Trigger Finger Due to Anomaly of Lumbrical Insertion: A Case Report and Review of Literature.

CASE: Trigger finger (TF), or stenosing synovitis, is a common condition that can usually be diagnosed by physical examination. We recently operated on a patient with TF who did not respond to conservative treatment. At surgery, we found an anomalous insertion of the fourth lumbrical muscle to the A1 pulley. This insertion was observed to cause mechanical narrowing of the pulley due to a pulling effect by the muscle, which was relieved by resection. CONCLUSION: Although rare, the operating surgeon should be aware that local anatomical anomalies, such as insertion of a lumbrical into the A1 pulley, can be a cause of trigger finger.

[MEDIAN NERVE COMPRESSION BY LIPOMA CAN MIMIC CARPAL TUNNEL SYNDROME].

INTRODUCTION: Lipoma of the nerve is an uncommon tumor, and usually has the highest incidence in the upper limb, especially in the median nerve. When the lesion is large it can cause peripheral neuropathy such as carpal tunnel syndrome. Therefore, a physical examination is paramount for correct surgery and patient preparation. In this article we present a case that was mainly diagnosed by a complete physical examination, which led to the selection of appropriate surgery for the patient.

[ACUTE INJURY TO FLEXOR TENDONS OF THE HAND: ASSESSMENT, DIAGNOSIS AND TREATMENT].

INTRODUCTION: Hand lacerations are common injuries seen by the primary care physician. Even seemingly small cuts carry a high risk of injury to flexor tendons of the hand which requires surgical treatment by a specialist. Elucidation of the relevant history, along with a dedicated and focused physical examination is imperative for an early intervention which, along with a meticulous surgical technique and dedicated rehabilitation by occupational therapists, will lead to a much improved functional prognosis for the patient. This is a brief review of the anatomy and physiology of flexor tendons injury and repair, with historical milestones of developments in the approach to the injury. The article also highlights the surgical procedure brought forth by the late Professor Isidor Kessler, one of the founders of surgery of the hand in Israel, presented here as an overview and guidance to the primary care physician.

Treatment of Adolescent Hallux Valgus With Percutaneous Distal Metatarsal Osteotomy.

Background. Hallux valgus is a complex deformity of the first ray of the foot, and a significant number of adolescents develop this deformity. More than 130 surgical procedures have been described to treat hallux valgus, but there is no compelling evidence to prefer one method over another. Minimal invasive techniques have been proposed and reported to be successful and cost-effective. The objective of this study was to describe the clinical course of adolescent patients treated with percutaneous distal metatarsal osteotomy. Methods. A retrospective study included patients who had a percutaneous hallux valgus correction during the years 2008 to 2015. The following measurements were compared before surgery up to last follow-up: AOFAS Hallux-Metatarsophalangeal-Interphalangeal questionnaire and radiological measurements (HVA, IMA, DMAA). Any postoperative complications were extracted from the medical records. Results. The procedure was performed on 32 feet (27 patients). All patients were <18 years of age. There were 10 male patients (12 feet) and 17 female patients (20 feet). Average age at surgery was 15.8 years (range = 13-18 years). Average follow-up time was 43 months (range= 24-94 months). The average AOFAS score before surgery was 66, and after surgery, at last follow-up was 96. This difference was significant (P value <.0001). Most patients were pain free after the procedure and returned to appropriate age functioning. Significant improvement was noted in all radiological criteria. Conclusions. Percutaneous distal metatarsal osteotomy is safe, reliable, and effective for the correction of mild to moderate symptomatic hallux valgus in adolescents.Levels of Evidence: Level IV.