Simultaneous herpes zoster rash in the upper extremity and interscapular region that resembles innervation zone of the dorsal ramus of the cervical nerve root: a case report.

In daily medical practice, scapular pain associated with cervical radiculopathy is commonly seen prior to the onset of pain of the upper extremity; however, the cause of the scapular pain is uncertain. We report a case of herpes zoster with simultaneous skin rash in both the upper extremity and interscapular region, which corresponds to the painful scapular region in case of C8 cervical radiculopathy. A 71-year-old healthy woman complained of shoulder and scapular pain followed by a blistering skin rash on both the ulnar side of her upper extremity and intrascapular region on the right side. She was diagnosed with herpes zoster and was prescribed amenamevir as oral treatment with vidarabine ointment. After 1 year, she still had mild causalgia on her III-V fingers and needed oral treatment with pregabalin. To our knowledge, this is the first case report of a herpes zoster rash in the upper extremity and intrascapular region simultaneously. We speculate that the rash in the two regions is caused by the varicella zoster virus (VZV) traveling from the same ganglion, probably the C8 ganglion, considering the dermatome of the rash area in the upper extremity and the intrascapular region correspond to the innervation zone of the medial branches of the dorsal ramus of the cervical nerve root, which resembles the scapular region in case of cervical radiculopathy. This phenomenon implies the mechanism of scapular pain is related to cervical radiculopathy. Further case reports are needed to confirm this.

Sacral fatigue fracture in a young girl with no history of trauma or reported athletic activity: a case report.

Sacral fatigue fractures in the young population usually occur due to repetitious physical strain from vigorous athletic activity; they are extremely rare in those younger than 13 years without intense physical activity. We report a case of sacral fatigue fracture in a healthy elementary school girl without any history of trauma or excessive athletic activity. A healthy 11-year-old girl experienced sudden low back pain upon standing after a short break in a normal running exercise for physical education at school. At her first orthopaedic visit, she was unable to walk independently and was limping on her left leg. Neurological examination revealed that the left straight leg raising test was positive at 80 degrees with associated left buttock pain but without motor and sensory deterioration. Radiological examination showed no obvious fractures in the lumbar vertebrae or pelvis. Magnetic resonance imaging demonstrated high intensity signal changes on the short tau inversion recovery image of the left ala, and sacral fatigue fracture in the left ala was diagnosed. She was instructed to rest at home and allowed minimal walking with a crutch under endurable pain for 4 weeks. Within 3 weeks, her low back pain gradually reduced, and after 4 weeks, she could walk independently without gait pain. Sacral fatigue fractures should be considered in the diagnosis of young patients who present with unexplained low back pain.

Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders I: development of standard rating system.

BACKGROUND: The aim of this study was to report the five scales comprising the rating system that the Japanese Society for Surgery of the Foot (JSSF) devised (JSSF standard rating system) and the newly offered interpretations and criteria for determinations of each assessment item. METHODS: We produced the new scales for the JSSF standard system by modifying the clinical rating systems established by the American Orthopaedic Foot and Ankle Society (AOFAS scales) and the Japanese Orthopaedic Association's foot rating scale (JOA scale). We also provided interpretations of each assessment item and the criteria of determinations in the new standard system. RESULTS: We improved the ambiguous expressions and content in the conventional standard rating systems so they would be easily understood by Japanese people. The result was five scales in total. Four were designed for use specifically for ankle-hindfoot, midfoot, hallux metatarsophalangeal-interphalangeal, and lesser metatarsophalangeal-ineterphalangeal sites; and the fifth was for the foot and ankle with rheumatoid arthritis. Furthermore, we described interpretations and criteria for determinations with regard to evaluation items in each scale. CONCLUSIONS: Conventionally, the AOFAS scales or the JOA scale have been separately applied depending on the sites or disorders concerned, but it was often difficult to decide on scores during practical evaluations because of differing expressions in different languages and also because of ambiguity in the interpretation of each evaluation item and in scoring standards as well. JSSF improved these scales and added definite interpretations of evaluation items as well as criteria for the rating (to be reported here in part I). Because these steps were expected to improve the reliability of outcomes assessed by each scale, we examined the reliability in scores of the newly developed scales, which are reported in part II (in this issue).

Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders II: interclinician and intraclinician reliability and validity of the newly established standard rating scales and Japanese Orthopaedic Association rating scale.

BACKGROUND: This study evaluated the validity and inter- and intraclinician reliability of (1) the Japanese Society of Surgery of the Foot (JSSF) standard rating system for four sites [ankle-hindfoot (AH), midfoot (MF), hallux (HL), and lesser toe (LT)] and the rheumatoid arthritis (RA) foot and ankle scale and (2) the Japanese Orthopaedic Association's foot rating scale (JOA scale). METHODS: Clinicians from the same institute independently evaluated participating patients from their institute by two evaluations at a 1- to 4-week interval. Statistical evaluation was as follows. (1) The intraclass correlation coefficient (ICC) was calculated from data collected from at least two examinations of each patient by at least two evaluating clinicians (Data A). (2) Total scores for the two evaluations were determined from the distribution of differences in data between the two evaluations (Data B); each item was evaluated by determining Cohen's coefficient of agreement. (3) The relation between patient satisfaction and total score was investigated only for patients who underwent surgery (Data C). Spearman's rank correlation coefficient was obtained. RESULTS: Participants were 65 clinicians and 610 patients, including those with disorders of the AH (313), MF (47), HL (153), and LT (50) and those with RA (47). From Data A, the ICC was high for AH and HL by JSSF scales and for AH, MF, and LT by the JOA scale. From Data B, the coefficient showed high validity for both scales for AH, with almost no difference between the two scales; the validity for HL was higher with the JOA scale than with the JSSF scale. From Data C, correlations were significant between patient satisfaction and outcome for AH and HL by the JSSF scales and for AH, HL, and LT by the JOA scale. CONCLUSIONS: The validity of both scales was high. Clinical evaluation of the therapeutic results using these scales would be highly reliable.

Stress fracture of an os peroneum.

Fracture of the os peroneum is relatively rare, and a stress fracture of the os peroneum is even rarer. We report a case of stress fracture of the os peroneum in a 38-year-old laborer who had been working in a crouching position. X-rays showed a multipartite os peroneum. Bone scintigram showed uptake at the os peroneum. The histology of the excised os peroneum revealed various stages of fracture healing. Excision of the fractured os peroneum and reconstruction of the peroneus longus tendon by end-to-end suture resulted in an excellent outcome.