Lipofibromatous Hamartoma of the Median Nerve - A Rare Condition in the Hand.

Lipofibromatous hamartoma (LFH) of the median nerve is a rare condition in the hand and often remains asymptomatic for a significant period. MRI imaging can reveal unique tumour characteristics; however, the definitive diagnosis is confirmed through a tissue biopsy. In this report, a 38-year-old male presented with a gradually growing mass on his right hand. Physical examination revealed a large soft tissue mass extending from the thenar area to the wrist, causing compression of the median nerve. MRI confirmed the presence of a distinct soft tissue mass on the volar side of the hand. The mass was excised along with a fascicle and confirmed by histological examination. One year after surgery, sensation has improved, but weakness remains and opponensplasty was offered to the patient. Although the treatment strategy of LFH of the median nerve remains controversial, delayed treatment can result in severe compressive neuropathy and irreversible nerve damage. Level of Evidence: Level V (Therapeutic).

Recurrence Leiomyosarcoma of the Popliteal Vein: A Rare Soft Tissue Sarcoma.

Background: Leiomyosarcoma (LMS) is a soft tissue sarcoma that originates from smooth muscle cells and constitutes approximately 5-10% of all soft tissue sarcomas. Vascular LMS is the least common subtype of LMS. About one-third of vascular LMS is located in the extremities, most commonly in the saphenous vein (25%). Vascular LMS originating from the popliteal vein is very rare, and to the best of our knowledge, only nine cases have been reported to date. Case presentation. We herein report a case of a 49-year-old woman who presented with recurrence of a mass that was located at the posterior aspect of the right proximal leg and extended to the popliteal fossa. She had mild pain and intermittent claudication without a history of an edematous leg. The tissue diagnosis was LMS. Wide en bloc resection of the tumor, including the segment of the involved popliteal vein, was performed without venous reconstruction. The patient received no other adjuvant treatments. At the 16-month follow-up, she had good oncologic and functional outcomes. Conclusion: Vascular LMS at the popliteal vein is uncommon but should be considered as a differential diagnosis in a patient who presents with a mass at the popliteal fossa. The magnetic resonance imaging (MRI) and core needle biopsy were needed for a definite diagnosis. The mainstay of treatment is wide en bloc resection of the tumor, including the involved segment of the vein. Venous reconstruction after resection is unnecessary in chronic cases without a history of an edematous leg. Radiotherapy is an important adjuvant for local control when the surgical margins are close or positive. The role of chemotherapy in systemic management remains unclear.

Imaging features of bone metastases from cholangiocarcinoma.

PURPOSE: Cholangiocarcinoma (CCA) is the second most common primary malignant hepatic tumor originating from bile duct epithelia. Bone metastasis is uncommon and less documented. The aim of this study was to characterize the imaging features of bone metastasis from CCA. METHODS: A retrospective descriptive imaging characteristics in 199 patients (1465 lesions) diagnosed as CCA with bone metastasis were evaluated based on plain radiography, computed tomography (CT), magnetic resonance imaging (MRI) and Tc-99 m methylene diphosphonate bone scan. RESULTS: The common vertebral metastatic sites were lumbar spines (94 [47.2 %], 95 %CI 40.1-54.4), upper thoracic spines (89 patients [44.7 %], 95 % CI 37.7-51.9), and lower thoracic spines (80 [40.2 %], 95 % CI 33.3-47.4). On plain radiograph, most of lesions had osteolytic pattern (68 %) with pedicular destruction (45.3 %) whereas on CT had mixed osteolytic and osteosclerotic destruction (40.8 %). The common non-vertebral metastatic sites were ribs and pelvis (80 patients [40.2 %], 95 % CI 33.3-47.4 and 60 [30.2 %], 95 % CI 23.9-37). On plain radiograph, in the long bones, usually had permeative destruction (58.9 %), whereas on CT showed mixed osteolytic and osteosclerotic (34.6 %). On bone scan, increased-uptake was the common pattern, found in the vertebral and non-vertebral sites (93.6 % and 92.4 %). CONCLUSIONS: Bone metastasis from CCA usually occurred in the axial skeleton. The common patterns of destruction were osteolytic or mixed osteolytic and osteosclerotic. Periosteal reaction was scant in the appendicular long bones. On bone scan commonly had increased-uptake.

Tuberculous Distal Biceps Tendon Rupture: Case Report and Review of the Literature.

Tuberculous distal biceps tendon rupture is a rare condition in orthopedics. Musculoskeletal tuberculosis usually presents with bursitis, synovitis, myositis, and osteomyelitis, conditions which demonstrate an excellent response to antituberculosis chemotherapy. Tendon rupture is often associated with delayed diagnosis and treatment. We report a rare manifestation of musculoskeletal tuberculosis in the distal biceps tendon with delayed diagnosis.

Prevalence of musculoskeletal symptoms among garment workers in Kandal province, Cambodia.

