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A 48-year-old man presented with soft tissue lumps over the metacarpophalangeal joints of the long and index fingers of his left hand due to tendon xanthomas. His personal history and laboratory investigations were negative for familial hyperlipidemia or other medical conditions. A simple debulking procedure produced a good cosmetic and functional result at 7 years' followup.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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OBJECTIVE: Thyroid dysfunction may cause musculoskeletal symptoms. We have evaluated the prevalence of adhesive capsulitis, Dupuytren's contracture, trigger finger, limited joint mobility and carpal tunnel syndrome in a series of patients with various thyroid diseases and differing levels of function. DESIGN AND PATIENTS: Patients with euthyroid (diffuse and/or nodular) goitre, Hashimoto's thyroiditis, Graves' disease, toxic nodular goitre, toxic diffuse goitre and patients with goitre who had partial thyroidectomy were included in the study (n = 137). Neurological and musculoskeletal examinations were performed after a standardized symptom questionnaire. The prevalence of musculoskeletal problems was analysed with respect to thyroid function and thyroid autoantibody status. MEASUREMENTS: Serum concentrations of free T3, free T4, TSH and thyroglobulin and thyroperoxidase antibodies were determined. Serum levels of creatine kinase, lactate dehydrogenase, calcium and phosphate along with erythrocyte sedimentation rate were measured to exclude other causes of musculoskeletal complaints. RESULTS: When the study group (n = 137) was divided according to thyroid status, 30.6% (n = 42) were thyrotoxic, 16.8% (n = 23) had subclinical thyrotoxicosis, 28.5% (n = 39) were euthyroid, 7.3% (n = 10) had subclinical hypothyroidism and 16.8% (n = 23) were hypothyroid. Overall, adhesive capsulitis was found in 10.9% (n = 15), Dupuytren's contracture in 8.8% (n = 12), limited joint mobility in 4.4% (n = 6), trigger finger in 2.9% (n = 4) and carpal tunnel syndrome in 9.5% (n = 13) of the patients. The prevalence of adhesive capsulitis was highest in patients with subclinical thyrotoxicosis (17.4%); Dupuytren's contracture, limited joint mobility and carpal tunnel syndrome were commonest in hypothyroid patients (21.7%, 8.7% and 30.4%, respectively). Trigger finger occurred in 10% of patients with subclinical hypothyroidism. When these prevalences were analysed with respect to thyroid status, carpal tunnel syndrome was significantly more prevalent in the hypothyroid group (P = 0.004). When thyroperoxidase antibody-positive and -negative patients were compared, adhesive capsulitis negatively (P = 0.03, r =-0.18) and trigger finger positively correlated with (P = 0.03, r = 0.21) thyroperoxidase antibody existence. CONCLUSIONS: These results demonstrate that musculoskeletal disorders often accompany thyroid dysfunction. In addition to the well-known observation that these disorders are common in patients with hypothyroidism, they are also observed in patients with thyrotoxicosis. Patients with thyroid dysfunction should be questioned for musculoskeletal complaints and referred to a specialist if necessary.
The clinical records and radiographs of 45 patients who had undergone replantation of a total hand, or a part thereof, were reviewed in order to determine the prevalence and the type of articular changes occurring distal to the site of anastomoses. In three patients, destructive joint changes were observed, consisting of bony fragmentation, spiculation, and cystic or erosive lesions. These changes, which developed between five and ten months after replantation, are most likely neuropathic or osteonecrotic in pathogenesis.
Two transverse curved incisions have been used for surgical procedures on all 4-finger MP joints. The edema and hematoma beneath the incision are reduced, and the skin healing is excellent. The exposure is more than sufficient for all the commonly employed surgical procedures on these 4 joints. The final appearance is as good as with a single transverse curved incision.
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An exostosis around the distal interphalangeal joint can cause finger deformity that resembles mallet finger. We report 2 cases of pseudomallet finger associated with exostosis, both of which were successfully treated with bone resection.
The use of a spiral oblique retinacular ligament (SORL) reconstruction is reported in a middle finger that had previously undergone reconstruction of the proximal interphalangeal (PIP) joint, using a free, vascularized, second-toe PIP joint transfer. The SORL procedure was applied for the reconstruction of the terminal tendon. A satisfactory postoperative range of joint mobility and stability was achieved.