Finger Lesions Research Articles

Development of a measuring app for systemic sclerosis-related digital ulceration (SALVE: Scleroderma App for Lesion VErification).

To test the hypothesis that photographs (in addition to self-reported data) can be collected daily by patients with systemic sclerosis (SSc) using a smartphone app designed specifically for digital lesions, and could provide an objective outcome measure for use in clinical trials. An app was developed to collect images and patient reported outcome measures (PROMS) including Pain score and the Hand Disability in Systemic Sclerosis-Digital Ulcers (HDISS-DU) questionnaire. Participants photographed their lesion(s) each day for 30 days and uploaded images to a secure repository. Lesions were analysed both manually and automatically, using a machine learning approach. 25 patients with SSc-related digital lesions consented of whom 19 completed the 30-day study, with evaluable data from 27 lesions. Mean (standard deviation [SD]) baseline Pain score was 5.7 (2.4) and HDISS-DU 2.2 (0.9), indicating high lesion and disease-related morbidity. 506 images were used in the analysis (mean number of used images per lesion 18.7, SD 8.3). Mean (SD) manual and automated lesion areas at day 1 were 11.6 (16.0) and 13.9 (16.7) mm2 respectively. Manual area decreased by 0.08mm2 per day (2.4mm2 over 30 days) and automated area by 0.1mm2 (3.0mm2 over 30 days). Average gradients of manual and automated measurements over 30 days correlated strongly (r = 0.81). Manual measurements were on average 40% lower than automated, with wide limits of agreement. Even patients with significant hand disability were able to use the app. Automated measurement of finger lesions could be valuable as an outcome measure in clinical trials.

Rapidly Growing Finger Lesion

Rapidly Growing Finger Lesion

A rare clinical presentation of lung cancer: two cases of solitary digital metastasis on Tc-99m MDP bone scan

BackgroundAcrometastases are accounted for a very small proportion of bone metastases. Lung cancer is the most common acrometastasis origin, and it often has a poor prognosis. The aim of the present cases is to describe the probability of an acrometastasis in the differential diagnosis of finger lesions and to emphasize the importance of taking local views of extremity of complaint for proper interpretation in such patients.Case presentationHere we reported two patients with metastases to the fingers with occult primary lung carcinoma and a history of prior lung malignancy, respectively. First case was a 58-year-old man with history of pain and swelling in the fourth finger of his left hand. He underwent an amputation from the metacarpophalangeal level and the pathological diagnosis was metastatic NSCLC. The second case was a 65-year-old ex-smoker man with a history of prior lung cancer (adenocarcinoma) suffered from a swollen, erythematous, painful tip of the right third finger. Phalangectomy was performed and the histological examination of the amputated part revealed the presence of a metastatic differentiated carcinoma of pulmonary origin.ConclusionsWhen assessing the masses located at fingers, possibility of a solitary metastatic lung lesion should be considered.

MR imaging differences between Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders: A single institutional study in a tertiary referral centre in Sri Lanka.

Background and objectives- Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorders (NMOSD) are the commonest demyelinating diseases of the central nervous system with overlapping clinical and radiological features, leading to frequent misinterpretation. This study aimed to describe neuroimaging features for differentiating MS and NMOSD and also comparing NMOSD subcategories.Methods- A cross sectional study was conducted at a single tertiary referral center in Sri Lanka. The magnetic resonance imaging (MRI) characteristics of 82 MS and 36 NMOSD patients were prospectively evaluated by a fourth-year resident under the supervision of consultant radiologists and were analyzed using standard descriptive statistical tests. Results- Statistical analyses indicated significance (p<0.05) in distinguishing both entities (MS and 36 NMOSD) across lesions in periventricular, subcortical, intracortical, inferior temporal, corpus callosum, and infratentorial locations by MRI. Dawson finger lesions, U fibers, calloso-septal interface involvement and T1 black holes indicated MS, whereas linear ependymal lesions suggested NMOSD. In the spinal cord, peripherally located short-segment lesions were significant for MS (p=0.000) and longitudinally extensive lesions involving central grey matter (p=0.000) pointed towards NMOSD. There was only a slight variation in lesion distribution between cervical and thoracic cord. MS showed more brain parenchymal volume loss while spinal cord atrophy was higher in NMOSD. Symmetry and location of the optic pathway lesions reinforced the differentiation.Conclusion- Comprehensive analyses support the use of neuroimaging in distinguishing between NMOSD and MS. However, further multicentric longitudinal studies are required to differentiate NMOSD phenotypes.

