Right Hand Pain Research Articles

Ultrasound Guided Hydrodissection of Median Nerve with the Use of 5% Dextrose in Carpal Tunnel Syndrome: A Case Report

Carpal tunnel syndrome is an entrapment neuropathy of median nerve in wrist presenting with symptoms like pain, numbness, and paresthesia in hand and lateral three fingers. Conservative treatments are effective for mild to moderate cases, whereas severe or refractory carpal tunnel syndrome may require surgical intervention. Hydrodissection, a technique involving the separation of the nerve from surrounding tissues, has emerged as a minimally invasive and effective treatment option for carpal tunnel syndrome, leading to faster recovery and lower complication.In this case report, a 48 years female with two years history of severe pain and paresthesia in right hand, underwent ultrasound-guided hydrodissection of median nerve with 5% dextrose. Following intervention, the patient reported decreased symptoms and expressed satisfaction with the treatment during subsequent follow-up after 2 weeks. Ultrasound-guided hydrodissection of median nerve with 5% dextrose is effective treatment modality for patients with failed conservative management of carpal tunnel syndrome.

Gallbladder sinistroposition (left-sided) finding in laparoscopic cholecystectomy, a case report

A left-sided gallbladder (LSGB), also known as sinistropostition, is a rare anatomical variant with a reported incidence of 0.2-1.1%. It is defined as a gallbladder located on the left side of the falciform ligament, embedded in the third hepatic lobe, without situs inversus viscerum. A 37-year-old Latino man with a history of bilateral inguinal repair underwent a scheduled laparoscopic cholecystectomy due to multiple gallbladder polyps. Preoperative ultrasound reported a gallbladder of 60x20 mm, wall thickness of 1 mm, with polyps of up to 10 mm. Standard laparoscopic cholecystectomy trocar placement was used. Upon revision of the right hepatic lobe, there was an absence of the GB in the visceral side of segments IV, V, or VI. It was identified to the left of the falciform ligament with adhesions to the anterior and superior portions of the pylorus and lesser curvature. The subxiphoid trocar was adjusted to the left of the falciform ligament, and Calot’s triangle dissection was performed to obtain a critical view of safety. No other anatomical variants were identified. The procedure was performed safely with a satisfactory view of critical cholecystectomy steps and anatomy identification. After the procedure, the surgeon complained of right-hand pain and numbness due to a medial position of the subxiphoid trocar for dissection. The surgical approach of a LSGB in laparoscopic surgery should be individualized for each patient. A minimally invasive approach may be realized successfully when critical thinking by the surgeon is applied and always prioritizing the safety of the patient.

Vegetarian diet induced new onset acute gouty arthritis in a middle-aged genetically predisposed male: A rare presentation

Gout is a metabolic disease characterised by acute or chronic arthritis which is due to deposition of Monosodium urate (MSU) crystals in joints and soft tissues. Classically described as a disease associated with hyperuricemia which may be due to metabolic defect in uric acid production or due to impaired renal excretion.We present a case of 45 year old nondiabetic, non-alcoholic, non-smoker male presented to orthopaedic OPD with complain of pain in right hand and left leg with restriction of joint mobility for past 14 hours.On carefully eliciting the dietary history patient revealed that he was a vegetarian and was on high purine rich diet for past 2 weeks due to family functions and various gatherings. Patient gave the history of consumption of cauliflower, mushrooms, beans along with sweetened carbonated drinks on two consecutive days before the onset of these symptoms.Serum uric acid 4.5 mg/dl, C-reactive protein was 9 mg/dl. To best of our knowledge this is the first case being reported in literatures where purine rich vegetarian diet has induced new case of gout.This kind of gout precipitation after consuming vegetarian diet is rarely reported in literature. This case report emphasizes upon the need of special caution to be taken by persons who are genetically predisposed to gout, while consuming purine rich diet like red meat, seafood, cauliflowers, spinach, rajma, Bengal gram, mushrooms, soft drinks sweetened with fructose.

