Soft Tissue Benign Hand Masses in the First Web Space: A Retrospective Case Series

INTRODUCTION

Hand masses are fairly common. While most of these masses are either ganglion cysts or benign tumors, masses in the first web space are not rare, and they may in fact represent a variety of lesions. These include both benign and malignant tumors, metastases, or congenital and anomalous structures, and may involve nerves, vascular structures, connective tissue, and joints.

METHODS

In this retrospective case series, data on 12 cases of first dorsal web space hand mass treated at our center over a period of five years were collected and analyzed.

RESULTS

 Twelve consecutive patients presenting with a first dorsal web space hand mass over a period of five years were reviewed. This represented a group of nine females and three males, with a mean age of 53 years (range = 16-70 years). Seven patients had a mass on the right side and five on the left side. The surgical approach to resect the mass in all 12 patients was dorsal. The most common diagnosis was ganglion cyst (50%), followed by lipoma (25%) and aneurysm (16.6%). There was one case of eccrine spiradenoma.

CONCLUSION

First dorsal web space hand masses can encompass multiple different pathologies, and the first web space has an intricate anatomy. Both of these factors mandate a careful approach that includes meticulous preoperative planning with appropriate advanced imaging studies, which helps to make the surgical procedure more efficient and accurate.

Severe Hand Injuries From Fireworks: Injury Patterns, Outcomes, and Fireworks Types

PURPOSE

The purpose of this study was to characterize injury patterns and outcomes of fireworks-related hand injuries and determine if there was an association with certain fireworks types.

METHODS

A retrospective cohort study was conducted on patients treated at a trauma center between 2005 and 2015. A total of 105 patients sustaining operative hand injuries due to fireworks were identified. Medical records were reviewed to identify injury patterns, treatment outcomes, and fireworks types.

RESULTS

Eighty-eight patients (84%) sustained 92 thumb and/or first web space injuries. There were 12 thumb soft tissue-only injuries (13%) and 80 thumb fractures/dislocations (87%). Of these, there were 52 thumb carpometacarpal (CMC) joint dislocations (57%) and 36 thumb fractures outside the thumb CMC joint (39%). Fifteen hands (16%) sustained both thumb CMC joint dislocations and additional thumb fractures. Twenty-three hands (25%) required thumb revision amputation. The number of surgeries for acute reconstruction ranged from 1 to 7, with 17 patients (19%) requiring 3 or more. Sixty-three hands had deep first web space injuries, and 11 (17%) required flaps acutely for first web space reconstruction. Six hands required secondary reconstruction of a first web space contracture. An external fixator was applied to 6 hands to maintain the first web space; none of these required secondary web reconstruction. Excluding isolated pin removals and dressing changes under anesthesia, 19 patients (22%) required later-stage surgeries. Shells/mortars (59%) were the most common fireworks type causing injury.

CONCLUSIONS

Among operative hand injuries, fireworks most commonly fracture the thumb, destabilize the thumb CMC joint, and deeply damage the first web space. The first web space requires particular consideration because deep injury may result in adduction contracture and require secondary reconstruction if not prevented.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Painless angioleiomyoma of the first web space of the hand

Angioleiomyoma is a benign dermal or subcutaneous tumor originating from the tunica media of small veins and arteries, and rarely occurs in the hand. Because of its non-specific imaging features, a definite preoperative diagnosis is quite difficult. We present an unusual case of angioleiomyoma arising in the first web space of the right hand of a 56-year-old male. Physical examination showed a 3-cm, elastic-soft, mobile, non-tender mass. Magnetic resonance imaging (MRI) revealed a well-demarcated, subcutaneous, soft tissue mass with iso- to slightly high signal intensity relative to skeletal muscle on T1-weighted sequences and heterogenous high signal intensity with scattered foci of low signal intensity on T2-weigthed sequences. Contrast-enhanced fat-suppressed T1-weighted sequences demonstrated heterogenous, strong enhancement throughout the mass. There was no vascular structure closely abutting the mass. Simple excision of the mass was performed, and the histology was characteristic of an angioleiomyoma. The patient had no evidence of local recurrence within four months of follow-up. Angioleiomyoma should be considered in the differential diagnosis of a well-defined, oval soft tissue mass in the first web space of the hand even when an adjacent tortuous vascular structure is not seen on MRI.