Repetitive Minor Trauma Research Articles

Middle phalanx epidermoid cyst, an unusual site: A case report

Epidermoid cysts are cutaneous cysts frequently observed among farmers, factory workers, carpenters, and tailors due to their occupations' predilection for repetitive minor hand trauma. A 66-year-old male laborer presented to our hospital with a swelling on the palmar aspect of his right middle finger. The swelling was accompanied by pain and an inability to work over the previous four months. A 2.5 cm × 2.5 cm smooth, tender, immobile, non-compressible hard swelling was detected just above the middle phalanx during the clinical examination on the volar aspect of the right middle finger. The diagnosis was confirmed by histopathology after excision. The patient's range of motion improved significantly following surgery, and his pain subsided. We present a novel location for an epidermal inclusion cyst and the importance of histopathologic evaluation in this case. Additionally, we emphasize the significance of extensively checking the cyst's epithelium to guarantee complete capsule removal and rule out any additional pathology.

A case of lunatomalacia

Lunatomalacia is a condition characterized by avascular necrosis of the lunate bone. It is also known as osteonecrosis, Kienbock´s disease, and aseptic or ischemic necrosis of the lunate. Although the mechanisms by which this disorder develops are not fully understood, compromise of the bone vasculature is the most commonly proposed cause. Both extraosseous and intraosseous blood vessels supply the lunate bone. Vessels that enter the lunate through the dorsal and volar poles of the bone make up the extraosseous blood supply. Pathomechanics where acute trauma or repetitive minor trauma leads to direct vessel break and ligament disruption causes blood supply interruption and bone necrosis. A 31-year-old male presented to the orthopedics outpatient department with pain and swelling over the right wrist since 1 year. Patient gave alleged history of trauma to wrist while lifting heavy object and Pain was sudden in onset, gradually progressive in nature and dull aching type which got aggravated by lifting weights and got relieved by taking rest and medication. On local examination, tenderness presented over radial styloid, ulna styloid and medial radio-ulnar joint. Wrist range of motion (ROM) range normal and terminally painful. Fovea sign - positive, suggest triangular fibrocartilage complex injury. Pain on ulnar deviation of wrist. The patient was managed with a form of splinting.

Topical Insulin and Normal Saline in Chronic Diabetic Foot Ulcers- A Prospective Analytical Study

Introduction: Diabetic foot ulcers are important diabetes-related microvascular complications aggravated due to multiple pre-existing factors such as peripheral arterial disease, immune system factors, bone abnormalities, diabetic neuropathy, infections and repetitive external or minor trauma. Diabetic foot ulcers could lead to lower limb amputation if not managed appropriately. Aim: To evaluate the use of topical insulin in chronic diabetic foot ulcers at a tertiary care centre. Materials and Methods: This prospective analytical study of 12 months duration was conducted in Department of Surgery, in diabetic patients between the age group of 25 to 70 years, presenting for the first time with diabetic foot ulcer. A total of 60 patients were divided into two groups alternately as group A patients underwent dressing with topical insulin and group B patients underwent dressing with regular normal saline. Sterile transparent gauze was placed on the wound to mark the wound borders and the wound area measured. With the help of ruler the two largest perpendicular diameters were measured and these were multiplied to obtain the wound area in cm2. Ulcers were cleaned with normal saline and a sterile gauze soaked with Human mixtard insulin and normal saline. Four units of 0.1 mL-Human mixtard insulin with 1 mL normal saline used for each 10 cm2 of wound in group A. Data was analysed by using SPSS software. Chi-square test was used and p-value of <0.05 was considered as significant. Results: Mean age distribution was 51.2±9.6 years and 50.6±10.9 years in group A and B, respectively. Mean HbA1c at admission was 6.3±0.9 and 6.1±0.8 in group A and B, respectively. On day 0,7,15 wound measurements were done. A statistically significant difference was noted in reduction of average surface area of wound at day 7, 15 between group A and B. Insulin dressing group showed better changes than saline dressing group. Percentage reduction of surface area of wound at day 15 was 67.8±11.45 in insulin dressing group and 49.51±18.21 in saline dressing group, statistically significant difference was noted. Average time required for granulation tissue to appear was 6.08±2.15 days and 9.48±4.21 days in group A and B, respectively, statistically significant difference was noted (p<0.001). Conclusion: The application of topical insulin is secure and successful in patients with diabetic foot ulcers. Topically applied insulin can increase speed of wound healing and there are no chances of systemic side effects.

