Unusual Duplication of Flexor Tendons in the Middle Finger Leading to Trigger Finger: A Case Report and Comprehensive Review.

Duplication of the flexor digitorum profundus (FDP) tendon is an extremely uncommon anatomical anomaly found within the flexor digitorum superficialis (FDS) muscle, with minimal documentation in the current literature. We present the case of a 45-year-old female manual laborer who exhibited symptoms suggestive of trigger finger in her right middle finger. Surgical exploration uncovered a duplicated FDP tendon, a previously unreported anatomical anomaly in this context. Despite attempting conservative treatment initially, surgical intervention involving release of the A1 pulley, excision of the A1 pulley, and identification of the duplicated tendon was performed. The unusual nature of this anatomical variation highlights the need for additional research into its clinical significance and treatment options. This case highlights the significance of conducting comprehensive anatomical assessments to diagnose and treat uncommon variations within the FDS muscle. It underscores the continued need for collaborative research to enhance treatment approaches, especially in instances where trigger finger symptoms are present.

Thickness Asymmetry of the Vertebral Artery Groove: A Dried Vertebrae Study.

BACKGROUND: The vertebral artery groove (VAG), located on the posterior arch of the first cervical (atlas) vertebra plays a pivotal role in guiding the vertebral artery's (VA) third part (V3). Deviations in VAG morphology and morphometry (dimensions) can influence vascular dynamics and pose clinical implications. AIM: The current study delves into the morphometric variants and explores the less-explored morphometric variable of the VAG thickness, highlighting possible laterality (asymmetry). METHODS: A morphometric investigation was conducted on 141 dried atlas (73 male and 68 female) vertebrae from a Greek adult population. The VAG's minimum thickness was investigated by considering the laterality (sides' differences), gender, and age impact on it. Measurements were performed by two independent researchers, ensuring the data reliability. RESULTS: A significant asymmetry was identified in the VAG thickness between the left (3.9 ± 0.9 mm) and right (4.1 ± 1.1 mm) (p=0.005) sides, with the left side having the mean minimum thickness. Gender had a significant impact on VAG thickness only on the left side, with females presenting a significantly thinner left-sided VAG (3.6 ± 0.9 mm) than males (4.10 ± 0.7 mm) (p=0.001). Age had no significant impact on the VAG thickness.  Conclusion: The present study underscores the significance of asymmetry in the VAG thickness in craniocervical interventions. This less-explored morphometric variable warrants careful consideration by surgeons during preoperative planning to minimize potential complications. The current findings highlight the importance of understanding the VAG thickness asymmetry and its clinical implications, as this osseous variable may be an index of a different diameter of the VA by side. It is recommended that surgeons incorporate this variable into their preoperative assessments to improve the safety and efficacy of craniocervical interventions.

A Case of Dysphagia Due to Large Osteophytic Lesions in the Cervical Spine: A Conservative Approach.

Dysphagia is a common symptom with various underlying etiologies, making its management challenging even for experienced physicians. The presence of osteophytes in the cervical spine may often impede swallowing, displace the larynx, and cause a sore throat. We describe a case of an 85-year-old male who presented with a two-year history of progressive dysphagia, exacerbated over the last two months, especially with solid foods and liquids, prompting an ENT evaluation. Despite prior investigations, including normal gastroscopy and empirical pain management, further assessment revealed bulging masses in the hypopharynx indicative of cervical osteophytes. Conservative management, including speech and swallow therapy, dietary modifications, and pharmacological interventions, resulted in significant symptom improvement without surgical intervention. This case demonstrates the effectiveness of conservative treatment measures in treating dysphagia caused by cervical osteophytes, emphasizing the significance of a multidisciplinary approach for optimal patient care.

The Prevalence and Morphometry of the Atlas Vertebra Retrotransverse Foramen.

