Double localization of giant cell reparative granuloma of the bone in the same finger. Differential diagnosis and treatment.

AIM: This article reports a case of GCRG seen in a young man with a rare double localization in the same finger and illustrates the degree of diagnostic difficulty and treatment. MATERIAL OF STUDY: A 16-year-old man presented with dull pain and swelling of the left middle finger. Plain radiography of the hand showed expansive and lucent lytic lesions with circumferential cortical destruction in the small bones of the proximal and middle phalanges. He underwent en-bloc resection and reconstruction. RESULTS: Histologic findings were consistent with the radiologic diagnosis of GCRG, although several of the features were considered atypical, including the appearance of the giant cells and the areas of the stroma that more closely resembled a giant cell tumor (GCT). At 6 months postoperatively, the morphologic recovery was complete and he had returned to unrestricted activities. His range of motion at the involved joint was the almost completely recovered, and his grip strength on the third setting of the Jamar scale was 48 and 42 kg for the right and left hands respectively. CONCLUSIONS: GCRG is a rare intraosseous lesion that must be considered in the differential diagnosis of hand and foot lesions, such us giant cell tumor, brown tumor, giant-cell-rich osteosarcoma.

Therapeutic management of hypothenar hammer syndrome causing ulnar nerve entrapment.

Introduction. The hypothenar hammer syndrome is a rare traumatic vascular disease of the hand. Method and Materials. We report the case of a 43-years-old man with a painful tumefaction of the left hypothenar region. The ulnar artery appeared thrombosed clinically and radiologically. The patient underwent surgery to resolve the ulnar nerve compression and revascularise the artery. Results. The symptoms disappeared immediately after surgery. The arterial flow was reestablished. Postoperatively on day 20, a new thrombosis of the ulnar artery occurred. Conclusion. Hypothenar hammer syndrome is caused by repetitive trauma to the heel of the hand. The alterations of the vessel due to its chronic inflammation caused an acute compression of the ulnar nerve at the Guyon's canal and, in our case, do not allow a permanent revascularisation of the ulnar artery.

High resolution ultrasonography in the diagnosis of the carpal tunnel syndrome.

PURPOSE: Carpal tunnel syndrome (CTS) is a neuropathy caused by compression of the median nerve in the carpal tunnel. Our purpose was to evaluate the role of high-resolution ultrasonography (US), performed with a 10-13 MHz probe, in the detection of morphovolumetric changes of the median nerve to confirm the clinical diagnosis. MATERIALS AND METHODS: Fifty healthy volunteers were examined first by US; subsequently we studied 294 wrists in 186 symptomatic patients, calculating the cross-sectional area of the median nerve at three levels: before the median nerve enters the carpal tunnel, at the carpal tunnel inlet and at the outlet. US was considered diagnostic for CTS when the median nerve area increased at the inlet or flattening was present along the carpal tunnel. RESULTS: Ultrasonography showed pathologic findings in 267 wrists: in 261 cases morphovolumetric changes of the median nerve were found; in six cases anatomic variant of the median nerve was detected. Surgery was performed in 277 cases and all patients became symptom-free. The sensitivity of US was 96.3 % . CONCLUSIONS: Our study confirms that quantitative ultrasonographic assessment is a useful support in confirming the clinical diagnosis of CTS.