The effectiveness of a Botulinum Toxin A infiltration in the management of bicipital cramps after arthroscopic biceps tenotomy.

A challenging complication of arthroscopic biceps surgery is the persistent painful cramping of the biceps. There is a paucity of data upon nonsurgical treatment of this debilitating complication. We pro- pose an intramuscular injection of botulinum toxin A (BTX-A) for painful bicipital cramping after tenotomy of the long head of the biceps brachii tendon (LHBT). Ten patients with a painful Popeye sign after tenotomy of LHBT, were treated with intramuscular injection of 100 IU of BTX-A. Mean patient age was 56 years and mean time from surgery to infiltration was 317 days. The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was obtained. Pain was objectified by a visual analogue scale (VAS). Patient satisfaction was described as excellent, good, satisfactory, or poor, three and six months after injection. Mean VAS prior to infiltration was 6.8 and decreased significantly to 2.6 at follow-up. Mean QuickDash was 54.04 prior to infiltration and decreased to 19.84 at follow-up. Patient satisfaction was excellent in 9 and good in 1 patient. We report a significant pain reduction and functional improvement following BTX-A infiltration as treatment of painful bicipital cramping after tenotomy of LHBT.

Synovial Chondromatosis of the Midcarpal Joint: A Case Report and Brief Review of Literature.

Objective Synovial chondromatosis is a rare benign proliferative disorder of synovium characterized by the formation of cartilaginous bodies in a joint. The condition typically affects one single large joint. The development of synovial chondromatosis in the joints of hand and wrist is extremely rare. Case description In this report, we present a case of synovial chondromatosis arising from the midcarpal joint and the arthroscopic treatment thereof. Literature review Owing to its rarity, literature on synovial chondromatosis occurring in the hand and wrist is extremely limited. To our knowledge, no report has been published describing the arthroscopic treatment of an isolated synovial chondromatosis of the midcarpal joint. Clinical relevance As synovial chondromatosis of the hand and wrist is extremely rare, and clinical and radiological findings can be nonspecific, the diagnosis might be overlooked initially. The condition does, however, require surgical treatment and thorough follow-up. Thus, awareness of this possible diagnosis among treating physicians is important.