Claw Hand in Parsonage Turner syndrome

An elderly patient with an extensive smoking history presented with acute severe right-hand pain and evolving weakness with patchy sensory deficit. He had minimal relief from multiple analgesics, gabapentin, and acupuncture. Motor deficits in his right-hand progressed. A nerve conduction study confirmed motor-predominant polyneuropathy and magnetic resonance imaging (MRI) of his C-spine and brachial plexus ruled out apical lung mass or other structural lesions. A positive GalNAc-GD1a ganglioside antibody (IgG) was noted. A diagnosis of immune mediated neuralgic amyotrophy or Parsonage-Turner Syndrome was made. Intravenous immune globulin (IVIG) was started with partial improvement in motor function, six months later. Although this patient did not have SARS-CoV-2 infection nor was he recently vaccinated, this case is of interest to hospital-based internists as the Covid pandemic has seen an increase in the in reported cases of neuralgic amyotrophy worldwide due to the virus itself as well as the associated COVID-19 vaccines.

A Rare Case of Melorheostosis in the Hand of a Saudi Woman

Melorheostosis is a very rare bone dysplasia, especially in the hand. Most cases were diagnosed incidentally, with the lower limbs being the most affected. This is the first Saudi woman with hand melorheostosis.A 33-year-old Saudi female had mild to moderate right-hand pain that started six years ago. Hand examination showed a full range of motion and full hand grip, and there was no tenderness upon palpation. Plain X-ray, unenhanced CT scan, and MRI of the hand showed an appearance resembling dripping candle wax as melorheostosis. The bone scan showed a nonvascular and nonacute lesion. An unenhanced CT scan demonstrated cortical and endosteal hyperostosis involving the proximal, middle, and distal third and fourth phalanges. Multi-sequential MRI of the hand demonstrated cortical hyperostosis involving the ulnar and radial aspect of the right fourth proximal, middle, and distal phalanges.Features in the X-ray, CT scan, bone scan, and MRI confirmed a diagnosis of melorheostosis with associated flexor tenosynovitis.

Ayurvedic management of Ischemic Gangrene due to Diabetes Mellitus - A Case Report

Medical science says that ischemia is a common complication in Diabetes, especially in the lower limb but this is a case presenting ischemic changes in upper limb which is unique and also in such type of acute ischemia amputation is the only choice of treatment to save the life of patient from septicaemia. Such a rare and interesting case was taken at Sri Sri Ayurveda Hospital and handled by proper Ayurvedic line of treatment by which circulation is re-established which saved both limb and life of patient. A patient by name Sundaramma, 62yr Female, visited Sri Sri Ayurveda Hospital on 29/2/2016 with a diagnosis of Right upper limb Ischemia with Diabetes Mellitus and Active TB. The main symptoms were severe pain and burning sensation in Right hand and forearm, discolouration of fingers with ulcers, Bluish black discolouration over right thumb, necrosis, pus dischargeand stiffness, associated with difficulty in movement of right arm, shoulder joint, elbow joint, palm and fingers. Diagnosed as Right Upper Limb Ischemia with Diabetes Mellitus and active TB. Therapeutic interventions like Right upper limb Doppler and CT angiogram were done. Such a complicated case was taken at Sri Sri Ayurveda Hospital, and carefully handled by Ayurvedic methods of management, which was ended up by preventing amputation of the limb and also achieving the re-establishment of arterial circulation.

Compartment Syndrome of the Hand: A Rare Sequela of Transradial Cardiac Catheterization

A 64-year-old man who underwent percutaneous coronary intervention via right radial artery access reported right-hand pain and swelling 2 hours after the procedure. He had developed compartment syndrome of the hand, specifically with muscular compromise of the thenar compartment but with no involvement of the forearm. He underwent emergency right-hand compartment release and carpal tunnel release, followed by an uneventful postoperative course. In addition to our patient's case, we discuss compartment syndrome of the hand and related issues.

