Mukund R. Patel

Percutaneous release of trigger digit with and without cortisone injection

Percutaneous release was done using the tip of an 18-gauge, 2.5-cm-long needle, mounted on a 3-mL3 syringe in 225 trigger digits. It was successful in 92 (89%) of the digits without cortisone injection (n = 105) and in 115 (96%) of the digits with cortisone injection (n = 120). Negligible or intermittent pain persisted for 8 weeks in the noncortisone group and 6 weeks in the cortisone group after percutaneous release. Of the first 10 digits, 2 needed repeat percutaneous release. With modification of technique, the incidence of repeat percutaneous release was zero in both groups. Open release was needed in 8% in the noncortisone group and 3% in the cortisone group. The procedure was done under local infiltration anesthesia in the office. This reduced patient anxiety, inconvenience and hospital cost.

Conservative management of chronic mallet finger

Ten cases of chronic mallet fingers that were 4 to 18 weeks old were treated conservatively by immobilization of the distal interphalangeal joint in extension for 8 continuous weeks and for 2 more weeks at night. With a stringent rating system, there were five excellent, four good, and one fair end result. Two patients had recurrence of the deformity within a week after treatment, and both fully recovered after 8 weeks of further splinting. Splinting is a predictable, safe, and simple method of treatment for chronic mallet fingers.

Osteochondritis dissecans of the patella

We reviewed 13 cases of osteochondritis dissecans of the patella followed-up for 18 months to 19 years. Two were treated conservatively with excellent results, and 11 by operation with six excellent, four good and one fair result. There was complete radiographic healing of the defect in 10 cases and partial healing in three. The size of the osteochondritic lesion appeared to be of prognostic significance. Osteochondritis dissecans of the patella is the result of repeated minor injuries to the articular surface. Operation is indicated for persistent pain, intra-articular loose bodies and subchondral sclerosis; excision of the fragment and curettage of the crater, with or without drilling, is recommended.

Conservative treatment of mallet thumb

Four cases of mallet thumb were treated conservatively by splinting the interphalangeal joint of the thumb in extension using the Stack splint. Two patients had sharply cut the extensor tendon on the dorsum of the proximal phalanx and two had avulsion of the extensor tendon from the base of the distal phalanx. Eight weeks of continuous splinting was followed by 2 weeks of night splinting. Six months of follow-up revealed excellent range of motion in all four cases.

Multiple schwannomas of the ulnar nerve: a case report.

Multiple schwannomas may occur as visible tumors or may occur as tumors in situ. The tumors in situ may be missed when the visible tumors are excised. In time, the schwannomas in situ grow and appear to be recurrent, while in fact, they are multicentric. The prognosis on multicentric schwannomas thus remains guarded.

Clicking at the wrist due to fibroma in an anomalous lumbrical muscle: A case report and review of literature

A 33-year-old man had clicking at the wrist and symptoms that were characteristic of carpal tunnel syndrome, which were secondary to a fibroma arising from an anomalous lumbrical muscle in the carpal tunnel. Carpal tunnel release and excision of the fibroma relieved both of the conditions.

Stress fracture of the ulnar diaphysis: Review of the literature and report of a case

A 22-year-old athlete developed chronic pain in the forearm aggravated by weight lifting. Physical examination revealed localized tenderness at the junction of the middle and distal third of the ulnar diaphysis. X-ray films revealed an osteolytic lesion at the same level. The patient developed an overt fracture at the same site when he failed to stop sports activities against advice. The fracture healed uneventfully with immobilization in a sleeve cast.

Extensor indicis proprius syndrome: A case report

A 24-year-old right-handed carpenter complained of a 4-month history of pain on the dorsum of his right distal forearm. The pain was mild at rest and severe upon performing heavy work. On physical examination, he was found to have minimal swelling on the dorsum of the distal third of the forearm. The swelling became more prominent when he made a fist. It was moderately tender to palpation. He had no pain when he made a tight fist with the wrist in neut r a l or when he flexed the wrist with fingers extended. When he was asked to flex the wrist actively or passively and flex the metacarpophalangeal joints, he developed severe pain localized to the dorsum of the forearm. MRI of the forearm showed hypertrophy of the EIP muscle (Fig. 1). At surgery, a thickened fourth extensor compartment was released and was noted to be 3 cm long. With the wrist and fingers in neutral position, 0.5 cm of EIP muscle extended into the fourth extensor compartment (Fig. 2A). When the wrist was flexed 60 ~ 1 cm of the muscle extended into the compartment (Fig. 2B). When the wrist and index finger were fully flexed, 2 cm of the muscle extended into the compar tment (Fig. 2C). The muscle belly of the EIP appeared hypertrophied but was of normal color and consistency. No significant tenosynovitis of EIP or extensor digitorum communis tendons was found. The wound was closed without closing the extensor retinaculum, and the wrist was splinted for 1 week. Active finger exercises were encouraged within pain tolerance the day after surgery. The patient was painfree and had full range of motion of the wrist at the 1 year follow-up examination. He had no subluxation of the extensor tendons on wrist extension. The grip strength was strong and equal on both sides.

Tenosynovial osteochondromatosis of the extensor tendon of a digit: Case report and review of the literature

Extra-articular tenosynovial osteochondromatosis in the hand rarely occurs. A case of tenosynovial osteochondromatosis of the extensor tendon of the digit is reported. None of the cases reported in the literature have involved the extensor aspect of the digits. A possible explanation for the paucity of this lesion in relation to the extensor tendons of the digits is the absence of a tendon sheath on the dorsum of the digits.

Median nerve neuralgia caused by a fibrovascular band in the distal forearm

A 67-year-old woman had experienced exquisite focal pain and tenderness for more than 1 year in the distal forearm 4.5 cm proximal to the distal wrist crease. Surgical exploration showed a venous fibrovascular band adherent to and transversing the epineurium of the median nerve precisely at the point of maximal tenderness. Resection of the fibrovascular band completely relieved the symptoms of focal pain and tenderness.