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  • 1. This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier’s archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright
  • 2. Author's personal copy Chirurgie de la main 29 (2010) 145–146 Pioneers of hand surgery Erik Moberg (1905–1993) Erik Moberg was, to say the least, a unique person and a one compass. They are not only useless, they are even of a kind personality with a multifold of skills. His misleading’’ [7]. contributions in the field of hand surgery are well documented Erik Moberg graduated from the Faculty of Medicine, and well known. Less known are maybe his other skills that University of Lund in 1932 and his first appointment as a doctor range from archeology and ancient cultures to being a devoted was in Persia (1932–33) where he met a Swedish nurse, Märta, sailor and collector of butterflies. His never-ending curiosity whom he married in 1934. He defended a thesis in experimental and willingness to learn and relearn in the broadest aspect of life pathology at University of Lund 1936 and began training in are assets that need to be emphasized and hopefully followed by orthopaedic surgery, moved to Göteborg and the Department of younger colleagues. Erik was a true academic and a role model Surgery at Sahlgrenska Hospital where -in 1942- he became a for people striving for perfection regardless of topic. He joined senior staff member. discussions, often with strong opinions, but with a good mood In 1944, he began to treat hand injuries inspired by and open mind. He delivered numerous memorable lectures that Dr Bunnell’s principles (Surgery of the Hand, 1944). He always took the audience further than expected by provoking organized a separate ward for treatment of fractures due to their the listener to become active and thoughtful. He was not afraid wound infections and abscesses. In 1949 he had the first hand of challenging the so-called state -of –the-art and he kept surgery ward in Scandinavia fully organized and established at stressing that state -of –the-art is a dynamic process that we are the Sahlgrenska Hospital. all involved in. In other words, the interaction between experts In 1947, Erik spent several months with Dr Sterling Bunnell on a regular basis was fundamental for development. In this in the U.S where he observed the post-war treatments at hand intensive process of communication, Erik stressed the need for surgical centers. Back in Sweden he started the first hand collecting information not only from experts but also from surgical ward in Scandinavia in Göteborg. patients and laymen because they may present, directly or Erik was always very interested in teaching and especially indirectly, the key to a major scientific break-through. his new concept of treating hand injuries. He wrote a book If one picked a special topic that magnetized Erik Moberg Emergency Surgery of the Hand in 1948, which has been it would no doubt be phenomenon and significance of skin translated into many languages and published in several sensation. In his clinical accomplishments sensation certainly editions over the years. Erik Moberg introduced hand surgery played an instrumental role. The following citation represents officially in Sweden in 1948. Erik’s interest bordering obsession of sensation as well as his In 1951, he formed the Nordic Hand Club (now the firm opinions about how to assess sensation. Or maybe more Scandinavian Society for Surgery of the Hand, SSSH). He was correctly what techniques not to use for evaluating sensation: inspired by the American Society for Surgery of the Hand ‘‘It must be emphasized that sensibility is, in my opinion and which was started by Bunnell in 1946. In the early 1970´s the according to my experience, the basis for reconstructive ‘‘Moberg lecture’’ was founded at these meetings. In 1956, Erik work. . . for reconstructive surgery, ‘‘feeling’’ is a totally Moberg was given a personal professorship in Extremity useless term, as it covers far too much and distinguishes Surgery and in 1958 in Hand Surgery. Erik trained several hardly anything. . . for examination of useful sensibility in surgeons, and five of them became full time hand surgeons and reconstructive hand surgery of all the tests evaluated by the themselves established centers in different parts of Sweden. authors, the only one which was found to be significant is the In 1958, Erik attended a meeting of the Second Hand Club two-point discrimination test now performed with a paperclip. and became one of the first Corresponding Members. This club All other tests of sensory function, in my opinion, should in even toured in Scandinavia and was accompanied by many this work be abandoned, including cotton wool and paper others from Europe and the USA in 1961. This was the first strip, pinprick, ordinary tuning fork, the difference between international meeting and was organized by Erik. This was also sharp and blunt, figure writing, the wrinkling skin test and the the foundation for meetings with a high level of scientific two-point discrimination test performed with sharp pointed papers. Arthur Barsky, President of the American Society, was 1297-3203/$ – see front matter doi:10.1016/j.main.2010.03.001