A Case Report of Complete Excision of Brachial Plexus Schwannoma: A Rare Entity

Brachial plexus schwannomas are rare benign nerve sheath tumors and only about 5% of schwannoma arise from the brachial plexus. They create a great challenge to surgeons due to their rare occurrence and complex anatomical location. We present a case of 37 yrs female presented with a right supraclavicular mass with severe radiating pain in right hand. Further investigation was done with MRI and FNAC which turns out to be huge right brachial plexus schwannoma. Gross total resection was done without any neurological motor defi cits. Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 92-93

Prevalence of musculoskeletal disorders among handloom weavers of Uttarakhand : an ergonomic study

Long hours of static work with awkward working postures at traditionally designed looms can cause high prevalence of musculoskeletal disorders (MSDs) among handloom weavers. Because of incompatible working situations handloom weaver in textile industries are confronting with many work related musculoskeletal problems related to pain and discomfort in upper and lower extremities. Keeping this in view, the present study was planned to assess the prevalence of musculoskeletal disorders and postural discomfort among handloom weavers. For this study, 64 (male and female) handloom weavers aged 20-55 years were selected randomly from Almora and Nainital districts of Uttarakhand state. To collect the information, standardized Nordic questionnaire was used to assess pain and discomfort in different body regions of handloom weavers. It was observed that those workers worked continuously in awkward postures during weaving activities. Consequently they suffered from high discomfort in their different body parts. High rate of pain and musculoskeletal disorder was most prevalent in right wrist, left wrist, hip/thigh, neck and lower back of the workers. The data reveled that since last 12 months, total 76.56 percent workers were suffered with pain and discomfort in right hand and 73.44 percent workers had pain and discomfort in both elbows. During last month, 73.44 percent workers were suffered with pain and discomfort in upper back because of awkward working postures whereas during 7 days, total 59.38 percent workers had pain in lower back. The study indicates that the traditional handloom weaving demands immediate ergonomic intervention in the workstation and process design.

Alexander Scriabin: his chronic right-hand pain and Its impact on his piano compositions.

Alexander Scriabin was an outstanding pianist and an avant-garde composer who influenced later generations with his innovative "multimedia" conceptions of aesthetic experience. As an adolescent, he was systematically trained as a concert pianist and received lessons from Vassily Safonoff, one of the founders of the legendary Russian Piano School. At age 20, Scriabin suffered an overuse injury of his right hand when attempting to improve the sound quality of his piano touch. This injury caused a deep crisis and influenced his later composition style in his piano works. From this time on, his works were frequently dominated by unusual virtuosic use and wide spans of his left hand. Rest, restricted repertoire, and an increased focus on composition contributed to recovery; however, he always remained anxious concerning the stamina of his right hand. The case report impressively demonstrates the stressors an aspiring young pianist had to cope with at the end of the nineteenth century. Furthermore, it is a convincing example of how resource-oriented behavior and intuition lead to the improvement of health status. Differential diagnoses and the modern concept of multimodal pain therapy in chronic overuse injury will be discussed from a historical perspective.

Unusual case of contralateral Horner's syndrome following stellate-ganglion block: a case report and review of the literature

Stellate-ganglion block (SGB) is a commonly performed procedure for the treatment of numerous conditions, including upper-extremity complex regional pain syndromes and arterial insufficiency. The appropriate response to SGB includes ipsilateral Horner’s syndrome and temperature elevation of affected extremity. Contralateral and bilateral Horner’s syndrome following SGB are rarely seen, with only six prior cases reported. We describe a case of a 47-year-old female with right-hand pain secondary to Raynaud’s phenomenon who underwent SGB with subsequent contralateral Horner’s syndrome and review the literature of this rare phenomenon.

