RESUMO
We present a case of volar rotatory subluxation of index finger proximal interphalangeal joint (PIPJ) following a skiing accident. The injury was initially perceived to be a central slip rupture and treatment was directed as such. After the initial delay in the diagnosis, the patient underwent surgery during which his radial collateral ligament was found to be avulsed from the proximal origin, the radial lateral band palmarly subluxed and was interposed in the joint space. This structure was also adhered to the uninjured volar plate.PIPJ volar rotatory subluxation could be readily missed in the acute setting. Without surgery, the functional outcome could be mediocre and to the patient's detriment.
Assuntos
Ligamentos Colaterais/lesões , Traumatismos dos Dedos/diagnóstico , Luxações Articulares/diagnóstico , Esqui/lesões , Adulto , Ligamentos Colaterais/diagnóstico por imagem , Ligamentos Colaterais/patologia , Ligamentos Colaterais/cirurgia , Diagnóstico Tardio , Traumatismos dos Dedos/etiologia , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/patologia , Articulações dos Dedos/cirurgia , Humanos , Período Intraoperatório , Luxações Articulares/etiologia , Luxações Articulares/cirurgia , Masculino , Diagnóstico Ausente , Placa Palmar/diagnóstico por imagem , Placa Palmar/patologia , Placa Palmar/cirurgia , Amplitude de Movimento Articular , Fatores de Tempo , Aderências Teciduais/diagnóstico , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND AND AIM: Treatment of palmoplantar warts is a challenge for dermatologists. We aimed to study the efficacy and safety of Falknor's needling method in palmoplantar warts. METHODS: In an open, nonrandomized study, the index wart of eligible patients was punctured several times with a 26-gauge needle to produce a "beefy" red wound. Patients were followed up to 6 months. RESULTS: Out of 82 patients, complete resolution occurred in 58 (70.7%) and partial response in 5 (6.1%) patients. Nine (10.9%) patients developed secondary infection. LIMITATIONS: Small sample size, No comparison group. CONCLUSION: Falknor's needling method provides a high rate of complete resolution after a single treatment session. It is easy to perform and is cost effective.
Assuntos
Imunoterapia/métodos , Agulhas , Placa Palmar/patologia , Placa Plantar/patologia , Verrugas/diagnóstico , Verrugas/terapia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Imunoterapia/instrumentação , Masculino , Pessoa de Meia-Idade , Placa Palmar/imunologia , Placa Plantar/imunologia , Estudos Prospectivos , Verrugas/imunologia , Adulto JovemRESUMO
PURPOSE: Volar plates positioned at, or distal to, the watershed line have been shown to have a higher incidence of attritional rupture of the flexor pollicis longus (FPL). In this study, we aimed to evaluate the effect of wrist extension and volar tilt on the contact between the plate and the FPL tendon in a cadaver model. We hypothesized that, following volar plate application, loss of native volar tilt increases the contact between the FPL and the plate at lower degrees of wrist extension. METHODS: A volar locking plate was applied on 6 fresh-frozen cadavers. To determine the contact between the plate and the FPL tendon, both structures were wrapped with copper wire and circuit conductivity was monitored throughout wrist motion. A lateral wrist radiograph was obtained at each circuit closure, indicating tendon-plate contact. Baseline measurements were obtained with plate positioned at Soong grades 0, 1, and 2. An extra-articular osteotomy was made and contact was recorded at various volar tilt angles (+5°, 0°, -5°, -10°, -15°, and -20°) in 3 different plate positions. A blinded observer measured the degree of wrist extension on all lateral radiographs. Data were analyzed using linear mixed-effects regression model. RESULTS: Plates placed distal to the watershed line had the most contact throughout wrist range of motion. Significantly, less wrist extension was required for contact in wrists with neutral or dorsal tilt and in distally placed volar plates. Volar tilt, wrist extension, and plate position were 3 independent risk factors determining contact between plate and tendon. CONCLUSIONS: Loss of volar tilt, increased wrist extension, and higher Soong grade plate position result in greater contact between wire-wrapped FPL tendon and plate. CLINICAL RELEVANCE: The FPL/plate contact chart generated in this study may be used to assess the risk of rupture in the clinical setting.
Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Placa Palmar/cirurgia , Amplitude de Movimento Articular/fisiologia , Traumatismos dos Tendões/etiologia , Articulação do Punho/fisiopatologia , Idoso , Cadáver , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Placa Palmar/patologia , Placa Palmar/fisiopatologia , Fraturas do Rádio/cirurgia , Fatores de Risco , Ruptura/etiologia , Articulação do Punho/patologia , Articulação do Punho/cirurgiaRESUMO
BACKGROUND: Distal radius fractures (DRFs) are the second most common fractures, after hip fractures, seen in clinical practice. The high incidence of low-energy trauma DRFs in elderly patients raises questions about the best treatment method in terms of function, pain, and quality of life. Although the majority of these fractures are treated non-operatively with cast immobilization, valid scientific evidence of the optimal cast immobilization is lacking. In addition, several publications, including Cochrane review have outlined the need for more evidence to determine the most appropriate method of cast immobilization. METHODS: This study is a pragmatic, prospective, randomized, multi-centre trial. The trial is designed to compare two widely used cast positions (volar flexion-ulnar deviation position and functional position) for the non-operative treatment of DRF in patients over 64 years of age. The main hypothesis of the trial is that function position yields corresponding functional outcome, pain relief and quality of life when compared to the volar flexion-ulnar deviation position. The primary outcome measure is Patient Rated Wrist Evaluation (PRWE) score and the secondary outcome measures will be the Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analogue Scale (VAS), 15-dimensional (15D) value and rate of surgical interventions. The results of the trial will be analysed after 1 and 2-years. DISCUSSION: This publication presents a prospective, pragmatic, randomized, national multi-centre trial study protocol. It provides details of patient flow, randomization, follow-up and methods of analysis of the material as well as publication plan. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02894983 22 August 2016.
Assuntos
Moldes Cirúrgicos/tendências , Placa Palmar/cirurgia , Fraturas do Rádio/cirurgia , Ulna/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Consolidação da Fratura/fisiologia , Humanos , Masculino , Placa Palmar/patologia , Estudos Prospectivos , Fraturas do Rádio/diagnóstico , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento , Ulna/patologiaRESUMO
BACKGROUND: Mohawk (Mkx) is a homeodomain-containing transcription factor that is expressed in various mesoderm-derived tissues, particularly in developing tendons. In this study, we investigate the exact expression pattern and functions of Mkx in forelimbs. METHODS: We analyzed the forelimbs of Mkx knockout mice [from embryonic day (E) 18.5 to postnatal day (P) 28 weeks] by using knocked-in Venus signals, Masson trichrome staining, and hematoxylin and eosin (H&E) staining. RESULTS: We detected Venus signals in forelimb tendons, pulleys, and volar plates (VPs) in P21 mice. In-depth histological analysis showed that compared to the wild-type mice, the Mkx knockout mice showed significant hypoplasia in the flexor digitorum profundus tendons from E18.5. The VPs and pulleys appeared normal until P0; however, by P14, they became increasingly thicker in Mkx-null mice compared to wild-type mice. The fiber alignment was particularly disrupted in VPs of Mkx-null mice. CONCLUSIONS: These results suggest that Mkx is an important regulator of the differentiation of VPs and pulleys, as well as of tendon differentiation.
