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A case with spontaneous extensor tendon dislocation was treated operatively. Right hand was more severely affected with contracture of the metacarpophalangeal joints. Centralisation of the extensor tendons and sectioning of ulnar intrinsic muscles sufficed correction of the pathology. No recurrence occurred in the last 24 months.

The objective of this report is to present a case of hand burn linear contracture release performed under local anesthesia. It also introduces the one-per-mil tumescent solution consisted of 0.2% lidocaine and 1:1.000.000 epinephrine as a local anesthesia formula, which has the potential of providing adequate anesthesia as well as hemostatic effect during surgery of the hand without tourniquet. The surgery was performed on a 19 year-old male patient with multiple thumb and fingers flexion linear contracture for 105 minutes without any obstacle. The patient did not complain any pain and discomfort during the procedure; while bloodless operative field was successfully achieved. At four-month follow up, the patient could fully extend his thumb, middle and ring finger, while the index was limited by 10° at the DIP joint. Overall, the patient was satisfied with the outcome.

Dupuytren’s disease gained its eponym from the surgeon Baron Guillaume Dupuytren (1777-1835). However, the terms “Cline’s contracture” and “Cooper’s contracture,” named after the two surgeons who proposed the treatment for the palmar contractures prior to Dupuytren, have also been used to describe the disease. In addition to the eponyms attributed to these three surgeons, a number of other appellations with interesting provenance exist for Dupuytren’s disease including the “Curse of the MacCrimmons,” “Celtic hand,” “Viking’s disease,” and the “Hand of Benediction.” These terms all have interesting provenance; however, contention exists with regard to the appropriateness of their coinage. Of these terms, the “Hand of Benediction” is based upon the oldest history, supposedly thought to be a result of an early Pope afflicted with Dupuytren’s disease. This report suggests that Dupuytren’s disease was recorded in history prior Christianity, the Vikings, as well as Dupuytren, Cline, and Cooper. Nearly 100 votive “Hand of Sabazios” artifacts from Antiquity appear to document Dupuytren’s disease via sculpture. The report posits that Dupuytren’s disease may have been represented by the “Hand of Sabazios,” subsequently inspiring the “Hand of Benediction” and “Hand of God” that has permeated Christian art and culture for thousands of years.

Background: Postoperative contracture as a major complication of surface replacement arthroplasty (SRA) remains an unresolved problem. Contracture after SRA can occur early in the postoperative period due to mechanical dysfunction, and tardy contracture where ROM declines with time postoperatively is also reported.

Methods: 13 fingers with degenerative osteoarthritis and two fingers with post-traumatic arthritis where SRA was performed using volar approach were involved. Contracture was defined as limited ROM of less than 35 degrees. Cases were then categorized into two groups according to time of onset of contracture; early contracture and tardy contracture. Characteristic findings of postoperative X-rays in each contracture group were examined. Required procedures and efficacy of any further surgery was also reviewed.

Results: Early contracture was observed in three cases, all of which suffered intra-operative fracture or fragility of the central slip insertion on the dorsal rim of the middle phalanx. This was observed in a further two cases, both of which deteriorated to tardy contracture. Tardy contracture was observed in five cases, and the average ROM was 63 degrees preoperatively, 48 degrees one year postoperatively and 21 degrees at the most recent follow-up, or at the time of the second surgery. In the three cases, development of osteophyte formation on the volar aspect of the proximal head component was observed on the follow-up X-rays. Required further surgeries were resection of the volar plate in two cases, resection of ossification in one and resection of the osteophyte in two. The results of further surgeries were mediocre in all but one case.

Conclusions: This study showed that intra-operative fracture or fragility of the central slip insertion was a risk factor for postoperative contracture after SRA, and that development of osteophyte formation can be a cause of deterioration in ROM of the PIP joint.

Infantile Digital Fibromatosis (IDF) is a rare benign lesion that can affect the fingers, often appearing at birth or early on in life. Treatment is controversial due to a high recurrence rate following surgical excision, and the tendency of the lesions to regress or resolve completely after the age of one year. Functional loss has rarely been described. We describe a case of IDF with joint contracture and significant functional deficit that was treated with cryotherapy and post procedural occupational therapy with an excellent result. Indications for treatment and cryotherapy as a therapeutic modality for IDF are discussed.

Background: Revision surgery after syndactyly separation is challenging. Web creep and scarring have a great impact on function and appearance of the hand. There is a paucity of literature on revision surgery for syndactyly. The aim of this study is to present the outcomes of revision surgery for syndactyly.

Methods: This retrospective study included patients who required revision surgery after syndactyly release for web creep, scar contracture affecting motion and/or bony deformities. Web creep was graded using the Withey classification and scars were graded as minimal, mild, moderate and severe based on the impact on range of motion (ROM). All patients underwent dorsal and volar triangular flaps for correction for web creep, multiple Z-plasty and/or proximal interphalangeal joint (PIPJ) release for correction of scar contractures and osteotomy for correction of angular/rotational bony deformities. Improvement in web creep grading, scar contracture and change in angular and/or rotational deformities were recorded.

Results: The study included 9 hands in 7 patients who required surgery for 13 web creeps (four grade 2, four grade 3 and five grade 4), 20 scar contractures (five mild, seven moderate and eight severe), 6 angular (five ≤15° and one = 40°) and 1 rotational deformity. All web creeps improved to grade 1. Out of the 20 scar contractures, 14 improved to mild and 6 to moderate. Two patients underwent corrective osteotomy, one for rotational deformity and one for a 40° angular deformity which improved to 5°.

Conclusions: Double opposing triangular flap presents a good option for revision of the web with no recurrence of web creep after a 1-year follow-up period. We suggest a grading system which assesses the effect of scarring on finger motion. Finally, avoiding straight volar suture lines decreases the incidence of recurrence.

Level of Evidence: Level IV (Therapeutic)

Contracturing granulomatous myositis (CGM) is a very rare myopathic syndrome where patients present with slowly progressive muscle pain or weakness affecting mainly proximal muscles together with flexion contractures of the limbs. To date, there have only been several case reports of CGM, which have been reported to occur most commonly in association with sarcoidosis. We report a case of CGM associated with recurrent malignant thymoma and myasthenia gravis (MG).

A gentleman with history of treated malignant thymoma presented with new onset proximal muscle weakness and pain that later evolved into contractures that persisted despite treatment with steroids and intravenous immunoglobulin. A malignancy workup revealed recurrence of his malignant thymoma warranting chemotherapy treatment. His contractures only resolved after addition of chemotherapy treatment. He later developed clinical features of MG 1 year after his initial elevation in Anti-acetylcholine (Anti-AChR) antibody levels.

We postulate CGM to be a paraneoplastic phenomenon of underlying malignant thymoma. Treatment of thymoma together with immunosuppressive therapies led to clinical improvement of our patient’s CGM. The sole elevation of Anti-AChR levels without the accompanying clinical features does not equate to a MG diagnosis, but should raise the clinician’s vigilance for future development of the condition.