Nonoperative treatment of anterior interosseous nerve paralysis.

Although the current recommendation for the treatment of spontaneous anterior interosseous nerve paralysis is surgical decompression, there has been recent evidence in the neurologic literature that these lesions are examples of a neuritis. We followed 10 cases of spontaneous partial anterior interosseous nerve paralysis. All patients were seen initially with a typical history of pain. Seven had signs of other nerve involvement either on physical examination or electromyogram analysis. Eight patients treated by observation had signs of recovery in 6 months and full recovery within 1 year. Surgical decompression did not affect recovery time in the other patients. Our findings suggest that anterior interosseous nerve paralysis is a form of neuritis and can safely be treated without operation. These patients will achieve complete recovery.

Treatment considerations in the complicated rheumatoid hand.

The rheumatoid patient with complex involvement or multiple deformities of the hand and wrist can be a challenge to the hand surgeon. A systematic and orderly approach is used to formulate and execute a treatment plan that is realistic and that can result in modest, but significant improvement in overall hand function. The evaluation and treatment philosophy which is described can help turn a complicated and seemingly overwhelming situation into smaller components which can be treated in one or more surgical stages.

Dupuytren's (subungual) exostosis.

Because it may produce a bewildering array of histologic patterns, the clinical entity of subungual exostosis (Dupuytren's exostosis), is sometimes confused with chondrosarcoma. However, this lesion is a distinct entity. It begins as a reactive growth of cellular fibrous tissue and metaplastic cartilage, which undergoes enchondral ossification. The rate of growth may be exuberant, but it is limited. We present a series of 15 cases as well as a review of the literature. Postadolescents and young adults are most commonly affected, and the majority of cases (80%) occur on the dorsal-medial aspect of the great toe. Trauma, whether chronic or acute, and infection are frequent inciting factors. The radiologic picture is consistent and can be diagnostic. In more than half our cases, chondrosarcoma was suspected initially. However, if the entire clinical picture is evaluated, the histologic findings should not lead to confusion with a malignant process. This acquired exostosis is benign; local excision is curative. However, recurrence is common (53%) after incomplete excision or when the lesion has not achieved full maturation.