Lipoma of the Tendon Sheath Causing Symptoms of de Quervain’s Tenosynovitis: A Case Report

Deep lipomas arising from the extensor compartments of the wrist are extremely rare. Owing to infrequent presentation and mass effect on nearby structures, lipomas can be mistaken for other clinical entities. We describe a 70-year-old woman who presented to our clinic with symptoms initially suggestive of de Quervain’s tenosynovitis of the left wrist. However, findings of physical examinations and imaging techniques revealed a lipoma of the tendon sheath of the second dorsal compartment. The patient was successfully treated operatively, with excision and release of the first dorsal compartment. To help accurately diagnosis and treat lipomas of the wrist in deep-tissue areas—with symptoms initially similar to de Quervain’s tenosynovitis—surgeons should consider performing thorough physical examinations and, if needed, magnetic resonance imaging

Recurrent Trigger Finger in the Early Postoperative Period: A Case Report

Postoperative complications of trigger finger, a type of tendon entrapment, are low, and there is little information regarding evaluation after a complication occurs. Recurrent trigger finger is a rare occurrence, but often requires additional procedures to relieve symptoms. Here we present a case of recurrent trigger finger in the immediate postoperative period after the patient developed a cyst distal to the A1 pulley and synovitis. The first procedure demonstrated a thickened and tight A1 pulley as well as synovitis around the tendon. The patient developed continued clicking and trigger symptoms distal to the A1 pulley at the level of the proximal interphalangeal (PIP) joint postoperatively. Findings of magnetic resonance imaging (MRI) revealed further synovitis distal to the A1 pulley and a cyst. After a second procedure, the patient’s trigger symptoms resolved. Imaging, such as MRI, can be useful in the diagnosis of recurrent trigger finger and help identify the location of the recurrence

Radiographic Prevalence of Osteoarthritis of the Scaphotrapeziotrapezoid Joint in Patients With Carpometacarpal Osteoarthritis of the Thumb: A Retrospective Case Series

Background: In planning operative treatment of thumb carpometacarpal (CMC) joint osteoarthritis, surgeons should consider the presence of an arthritic scaphotrapeziotrapezoid (STT) joint. We aimed to determine the radiographic prevalence of concomitant (STT) osteoarthritis with thumb CMC osteoarthritis in patients who underwent surgical treatment at our institution. We hypothesized that the prevalence of concomitant arthritis at these 2 joints (STT and CMC) would be lower than previously reported. Methods: Between September 2005 and July 2012, a total of 417 patients were identified from our institution using the Current Procedural Terminology code for thumb CMC joint arthroplasty (25447). After applying exclusion criteria and identifying patients who underwent treatment, a total of 194 patients were included and 218 preoperative radiographs were available for review. Each radiograph was categorized according to the Eaton classification of thumb CMC osteoarthritis, with stage 4 involving the (STT) joint. Evaluation was performed by four reviewers independently. Results: A total of 47 (21.6%) patients had varying degrees of concomitant (STT) joint osteoarthritis with the thumb CMC joint osteoarthritis. Stage 4 was reported in 6.4% (14) of the radiographs. Conclusions: The radiographic prevalence of concomitant (STT) osteoarthritis with thumb CMC osteoarthritis may be lower than previously reported. Further studies that include a similarly large sample size and additional radiographic views can help evaluate the likelihood of these conditions in patients who elect to undergo surgical treatment of thumb CMC osteoarthritis

Lipoma of the Index Finger in a 64-year-old Man: A Case Report

Lipomas are benign tumors composed of adipose tissue and typically encountered in middle-aged patients. Although the etiology remains unknown, this lesion can occur throughout the body. However, it is rarely seen in the finger. Typical treatment has often involved observation, but excision techniques have also reported successful outcomes. We describe a 64-year-old male patient who reported to our clinic with a painless soft-tissue mass in the index finger of his left hand, and we performed operative excision for treatment. The findings of physical examinations, radiographs, and magnetic resonance imaging tests had indicated the presence of lipoma, and results of pathological tests confirmed this diagnosis. Surgeons should carefully evaluate benign soft-tissue masses of the finger, with careful consideration given to the rare yet possible presence of lipoma

