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Huang J, Li J, Li R, Wu X, Lei Y, Zhou Z. Infectious wrist arthritis complicating acute carpal tunnel syndrome in a child: A CARE-compliant case report. Medicine (Baltimore) 2024; 103:e39276. [PMID: 39151517 PMCID: PMC11332741 DOI: 10.1097/md.0000000000039276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION The objective of this case report is to provide clinical evidence that acute infectious wrist arthritis in children can lead to the rare condition of acute carpal tunnel syndrome (ACTS). This article discusses in detail the characteristics of infectious wrist arthritis complicating ACTS in children in terms of etiology, pathogenic bacteria, treatment modalities, and sequelae to improve the understanding of this disease. PATIENT CONCERNS A 10-year-old male child presented with a 15-day history of swelling and pain in the left forearm, wrist, and hand. DIAGNOSES Left-sided infected wrist arthritis complicating ACTS. INTERVENTIONS The child received emergency surgery and anti-infective treatment combined with regular rehabilitation. OUTCOMES During the treatment period, the child's wrist pain and swelling gradually improved, and wrist movement was restored compared with the preoperative period. At 6-month follow-up, the activities of the metacarpophalangeal joints of the left hand were close to normal, and the flexion of the left wrist joint was slightly limited. CONCLUSION In infectious wrist arthritis in children, ACTS is a serious complication that requires aggressive surgical carpal tunnel release to avoid median nerve injury in addition to anti-infective therapy.
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Affiliation(s)
- Jihui Huang
- Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Jun Li
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ruichen Li
- Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Xing Wu
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yuanxue Lei
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Zhiguo Zhou
- Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Lui TH, Leung OT. Endoscopic Resection of Ulnar Bursa of the Palm: 2 Ulnar Portals Technique. Arthrosc Tech 2023; 12:e1765-e1771. [PMID: 37942104 PMCID: PMC10627874 DOI: 10.1016/j.eats.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/15/2023] [Indexed: 11/10/2023] Open
Abstract
Ulnar bursa of the hand invaginates the flexor digitorum superficialis and flexor digitorum profundus tendons of the little, ring, long, and index fingers. Distension of this bursa can have an inflammatory or infective cause. It can also originate from pathology of another site (e.g., degenerative wrist joint). Because of the tough overlying palmar aponeurosis, distended ulnar bursa can have swelling at a remote site. The distended ulnar bursa can also have compressive neuropathy to the ulnar nerve and median nerve. The purpose of this Technical Note is to describe the technical details of the 2 ulnar portals technique involving endoscopic resection of the ulnar bursa. This is indicated for symptomatic distension of the ulnar bursa, especially with hypothenar extension.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China
| | - Odin Tymon Leung
- Department of Orthopaedics and Traumatology, United Christian Hospital, Hong Kong SAR, China
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Shih S, Francoisse CA, Xu KY, Tadisina KK. Skin Popping for the Hand Surgeon: A Case Report and Review. Ann Plast Surg 2023; 91:64-77. [PMID: 37450863 DOI: 10.1097/sap.0000000000003602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Subcutaneous injection of illicit drugs, colloquially known as skin popping, is associated with skin and soft tissue infections of the upper extremity. Sequelae of these infections often present to hand surgeons in the late stages of disease, are associated with challenging clinical scenarios, and are a significant burden to both patients and providers. The authors present an illustrative case and review the literature regarding this growing phenomenon in upper extremity surgery. METHODS A case report detailing the surgical reconstruction of a large forearm wound in the setting of intravenous heroin use and skin popping is presented. Search terms related to upper extremity subcutaneous drug injection were used to find relevant articles in PubMed and EMBASE. A total of 488 articles were found, with 22 studies meeting the inclusion criteria. RESULTS In this case report, the patient had a long history of skin popping to the forearm and presented with a chronic wound with exposed bone. The patient was treated with serial debridement, bony fixation, intravenous antibiotics, and soft tissue coverage using an arteriovenous loop and a muscle-only latissimus flap. Literature review yielded 22 studies comprising 38 patients with 55% (11/20) women and age range of 23 to 58 years. Heroin was the most commonly used drug (50.0%). The most common presentation was soft tissue infection (6/20 patients), manifestations of noninfected wounds (5/20), and wound botulism (4/20 of patients). Seventy percent of patients presented with multiple injection sites. Surgical management was described in 18% of cases, with all but one case describing drainage and debridement techniques. Only one case of formal reconstruction using a dermal template was described. CONCLUSIONS Skin popping infections have unique pathogenesis, presentation, and management patterns that hand surgeons must be aware of when treating these patients. A literature review revealed a relative paucity of reports regarding risk factors and surgical management of "skin popping" sequelae. If patients are reconstructive candidates, complex reconstruction requiring free tissue transfer may be warranted.
