Venous pectoralis minor syndrome: a rare subdivision of the thoracic outlet syndrome.

We analysed data of all patients who had received surgery for rare, isolated venous pectoralis minor syndrome at our tertiary institution from January 2015 to December 2018. Venous duplex scan was the preferred mode of diagnosis in all our patients. We operated on patients via a 5-6 cm deltopectoral groove incision. Ten procedures were performed on 6 patients, of whom 5 were female. The median age was 23 years (range 17-33 years). Three patients (2 female, 1 male) with bilateral pectoralis minor syndrome had separate procedures performed over a course of a few weeks. The median operating time was 22 min (range 15-95 min). Median blood loss was 20 ml (range 5-410 ml). The median hospital stay was 2 days (range 1-5 days). There was one complication in the form of a recurrence on the right side in a patient who had bilateral pectoralis minor syndrome. No other morbidities were recorded. Nine of 10 procedures (90%) were classified by patients as being satisfactory, where symptoms had partially or completely resolved. Our experience emphasizes the need for a systematic search and to maintain a high index of suspicion for venous pectoralis minor syndrome in all patients complaining of painful symptoms related to thoracic outlet syndrome. The deltopectoral groove approach is a simple and straightforward incision with a gentle learning curve.

Medial Meniscus Posterior Root Tear Repair Using a 2-Simple-Suture Pullout Technique.

Medial meniscus posterior root tear is one of the underestimated knee injuries in terms of incidence. Despite its grave sequelae, using simple but effective technique can maintain the native knee joint longevity. In the current note, a 2-simple-suture pullout technique was used to effectively reduce the meniscus posterior root to its anatomic position. The success of the technique depended on proper tool selection as well as tibial tunnel direction that allowed easier root suturing and better suture tensioning, without inducing any iatrogenic articular cartilage injury or meniscal tissue loss. Using anterior knee arthroscopy portals, anterolateral as a viewing portal and anteromedial as a working portal, a 7-mm tibial tunnel starting at Gerdy tubercle and ending at the medial meniscus posterior root bed was created. The 2 simple sutures were retrieved through the tunnel and tensioned and secured over a 12-mm-diameter washer at the tibial tunnel outer orifice. Anatomic reduction of the medial meniscus posterior root tear was confirmed arthroscopically intraoperatively and radiologically by postoperative magnetic resonance imaging.

Ulnar Nerve Repair With Simultaneous Metacarpophalangeal Joint Capsulorrhaphy and Pulley Advancement.

PURPOSE: To evaluate the validity of performing a static anti-claw procedure (metacarpophalangeal joint volar capsulorrhaphy and A1 and A2 pulley release) at the time of ulnar nerve repair for acute or chronic lacerations to prevent development of claw hand deformity and disability or to correct them. METHODS: We present a case series of 14 patients for whom metacarpophalangeal joint capsulorrhaphy and pulley advancement were done at the time of ulnar nerve management. Direct nerve repair was performed in 10 patients, nerve grafting in 2, neurolysis in 1, and combined direct repair and anterior interosseous nerve transfer in 1. Outcome measurements included assessment of claw hand correction and sequence of phalangeal flexion according to modified evaluation criteria of Brand and motor recovery of ulnar nerve function using the British Medical Research Council (MRC) scale. RESULTS: Average follow-up was 39 months. At 3 months, 12 patients had good and 2 had fair claw hand correction. At 6 months, 2 patients had excellent, 10 patients had good, and 2 patients had fair correction. At final follow-up, 13 patients had good to excellent correction and 1 had fair correction. Motor recovery of the intrinsic muscles was rated from 2 to 5 according to the MRC scale. CONCLUSIONS: This technique is simple and effective. It acts as an internal orthosis during recovery of sufficient strength of the intrinsic muscles. In cases of incomplete recovery of the intrinsic muscles (up to MRC grade 2), it may eliminate the need for secondary surgery to correct a claw hand deformity. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

New technique for reducing fibrosis in recurrent cases of carpal tunnel syndrome.

PURPOSE: Synthetic bio-degradable materials have been used as an artificial barrier in prophylaxis of adhesions. We report on the use of lactid caprolacton film (Mesofol) in recurrent carpal tunnel syndrome. We hypothesise that its use will give favourable results regarding the functional outcome and the recurrence rate. PATIENTS AND METHODS: Fourteen patients were prospectively reviewed following neurolysis and application of Mesofol film. Average age was 48 years. Outcome assessment measures included; two-point discrimination, verbal rating scale, and Boston Questionnaire. RESULTS: Follow-up period averaged 25.5 months. Post-operative two-point discrimination improved to an average of 4.57 mm. The post-operative average verbal rating scale was 1.5. The mean symptom severity score improved to 1.88 and the mean functional score improved to 1.69 post-operatively. CONCLUSION: In cases of recurrent carpal tunnel syndrome, the use of mesofol barrier yields good functional results at the short term follow-up. The technique is simple. No patients needed further surgeries.

Treatment of diffuse pigmented villonodular synovitis of the knee with combined surgical and radiosynovectomy.

Treatment of extensive diffuse pigmented villonodular synovitis (PVNS) of large joints by isolated surgical resection is unsatisfactory, with high rates of local recurrence. Post-synovectomy adjuvant treatment with external beam radiation therapy or intra-articular injection of radioactive material as yttrium-90 ((90)Y) yielded better results. Between January 2005 and January 2007, 12 patients (eight men and four women aged 19-49 years) with extensive diffuse PVNS of the knee were treated. All patients had an adjuvant post-operative external beam radiation therapy (2,600-3,000 cGy) conventionally fractionated 200 cGy/fraction, five fractions/week, 6-8 weeks after surgery. Mean follow-up time was 27 months (range from 20 to 36 months). All patients were followed up using clinical assessment, magnetic resonance imaging, and plain X-ray. In all patients, neither evidence of disease recurrence nor progression of bone or articular destruction was noted. No complications were noticed after surgery or after post-operative external beam radiation therapy. A combination of debulking surgery using anterior and posterior approach with adjuvant post-operative external beam radiation therapy for extensive diffuse PVNS of the knee joint is a reliable treatment method, with good results in regard to the incidence of local recurrence and functional outcome.