OBJECTIVE: The current study records the prevalence of the accessory foramen, located posterior to the transverse foramen (TF), the so-called the retrotransverse foramen (RTF), its morphometry, exact location, and coexistence with ossified posterior bridges. Additionally, factors associated with the length of the RTF are investigated. MATERIALS: One-hundred and forty-one dried atlas vertebrae were examined. RESULTS: Thirty-seven out of the 141 vertebrae (26.2%) had at least one RTF. The RTF was unilateral in 67.6% and bilateral in 32.4%. The mean RTF anteroposterior diameter (length) was 4.2±1.4 mm on the right and 3.8±1.0 mm on the left side. The mean RTF laterolateral diameter (width) was 2.6±1.2 mm on the right and 2.5±0.8 mm on the left side. Both dimensions were symmetrical. The RTF was symmetrically located from the TF, at a mean distance of 4.6±1.1 mm on the right and of 4.5±0.9 mm on the left side. For the given TF-RTF distance, laterality, and presence of posterior bridges, each mm increase in the RTF width was associated with a 0.74 mm increase in the relevant length. CONCLUSION: The estimated prevalence was higher than most of those reported in other studies. However, the between-studies prevalence varies to a significant degree. Hence, a systematic review and meta-analysis should be performed to identify a more precise estimate due to the clinical importance of the RTF.

Corrigendum to "Revision of Carpal Tunnel Release due to Palmaris Longus Profundus".

[This corrects the article DOI: 10.1155/2015/616051.].

A morphometric study of the atlas occipitalization and coexisted congenital anomalies of the vertebrae and posterior cranial fossa with neurological importance.

PURPOSE: Our study highlights the morphometry of the partial and complete atlas occipitalization (AOZ), its coexistence with fusions of the 2nd and 3rd cervical vertebrae and morphological and morphometric abnormalities of the posterior cranial fossa that are of paramount neurological importance. METHODS: One hundred and eighty adult dry skulls, the atlas and axis vertebrae were examined. RESULTS: Four skulls (2.2 %) showed AOZ. Two of them (1.1 %) presented a partial AOZ, one male skull (0.6 %) a complete AOZ and a female skull (0.6 %) had a fused left hemiatlas with the occipital bone and a fusion of the 2nd and 3rd cervical vertebrae. The inner anteroposterior and transverse diameters of the foramen magnum (FM) in the control group were 34.6 ± 3.46 and 29.3 ± 3.47 mm. Only the skull with the complete AOZ had a reduced outer anteroposterior diameter of the FM (29.8 mm), while no specimen was found with a reduced transverse diameter. A wide total decrease (range 13.1-50.9 %) in the surface area of the FM in skulls with AOZ was detected. Extracranial, the clivus length in two skulls with AOZ was smaller than the normal range. No skull was detected with a reduction in the intracranial length of the clivus. All skulls with the AOZ had a vermian fossa. CONCLUSIONS: The study adds important morphometric details about the partial and complete AOZ and correlates the phenomenon of synostosis with the narrowing of the FM, particularly in the case of complete AOZ. Awareness of the AOZ and other fusions of the upper cervical vertebrae and their topographical relations and attendant problems are of paramount importance to surgeons, when operate to the craniocervical junction, or interpret imaging studies to plan a safe surgery for nerve or spinal tissue decompression.

Revision of Carpal Tunnel Release due to Palmaris Longus Profundus.

Purpose. The palmaris longus profundus has been documented throughout the literature as a cause of carpal tunnel syndrome. We present a case of palmaris profundus tendon removal during the revision of carpal tunnel release. Method. During a carpal tunnel release in a 66-year-old woman, palmaris profundus tendon was found inside the tunnel under the transverse carpal ligament, just above the median nerve, but it was left intact. The patient complained of pain in the hand at night and weakness of her hand one month after surgery. We decided on a revision of the carpal tunnel release. The palmaris profundus tendon was found and was removed. Results. The patient had a normal postoperative course. Two months later she returned to her normal activities and was asymptomatic. Conclusions. When a palmaris profundus muscle is located in carpal tunnel, we recommend its excision during carpal tunnel release. This excision will eliminate the possibility of recurrent compression over the median nerve.

Rectus abdominis overuse injury in a tennis athlete treated with traumeel.

