Multiple Giant Cell Tumors of the Tendon Sheath : Separate Volar and Dorsal Lesions Involving Three Digits of the Same Hand Following Repetitive Trauma.

Giant-cell tumors of the tendon sheath correspond to a localized form of pigmented villonodular synovitis. GCTTS typically occur in the hand where they represent the second most common type of soft tissue tumors after synovial ganglions. The etiology of giant cell tumors of the tendon sheath is unknown. Pathogenetic theories have included inflammatory process, trauma, immune mechanisms, neoplasia. Giant cell tumors usually present as a solitary and firm slow-growing nodular lesion, which affects the volar aspect of the hand. Multifocal lesions are rarely described in the literature and commonly involve the same finger or the volar aspect of different fingers. We report a rare case of three separate GCT occurring on both aspects of the hand thus raising the question of their etiology.

Hospitalization for Dupuytren's disease: a French national descriptive analysis, 2002 to 2009.

OBJECTIVES: The goal of this study is to describe hospitalization for treatment of Dupuytren's disease in France between 2002 and 2009. METHODS: A repeated, annual, cross-sectional national survey of public and private French hospitals was performed between 2002 and 2009, with planned selection criteria for data extraction. Outcomes were age, sex, number of hospitalizations, length of stays, and types of surgical procedure. Types of surgical procedure included aponeurectomy, aponeurotomy, transplantation (skin graft), arthrolysis, amputation, arthrodesis, combined procedures. RESULTS: The selected hospital stays represented 95% to 97% of all stays with Dupuytren's disease coded as the primary diagnosis. The hospitalizations involved mainly men in the 7th decade. The mean number of hospitalizations for Dupuytren's disease was 16,487, for between 7 and 8/10,000 total hospitalizations each year. Most of the hospitalizations for Dupuytren's disease were one-day stays in private settings. Over time, the mean length of hospital stay significantly shortened and the proportion of one-day stays significantly increased. Aponeurectomy was the most reported treatment. The distribution of aponeurectomy of 1 finger or ≥ 2 fingers was balanced. The performance of arthrolysis, transplantation, amputation and arthrodesis was low. CONCLUSIONS: Despite of shortening of hospitals stays over time, hospitalization for surgery for Dupuytren's disease in France still represents a meaningful economic burden. LEVEL OF EVIDENCE: Observational study II.

[Dupuytren's contracture: percutaneous needle aponeurotomy is an alternative to surgery]. / Maladie de Dupuytren : l'aponévrotomie percutanée à l'aiguille est une alternative à la chirurgie.

Dupuytren's contracture is a retractile fibrosis of the superficial palmar aponeurosis of the hand, resulting in a progressive and fixed flexion of the fingers that may result in severe limitation of hand function. It affects several millions of people in Europe and North America. Risk factors are genetic and sometimes related to mellitus diabetes. There is no spontaneous remission. Until recently, surgery was the only treatment, but now needle aponeurotomy emerges as a therapeutic alternative. It should be performed as first line treatment by a trained practitioner. Short and long-term results of needle aponeurotomy appear identical to those of surgery, with milder complications. It is indicated in palmar, palmo-digital, as well as in strictly digital forms of the disorder. The "table-test" is used to assess the loss of extension of the digit and to select the indication to needle aponeurotomy. A medico-surgical consensus should define the optimum treatment strategy in this affection.

Humeral head osteonecrosis following arthroscopic rotator cuff repair.

Humeral head chondrolysis and osteonecrosis of the glenoid have been reported; however, there is no report to date about humeral head osteonecrosis following arthroscopic shoulder procedure. We report a case of osteonecrosis of the humeral head following arthroscopic rotator cuff repair what we believe is probably secondary to disruption of its blood supply after placement of multiple metallic suture anchors. The surgical records were also reviewed in an attempt to identify the cause of the humeral head osteonecrosis.

Double extensor pollicis longus tendon in independent extensor compartments: a case report of an anatomical variation requiring alteration of surgical strategy.

The authors report the case of an anatomical variation with a double extensor pollicis longus tendon found during a dorsal approach to the wrist for rheumatoid arthritis. The accessory tendon was located in an additional separate wrist dorsal compartment, which is an extremely rare arrangement.

[Bilateral congenital fusion of the scaphoid and the trapezium. A case report]. / Synostose scaphotrapézienne congénitale bilatérale.

Congenital synostosis has been described between nearly all of the carpal bones. It can occur in an isolated form or most commonly in relation between the lunatum and the triquetrum. It can also occur in a multiple form and be associated with other malformations. We report a rare case of scaphoid-trapezium fusion observed bilaterally in a nearly asymptomatic 63-year-old patient.

[Imaging of wrist injuries in athletes]. / Imagerie du poignet du sportif.

