Partial Resection of First Dorsal Compartment Extensor Retinaculum in De Quervain's Stenosing Tendovaginitis Release.

Various surgical techniques exist to treat de Quervain's stenosing tendovaginitis. Specific surgical techniques for de Quervain's are designed to avoid complications including injury to branches of the superficial branch of the radial nerve, inadequate decompression, reflex sympathetic dystrophy, and palmar subluxation of the released tendons. A simple dorsal incision through the extensor retinaculum is advocated by many as a means to release the compartment while preventing postoperative subluxation. A single incision through the retinaculum limits exposure of the compartment and could lead to reannealing of the retinaculum and recurrent symptoms. Partial resection of the extensor retinaculum provides a more complete release and has not been found to lead to palmar tendon subluxation.

Irreducible Lisfranc injury by tibialis anterior tendon entrapment: A case report.

RATIONALE: Lisfranc injuries are a dislocation of the metatarsal bones from the tarsal bone. Although closed reduction is possible in most cases of Lisfranc injury when attempted in the early stage, there are some rare cases for which open reduction is required. Herein we report a case of irreducible Lisfranc injury in a 34-year-old man who presented to our institution with painful swelling. PATIENT CONCERNS: We report a 34-year-old man presented to our institution with painful swelling after a fall from 1.0 m height. DIAGNOSES: We diagnosed it as irreducible Lisfranc injury by tibialis anterior tendon entrapment through plain radiologic study and surgical findings. INTERVENTIONS: Plain X-ray, C-arm fluoroscopy and open surgery were performed. OUTCOMES: We did a closed reduction under a C-arm fluoroscopic guide, but it was not successful. Thus, we had to do an open reduction of a Lisfranc dislocation. Upon exposure, we observed the entrapment of the tibialis anterior tendon between the medial and intermediate cuneiform bones. LESSONS: Our report is valuable in that it can contribute to the diagnosis and suggest a clue to the treatment of such a rare pathology. The knowledge in the rare case of entrapment of the tibialis tendon and the understanding of management will be useful when a irreducible Lisfranc dislocation is unsuccessful after an attempt at closed reduction.

Radial artery aneurysm secondary to dynamic entrapment by extensor pollicis longus tendon: a case of snapping thumb.

Aneurysms of the distal radial artery at the level of the wrist are rare. Most reported cases are posttraumatic, either from iatrogenic arterial puncture for radial arterial access or from a penetrating injury. Other causes include infection and connective tissue disorders. Early diagnosis is important to avoid the potential complications of thrombus formation, distal digital ischemia, and rupture. Evaluation of the radial artery is typically performed using non-invasive modalities like ultrasonography, computed tomographic angiography (CTA), and magnetic resonance angiography (MRA). Invasive angiography can also be performed, particularly if minimally invasive treatment options are being considered. We report a case of a 35-year-old male mechanic who presented with pain at the base of the left thumb dorsally, with reproducible painful snapping on dynamic exam. Ultrasound demonstrated a fusiform aneurysm of the radial artery. At the level of the aneurysm, there was dynamic entrapment of the artery between the extensor pollicis longus (EPL) tendon and the underlying trapezium. The patient's symptoms improved with conservative management and avoidance of the snapping-producing maneuvers. To our knowledge, this is the first published case of snapping at the base of the thumb resulting in repetitive entrapment of the radial artery by the EPL tendon captured on dynamic ultrasound examination.

Síndrome de Haglund. A propósito de 2 casos / Haglund's syndrome. Two case reports

El síndrome de Haglund es una causa de atrapamiento tendino-bursal posterior del talón, producida por una exostosis posterosuperior del calcáneo, denominada deformidad de Haglund, asociada a tendinitis aquílea y bursitis retrocalcánea. Su patogenia es desconocida. Se presentan 2 casos, diagnosticados clínicamente, confirmados radiológicamente, y tratados conservadoramente uno y con cirugía el otro. El diagnóstico se realiza por la clínica y por las imágenes radiológicas con el método de medición de las líneas de inclinación paralelas, en una radiografía lateral del tobillo. El tratamiento inicial suele ser conservador e incluye antiinflamatorios o analgésicos, fisioterapia y zapatos con talón abierto y sin tacón alto. Si el tratamiento conservador no alivia el dolor, puede ser necesaria la cirugía (AU)

