Closed traumatic avulsion of both ring finger flexors with successful primary repair more than 4 weeks after injury and a review of the literature.

Closed flexor digitorum profundus (FDP) tendon avulsions are a recognized injury in hand surgery. However, closed tendon avulsion of both flexor tendons in the same digit is rare, with the few cases reported in the literature and presented here. Management includes primary repair ideally within the first 2 weeks to achieve optimal outcome. While beyond 4 weeks a two-stage repair is the dictum, we present a case where both tendons were avulsed but primary repair of the FDP was possible more than 4 weeks after the injury, with a good outcome. This case highlights that primary tendon repair at 32 days, the longest noted in the literature in this group of patients, can result in a good outcome even if the injury is more than 4 weeks old. However, good intraoperative decision-making is key and the skillset must be present for conversion to a two-stage repair if necessary.

Acute compartment syndrome of the leg with avulsion of the peroneus longus muscle: a case report.

UNLABELLED: A rare case of avulsion of the peroneus longus origin associated with acute lateral compartment syndrome is presented. Pain on passive stretch of the peroneus longus was not reported owing to the lack of proximal attachment of muscle. Other less reliable signs of compartment syndrome were relied on make an accurate and timely diagnosis. The surgical decompression and clinical course are presented. LEVEL OF CLINICAL EVIDENCE: 4.

Adhesive shoulder capsulitis: does the timing of manipulation influence outcome?

The purpose of this study was to assess the influence of timing of manipulation under anaesthesia for adhesive capsulitis of the shoulder on the long-term outcome. One hundred and eighty consecutive patients with a diagnosis of adhesive capsulitis according to Codman's criteria were selected from a shoulder surgery database; 145 were available for follow-up after a mean period of 62 months (range: 12 to 125). All patients underwent manipulation under anaesthesia (MUA) with intra-articular steroid injection. A statistically significant improvement in range of movement, function (Oxford Shoulder Score) (OSS) and Visual Analogue pain intensity Score (VAS) was obtained following manipulation. Ninety percent of the 145 patients who successfully completed the study were satisfied with the procedure. Eighty-nine percent indicated that they would choose the same procedure again, if the same problem arose in the opposite shoulder. Eighty-three percent of the patients had manipulation performed less than 9 months from onset of symptoms (early MUA). The remainder had manipulation performed after 9-40 months (late MUA). Patients who had early intervention had a significantly better Oxford Shoulder Score at final follow up; mobility and pain (VAS) were also letter than in the late group, but not significantly.

An unusual case of haemorrhagic median neuropathy.

The authors describe a rare case of carpal tunnel syndrome secondary to intraneural haemorrhage of the median nerve.

Glenohumeral articular cartilage changes in rotator cuff disease.

This study aims to clarify the natural history of glenohumeral articular cartilage changes in rotator cuff disease. We assessed 33 cadaveric shoulder joints, examining the rotator cuffs for macroscopic tears and the articular surfaces for degenerative changes. Ten specimens had tears of the rotator cuff. Articular degenerative changes were noted in 23 joints. Articular cartilage degeneration was almost twice as frequent in the group with rotator cuff tears (10/10 shoulders) as in those without tears (13/23 shoulders). This difference was statistically significant. This strong correlation between tears of the rotator cuff and articular degeneration has not been documented previously, other than in the extreme situation of massive cuff tears and cuff-tear arthropathy. This is deserving of further study because it may have implications for surgical management.