Hand involvement in sarcoidosis is rare and it presents as tenosynovitis, dactylitis, nodules and osteoarticular bony destruction.We describe an unusual presentation of progressive intrinsic muscle contracture of both hands in a 42-year-old woman with sarcoid myopathy who presented with painful swelling and weakness of all four extremities. Her systemic symptoms improved with oral corticosteroids, but the hand muscle contracture remained after resolution of myositis. Serial soft tissue releases of intrinsic muscle contracture improved hand function markedly. This case highlights that surgery is a viable option to treat intrinsic muscle contracture in patients with chronic sarcoid myopathy complicated with severe muscle contracture.

Cervical spinal cord injury (SCI) often causes debilitating loss of function of the upper limb. Upper extremity reconstruction surgery can restore some of the upper limb function in tetraplegic patients with SCI. The procedures are typically muscle-tendon unit transfer surgeries, which redistribute the remaining functional muscles to restore active elbow extension, key grip, and finger grasping. In addition to the tendon transfer surgeries, nerve transfers have emerged recently and are showing promising results. However, despite more than half of the tetraplegic patients can benefit from upper limb surgery, only a few of them receive the procedures. This missed opportunity may be due to the lack of communication between SCI specialists and hand surgeons, or the lack of awareness of such options among the specialists and patients. In this review, we provide a basic overview of upper limb reconstruction in tetraplegic patients with target audience of SCI specialists for their better understanding of the basic concept of surgery and information for patient consultation before referring to hand surgeons.

Introduction: The emergence of the COVID-19 pandemic had affected the Orthopaedic Specialty Committee (OSC) Exit Examination candidates. The objective of this study was to evaluate the impact of this pandemic on the candidates’ teaching and learning, mental well-being, and personal experience during the examinations. Methods: A cross-sectional study was conducted from 1st to 31st January 2021. 103 candidates for the OSC Exit Examination November 2020 were asked to answer a questionnaire. Wilcoxon signed-rank tests were used to compare differences in the frequencies before and during the pandemic. A p-value of less than 0.05 was taken as significant. Results: There was a significant reduction in the number of classes (P-value < 0.001) and examination preparatory courses conducted, reduced number and variety of patients attended and limited exposure in the operation theatre. Most candidates had virtual and physical classes, and agreed virtual clinical teaching was less effective. A majority had increased caffeine intake and smoking habits, decreased time spent with family and sports activities and no impact on sleeping hours, alcohol and analgesic usage. During the examinations, most candidates felt disturbed by the COVID-19 safety protocol and worried about the risk of contracting the infections. Conclusion: The effect of this pandemic on the post-graduate Orthopaedics students teaching and learning is massive. Virtual teaching programmes or applications that can replace the traditional clinical teaching methods should be explored and developed for the benefit of our education system.