Tuberculosis of the hand.

There has been recent interest in tuberculosis of the hand because of a rising incidence owing to increasing numbers of immigration, an aging population, and immunosuppressed people including affected patients with human immunodeficiency virus. In this article, we review the epidemiology, bacteriology, pathophysiology, diagnosis, and principles of treatment of tuberculosis of the hand. The second part of the report emphasizes the classification of hand tuberculosis (cutaneous lesions, tenosynovitis, bursitis, osteomyelitis, arthritis, and tuberculous hypersensitivity reactions) along with the classic presentations of each of these hand lesions.

The clinical features of ulnar polydactyly in a middle eastern population.

Two clinical forms of ulnar polydactyly are recognised in the literature, viz the African and the Caucasian forms. The current study investigated the clinical and radiological features of ulnar polydactyly in 94 Saudi patients. The incidence of ulnar polydactyly was one in 1000 live births. There were 41 males and 53 females. Positive family history, syndromal cases, associated hand anomalies, polydactyly of the little toe and systemic abnormalities were seen in 11%, 6%, 5%, 29% and 23% of cases, respectively. There were 50 unilateral (53%) and 44 bilateral cases (47%). In unilateral cases, the left hand was more commonly affected. Using a modified Rayan-Frey classification, the majority of cases were classified as Type II (pedunculated polydactyly, 52 (55%) cases) and Type III (a functioning and articulating extra digit without complete duplication of the metacarpal, 29 (31%) cases). It was concluded that the Saudi clinical presentation of ulnar polydactyly is somewhat different epidemiologically and lies between the African and Caucasian forms.

Classification of benign fatty tumours of the upper limb.

In this paper, the authors offer a classification of benign fatty tumours of the upper limb. There are three histologically distinct types of fat cells: immature fat cells which give rise to lipoblastomas, mature brown fat cells which give rise to hibernomas and mature white fat cells which give rise to lipomas. Lipomas are the most common and they are sub-classified according to the anatomic site of fat cells into dermal, subcutaneous and sub-fascial lipomas; or tumours directly related to muscle, bone, synovium or nerve. Finally, the authors review 67 patients with benign fatty tumours of the upper limb and provide clinical examples of these tumours including their characteristic histological and radiological features.

Magnetic resonance imaging in the diagnosis of glomus tumours of the hand.

This paper studies the sensitivity, specificity and predictive values of MRI in the diagnosis of glomus tumours of the hand and investigates the final diagnosis and outcome in cases with false positive or negative imaging tests. A total of 42 cases with the clinical diagnosis of a glomus tumour were included in the study. All patients underwent MRI and the results of MRI were correlated with the final histological diagnosis of the excised lesion. MRI had a sensitivity of 90%, a specificity of 50%, a positive predictive value of 97% and a negative predictive value of 20%. The four cases in which the MRI was negative all proved histologically to be glomus tumours. All four tumours were small (2-3mm in diameter) and the lack of delineation of the lesions by MRI was attributed to their small size. Despite negative MRIs, surgical exploration identified the glomus tumours. Based on the results of the current study and the cost of MRI, the senior author has stopped ordering pre-operative MRIs in patients clinically diagnosed with a glomus tumour.

Classification of the mirror hand-multiple hand spectrum.

A rare variant of mirror hand is described. The hand had eight fingers and the forearm contained an ulna and a hypoplastic radius. A classification of the mirror hand-multiple hand spectrum is offered and its embryology discussed.