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We report a case of multiple schwannomas of the median nerve. Multiple schwannomas can be difficult to diagnose on clinical grounds and can be mistakenly diagnosed as carpal tunnel syndrome or ganglia as in our case. Nerve conduction studies helped locate non-visible tumours. Magnetic resonance imaging (MRI) is useful in the preoperative planning of these tumours. The appearances on scanning however can be sometimes confused for ganglia as in this case. Intraneural dissection of the schwannomas was carried out and the pathology is described.

In this paper, the authors offer a classification of benign fatty tumours of the upper limb. There are three histologically distinct types of fat cells: immature fat cells which give rise to lipoblastomas, mature brown fat cells which give rise to hibernomas and mature white fat cells which give rise to lipomas. Lipomas are the most common and they are sub-classified according to the anatomic site of fat cells into dermal, subcutaneous and sub-fascial lipomas; or tumours directly related to muscle, bone, synovium or nerve. Finally, the authors review 67 patients with benign fatty tumours of the upper limb and provide clinical examples of these tumours including their characteristic histological and radiological features.

The superficial radial nerve might be compressed or injured at various anatomical sites along its course in the forearm. Most of the superficial radial nerve neuropathy are caused by pathological lesions such as trauma, a mass or tight band at the distal third of the forearm. Wartenberg's syndrome is the most common cause of sensory radial entrapment at the distal forearm. Compression of superficial radial nerve occurring at the proximal third of forearm is unusual. We present a rare case of superficial radial nerve compression due to a parosteal lipoma of proximal radius. Results of complete physical and radiological examinations are also presented. Surgical intervention of the tumour mass was performed for nerve decompression. The patient reported total relief of the neurological symptom post-operatively. This rare case demonstrates the unique characteristics of parosteal lipoma with unusual superficial radial nerve neuropathy at the proximal radius. This report reminds us that there is the possibility of superficial nerve compression caused by tumour mass over the proximal third of forearm.

We present a rare case of a 72-year-old woman who had a metastatic bone tumour on the fifth metacarpal of the left hand from gastric cancer. It had occurred in the patient, two years after subtotal gastrectomy and partial resection of a liver for advances gastric cancer with metastasis to the liver. A number of investigations and the needle biopsy confirmed the diagnosis of the metastatic malignant tumour of fifth metacarpal bone and an amputation was performed. Although our patient died 12 months after hand surgery, amputation was effective in providing relief from pain in the affected hand for the remainder of her life.

It is necessary to consider rare acrometastasis to the hand if a patient complains of swelling and pain of the hand without a trigger if there is a history of malignancy, including gastric cancer.

An intraosseous xanthoma is a very rare condition. It has an aggressive appearance on radiographs mimicking primary or metastatic malignant bone tumors. We report a case of intraosseous xanthoma of the distal radius in a 51-year-old male with no history of hyperlipidaemia. To the best of our knowledge, this condition has not been reported so far in the wrist and forearm region. The lesion was successfully excised and at last follow-up, there were no signs of recurrence and patient has been symptom-free.

Background: The purpose of this study was to compare the diagnostic accuracy of a smartphone flashlight to a conventional penlight with regards to transillumination of simulated soft tissue masses of the hand and wrist.

Methods: Eight participants performed transillumination assessments in a fresh frozen cadaver upper extremity model. Spheres measuring 9.5 mm were used to simulate fluid-filled or solid soft tissue masses. Two spheres were placed on the volar aspect and two on the dorsal aspect of the wrist. These were then evaluated with either a smartphone flashlight or penlight. Participants noted whether each sphere did or did not transilluminate. Each participant performed two evaluations at an interval of 3 weeks.

Results: The overall sensitivity, specificity and accuracy of the smartphone were 100%, 44% and 72%, respectively. The overall sensitivity, specificity and accuracy of the penlight were 100%, 75% and 88%, respectively. The difference in accuracy between the smartphone group and penlight group was statistically significant (p = 0.029). The kappa value, indicating intra-observer agreement, for the smartphone group and penlight group was 0.76 and 0.76, respectively.

Conclusion: In conclusion, transillumination with a penlight is a viable adjunct to the examination of soft tissue masses of the hand and wrist. The use of a smartphone flashlight, while convenient, is less accurate than a penlight and can lead the examiners to misinterpret the composition of soft tissue masses.

Level of Evidence: Level IV (Diagnostic)

Background: Synovial chondromatosis is a condition that rarely occurs in the hand and wrist. Recurrence and malignant transformation are two potential complications of the disease. We set out to retrospectively review 35 years of practice within our sarcoma and tertiary hand unit and identify recurrence or malignant transformation.

Methods: This is a retrospective analysis of patients with synovial chondromatosis seen at our sarcoma and tertiary hand unit for the past 35 years. Incidence of recurrence or malignant transformation was noted. Where possible, patients were clinically and radiologically reviewed with range of motion, grip strength and patient evaluation measures obtained.

Results: Of 12 patients presenting to the practice, seven patients were followed up and, of these, two demonstrated recurrences. The recurrence was diagnosed based on patient-reported symptoms, clinical examination and the requisition of further imaging. Of the five who could not be followed up, two demonstrated recurrence and one had malignant transformation with a low-grade chondrosarcoma on histology.

Conclusions: While a rare disease, we demonstrated recurrence within our small case series. Fusion to obliterate the joint is an option in the management of recurrence. For the diagnostically challenging, genetic testing may be beneficial, though genetic rearrangements are not seen in all cases. All patients should be counselled on symptoms to watch for as a small proportion may experience recurrence and a small percentage may undergo malignant transformation.

Level of Evidence: Level IV (Therapeutic)