1/17. An operative procedure for advanced Kienbock's disease. Excision of the lunate and subsequent replacement with a tendon-ball implant.Excision of the lunate and subsequent replacement with a tendon implant was performed in 22 patients with Kienbock's disease between 1971 and 1985. This procedure was indicated mainly for those with advanced Kienbock's disease, i.e., stage III or IV according to the Lichtman classification. After the collapsed lunate is removed, a tendon-ball implant, made of the palmaris longus and plantaris tendons is placed in the resultant space in the carpus. A forearm distractor is applied during the operation, and distraction is continued for 4 weeks postoperatively. We report the long-term results in 15 patients, whose average follow-up period was 16 years and 3 months. One patient with infection was excluded from the study because the implanted tendon was removed 2 weeks after the operation, and 6 patients were lost to follow-up. All patients were free of pain after the surgery. The flexion-extension range of the wrist increased by 14.2 degrees, on average, after the surgery. The average grip power of the operated hand was 90.2% of that in the non-operated hand. Calcification and ossification were frequent in the implanted tendons a few months postoperatively. The average carpal height ratio (defined as carpal height/length of the third metacarpal) was 0.53 before the operation and 0.49 at the time of follow-up. According to Dornan's classification of clinical results, 9 of the 15 patients were classified as having excellent results and 6 as good.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/17. A tennis player with hand claudication.The case of a professional tennis player presenting exercise-induced hand pain with late appearance of digital blanching is reported. A bilateral hypothenar hammer syndrome and stenosis of the common palmar digital arteries close to the head of the metacarpals where the racket handle exerts its maximal force was observed with arteriography. As the patient decided to stop tennis practice, the condition improved without any medication. Six months after stopping tennis he was symptom free. Three conclusions can be drawn from this case report: 1) arteries of both hands can be injured by intense tennis practice, 2) pain in the dominant hand during tennis practice can be due to arterial insufficiency even in the absence of digital blanching which is a sign of severity, 3) hypothenar hammer syndrome is the main cause but stenosis of the common palmar digital arteries can possibly contribute to the ischemic phenomenon. Early recognition is important to avoid ineffective treatment and permanent symptoms. Therefore, we recommend an arterial examination in tennis players suffering from exercise-induced hand pain even in the absence of digital blanching which can be only a late manifestation.- - - - - - - - - - ranking = 2keywords = palm (Clic here for more details about this article) |
3/17. Punctate keratoderma-like lesions on the palms and soles in a patient with chloracne: a new clinical manifestation of dioxin intoxication?We report what we believe to be a novel skin manifestation of dioxin intoxication. A 30-year-old woman with 2,3,7, 8-tetrachlorodibenzo-p-dioxin levels of 144,000 pg g-1 blood fat presented with severe chloracne that affected the entire integument. She also exhibited acral granuloma annulare-like lesions and distal onycholysis and, at a later time point, showed signs of hypertrichosis, as well as brownish-grey hyperpigmentation of the face. In addition, she developed punctate keratoderma-like lesions on the palms and soles. These lesions were negative for human papillomavirus and histologically characterized by cone-shaped hyperkeratoses invaginating, but not penetrating, into the dermis. Squamous syringometaplasia of the eccrine glands was observed in the immediate vicinity of these lesions. Both clinically and histologically these alterations are essentially indistinguishable from what is described as keratosis punctata palmaris et plantaris (KPPP). Although a fortuitous coincidence of chloracne and KPPP cannot be formally excluded, the possibility exists that in our patient toxic levels of dioxin were causally involved in this disorder of keratinization.- - - - - - - - - - ranking = 6keywords = palm (Clic here for more details about this article) |