Finger Pain as an Uncommon Primary Manifestation of Lung Carcinoma

A 54-year-old patient presented with progressive pain for one month in the second finger of the right hand with an emphasis on the proximal interphalangeal (PIP) joint. Subsequent magnetic resonance imaging (MRI) showed a diffuse intraosseous lesion at the base of the middle phalanx with destruction of the cortical bone and extraosseous soft tissue. An expansively growing chondromatous bone tumor, e.g., a chondrosarcoma, was suspected. After incisional biopsy, the pathologic findings finally revealed, surprisingly, a metastasis of a poorly differentiated non-small cell adenocarcinoma of the lung. This case illustrates a rare but important differential diagnosis for painful finger lesions.

Operative outcome of mucous cyst of lesser toes: A comparison between cyst excision with osteophytectomy and distal interphalangeal fusion

BackgroundTo date, the optimal operative treatment for mucous cysts of the lesser toes (MCLT) has not been discussed in detail, although many previous studies have focused on treating finger lesions. Therefore, we evaluated the operative outcomes of two different procedures for MCLT: cyst excision with osteophytectomy and cyst excision with distal interphalangeal (DIP) fusion. MethodsWe retrospectively reviewed and compared the clinico-radiographic outcomes of patients who underwent cyst excision with osteophytectomy (group 1, 22 cases) or cyst excision with DIP fusion (group 2, 16 cases) for MCLT between January 2010 and August 2021. The minimum follow-up duration for inclusion in the study was 12 months. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) lesser toes metatarsophalangeal-interphalangeal scale and the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) subscale. We also collected information on postoperative recurrence and operation-related complications. ResultsThe preoperative and postoperative AOFAS and FAAM-ADL scores were not significantly different between the two groups (P > 0.05, each). However, the postoperative recurrence rate was 31.8 % in group 1 (7 of 22 cases), whereas no recurrence was observed in group 2. Every recurrence occurred within 8 postoperative weeks (mean, 4.8 weeks; range, 3–8 weeks). Nonunion of the fusion site was observed in one patient (6.3 %). ConclusionWe confirmed that postoperative recurrence was significantly lower in the case of cyst excision with DIP fusion than in cyst excision with osteophytectomy for the treatment of MCLT. Clinical outcomes were not significantly different between the two procedures. Level of evidenceLevel III, retrospective comparative study.

Feasibility study of mobile phone photography as a possible outcome measure of systemic sclerosis-related digital lesions.

Clinical trials assessing systemic sclerosis (SSc)-related digital ulcers have been hampered by a lack of reliable outcome measures of healing. Our objective was to assess the feasibility of patients collecting high-quality mobile phone images of their digital lesions as a first step in developing a smartphone-based outcome measure. Patients with SSc-related digital (finger) lesions photographed one or more lesions each day for 30 days using their smartphone and uploaded the images to a secure Dropbox folder. Image quality was assessed using six criteria: blurriness, shadow, uniformity of lighting, dot location, dot angle and central positioning of the lesion. Patients completed a feedback questionnaire. Twelve patients returned 332 photographs of 18 lesions. Each patient sent a median of 29.5 photographs [interquartile range (IQR) 15-33.5], with a median of 15 photographs per lesion (IQR 6-32). Twenty-two photographs were duplicates. Of the remaining 310 images, 256 (77%) were sufficiently in focus; 268 (81%) had some shadow; lighting was even in 56 (17%); dot location was acceptable in 233 (70%); dot angle was ideal in 107 (32%); and the lesion was centred in 255 (77%). Patient feedback suggested that 6 of 10 would be willing to record images daily in future studies, and 9 of 10 at least one to three times per week. Taking smartphone photographs of digital lesions was feasible for most patients, with most lesions in focus and central in the image. These promising results will inform the next research phase (to develop a smartphone monitoring application incorporating photographs and symptom tracking).