  • 3. Author's personal copy 146 Pioneers of hand surgery / Chirurgie de la main 29 (2010) 145–146 did not want hand surgery to be a specialty on its own, but rather as ‘‘extremity surgery’’ which would cover upper and lower extremities, spine and pelvis. The creation of the first specialized hand surgery units and even more so the recognition of the hand surgery specialty were directly against the desired development of Erik Moberg. He was, however, flexible and once a fact, he played a major role to evolve and refine the hand surgery profession. In 1971, after his retirement Erik started working on the surgical rehabilitation of patients with tetraplegia [4]. He continued this work during the remaining years of his life. His extensive monography on tetraplegia surgery from 1978 is today considered a bible [5]. His last article on this subject was published in 1992. Moberg has said ‘‘after hearing Bunnell Fig. 1. Professor Moberg in his beloved sailboat. Many of Erik Moberg’s speak, I have never been able to leave the question of sensibility international guests participated in and enjoyed shorter or longer sail trips along in hand function’’. He applied much of his knowledge about the Swedish west coast. sensation to classification and treatment strategies in tetra- plegia. Erik Moberg had earlier introduced the Ninhydrin test to document objectively innervation. He defined hand function as precision-sensory and gross-sensory grips. He correlated Weber two-point discrimination with hand function. He introduced the pick-up test to document hand function. He coined the term ‘‘tactile gnosis’’. He hypothesized that proprioception is principally due to skin- not joint- afferents and he classified the tetraplegic hand according to its combined sensory and motor capacity. Above-mentioned examples just represent a selection of the multi-fold of remarkable achievements [6,7] and wonderful memories that Erik Moberg generously distributed to the academic, clinical and social world (Figs. 1 and 2). The first, second and probably even later generations of hand surgeons in Sweden and many other countries certainly consider Erik Fig. 2. Professor Moberg congratulating Dr. Esther May at her Ph.D. disserta- Moberg a role model and leading star in their careers. tion in 1992. Photo Dr. Ann Nachemson. References [1] Moberg E. Objective methods for determining the functional value of approached and many international meetings in Edinburgh, sensibility in the hand. J Bone Joint Surg (Br) 1958;40(3):454–76. [2] Moberg E. Objective method of evaluating hand sensation and its use in Turin, Rio de Janeiro led to the beginning of the International reconstructive surgery. J Bone Joint Surg (Am) 1959;41(4):777. Federation. [3] Moberg E. Technical aspects of the transfer of neurovascular flaps. J Bone In 1962, he presented the first annual Sterling Bunnell Joint Surg (Br) 1964;46:359. Lecture to the American Society for Surgery of the Hand. The [4] Moberg E. Reconstructive hand surgery in tetraplegia Stroke and cerebral palsy: some basic concepts in physiology and neurology. J Hand Surg (Am) title of the lecture was ‘‘Aspects of sensation in reconstructive 1976;I(I):29–34. surgery of the upper extremity’’. Erik Moberg made several [5] Moberg E. The upper limb in tetraplegia: a new approach to surgical important scientific contributions in the field of hand surgery. rehabilitation. Stuttgart: Georg Thieme Verlag; 1978. He was especially interested in sensibility and he introduced the [6] Hagert CG. Erik Moberg 1905–1993. Acta Orthop Scand 1993;64(6):717– term ‘‘academic sensation’’ or tactile-gnosis type of sensi- 24. motor feed-back driven performance-related sensation (‘‘what [7] Dellon AL. The sensational contributions of Erik Moberg. J Hand Surg (Br) 1990;15B:14–24. a hand can do’’) as opposed to functional or discriminatory sensation [1,2]. He devised methods of ‘‘transferring sensa- tion’’ by moving island flaps from a less important area to ´ J. Friden* contact surface for grips [3]. He also spoke of early M. Knall synovectomy for the small joints in rheumatoid disease. Department of Hand Surgery, Sahlgrenska University Hospital, In 1968, Erik was elected as the very first president of the SE-413 45 Göteborg, Sweden International Federation of Societies for Surgery of the Hand, IFSSH. In 1969 Sweden became the first country in the world to *Corresponding author have hand surgery recognized as a separate specialty. Moberg E-mail address: jan.friden@orthop.gu.se