BACKGROUND: Rectus abdominis injuries are common in tennis players at all levels of competition. Traumeel(®) injection can be used for treatment of muscle strains and hematomas. CASE REPORT: A 21-year-old female tennis athlete was injured on the non-dominant rectus abdominis during the cocking phase of the service motion. She suffered from pain and tenderness. One week later, during a serve, she experienced severe pain on the contralateral side of her abdomen. Conservative treatment was performed by the team physician with rest, ice therapy and analgesics for 20 days, but she had recurrent injuries. The ultrasonography and MRI showed hematoma of the rectus abdominis muscle. She was treated with 2 injections of Traumeel(®) on the 2(nd), 4(th), 6(th) post-traumatic day and received 1 injection on the 10(th) post-traumatic day. She also modified her serve technique. On the fourth post-treatment week the athlete had pain-free function and both the MRI appearance and the size of rectus abdominal muscle were normal. She returned to her sport activities. There is no recurrence of her injury 2 years later. CONCLUSIONS: Rectus abdominis hematoma must be diagnosed early. Traumeel(®) injections are effective, safe and well-tolerated for the treatment of overuse injury of the rectus abdominis following strain.

Efficacy of paracetamol versus diclofenac for Grade II ankle sprains.

BACKGROUND: Ankle sprains are usually treated with the RICE protocol often with nonsteroidal anti-inflammatory drugs (NSAID) for pain reduction. We evaluated the effect of diclofenac, an NSAID, versus paracematol in the reduction of pain and acute edema of severe ankle sprains. MATERIALS AND METHODS: Ninety patients, 18 to 60 years old, with Grade II acute ankle sprains were randomized into two groups. Group A (45 patients) received for the first 10 days diclofenac 75 mg orally twice per day. Group B (45 patients) received paracetamol 500 mg orally three times per day for the same period. We evaluated ankle joint edema with the Figure-of-Eight method and with the volumetric method, as well as pain with the Visual Analogue Scale (VAS) in both groups. RESULTS: The patients had no significant differences concerning their baseline values (p > 0.05). The ankle joint edema was decreased in both groups (p < 0.001) but there was more edema in group A than in group B at the third post-traumatic day with both measurement methods (p = 0.028/0.025). By the tenth post-traumatic day no difference was found. Pain decreased in both groups at the third day and at the tenth day (p < 0.001). CONCLUSION: According to these results, diclofenac and paracetamol had the same effect on pain reduction of ankle sprains but more acute ankle edema was present in patients who were treated with diclofenac than in patients who were treated with paracetamol.

Are venotonic drugs effective for decreasing acute posttraumatic oedema following ankle sprain? A prospective randomized clinical trial.

OBJECTIVE: Lower leg oedema after trauma may cause various degrees of pain, disability and delay in patient recovery. In this prospective randomized study, we hypothesized that venotonic drugs had no effect in clinical outcome of patients with ankle sprain. PATIENTS AND METHODS: Eighty-one patients with type II and III ankle sprain were screened and randomly assigned for receiving standard conservative treatment alone (control group, 39 patients) or with oral intake of a venotonic drug (micronized purified flavonoid fraction, Daflon 1,000 mg × 3) for 20 days (study group, 42 patients). Measurement of the circumference of ankle region in two different locations and assessment of pain intensity with the Visual Analogue Score were performed at the time of patients' admission and during the 7th and 20th posttraumatic day. RESULTS: Patients demographics were comparable in both groups. There were no significant differences between the two groups regarding the values of perimeter of ankle joint or pain intensity at all the examined time points. CONCLUSIONS: Venotonic drugs seem not to decrease the posttraumatic oedema or pain in patients who suffer from moderate or severe ankle sprain.

Isolated thumb carpometacarpal joint dislocation: a case report and review of the literature.

BACKGROUND: Isolated thumb carpometacarpal dislocation is a rare injury pattern and the optimal treatment option is still controversial. CASE DESCRIPTION: We present a 27-year-old basketball player who underwent an isolated dorsal dislocation of the thumb carpometacarpal joint after a fall. The dislocation was successfully reduced by closed means but the joint was found to be grossly unstable. Due to inherent instability, repair of the ruptured dorsoradial ligament and joint capsule was performed.The ligament was detached from its proximal insertion into trapezium and subsequently stabilized via suture anchors. The torn capsule was repaired in an end-to-end fashion and immobilization of the joint was applied for 6 weeks. RESULTS: At 3-year follow up evaluation the patient was pain free and returned to his previous level of activity. No restriction of carpometacrpal movements or residual instability was noticed. Radiographic examination showed normal joint alignment and no signs of subluxation or early osteoarthritis. CONCLUSION: Surgical stabilization of the dorsal capsuloligamentous complex may be considered the selected treatment option in isolated carpometacarpal joint dislocations, that remain unstable after closed reduction in young and high demand patients. LEVEL OF CLINICAL EVIDENCE: Level IV.

