Guyon tunnel syndrome secondary to excessive healing tissue in a child: a case report

We describe a case of an 8-year-old boy who developed a combined motor and sensory neuropathy of the distal ulnar nerve, after sustaining a superficial injury to the right flexor carpi ulnaris tendon at the level of the distal wrist crease. Guyon's canal syndrome is a very rare entity during childhood. We have noted only one prior description of this syndrome in the pediatric age group in a review of the English literature

Intraneural hemangioma of the median nerve: A case report

Hemangiomas of the median nerve are very rare and, so far, only ten cases of intraneural hemangioma of this nerve have been reported in the literature. We present a case of 14-year-old girl who had a soft tissue mass in the region of the left wrist with signs and symptoms of carpal tunnel syndrome. Total removal of the mass was achieved using microsurgical epineural and interfasicular dissection. The symptoms were relieved completely, after this procedure, without any neurologic deficit. On follow-up two years later, no recurrence was observed. Whenever a child or young adult patient presents with CTS the possibility of a hemangioma involving the median nerve should be kept in mind in the differential diagnosis

Femoral nerve compression secondary to a ganglion cyst arising from a hip joint: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Femoral nerve compression due to a cystic lesion around the hip joint is rare and only a few cases have been described in the literature. Among these, true ganglion cysts are even more rare.</p> <p>Case presentation</p> <p>We report the case of a 57-year-old woman with femoral nerve compression caused by a true ganglion cyst of the hip joint.</p> <p>Conclusion</p> <p>A high index of suspicion is required to predict a non-palpable cystic lesion around the hip joint as it may mimic different disorders and should be kept in mind in the differential diagnosis of unusual groin pain, radicular pain and peripheral vascular disorders.</p

Aynı hastada ikitaraflı karpal ve tarsal tünel sendromu : Olgu sunumu

Klinik muayene ve elektrofizyolojik çalışmalarla tanı konmuş, iki taraflı ciddi tarsal tünel sendromlu ve iki taraflı ciddi karpal tünel sendromlu, nadir bir vaka sunuyoruz. Kompresyon nöropatisi, özellikle iki taraflı veya multipl olduğunda sistemik bir hastalığa sekonder olabilir. Literatürde, bugüne kadar, aynı hastada iki taraflı tarsal tünel sendromu ve iki taraflı karpal tünel sendromu, sadece bir kaç vakada bildirilmiştir.We report, an unique case with co-existing bilateral severe tarsal tunnel syndrome (TTS) and bilateral severe carpal tunnel syndrome (CTS), which were diagnosed by clinical examination and electrophysiological studies. Compression neuropathy, especially when bilateral or multiple may be secondary to a systemic disease. To date, bilateral carpal and tarsal tunnel syndromes in the same patient have been reported only a few cases in the literature

Intracorporeal pneumatic shock application for the treatment of chronic plantar fasciitis: a randomized, double blind prospective clinical trial

This pilot study showed that IPST is an effective and safe method of treatment of patients with chronic PF not responding to conservative measures. IPST application should be considered before surgical intervention when the extracorporeal shock devices are not available for daily practice. However, further evaluation of this novel treatment is necessary to understand the exact mechanism of action

Giant-cell tumor of the tendon sheath in the teo : A report of three cases

Tendon kılıfı sinovyal hücrelerinden köken alan iyi huylu yumuşak doku tümörüdür. Ayak parmaklarında görülmesi nadirdir. Bu yazıda ayak parmakları tendon kılıfından köken alan dev hücreli tümör nedeniyle tedavi edilen üç olgu sunuldu. Olguların ikisi kadın (yaş 25 ve 50), biri erkekti (yaş 21). Üç hastada da ayak parmaklarında hafif ağrılı yumuşak doku kitlesi vardı. Manyetik rezonans görüntüleme ayırıcı tanıda yardımcı olmadı. Tanı tümüyle çıkarılan kitlelerin histopatolojik değerlendirilmesiyle kondu. Ortalama 18 aylık takipte hiçbir olguda lokal nüks görülmedi.Giant-cell tumor of the tendon sheath is a benign, soft-tissue tumor usually arising from synovial cells of the tendon sheaths in the hand. Involvement of the toes is quite rare. We presented three patients including two women with ages 25 and 50 years, and one man aged 21 years, who underwent surgery for mass lesions originating from tendon sheaths of the toe. All the patients presented with a slightly painful soft tissue mass in the toe. Magnetic resonance imaging was not helpful in the differential diagnosis. Diagnosis of the tumors was made by histopathologic evaluation of completely excised lesions. No local recurrences were encountered during a mean follow-up of 18 months

