ABSTRACT
Biparietal thinning resulting in bilateral and symmetrical resorption and loss of thickness of the parietal bones is an uncommon to rare condition in the anthropological and clinical literature. This enigmatic condition of unknown etiology was first reported in the 18th century and has been variously described as a nonmetric trait, anatomical variant, anomaly, and pathology. Biparietal thinning presents grossly and radiographically as oval-shaped depressions in 0.25-0.8% and 0.4-0.5% of individuals and with a higher frequency in females over the age of 60 years. A review of the literature revealed only one example of cranial trauma associated with biparietal thinning and none of fatal trauma associated with this condition. This case reports a rare example of fatal trauma in an elderly man that resulted from a backward fall from a standing height and highlights the increased risk of craniocerebral trauma in individuals with this condition.
Subject(s)
Accidental Falls , Occipital Bone/injuries , Osteoporosis/pathology , Parietal Bone/injuries , Skull Fracture, Depressed/pathology , Aged , Bone Resorption/pathology , Hematoma, Subdural/pathology , Humans , Male , Occipital Bone/pathology , Parietal Bone/pathology , Subarachnoid Hemorrhage/pathologyABSTRACT
Apophyseal spinous process avulsion injury was first described in 1941. Since then, there have been sparse additional reports in the literature. The authors report their second case, involving an elite adolescent tennis player. The patient underwent surgical excision of the avulsed spinous process 12 weeks after initial presentation and experienced complete resolution of back pain. The authors provide the first reported histopathological analysis of the avulsion fracture site in the literature for both of their cases. The avulsion injury of the interspinous ligament was characterized by hypercellular fibrocartilage tissue, similar to that seen in severe Osgood-Schlatter's disease. The key physical examination finding in patients with avulsion spinous process fractures is acute tenderness directly over the fracture site that worsens with flexion rather than extension (unlike in spondylolysis). Patients should have routine radiographs, including dynamic flexion-extension views, magnetic resonance imaging, and computed tomography. The authors conclude that after 6 months of nonsurgical management for an athlete, surgical excision should be offered as an alternative. In both of their cases, nonsurgical management failed. Surgical excision offers definitive and simple treatment, as well as early return to athletic activities. Both patients were allowed to return to their competitive level of performance 6 weeks after surgery.
Subject(s)
Low Back Pain/etiology , Low Back Pain/prevention & control , Lumbar Vertebrae/injuries , Spinal Fractures/diagnosis , Spinal Fractures/surgery , Tennis/injuries , Child , Fracture Healing , Humans , Low Back Pain/diagnosis , Lumbar Vertebrae/pathology , Lumbar Vertebrae/surgery , Magnetic Resonance Imaging/methods , Male , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
A variety of different diseases affect the synovium, including infection, noninfectious immunologic inflammatory conditions, degenerative arthroses, crystal deposits, trauma, and tumors. Tumors of the synovium are relatively uncommon. Any mesenchymal tumor may arise in the synovium, but most recapitulate its normal counterpart including synoviocytes, blood vessels, fat, and fibrous tissue. These tumors can arise in any synovial lined structures both within joints and in extraarticular locations. Most synovial tumors are benign. Malignant tumors are rare but important to recognize because many are aggressive and must be treated appropriately. Among common nonneoplastic conditions that affect the synovium and surrounding structures are crystal deposits such as monosodium urate crystals, calcium pyrophosphate dihydrate crystals, and hydroxyapatite crystals. These crystal deposits may be asymptomatic or cause severe pain or chronic joint destruction. Their accurate identification is important to guide appropriate therapy.
Subject(s)
Soft Tissue Neoplasms/pathology , Synovial Membrane/pathology , Biomarkers, Tumor/metabolism , Crystallization , Fibroma/pathology , Giant Cell Tumors/pathology , Gout/pathology , Hemangioma/pathology , Hemosiderin , Humans , Joint Loose Bodies/pathology , Lipoma/pathology , Sarcoma/pathology , Soft Tissue Neoplasms/genetics , Soft Tissue Neoplasms/metabolism , Synovitis/pathology , Synovitis, Pigmented Villonodular/pathology , Tendons/pathologyABSTRACT
Neoplasms of the hand are not common. Giant cell tumor of tendon sheath (GCTTS) is the most common primary tumor of the hand. Many different theories have recently been proposed as to whether GCTTS is a neoplasm or a localized reactive process. We believe the evidence supports a neoplastic origin. Although the origin is still not proved, the presentation, diagnosis, and treatment of GCTTS have been clear for a long time.