Assuntos
Regulação da Expressão Gênica no Desenvolvimento , Proteínas de Homeodomínio/genética , Morfogênese/genética , Placa Palmar/crescimento & desenvolvimento , RNA Mensageiro/genética , Tendões/crescimento & desenvolvimento , Animais , Animais Recém-Nascidos , Diferenciação Celular , Modelos Animais de Doenças , Membro Anterior , Técnicas de Inativação de Genes , Proteínas de Homeodomínio/biossíntese , Imuno-Histoquímica , Camundongos , Camundongos Knockout , Placa Palmar/patologia , Fenótipo , Tendões/patologia , Transcrição GênicaRESUMO
BACKGROUND: In open reduction and volar plate fixation of distal radius fractures, the pronator quadratus (PQ) muscle is usually detached at the radial edge of the distal radius. Repair of the muscle is reasonable for coverage of the plate and to maintain normal pronation of the forearm. However, repair of the muscle is not always satisfactory. In this study, the topographic relationship of both the PQ and the brachioradialis muscle (BR) insertions are investigated with regard to optimising the repair of the PQ in open reduction and volar plate fixation of distal radius fractures. MATERIALS AND METHODS: Twelve forearm pairs fixed in formalin were examined. The muscular boundaries of the PQ and the insertion of the BR were dissected, photographs were taken and measured digitally. RESULTS: The average distance of the PQ insertion was 4.75 cm. Distally, a close topographic relationship exists between the insertions of both the PQ and BR. A fascial connection of both muscles was detected in all specimens. The average distance of the common insertion was 1.75 cm. After removal of the PQ fascia, 0.85 cm of common insertion remained. In 25 % a muscular connection between both the PQ and BR was detected after removal of the PQ fascia. CONCLUSION: Both the PQ and BR have a common connective tissue and partially a common muscular insertion. Detaching the PQ insertion with a part of the BR insertion in open reduction and volar plate fixation of distal radius fractures can presumably lead to a more stable repair of the PQ in contrast to a repair within the muscle.
Assuntos
Fixação Interna de Fraturas/métodos , Músculo Esquelético/patologia , Placa Palmar , Fraturas do Rádio/patologia , Fraturas do Rádio/cirurgia , Traumatismos do Punho/patologia , Traumatismos do Punho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Modelos Anatômicos , Tratamentos com Preservação do Órgão/métodos , Placa Palmar/lesões , Placa Palmar/patologia , Placa Palmar/cirurgiaRESUMO
Magnetic resonance imaging (MRI) with small surface coils is a well established method for the diagnostic evaluation of finger masses. Until now, histological examination has been required to reliably assess tumor extent and infiltration of surrounding structures. Ultra-high-field MR microscopy (MRM) allows evaluation of anatomical structures and pathologies with submillimeter resolution. This study describes the diagnostic prospects and potential of MRM based on the ex-vivo examination of different finger pathologies. Ten human digits were examined by ex-vivo MRM at 7.1 Tesla (ClinScan, Bruker BioScan) using a T2-weighted turbo spin echo (TSE) sequence. Imaging parameters were: TE 48 ms; TR 8370 ms; slice thickness 700 µm; matrix size 1024 × 1024 pixels; FOV 37 × 37 mm; in-plane resolution 36 × 36 µm/voxel. Afterwards specimens were examined histologically. Histology and MRM were correlated. MRM allowed evaluation of the anatomy of the nail, the tendon insertions, the distal interphalangeal joint, and the neurovascular bundles. Finger abnormalities evaluated by MRM included osteomyelitis and metastatic disease. Subsequent histological examination confirmed MRM findings regarding origin, internal makeup, and extent of the structures visualized. This study demonstrates the potential of MRM for imaging small anatomical structures and pathologies of the human finger. Our ex-vivo findings correlate strongly with histology, suggesting that MRM may gain a central role in assessing anatomical structures and pathology in terms of morphology, extent, and infiltration of surrounding structures. Therefore, with increasing availability, MRM is expected to become an essential tool not only in experimental studies but also for daily routine.
Assuntos
Dedos/patologia , Técnicas Histológicas/métodos , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Articulações dos Dedos/patologia , Humanos , Pessoa de Meia-Idade , Unhas/patologia , Placa Palmar/patologia , Estudos Prospectivos , Tendões/patologiaRESUMO
INTRODUCTION: Anatomicaly preformed variable-angle locking plates are technologically mature and appear to be optimal for the fixation of distal radius fractures. However, there is still much argument about whether volar plating is equivalent to dorsal (buttressing) plating, especially in the management of intra-articular extension fractures. This biomechanical study was performed to determine, in a simple intra-articular fracture model, whether dorsal or volar plate constructs would be more stable. MATERIALS AND METHODS: Six pairs of fresh frozen radii were examined with dual-energy absorptiometry (DXA) to determine their bone mineral density (BMD). An AO type 23 C2.1 fracture was created. Volar fixation was with a 2.4mm Variable-Angle LCP Two-Column Volar Distal Radius Plate; dorsal fixation was with two orthogonal 2.4 mm Variable-Angle LCP Dorsal Distal Radius Plates (both devices: Synthes, Oberdorf, Switzerland). Biomechanical testing used a proven protocol involving static tests of stiffness, and a cyclic test to obtain range of motion (ROM), maximum deformation, and subsidence data. RESULTS: None of the constructs failed during biomechanical testing. The two groups (volar and dorsal plating, respectively) did not differ significantly in terms of initial (pre-cyclic-testing) and final (post-cyclic-testing) stiffness. Equally, there was no significant difference between the subsidence values in the two groups. The post-cyclic-testing ROM was significantly greater in the dorsal-plate group as compared with the volar-plate group. The volar constructs showed a significant decrease in the ROM between pre- and post-cyclic testing. CONCLUSION: Biomechanically, volar plating with a modern variable-angle locking plate is equivalent to dorsal plating with two modern variable-angle locking plates.
Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Placa Palmar/cirurgia , Fraturas do Rádio/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Placas Ósseas , Cadáver , Feminino , Humanos , Fraturas Intra-Articulares/patologia , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Placa Palmar/patologia , Fraturas do Rádio/patologiaRESUMO
Dupuytren's disease (DD) is a common fibrotic condition of the palmar fascia, leading to deposition of collagen-rich cords and progressive flexion of the fingers. The molecular mechanisms underlying the disease are poorly understood. We have previously shown altered expression of extracellular matrix-degrading proteases (matrix metalloproteases, MMPs, and 'a disintegrin and metalloprotease domain with thrombospondin motifs', ADAMTS, proteases) in palmar fascia from DD patients compared to control and shown that the expression of a sub-set of these genes correlates with post-operative outcome. In the current study we used an in vitro model of collagen contraction to identify the specific proteases which mediate this effect. We measured the expression of all MMPs, ADAMTSs and their inhibitors in fibroblasts derived from the palmar fascia of DD patients, both in monolayer culture and in the fibroblast-populated collagen lattice (FPCL) model of cell-mediated contraction. Key proteases, previously identified in our tissue studies, were expressed in vitro and regulated by tension in the FPCL, including MMP1, 2, 3, 13 and 14. Knockdown of MMP2 and MMP14 (but not MMP1, 3 and 13) inhibited cell-mediated contraction, and knockdown of MMP14 inhibited proMMP-2 activation. Interestingly, whilst collagen is degraded during the FPCL assay, this is not altered upon knockdown of any of the proteases examined. We conclude that MMP-14 (via its ability to activate proMMP-2) and MMP-2 are key proteases in collagen contraction mediated by fibroblasts in DD patients. These proteases may be drug targets or act as biomarkers for disease progression.
Assuntos
Contratura de Dupuytren/metabolismo , Metaloproteinase 14 da Matriz/metabolismo , Metaloproteinase 2 da Matriz/metabolismo , Células Cultivadas , Contratura de Dupuytren/patologia , Fáscia/metabolismo , Humanos , Metaloproteinase 1 da Matriz/genética , Metaloproteinase 1 da Matriz/metabolismo , Metaloproteinase 13 da Matriz/genética , Metaloproteinase 13 da Matriz/metabolismo , Metaloproteinase 14 da Matriz/genética , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 3 da Matriz/genética , Metaloproteinase 3 da Matriz/metabolismo , Placa Palmar/patologia , Interferência de RNA , RNA Interferente PequenoAssuntos
Neoplasias da Mama/complicações , Fasciite , Articulações dos Dedos , Placa Palmar , Síndromes Paraneoplásicas/etiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Carcinoma/complicações , Carcinoma/patologia , Carcinoma/terapia , Quimioterapia Adjuvante , Contratura/etiologia , Contratura/patologia , Contratura/fisiopatologia , Fasciite/etiologia , Fasciite/patologia , Fasciite/fisiopatologia , Feminino , Articulações dos Dedos/patologia , Articulações dos Dedos/fisiopatologia , Humanos , Mastectomia Radical Modificada , Pessoa de Meia-Idade , Placa Palmar/patologia , Placa Palmar/fisiopatologia , Síndromes Paraneoplásicas/patologia , Síndromes Paraneoplásicas/fisiopatologia , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