Bilateral rectus femoris intramuscular haematoma following simultaneous quadriceps strain in an athlete: a case report.

INTRODUCTION: Bilateral rectus femoris haematoma following a simultaneous strain of the quadriceps muscles is a very rare condition. CASE PRESENTATION: We report the case of a 21-year-old Greek Caucasian female rowing athlete who was injured on both thighs. She complained of pain and inability to walk. Physical examination revealed tenderness over the thighs and restriction of knee movement. The result of a roentgenogram was normal, and there was no evidence of fracture or patella displacement. Magnetic resonance imaging revealed haematoma formation in both the rectus femoris muscles. The diameters of the left and right haematomas within the muscles were 6 cm and 5 cm, respectively. Therapeutic approaches included compression bandages, ice application, rest, elevation, and administration of muscle relaxant drugs. Active stretching and isometric exercises were performed after three days. The patient was able to walk using crutches two days after the initiation of treatment. On the seventh day, she had regained her full ability to walk without crutches. Non-steroidal anti-inflammatory drugs were administered on the fifth day and continued for one week. Six weeks later, she had pain-free function and the result of magnetic resonance imaging was normal. She was able to resume her training programme and two weeks later, she returned to her previous sport activities and competitions. CONCLUSION: There are references in the literature regarding the occurrence of unilateral quadriceps haematomas following strain and bilateral quadriceps tendon rupture in athletes. Simultaneous bilateral rectus femoris haematomas after a muscle strain is a rare condition. It must be diagnosed early. The three phases of treatment are rest, knee mobilization, and restoration of quadriceps function.

Closed subtalar dislocation with non-displaced fractures of talus and navicular: a case report and review of the literature.

Closed subtalar dislocations associated with talus and navicular fractures are rare injuries. We report on a case of a 43-year-old builder man with medial subtalar dislocation that was further complicated by minimally displaced talar and navicular fractures. Successful closed reduction under general anesthesia was followed by non-weight bearing and ankle immobilization with a below-knee cast for 6 ;weeks. At 3 years post-injury, the subtalar joint was stable, the foot and ankle mobility was in normal limits and the patient could still work as a builder. However, he complained for occasionally mild pain due to the development of post-traumatic arthritis in subtalar and ankle joints. Our search in literature revealed that conservative treatment of all the successfully reduced and minimally displaced subtalar fracture-dislocations has given superior results compared to surgical management. However, even in cases with no or slight fracture displacement, avascular necrosis of the talus or arthritis of the surrounding joints can compromise the final functional outcome.

Surgical management of closed tibiotalar dislocation: a case report and 2-year follow-up.

UNLABELLED: We report a case of a closed tibiotalar dislocation without an associated malleolar fracture, in the presence of medial malleolar hypoplasia, treated with closed reduction and surgical repair of the deltoid ligament, followed by cast immobilization. Post-reduction radiographs, before open repair of the deltoid ligament, revealed an Elisé test ratio of 0.43. The ruptured superficial and deep portions of the deltoid ligament and the anterior ankle capsule were primarily repaired with suture, after which cast immobilization and non-weight bearing were used before physiotherapy and rehabilitation. Two years after the injury, the patient was pain free with a full range of ankle motion, and there were no signs of residual instability or early osteoarthritis. Subjective clinical testing using a valid health measurement instrument revealed an excellent clinical outcome. Based on our experience in this case, closed ankle dislocation in the presence of a hypoplastic medial malleolus and stress manipulation evidence of medial instability indicates the need for primary repair of the deltoid ligament. LEVEL OF CLINICAL EVIDENCE: 4.