Topical insulin and normal saline in chronic diabetic foot ulcers- A Prospective comparative study

Background: Diabetic foot ulcers are diabetes-related microvascular complications aggravated due to multiple pre-existing factors such as peripheral arterial disease, immune system factors, bone abnormalities, diabetic neuropathy, infections & repetitive external or minor trauma. Diabetic foot ulcers could lead to lower limb amputation if not managed appropriately. Studies have shown that insulin plays a vital role in wound healing. Objective: To evaluate the use of topical insulin in chronic diabetic foot ulcers at a tertiary care centre. Methods: A prospective study was conducted for a period of 12 months on 60 patients of the age group from 25-75 years who presented with diabetic foot ulcers were included. The subjects were divided into two groups, “group A” underwent dressing with topical insulin and group B underwent regular saline dressing. Sterile transparent gauze was used to measure the diameter). To calculate the wound area, these two diameters are multiplied to obtain an area in cm2. Ulcers were cleaned with normal saline and a sterile gauze soaked with Human mixtard insulin and normal saline 4 units 0.1 ml-Human mixtard insulin in 1 ml normal saline for each 10 cm2 of the wound in group A. Study data was analysed using SPSS software and Microsoft Excel software. Chi-square test was used to evaluate the results and P-value of <0.05 is considered significant. Results: Total of 60 patients were studied with Mean Age of 51.2 ± 9.6; 50.6 ± 10.9 years in group A & B respectively On day 0,7,15 wound measurements were done. A statistically significant difference was noted in the reduction of the average surface area of the wound at day 7, 15 between group A & B. insulin dressing group shown better changes than saline dressing group. Mean reduction in average surface area of the wound at day 15 was 67.8 ± 11.45 in insulin dressing group and 49.51 ± 18.21 in saline dressing group, statistically significant difference was noted. Average time required for granulation tissue to appear was 6.08 ± 2.15 days & 9.48 ± 4.21 days in group A & B respectively, statistically, a significant difference was noted (p< 0.001). Conclusion: The use of topical insulin is safe and effective in patients with diabetic foot ulcers. Topically applied insulin can accelerate wound healing without any systemic side effects.

Pachydermodactyly: A Rare Type of Macrodactyly as a Dermatological Sign of Compulsive Behavior and Repetitive Minor Trauma; a Case Report and Review of the Literature

Introduction: Pachydermodactyly is a very rare type of macrodactyly. It clinically resembles juvenile rheumatoid arthritis, but it has a non-inflammatory etiology without bone, articular, or synovial involvement. Case Presentation: In this study, we report the case of a 15-year-old boy with repetitive behavior diagnosed with a pachydermodactyly after evaluation of bilateral swelling of the proximal interphalangeal joints. Histologic examination revealed epidermal hyperorthokeratosis, thickening of the dermis with increased dermal collagen and absence of inflammatory cells. Pachydermodactyly is a very rare condition associated with compulsive behavior and results from repetitive minor trauma that causes localized proliferation of fibrous tissue. Conclusions: Pachydermodactyly is a dermatological sign of compulsive behavior and repetitive minor trauma, and it should be distinguished from other forms of joint enlargement to avoid unnecessary medicamentous treatment. Control examinations did not reveal clinically relevant worsening even without any treatment applied.