Advanced stages of basal joint arthritis are sometimes characterized by an adduction deformity of the first metacarpal and a hyperextension deformity of the unstable metacarpophalangeal (MCP) joint. Stabilizing the MCP joint in these patients is critical to ensure a pain-free repair and efficient pinch mechanism. This study presents the anatomic basis for a novel capsulodesis technique using the volar plate that can be incorporated into any reconstructive basal joint procedure when clinically indicated. Eleven normal cadavers were dissected to expose the volar plate. The dimensions of the volar plate, relationship of the sesamoid bones to the oblique pulley, and the distance from the sesamoids to the base of the proximal phalanx were compared between specimens. The radial border of the volar plate measured 8.5 ± 1.3 mm, ulnar border 8.8 ± 1.0 mm, proximal border 7.5 ± 1.0 mm, and distal border 7.8 ± 0.6 mm. The distance between the ulnar sesamoid bone and the oblique pulley measured 12.1 ± 1.1 mm and from the radial sesamoid to the oblique pulley measured 16.6 ± 0.2 mm. The distance between the sesamoids and the base of the phalanx measured 2.2 ± 0.2 mm. The anatomic studies provide a foundation on which the surgeon can understand the complex nature of the MCP joint. This study describes a novel technique for MCP capsulodesis of the thumb in which volar plate flaps are imbricated to provide stability to the MCP joint, obviating the need for suture anchors and tendon grafts.
Assuntos
Artrodese/métodos , Deformidades Articulares Adquiridas/cirurgia , Instabilidade Articular/cirurgia , Articulação Metacarpofalângica/cirurgia , Osteoartrite/cirurgia , Placa Palmar/cirurgia , Polegar , Artroplastia/métodos , Artroplastia/reabilitação , Cadáver , Humanos , Articulação Metacarpofalângica/patologia , Placa Palmar/patologiaRESUMO
PURPOSE: Controversy exists over the pathologic anatomy of irreducible dorsal metacarpophalangeal (MCP) dislocation. The aim of this work is to develop a cadaveric model of MCP joint dislocation that closely simulates the clinical situation and to study the structures around the MCP joint and their contribution to irreducibility of the dislocation. METHODS: Nine fresh-frozen cadaveric specimens were amputated at the radiocarpal joint and stabilized in a specially formulated fixture. The dislocation was created by an impact load delivered by a servohydraulic testing machine, at a displacement rate of 1000 mm/s and with a maximum displacement of 60 mm. An irreducible dislocation was successfully created in 6 index fingers. An attempt at closed reduction was followed by a dissection of the dislocated joint. RESULTS: In the 6 examined specimens, the flexor tendons were ulnar to the joint in all cases, the radial digital nerve was superficial (5 cases) or radial (5 cases) to the metacarpal head, and the lumbrical was usually radial (5 of 6 cases) to the joint. Division of the superficial transverse metacarpal ligaments, natatory ligaments, flexor tendons, or lumbricals does not aid reduction of the dislocation. Division of the volar plate was necessary for reduction of the dislocation in all 6 cases, whereas division of the deep transverse metacarpal ligaments does not allow reduction of the dislocation. CONCLUSIONS: We present a model for creating an irreducible MCP joint dislocation using an impact load that simulates the clinical situation. The volar plate is the primary structure preventing reduction of the dislocation. Division of the deep transverse metacarpal ligament is not effective in reducing the dislocation. The flexor tendons, lumbricals, superficial transverse metacarpal ligament and natatory ligaments do not contribute to irreducibility. The anatomy of the structures surrounding the MCP joint is variable, and careful dissection to prevent iatrogenic injuries is mandatory.