Modifiye kessler tendon onarımında karşı yanda uygulanan tekli kilitleme yöntemi ile ayrışma ve dikiş kopmasının önlenmesi: Koyun tendonları üzerinde biyomekanik inceleme

Objectives: Locking loops are invented to prevent pull-out complication during early active rehabilitation after flexor tendon repair. This study compares the mechanical properties of the side-locking modified Kessler repairs with four- and two- side locking points. Materials and methods: Twenty fresh flexor digitorum profundus tendons of the healthy adult sheep forelimbs were sutured by the two-strand modified Kessler with the side-locking loop technique (group A: four locking points), and by the two-strand modified Kessler repair method with a side locking knot on the opposite corners of the repair (group B: two locking points). To assess the mechanical performance of the repairs, the tendons were subjected to a linear non-cyclic load-to-failure test using a material testing machine. Outcome measures included the 2.0 mm gap force at the tendon ends, the ultimate forces and the mode of failure. Results: The mean value for the 2.0 mm gap strength was 19.2&plusmn;1.4 for group A and 19.3&plusmn;1.9 for group B. The mean value of the failure strength was 33.1&plusmn;2.6 for group A and 29.8&plusmn;3.2 for group B. Regarding the 2.0 mm gap strength between the tendon ends, no significant difference was observed between the two groups. There were statistically significant differences in failure strengths of the two groups (p=0.019). As regards the mode of failure, no suture pull-out was observed. All the specimens failed due to suture breakage at the repair site. Conclusion: Results of this study revealed that gap formation and suture pull-out can be prevented using single side locking points on the opposite corners of the modified Kessler repair.Amaç: Bu çalışmada, fleksör tendon onarımlarından sonra erken rehabilitasyonda dikiş kopması komplikasyonunun önlenmesi için geliştirilen yandan kilitli modifiye Kessler fleksör tendon onarımı yöntemi ile iki ve dört köşeden kilitli yöntemin mekanik özellikleri karşılaştırıldı.Gereç ve yöntemler: Sağlıklı yetişkin koyunlardan elde edilen 20 adet taze ön ayak fleksör digitorium profundus tendonu iki gruba ayrılarak yandan kilitli modifiye Kessler yöntemiyle onarıldı. Birinci grupta (A grubu) dört köşeden yan kilitleme yöntemi uygulandı. İkinci grupta (B grubu) ise, dört köşeden sadece karşılıklı iki çapraz köşeye yan kilit düğümü uygulanırken, diğer iki çapraz köşeye kilitsiz düğüm uygulandı. Onarımın mekanik özellikleri, mekanik test cihazı ile tendon kopana kadar, sürekli tek yönlü yük uygulanarak ölçüldü. Tendon uçları arasında 2.0 mm ayrışma gücü (N), kopma gücü (N) ve kopma şekli değerlendirildi. Bulgular: 2.0 mm ayrışma gücü karşılaştırıldığında; ortalama değer A grubunda 19.2±1.4, B grubunda 19.3±1.9 olarak bulundu. Ortalama kopma gücü ise A grubunda 33.1±2.6, B grubunda 29.8±3.2 bulundu. Tendon uçları arasında 2.0 mm ayrışma gücü değerlendirildiğinde; iki grup arasında anlamlı fark saptanmadı. Kopma gücü karşılaştırıldığında ise iki grup arasında anlamlı fark bulundu (p=0.019). Her iki grupta da hiçbir örnekte dikiş kaymasına bağlı yetmezliğe rastlanmadı. Her iki grupta da kopma yeri iki ucun arasında kalan düğümün altından gerçekleşti. Sonuç: Bu çalışmanın sonuçları, çapraz köşelere uygulanan iki adet yan kilit düğümü tekniğinin, onarım bölgesindeki ayrışmayı ve dikiş kaymasına bağlı yetmezliği önlediğini göstermiştir

Nitric oxide levels and superoxide dismutase enzyme activity in synovial fluid of patients with knee osteoarthritis