Haglund's syndrome produces posterior impingement of the heel, which is caused by a posterosuperior calcaneal exostosis, known as Haglund's deformity, associated with Achilles tendinitis and retrocalcaneal bursitis. Its pathogenesis is unknown. We report two cases that were diagnosed clinically and confirmed radiographically. One patient was treated conservatively and the other underwent surgery. The diagnosis is based on clinical signs and radiological images, using the measurement of the parallel pitch lines, in a lateral radiograph of the ankle. Initial treatment is usually conservative and includes anti-inflammatory or analgesic agents, physiotherapy and low-heeled, open-heeled shoes. If conservative treatment does not relieve the pain, surgery may be necessary (AU)

[Aggravated reduction of the posterior malleolar fracture due to incarceration of the flexor digitorum longus tendon]. / Repositionshindernis des hinteren Volkmann-Dreiecks durch Interposition der Sehne des M. flexor digitorum longus.

The indications for stabilization of the posterior malleolus (Volkmann triangle) while fixing ankle fractures are controversially discussed. Detailed descriptions of possible obstacles to reduction are scarce. The following case describes the difficulty of reduction of the posterior malleolus caused by interposition of the flexor digitorum longus tendon. The fracture line of the posterior malleolus passed in an atypical manner vertically to the posterior-medial tibial margin with direct contact to the anatomical pathway of the tendon. The impaction of the tendon was already present in the computed tomography (CT) scan taken preoperatively but the tendon hindering malleolar reduction was first realized during surgery after several unsuccessful attempts at repositioning.

Complete encasement of the peroneal tendons by the peroneal tubercle.

The peroneal tubercle is an osseous structure on the lateral side of the calcaneus present in 90% of individuals. Hypertrophy of the peroneal tubercle resulting in stenosing peroneal tenosynovitis has been well described in the literature. Repair of this condition involves operative treatment to remove the hypertrophied peroneal tubercle and repair any resulting tendon pathology. The authors report a unique case of a hypertrophied peroneal tubercle with an associated tarsal coalition, resulting in complete bony encasement of the peroneal tendons. In this case, a 50-year-old white man presented with worsening bilateral foot and ankle pain for several years. On examination, he had fixed hindfoot varus and bilateral equinocavovarus feet. Magnetic resonance imaging and weight-bearing radiographs showed a calcaneonavicular coalition. Intraoperatively, the authors discovered complete bony encasement of the peroneal longus and brevis tendons. On examination, the peroneal longus and brevis were severely stenotic, with the peroneal brevis to the point of near laceration. This painful condition was repaired by takedown of the calcaneonavicular coalition, the peroneal tubercle was resected, and the peroneal tendons were freed from their bony encasement. Tenodesis of the peroneus brevis to longus was performed and the hindfoot varus was corrected with wedge osteotomy of the calcaneus. The patient reported excellent postoperative results. At 3 months postoperatively, he was pain-free and his calcaneal osteotomy was well healed. This case appears to be the first of its type to be reported in the literature. The details of the case are presented along with a review of the relevant literature.

Labral injuries due to iliopsoas impingement: can they be diagnosed on MR arthrography?

