Carpal tunnel syndrome caused by lipoma: a case report

Lipoma is a relatively frequent, benign soft-tissue tumor rarely located in the hand. A lipoma of the hand causing a carpal tunnel syndrome by compression of the median nerve is exceptional. We report the case of a 70-year-old female presenting with a carpal tunnel syndrome. A compression of the median nerve by a lipoma was discovered during surgery. Transverse carpal ligament release with lipoma excision and neurolysis of the median nerve were performed. Histopathological study of the resected mass was consistent with a lipoma. Two-month postoperatively, the patient recovered full hand function with entire disappearance of  acroparesthesia. Carpal tunnel syndrome caused by space occupying lesions is rare. Diagnosis is difficult, usually based on the clinical study, electrophysiology and magnetic resonance imaging (MRI). Transverse carpal ligament release and excision of lipoma provides excellent functional recovery.Key words: Lipoma, carpal tunnel syndrome, median nerve, nerve compressio

Scaphoid Non-Union Treated by Zaidemberg’s Vascularized Bone Graft: About 30 Cases

Introduction: Scaphoid fractures evolves in 10% of cases to nonunion. Untreated, it progresses to arthrosis of the wrist that may compromise the function of the hand. The recently described vascularizedbone grafts have helped to expand the armamentarium of management of scaphoid nonunion. We wantedto verify those data by studying the results of Zaidemberg’s graft made in our orthopedic department. Materials and methods: 30 scaphoid nonunion cases treated by a vascularized bone graft usingZaidemberg’s procedure were studied retrospectively. The clinical criteria studied were: range of motion,the Mayo Wrist Score, the Quick Dash, and PWRE. The radiographs have controlled the consolidation and performed a full radiometry.Results: Our series is made up of young adults (average age 28 years), a male-dominated manual workers. The dominant side is attained in 60% of cas.57% of patients are smokers. The seniority of the nonunion was 4 years on average. Nonunion sat, according to Schernberg’s classifi cation in zone 3 in 30% of cases. We had 50% in stage 2a and 30% in stage 2b according to Alnot’s classifi cation. Fixationwas realized by pins followed by immobilization during 6 weeks on average. We had a consolidation in all cases. The tobacco intoxication had a deleterious effect, a delayed union was observed in smokers’ patients. Our patients had a Mayo Wrist Mean score 72%, a PRWE to 11% and a Quick DASH 10%. Analysis of radiometry showed an improvement of the analyzed parameters.Conclusion: Zaidemberg’s graft is a reliable vascularized bone graft; it requires a learning curve, theseresults are better than inert transplants and Kuhlmann’s graft, it is indicated in the old nonunion, stage 2 Alnot the “proximal pole necrosis and changing of the scaphoid shape”.</p

Pseudotumoral form of soft-tissue tuberculosis of the wrist

Tuberculosis is a major public health problem in developing countries. Hand and wrist is a rare localization for extra-pulmonary tuberculosis, a pseudotumoral form of soft tissue tuberculosis of the wrist is exceptional. We report the case of a 45-year-old male presenting with a painful swelling of the dorsal aspect of the right wrist evolving for six months. Clinical study was evoking a ganglion cyst of the wrist. Intraoperatively a pseudotumoral mass with rice bodies was found, suggesting tuberculous tenosynovitis. The histopathological study revealed caseating giant cell granulomas with epithelioid cells. Cultures on Löwenstein–Jensen medium detected Mycobacterium tuberculosis. Synovectomy with removal of all the rice bodies followed by anti-tuberculous chemotherapy provided uneventful recovery

An exceptional location of tuberculous arthritis: The metatarsal phalangeal joint

Osteoarticular tuberculosis is a rare type of tuberculosis. The spine is the most frequent location, while peripheral locations in the limbs are rare. We report a case of tuberculous osteoarthritis of the metatarsophalangeal joint of the first ray of the foot in a 48-year-old woman. The patient presented with painful swelling of the dorsum of the big toe, insidiously evolving for 6 months. Diagnosis was obtained with histological study after surgical biopsy. Antitubercular chemotherapy for 12 months promoted healing. Through this clinical case the authors describe the epidemiological, diagnostic features, and treatment of osteoarticular tuberculosis and discuss the causes of delayed diagnosis often encountered in these exceptional locations and differential diagnoses, gout in particular, for this particular case