Tumoral calcinosis of the foot: An unusual differential diagnosis of calcaneal mass

Introduction Tumoral calcinosis (TC) is a rare disorder characterized by the development of calcified masses within the periarticular soft tissues of large joints. It commonly involves the hip, shoulders, and elbows. TC rarely involves the feet. Case presentation In this report, we describe an unusual case of primary TC of the foot in a 76-year-old female and discuss the pathophysiology, diagnosis, and therapeutic interventions of the condition. Discussion Due to the wide range of conditions mimicking TC, its diagnosis could be challenging. Diagnosis of TC is mainly based on the radiographic findings, the patient's biochemical profile, and the medical history plus differentiating the condition from its mimics. Conclusion TC should be considered in the differential diagnosis of any soft tissue calcification. ©2015 Published by Elsevier Ltd. on behalf of Surgical Associates Ltd

Early postoperative pain as a risk factor of shoulder stiffness after arthroscopic rotator cuff repair

Background: The role of postoperative pain in incidence of shoulder stiffness (SS) after shoulder arthroscopy has not been thoroughly investigated. The present study was conducted to assess the effects of early postoperative pain (EPOP) on onset of SS after arthroscopic rotator cuff (RC) repair. Materials and methods: In a retrospective analysis of a prospectively collected database, 335 patients who underwent arthroscopic RC repair were evaluated. RC tendons were sutured to the bone using the double-row technique. EPOP was evaluated 1 week after surgery using the visual analog scale (VAS). SS was assessed 3 months after surgery and was categorized into moderate or severe based on shoulder range of motion (ROM). Each type of complication including SS was identified and recorded. Results: Postoperative shoulder stiffness (POSS) was identified in 121 patients (36.2) that was moderate in 86 patients (70.1) and severe in 35 patients (28.9). After 1 week, VAS pain score was equal to 7.7 ± 3.1 and 4.5 ± 2.1 in the patients with and without stiffness, respectively (p < 0.001). Diabetes and traumatic tear were found to be associated with postoperative stiffness (p = 0.046 and p < 0.001, respectively). Similar associations were found on multivariate analysis of data. VAS pain score was higher in the patients with severe stiffness compared with those with moderate stiffness (p < 0.001). Conclusions: Our findings revealed that EPOP is associated with shoulder stiffness after arthroscopic RC repair. Therefore, strategies to ameliorate EPOP could be opted to decrease rate of POSS. Level of evidence: Level IV © 2021, The Author(s)

Surgical Treatment Outcomes in Patients With Syndactyly in Imam Khomeini Hospital in Tehran, Iran During 1996-2011: A Breif Report

Background: Syndactyly is the most common congenital malformation of the hand, with an incidence of 1 in 2000-2500 live births. In this study we evaluated the surgical outcomes and complications of patients with syndactyly.Methods : The surgical outcomes and complications of 42 patients, 27 male and 15, female, undergoing surgery for syndactyly were evaluated. The study took place in Imam Khomeini Hospital, in Tehran, Iran during 1996 to 2011. Having had the inclusion criteria, the patients were assessed for function, cosmetic outcome, sensation and occurrence of complications. The patients were followed-up for at least 3 years.Results : The mean age of patients was 4.4 years. There was a positive familial history for the disease in 8 patients. 71.4%, 90.4% and 73.8% of the participants had good results regarding cosmetic outcome, sensation and function, respectively.Conclusion: The overall results of surgery for syndactyly in this study were interpreted as good in 78.5%, moderate in 12.5% and fair in 8.4% of the patients. This study confirmed better surgical outcomes in patients older than 18 months

Regional vitamin C in Bier block reduces the incidence of CRPS-1 following distal radius fracture surgery

Background: Systemic vitamin C supplementation after wrist fracture has been suggested to reduce the incidence of complex regional pain syndrome (CRPS). This study aimed to evaluate the effect of regional vitamin C in Bier block in the early phase of fracture on CRPS occurrence following surgery for distal radius fractures. Methods: Seventy-four patients with isolated extra-articular distal radius fracture with the plan of fixation under Bier block were enrolled. Patients were assigned randomly into two groups: receiving either 500 mg vitamin C or sterile water as a Bier block adjuvant. Both groups received 500 mg of oral vitamin C for six weeks. The patients were evaluated for CRPS signs and symptoms at 2, 4, 6, and 12 weeks post-surgery. Results: The overall incidence of CRPS 12 weeks after surgery in the vitamin C group was significantly less than the controls (22.9 vs 45.5, p = 0.04). Logistic regression analysis showed that the only significant contribution in predicting the incidence of CRPS came from the intervention variable (OR 0.26, CI95 0.08�0.85; P = 0.027). Conclusions: The findings suggest that adding vitamin C 500 mg to the local anesthetic in Bier block significantly reduces the incidence of CRPS following distal radius fractures. © 2020, Springer-Verlag France SAS, part of Springer Nature

Comparison of ultrasound-guided local ozone (O2-O3) injection vs corticosteroid injection in the treatment of chronic plantar fasciitis: A randomized clinical trial

Objective. Plantar fasciitis (PF) is one of the most common causes of heel pain. The affected area is often close to the attachment of plantar fascia to calcaneus bone. The purpose of this study was to compare the effects of ozone (O2-O3) injection to corticosteroid injection under ultrasound guidance for the treatment of chronic PF. Design. Randomized clinical trial. Setting. Academic University and Neuromusculoskeletal Research Center. Subjects. Thirty patients with chronic PF. Methods. The patients were randomly divided into two groups receiving methylpredniso-lone (15 subjects) vs ozone (O2-O3; 15 subjects). The following outcome measures were assessed before injection and then two weeks and 12 weeks after the injection in each group; morning and daily pain via visual analog scale, daily life and exercise activities via the Foot and Ankle Ability Measure, and plantar fascia thickness at insertion and 1 cm distal to its insertion into the calcaneus via ultrasound imaging. Results. Intragroup changes showed significant improvement in pain, functional parameters, and sonographic findings in both groups (P < 0.05). Pain reduction (both daily and morning) and daily activity improvement were better in the corticosteroid group two weeks after injection; however, at 12 weeks, the ozone (O2-O3) group had significantly more improvement (P ¼ 0.003, P ¼ 0.001, and P ¼ 0.017, respectively). Conclusions. Both methods were effective in the treatment of chronic PF. Steroid injection provided a more rapid and short-term therapeutic effect. However, ozone (O2-O3) injection led to a slow and longer-lasting treatment outcome. Ozone (O2-O3) injection can be an effective treatment, with slow onset and a longer durability in the treatment of chronic PF. © 2018 American Academy of Pain Medicine. All rights reserved