Wrist imaging is currently used for diagnosis of sport injuries as part of a global strategy of rapid recovery. Standard x-rays are the first step in this procedure. Although arthrography is still the reference for the diagnosis of intrinsic ligament and cartilaginous lesions, MRI can sometimes be sufficient. Ultrasonography is a dynamic process and is accurate in detecting tendon injuries. Wrist sport injuries are frequent and often asymptomatic. Here we review the usual aspects of bone, ligament, and tendon lesions encountered in each sport, while providing advice on the most appropriate imaging for each clinical symptom.

Closed rupture of the thumb flexor tendon pulleys.

Closed flexor tendon pulley ruptures are relatively rare injuries. All previously reported cases have been in the long finger pulleys. To our knowledge, there has not been a case of closed thumb flexor tendon pulley rupture reported in the literature. This paper presents two cases of this pathology and discusses appropriate treatment of it.

[Osteogenic exostosis of the capitate bone. Case report and review of the literature]. / L'exostose ostéogénique du capitatum. Présentation d'un cas et revue de la littérature.

The occurrence of an osteochondroma in the carpus is very rare and its excision is indicated in the case of significant symptoms or change in its appearance. The diagnosis is often made in adulthood due to the onset of a functional problem even though development of the tumour occurs during skeletal growth. We report the case of a 38 year old patient, with no antecedent trauma, who presents with simultaneous exostoses on the dorsal and palmar surfaces of the capitate, which has not been previously described in the literature. The existence of a bipolar lesion extending anteriorly and posteriorly in the carpus is a possibility which may not be apparent and renders plain radiograph insufficient in the investigation of such a lesion. CT scan and MRI scan are indispensable in the investigation of this kind of carpal lesions, allowing better visualization of the base of the tumour, the expansion of the tumour and relation to the neighbouring soft tissues and the presence of malignant degeneration.

Surgical treatment of compression of the lateral antebrachial cutaneous nerve.

We describe an operation to relieve compression of the lateral antebrachial cutaneous nerve at the elbow. Between 1987 and 1997 we operated on seven patients, one with bilateral compression. In two the compression was associated with injury to biceps. A longitudinal or a transverse incision was carried out and the nerve was released from the deep fascia. Partial excision of the biceps aponeurosis was undertaken in the patients who did not have injury to biceps; some additional procedures were required for those patients with injuries. All patients had symptomatic relief.

Primary synovial osteochondromatosis of the hand and wrist. Report of a series of 21 cases and literature review.

OBJECTIVES: To define the characteristics of synovial osteochondromatosis of the hand and wrist. PATIENTS AND METHODS: Retrospective study of 21 patients, including 11 with intraarticular and 10 with tenosynovial disease. Cases secondary to degenerative joint disease were excluded. Surgery consisted in removal of the osteocartilaginous bodies and of the adjacent synovial membrane. Mean follow-up was seven years (range, three to 18 years). The relevant literature was reviewed in part. RESULTS: Recurrence was seen in four patients and was multiple in two of these four. Most recurrences occurred within five to ten years after surgery. All four patients with recurrences had intraarticular disease. No cases of malignant transformation were seen. The characteristics of synovial osteochondromatosis at the hand and wrist are reviewed. CONCLUSION: Detailed preoperative investigations including computed arthrotomography and magnetic resonance imaging should be performed to increase the likelihood of complete excision.

Diagnosis of digital pulley rupture by computed tomography.

Seven patients who presented with a rupture of the digital pulley were investigated by computed tomography. The rupture involved the A2 and A4 pulleys in four cases, the A2 pulley in two cases and, in the final case, the A4 pulley alone. A sagittal-plane CT scan gave a precise analysis of the rupture in all cases. Two cases were surgically repaired and CT scanning was used in their postoperative assessment. When performed by a radiologist with an interest in musculoskeletal pathology, we have found CT scanning to be an excellent imaging procedure in the investigation and diagnosis of digital pulley injury. This can be useful when the diagnosis of digital pulley rupture cannot be made by history and physical examination.

[Arthroscopic internal meniscectomy in patients over 55 years of age. Results over more than 4 years]. / Méniscectomies internes arthroscopiques chez les sujets de plus de cinquante-cinq ans. Résultats à plus de quatre ans.

Fifty-one meniscectomies by arthroscopy were realised on patients of more than 55 years of age between 1981 and 1986. Twenty-four patients were reviewed after at least 4 years of follow up, 12 of them after a 7.5 years follow up. 21 results were noted as functionally very good or good, 3 were poor. The radiological analysis of femoro-tibial compartments in comparison with the non operative side showed a clear pejorative difference in one case, moderate in 5 without incriminating the morphological type. If the quality of result does'nt correlate with age, it was'nt the same for the type of lesion seen during arthroscopy, the best results after arthroscopic meniscectomies were seen in traumatic lesions occurring on normal menisci or on degenerative ones. The authors concluded that medial meniscectomy in patients older than 55 years is justified in precise indications: a known traumatism or also acute medial pain, or speedy with normal or subnormal X-ray and after a positive arthrography.