4/17. Occlusive arterial diseases of the upper and lower extremities found in workers occupationally exposed to vibrating tools.hand-arm vibration syndrome (HAVS) is primarily a disorder of the fingers and hands. However, in some cases, vibration-exposed workers are observed to have also episodic blanching of the hands and feet. In latter cases, arteriographies of both the upper and lower extremities are necessary to diagnose the background arterial disorders. In this study, eight HAVS subjects with such disorders were examined by arteriography for differential diagnosis in cases of workers' accident compensation. In three HAVS cases with thromboangiitis obliterans, the arteriographic examination revealed obstructive changes in the palm and forearm as well as three below-knee lesions in the lower extremities. In five HAVS cases with arteriosclerosis obliterans, obstruction kinking or coiling, stenosis and/or tapering-off of the proper digital arteries were observed together with two below-knee lesions and three high lesions in the lower extremities. From the viewpoint of occupational health, palpation of superficial arteries of both the upper and lower extremities should be routinely performed during both pre-placement and periodic medical examinations for workers exposed to vibrating tools for early detection and/or prevention of any worsening of the background disorders.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
5/17. Hypothenar hammer syndrome--review and case report.ulnar artery aneurysms distal to the carpal ligament represent an uncommon but uniquely characteristic disease entity. As a result of repetitive palmar trauma, the hypothenar hammer syndrome should be suspected in males with this history and unilateral digital ischemia which spares the thumb. The pathophysiology of this syndrome and its management is reviewed with presentation of an index case.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
6/17. Hypothenar Hammer Syndrome: rare or underdiagnosed?Hypothenar hammer Syndrome (HHS) is a condition characterised by digital ischaemia as a result of repetitive trauma to the hypothenar eminence of the hand. It occurs in people who repeatedly use the palm of the hand as a hammer to push, grind or twist objects. It is a curable and a preventable cause of upper digital ischemia. In this report we present a case of HHS and discuss the causes and pathogenesis of this syndrome. We review the incidence, clinical characteristics, differential diagnosis, investigation and treatment.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
7/17. Hypothenar hammer syndrome. Form of reversible Raynaud's phenomenon.Hypothenar hammer syndrome is a reversible yet uncommonly encountered cause of Raynaud's phenomenon. Characteristic findings include coldness in the dominant hand of a male, absence of triphasic color change and thumb involvement, and occupational or recreational use of the hand as a hammer. angiography demonstrates the specific findings of irregularity or occlusion of the ulnar artery, downstream occluded proper digital arteries, and intraluminal emboli at the sites of distal obstruction. A vulnerable area of traumatic occlusion is provided by the anatomic relationship of the superficial branch of the ulnar artery to the hamate bone and the palmar aponeurosis. Pathologic studies separate the hypothenar hammer syndrome from clinically similar vasculitis. It is important to recognize the hypothenar hammer syndrome as a distinct entity because treatment is curative and consists of resection of the affected vascular segment and avoidance of the aggravating conditions.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
8/17. Frictional contact dermatitis.Frictional trauma to the palms and fingertips can provoke a dermatitis. Cases of frictional dermatitis have been recognized in workers handling large quantities of pressure-sensitive carbonless paper. Elimination of the trauma led to healing within 2-3 weeks.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
9/17. Vibration-induced white finger disease: a case report.A syndrome of pain, stiffness and numbness associated with vascular changes that develops in the hands of those who use vibrating tools has been termed vibration-induced white finger disease. The authors describe such a case that occurred in a 22-year-old man. A change of job and a course of physiotherapy alleviated the symptoms and improved circulation. A review of the literature and the authors' findings suggest that this condition is a result of marked changes in the vascular supply to the hand from repetitive blunt trauma. Arteriographic evidence of deficient palmar arch vasculature is presented.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
10/17. Compression of the deep palmar branch of the ulnar nerve: clinical and electromyographic findings after a new method of decompression.Five cases of compression of the deep palmar branch of the ulnar nerve were operated upon and the hiatus released by subperiosteal removal of the pisiform bone. The clinical and electromyographical results after a minimum follow-up of eight months showed an improvement in all cases. The authors stress the importance of accurate electromyographic examination for a correct preoperative diagnosis.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
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