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Distribution of Glomus Tumors in Fingers.

Eun Sun MOON ; Min Sun CHOI ; Myung Sun KIM ; Il Kyu KONG ; Byoung Jin KIM

Journal of the Korean Society for Surgery of the Hand.2009;14(3):138-143.

PURPOSE: Glomus tumor has known as smaller than 1 cm, hard to palpate, therefore patients often suffer from chronic pain. Based on our experiences about glomus tumors, we would like to evaluate their distributions. MATERIALS AND METHODS: This study includes 24 cases that underwent surgery for clinically diagnosed glomus tumor from January, 2001 to May, 2009. Clinical symptoms were firstly evaluated and ultrasonography in 8 cases and Magnetic Resonance Imaging (MRI) in 5 cases were performed for more accurate diagnosis and localization. Complete resection with biopsy was done in all cases. RESULTS: According to pathologic findings, 20 out of 24 cases were reported as glomus tumor, and the other 4 cases were 2 fibrous tumor with chronic inflammation, 1 hemangioma, and 1 neuroma. Twenty glomus tumors at dorsal side under the nail were distributed to proximal radial in 11 cases, proximal ulnar in 6 cases, distal radial in 2 cases and distal ulnar in 1 case. Tumors were more frequently found at proximal in 17 cases(85%) and at radial side in 13 cases(65%). CONCLUSIONS: Glomus tumors tend to occur under nail of proximal and radial part. We think that accurate diagnosis and location of glomus tumors are needed to complete surgical resection.
Biopsy ; Chronic Pain ; Fingers ; Glomus Tumor ; Hemangioma ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Nails ; Neuroma

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Results of Open Synovectomy for Rheumatoid Elbow.

Bong Gun LEE ; Wan Sik SEO ; Won Min JO ; Kwang Hyun LEE

Journal of the Korean Society for Surgery of the Hand.2009;14(3):131-137.

PURPOSE: To identify the recovery of joint movement and decrease in pain through the radiological findings after open synovectomy for the elbow with rheumatoid arthritis which was not cured by medication. MATERIALS AND METHODS: From 1997 to 2008, the research on open synovectomy for the elbow with rheumatoid arthritis was done in 19 patients with 21 cases whose average follow-up was 12 months. Despite the medical treatment, the indication of operation was towards the patients with Larsen grade I~III rheumatoid arthritis whose joint swelling and pain had not been improved. Also, the indication of operation included the patients with Larsen grade IV who rejected joint replacement or needed to postpone the operation due to young age. Main symptom was pain in all cases; Preoperative flexion contracture and flexion-extension movement on average was 29 degree and 86 degree, respectively.Postoperative radiological and physical examination were done; Visual analogue scale and Mayo elbow performance score were measured. RESULTS: Joint swelling recurred in two cases (9.5%). However, the size of swelling was mild compared to preoperative condition. Preoperative total mean flexion contracture was 29 degree (10~45 degree) and total mean flexion-extension movement was 86 degree (60~135degree). Last follow-up total mean flexion contracture was 18 degree (5~50 degree) and total mean flexion movement was 102 degree (35~150 degree). Statistically, the increase of range of joint movement was not significant. Radiologically, there were 11 cases(52.3%) showing no changes in preoperative and postoperative grade while there were 10 cases(47.6%) with increase in grade. As for VAS score, total mean preoperative score was 5 and postoperative score was 2.3(0~8) showing less pain than the past. After statistical analysis separated by Grade I, II, III and IV, last follow-up of VAS score, Mayo elbow performance score and elbow joint movement showed no statistical difference compared to Larsen grade (p=0.075). CONCLUSIONS: Open Synovectomy for elbow with rheumatoid arthritis can not stop radiological progress, and the increase in range of joint movement is not statistically meaningful. However the operation displays clinical improvement such as decrease in pain and increase in range of joint movement.
Arthritis, Rheumatoid ; Contracture ; Elbow ; Elbow Joint ; Follow-Up Studies ; Humans ; Joints ; Physical Examination ; Synovitis

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Extended Kocher Approach for Total Elbow Arthroplasty.

Chang Goo PARK ; Joo Hyoun SONG ; Joo Yup LEE

Journal of the Korean Society for Surgery of the Hand.2009;14(3):126-130.