OBJECTIVE: Iliopsoas impingement is a new arthroscopic diagnosis that refers to an anterior labral injury caused by the iliopsoas tendon. Currently, there are no preoperative criteria to establish the diagnosis of iliopsoas impingement. The goal of this study was to determine whether there are imaging criteria that would identify iliopsoas impingement on preoperative MR arthrography. MATERIALS AND METHODS: This study compared the preoperative MR arthrograms of 23 patients who had iliopsoas impingement diagnosed at hip arthroscopy with the arthrograms of 24 patients who did not have iliopsoas impingement found at hip arthroscopy. All of the arthroscopies were performed by a single orthopedic hip surgeon. In all cases of impingement, there was an isolated injury to the labrum at the 3-o'clock position. All were treated by arthroscopic iliopsoas tenotomy performed at the labral level. The MR examinations of the 47 patients were evaluated independently by two musculoskeletal radiologists who were blinded to the diagnosis. The following characteristics of the iliopsoas tendon at the level of the anterior labrum were evaluated: lateral dip, increased signal intensity (SI) between the iliopsoas tendon and labrum, irregularity of the deep margin of the iliopsoas tendon, edema within the iliopsoas tendon or capsule at the 3-o'clock position, presence of a labral tear at the 3-o'clock position, dimensions of the iliopsoas tendon, and location of iliopsoas tendon as it passed the labrum. Statistical analysis was performed using the Kruskal Wallis test, Fisher exact test, and Cohen kappa. Values for p less than 0.05 were considered significant. RESULTS: Nineteen women (mean age, 35 years) and four men (mean age, 36 years) had central iliopsoas impingement. Sixteen women (mean age, 38 years) and eight men (mean age, 35 years) did not have central iliopsoas impingement (p=0.318). For the impingement and nonimpingement groups, lateral dip of the iliopsoas tendon was seen in 15 of 23 (65%) and 17 of 24 (71%) for reader 1 and 18 of 23 (78%) and 11 of 24 (46%) for reader 2, respectively (p=0.76 and 0.036, respectively). There was no difference between the groups for increased SI between the iliopsoas tendon and labrum (p=0.38 and 0.82, respectively), irregular deep margin of the iliopsoas tendon (p=0.61 and 0.35, respectively), thickness of the iliopsoas tendon (p=0.33), or tendon or capsule edema (p=0.37 and 0.77, respectively). Reader 1 found 20 of 23 and reader 2 18 of 23 labral tears at the 3-o'clock position in the iliopsoas impingement group, with 13 of 24 and 10 of 24 in the non-iliopsoas impingement group respectively (p=0.024 and 0.017, respectively). The combined iliopsoas tendon width for both readers was 10.2 mm (range, 8.1-14.3 mm) in women and 11.9 mm (range, 11.1-13.4 mm) in men in the iliopsoas impingement group (p=0.0285), and 11.0 mm (range, 9.0-12.6 mm) for women and 11.8 mm (range, 8.7-15.1 mm) for men in the non-iliopsoas impingement group (p=0.159). The iliopsoas tendon most commonly crossed the labrum at the 3-o'clock position in both groups (p=0.83-0.17). CONCLUSION: An acetabular labral tear at the 3-o'clock position should suggest the diagnosis of iliopsoas impingement.

[Irreducible physeal fracture of the distal radius due to entrapment of the extensor pollicis longus. A case report]. / Fractura fisaria de radio distal irreducible por atrapamiento del extensor pollicis longus. Reporte de un caso.

We present a clinical case of entrapment of the extensor pollicis longus at the level of the fracture site in a distal radius epiphysiolysthesis. The active mobility deficit of the patient's thumb, pain upon passive mobility, and the X-rays should make us suspect this lesion.

Snapping wrist caused by tenosynovitis of the extensor carpi radialis longus tendon subsequent to subcutaneous muscle rupture in the forearm: case report.

We report a rare case of snapping in the dorsal wrist that was caused by extensor carpi radialis longus tenosynovitis occurring after rupture of the muscle in the middle forearm. After resection of the tendon at the wrist, the snapping disappeared.

Tratamiento quirúrgico del síndrome de atrapamiento de arteria poplítea: nuestra experiencia / Surgical treatment of popliteal artery entrapment syndrome: our experience

Introducción: El síndrome de atrapamiento de la arteria poplítea (SAAP) es una entidad pocofrecuente cuya incidencia varía del 0,17 al 3,5 %.Objetivo: Revisamos a los pacientes tratados quirúrgicamente en nuestro servicio durante losúltimos 15 años.Material y métodos: Estudio retrospectivo entre 1995 y 2009, en que se registraron variablesdemográfi cas, comorbilidad, clínica, exploración física, pruebas complementarias, tratamientoquirúrgico realizado, así como evolución a los 15 años.Resultados: Se intervino quirúrgicamente a 8 pacientes (el 50 %, varones) por SAAP con una medianade edad de 41,5 (intervalo, 16-62) años; 2 pacientes (25 %) presentaron claudicación invalidante,5 (62,5 %), dolor de reposo y en 1 caso (12,5 %), lesiones trófi cas. La prueba de elecciónen todos ellos fue la arteriografía, aunque también en 2 casos se realizó TC y en 3, angio-RM. Eltratamiento quirúrgico fue miotomía con liberación de la arteria poplítea en 3 pacientes (37,5 %)(en uno de ellos se asoció injerto venoso), miotomía junto a trombectomía poplítea en 2 pacientes(25 %), bypass poplíteo-poplíteo con vena en otros 2 (25 %) y un caso de simpatectomía lumbar(12,5 %). La arteriografía intraoperatoria fue normal. Durante el seguimiento a 15 años (medianade seguimiento 7,5 ± 3,98 años) el 50 % de los pacientes estaba asintomático, el 25 %presentaba claudicación no invalidante y otro 25 % falleció como consecuencia de su afecciónconcomitante.Conclusiones: En nuestra experiencia, la liberación de la arteria poplítea mediante miotomíadel tendón de inserción anómalo, asociada o no a la realización de un bypass poplíteo-poplíteo,es el tratamiento quirúrgico de elección(AU)