A Call for Attention: Pediatric Monkeypox Case in a Context of Changing Epidemiology.

To the Editors: Considering the major outbreaks of monkeypox reported in nonendemic areas, as well as the changing epidemiology, there is a need to highlight the difficulties in diagnosing monkeypox infection in children, given the current low index of suspicion. Monkeypox is a zoonotic disease described in 1970 as endemic in West-Central African countries.1 However, from May 2022 onwards, the highest outbreaks have been reported in nonendemic countries. Nowadays, Spain is the most affected country in Europe.2 There are currently few publications on pediatric cases in nonendemic countries, and even fewer without a clear epidemiologic background. The current health alert focuses on sex-related transmission, yet transmission may occur through respiratory droplets, contact with fluids or lesions unrelated to sex, and through fomites.3,4 Prodromal symptoms have been described, followed by characteristic skin lesions. Involvement seems to be more severe in children under 10 years of age. The mortality rate described in African countries ranges from 3% to 10%.1,3 This letter is written to describe a case that posed a diagnostic challenge in our center, as it did not refer any compatible epidemiologic background. A 13-month-old boy came to the pediatric emergency room due to vomiting, diarrhea and fever for 48 hours. He presented a purulent blistering lesion on a finger and crusty lesions on the scalp and on a toe. Close relatives did not report any symptoms or traveling abroad in the last months. The blistering lesion was drained taking a sample for bacterial culture (Fig. 1A) and oral amoxicillin-clavulanate was prescribed. Methicillin-resistant Staphylococcus aureus was isolated, and treatment was changed to trimethoprim-sulfamethoxazole. After 48 hours, he presented a new gluteal warm and swollen lesion. The lesion evolved into an abscess and was drained (Fig. 1B).FIGURE 1.: General caption: Monkeypox lesions. A: Blistering lesions with a total loss of epidermis and dermis and exposition of the tendon. B: Vesicle, which evolved into a pustule, and later to an abscess in the gluteal region.Despite the methicillin-resistant S. aureus infection, the epidemiologic alert and suggestive lesions led us to request a monkeypox virus polymerase chain reaction, which was positive. The patient evolved favorably. Fever and gastrointestinal symptoms ceased after 5 days. The case was notified to the Epidemiological Surveillance Network. Family members and other close contacts did not show any monkeypox signs. Monkeypox polymerase chain reaction testing in pharyngeal swabs and blood samples taken from family members were negative. After a detailed epidemiologic survey, an index case was not detected. To note, he was not attending a kindergarten. Sexually transmitted infections (HIV, syphilis, hepatitis B and C) were excluded. This letter aims to: Alert about the increasing community transmission of monkeypox in children, and the need to suspect it even in the absence of a clear epidemiologic background. Highlight that bacterial infections could obscure a potential case of monkeypox. Clinical suspicion should lead to a diagnostic monkeypox test even with bacterial isolation as bacterial superinfections are common.5 Call for the need to create specific protocols for pediatric patients to face the challenges posed by this global outbreak. Emphasize that multidisciplinary work between pediatricians, pediatric surgeons and microbiologists is essential to reach the diagnosis and should be considered to detect, treat and trace new cases.

A Case of Necrotizing Finger Lesions in a Patient With AIDS.

A Case of Necrotizing Finger Lesions in a Patient With AIDS.

P230 Feasibility study of mobile phone photography as a possible outcome measure of systemic sclerosis-related digital ulcers