OBJECTIVES: The main objectives of this cross-sectional descriptive study were to identify the prevalence of musculoskeletal symptoms and workstation biomechanical risk levels for garment workers in Kandal Province, Cambodia. METHODS: This cross-sectional descriptive study used multistage sampling techniques to select 714 workers from three garment factories among 22 medium-size factories (250-1,000 workers). Face-to-face interviews and direct observation using the rapid upper limb assessment scale (RULA) were used to collect data. RESULTS: The response rate was 98.3% (702/714), and the majority (89.3%) of the respondents were female. Ninety-two percent (95% CI=90.0-94.0) of the workers reported musculoskeletal symptoms in at least one body region in the previous 12 months and 89.0% (95% CI=86.7-91.3) of the workers reported such symptoms in the past seven-day period. The neck, shoulder, and lower back were the most affected body regions. In addition, the RULA data showed that 81.2% of the workers' postures were rated as action level 3, indicating that investigation and change were required soon, and that 7.5% their postures were rated as action level 4, indicating that investigation and change were required immediately. CONCLUSIONS: Cambodian garment workers reported a high prevalence of musculoskeletal symptoms in upper body regions, and their workplaces were rated as high risk ergonomically.

MRI Findings of Giant Cell Tumor of Tendon Sheath and Other Benign Soft Tissue Tumors in Hand.

Objective: To describe and determine different magnetic resonance imaging (MRI) findings of giant cell tumor of tendon sheath (GCTTS) and other benign soft tissue tumors in hand.. Material and Method: Between January 2008 and October 2014, 21 patients' data and MRI findings were retrospectively reviewed by two musculoskeletal radiologists; data including sex, age, location of mass, number of lesion, size, shape, fatty component, adhesion to the tendon, signal intensity, neurovascular, and osseous involvement was recorded. The present study was approved by the Ethics Committee for Human Research of Khon Kaen University. Results: The intra-observer and inter-observer reliability of MRI interpretation gave good agreements between two radiologists. Six patients had proven GCTTS and 15 patients had other benign soft tissue tumors, including four cases of hemangioma, four cases of lipoma, two cases each of fibroma and nodular fasciitis, and one case each of neulilemmoma, glomus tumor, and soft tissue chondroma. All GCTTS were solitary lesion with the diameter ranging from 1.2 to 6.4 cm, had well-circumscribed border and lobulation. All GCTTS were located at the volar aspect, attached to the flexor digitorum tendon. In MRI, they appeared as isointensity on T1-weighted images and hyperintensity on T2-weighted images with uniform or non-uniform enhancement. Osseous involvement was seen in all GCTTS cases. All other benign non-GCTTS showed variable MR characteristics. Two significant MRI findings on GCTTS were the presence of homogenous enhancement (p<0.01) and osseous involvement (p<0.04). Conclusion: Benign soft tissue tumors in hand gave variable and overlapping MRI features. Two major MRI findings of GCTTS are the presence of uniform enhancement and/or osseous involvement. These two MRI features may be helpful for differential diagnosis of GCTTS among well-circumscribed lobulated soft tissue mass arising from the tendon of the hands.

Interrater Reliability of the Postoperative Epidural Fibrosis Classification: A Histopathologic Study in the Rat Model.

STUDY DESIGN: Agreement study. PURPOSE: To validate the interrater reliability of the histopathological classification of the post-laminectomy epidural fibrosis in an animal model. OVERVIEW OF LITERATURE: Epidural fibrosis is a common cause of failed back surgery syndrome. Many animal experiments have been developed to investigate the prevention of epidural fibrosis. One of the common outcome measurements is the epidural fibrous adherence grading, but the classification has not yet been validated. METHODS: Five identical sets of histopathological digital files of L5-L6 laminectomized adult Sprague-Dawley rats, representing various degrees of postoperative epidural fibrous adherence were randomized and evaluated by five independent assessors masked to the study processes. Epidural fibrosis was rated as grade 0 (no fibrosis), grade 1 (thin fibrous band), grade 2 (continuous fibrous adherence for less than two-thirds of the laminectomy area), or grade 3 (large fibrotic tissue for more than two-thirds of the laminectomy area). A statistical analysis was performed. RESULTS: Four hundred slides were independently evaluated by each assessor. The percent agreement and intraclass correlation coefficient (ICC) between each pair of assessors varied from 73.5% to 81.3% and from 0.81 to 0.86, respectively. The overall ICC was 0.83 (95% confidence interval, 0.81-0.86). CONCLUSIONS: The postoperative epidural fibrosis classification showed almost perfect agreement among the assessors. This classification can be used in research involving the histopathology of postoperative epidural fibrosis; for example, for the development of preventions of postoperative epidural fibrosis or treatment in an animal model.

Percutaneous release of the A1 pulley using a modified Kirschner wire: a cadaveric study.

