Case Report A Rare Case of a 15-Year-Old Boy with Two Accessory Nipples: One in the Forearm and One in the Milk Line

A 15-year-old male presented for evaluation of a volar forearm mass that he noticed four years before. The mass was not painful and his main concern was cosmesis. The mass was two centimeters in diameter with a pinpoint central sinus and scant drainage. After excision, the pathology report noted pilosebaceous units and smooth muscle bundles, consistent with an accessory nipple. In addition, the patient had another accessory nipple in the "milk line" on his torso. While accessory nipples and breast tissue have been reported in numerous locations throughout the body, this is the first reported case of an accessory nipple on the forearm

Ultrasound versus MRI in the evaluation of the thumb metacarpophalangeal joint

An intricate and unique combination of ligamentous, fibrocartilaginous, and osseous structures stabilize the thumb metacarpophalangeal joint. Both ultrasound and high-resolution magnetic resonance imaging are extremely useful in evaluating these critical structures. This article reviews common injuries of the thumb metacarpophalangeal joint, while highlighting the merits, limitations, and pitfalls of the two imaging modalities. A clear appreciation of each method, paired with anatomic knowledge, will lend greater confidence and accuracy to diagnosing impactful injuries and guiding intervention

Erosive Arthritis, Fibromatosis, and Keloids: A Rare Dermatoarthropathy

Polyfibromatosis is a rare disease characterized by fibrosis manifesting in different locations. It is commonly characterized by palmar fibromatosis (Dupuytren’s contracture) in variable combinations with plantar fibromatosis (Ledderhose’s disease), penile fibromatosis (Peyronie’s disease), knuckle pads, and keloids. There are only three reported cases of polyfibromatosis and keloids with erosive arthritis. We report one such case and review the existing literature on this rare syndrome

A Rare Case of a 15-Year-Old Boy with Two Accessory Nipples: One in the Forearm and One in the Milk Line

A 15-year-old male presented for evaluation of a volar forearm mass that he noticed four years before. The mass was not painful and his main concern was cosmesis. The mass was two centimeters in diameter with a pinpoint central sinus and scant drainage. After excision, the pathology report noted pilosebaceous units and smooth muscle bundles, consistent with an accessory nipple. In addition, the patient had another accessory nipple in the “milk line” on his torso. While accessory nipples and breast tissue have been reported in numerous locations throughout the body, this is the first reported case of an accessory nipple on the forearm

A Survey of the Prevalence and Practice Patterns of Human Acellular Nerve Allograft Use

Background:. There have been many technical and scientific advances over the last decade in peripheral nerve surgery. Human acellular nerve graft (HANA) has become increasingly popular but current practice patterns among hand surgeons have yet to be defined. Coding practices may not have kept up with this innovation. A 26 question survey of hand surgeons was performed to evaluate the adoption of HANA, and current coding and billing practices. The survey was sent to hand surgeons trained in orthopedic, plastic, general, and neuro surgery. The survey was designed and implemented by the Mayo Clinic Survey Center. Results:. Four hundred sixty-one responses to the survey were received. Most respondents currently use HANA (70%). Of those surgeons who do use HANA, nearly all use it less than 10 times per month (98%). There was no significant difference in the use of HANA across different specialties. There was a significant difference in HANA use depending on practice type with higher use by those in group private practice (57%) compared with academic practice (28%), solo practice (12%), and other practice environment (3%). There was a significant difference in HANA use depending on the number of years in practice. Those in practice less than 5 years used HANA the most (32%), followed by > 20 years in practice (27%), 6–10 years in practice (16%), 16–20 years in practice (14%), and 11–15 years in practice (11%). When asked the Current Procedural Terminology code they would use to bill for the procedure of choice, the most common response was 64910 (nerve repair with synthetic conduit or vein allograft). Conclusions:. HANA has surpassed nerve conduit as the traditional gold standard in our study with nearly 70% of hand surgeons using HANA in their practice and a greater percentage of respondents choosing HANA as their first choice to repair as compared with nerve conduit, nerve autograft, or vein graft. There remains confusion regarding appropriate billing practices for the use of HANA. Due to its common use, a Current Procedural Terminology code should specifically designated for the use of HANA in the hand

Excision of recurrent penile schwannoma with neurovascular bundle sparing: A novel surgical approach

Penile schwannomas are rare, often painless lesions usually growing on the dorsum of the penis. A young and otherwise healthy male with recurrent painful penile schwannomas and decreased libido was successfully treated with surgical excision. Through fine dissection of the nerve fascicles leading to the primary schwannoma, the lesion was successfully removed without compromising erectile or ejaculatory function. This novel approach allowed for significant symptomatic relief and improved quality of life

The Effects of Obesity and Bariatric Surgery on Rates of Upper Extremity Compression Neuropathies

Objectives:. To estimate the effects of obesity on all types of upper extremity compression neuropathies (UECN) (carpal tunnel syndrome and other median nerve, radial nerve, and ulnar nerve compression neuropathies) and to assess whether bariatric surgery modifies these effects. Background:. UECN are increasingly prevalent and decrease the quality of life of affected individuals. Studies suggest obesity as a risk factor for carpal tunnel syndrome, the most common type of UECN. Methods:. A retrospective cohort study was conducted using the PearlDiver Mariner Database, an all-payor claims database containing claims for over 53 million patients from 2010 to 2019 in all 50 US states. Rates and odds of all types of UECN were compared between 1:1:1 exact matched cohorts of obese patients who were medically managed, obese patients who underwent bariatric surgery, and nonobese patients (111,967 patients in each cohort). Results:. Compared with nonobese patients, patients with obesity were significantly more likely to develop any UECN (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.09–1.18), carpal tunnel syndrome (OR, 1.15; 95% CI, 1.10–1.30), and 2 or more UECN (OR, 1.34; 95% CI, 1.20–1.48). Compared with obese patients who were managed medically, obese patients who underwent bariatric surgery were significantly less likely to develop any UECN (OR, 0.87; 95% CI, 0.84–0.91) and carpal tunnel syndrome (OR, 0.85; 95% CI, 0.81–0.89). Conclusions:. Obese patients have higher odds of both single and concomitant UECN, specifically carpal tunnel syndrome, compared with nonobese patients. Bariatric surgery decreases the odds of developing UECN compared with obese patients not undergoing surgical intervention