Intraneural glomus tumor within digital nerve: a case report

A glomus tumor is a soft tissue tumor that arises from the glomus body, a peripheral organ responsible for temperature regulation of the skin. It accounts for about 1% to 5% of tumors occurring in the hand, is mainly located in the subungal, and is less than 1 cm in size. Diagnosis is mainly based on clinical symptoms, and the main symptoms are pain at the site of glomus tumor, pinpoint tenderness, and cold intolerance. The pain is severe and usually requires surgical resection, and the results of treatment are good with complete resection of the tumor. In this case report, the patient is a 37-year-old female who developed pain in the radial side around the proximal interphalangeal joint of the right second finger without any traumatic history. On physical examination and imaging, it was diagnosed as a glomus tumor of the digital nerve and resected. After surgery, the symptoms improved and there was no recurrence. A careful examination and accurate diagnosis and treatment are necessary for symptomatic masses.

Arthrodesis of the proximal interphalangeal joint of the finger – a systematic review

Arthrodesis of the proximal interphalangeal (PIP) joint of the finger is an established procedure for advanced osteoarthritis. As there are different techniques of fusion, it seems necessary to evaluate the results. Primary outcome of this review was to evaluate different arthrodesis methods of the PIP joint and describe different numbers of non-unions. Secondary outcome was to evaluate time to consolidation. Respective complications, if mentioned, were listed additionally. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The selected databases were PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. In total, 6162 articles could be identified, 159 full-texts were assessed and 64 studies were included. Methodological quality was assessed using Methodological Index for Non-Randomized Studies. A total of 1923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate of 8.6% was achieved by interosseous wiring. All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is a tendency in the more recent literature for the use of compression techniques.

Clinical Outcomes of Operative Repair for Patients Who Fail to Conserve the Complete Rupture of the Collateral Ligament in the Proximal Interphalangeal Joint

Objective: The purpose of this study was to compare the preoperative and postoperative outcomes of surgical treatment for patients who fail to conserve the complete rupture of the collateral ligament in the proximal interphalangeal (PIP) joint.Methods: A complete rupture of the collateral ligament was confirmed by a radiologist using ultrasound or magnetic resonance imaging for patients who had symptoms after 4 weeks of conservative treatment. Eleven patients underwent operative collateral ligament repair using an anchor. All patient was followed up for at least 6 months postoperatively. We evaluated clinical outcomes preoperatively and at 6 months follow-up: (1) range of motion of the PIP, (2) joint stability, (3) Visual Analog Scale score, (4) fusiform index of the PIP joint, and (5) functional & cosmetic satisfaction.Results: There was no instability in the lateral stress test at 6-month follow-up. The ranges of motion of the PIP were not statistically different between preoperative and at 6-month follow-up. Patients had less pain but the cosmetic appearance of the PIP joint did not improve. Functional satisfaction differed statistically, but there was no difference in cosmetic satisfaction.Conclusion: Surgical treatment for patients who fail to conserve the complete rupture of the collateral ligament in the PIP joint can provide good joint stability, functional recovery.

Proximal Interphalangeal Joint Arthroplasty Using the Wide-Awake Local Anesthesia No Tourniquet Technique

Background: Proximal interphalangeal joint (PIPJ) osteoarthritis is a common condition that results in pain, stiffness, and loss of function in the affected hand. Proximal interphalangeal joint arthroplasty is an effective treatment option when conservative methods have failed. The wide-awake local anesthesia no tourniquet (WALANT) technique to perform surgery carries advantages such as lack of tourniquet discomfort, reduces the staffing and costs associated with anesthesia and sedation, and allows faster recovery. We aimed to determine whether the WALANT technique was safe and effective in the context of PIPJ arthroplasty. Methods: Patients were enrolled retrospectively from January 2015 to October 2020 by examining operating theater records and surgeon logbooks. Electronic patient records were examined to obtain patient data. Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and Visual Analog Scale (VAS) for pain were sent by post to patients—with a separate DASH and VAS for each digit operated on. Results: Twenty-nine PIPJ arthroplasties were carried out using WALANT technique by 3 different surgeons all using the dorsal approach. All cases were successfully carried out as day-case procedures. There was a significant correlation with increasing VAS and increasing DASH score. Proximal interphalangeal joint arthroplasty improved range of motion from 28.9 ± 5.5° to 79.4 ± 13.3° ( P < .0001). Two cases developed complications related to surgery. Conclusions: Our study is the first to report the use of WALANT to perform PIPJ arthroplasty, and shows comparable results with traditional methods. Larger, multicenter prospective trials are required to determine the efficacy of this technique and to quantify its economical benefit.