Influences on morphology and biomechanics in rabbit’s femur cortex of ovariectomy

Objective To investigate the influences on the femur cortex of the rabbit after ovariectomy and its mechanism. Methods Eighty 6 months-old female pure New Zealand rabbits were divided into two groups: 40 rabbits in ovariectomy group and 40 in sham-operation group. The weight averaged 2.2±0.28 kg. Four weeks and 8 weeks after operation, a series of tests were performed in both groups concerning the number, the volume, the rate and the maximal load of cortical bone porosity. The number, the length and the density of linear crack in rabbit femur cortex were documented after repetitive application of minor trauma. Results Micro-CT demonstrated that both on week 4 and 8 after operation, the number, the volume and the rate of cortical bone porosity were all significantly higher in ovariectomy group than that of the control group. Four weeks after operation, the biomechanical test showed the significantly lower average maximal load of rabbit femur in ovariectomy group (1 892.60±59.09) than that of in control group (1 949.25±53.12) (P=0.003). Eight weeks after operation, the average load of both groups decreased to some extent, which was 1 944.55±41.76 in control group and 1 692.40±85.08 in ovariectomy group respectively (P=0.000). However, the average maximal load of ovariectomy group decreased more significantly. Having application of repetitive minor trauma to the bone, the number, the length and the density of linear crack of cortical bone were 3.40±1.67, 216.80±17.60 μm and 0.40±0.08/mm2 in ovariectomy group, and 2.00±1.17, 160.45±16.89 μm and 0.29±0.13/mm2 in control group 4 weeks later. And after 8 weeks, they were 5.15±1.18, 334.60±13.94 μm and 0.35±0.10/mm2 in ovariectomy group, and 3.10±1.37, 182.10±9.80 μm and 0.24±0.09/mm2 in control group. The number, the length and the density of linear crack of cortical bone were all significantly higher in ovariectomy group than that of in control group both on week 4 and on week 8 after operation. Conclusion Ovariectomy increases the porosity of cortical bone of rabbit, destroys its biological property, accelerates the fatigued damage and delays the healing process. These changes may be attributed to fracture and delayed union after fracture. Key words: Rabbits; Ovariectomy; Femur; Biomechanics

Bilateral Stress Fracture at the Inferior Pole of Patella in a Juvenile Athlete

Patellar fractures in children occur rarely in approximately 1% of all pediatric fractures and 57% of these are osteochondral or cartilaginous avulsion fractures, a type of sleeve fracture. They may be missed in diagnosis due to small bony fragment on simple radiographs, and they always occur ipsilaterally; however, only a few cases of bilateral patellar fracture of the inferior pole have been reported. We experienced an 11 year-old patient an athlete, who suffered repetitive minor trauma, with a stress fracture, which occurred at the inferior pole of the patella bilaterally, and we report on this unusual case with a literature review.

Hemilaminoplasty for the treatment of lumbar intraspinal synovial cysts (LISCs) and literature review.

The present report intended to introduce the hemilaminoplasty technique and evaluate the efficacy of our surgical procedure for LISCs. This retrospective study was conducted to analyze the results in 24 LISCs who had undergone our hemilaminoplasty between 2000 and 2012 in two hospitals. All were confirmed by pathological histology and mid- to long-term follow-up had been performed in all cases with a mean of 4.9years. Using the Japanese Orthopedic Association scoring system (JOA score) and visual analog scale (VAS), symptoms resulting from cyst compression were quantified at various stage for statistical analysis. The JOA score and VAS of back/leg pain following surgery were improved significantly (P<0.01). At final follow-up, with normal aging there was a little decrease in JOA score and VAS of back/leg pain, but still significantly improved (P<0.01). Similarly, mean improvement rate of JOA was 83.5% at 1year after surgery while 75.6% at final visit. Successful bone healing was obtained at a mean of 3.8months after surgery. No cyst reformation and recurrent back/leg pain were observed around the surgical sites. These lesions could be regarded as a result of facet arthrosis/instability and repetitive facet minor trauma with herniation of synovium through the defective joint capsule. Improvement in lumbago and leg pain may be a consequence of complete cyst resection via hemilaminoplasty plus partial facetectomy with anatomical reconstruction of the posterior spinal elements.