PURPOSE: Total elbow arthroplasty is most commonly performed through a posterior approach by splitting or reflecting the triceps off the olecranon, but triceps avulsion, triceps weakness, and wound healing problems have been reported. We present the clinical results of total elbow arthroplasty using extended Kocher approach. MATERIALS AND METHODS: From September 2005 to October 2007, five patients who underwent total elbow arthroplasty using triceps preserving approach were evaluated. There were 4 women and 1 man. The mean age of the patients was 58 years (range, 36~68). The mean follow- up was 10 months. The patients were placed in the lateral decubitus position, and lateral Kocher interval is made through a straight posterior incision. Elbow joint is exposed by supinating the forearm and prosthesis was inserted. Postoperatively, the elbow was immobilized in extension for 1 week, and active range of motion exercise was begun. Range of motion, triceps strength, Mayo elbow performance score, Korean DASH questionnaire were evaluated at the last follow-up. RESULTS: Average operation time was 115 minutes (range, 97~138). Postoperative complications such infection, skin necrosis were not developed. Triceps strength was measured as grade IV in all patients except one who has triceps insufficiency preoperatively. Mean elbow range of motion was from 8 degrees to 124 degrees. Mean Mayo elbow performance score was 87 (range 75~95), and DASH score was 18 (range 9~34). CONCLUSIONS: Extended Kocher approach can be a reasonable alternative for total elbow arthroplasty. Linking the assembly can be difficult, so modification of the implant design is needed to solve this problem.
Arthroplasty ; Elbow ; Elbow Joint ; Female ; Forearm ; Humans ; Necrosis ; Olecranon Process ; Postoperative Complications ; Prostheses and Implants ; Surveys and Questionnaires ; Range of Motion, Articular ; Skin ; Wound Healing

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Distal Intersection Syndrome of the Wrist: Three Cases Report.

Seung Oh NAM ; Dong Ju SHIN ; Tae Eun KIM ; Sung Wook KIM ; Hun Sik CHO

Journal of the Korean Society for Surgery of the Hand.2011;16(4):259-263.

Distal intersection syndrome indicates simultaneous tenosynovitis or tendinosis of the second and third extensor compartment where extensor pollicis longus cross with the tendons of the second extensor compartment. We report three cases of distal intersection syndrome which differ from usual intersection syndrome.
Tendinopathy ; Tendons ; Tenosynovitis

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Compartment Syndrome Following an Olecranon Fracture in a Stroke Patient Taking Ticlopidine and Aspirin.

Sanglim LEE ; Su Chan OH ; Su Young BAE

Journal of the Korean Society for Surgery of the Hand.2011;16(4):255-258.

We report a case of compartment syndrome following an olecranon fracture in the stroke patient with quadriparesis taking ticlopidine and aspirin. Antithrombic and antiaggregating ability of the medications could increase the bleeding tendency. Intraoperatively, the deep fascia of the forearm was found to be thick and tight due to long-standing spasticity, which made it difficult to minimize increased intra-compartmental pressure due to the hemorrhage from the fracture site. The chronically spastic limb of the stroke patients taking ticlopidine and aspirin should be observed carefully for the occurrence of compartment syndrome even after a low energy injury.
Aspirin ; Compartment Syndromes ; Extremities ; Fascia ; Forearm ; Hemorrhage ; Humans ; Muscle Spasticity ; Olecranon Process ; Quadriplegia ; Stroke ; Ticlopidine

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Cryptococcal Tenosynovitis of the Hand in a Patient with Rheumatiod Arthritis: A Case Report.

Ji Hwan KIM ; Dong Ju SHIN ; Young Soo BYUN ; Sung Wook KIM ; Tae Eun KIM

Journal of the Korean Society for Surgery of the Hand.2011;16(4):251-254.

Cryptococcosis is a fungal infection caused by Cryptococcus neoformans which is frequently occurred in the immunosuppressed host. Any organ or tissue may become infected, however, tendon sheath infection is extremely rare. We report a case of primary cryptococcal tenosynovitis after direct skin injury in a patient with rheumatoid arthritis who has been treated with methotrexate and leflunomide.
Arthritis, Rheumatoid ; Cryptococcosis ; Cryptococcus neoformans ; Hand ; Humans ; Immunocompromised Host ; Isoxazoles ; Methotrexate ; Skin ; Tendons ; Tenosynovitis

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Multiple Epidermal Inclusion Cysts in Previous Bone Graft Site of the Thumb: A Case Report.

So Min HWANG ; Hong Il KIM ; Sung Min AHN ; Kwang Ryeol LIM ; Yong Hui JUNG ; Jennifer K SONG

Journal of the Korean Society for Surgery of the Hand.2011;16(4):247-250.

We report a 71-year-old male presenting with painful growing mass on his left thumb. The patient had received iliac bone graft on his left thumb 20 years ago, and removed all the grafted bone 8 years ago due to recurrent ulcer. Biopsy revealed multiple eidermal inclusion cysts on the dorsal surface of the bone graft site. Surgeon should be aware of epidermal inclusion cyst occurred at the previous bone graft site of the finger.
Aged ; Biopsy ; Fingers ; Humans ; Male ; Thumb ; Transplants ; Ulcer

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Extracorporeal Shock Wave Therapy versus Platelet-rich Plasma Injection for the Treatment of Lateral Epicondylitis: A Prospective Randomized Clinical Trial.