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Affiliation(s)
- Sabrina Shih
- From the Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Caitlin A Francoisse
- Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St Louis, MO
| | - Kyle Y Xu
- Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL
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Ederer I, Schreiner J, Stahl S, Daigeler A, Wahler T. Role of antibiotic treatment after surgical debridement of superficial hand infection in 180 patients. HAND SURGERY & REHABILITATION 2022; 41:384-390. [DOI: 10.1016/j.hansur.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 10/18/2022]
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Pillai S, Campbell E, Mifsud A, Vamadeva SV, Pahal GS. Hand infections. Br J Hosp Med (Lond) 2020; 81:1-14. [PMID: 33263466 DOI: 10.12968/hmed.2020.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The hand is an extremely versatile organ adapted for fine tasks with various clinicoanatomical compartments. This article reviews the types of common hand infections that present to the emergency department and/or hand surgeon, with relevant investigations and strategies for diagnosis and treatment, with the emphasis on distinguishing between superficial and more serious infections.
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Affiliation(s)
- S Pillai
- Department of Plastic Surgery, Royal London Hospital, London, UK
| | - E Campbell
- Department of Plastic Surgery, Royal London Hospital, London, UK
| | - A Mifsud
- Department of Microbiology, Whipps Cross Hospital, London, UK
| | - S V Vamadeva
- Department of Plastic Surgery, Royal London Hospital, London, UK
| | - G S Pahal
- Department of Plastic Surgery, Royal London Hospital, London, UK
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Abstract
Hand infections can lead to significant morbidity if not treated promptly. Most of these infections, such as abscesses, tenosynovitis, cellulitis, and necrotizing fasciitis, can be diagnosed clinically. Laboratory values, such as white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and recently, procalcitonin and interleukin-6, are helpful in supporting the diagnosis and trending disease progression. Radiographs should be obtained in all cases of infection. Ultrasound is a dynamic study that can provide quick evaluation of deeper structures but is operator dependent. Computed tomographic and MRI studies are useful for evaluating deep space or bony infections and preoperative surgical planning.
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Dastagir K, Vehling M, Könneker S, Bingoel AS, Kaltenborn A, Jokuszies A, Vogt PM. Spread of Hand Infection According to the Site of Entry and Its Impact on Treatment Decisions. Surg Infect (Larchmt) 2020; 22:318-325. [PMID: 32735480 DOI: 10.1089/sur.2020.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Hand infections can spread quickly and destroy functional structures. Early diagnosis and adequate therapy can prevent severe morbidities. The aim of this study was to evaluate systematically the spread of hand infections according to injury mechanism, pathogens, and entry site. Methods: The data and medical records of 425 patients were collected and analyzed retrospectively. Results: The entry site had a significant influence on the severity of hand infections. Especially finger lesions led to severe infections. Furthermore, a high C-reactive protein (CRP) concentration correlated with more involved compartments of the hand. Bacterial counts also correlated with the number of compartments involved. Conclusions: Compared with known factors for the severity of hand infections finger lesions lead to especially severe infections and should not be underestimated. If there is a higher CRP concentration or more than one bacterial species isolated, compartments adjacent to the site of injury should be checked intra-operatively.
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Affiliation(s)
- Khaled Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Medical School Hannover, Hannover, Germany
| | - Malte Vehling
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Medical School Hannover, Hannover, Germany
| | - Sören Könneker
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Medical School Hannover, Hannover, Germany
| | - Alperen Sabri Bingoel
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Medical School Hannover, Hannover, Germany
| | - Alexander Kaltenborn
- Department of Trauma and Orthopedic Surgery, Plastic, Hand and Reconstructive Surgery, Armed Forces Hospital Westerstede, Westerstede, Germany
| | - Andreas Jokuszies
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Medical School Hannover, Hannover, Germany
| | - Peter Maria Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Medical School Hannover, Hannover, Germany
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Griffith JF, Yip SWY, Hung EHY, Fong RCW, Leung J, Ng AWH, Tong CSL, Lee RKL. Accuracy of ultrasound in the characterisation of deep soft tissue masses: a prospective study. Eur Radiol 2020; 30:5894-5903. [PMID: 32591891 DOI: 10.1007/s00330-020-07002-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/08/2020] [Accepted: 06/03/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE To investigate the accuracy of ultrasound in characterising the type of mass and likelihood of malignancy in deep soft tissue masses. METHODS Five hundred seventy-nine deep soft tissue masses were prospectively studied by ultrasound. Masses (n = 137) with prior MRI or CT were not included. Following ultrasound examination, the likely nature of the mass as well as the confidence of the reporting radiologist ('fully confident' versus 'not fully confident') about