Cartilage Imaging: A Review of Current Concepts and Emerging Technologies

s t b c c u o i m The evaluation of articular cartilage using advanced imaging techniques has become a focus of intensive research with numerous advancements in recent years. Cartilage damage may occur as the result of an acute injury or as a chronic degenerative process as in osteoarthritis. Acute injuries affecting articular cartilage are common in young athletes. In skeletally immature patients, chondral injuries are more prevalent than meniscal or cruciate ligament injuries.1 Chondral injuries can be classified into 3 basic patterns: (1) those that cause chondral, and possibly subchondral bone, damage but without disruption of the articular surface; (2) those that do disrupt the articular surface but are limited to involvement of the cartilage; and (3) those that cause mechanical disruption of both the cartilage and underlying bone.2 It is important to characterize the type of injury that has occurred so that the surgeon can make an informed decision as to the appropriate course of therapy. The sequela of chondral injury, whether due to an isolated major injury or repetitive minor trauma, is the development of osteoarthritis.3,4 Osteoarthritis is a degenerative joint disease affecting cartilage and the underlying bone. It is the most common arthritis and affects men and women equally. From 2007 to 2009, an estimated 22.2% (approximately 50 million) adults in the United States reported-doctor diagnosed arthritis and 9.4% reported arthritis-attributable activity limitation.5 It is the most common cause of disability among US adults. By 2030, an estimated 67 million Americans aged 18 years are proected to have doctor-diagnosed arthritis.6 The burden on the health care system from arthritis is not insignificant. In 2004, an estimated 3% of hospitalizations and 5% of ambulatory visits had a primary diagnosis of arthritis.6 In 2003, the estiated total cost attributable to arthritis and other rheumatoogic conditions in the United States was 128 billion dollars, ith an additional estimated 47 billion dollars in earning osses.6,7

Hand ischemia caused by solitary humeral exostosis irritating the brachial artery

A 39-year-old woman presented with ischemia of the left hand. Angiography revealed thrombosis of forearm arteries. Surgical intervention was unsuccessful. CT angiography revealed an exostosis on the distal humerus close to the brachial artery which we believe was the cause of repetitive minor trauma to the brachial artery leading to embolic occlusion of the radial and ulnar arteries. Early diagnosis of the underlying cause is the key to successful treatment of hand ischemia. For patients without risk factors for arterial occlusive disease, imaging of bony structures must be performed in order not to miss the likely cause of an insidious repetitive vascular trauma.

Cutaneous Metaplastic Synovial Cyst of the Cheek Generated by Repetitive Minor Trauma

Cutaneous metaplastic synovial cyst (CMSC) refers to a cyst lined by metaplastic synovial tissue including villous structures. It is thought to be a tissue reaction to local trauma, and most cases have a history of preceding surgery or trauma. Clinically, most of the lesion is a tender intradermal nodule that is associated with scar tissue. However, dermatologists have difficulty in diagnosing CMSC because CMSC is reported only rarely and its clinical manifestation can be confused with implantational epidermal cyst, suture granuloma or other cutaneous cysts. Thus, a histopathological exam is mandatory for diagnosis of CMSC. Herein we report the case of an 18-year-old man who developed CMSC on the left cheek on the posterior ramus of the mandible. He had a history of repetitive digital manipulation of the lesion before the onset of CMSC.

A Case of Pachydermodactyly

Pachydermodactyly (PDD) is a rare, benign form of digital fibromatosis and this is characterized by asymptomatic soft tissue swelling that affects the lateral aspects of the proximal interphalangeal (PIP) joints of the fingers. Although the etiology of PDD is unknown, the possibility of repetitive minor trauma by habitual or compulsive habits of interlacing the fingers or rubbing of the fingers has been suggested as a cause by several authors. We experienced a 14-year-old boy who was diagnosed as having PDD by the clinical manifestations and this was supported by a radiological study and the routine laboratory tests. He also had the habit of repetitively manipulating his hands when feeling emotional distress. PDD sometimes can be misdiagnosed as a rheumatic condition. Although an unusual disorder, PDD should be considered in the differential diagnosis of patients who present with digital bulbous swelling.

