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Ariyaratne S, Abudu A, Sumathi V, Botchu R, Azzopardi C. An unusual case of nodular fasciitis presenting as an intra-tendinous mass. Skeletal Radiol 2024:10.1007/s00256-024-04728-x. [PMID: 38888624 DOI: 10.1007/s00256-024-04728-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
Nodular fasciitis is a benign soft tissue pseudotumour typically occurring in the upper extremities, head and neck, thigh and trunk. It is most commonly seen in subcutaneous locations but also can be present in intramuscular and intermuscular (fascial) locations. Its occurrence in the hand is rare, and while it can occur in close proximity to tendons, its presentation as an intra-tendinous mass has not been previously described. We present a unique and rare case of nodular fasciitis arising within the flexor digitorum profundus (FDP) tendon of the hand in a 16-year-old female. The patient presented with a painful swelling in the volar aspect of the base of her left middle finger, with progressive flexion deformity of the finger. Ultrasound and magnetic resonance imaging revealed a mass within the FDP tendon of the middle finger. An ultrasound-guided biopsy revealed a diagnosis of nodular fasciitis. Given the self-limiting nature of the condition, she was managed conservatively with close clinical and imaging follow-up. This case highlights the importance of considering nodular fasciitis in the differential diagnosis of an intra-tendinous lesion in the hand, even though it is a rare occurrence in this location. The clinical presentation, diagnostic workup, and management of this unique case are discussed, emphasising the potential for its misdiagnosis as a malignancy which can have important implications in management.
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Affiliation(s)
- Sisith Ariyaratne
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
| | - Adesegun Abudu
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Vaiyapuri Sumathi
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Pirri C, Pirri N, Stecco C, Macchi V, Porzionato A, De Caro R, Özçakar L. Hearing and Seeing Nerve/Tendon Snapping: A Systematic Review on Dynamic Ultrasound Examination. SENSORS (BASEL, SWITZERLAND) 2023; 23:6732. [PMID: 37571516 PMCID: PMC10422582 DOI: 10.3390/s23156732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Nerve/tendon snapping can occur due to their sudden displacement during the movement of an adjacent joint, and the clinical condition can really be painful. It can actually be challenging to determine the specific anatomic structure causing the snapping in various body regions. In this sense, ultrasound examination, with all its advantages (especially providing dynamic imaging), appears to be quite promising. To date, there are no comprehensive reviews reporting on the use of dynamic ultrasound examination in the diagnosis of nerve/tendon snapping. Accordingly, this article aims to provide a substantial discussion as to how US examination would contribute to 'seeing' and 'hearing' these pathologies' different maneuvers/movements.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Nina Pirri
- Department of Medicine—DIMED, School of Radiology, Radiology Institute, University of Padua, 35122 Padova, Italy;
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey;
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Draghi F, Ferrozzi G, Bortolotto C, Ballerini D, Fiorina I, Preda L. Sonography before and after carpal tunnel release: video article. J Ultrasound 2020; 23:363-364. [PMID: 32378166 DOI: 10.1007/s40477-020-00465-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 11/25/2022] Open
Abstract
Carpal tunnel release for compression of the median nerve at the wrist is a common procedure, often resulting in good clinical outcomes. There are, however, many anatomical variations in and around the carpal tunnel and it is important to be aware of these during carpal tunnel release. After surgery, recurrent carpal tunnel syndrome is uncommon, but difficult to diagnose and treat. Ultrasonography is often necessary for the evaluation of the anatomical variations before carpal tunnel release and to evaluate the most common complications after carpal tunnel release.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Guia Ferrozzi
- Diagnostic Imaging Department, Centro Medico Inacqua, Piacenza, Italy
- Diagnostic Imaging Department, Centro Medico Riabilitativo Rocca, Piacenza, Italy
| | - Chandra Bortolotto
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Daniela Ballerini
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy.
| | - Ilaria Fiorina
- Unit of Interventional Radiology-Radiology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Preda
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
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Gervasio A, Stelitano C, Bollani P, Giardini A, Vanzetti E, Ferrari M. Carpal tunnel sonography. J Ultrasound 2020; 23:337-347. [PMID: 32323256 DOI: 10.1007/s40477-020-00460-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy of peripheral nerves, with an incidence of 1-3 patients in 1000. CTS typically occurs between 45 and 60 years of age, and it is more frequent in women than in men. The main cause of CTS is chronic compression of the median nerve and ischemic suffering secondary to increased pressure in the carpal tunnel. There are many possible causes of CTS, which can be differentiated into idiopathic causes, which include most cases, and secondary causes. Classical CTS diagnosis is based on the patient's clinical examination and electrophysiological tests, such as electromyography and nerve conduction studies. The latter are helpful for determining the site of nerve compression, assessing its severity, monitoring the course of the disease after therapy, and excluding other causes of median nerve pain, such as cervical radiculopathies, brachial plexopathies, polyneuropathy, or other forms of mononeuropathies. However, clinical examination and electrophysiological tests are not able to differentiate idiopathic forms from secondary forms of CTS, and discrepancies are possible between clinical examination and electrophysiological tests (false negatives). Ultrasound examination is able to recognize most of the secondary forms of CTS. It can evaluate the morphological alterations of the nerve and correlate them with the severity of nerve suffering in all cases, even idiopathic ones, with a sensitivity and specificity equal to those of electrophysiological tests. It can also highlight some anatomical predisposing variants or conditions that may represent contraindications to minimally invasive treatments. Ultrasound examination also plays a fundamental role in evaluating patients with an unfavorable outcome after surgical treatment.
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Affiliation(s)
- A Gervasio
- Radiology Department, San Donato Hospital Group, Istituto Clinico Città di Brescia, Via Bartolomeo Gualla 15, 25128, Brescia, Italy
| | - C Stelitano
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - P Bollani
- Radiology Department, San Donato Hospital Group, Istituto Clinico Città di Brescia, Via Bartolomeo Gualla 15, 25128, Brescia, Italy
| | - A Giardini
- Radiology Department, San Donato Hospital Group, Istituto Clinico Città di Brescia, Via Bartolomeo Gualla 15, 25128, Brescia, Italy
| | - E Vanzetti
- Radiology Department, San Donato Hospital Group, Istituto Clinico Città di Brescia, Via Bartolomeo Gualla 15, 25128, Brescia, Italy
| | - M Ferrari
- Radiology Department, San Donato Hospital Group, Istituto Clinico Città di Brescia, Via Bartolomeo Gualla 15, 25128, Brescia, Italy
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