Hypothenar Hammer Syndrome: Case Report and Review

BackgroundHypothenar hammer syndrome is a rare vascular overuse syndrome characterized by post-traumatic vascular insufficiency of the hand from repetitive compression over the hypothenar eminence. Patients with occupations predisposing to repetitive use of the hypothenar eminence as a tool are at high risk. Repetitive trauma compresses a superficial segment of the ulnar artery against the hook of hamate as it exits Guyon’s canal, damaging the intimal layer of the artery and causing vasospasm, platelet aggregation, and thrombus formation, leading to pain and paresthesias that eventually progress to claudication and ischemia. ObjectiveThe main objectives of this case report are to describe a representative example of hypothenar hammer syndrome and review common aspects of this clinical entity. Case ReportWe describe the case of a 71-year-old man working as a car mechanic who presented with right-hand pain of several months’ duration that was noted to have swelling and pain over the hypothenar eminence with associated paresthesias of the fifth digit. Duplex ultrasound imaging confirmed the presence of a dilated ulnar artery with arterial thrombus characteristic of hypothenar hammer syndrome. Conservative treatment, including cessation of activities that utilize the hypothenar region, was instituted with improvement in symptoms on follow-up evaluation. ConclusionsThis case report illustrates a rare clinical condition that with prompt and early identification by Emergency Physicians can prevent significant morbidity and progression of disease. The epidemiology, clinical features, and diagnosis are discussed along with a review of the relevant literature regarding available treatment options.

Ewings sarcoma of 4th metacarpal bone of right hand, a rare case report

Ewings sarcoma of the hand is relatively rare. Ewings sarcoma can present with minimal pain and swelling of the affected digit. The Erythrocyte sedimentation rate and C-reactive protein may be high. Because of these features, this can be confused with an inflammatory lesion. This leads to starting of inappropriate treatment and delay in diagnosis. Radiologically, Ewings sarcoma can present with a plethora of features from permeative bone destruction to expansile lesions with or without periosteal reaction. We present a case of 10 year old male, with complaints of pain and swelling in right hand, which on X-ray showed periosteal reaction, giving a sun burst appearance. So the provisional diagnosis of osteosarcoma was made. The diagnosis of ewings sarcoma was made on FNAC [fine needle aspiration cytology] which was later on confirmed on histopathology. We intend to report this case, because it is very rare location and the radiological features can mimic other lesions which commonly occur in this location like chronic osteomyelitis, osteosarcoma so it can be easily missed especially at preliminary evaluations.

The Doctor and the Elderly: A Patient's Perspective

The Doctor and the Elderly: A Patient's Perspective

Guyon's canal syndrome due to tortuous ulnar artery with DeQuervain stenosing tenosynovitis, ligamentous injuries and dorsal intercalated segmental instability syndrome, a rare presentation: a case report

The Guyon's canal syndrome is a well known clinical entity and may have significant impact on patient's quality of life. We report a case of 43-year-old male who presented with complaints of pain and numbness in right hand and difficulty in writing for past one month. On imaging diagnosis of Guyon's canal syndrome because of tortuous ulnar artery was made with additional findings of DeQuervain's stenosing tenosynovitis and dorsal intercalated segmental instability syndrome with ligamentous injury and subsequently these were confirmed on surgery.Although it is a rare syndrome, early diagnosis and treatment prevents permanent neurological deficits and improve patient's quality of life.

Melorheostosis in the Upper Extremity

Melorheostosis is a rare mesodermal disease affecting the skeleton and adjacent soft tissues. Often it is incidentally detected on radiographs. In the standard radiology and orthopedics literature, melorheostosis is described as a "flowing hyperostosis, resembling dripping candle wax as an incidental radiographic finding." A 22-year-old man presented with a 2-year history of right-hand pain. Radiologic evaluation of the hand showed massive sclerotic changes in the first and second metacarpal and phalangeal bones on the right side. Further radiographic evaluation of the right upper extremity revealed the same sclerotic changes in the right scapula, humerus, radius, and scaphoid. Computed tomography (CT) scans showed a high attenuation undulating cortical hyperostosis with a "dripping candle wax appearance" involving the radial and/or dorsal aspects of humerus, radius, scaphoid, and first and second ray bones of the hand. Radionuclide triphasic bone scintigraphy showed diffuse homogenous radiotracer uptake within the entire right upper extremity involving the scapula, humerus, radius, scaphoid, and first and second metacarpals and phalangeal bones of the hand. The patient was followed conservatively, and 1-year follow-up revealed no change in the clinical, laboratory, or radiological findings. The diagnosis of melorheostosis was made on the basis of the characteristic distribution, location, and combined radiographic, CT, and radionuclide imaging features of the abnormalities. Conservative treatment was recommended for the patient. After 26 months of follow-up, despite the persistence of the radiologic findings, the patient is currently well, with no painful symptoms unless he performs forceful exercise.