Introduction: Popliteal artery entrapment syndrome (PAES) is a rare condition with an incidencethat varies from 0.17-3.5 %.Aim: We reviewed patients treated with surgery in our department over the past 15 years.Material and methods: A retrospective study between 1995-2009 recorded demographicvariables, comorbidity, physical examination, diagnostic tests, surgical treatment and outcomeat 15 years.Results: Eight patients (50 % male) were treated with surgery for PAES, with a mean age41.5 years (range, 16-62). Two patients (25 %) had disabling claudication, 5 (62.5 %) pain at rest,and in one case (12,5 %) trophic lesions. The test of choice in all of them was arteriography,although two patients also had a CT and three an angio-MR. Surgery was myotomy with releaseof the popliteal artery in three patients (37.5 %) (one of them involving vein graft), myotomywith popliteal thrombectomy in two patients (25 %), popliteal-popliteal bypass with vein inanother 2 (25 %), and one case of lumbar sympathectomy (12.5 %). Intraoperative arteriographywas normal in all cases. During follow-up to 15 years (mean 7.5 ± 3.98 years), 50 % of patientswere asymptomatic, 25 % had no disabling claudication, and another 25 % died as a result ofdisease.Conclusions: In our experience, the release of the popliteal artery by myotomy abnormal tendoninsertion, with or without conducting a popliteal-popliteal bypass, is the surgical treatment ofchoice(AU)

Irreducible Lisfranc dislocation due to the interposition of the tibialis anterior tendon: case report and literature review.

We report a case of a lateral type A (according to Myerson) Lisfranc dislocation irreducible by closed manipulation. Upon surgical exploration the lateral slip of the tibialis anterior tendon was found trapped between the medial and the middle cuneiform. Once the tendon was reduced, the dislocated first ray spontaneously reverted to its anatomical position and the joint was fixed with Kirschner wires. Seven similar cases have been reported in the literature. After analysis of all the reported cases we were able to describe a pattern of injury that may predict tibialis anterior interposition: (a) lateral type A according to Myerson dislocation; (b) after closed manipulation the 1st ray remains dislocated while the 5th metatarsal reduces; (c) there is a gap between the medial and the middle cuneiform or a fracture at the base of the 2nd metatarsal.

False FHL: a normal variant posing risks in posterior hindfoot endoscopy.

Posterior hindfoot endoscopy has been more commonly used in the treatment of various pathologies by surgeons with different arthroscopic experience. The flexor hallucis longus is usually the initial and most important landmark serving as a medial boundary for the arthroscope and instruments to avoid inadvertent injury to the tibial nerve and vessels. We report 2 cases in which the presence of the peroneocalcaneus internus muscle, "false FHL," imitated the flexor hallucis longus, risking imminent neurovascular injury during the initial endoscopic exposure. Awareness of this rare anatomic variation, preoperative magnetic resonance imaging studies, and intraoperative differentiation techniques were found helpful to avoid devastating complications.

Long-term results of surgical release of de Quervain's stenosing tenosynovitis.

The management of de Quervain's disease (DD) is nonoperative in the first instance, but surgery should be considered if conservative measures fail. We present the long-term results of operative treatment of DD. From July 1988 to July 1998, 94 consecutive patients with DD were treated operatively by a single surgeon. There were 80 women and 14 men. Average age at the time of operation was 47.4 years (range 22-76). The right wrist was involved in 43 cases, the left in 51 cases. All operations were done under tourniquet control with local infiltration anaesthesia using a longitudinal incision and partial resection of the extensor ligament. There were six perioperative complications, including one superficial wound infection, one delayed wound healing, and four transient lesions of the radial nerve. A successful outcome was achieved in all cases with negative Finkelstein's test. Simple decompression of both tendons and partial resection of the extensor ligament with a maximum of 3 mm can be recommended in operative treatment of DD with excellent long-term results.

Complex dorsal metacarpophalangeal joint dislocation caused by interosseous tendon entrapment: case report.

We report a patient with open complex, dorsal metacarpophalangeal joint dislocation of the index finger with interposition of the first dorsal interosseous tendon and the transverse ligament of the palmar aponeurosis. To our knowledge, entrapment of the first dorsal interosseous tendon has not been reported to be the cause of irreducible dislocation of the metacarpophalangeal joint.