ABSTRACT
INTRODUCTION: the association of carpal tunnel syndrome with stenosing tenosynovitis of the hand is very rare, even more, if it is generated by a fibrolipoma at the carpal tunnel. The imaging study useful to detect this type of hand injuries are X-ray screening for carpal tunnel, computed tomography and magnetic resonance imaging. But these are not commonly used for the study of protocolized carpal tunnel syndrome and much less trigger finger. OBJECTIVE: the aim of this work is to report a case of a middle-aged female with carpal tunnel syndrome characteristic symptoms, associated with the third trigger finger; she was handled with the release of the median nerve by a minimally invasive approach, in addition to the A1 pulley release. CLINICAL CASE: the patient persists with both problems and at a secondary surgical review, we detected wrist locking sensation. The patient was reoperated finding an ovoid encapsulated tumor, measuring 3.0 × 2.0 × 1.0 cm, with smooth outer surface, whitish appearance, and soft rubbery consistency. The biopsy pathology outlines identified an encapsulated fibrolipoma, causing nerve compression and locking flexor tendon. CONCLUSION: the importance of this writing is in adding tumors to the etiological repertoire, which can cause compression of the median nerve and even less frequent as a cause of the flexor tendons of the hand snagging.
INTRODUCCIÓN: la asociación del síndrome del túnel del carpo con tenosinovitis estenosante de la mano es muy rara, aún más, si es generada por un fibrolipoma a nivel del túnel del carpo. El estudio de imagen para detectar este tipo de lesiones en la mano incluye: desde una radiografía con proyección para el túnel del carpo, tomografía axial computarizada y resonancia magnética nuclear; pero éstos no se utilizan habitualmente para el estudio protocolizado del síndrome del túnel del carpo y mucho menos para los dedos en gatillo. OBJETIVO: el objetivo de este trabajo es reportar un caso en el cual se presenta la sintomatología característica de un síndrome de túnel del carpo, asociada a tercer dedo en gatillo, el cual se maneja con la liberación del nervio mediano por medio de un abordaje de mínima invasión, además de la polea A1. CASO CLÍNICO: la paciente persistió con ambas alteraciones y en la revisión secundaria se detectó bloqueo a nivel de la muñeca. Se intervino nuevamente a la paciente y se encontró una tumoración encapsulada, que midió 3.0 × 2.0 × 1.0 cm, con superficie externa lisa, blanquecina, de aspecto ovoide y consistencia blanda "ahulada". El estudio anatomopatológico la identificó como un fibrolipoma encapsulado que ocasionó la compresión nerviosa y el bloqueo del tendón flexor. CONCLUSIÓN: la importancia de este reporte de caso radica en agregar los tumores al repertorio etiológico, que además pueden provocar una compresión del nervio mediano y en que sean aún menos frecuentes como causa de atrapamiento de los tendones flexores de la mano.
Subject(s)
Carpal Tunnel Syndrome , Lipoma , Trigger Finger Disorder , Middle Aged , Humans , Female , Wrist , Carpal Tunnel Syndrome/etiology , Carpal Tunnel Syndrome/surgery , Trigger Finger Disorder/complications , Trigger Finger Disorder/diagnosis , Fingers/surgery , Wrist JointABSTRACT
OBJECTIVE: To show the utility of posterior release to correct adduct congenital talipes equinovarus (CTE) and describe the surgical technique. MATERIAL AND METHODS: This clinical trial was conducted from February 2002 to November 2008. Patients ages 0-24 months old with a diagnosis of adduct CTE were enrolled. Surgical treatment consisted of a posterior approach to the foot with Z-plasty of the tibialis posterior, flexor digitorum longus and flexor hallucis longus, capsulotomy, adductor hallucis release, and cast immobilization for 8 weeks. ANALYSIS: The sampling was non-randomized, non-probabilistic; patients were enrolled based on the diagnosis. The statistical analysis included the central trend and scatter measures, the Student "t" test, RR, and homogeneity chi square test. RESULTS: Twenty-five patients were enrolled, 13 females and 12 males, with a total of 30 feet, 10 left and 6 right, and 7 bilateral patients. Median age was 15 years (range 11-24 years). Correction was achieved and maintained in 27 feet. Three cases had adduct relapse and were managed conservatively. The statistical analysis showed the effectiveness of treatment. The result of the Student "t" test and the chi square test was p < 0.0002. DISCUSSION: The proposed treatment was effective to correct the adduct CTE, with a proven effectiveness of more than 90% in the patients included in this study. The age of onset of treatment > 18 months was a risk factor for residual adduct with a RR = 3.7.
