An unusual cause of pain in the finger

Ganglions are the most common soft tissue tumour of the hand. Ganglion of the proximal interphalangeal joint however, is rare. Lack of knowledge of this condition caused delayed treatment of this patient. We report here a case of a ganglion of the proximal interphalangeal joint in a 43 year old Malay lady who was initially misdiagnosed

Squamous cell carcinoma of the thumb nail bed.

Squamous cell carcinoma arising from the nail bed is not common. This condition can be easily misdiagnosed, especially if there is preceding trauma. We present here a case of squamous cell carcinoma of the right thumb in a 70 year-old man. The distal phalanx and part of the proximal phalanx were also involved. We performed a disarticulation of the metacarpophalangeal joint of the right thumb. The wound healed well. If an early diagnosis is made, then Moh′s micrographic surgery or wide local excision with the use of a local flap could be advocated. In late stages, amputation or disarticulation is the treatment of choice

Outcome of reconstruction for duplication of the thumb in adults aged over 40.

Congenital duplication of the thumb is usually reconstructed by 18 months of age. This paper reports satisfactory outcome following reconstruction of two Wassel Type IV duplicate thumbs in adults aged over 40. Both achieved a good outcome based on Tada's criteria and a subjective Visual analogue score 8

Psychiatric manifestations in orthopedic patients on Celecoxib therapy

Introduction: The Cyclooxygenase-2 (COX-2) enzyme is responsible for the synthesis of prostaglandin which is responsible for inflammation and pain. Celecoxib a cyclooxygenase-2 inhibitor was first used as a non-steroidal anti-inflammatory drug in 1999. Celecoxib is as effective as NSAJDs but causes less ulceration of the gastrointestinal tract, hence it is commonly used. It has been widely used in patients with osteoarthritis and rheumatoid arthritis. We present 3 cases of temporary psychiatric disorders associated with consumption of celecoxib, two of the patients presented with auditory hallucinations while one was diagnosed to be having depression. None had pre-existing psychiatric disorders or consumed alcohol or substance of abuse. All 3 patients recovered from their temporary psychiatric disorders after stopping celecoxib. Discussion: It is important to be aware of the psychiatric side effects when prescribing the drug for prolonged periods

To repair, reconstruct, replace & reduce: upper limb injuries amongst other orthopaedic problems

Injuries of the limbs are very common from many different causes, and can be devastating to the patient as it may lead to a range of functional deficits which unless managed properly, can result in death or loss of the limb. Injuries to the limb can be treated by skilful neglect or by performing various surgical procedures, ranging from simple debridement to complex reconstructive procedures or replacement of the defective part. Challenges in treating limb injuries include limited availability of operating theatre time for general anaesthesia, but for hand injuries this can sometimes be overcome by using local anaesthesia. Although there are problems with the use of local anaesthesia, there are ways to resolve these problems. The injured limb is often swollen, obscuring landmarks which locate the site of surgical incision. Sometimes direct repair of the injured part may not be possible, and the use of parts harvested from the patient may be required. It is important to know if the length of the harvested parts is adequate, and this can be estimated using a mathematical formula. The outcome of the treatment also has to be assessed to determine if the patient has improved following treatment. While injury can be caused by accidents, it can also be the result of improper use of a daily object, improper posture, and repetitive use of office equipment. Although rare, injuries can also be inflicted by the patient for various reasons. These self-inflicted injuries can mimic other pathological conditions, and could lead to a wrong diagnosis if not recognized. Injuries can also result in ganglion cyst, a benign condition which can occur in rare locations such as the proximal interphalangeal joint. Besides that, injuries from plant thorns and cat bites can result in fungal infections whereas squamous cell carcinoma of the nailbed is believed to be related to preceding trauma. Injuries that occur at the office are usually musculoskeletal disorders and can be prevented by proper measures. Exercises can help prevent and treat musculoskeletal disorders. Joints that cannot be repaired need to be replaced using joint prosthesis and the commonly used joint prosthesis are for the knee and hip. The use of different materials and configurations can affect the rate of wear and tear as well as loosening of the prosthesis. Meanwhile, understanding of the forces acting on the femoral femur bone is essential in developing a good prosthesis for the hip, whereas finite element analysis is used to study the stress acting on the bone. While the treatment of injuries is important, the prevention of injuries should be given just as much attention and importance. Injuries caused by motor vehicle accidents can be prevented by understanding the injury mechanism and by developing preventive strategies. This may be aided by the use of computer simulation using finite element models and crash test dummies which can help in understanding the mechanism of injury and designing better safety devices. Hence the study of limb injuries and musculoskeletal disorders is diverse in its requirements for solutions that range from treatment as well as prevention

Novel method to estimate the length of palmaris longus tendon

Palmaris longus is tendon of choice in reconstructive, plastic and cosmetic surgeries. Thus, a suitable length is required and it would be more convenient if the length of the tendon of the palmaris longus could be estimated before harvesting. This study was carried out to determine the relationship between the length and width of the palmaris longus tendon and the length of forearm and hand, the relationship between the length and the width of the palmaris longus tendon and wrist width and wrist circumference, as well as to identify a technique to estimate the length of the tendinous part of palmaris longus before harvesting it. A standardized proforma was used to collect the data of each of the 31 cadavers upper limbs. These data were analysed using SPSS software version 17. It is important to note that p value less than 0.05 is considered as statistically significant in this study. Out of the 31 upper limbs, palmaris longus tendon was absent in 3 (9.68%). Meanwhile, the mean length and width of the palmaris longus tendon was found to be 16.20 cm and 0.48 cm, respectively. The mean length of the forearm and hand was 26.6 cm and 21.2 cm, respectively. The mean width of the wrist and wrist circumference was 8.2 cm and 14.82 cm, respectively. These indicate a significant and moderate relationship between the length of palmaris longus tendon and the length of forearm (r = 0.49, r2=0.24, p < 0.01). In addition, there was also a significant relationship between the length of palmaris longus tendon and the length of hand (r = 0.56, p < 0.01). This paper presents the technique used to estimate the length and width of the tendinous part of palmaris longus before harvesting. The length of palmaris longus can be estimated pre-operatively by measuring the length of the hand by using the technique explained in this paper

