Hydroxyapatite crystal deposition disease (HADD) of the hand and wrist is rare but can cause acute inflammatory syndromes that mimic infectious arthritis. These symptoms, which rapidly resolve with ...systemic anti-inflammatory drugs, are a source of diagnostic errors and inappropriate treatment. It is of crucial importance to make the diagnosis in order to avoid iatrogenic surgical management. The aim of this study was to determine the clinical and radiographic signs and the key features on which diagnosis depends. Treatment effectiveness and the course of the disease were also examined. Between 1992 and 2008, 12 patients consulted for an isolated acute local inflammatory syndrome of the hand or wrist, which was accompanied by a unique radiographic picture of calcific density. All patients were reassessed clinically and radiographically with a minimum follow-up of 2 years. All patients had presented with acute local inflammatory syndromes. Nine patients had edema and 8 had swelling and erythema. No patient had fever. The course was favorable in 11 patients and one patient required surgery. No patient had a recurrence at the mean final follow-up of 90 ± 64 months. The symptoms associated with hydroxyapatite crystal deposits suggest septic arthritis with acute joint inflammation. The radiological appearance is characteristic and corrects the diagnosis. Oral anti-inflammatory treatment gives more rapid spontaneous improvement, with complete and long-lasting resolution.
Introduction
Thoracic outlet syndrome is a controversial cause of neck and shoulder pain due to complex mechanisms involving muscular dysfunction and nerve compression. Although management of ...thoracic outlet syndrome must be based on a multidisciplinary approach, physicians and occupational therapist should be familiar with the principles of diagnosis and treatment.
Method, results and conclusion
The purpose of this article is to review the definitions, diagnosis and management of this syndrome. A particular emphasis was described on the links between the workplace and the individual in the pathogenesis, prevalence in the workforce and the course of this disease.
Purpose
Despite their functional importance, the infraspinatus (ISP) and teres minor (TM) muscles have been little investigated. This study aimed to describe the macroscopic morphology, innervation, ...and inter-relations of the ISP and TM muscles.
Methods
Forty fresh cadaver dissections and histologic analysis were performed. Three groups of specimens were distinguished according to the rotator cuff tendon status: (1) intact rotator cuff; (2) supraspinatus tendon tears with intact ISP tendon; and (3) both supraspinatus and ISP tendons torn. Muscle fiber organization and muscle and tendon length were recorded. ISP and TM innervation and fiber structure were studied.
Results
ISP muscles were composed of three groups of fiber organized in two planes: two superficial groups, with mean pennation angles of, respectively, 27° ± 4° and 23° ± 3° with respect to the axis of the central tendon of the underlying group. TMs were thick fusiform muscles showing a parallel organization; 26 specimens (67 %) had aponeuroses isolating the TM, with a mean length of 5.2 ± 2.7 cm. Rotator cuff lesions were associated with relatively greater ISP tendon than muscle length. Innervation of the ISP muscle comprised 2–4 main branches from the suprascapular nerve and that of the TM 1 branch from the axillary nerve.
Conclusion
ISP muscle body morphology derives from three groups of fibers in two planes. The TM has a parallel organization. Several nerve branches innervate the ISP muscle, whereas only one supplies the TM. The limits between the two muscles bodies consist of an aponeurotic fascia in two-thirds of cases.
Posterolateral rotatory instability (PLRI) is the most frequent form of both acute and chronic elbow instability. It is due to mechanical incompetence of the lateral collateral ligament. O’Driscoll ...et al described treatment of this instability by autologous reconstruction of the lateral ulnar collateral ligament. The aim of our study was to evaluate the medium and long-term clinical, functional and radiological results of patients who were surgically treated for PLRI by this technique. We hypothesized that such ligament reconstruction restores a functional joint complex and durably stabilizes the elbow and limits the long-term risk of osteoarthritis.
All patients treated for symptomatic PLRI by ligament reconstruction since January 1995 and who had a minimum follow-up of 36 months were retrospectively included.
Thirty-two patients (32 elbows) underwent clinical and radiological evaluation with a mean follow-up of 112 months (range, 36-265 months). The success rate of the procedure was 97% with one patient requiring revision reconstruction. Twenty-four patients (75%) were free from pain. Pain was significantly greater in patients with associated lesions (P = .03) and those with morbid obesity (body mass index ≥40) (P = .03). Twenty-nine (91%) patients had resumed their previous activities. Twenty-eight patients (87%) were satisfied or very satisfied. The mean Mayo Clinic score was 96/100 and the QuickDash 14.7/100. Two patients (6%) with accompanying lesions developed severe osteoarthritis.
Elbow ligament reconstruction by the technique of O’Driscoll et al effectively restores stability and limits progression to osteoarthritis in the long term. The only failure in our series was due to several technical errors. Patients who had dislocation with associated lesions or morbid obesity are at risk of poorer functional results.