Intraoperative Finding of Vascular Malformation During Carpal Tunnel Release: A Case Report

Carpal tunnel release is a common surgical procedure performed by hand surgeons. The procedure is typically straightforward; however, uncommon causes of median nerve compression encountered intraoperatively may add complexity. We describe a 67-year-old man with carpal tunnel syndrome and an intraoperative finding of a compressive vascular malformation during a mini-open carpal tunnel release. A space-occupying malformation of a persistent median artery was bisecting the nerve and thought to be responsible for the patient’s symptoms. The compression was relieved through extended carpal tunnel release without requiring removal of the vascular malformation. The patient’s symptoms improved postoperatively. Hand surgeons undertaking this procedure should be aware of a potential vascular malformation and be prepared to address the condition intraoperatively

Simultaneous Presence of a Transligamentous Recurrent Motor Branch of the Median Nerve and Palmaris Profundus Tendon in a Patient with Carpal Tunnel Syndrome: A Case Report

Carpal tunnel syndrome (CTS) is the most frequently encountered entrapment of the peripheral nerves in the upper extremity. Abnormal anatomical variations involving the recurrent motor branch of the median nerve and presence of a palmaris profundus tendon have been reported. We present a 53-year-old man in whom open carpal tunnel release led to complete resolution of numbness, tingling, and pain in the right hand by 1 month postoperatively. Intraoperatively, the simultaneous presence of a transligamentous recurrent motor branch of the median nerve and palmaris profundus tendon in the carpal tunnel was found and excised. Surgeons should be aware of the potential presence of these abnormalities in successfully treating patients with CTS

Carpal Tunnel Release During Pregnancy: Report of Two Cases

Symptoms of carpal tunnel syndrome are common occurrences during pregnancy, particularly in the third trimester. Most patients undergo successful nonoperative treatment shortly after birth or the cessation of breast feeding. However, symptoms noted earlier during pregnancy are more likely to be severe and persistent. We present the cases of two women who developed symptoms of severe carpal tunnel syndrome during the second trimester and did not improve with nonoperative measures. Both underwent carpal tunnel release during pregnancy, with excellent postoperative result. Obstetric providers and surgeons alike should consider surgical treatment for patients with carpal tunnel syndrome who do not improve after nonoperative methods

Third Extensor Compartment Disruption and the Biomechanics of Thumb Extension

Background: Procedures involving release of the third dorsal wrist compartment have been thought to transpose the extensor pollicis longus (EPL) tendon from its anatomical position. Few studies, however, have reported on the effects this might have on function and mechanics of the thumb. We analyzed the impacts of intact extensor retinaculum, release of the third dorsal compartment, and removal of Lister’s tubercle on thumb extension. Methods: A total of 15 fresh-frozen cadaveric upper extremities (eight male, seven female; mean age, 52 years; range, 38-59 years) were used. For each specimen, three phases of testing were analyzed: the extensor retinaculum was intact, third dorsal compartment was released, and Lister’s tubercle was released. Force-displacement measurements were obtained to determine maximum extension and stiffness of the thumb by applying 1 N increments on the EPL until full extension of the thumb occurred. A one-way analysis of variance was used for statistical comparison. Results: In 14 of 15 specimens, the EPL tendon transposed during the first trial after release of the extensor retinaculum. No significant difference in mean maximum extension or stiffness of the thumb was found (P = 0.45 and P = 0.74, respectively). Conclusion: Functional loss of thumb extension may not occur with EPL transposition after release of the third dorsal compartment or removal of Lister’s tubercle. In patients with weakness in thumb extension, repairing the third dorsal compartment or creating a new pulley may not be effective