the ultrasound diagnosis was recorded. Clinical and ultrasound diagnoses were compared with the histological diagnosis which was available in 134 (23%) of the 579 masses. RESULTS Compared with histology, clinical and ultrasound accuracy for characterising the type of mass were 47% and 88% respectively when all differential diagnoses were considered. The radiologist was fully confident regarding the type of 436 (75%) of 579 masses and, in this setting, for those cases that could be compared with histology, diagnostic accuracy was 96%. For the remaining masses, where the radiologist was not fully confident, accuracy compared with histology was 58% for the first differential diagnosis and 80% for all differential diagnoses. For identifying malignancy, sensitivity, specificity, and positive and negative predictive value of ultrasound were 97%, 58%, 67%, and 99% respectively. Ultrasound alone was considered sufficient for diagnostic workup in over half of all deep soft tissue masses. CONCLUSION Ultrasound is useful at characterising and recognising malignancy in deep soft tissue masses. Provided local practice patterns are favourable, ultrasound may be considered a first-line investigation in the diagnostic workup of deep soft tissue masses. KEY POINTS • In three-quarters of cases, one can be fully confident about characterising the nature of deep soft tissue masses on ultrasound and, for those fully confident cases that could be compared with histology, the diagnostic accuracy of ultrasound was 96%. • Ultrasound can correctly recognise nearly all malignant deep soft tissue masses but some benign masses will also be considered possibly malignant. • Ultrasound alone was considered sufficient for imaging workup in over half of deep soft tissue masses.
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Affiliation(s)
- James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Stefanie W Y Yip
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Esther H Y Hung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Raymond C W Fong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cina S L Tong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ryan K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Abstract
Necrotizing infections of the hand and wrist are important clinical entities because of their rapidly progressive and potentially lethal nature. These infections encompass a spectrum of diseases with overlapping signs and symptoms, which can be subtle and nonspecific. If the brief prodromal period of these infections goes unrecognized, a local area of devitalized tissue can evolve into fulminant infection, multiorgan failure, and potentially death. Early recognition and treatment including administration of broad-spectrum antibiotics and surgical débridement are paramount to improving patient outcomes.
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Lui TH, Lee JCY. Endoscopic Synovectomy of the Ulnar Bursa of the Palm of the Hand. Arthrosc Tech 2018; 7:e1257-e1261. [PMID: 30591871 PMCID: PMC6305889 DOI: 10.1016/j.eats.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/03/2018] [Indexed: 02/03/2023] Open
Abstract
Synovitis of the ulnar bursa is associated with tenosynovitis of the flexor tendons. Reported causes include suppurative or tuberculous infection, rheumatoid arthritis, and pigmented villonodular synovitis. Open synovectomy requires extensive soft-tissue dissection and may result in extensive scarring. The purpose of this Technical Note is to describe the technical details of endoscopic synovectomy of the ulnar bursa of the palm of the hand. This minimally invasive approach with small incisions allows aggressive postoperative hand therapy and avoids the complications of tendon adhesions, joint contractures, and hand stiffness.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, China,Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China
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Lui TH, Lee CH. Little Finger Flexor Tendoscopy, Endoscopy of the Ulnar Bursa and Midpalmar Space. Arthrosc Tech 2018; 7:e817-e822. [PMID: 30167359 PMCID: PMC6112227 DOI: 10.1016/j.eats.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 04/06/2018] [Indexed: 02/03/2023] Open
Abstract
Inflammatory, infectious, and even neoplastic processes can involve the deep subfascial space of the hand. Suppurative deep-space infection is treated primarily with surgical drainage. Open approaches to these deep spaces carry the risk of exposed flexor tendons and nerves without adequate soft tissue coverage. The purpose of this Technical Note is to describe the technical details of little finger flexor tendoscopy, endoscopy of the ulnar bursa and midpalmar space, which will reduce the risk of exposed tendons or nerves associated with open approaches and allow aggressive hand therapy in the early postoperative period because of the minimal surgical trauma and small surgical wounds.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S. (H.K.), F.R.C.S. (Edin.), F.H.K.A.M., F.H.KC.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Rd, Sheung Shui, NT, Hong Kong SAR, China.
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Abstract
OBJECTIVE The purposes of this article are to review hook of the hamate anatomy, describe the imaging features of the spectrum of pathologic conditions, and discuss the pearls and pitfalls of imaging for clinical decision making for pathologic entities affecting the hook of the hamate. CONCLUSION Knowledge of the anatomy, imaging appearance, and clinical management of hook of the hamate abnormalities is important for radiologists in guiding the care of patients with ulnar-sided wrist symptoms.
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