Jeong Hwan OH ; Sang Hoon LHEE ; Jin Young PARK ; Hyeuk Woo CHOI ; Seung Hyub JEON ; Joon Sang EOM

Journal of the Korean Society for Surgery of the Hand.2011;16(4):241-246.

PURPOSE: To compare clinical outcomes of extracorporeal shockwave therapy and platelet-rich plasma injection for the treatment of lateral epicondylitis of the elbow. MATERIALS AND METHODS: Consecutive patients with a lateral epicondylitis who had refractory elbow pain more than 6 months and no response to treatment more than 3 months were recruited for this study. Diagnosis was made on the basis of physical examination and ultrasound imaging study. Prospective randomized trial was performed between two treatment groups; extracorporeal shockwave therapy versus platelet-rich plasma injection. Fifty patients for each group were allocated based on the results of power analysis. Disabilities of arm, shoulder and hand (DASH) scores obtained before treatment and at 1 year after the last treatment were compared between two groups. RESULTS: Both groups showed significant improvement of DASH scores after treatment. The patients who had platelet-rich plasma injection showed significantly greater improvement of DASH scores (from 37.0 to 11.1) than the patients who had extracorporeal shockwave therapy (from 41.9 to 29.9). CONCLUSION: Better subjective outcomes can be expected after platelet-rich plasma injection compared with extracorporeal shockwave therapy in patients with a refractory lateral epicondylitis.
Arm ; Elbow ; Hand ; Humans ; Physical Examination ; Platelet-Rich Plasma ; Prospective Studies ; Shock ; Shoulder

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Efficiency of the Boston Questionnaire in Carpal Tunnel Syndrome: Comparing Scores with Provocation Tests and Electrophysiological Studies.

Taewon JEONG ; Duck Sun AHN

Journal of the Korean Society for Surgery of the Hand.2011;16(4):232-240.

PURPOSE: We aimed to make a comparison of Boston Questionnaire scores with provocation tests and findings of electrophysiological studies in patients with a carpal tunnel syndrome. MATERIALS AND METHODS: The Boston Questionnaire was applied preoperatively for 248 hands in 142 patients with an idiopathic carpal tunnel syndrome. Boston Questionnaire scores were compared with provocation tests (Phalen's test, Tinel's sign, compression test and hand elevation test) and electrophysiological findings. RESULTS: Correlation study between the Boston Questionnaire scores and electrophysiological findings showed that the electrophysiological findings correlated more with symptom severity score (Spearman coefficient, 0.545; p<0.01) than with functional status score (Spearman coefficient, 0.307; p<0.01). Symptom severity score and functional status scores of the Boston Questionnaire correlated more linearly with the hand elevation test than with other provocation tests. CONCLUSION: This study demonstrates a high correlation of Boston Questionnaire scores with the electrophysiological findings and the hand elevation test.
Boston ; Carpal Tunnel Syndrome ; Hand ; Humans ; Surveys and Questionnaires ; Statistics as Topic

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Repetitive Microtrauma as a Cause of Thoracic Outlet Syndrome.

Ji Youn KIM ; Young Ho KWON

Journal of the Korean Society for Surgery of the Hand.2011;16(4):225-231.

PURPOSE: The aim of this study was to analyze the repetitive stress of neck and shoulder area as a cause of thoracic outlet syndrome which is relatively common but frequently underestimated. MATERIALS AND METHODS: We analyzed 110 patients (114 cases) diagnosed as thoracic outlet syndrome. We designed diagnostic criteria of thoracic outlet syndrome involving symptom, tenderness, Tinel's sign and provocation tests. We reviewed the clinical, radiologic records and questionnaire about repetitive job related microtrauma. The questionnaire was established to investigate the relation between work history and thoracic outlet syndrome based on Labor Standards by Ministry of Employment and Labor. RESULTS: Accumulated repetitive stress on the neck and shoulder associated with work as a presumed cause of thoracic outlet syndrome were found in 88 cases (77.2%). The most common stress related to the development of thoracic outlet syndrome was occupation that requires repetitive shoulder action (more than 2.5 times per a minute) and the most common duration they exposed to the labor per day was more than 4 hours a day. CONCLUSION: Repetitive microtrauma of neck and shoulder can be a cause of thoracic outlet syndrome. In patients with a history of work related microtrauma, accurate physical examination and clinical history are important for diagnosing thoracic outlet syndrome.
Employment ; Humans ; Neck ; Occupations ; Physical Examination ; Surveys and Questionnaires ; Shoulder ; Thoracic Outlet Syndrome

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