Abstract Background/Aims Digital ulcers cause pain and disability in patients with systemic sclerosis (SSc). They are often used as outcome measures in clinical trials; however, trials have been hampered by a lack of reliable outcome measures of healing. Photographic monitoring of digital ulcers using smartphones could overcome this difficulty. Our objective was to assess the feasibility of patients collecting mobile-phone images of their digital ‘lesions’ as a first step in a programme of research to develop a smartphone-based outcome measure. Methods An imaging protocol was developed with input from a patient representative group. Patients with SSc-related digital lesions were recruited and instructed to photograph one or more finger lesions each day over 30 days using their smartphone, at the same time each day. Instructions on how to take the photographs were given either face-to-face or remotely. An adhesive dot, placed adjacent to the lesion(s), provided a 1cm reference scale to help extract accurate measurements. Images were uploaded by each patient to a secure Dropbox folder. Image quality was assessed using six criteria: blurriness, shadow, uniform lighting, dot location, dot angle, and central positioning of the lesion. After image collection, patients were asked to complete a feedback questionnaire, with most questions on a scale of 1 (very easy) to 10 (very difficult). Results Twelve patients (10 female, age 37 to 72 years, disease duration 1 to 27 years) returned 331 photographs of 19 lesions (maximum three lesions per patient). Each patient sent a median of 30 photographs (IQR 14 to 33), with a median of 15 photographs per lesion (IQR 2 to 31). Of the 331 photographs, 24 were ‘duplicates’ taken on the same day, meaning that there were 263 ‘missing’ photographs (i.e., 570 photographs would have been taken if 19 lesions had been photographed every day). Image quality results included the following: 255 (77%) of photographs were sufficiently in focus; 268 (81%) had some shadow; lighting was even in 55 (17%); dot location was acceptable in 231 (70%); dot angle was ideal in 107 (32%); the lesion was centred in 254 (77%). Patient feedback showed 9/10 responses would be willing to record images at least 1-3 times per week, and the overall patient experience taking photographs was good, with a median rating of 3 (IQR 3 to 4). Conclusion Capturing photographs of digital lesions with a smartphone was feasible for most patients. They were able to take photographs in focus and with lesions central in the image. Support will be required to improve lighting, shadow, and dot positioning while minimising discomfort. These encouraging results will inform the next research phase to develop a smartphone app for monitoring finger lesions. Disclosure A.K. Davison: None. H. Patrick: None. P. New: None. G. Dinsdale: None. V.P. Taxiarchi: None. W.G. Dixon: None. A. Vail: None. A.K. Murray: None. M. Dickinson: None. C. Taylor: None. A.L. Herrick: None.

Recurrent Intra Articular Osteochondroma of Left 4th Finger.

Osteochondromas are common benign bone tumors arising from metaphyseal region of long bones. They are notorious for undergoing malignant transformation. We present a case of a middle aged woman with recurrent episodes of swelling in the middle of left 4th finger post excision. Bone scan was performed to look for any malignant transformation of finger lesion and also to rule out skeletal metastases due to recent onset bone pains. 99m Tc MDP (Technetium methylene diphosphonate) bone scan demonstrated a focal hot spot in middle of left 4th finger along the radial side. There was no evidence of skeletal metastases. Surgery is usually curative (70-90%). Limb sparing wide local excision is treatment of choice.

Spontaneous sacral fracture with associated acrometastasis of the hand

Background: Acrometastases, secondary tumors affecting oncological patients with systemic metastases, are associated with a poor prognosis. In rare cases, acrometastases may precede establishing the primary tumor diagnosis.Case Description: A 72-year-old female heavy smoker presented with low back pain, and right lower extremity sciatica/radiculopathy. X-rays, CT, MR, and PET-CT scans documented primary lung cancer with multi-organ metastases and accompanying pathological fractures involving the sacrum (S1) and right 4th digit. She underwent a S1 laminectomy and amputation of the distal phalanx of the right fourth finger. The histological examination documented a poorly differentiated pulmonary adenocarcinoma infiltrating bone and soft tissues in the respective locations. The patient was treated with a course of systemic immunotherapy (i.e. pembrolizumab). At 6-month follow-up, the patient is doing well and can stand and walk without pain.Conclusion: Spontaneous sacral fractures may be readily misdiagnosed as osteoporotic and/or traumatic lesions. However, in this case, the additional simultaneous presence of a lytic finger lesion raised the suspicion that these were both metastatic tumors. Such acrometastases, as in this case attributed to a lung primary, may indeed involve the spine.

A Review of 1073 Cases of Wide-Awake-Local-Anaesthesia-No-Tourniquet (WALANT) in Finger and Hand Surgeries in an Urban Hospital in Malaysia.