Subject(s)
Clubfoot/surgery , Adolescent , Child , Female , Humans , Male , Orthopedic Procedures/methods , Prospective Studies , Young AdultABSTRACT
OBJECTIVE: The objective of this study is to show that the Ludloff-Ferguson approach is feasible in patients aged 2-4 years and as an outpatient procedure. MATERIAL AND METHODS: Prospective, longitudinal, clinical-trial type of study, conducted from January 2008 to December 2009. Patients aged 2-4 years with a diagnosis of congenital hip dislocation were included. All of them underwent open reduction using the Ludloff-Ferguson approach as an outpatient procedure and they wore a Callot type of cast for 6 weeks. Bilateral hips were treated in a single stage. The study variables included the age, sex, operative time, bleeding, anesthetic time, infections and avascular necrosis of the femoral head. A nonrandomized, non-probabilistic sampling was performed; the statistical analysis included the central trend and scatter measurements, the relative risk, the Spearman correlation and chi2. RESULTS: Fifteen patients were included, 8 females and 7 males, for a total of 21 hips. The latter included 4 left and 3 right hips, and 7 cases were bilateral. Median age was 3 years (range 2-4 years). The mean bleeding was 20 cc with a SD of 5 cc (range: 15-30 cc). The mean operative time was 25 minutes, SD = 7 minutes (range: 17-30 minutes). The chi2 test rejected the Ho for sex and necrosis, and age and avascular necrosis, with a P = 0.005. The results of the Spearman test for sex and necrosis were r = 0.23, P = 0.002, for age and necrosis r = 0.25, and a P = 0.003, for the operative time and avascular hip necrosis r = 0.28, P = 001. There were no infections. DISCUSSION: The open reduction technique with the Ludloff-Ferguson approach is feasible in patients aged 2-4 years as an outpatient procedure, and the risk of avascular necrosis was minimum.
Subject(s)
Hip Dislocation, Congenital/surgery , Child, Preschool , Female , Humans , Male , Orthopedic Procedures/methods , Prospective StudiesABSTRACT
OBJECTIVES: The purpose of this study is to show that a simplified stretching exercise regimen for the pelvic limbs, together with analgesics and physical therapy, may improve growing pains during an 8-week period. The Evans and Scutter diagnostic criteria modified by Peterson were used. MATERIAL AND METHODS: Prospective, longitudinal study of the clinical trial type, conducted from November 2002 to December 2008. The following tests were requested from patients: CBC, rheumatoid factor, antistreptolysins and a pharyngeal smear. A simplified regimen consisting of three stretching exercises for the adductors, the knee extensors and the hamstrings, plus analgesics and physical therapy was used. Both parents and patients were instructed on the regimen. The treatment was performed by parents at home. ANALYSIS: The sampling was non-randomized; patients were selected based on the diagnosis. The statistical analysis included the central tendency measurements and scatter plots, the Z-test for comparison of means, and the linear correlation. RESULTS: The correlation between treatment and pain relief resulted in an r = 0.97, the correlation between pain and the study variables resulted in the following: sports practice r = 0.82, obesity r = 0.86. The Z-test corroborates the improvement in the clinical picture with the treatment provided, with p = 0.0001. CONCLUSION: The simplified treatment regimen was effective to improve growing pains in the patients in the study. The high risk factors were: age, male gender and practicing sports.