Assuntos
Luxações Articulares/patologia , Articulação Metacarpofalângica/lesões , Adulto , Feminino , Humanos , Luxações Articulares/cirurgia , Ligamentos Articulares/lesões , Ligamentos Articulares/patologia , Ligamentos Articulares/cirurgia , Masculino , Articulação Metacarpofalângica/patologia , Articulação Metacarpofalângica/cirurgia , Pessoa de Meia-Idade , Modelos Anatômicos , Placa Palmar/patologia , Placa Palmar/cirurgiaRESUMO
PURPOSE: The objective of this study was to measure the size and shape of Lister's tubercle and the depth of the extensor pollicis longus (EPL) groove to assess the risk of injury to the EPL tendon when performing volar plating of distal radius fractures. METHODS: The length and height of Lister's tubercle and the depth of the EPL groove were measured in 100 cadavers. RESULTS: The size of Lister's tubercle varied from 2 to 6 mm (average, 3.6 mm) in height radial to the tubercle and from 6 to 26 mm (average, 18.3 mm) in length. The depth of the EPL groove varied from 1 to 5 mm (average, 2.8 mm), with 63% being greater than 2 mm in depth. The height between the depth of the groove and the tip of the tubercle varied between 4 and 10 mm (average, 7.1 mm). No correlation was found with gender or right-side or left-side specimens. CONCLUSIONS: The individual and combined height of Lister's tubercle and the depth of the EPL groove are considerable. This fact needs to be considered when performing volar plating of distal radius fractures because of the possibility that it might be difficult to determine precisely the presence and amount of past-pointing of the distal screws.
Assuntos
Fixação Interna de Fraturas , Placa Palmar/patologia , Placa Palmar/cirurgia , Fraturas do Rádio/cirurgia , Tendões/patologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Epífises/patologia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/prevenção & controleRESUMO
Volar melanotic macules are asymptomatic, tan-brown to brownish-black macules found on the palms, fingers, soles, and/or toes of dark-skinned individuals and are infrequently reported in light-skinned individuals. Herein, we report the acquisition of multiple, brownish-black volar digital macules in a 63-year-old white woman and avid gardener that were noted after the onset of pruritic, chronic hand dermatitis over a 10-month period. She was healthy without any medical conditions or medications. No family history of intestinal polyposis or mucosal melanosis existed. At presentation, she had less than 20 brownish-black, 2- to 10-mm irregular macules over the volar aspect of the thumbs and index fingers, left greater than right hand, associated with erythema, scale, and a negative potassium hydroxide examination. In addition, she had melanotic macules of her lips, buccal mucosa, and conjuctiva. No nail or anogenital macules were found. Biopsy demonstrated a region of epidermal hyperplasia, hyperkeratosis, and interface dermatitis associated with melanophages and sparse lymphocytic infiltrate. Melanin staining revealed diffuse pan-epidermal hypermelanization, dermal melanin, and dendritic melanocytes, which expressed HMB-45. After 1-year follow-up and treatment with topical corticosteroid, the volar macules have faded to tan brown. Based on the location, avocation, and coexisting mucosal melanotic macules, an irritant phytodermatitis with postinflammatory hyperpigmentation was diagnosed in the setting of Laugier-Hunziker syndrome-a disorder denoted by macular hyperpigmentation of nail, volar, and/or mucosal surfaces in healthy adults. Volar melanotic macules can also complicate 5-flourouracil therapy, tinea pedis, and other inflammatory disorders; be associated with acral melanomas; or represent a cutaneous manifestation of systemic disease such as Addison disease, Peutz-Jegher syndrome, Leopard syndrome, Carney syndrome, AIDS, and neurofibromatosis.
Assuntos
Dermatite Alérgica de Contato/diagnóstico , Jardinagem , Hiperpigmentação/diagnóstico , Melanócitos/patologia , Placa Palmar/patologia , Corticosteroides/uso terapêutico , Dermatite Alérgica de Contato/patologia , Diagnóstico Diferencial , Feminino , Humanos , Hiperpigmentação/patologia , Melanose/diagnóstico , Melanose/patologia , Pessoa de Meia-IdadeRESUMO
We report a case of carpal tunnel syndrome caused by volar dislocation of the lunate in a patient with rheumatoid arthritis. A 74-year-old woman complained of numbness in her fingers. Carpal tunnel syndrome was diagnosed, and carpal tunnel release was performed. However, the symptoms recurred. Three-dimensional computed tomography and magnetic resonance imaging revealed volar dislocation of the lunate and synovitis around the distal radioulnar joint, respectively. Resection of the lunate and the Sauvé-Kapandji procedure were effective.