Isolated Fourth Carpometacarpal Joint Injury in High-Level Baseball Players: A Case Series.

BACKGROUND: We present a case series of high-level baseball players having sustained a rare, isolated injury to the fourth carpometacarpal joint of the nondominant or bottom hand during a jammed swing. METHODS: Ten patients were evaluated for ulnar-sided wrist pain and were subsequently diagnosed with fourth carpometacarpal joint synovitis based on physical examination and magnetic resonance imaging revealing increased signal intensity within the joint. RESULTS: Conservative treatment modalities including rest, nonsteroidal anti-inflammatory medications, splinting, and corticosteroid injections resulted in return to play within 4 weeks for all patients. CONCLUSIONS: We propose a mechanism of injury involving the bottom hand in relative pronation receiving a dorsally directed force from bat during a jammed swing resulting in isolated injury to the fourth carpometacarpal joint. This report serves to highlight this rare injury in high-level baseball players and recommend a treatment algorithm for early return to play.

Lacertus syndrome: Use of pre- and post-exercise MRI to aid in diagnosis and treatment.

Lacertus syndrome is a chronic exertional compartment syndrome of the forearm that is unlike exertional compartment syndrome of the lower extremity. It differs from traditional exertional compartment syndrome in terms of the anatomy, symptoms and physical exam findings. This is a case where dynamic magnetic resonance imaging is used to confirm the diagnosis rather than relying solely on a clinical diagnosis or invasive compartment pressure monitoring. Surgical release of the lacertus fibrosis can effectively relieve the pressure over the pronator and allow the patient to resume previous activities.

Could a Titanium Ulnar Shortening Plate Trigger a Metal Allergy? A Case Report.

Background With the growing use of metallic implants, increased research has focused on metal hypersensitivity. The purpose of this case report is to describe a patient with a suspected metal allergy to a titanium plate and to review the literature behind this controversial topic. Case Description A 45-year-old woman underwent ulnar shortening osteotomy for ulnocarpal abutment. One year later, the patient continued to have chronic pain at the site of the implant, with negative work-up for infection, hardware loosening, or failure. During hardware removal, intraoperative findings revealed titanium particle wear in the surrounding tissues, and subsequent allergy testing revealed a new diagnosis of nickel allergy. Following hardware removal, the patient had complete resolution of her symptoms at 3 months without any recurrence after 12 months from the date of surgery. Discussion Metals are the most common cause of allergic contact dermatitis. With the increased use of metallic implants, it is no surprise that metal implant allergies have become a cause for concern. While there are multiple tests to try and diagnose a metal implant allergy, there is no gold standard, and results are often difficult to interpret. Physicians need to be cognizant of metal allergies with there often vague symptoms as we continue to search for more reliable and affordable testing. Clinical Relevance Metal implant allergies can be difficult to diagnose. It is often a diagnosis of exclusion but requires a heightened sense of awareness in the face of a negative work-up with persistent symptoms.