Neglected simultaneous bilateral femoral neck fractures secondary to narcotic drug abuse treated by bilateral one-staged hemiarthroplasty: a case report

Simultaneous bilateral femoral neck fractures are extremely rare and associated with various conditions. Up to now Most cases had correlations with major trauma, repetitive minor trauma, seizure, parathyroid or renal dysfunction, anti-epileptic medications, seizure, etc. A 28-year-old addict man referred to us with a 10-year history of narcotic drug abuse and history of 8 months bilateral groin pain. He admitted with displaced bilateral femoral neck fracture. Because of long duration of this condition and osteonecrosis revealed on bone scan, one-staged bilateral hip hemiarthroplasty was done. A good function was noted after surgery to 4-month follow up. Up to now, have not be founded in the literature that a case of bilateral femoral neck fracture associated with narcotic drug abuse.Because of negative effects of opium or smoking on bone tissues, a simple bone pain should aware us about the risk of stress or fatigue fracture.

Aetiology of Kienböck's Disease

A definite pathogenesis for Kienböck's disease (KD) has not been identifed yet. Considering our clinical experience, mechanical factors, acute trauma or repetitive minor trauma seem to not be a primary cause, but rather factors that cause symptom aggravation of an already present KD. I feel we should look for a biological more than for a mechanical cause. Probably a vascular non-traumatic process, with a minor infarction pattern in the proximal subchondral area, is nearest to the truth. Bone remodelling results from bone resorption by osteoclasts and the formation of new bone by osteoblasts. Why osteoclast action should overpass the osteoblastic activity in the repair process is still not known. Studies of genes related to osteogenesis with polymerase chain reaction (PCR) arrays are a new option. Considering avascular necrosis as a possible reactive arthritis, PCR and viral RNA analysis could help in making the diagnosis.

A Case of Avascular Necrosis of the Capitate Bone in a Pallet Car Driver

Avascular necrosis (AVN) of the capitate bone is very rare. It was first reported by Jonsson in 1942 and about 30 additional cases have been reported since. Most of the cases were associated with serious trauma, but in some cases, severe trauma has not played a major etiologic role. In our case, we propose that the cause of the avascular necrosis of the capitate bone was repetitive minor trauma and pressure on the palm that disturbed the blood supply.

Stress fractures of the base of the metatarsal bones in young trainee ballet dancers

Classical ballet is an art form requiring extraordinary physical activity, characterised by rigorous training. These can lead to many overuse injuries arising from repetitive minor trauma. The purpose of this paper is to report our experience in the diagnosis and treatment of stress fractures at the base of the second and third metatarsal bones in young ballet dancers. We considered 150 trainee ballet dancers from the Ballet Schools of "Teatro Alla Scala" of Milan from 2005 to 2007. Nineteen of them presented with stress fractures of the base of the metatarsal bones. We treated 18 dancers with external shockwave therapy (ESWT) and one with pulsed electromagnetic fields (EMF) and low-intensity ultrasound (US); all patients were recommended rest. In all cases good results were obtained. The best approach to metatarsal stress fractures is to diagnose them early through clinical examination and then through X-ray and MRI. ESWT gave good results, with a relatively short time of rest from the patients' activities and a return to dancing without pain.

Epidermolysis bullosa acquisita: concise review and practical considerations

Introduction Epidermolysis bullosa acquisita (EBA) is a cutaneous subepi-dermal autoimmune blistering disorder (CSEAIBD) that resultsfrom the effects of IgG autoantibodies directed against the145-kDa noncollagenous amino-terminal (NC-1) domain ofcollagen VII, a major component of anchoring fibrils (Fig. 1).

Examining the burden of work-related hospitalized injuries: definitional issues

Background:Identifying work-related injuries from hospitalization data is not straightforward. How a work-related injury, either acute or non-acute, is defined will affect injury enumeration, injury burden estimates, and subsequent priority setting...

