Thomas Pagonis

Complications arising from a misdiagnosed giant lipoma of the hand and palm: a case report

IntroductionLipomas are benign tumors which may appear in almost any human organ. Their diagnosis rate in the hand region is not known.Case PresentationWe present the case of a 63-year-old Greek Caucasian woman with a giant lipoma of the hand and palm which was not initially diagnosed. After repeated surgical decompression of the carpal tunnel the patient was referred with persisting symptoms of median and ulnar nerve compression and a prominent mass of her left palm and thenar eminence. Clinical examination, magnetic resonance imaging, nerve conduction study and biopsy, revealed a giant lipoma in the deep palmar space (8.0 × 4.0 × 3.75 cm), which was also infiltrating the carpal tunnel. She had already undergone two operations for carpal tunnel syndrome with no relief of her symptoms and she also ended up with a severed flexor pollicis longus tendon. Definitive treatment was performed by marginal resection of the lipoma and restoration of the flexor pollicis longus with an intercalated graft harvested from the palmaris longus. Thirty months after surgery the patient had a fully functional hand without any neurological deficit.ConclusionNot all lipomas of the wrist and hand are diagnosed. Our report tries to emphasize the hidden danger of lipomas in cases with carpal tunnel symptoms. The need for a high index of suspicion in conjunction with good clinical evaluation and the use of appropriate investigative studies is mandatory in order to avoid unnecessary operations and complications. Marginal excision of these tumors is restorative.

Improved Corticosteroid Treatment of Recalcitrant de Quervain Tenosynovitis With a Novel 4-Point Injection Technique:

Background: Previously described corticosteroid injection techniques for de Quervain tenosynovitis (DQT) refer to either 1-point or 2-point injection techniques, showing superiority of the latter. Hypothesis: The authors’ novel 4-point injection technique (point 4 technique) yields more favorable results than do the older techniques. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: The authors treated 2 groups (A and B), each including 24 high-resistance training individuals (randomly allocated to each group) with persistent DQT. Group A received the point 4 technique, and group B, the 2-point injection technique. Follow-up was in 2, 4, 8, and 52 weeks after the first treatment. Results: After 2 weeks of treatment, 7 group A patients were symptom-free, whereas the rest scored better than their group B counterparts on the DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure, of whom only 1 was symptom-free. Ten group A patients received repeated injections, in contrast to 19 from group B. Four weeks after the first treatment, 13 group A patients were symptom-free, in contrast to 4 from group B. In group A, 2 patients received repeated injections, in contrast to 20 in group B. Eight weeks after the first treatment, 1 group A patient received repeated injection. One group B patient relapsed, whereas 4 opted for surgical decompression and 16 received repeated injections. Fifty-two weeks after the first treatment, 21 patients in group A were symptom-free, 1 was operated on, and 2 relapsed; in group B, 12 were symptom-free, 9 were operated on, 3 relapsed, and 3 received repeated injections. Conclusion: In high-resistance training athletes, recalcitrant DQT responds more favorably to the novel point 4 technique than to the standard 2-point injection technique.

The effect of steroid-abuse on anatomic reinsertion of ruptured distal biceps brachii tendon

INTRODUCTION There is an increase in the number of anabolic-steroid (AS)-abusing trainees, who suffer from sports injuries, needing reconstruction surgery. Rupture of the distal biceps brachii tendon is a common injury in this group. PURPOSE The study aimed to investigate the effect of AS abuse in the anatomic reconstruction of the ruptured distal biceps brachii tendon along with an immediate range-of-motion postoperative protocol. METHODS We conducted an observation study of 17 male athletes suffering from distal biceps tendon ruptures. Six of them reported that they abused AS (group A), whereas the non-users comprised group B (n=11). Both groups were treated with the modified single-incision technique with two suture anchors and an immediate active range-of-motion protocol postoperatively. Follow-up was at 4, 16 and 52 weeks postoperatively, with a final follow-up at 24 months. RESULTS Follow-up at 4, 16 and 52 weeks postoperatively showed a statistical significance in favour of group A for therapeutic outcomes concerning flexion, supination, pronation, Disabilities of the Arm, Shoulder and Hand (DASH) Disability Symptom Scores, Mayo Elbow Performance Elbow Scores and isometric muscle strength tests for both flexion and supination. Twenty-four months postoperatively, statistical significance in favour of group A was recorded in isometric muscle strength tests for both flexion and supination and also in DASH Disability Symptom Score. DISCUSSION The results of our study suggest that there is a correlation between the effect of AS and the quicker and better recuperation and rehabilitation observed in group A. Nonetheless, these results must be interpreted with caution, and further in vivo research is needed to confirm these findings.

Abuse of Growth Hormone Increases the Risk of Persistent de Quervain Tenosynovitis

Background de Quervain tenosynovitis usually responds well to nonsurgical treatment. Hypothesis Growth hormone abuse is associated with increased de Quervain tenosynovitis incidence in weight-training persons. Study Design Cohort study; Level of evidence, 3. Methods We treated 19 weight-training male patients with de Quervain tenosynovitis. Nine were abusing growth hormone (group A), and 10 were not (group B). Four group A patients elected to cease growth hormone abuse. Treatment was stratified into 3 grades: (1) splinting and nonsteroidal anti-inflammatory drugs, (2) same as first grade but with the addition of cortisone injections, and (3) surgical decompression (after failure of treatment of first and second grades). Follow-up was at 3, 9, and 24 months. Results First follow-up: Only 33.3% of those using growth hormone in group A responded to splinting and nonsteroidal anti-inflammatory drugs, compared with 90% in group B. Six patients (66.6%) in group A experienced persistent symptoms and received second-grade treatment, compared with 1 patient in group B (10%). Second follow-up: Four patients (44.4%) in group A moved from second- to third-grade treatment, 1 symptom-free patient (11.1%) relapsed and received second-grade treatment while 2 (22.2%) requested conservative treatment, declining surgery. Group B patients were 100% symptom-free. Final follow-up: Six patients (66.6%) in group A were operated on and 1 (11.1%) suffered from persistent de Quervain tenosynovitis, declining surgery. In group B, 1 patient relapsed and was started on second-grade treatment. No patients in group B had surgery. Conclusion Our results suggest that growth hormone abuse is associated with a more recalcitrant form of de Quervain tenosynovitis that does not respond well to nonsurgical treatment, thus leading to increased likelihood of surgical decompression.

Outcome of Surgical Treatment for Complicated Humeral Shaft Fractures in Elderly Adults with Osteoporosis

ments, as illustrated by the decrease in 25OHD concentration during follow-up (Table 1). With this design, the effect of receiving vs not receiving vitamin D supplements and, indirectly, the effect of increasing vs decreasing 25OHD concentrations was captured. Finally, an improvement was also found in executive functions after vitamin D3 supplementation. This is concordant with previous studies suggesting that brain structures underlying executive functions are the target of neuroprotective and vasculoprotective properties of vitamin D. Nevertheless, the pre–post design of the current study without randomization limits the exploration of the cognitive effect of vitamin D repletion. Placebo-controlled randomized clinical trials are needed to corroborate these results with higher levels of evidence.