Complex trigger wrist associated with carpal tunnel syndrome: a case report.

BACKGROUND: There are few reports of trigger wrist in the literature, as it is a rare pathology. Furthermore, various authors report that it is also hard to diagnose. It manifests with neurological symptoms at the affected wrist, which are usually induced by wrist movement, and can lead to partial or full loss of wrist function and sensitivity. The reason for reporting this specific case is that it was hard to differentiate between trigger finger and trigger wrist by clinical symptoms; no pathology was palpable or clearly seen on magnetic resonance imaging scan of the wrist. We propose a new diagnostic statement relative to this pathology. CASE PRESENTATION: A case of a 45-year-old white slavic man with trigger wrist associated with carpal tunnel syndrome, caused by a fibroma of the flexor tendon sheath, is reported. Despite careful clinical examination, it was not possible to differentiate between trigger finger and trigger wrist. Magnetic resonance imaging was performed to arrive at the right diagnosis but did not reveal any pathology in the wrist area. Carpal tunnel release was performed with a fibroma identified and excised. Wrist function was maintained well; no signs of carpal tunnel syndrome were seen at last follow-up. CONCLUSIONS: Trigger wrist can be misdiagnosed as trigger finger even if adequate clinical evaluation is performed, and this can lead to inadequate treatment. We state that, when clinical symptoms of both trigger wrist and trigger finger are present, except painful palpation of the A-1 pulley region, the case should be referred to as trigger wrist.

Anaplastic Carcinoma of the Pancreas: Clinical and Morphological Characteristics.

Anaplastic pancreatic carcinoma is a very rare histological subtype of pancreatic cancer, which is characterized by a more aggressive course than for conventional ductal adenocarcinoma. In this article, we consider the features of the clinical course, the difficulties of diagnosis in connection with the absence of pathognomonic signs of pancreatic cancer, and the morphological picture of this disease in a patient 60 years of age. This clinical case clearly demonstrates the complexities of the pancreatic carcinoma diagnosis, fast disease progression, and extremely unfavorable prognosis. It is important for clinicians to remember that this pathology often has a subclinical course, and the oncomarker levels are not always true.