PURPOSE. To evaluate the outcome of percutaneous release of the A1 pulley in 40 cadaveric fingers using a modified Kirschner wire. METHODS. A 2.5-mm-diameter Kirschner wire measuring >12 cm in length was used. One end of the wire was sharpened into a 'J' shape using a grinder. The J-shaped tip featured a blunt, elongated lower tip, a sharp J-shaped curve, and a blunt upper tip. Completeness of A1 pulley release and injuries to the A2 pulley, flexor tendon, and neurovascular structures were evaluated in 40 cadaveric fingers. RESULTS. Complete release of the A1 pulley was achieved in 8 index, 7 middle, 8 ring, and 8 little fingers, whereas incomplete release of the distal part was noted in 2 index, 2 middle, 2 ring, and one little fingers; release was missed in one middle and one little fingers. Injury to the A2 pulley was noted in 2 index fingers; the injury was minimal and limited to the proximal 2 mm of the A2 pulley. There was no flexor tendon or digital nerve injury in any finger. CONCLUSION. Percutaneous release of the A1 pulley using a modified Kirschner wire achieved complete release in 78% of cadaveric fingers, which is comparable to that using a specially manufactured push knife.

Peridural methylprednisolone and wound infiltration with bupivacaine for postoperative pain control after posterior lumbar spine surgery: a randomized double-blinded placebo-controlled trial.

STUDY DESIGN: A randomized, double-blind placebo controlled trial in multimodal analgesia for postoperative pain was conducted. OBJECTIVE: To examine whether combination of corticosteroid and bupivacaine administered in patients undergoing posterior lumbosacral spine surgery reduces postoperative morphine consumption, back and leg pain relief, and improves functional disability and general health status. SUMMARY OF BACKGROUND DATA: Patients with lumbar spine surgery had moderate to severe postoperative pain. Administration of corticosteroid or injection of local anesthetic agent has been additive treatment methods for opioid drugs. There is uncertainty as to whether corticosteroid and bupivacaine combination improves outcomes in lumbosacral spine surgery. METHODS: A total of 103 patients who were scheduled to undergo elective posterior lumbar discectomy, decompressive laminectomy with or without instrumented fusion for degenerative spinal diseases, received either methylprednisolone locally applied to the affected nerve roots (and bupivacaine was infiltrated into the wound) or injected placebo. Morphine consumption and pain scores were recorded at 1, 2, 3, 6, 12, 24, and 48 hours after surgery. Oswestry Index and Short Form SF-36 scores were recorded before surgery and at 1 and 3 months later. RESULTS: Demographic data between the 2 groups were comparable. The cumulative morphine dose and postoperative pain was significantly lower in the study group than in the placebo group (P = 0.01 and P = 0.001, respectively). When performing subgroup analyses, the beneficial effects were found in all groups of surgery but could not demonstrated statistically significant difference for all subgroup comparisons. There was no significant difference between the 2 groups with regard to pain on cough, Oswestry Index, and SF-36 scores. No complications were associated with the perioperative use of methylprednisolone or bupivacaine. CONCLUSIONS: Administration of methylprednisolone-bupivacaine provided a favorable effect immediately after posterior lumbosacral spine surgery for discectomy, decompression, and/or spinal fusion without complication.

Reliability of the Roland - Morris Disability Questionnaire (Thai version) for the evaluation of low back pain patients.

OBJECTIVE: To determine the reliability of the Thai version of the Roland - Morris disability questionnaire in low back pain patients. MATERIAL AND METHOD: To develop Thai version of the Roland - Morris disability questionnaire and test it in 120 low back pain patients. Reliability of the Thai version of the Roland - Morris disability questionnaire was assessed by internal consistency using Cronbach's alpha coefficient. RESULTS: The overall Cronbach's alpha coefficient of the scale was 0.83. The Cronbach's alpha coefficient of each question in the Thai version of the Roland - Morris disability questionnaire exceeded 0.7 (range, 0.71- 0.93). The Cronbach's alpha coefficient tested in acute or chronic low back pain patients whether they have back pain only or back pain with radiculopathy which also exceeded 0.7 (range, 0.83-0.87). CONCLUSION: The Thai version of the Roland - Morris disability questionnaire is a reliable tool for assessing functional disability of low back pain in Thai patients.

Reliability of the medical outcomes study short-form survey version 2.0 (Thai version) for the evaluation of low back pain patients.

OBJECTIVES: To determine the reliability of Thai version of the medical outcomes study short-form survey version 2.0 (SF-36V2) in low back pain patients. MATERIAL AND METHOD: The authors developed the Thai version of the Medical Outcomes Study Short-Form Survey version 2.0 (SF-36V2) and tested it in 100 low back pain patients. Reliability of the Thai version of SF-36V2 was assessed by internal consistency using Chronbach's alpha coefficient and item-scale correlation. RESULTS: The authors demonstrated that the Chronbach's alpha coefficient of the physical health and mental health summary scales were 0.93 and 0.92 respectively. The Chronbach's alpha coefficient of eight scales in the Thai version of the SF-36V2 ranging was 0.72 - 0.94. The Chronbach's alpha coefficient tested in acute or chronic low back pain patients whether they have back pain only or back pain with radiculopathy ranging was 0.72-0.93. The item correlation coefficient for the 35 items within the eight health aspects ranged from 0.43 to 0.8. CONCLUSION: The Thai version of the Medical Outcomes Study Short-Form Survey version 2.0 (SF-36V2) is a reliable tool for assessing functional disability of low back pain in Thai patients.