Amaç: Diz osteoartritli (OA) hastaların eklem sıvısında nitrik oksit (NO) düzeyi ve süperoksit dismutaz (SOD) enzim aktivitesi araştırıldı. Hastalar ve yöntemler: Amerikan Romatoloji Birliği OA ölçütlerine uyan 36 hasta (31 kadın, 5 erkek; ort. yaş 63; dağılım 48-88) çalışmaya alındı. Hastaların diz grafileri Kellgren-Lawrence radyografik sınıflamasına göre derecelendirildi. Sinovyal sıvı örnekleri, OA nedeniyle diz protezi veya hiyaluronik asit enjeksiyonu yapılan hastalardan girişimden önce iğne aspirasyonuyla toplandı, daha sonra Eppendorf tüplerine aktarılarak -80 °C’de saklandı. Sinovyal sıvıdaki nitrit ve nitrat değerleri Griess reaksiyonuna dayalı spektrofotometrik yöntemle belirlendi. Toplam SOD aktivitesi de spektrofotometrik yöntemle ölçüldü. Sonuçlar, diz eklemleri klinik ve radyografik olarak normal bulunan, ancak nedeni bilinmeyen diz ağrısından dolayı artroskopi uygulanan 10 hastayla (6 kadın, 4 erkek; ort. yaş 49; dağılım 26-70) karşılaştırıldı. Bulgular: Osteoartritli hasta grubunda NO düzeyi kontrol grubuna göre anlamlı derecede yüksek, SOD aktivitesi düşük bulundu (p0.05). Sonuç: Bulgularımız NO’nun kıkırdak yıkım mediyatörü, SOD’nin ise antioksidan mediyatör olduğunu düşündürmektedir. Bu değerlerin klinik önemini aydınlatmak için daha kapsamlı çalışmalara ihtiyaç vardır.Objectives: We investigated nitric oxide (NO) levels and superoxide dismutase (SOD) enzyme activity in synovial fluid of patients with primary knee osteoarthritis (OA). Patients and methods: The study included 36 patients (31 females, 5 males; mean age 63 years; range 48 to 88 years) with knee OA according to the diagnosis criteria of American College of Rheumatology. Radiographic severity of OA was assessed according to the Kellgren-Lawrence grading system. Synovial fluid samples were taken by needle aspiration before knee arthroplasty or hyaluronic acid injection and stored at -80 &deg;C in Eppendorf tubes. Nitrite and nitrate levels were determined by the spectrophotometric method based on the Griess reaction. Total SOD activity was determined by the spectrophotometric method. The results were compared with those of 10 controls (6 females, 4 males; mean age 49 years; range 26 to 70 years) who clinically and radiographically had normal knees, but underwent arthroscopic examination for knee pain of unknown origin. Results: Compared to controls, NO levels were significantly higher and SOD activity was significantly lower in patients with OA (p&lt;0.001). No significant differences were found between radiographically graded groups with regard to NO level and SOD activity (p&gt;0.05). Conclusion: Our data suggest that NO acts as a potent mediator of cartilage damage and SOD as an antioxidant mediator in OA. Further studies are needed to clarify the clinical significance of these parameters

Treatment of plantar fasciitis using four different local injection modalities: a randomized prospective clinical trial.

Background: To determine the effectiveness of four different local injection modalities in the treatment of plantar fasciitis. Methods: In a prospective randomized multicenter study of plantar fasciitis, 100 patients were divided into four equal groups and were treated using four different methods of local injection: group A was treated with 2 mL of autologous blood alone; group B, an anesthetic (2 mL of lidocaine) combined with peppering; group C, a corticosteroid (2 mL of triamcinolone) alone; and group D, a corticosteroid (2 mL of triamcinolone) combined with peppering. The outcome was defined by using a 10-cm visual analog scale and modified criteria of the Roles and Maudsley score 3 weeks and 6 months after the injection and compared with the pretreatment condition. Results: The successful results in all of the groups after injections were higher than those in the pretreatment condition (P = .000). In groups C and D, in which local corticosteroid injections were used, excellent results were obtained, with superior effect in the group in which peppering was used (P &amp;lt; .05). Conclusions: In the treatment of plantar fasciitis, combined corticosteroid injections and peppering is effective and produces better clinical results. (J Am Podiatr Med Assoc 99(2): 108–113, 2009)</jats:p