ABSTRACT
Adolescence is a difficult time, both physically and emotionally. Rapid growth coupled with physical changes in the background of high levels of activity can be overwhelming. Meanwhile, unfamiliar life stressors coupled with undeveloped compensatory mechanisms can lead to overwhelming anxiety and emotional distress. Emotional factors can make injuries and overuse syndromes feel more catastrophic. Occasionally, an adolescent's emotional distress can manifest physically, without antecedent injury or physiologic cause. Understanding the psychological milieu is as important as understanding the disease processes that can affect adolescents if one hopes to manage these patients effectively.
Subject(s)
Cumulative Trauma Disorders , Wrist , Adolescent , Humans , Anxiety , ArthralgiaSubject(s)
Radius Fractures , Humans , Network Meta-Analysis , Randomized Controlled Trials as TopicABSTRACT
Cutibacterium (Propionibacterium) acnes (C. acnes, previously known as P. acnes) is an anaerobic organism that commonly colonizes the human skin. After Staphylococcus spp. and Streptococcus spp., it is a common organism associated with deep prosthetic shoulder joint infections. We describe the case of rapidly progressive arthropathy of the native wrist secondary to infection with C. acnes. Diagnosis was made on prolonged enrichment cultures. The patient went on to complete a long-term course of oral sulfamethoxazole-trimethoprim with clinical improvement. To the best of our knowledge, this is the first report in the literature that C. acnes has been the main causative organism implicated in infection of the native wrist joint. It is imperative to request and wait for results of prolonged enrichment cultures to aid microbiological diagnosis in such cases.
Subject(s)
Arthritis, Infectious , Shoulder Joint , Arthritis, Infectious/diagnosis , Arthritis, Infectious/drug therapy , Humans , Propionibacterium acnes , Shoulder , Wrist , Wrist JointABSTRACT
Relapsing-remitting sixth nerve palsy is usually due to ophthalmoplegic migraine (recurrent cranial nerve palsy) in younger patients and microvascular disease in older patients. There have been isolated reports, however, of it occurring in the presence of a skull base tumour. We report a 20-year-old woman with Ollier's disease who presented with a relapsing-remitting sixth nerve palsy. Neuro-imaging revealed a skull base enchondroma.
ABSTRACT
UNLABELLED: consequently reports in the international literature are mainly of individual cases and small series. MATERIAL OF STUDY: This is a retrospective review of a series of 25 patients with lipomatous tumours of the hand and wrist treated between 2001 and 2009. All patients underwent clinical and radiological assessment and a marginal excisional biopsy. 23 lipomas, 1 fibrolipomatous hamartoma (FLH) and 1 well differentiated lipoma-like liposarcoma/atypical lipomatous tumour (WDLLL/ALT) were identified. CONCLUSION: Choosing the most appropriate investigations is mandatory for a correct diagnosis and planning. Ultrasound should always be considered as the first line investigation. MRI helps delineating the anatomy of the lesions and their relationships with the surrounding structures in the hand and wrist, enabling more accurate surgical planning. Histological examination of the excised specimen remains the gold standard for the formulation of the definitive diagnosis and should be performed in every case. KEY WORDS: Digits tumours, Fibrolipomatous hamartoma, Hand tumours, Lipoma, Lipoma-like liposarcoma, Wrist tumours.
Subject(s)
Hamartoma/diagnosis , Lipoma/diagnosis , Liposarcoma/diagnosis , Skin Neoplasms/diagnosis , Biopsy , Diagnosis, Differential , Hamartoma/surgery , Hand/pathology , Humans , Lipoma/surgery , Liposarcoma/surgery , Magnetic Resonance Imaging/methods , Retrospective Studies , Skin Neoplasms/surgery , Treatment Outcome , Ultrasonography/methods , Wrist/pathologyABSTRACT
The purpose of this study was to describe and evaluate a new technique for ultrasound-guided percutaneous release of the annular pulley in trigger digit using a modified hypodermic needle. A total of 35 ultrasound-guided percutaneous releases were performed on 25 patients diagnosed and referred by hand surgeons in our institution over 16 months from October 2006. Inclusion criteria were as follows: adulthood, triggering present for at least 4 months, failure to respond to conservative management or steroid injections, no previous history of pulley release in the affected digit. Under ultrasound guidance, the affected pulley was released using a standard 19-gauge hypodermic needle bent at two points as the cutting device. Follow-up took place at 12 weeks and 6 months with improvement in triggering and clinically graded pain. At follow-up, no complications had occurred and all patients demonstrated improvement in their triggering, with complete resolution in 32 digits (91%), good improvement in 2 digits (6%) and some improvement in 1 digit (3%). This new technique uses a widely available and safe cutting device and is safe and can be used to provide definitive management for trigger finger, allowing the procedure to be performed in a variety of clinical settings.
Subject(s)
Plastic Surgery Procedures/methods , Surgery, Computer-Assisted/methods , Tendons/surgery , Trigger Finger Disorder/diagnostic imaging , Trigger Finger Disorder/surgery , Ultrasonography, Interventional/methods , Female , Humans , Male , Treatment OutcomeABSTRACT
Holes are frequently drilled across small bones to achieve fixation with intraosseous wires. We describe an effective, simple and cheap alternative to the use of K-wires for this purpose in this article.
