[Oberst's block anesthesia]. / Leitungsanästhesie nach Oberst.

OBJECTIVE: Complete anesthesia of the phalanges of the fingers and toes. INDICATIONS: All lesions distal to the metacarpophalangeal/metatarsophalangeal joint. CONTRAINDICATIONS: Local infections at the injection site. Lesions proximal to the metacarpophalangeal/metatarsophalangeal joint. TECHNIQUE: A subcutaneous deposit of a 0.5-2% local anesthetic is administered dorsoradially and dorsoulnarly at the base of the metacarpophalangeal/metatarsophalangeal joint. With the cannula advanced to palmar, an additional 0.5-1.5 ml is then administered to achieve complete anesthesia. POSTOPERATIVE MANAGEMENT: The effect of the local anesthesia is self-limiting. RESULTS: The Oberst block results in reliable anesthesia of the finger and toe. All surgical procedures distal to the metacarpophalangeal/metatarsophalangeal joint can be performed without pain.

Short-term effect of shockwave therapy, temperature controlled high energy adjustable multi-mode emission laser or stretching in Dupuytren's disease: a prospective randomized clinical trial.

Dupuytren's disease is a debilitating disease of the hand characterized by nodules on the surface of the palm with progressive loss of finger extension. The chosen forms of treatment are infiltrative and surgical. Conservative treatment could be useful but few studies have been carried out and these regarded mainly stretching exercises and thermo-therapy. To date, no study has analyzed the effects of biostimulation with shock-waves (SW) and high energy laser therapy [Temperature controlled High Energy Adjustable multi-mode emission Laser (THEAL)]. We recruited 45 patients, 32 males and 13 females (average age 63.4 years) affected by early or late stage Dupuytren's disease [33 metacarpophalangeal (MCP) joints, 12 proximal interphalangeal (PIP) joints]. We randomized the patients into three treatment groups: extracorporeal shockwave therapy (ESWT), THEAL and stretching exercises. Follow-ups were at the end of treatment (T1), after 1 month (T2), and after 3 months (T3). The three forms of treatment determined a progressive clinical-functional improvement. The pain relief was statistically significant for SW and THEAL at all follow-ups (FUs) (p

Atypical Rocky Mountain spotted fever with polyarticular arthritis.

BACKGROUND: Rocky Mountain spotted fever (RMSF) is an acute, serious tick borne illness caused by Rickettsia rickettsi. Frequently, RMSF is manifested by headache, a typical rash and fever but atypical disease is common, making diagnosis difficult. Inflammatory arthritis as a manifestation is rare. The purpose of this study is to describe a patient with serologically proven RMSF who presented in an atypical manner with inflammatory arthritis of the small joints of the hands and to review the previously reported patients with rickettsial infection and inflammatory arthritis. METHODS: An 18-year-old woman presented with a rash that began on the distal extremities and spread centrally, along with hand pain and swelling. She had tenderness and swelling of the metacarpophlangeal joints on examination in addition to an erythematosus macular rash and occasional fever. RESULTS: Acute and convalescent serology demonstrated R rickettsi infection. She was successfully treated with doxycycline. CONCLUSIONS: Inflammatory arthritis is a rare manifestation of RMSF or other rickettsial infection with 8 previously reported patients, only 1 of whom had RMSF. Physician must have a high index of suspicion for RMSF because of atypical presentations.

Efeito analgésico do laser de baixa intensidade (LILT) na artrite reumatóide aguda / Effect analgesic of low intensity laser (LILT) in rheumatoid arthritis acute

Introdução - Avaliar a efetividade da laserterapia de baixa intensidade (LILT) na promoção da analgesia em portadores de artrite reumatóide. Material e Métodos - Dez sujeitos, portadores de artrite reumatóide (05 pertencentes ao grupo irradiado e 05 pertencentes ao grupo placebo) foram submetidos à 10 sessões de LILT, divididas em 5 semanas (2 sessões/semana). O Questionário de Dor Br-MPQ foi aplicado no início e ao final do protocolo. Resultados - Obteve-se um resultado significativo de menor algia no grupo controle (80%) e um resultado de maior algia no grupo irradiado(40%), o que não se implica em um resultado efetivo ao estudo. Conclusão - A LILT (904 nm) não foi efetiva na analgesia em portadores com artrite reumatóide.

Introduction - Evaluating the effectiveness of low power laser therapy in order to promote analgesic effect in rheumatoid arthritis bearers. Material and Methods - Ten subjects bearer of rheumatoid arthritis (05 belonging to radiated group and 05 belonging to placebo group) were evaluated in ten session of LILT, divided in five weeks (two session/week). The Brazilian version of Dor Br - MPQ questionnaire from McGill Pain Questionnaire was used and applied at the beginning and at the end of the protocol. Results - We got a pretty smaller result from the control group (80%) and a bigger result from the radiated group (40%), what does not mean an effective result to this study. Conclusion - The LILT (904 nm) was not effective in the analgesic effect in rheumatoid arthritis bearers.

Osteosarcoma of the hand: a rare case for radiographic appearance, location, and age.

OBJECTIVE: This case describes the history, process of correct diagnosis, and treatment of a patient with pain in her left fourth finger, later found to be an osteosarcoma. CLINICAL FEATURES: A 28-year-old woman presented with pain in her left fourth finger, which she also noticed had been "getting bigger." Moderate tenderness and decreased range of motion were noticed over the metacarpophalangeal joint of the involved finger. INTERVENTION AND OUTCOME: Initial radiographs indicated a benign tumor with a pathological fracture, and the patient was referred to a hand surgeon. After debridement of the area, the pathology report returned with a diagnosis of osteoblastic osteogenic osteosarcoma. The patient then underwent amputation of the fourth ray and chemotherapy. CONCLUSION: This case presents a rare bone tumor of the hand and highlights the importance of clinical decision-making to lead to appropriate patient care.