Digital mucous cyst Laulan, Jacky; Chammas, Michel
Hand surgery and rehabilitation,
April 2024, 2024-04-00, 20240401, Volume:
43
Journal Article
Peer reviewed
Mucous cyst is a benign but recurrent lesion. It is located on the dorsal surface of the digital extremity between the distal interphalangeal joint and the base of the nail. The nail is often ...affected by the cyst because of its topographical proximity. Nail plate deformity may even be the first obvious abnormality indicating the presence of a small mucous cyst or subungual cyst. Mucous cyst is associated with osteoarthritis of the joint, osteophytes probably being the main contributing factor. Surgical treatment by joint debridement and cyst removal is the most effective way of preventing recurrence.
Posterolateral instability is the most frequent form of both acute and chronic elbow instability. Joint incongruity due to posterolateral unlocking leads to shear and compression stress of the ...internal aspect of the humeroulnar joint. We carried out long-term analysis of patients with posterolateral elbow instability in order to determine whether, in addition to improving their symptoms, reconstruction of the lateral collateral ligament complex may play a protective role against the development of post-traumatic osteoarthritis. We hypothesized that ligament reconstruction according to the technique of O'Driscoll stabilizes the elbow and also limits the development of osteoarthritis in the long term.
Patients with symptomatic posterolateral instability of the elbow and who underwent ligament reconstruction according to the technique of O'Driscoll from January 1995 to December 2010 were identified and retrospectively included for 2 follow-up evaluations at a mean of 5 and 14 years.
Fourteen elbows in 14 patients were included. All had a negative lateral pivot shift test and none reported a new episode of instability. Two patients (14%) had osteoarthritis. The 2 radiographic evaluations showed no progression of osteoarthritis. Osteoarthritis developed in 33% of patients with intra-articular fracture. In simple dislocations, pre-existing osteoarthritic lesions were stabilized and there were no new cases of osteoarthritis.
Elbow ligament reconstruction according to the technique of O'Driscoll gives effective posterolateral stabilization and appears to protect against progression to osteoarthritic degeneration in the long term. In the absence of associated lesions, it prevents the development of osteoarthritis or the worsening of pre-existing osteoarthritis.
Les luxations et factures luxations radiocarpiennes (FLRC) sont des lésions sévères, mais rares dont le traitement et le devenir restent mal définis. L’objectif de cette étude rétrospective des FLRC ...traitées dans le service, était de préciser la prévalence des différents types lésionnels et leur évolution à long terme. De 1992 à 2014, 41 patients ont été pris en charge, dont 36 en urgence et 5 en secondaire. La classification de Dumontier et al. a été utilisée pour définir le type de FLRC. Il y avait 4 FLRC de type 1 et 37 FLRC de type 2. Treize patients ont pu être revus en consultation avec un recul moyen de 168 mois (20–260). Ont été précisés, la douleur quantifiée par l’EVA, les mobilités, le QuickDASH et le score PWRE. Des radiographies standard de face et de profil ont été réalisées à la recherche de signes d’instabilité et d’arthrose. Parmi les 41 patients, 6 avaient nécessité, secondairement, une arthrodèse du poignet (5 partielles et une totale), et 1 autre une résection de la tête ulnaire associée à une ligamentoplastie pour instabilité radio-ulnaire distale. Au plus long recul, la mobilité en flexion–extension était de 100° (25°–152°), la force moyenne de 86 % (10 kg/F–112 kg/F), l’EVA moyenne de 1,3 (0–5), le QuickDASH moyen de 23 (0–59) et le PWRE moyen de 27 (0–75). Six patients avaient une arthrose à la fois radiocarpienne et médiocarpienne. La qualité du résultat fonctionnel et l’absence d’arthrose étaient liées à la qualité de la réduction et de la stabilisation radiocarpienne ainsi qu’à l’absence de lésions marginales radiales et intracarpiennes. Pour les FLRC de type 1 sous réserve d’une réduction parfaite de la luxation maintenue par broches ou fixateur externe et contrôlée par voie postérieure, il ne paraît pas indispensable de réaliser une suture capsulo-ligamentaire palmaire. Concernant les FLRC de type 2, lorsque la réduction du processus styloïde du radius est parfaite, il peut être réalisé un embrochage stylo radial seul, et l’abord chirurgical n’est pas indispensable. L’arthrodèse radio-lunaire semble une bonne solution pour traiter les complications des FLRC de type instabilité. Les FLRC nécessitent un recentrage articulaire optimal radiocarpien dans les types 1 et une ostéosynthèse anatomique du processus styloïde radial dans les types 2. La prévalence des problèmes secondaires reste élevée.
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