flap failure in our study population. Postoperative anaemia could adversely affect the tissue oxygenation of the free flap and delay the re-exploration due to the high anaesthetic risk. Dextran was routinely used for postoperative anticoagulation. There were also rescue attempts using heparin infusion when needed. The overall failure rate was 13.1%. Besides good anaesthetic support, a well-prepared protocol is necessary both for the preoperative planning of free flap surgery as well as salvaging a failure.

Hand Surgery in Malaysia

Ahmad TS, Ahmad AA, Abdullah S

J Hand Microsurg, 2021 Jan;13(1):21-26.

PMID: 33707919 DOI: 10.1055/s-0040-1721942

We have all heard the old aphorism, "Necessity is the mother of invention." While the provenance of the proverb is uncertain, its truth is not in doubt. This is true for the development of hand surgery in Malaysia. As part of the management for leprosy, patients with high ulnar nerve palsies were managed by the pioneers of hand surgery in Malaysia. They did tendon transfers to improve the quality of life of these patients. Since then, hand surgery in Malaysia have grown leaps and bounds. From a small humble beginning in the suburb of Sungai Buloh to organizing the 10th Congress of Asian Pacific Federation of Societies for Surgery of the Hand, hand surgery in Malaysia will only get better with time.

Nail bed and flap reconstructions for acute fingertip injuries - A case review and report of a chemical burn injury

Gunasagaran J, Sian KS, Ahmad TS

J Orthop Surg (Hong Kong), 2019 4 5;27(2):2309499019839278.

PMID: 30943852 DOI: 10.1177/2309499019839278

Nail bed injuries were commonly found concomitantly with fingertip injuries. Reconstruction of fingertip including the nail bed should be attempted at acute stage. Aim of the surgery was to restore as much finger length and achieve normal nail growth. In chemical burns, the initial presentation might not reflect the exact extent of injury. Appropriate acute management must be initiated while waiting for demarcation. We report a case of young stewardess who presented with fingertip chemical burn injury. Surgical debridement was done on third day post-injury. A cross-finger flap to cover skin defect and split-thickness nail bed grafting from the remnant of injured finger were done. Excellent functional and cosmetic outcome was achieved in 6 months. Surgical treatment in a chemical burn was similar to traumatic injury. Nail bed graft was the best option for nail bed reconstruction. In cases of soft tissue loss, advancement or pedicle flaps are beneficial.

A three-dimensional virtual morphometry study of the sigmoid notch of the distal radius

Shivdas S, Hashim MS, Ahmad TS

J Orthop Surg (Hong Kong), 2018 10 4;26(3):2309499018802504.

PMID: 30278809 DOI: 10.1177/2309499018802504

PURPOSE: Our primary objectives were to create a reliable, noninvasive method for three-dimensional morphometry of deep bony parameters within the sigmoid notch of the distal radius, to identify its morphological patterns, and to identify any significant variation between the left and the right wrists. Our secondary objectives were to obtain morphometric values that could represent our population and to identify any possible ethnic variations.

METHODS: Computed tomography scans of 102 wrists from 51 healthy individuals were analyzed using a virtualization software. Four anatomical parameters at the distal radius sigmoid notch, namely, the radius of curvature, depth, version angle, and sagittal slope were measured. Morphological patterns of the sigmoid notch surface were identified. The results were statistically analyzed to assess the reliability of the technique and were compared with previously published literature.

RESULTS: Comparing our findings with previously published values, our study revealed a slightly larger radius of curvature and sagittal slope, while revealing a smaller depth and version. We identified the S-type, C-type, and ski-slope morphological variants. The flat-face morphological variant, however, was not identified. The sigmoid notch at the left and right wrists were similar, except for the radius of curvature.

CONCLUSION: This study demonstrates a noninvasive, fast, reliable, and reproducible technique for analyzing the sigmoid notch of the distal radius. In wrist injuries with intact distal radius sigmoid notch but involving comminuted fractures of the ulnar head, ulnar head replacement may be indicated. In such cases, analysis of the ipsilateral intact sigmoid notch would allow us to prepare an ulnar head prosthesis of appropriate size.

A Comparative Study of Two Modalities in Pain Management of Patients Presenting with Chronic Brachial Neuralgia

Razak I, Chung TY, Ahmad TS

J Altern Complement Med, 2019 Aug;25(8):861-867.

PMID: 31211607 DOI: 10.1089/acm.2019.0052

Objectives:
The study aims to assess, evaluate, and compare the efficacy of acupressure and hypnotherapy in the management of pain in patients presenting with chronic brachial neuralgia (CBN).
Design:
Randomized controlled trial.
Settings/location:
Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Subjects:
Forty patients with CBN following traumatic brachial plexus injury from 2012 to 2017.
Intervention:
Therapy for a duration of 1 month in two groups; subjects in the hypnotherapy group received a weekly session of clinical hypnotherapy (total of four times) using a standardized protocol, while subjects in the acupressure group were guided by an acupuncturist during the initial session, received 2 month take home supply of acupressure patches, and were reviewed fortnightly.
Outcome measures:
The Visual Analog Scale, the Brief Pain Inventory, and the SF-36v2® Health Survey were recorded at different time points; 1 month pretreatment (week 0), pretreatment (week 4), post-treatment (week 8), and 4 months post-treatment (week 20).
Results:
There was a statistically significant improvement in the average pain intensity from pretreatment to post-treatment score in both groups. The pain intensity increased 4 months later; however, the pain intensity was still significantly reduced in comparison with pretreatment scores. The study suggests that both treatment outcomes are effective in terms of alleviating pain and improving quality of life in subjects with CBN, to a different degree.
Conclusion:
Overall, both therapies were able to improve the pain intensity and quality of life significantly during the treatment period. Hypnotherapy was observed to have a better carryover effect compared to acupressure, especially in terms of improving quality of life and the mental component score.

Displaying publications 1 - 20 of 48 in total