Iatrogenic flexor tendon rupture caused by misdiagnosing sarcoidosis-related flexor tendon contracture as tenosynovitis: A case report.

BACKGROUND: Sarcoidosis is a multisystem disease characterized by granuloma formation in various organs. Sarcoidosis-related flexor tendon contractures are uncommon in clinical settings. This contracture is similar to stenosing tenosynovitis and potentially leads to misdiagnosis and mistreatment. Herein, we report a rare case of sarcoidosis-related finger flexor tendon contracture that was misdiagnosed as tenosynovitis. CASE SUMMARY: A 44-year-old woman presented to our department with flexion contracture of the right ring and middle fingers. The patient was misdiagnosed with tenosynovitis and underwent acupotomy release of the A1 pulley of the middle finger in another hospital that resulted in iatrogenic rupture of both the superficial and profundus flexors. Radiological presentation showed multiple sarcoid involvements in the pulmonary locations and ipsilateral forearm. A diagnosis of sarcoidosis was made based on the presence of non-caseating granulomas with tubercles consisting of Langhans giant cells with lymphocyte infiltration on biopsy, and the patient underwent surgical repair for the contracture. After 2 mo, the patient experienced another spontaneous rupture of the repaired middle finger tendon and underwent surgical re-repair. Satisfactory results were achieved at the 10 mo follow-up after reoperation. CONCLUSION: Sarcoidosis-related finger contractures are rare; thus, caution should be exercised when dealing with such patients to avoid incorrect treatment.

Comparative study of radial head resection and prosthetic replacement in surgical release of stiff elbows.

PURPOSE: Elbow trauma can compromise the arc of elbow flexion and forearm rotation. This study aimed at comparing the outcomes of radial head resection and prosthetic replacement in the surgical release of post traumatic elbow stiffness and associated restriction in forearm rotation. METHODS: We retrospectively reviewed the data of patients who underwent open arthrolysis with radial head resection (n = 15; resection group) or radial head replacement (n = 19; replacement group). The pre- and postoperative measurements of the elbow range of motion (ROM) were recorded. Elbow function was evaluated by the Broberg and Morrey Evaluation System; the Mayo Elbow Performance Index (MEPI); and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS: Over a mean follow-up duration of 22 months, the improvement in the arc of flexion and extension was 79° (range, 45-125°) and 82° (range, 10-110°), while that in the ROM for forearm rotation was 96° (range, 40-150°) and 102° (range, 15-150°) in the resection and replacement groups, respectively. There were no significant intergroup differences in the elbow ROM measured at the last follow up. The Broberg and Morrey, MEPI, and Dash scores in the two groups were comparable. CONCLUSIONS: Both resection and prosthetic replacement of the radial head with open arthrolysis of post traumatic elbow stiffness were feasible in treating the associated restriction of forearm rotation. We recommend that if the elbow is stable after complete release, radial head resection is preferable to prosthetic replacement because it is technically less demanding.

Effect of cryotherapy after elbow arthrolysis: a prospective, single-blinded, randomized controlled study.

OBJECTIVE: To investigate the effect of cryotherapy after elbow arthrolysis on elbow pain, blood loss, analgesic consumption, range of motion, and long-term elbow function. DESIGN: Prospective, single-blinded, randomized controlled study. SETTING: University hospital. PARTICIPANTS: Patients (N=59; 27 women, 32 men) who received elbow arthrolysis. INTERVENTIONS: Patients were randomly assigned into a cryotherapy group (n=31, cryotherapy plus standard care) or a control group (n=28, standard care). MAIN OUTCOME MEASURES: Elbow pain at rest and in motion were measured using a visual analog scale (VAS) on postoperative day (POD) 1 to POD 7 and at 2 weeks and 3 months after surgery. Blood loss and analgesic consumption were recorded postoperatively. Elbow range of motion (ROM) was measured before surgery and on POD 1, POD 7, and 3 months after surgery. The Mayo Elbow Performance Score (MEPS) was evaluated preoperatively and 3 months postoperatively. RESULTS: VAS scores were significantly lower in the cryotherapy group during the first 7 PODs, both at rest and in motion (P<.05). There were no significant differences between the 2 groups in VAS scores at 2 weeks and 3 months after surgery. Less sufentanil was consumed by the cryotherapy group than the control group for pain relief (P<.01). No significant differences were found in blood loss, ROM, and MEPS between the 2 groups (P>.05). CONCLUSIONS: Cryotherapy is effective in relieving pain and reducing analgesic consumption for patients received elbow arthrolysis. The application of cryotherapy will not affect blood loss, ROM, or elbow function.

[Expression and significance of substance P, neurofilament-H in glomus tumors with chronic pain].

OBJECTIVE: To observe the expression and distribution of substance P (SP), neurofilament-H (NFH) in glomus tumors with chronic pain, and to discuss the process of chronic pain and the relationship with pain degree. METHODS: Twenty-seven patients diagnosed as glomus tumor with chronic pain were enrolled as case group, and divided into light pain symptomatic group (LPSG) (n = 12) and severe pain symptomatic group (SPSG) (n = 15) according to clinical manifestations. Control group (CG) were enrolled by 30 patients with amputated extremities or hands after trauma. Immunohistochemical methods were used to determine the expression of SP, NFH which were detected quantitatively by computer graph analysis system too. RESULTS: The positive expression and distribution of SP, NFH existed in all the three groups and SPSG expression level was the highest [Grayscale Value(SP) (143.3 +/- 7.5), Grayscale Value(NFH) (167.7 +/- 4.4)], LPSG followed [Grayscale Value(SP) (156.2 +/- 8.2), Grayscale Value(NFH) (194.8 +/- 4.0)], control group was the third [Grayscale Value(SP) (208.2 +/- 16.6), Grayscale Value(NFH) (225.1 +/- 8.3)]; The difference of expression level among three groups was significant [SPSG vs LPSG (P(SP) = 0.002, P(NFH) < 0.0001), SPSG vs CG (P(SP) < 0.0001, P(NFH) < 0.0001), LPSG vs CG (P(SP) < 0.0001, P(NFH) < 0.0001)]. The findings of Pearson product-moment correlation analysis between quantitative grayscale value of SP, NFH respectively and pain score in all the patients with glomus tumor showed linear negative correlation (r(SP) = -0.8974, P(SP) = 0.000001; r(NFH) = -0.6545, P(NFH) = 0.000212). CONCLUSION: SP is the mainly afferent pain transmitter in the process of chronic pain in glomus tumor, and NFH plays an important role in pain-transmitted activities.