Fracture of the ulnar sesamoid bone of the thumb with a concurrent ulnar collateral ligament tear: A case report.

While the ulnar sesamoid bone of the thumb and the ulnar collateral ligament (UCL) are in close anatomic proximity, concurrent injury to these structures has not been reported. We report a case of such an injury in a 53-year-old male after an altercation. He was treated with surgical repair of the UCL, postoperative immobilization, and a graduated rehabilitation program consisting of range of motion and strengthening exercises. After review of the literature, we recommend that clinicians consider not just a volar plate injury, but also a UCL injury, in patients presenting with radiographic evidence of a sesamoid fracture. Clinicians should have a low threshold for advanced imaging in these patients to confirm any suspected ligamentous injury.

Utilization of Electrodiagnostic Testing for Carpal Tunnel Syndrome by General Practitioners Prior to Hand Surgery Consultation.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral mononeuropathy and thus is frequently encountered by general practitioners (GPs). The aim of this study is to investigate the referral pattern of GPs with regard to electrodiagnostic (EDX) testing for suspected CTS prior to hand surgery consultation, as well as to investigate the results of EDX testing for suspected CTS when requested by GPs prior to evaluation by a hand surgeon. METHODS: We retrospectively reviewed patients referred to our hand surgery clinic over a consecutive 2-year period for suspected CTS. RESULTS: A total of 403 patients were referred to our hand surgery clinic from January 1, 2016, to December 31, 2017. Of the 403, 295 (73.2%) were referred by GPs. GPs obtained prereferral EDX testing in 198 (67.1%) of these patients. EDX testing confirmed their diagnosis in 177 patients (89.4%). There were 21 patients (10.6%) identified with normal EDX testing and a more likely diagnosis reached based on clinical examination. CONCLUSIONS: GPs make up the majority of our referrals for CTS, and they obtain EDX testing prior to consultation in two-thirds of referrals. GPs appear to accurately utilize EDX testing to confirm their diagnosis prior to referral and have a low rate of normal testing where symptoms are more readily explained by an alternative diagnosis.

Benign proliferative myositis of the sternohyoid muscle: review and case report.

We report a case of a 51-year-old woman who presented with a rapidly enlarging, painful, midline neck mass that developed over a three day period. A CT scan of the neck showed a solid circumscribed mass in the sternohyoid muscle. The initial differential diagnosis included inflammation of thyroglossal duct remnant, an abnormal lymph node, and thyroid carcinoma. The patient underwent operative excision with final pathology revealing proliferative myositis. Proliferative myositis is an uncommon benign proliferation of skeletal muscle and has only been reported a limited number of times in the head and neck region.

Cabozantinib for progressive metastatic medullary thyroid cancer: a review.

Medullary thyroid cancer is uncommon and patients typically present with advanced disease. Treatment options for patients with progressive, metastatic medullary thyroid cancer had been limited until recently. Tyrosine kinase inhibitors have garnered increasing interest in this subset of patients. The US Food and Drug Administration recently approved cabozantinib, a tyrosine kinase inhibitor, after promising results were shown in a large Phase III clinical trial. This review summarizes the clinical pharmacology, clinical trials, and safety data for cabozantinib and concludes with a discussion of possible future directions for the treatment of medullary thyroid cancer.