BackgroundThe Wide-Awake-Local-Anaesthesia-No-Tourniquet (WALANT) technique achieves an almost bloodless field for clear visualization during surgeries. WALANT utilizes lidocaine and epinephrine for anesthesia and hemostasis, respectively, without the usage of sedation and tourniquet. This avoids the potential side effects of tourniquet-related pain and sedation-related complications. However, acceptance is still low due to concerns regarding the safety of epinephrine injection in the finger. There is a persistent belief that epinephrine can cause digital ischemia.PurposeTo evaluate retrospectively possible complications of hand surgeries performed using the WALANT technique.MethodsAll finger and hand procedures performed under the WALANT technique from June 2016 to May 2021 in an urban tertiary hospital were studied retrospectively.ResultsThere were a total of 1073 cases, of which 694 were females and 379 were males. The mean age was 55 years. Finger surgeries (e.g., trigger finger release, excision of finger lesions, removal of implants) consisted of 707 cases; and the rest (366 cases) were hand surgeries (e.g., carpal tunnel release, excision of hand lesions, removal of implants). In all cases reviewed, there were no instances of circulatory compromise. There were also no circumstances where usage of reversal with phentolamine is recorded.ConclusionWe believe that performing finger and hand surgeries using the WALANT technique is safe and beneficial. The usage of WALANT in hand surgeries avoids tourniquet pain. However, WALANT should be used with caution in those with vascular insufficiency or disease.

The feasibility of high-resolution ultrasonography and MRI in diagnosing finger lesions.

To evaluate the diagnostic performance of both ultrasonography and MRI findings in finger lesions. This study was carried out on seventy symptomatic patients (53 females and 17 males). Their ages ranged from 6 to 64years. All patients were referred to the diagnostic radiology department from various outpatient clinics of general, orthopedic, cosmetic surgeries and rheumatology. All patients were subjected to history taking, clinical examination, laboratory investigations for rheumatoid arthritis patients and radiological investigations. Whenever we had a surgical and pathological final diagnosis, it was considered the gold standard of the results. When only ultrasound and MRI were correlated, MRI was considered the gold standard. In our study, we found that ultrasonography is useful for evaluating a variety of lesions of the finger. Its widespread availability, relatively low cost, and high spatial resolution make it an excellent tool for investigating finger disorders. MR is the best imaging modality for lesion characterization. By systematically using clinical history, lesion location, findings on radiographs and MR imaging features, the radiologist can differentiate between determinate and indeterminate lesions. We concluded that ultrasonography and MRI are complementary to reach a correct diagnosis in different etiologies of finger lesions.

Therapeutic Effectiveness of an Antiseptic Drug for Ulcerative Finger Lesions in Artiodactyls

The most common surgical pathology of cattle and small ruminants is purulo-necrotic disease in the hoof, which is caused by deep neurotic-dystrophic disorders and is the result of exposure to exogenous and endogenous factors, as well as inadequate, monotonous feeding and non-compliance with hygienic and quarantine measures. The success of the control of purulent-necrotic processes in the area of the hoof depends on the timely detection of sick animals, their correct treatment and effective preventative work. Scientists have proposed many approaches and methods for treating animals that have hoof diseases, but there is no consensus about the effectiveness of the existing drugs. For the treatment of cattle and small ruminants with purulo-necrotic disease of the hoof, we proposed a new antiseptic drug with bacteriostatic, fungicidal, astringent and regenerating effects. This drug contains copper sulfate, boric acid and succinic acid. It is applied as a powder. The healing of the purulo-necrotic ulcers in the experimental animals occurred under a fibrin-tissue scab, and by the 10th day, the abnormal focus was filled with granulations followed by epithelization, which was explained by the energetic metabolic effect on the cells of the succinic acid included in the drug. The advantage of the proposed method of treatment is in the simplicity of the technical preparation of the powder under the conditions of production and in the rapid recovery of animals. The powder does not possess inhibitory properties and does not have a toxic effect.
 Keywords: cows, sheep, ulcers, treatment, new powder

Magnetic Resonance Imaging Role in Evaluation and characterization of Hand and Finger Lesions