Focal Paraneoplastic Syndrome associated with small cell carcinoma of the lung

Sirs: Paraneoplastic neurological disorders (PND) are rare diseases, which are associated with systemic malignancy but are not caused by direct tumour invasion, infection, metabolic derangements or antineoplastic treatment. They are usually multi-focal but often comprise a number of distinct clinicopathological syndromes [1]. PND are most commonly associated with small cell lung cancer (SCLC). Other tumours include gynaecological cancers, lymphomas (especially Hodgkin’s disease), prostate, testicular, oesophageal and gastric cancers. Here we report a case of a focal paraneoplastic motor neuronopathy in association with SCLC. A 63 year-old right-handed female presented with loss of power and grip in the right hand, which rapidly became severe over a period of a few weeks. Her symptoms continued to worsen slowly for a total period of eight months. She had no pain or sensory loss in the right hand and no symptoms in the left hand or legs. Her neurological symptoms started 20 months after she was diagnosed with SCLC involving the left main bronchus, which was treated successfully with cryotherapy, local radiotherapy and cyclophosphamide, vincristine and etoposide chemotherapy. Her symptoms have been stable for the last 11 years. On examination there was gross wasting in the right hand with profound paralysis of all finger movements with normal upper limb reflexes. Routine blood tests were unremarkable. Antineuronal antibodies at first presentation were positive for the Hu antigen (1/500). CSF analysis showed intrathecal IgG synthesis but was otherwise normal. CT chest and bronchoscopy post-treatment did not show evidence of tumour recurrence. The Gadolinium enhanced MRI scan of the cervicalspine and brachial plexus was also normal. Neurophysiological studies are summarised in Table 1. Electromyography showed partial denervation and reinnervation in the C8, T1 segments. In summary, these results are consistent with a severe C8/T1 and moderate C7 segmental cord lesion which has been unchanged on repeated studies. PND typically but not necessarily precede the presentation of overt malignancy [1]. Here, we have described a case of unusual segmental cord damage at C7 to T1, which developed after the presentation and successful treatment of SCLC. Neurological involvement in this context is more commonly due to either tumour infiltration or a side effect of treatment. However, this is unlikely to be the case in our patient. Firstly, follow-up imaging and bronchoscopy excluded local tumour recurrence. Furthermore, contrast enhanced MR imaging of the cervical spine and brachial plexus did not show evidence of tumour infiltration. Secondly, the development of neuropathy outside the radiotherapy zone suggests that radiotherapy is unlikely to account for this presentation. Finally, vincristine neurotoxicity causes an early-onset dose-related sensorimotor neuropathy, which reverses with discontinuation [2] whereas etoposide causes a sensory-predominant or occasionally autonomic neuropathy [3]. SCLC is the commonest tumour found in association with PND, in the majority of cases with positive anti-neuronal antibodies [1]. Motor neuronopathy has been described mainly in Hodgkin’s disease and a case report of thymoma but not SCLC as a progressive, painless asymmetric weakness beginning in the legs associated with diminished or absent reflexes and lack of corticospinal tract signs [4, 5] which LETTER TO THE EDITORS

Patient's experience

Initially my husband and I thought that the symptoms I was experiencing (pain in my chest and right hand) were down to muscular pain and due to me carrying our...

Paroxysmal pain as sole manifestation of seizures

A developmentally normal 4-year-old white female who presented with pain in the right hand as the only manifestation of epilepsy is reported. Two years later, she developed complex partial seizures following right-hand pain. Computed tomography and magnetic resonance imaging were unremarkable. Prolonged ambulatory electroencephalography (EEG) as well as video-EEGs with ictal pain episodes failed to reveal abnormalities. Only a full night video-EEG performed after antiepileptic drug withdrawal demonstrated 2 right-hand pain episodes followed by a complex partial seizure with ictal epileptiform activity on the scalp EEG in the left parasagittal area, rapidly generalized and interictal discharges in the C3-P3 area. This patient had a very unusual presentation of epilepsy.