Winged Scapula Caused by Rhomboideus and Trapezius Muscles Rupture Associated with Repetitive Minor Trauma: A Case Report

We experienced a rare case of winged scapula that was caused by the rupture of the rhomboideus major and the lower trapezius muscles without any nerve injury in a 12 yr old female after she had carried a heavy backpack. Electrodiagnostic study revealed that the onset latencies, amplitudes and conduction velocities were normal in the long thoracic nerve, the spinal accessory nerve and the dorsal scapular nerve. The needle EMG findings were normal as well. An explorative operation was performed and the rupture of the rhomboideus major and lower trapezius muscles was detected. Direct surgical repair of the ruptured muscle was carried out and the deformity was corrected. The anatomical and functional restoration was satisfactorily accomplished.

Rupture of the distal biceps tendon: A complication of using the drag-type ski lift

Rupture of the distal tendon of the biceps brachii is a rare injury which has previously been thought to represent 3% of all ruptures of biceps brachii. The incidence of this injury has been estimated at 1.2 per 100,000 population per year. Although rare, the injury does appear to be most commonly caused by an unintentional eccentric load to a flexed elbow with a shortened and contracted muscle forcing the joint into extension. Risk factors for rupture of the distal tendon of biceps are thought to include both local and systemic factors. Local factors, such as increased functional demand (which may occur in heavy manual labour or weight lifting) are implicated and a theory of repetitive minor trauma and hypoxia caused by mechanical impingement of biceps tendon during forearm rotation has been proposed. Systemic factors such as smoking, steroid use, hypercholesterolaemia, obesity and diabetes mellitus are also implicated. As previously reported, in most cases of rupture, tendon degeneration and subsequent rupture has a multi-factorial aetiology with a mixture of predisposing hereditary, structural, overuse and social factors. Rupture of the distal tendon may lead to a significant functional deficit with both a reduction of power and a decrease in range of movement of flexion at the elbow and supination of the forearm. We report two cases of rupture of the distal biceps tendon which had been sustained in the process of using 'button' lifts on skiing holidays. Previously described mechanisms of rupture of distal biceps tendon include weight lifting, 'spotting' gymnasts, carrying and catching heavy loads and ten pin bowling. Although the overall injury rate for skiers is known to be between two and five skier injuries per 1000 skiing days, a thorough literature search has not revealed any previously described cases where rupture of the distal biceps tendon has resulted from the use of the drag lift in ski resorts. Both patients reported the flexed elbow being subject to an eccentric load forcing the arm into extension which supports this as the likely mechanism to cause rupture. The principle of the drag lift is that once the bar is 'loaded' with the mass of a skier, the coiled drag cable is gradually released with increasing tension until the tensile force in the cable is enough to overcome the force of resistance caused by the mass of the skier, the force of gravity, the co-efficient of friction between skis and snow and the effect of the angle of the slope. When the cable force exceeds this combined force of resistance, motion is initiated and the skier will then be accelerated to the speed of the drag lift. The ski lift operators and designers clearly have to accommodate a wide range of skiers of varying weights. Snow conditions (and therefore co-efficient of friction) will always be changeable throughout a ski season and gravity is clearly a constant. The 'spring boxes' which allow progressive loading of the individual drag cables are manufactured to regulation standards and lift operators cannot change these. This means that ski lift operators can only influence two remaining factors. One factor is the initial gradient of the drag-lift run up which the skier is being 'dragged' and the other is the speed at which the drag lift runs. The area where a skier 'catches' the drag-lift is known as the loading area and guidelines from ski-lift manufacturers state that this loading area should be without an incline (Harrusch Lift Manufacturers). Both cases reported a slight incline at the loading area involved. The other factor which can be influenced is the speed of the lift. Most drag lifts run at speeds of between 300 and 400 feet per minute which can be changed by lift operators. Faster lift speeds cause a more sudden loading of the drag cable which would increase the risk of tendon rupture or other injury. If injuries such as the tendon ruptures here described are occurring as a result of drag lift use, we suggest that either the gradient of incline at the loading area of the lift is too steep or that the speed at which the drag cable runs is too great. Both of these factors could easily be addressed and we suggest that the issue (and implementation) of guidelines to ski lift operators regarding optimal gradient of incline and optimal lift speed may help avoid the excessive eccentric load on distal biceps tendon which can lead to rupture.