Soo-Hwan Kang

An intraosseous epidermal cyst developing in a metacarpal bone after K-wire fixation: a case report

Intraosseous epidermal cysts (IECs) are rare benign lesions caused by the proliferation of epidermal cells within the bone. The pathogenesis of IEC remains unclear; however, trauma-triggered infiltration of the bone by epidermal elements has been suggested. Here, we present a case of an IEC in the metacarpal bone of the little finger associated with K-wire fixation for treatment of a fifth metacarpal fracture.

Suprascapular neuropathy caused by heterotopic ossification after clavicle shaft fracture: a case report

Suprascapular neuropathy is a rare peripheral neuropathy that can be easily overlooked in the differential diagnosis of shoulder pain and dysfunction. The suprascapular nerve may be injured as a result of repetitive overuse, constriction due to anatomic variants, compression due to space occupying lesions, retraction due to a massive rotator cuff tear and iatrogenic or traumatic lesions. Trauma-related suprascapular neuropathies are often caused by glenohumeral joint dislocations, scapular fractures, proximal humeral fractures, penetrating injuries and displaced clavicle fractures. Although many causes of suprascapular neuropathy have been described, there have been few reports of suprascapular neuropathy caused by heterotophic ossification after trauma around shoulder. Heterotophic ossification is the formation of bone in non-skeletal tissue, usually between the muscle and joint capsule. It usually occurs following trauma, surgery, burns, fractures, dislocation or soft tissue trauma. The spectrum of heterotophic ossification ranges from incidental radiographic findings to severe functional limitations. The range of motion can be decreased, resulting in soft tissue contractures. It can also cause peripheral neuropathy by impinging adjacent nerves. Management of heterotopic ossification is aimed at limiting its progression and maximizing function of the affected joint. Nonsurgical treatment is appropriate for early heterotopic ossification; however, surgical excision should be considered in cases of joint ankylosis or significant complications. We report a very unusual case of suprascapular neuropathy that resulted from heterotophic ossification after clavicle shaft fracture. This case was treated by open excision of the heterotophic ossification and external neurolysis of the suprascapular nerve. Although the incidence is very low, the heterotophic ossification should be considered as a possible cause of suprascapular neuropathy.

Cubital Tunnel Syndrome Caused by Anconeus Epitrochlearis Muscle

Objective We evaluated the clinical manifestation and surgical results following operative treatment of cubital tunnel syndrome (CuTS) caused by anconeus epitrochlearis (AE) muscle. Methods Among 142 patients who underwent surgery for CuTS from November 2007 to October 2015, 12 were assigned to the AE group based on discovery of AE muscle; 130 patients were assigned to the other group. We analyzed retrospectively; age, sex, dominant hand, symptom duration, and weakness in hand. Severity of the disease was evaluated using the Dellon classification and postoperative symptom were evaluated using disability of arm shoulder and hand (DASH) and visual analogue scale (VAS) scores. Surgery consisted of subfascial anterior transposition following excision of AE muscle. Results AE muscle was present in 8.5% of all patients, and was more common in patients who were younger and with involvement of their dominant hand; the duration of symptom was shorter in patients with AE muscle. All patients showed postoperative improvement in symptoms according to DASH and VAS scores. Conclusion The possibility of CuTS caused by AE muscle should be considered when younger patients have rapidly aggravated and activity-related cubital tunnel symptoms with a palpable mass in the cubital tunnel area. Excision of AE muscle and anterior ulnar nerve transposition may be considered effective surgical treatment.