Faculty Bibliography

The locked metacarpophalangeal joint of a finger is an unusual condition frequently confused with a "trigger finger." The causes can be classified into degenerative and spontaneous groups. Ten cases are presented. The cause of locking of one patient in the degenerative group was gouty arthritis, a cause not previously reported in the literature. Although surgery is usually necessary, joint mobility was restored in 30% of the cases by distending the joint capsule with an intraarticular injection of a local anesthetic followed by gentle manipulation. In addition to routine x-ray films, arthrotomography was found to be a useful diagnostic technique in determining the cause of locking.

An unusual rupture of a flexor profundus tendon, previously unreported in the literature, is presented. There was avulsion and proximal displacement of a large bone fragment from the palmar base of the distal phalanx and further retraction of the tendon unattached to the bone fragment.

Dorsal dislocations of the proximal interphalangeal joint are common injuries, and reduction is usually obtained by manipulation. We describe four cases of dorsal dislocation in which attempts at reduction by manipulation were not successful. Three of these injuries were open and one was closed. At surgery, the main block to reduction in all cases was the palmar plate that had ruptured from its proximal attachment and was interposed between the joint surfaces.

Fractures occurring at the base of the hook of the hamate are difficult to detect. Failure to visualize the entire hamulus on routine radiographs and conventional carpal tunnel view may contribute to a delayed diagnosis. Carpal tunnel trispiral thin-section tomography is a useful aid in the investigation of a suspected fracture of the hook of the hamate.

A case report is presented of a traumatized vascular hamartoma producing a forearm flexor compartment syndrome; such a case has not been reported previously. The role of minor trauma in this case was important. There is a need for a high degree of suspicion in order to make an early, accurate diagnosis. Delayed surgical decompression and resection of the pathologic muscle resulted in a dramatic improvement in sensibility and digital mobility

A case of an intraosseous ganglion arising in a phalanx is described. This condition has not been reported previously.

Forty patients who underwent submuscular transpositions of the ulnar nerve at the elbow (41 operations) were evaluated. A grading system was formulated to compare the preoperative and postoperative condition of each patient with respect to tenderness over the nerve, numbness, paresthesia, and muscle weakness. Thirty-seven of the 41 cases showed an improvement in grade. Of the 34 cases that demonstrated muscle weakness preoperatively, 25 improved following surgery, including five patients who had severe intrinsic muscle weakness with clawing of the ring and little finger. Muscle reattachment following nerve transposition was secure, even in a professional athlete.

Transfer of a flexor digitorum superficialis tendon is an effective procedure in restoring active flexion of the thumb following old lacerations or ruptures of the flexor pollicis longus tendon within the digital sheath when tendon repair or advancement is not possible. The ample length of the transferred tendon and, more importantly, its normal excursion make it the preferred procedure to the alternative tendon graft. The operation is usually carried out as a one-stage procedure, but, if there is severe scarring, it can follow the preliminary insertion of a silicone rod. For 23 patients, the operation was performed in a single stage in 18 and in 5 after insertion of a silicone rod. Postoperative mobility of the interphalangeal joint averaged 53.5 degrees. Mobility of the donor ring finger was complete in all patients.

Glomus tumors about the wrist area are rare. Three new cases are presented. A provocative diagnostic test using ethyl chloride spray has been found useful. This test is superior to the use of ice because application can be to a very small area.

A case of neurofibromatosis causing diffuse elephantoid hypertrophy of an upper limb is described. Infiltration by tumor mass led to disruption of the carpus and dislocation of the hand.