The bahasa Melayu version of cornell musculoskeletal discomfort questionnaire (CMDQ): reliability and validity study in Malaysia

BACKGROUND: The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was developed to assess the level of musculoskeletal discomfort among office workers related to their ergonomic situation. OBJECTIVE: The primary objective of this initial study is to analyze the validity and dependability of the Malay translation of the Cornell Musculoskeletal Discomfort Questionnaire. METHODS: The questionnaire was self-administered two times, with an interval of two weeks in order to evaluate the accuracy of the original findings with a retest. The study involved 115 participants. RESULTS: The range of Cronbach Alpha coefficient showed a considerable consistency of the items for each sub-scale (Cronbach’s a > 0.95). The range of Kappa coefficients was between (ICC = 0.690–0.949, p < 0.001), (ICC = 0.801–0.979, p < 0.001) and (ICC = 0.778–0.944, p < 0.001) for frequency, severity and interference scales. CONCLUSIONS: This research, introduced the Malay-language version of the CMDQ (CMDQ-M) as the first formal validation of the CMDQ, and confirmed a high reliability and validity for the evaluation of musculoskeletal discomfort among the study population

Development and validation of newborn child head numerical model dummy for impact simulations

Computer simulation using Finite Element Model (FEM) are often used as a substitute for human experimental head injury studies, especially in predicting car accident injuries, enhance understanding of injury mechanism and develop prevention strategies. The use of FEM in crash test dummies is advantageous over physical dummies because of the lower cost and repeatability. Numerous adult FEM of the head have been developed, but there are relatively few paediatric FEM due to scarcity of material property data for children. Consequently, there are not enough models representing newborn child. Child head injury is a costly problem, both in terms of morbidity and direct medical costs. In fact, it is the leading cause of death and disability for children under the age 18-years-old. Despite its importance and effect on the population, the study of paediatric head injury is obstructed by the lack of available paediatric Post-Mortem Human Specimen (PMHS) data. As a substitute for PMHS testing, Anthropometric Test Devices (ATDs) and FEM have been developed to model the head. However, there is a scarcity of data for the design and validation of these models. This paper presents the development and validation of a newborn (NB) FEM for head dummy and simulated results compared with the child cadaver experimental data under drop test conditions. Itis intended for automotive crashworthiness assessment. The model was developed by using both deformable and rigid body materials. The newborn head anthropometric data were obtained from published journal articles. Using recent published material property data, the infant skull, skin and scalp FEM of the newborn ATD head was developed to study the response in head drop tests. The head assembly was validated by using three different head drop tests set-ups. The three impact locations are one frontal/forehead, and two lateral (right and left parietal) drop tests. All tests with drop height of 130 mm are the certification procedure. The benchmark model used in this study was a modified version of the 6-year-old numerical model developed by Livermore Software Technology Corporation and National Crash Analysis Center. A morphing method within LS-Prepost software was used

Aseptic loosening of femoral components - materials engineering and design considerations

Aseptic loosening is one of the main reasons for the revision of a total knee replacement (TKR). The design of the key component of a TKR, the femoral component, is particularly problematic because its failure can be the result of different causes. This makes the development of new biomaterials for use in the femoral component a challenging task. This paper focuses on the engineering design aspects in order to understand the limitations of current materials and design deficiencies. The paper describes the introduction of a new biomaterial for a femoral component and justifies the recommendation to use multi-functional materials as a possible solution to aseptic loosening. The potential advantages of applying functionally graded biomaterials (FGBMs) in prosthetic femur are explained by reducing the leading causes of failure including wear, micro-motion and stress-shielding effect. The ideas presented in this paper can be used as the basis for further research on the feasibility and advantages of applying FGBM in other superior implant designs

Office exercise training to reduce and prevent the occurrence of musculoskeletal disorders among office workers: a hypothesis

Pain in specific areas of the body (including the lower back, neck, and shoulders) due to extended periods of sitting and inactivity is the most widespread musculoskeletal disorder worldwide and has consequences that are both socio-economic and personal. This condition is particularly prevalent in industrialised countries, affecting roughly 70% to 80% of adults at some point in their lives; approximately 1% of the U.S. population is chronically disabled by this type of pain disorder. A practical way to reduce the prevalence of musculoskeletal pain among office workers would have a significant positive impact. More work is required to develop a package of exercises designed to prevent and treat musculoskeletal pain in office workers. Such a package would be preferable to pharmacological treatments, which can have undesirable side effects. The main objective of this package would be to increase the flexibility and strength of trunk muscles in order to decrease the soreness, pain, and degree of discomfort. In this article, we introduce our proposed package of exercises, which are based on guidelines issued bythe American College of Sports Medicine