Background: MRI describes the main features of the encountered different pathological lesions of the hand and fingers, as well as specifies the signal characteristics and location, which help to differentiate them. In general, a specific diagnosis may be achieved by taking into account the location of the lesion within the hand or wrist and its signal characteristics. Aim: The aim of the study is to evaluate the role of MRI in diagnosis of various hand and finger pathologies using different sequences. Methods This is a prospective observational study of patients who suffers from hand or fingers swelling or trauma. The patients were investigated by MRI. Results: The study included 30 patients with hand or finger lesions who were evaluated by MRI and enrolled from Benha University hospitals. Conclusion: Magnetic resonance imaging is the preferable method of choice for evaluating various hand and finger lesions in traumatic and non-traumatic condition if conventional radiography isn’t enough

A Finger Lesion and Splint Treatment in the Rheumatoid Arthritis

関節リウマチの治療は，薬物治療の進歩により，「臨床的」「構造的」「機能的」寛解が望める時代となっている．発症早期からの生物学的製剤（Bio）の適用で，「炎症」「疼痛」「関節破壊」は抑制され，ADL・IADLが確保できる．しかし，Bio未使用患者や急性増悪時の局所的な関節の「炎症」「疼痛」「変形」の発生で，ADL・IADL・QOLの低下につながる可能性がある．その関節症状における1つの治療方法としてスプリント治療がある．本稿では，スプリントで得られた，「関節機能再獲得」「変形の改善と予防」「IADLおよびQOL支援」などの治療効果について症例を提示する．

CONSERVATIVE VERSUS K-WIRE PINNING OF ACUTE MALLET FINGER IN ADULTS

Mallet finger lesions are common. The diagnosis of mallet finger is essentially clinical, the patient's recent history includes the mechanism of injury. A radiographic lateral and anteroposterior views of the DIPJ usually see bony avulsion of distal phalanx or it may be a ligamentous injury with normal bony anatomy, Wehbe and Schneider described a method to measure the size and displacement of the bony fragment. The aim of this study is to compare the results between of conservative and K-wire pinning management of acute mallet finger Doyle type I in adult patients. Patients were divided into two groups. Group (A) were treated with aluminum orthosis that immobilized the DIPJ in full extension for six weeks. And Group (B) were treated with percutaneous fixation of the distal interphalangeal joint using a smooth Kirschner wire. No external splint age was used and the wire was removed after six weeks. A total of 40 patients suffering from acute mallet finger type I Doyle's classification admitted in orthopedics and traumatology department of Sohag university hospital from February 2019 to November 2019. All patients had Follow up radiographs taken of the affected finger at one week, four weeks, and eight weeks. Functional outcomes were determined using Crawford’s evaluation criteria. The final extensor lag was significantly better in the pin group (12.3 vs 6.6°). The amount of improvement between the groups was statistically significant and in favor of percutaneous pinning (16.15 vs 20.55°), also the flexion loss was lesser in pin group (5.4 vs 4.1°). The optimal treatment for mallet finger injuries remains controversial in the literature. Many orthotic devices for conservative management and surgical techniques have been described in the past. This study shows that closed reduction by use of K-wires provide functionally better result in acute mallet finger cases. Surgical treatment by a single k-wire is better than conservative treatment as regard clinical and radiological results. Conservative technique may have less complications, but the difference in final clinical results is in favor of surgical treatment

COVID-19 in Italy: The Point of View of the Italian Society of Pediatric Allergy and Immunology-COVID-19 Commission.

COVID-19 in Italy: The Point of View of the Italian Society of Pediatric Allergy and Immunology-COVID-19 Commission.

Spread of Hand Infection According to the Site of Entry and Its Impact on Treatment Decisions.

Background: Hand infections can spread quickly and destroy functional structures. Early diagnosis and adequate therapy can prevent severe morbidities. The aim of this study was to evaluate systematically the spread of hand infections according to injury mechanism, pathogens, and entry site. Methods: The data and medical records of 425 patients were collected and analyzed retrospectively. Results: The entry site had a significant influence on the severity of hand infections. Especially finger lesions led to severe infections. Furthermore, a high C-reactive protein (CRP) concentration correlated with more involved compartments of the hand. Bacterial counts also correlated with the number of compartments involved. Conclusions: Compared with known factors for the severity of hand infections finger lesions lead to especially severe infections and should not be underestimated. If there is a higher CRP concentration or more than one bacterial species isolated, compartments adjacent to the site of injury should be checked intra-operatively.