Volar Side Research Articles

A New Method for Detecting Dehydration of the Human Body Using Non-Contact Millimeter Wave Radiometry.

Dehydration is a common problem in the aging population. Medical professionals can detect dehydration using either blood or urine tests. This requires experimental tests in the lab as well as urine and blood samples to be obtained from the patients. This paper proposed 100 GHz millimeter wave radiometry for early detection of dehydration. Reflectance measurements were performed on healthy and dehydrated patients of both genders (120 males and 80 females) in the aging population. Based on the cause of dehydration, the patient groups were divided into three categories: (1) patients dehydrated due to less thirst sensation, (2) patients dehydrated due to illnesses (vomiting and diarrhea), and (3) patients dehydrated due to diabetes. Reflectance measurements were performed on eight locations: (1) the palm, (2) the back of the hand, (3) the fingers, (4) the inner wrist, (5) the outer wrist, (6) the volar side of the arm, (7) the dorsal surface of the arm, and (8) the elbow. Skin dehydrated due to vomiting and diarrhea was found to have lower reflectance at all the measurement locations compared with healthy and other types of dehydrated skin. The elbow region showed the highest difference in reflectance between healthy and dehydrated skin. This indicates that radiometric sensitivity is sufficient to detect dehydration in a few seconds. This will reduce the patient's waiting time and the healthcare professional's intervention time as well as allow early treatment of dehydration, thus avoiding admission to hospitals.

One-stage secondary debulking procedure: A unique technique to restore the differential contour of digit after groin flap reconstruction

BackgroundPedicled groin flap is a reliable reconstructive method for digits. However, problems with the contour, mobility and sensation especially while providing strict thin skin coverage still exist. Patients and MethodsA total of 17 cases with 36 digits injured by trauma were identified. One-stage secondary debulking procedure was adopted for flap revision. The skin over the flap was harvested as a full thickness graft. At the dorsal side of the reconstructed digit, the subcutaneous tissue and fat was debulked till the deep fascial layer. At the volar side, the flap was debulked till the superficial fascial layer. The skin was then re-grafted. The outcomes were reviewed after 12 months follow up. ResultsThe average timing for debulking procedure after flap reconstruction was 116 days. After removal of bolster dressing 7 days after debulking, all the grafted skin took well. A mean length of 2.5cm of digit was preserved for the non-replantatable digits. The reconstructed digits achieved comparable diameter and contour with that of the contralateral side. The two-point discrimination of the injured digits of adults was 10.4 ± 1.6mm. Using a 5-point Likert scale, post-debulking digits showed statistically significant improvement compared to pre-debulking digits. The evaluation of the patients’ satisfactory outcomes of the reconstructed digits was judged as “very satisfying” in 12 patients (75%) and “good results” in four (25%). ConclusionsOne-stage secondary debulking procedure resulted in excellent functional and aesthetic outcomes for digit according to different structure of dorsal and volar sides. Level of EvidenceIV, Retrospective

Monitoring of Caffeine Consumption Effect on Skin Blood Properties by Diffuse Reflectance Spectroscopy.

Caffeine is the most widely consumed psychoactive substance worldwide, affecting numerous tissues and organs, with notable impacts on the central nervous system, heart, and blood vessels. The effect of caffeine on vascular smooth muscle cells is an initial transient contraction followed by significant vasodilatation. In this study we investigate the use of diffuse reflectance spectroscopy (DRS) for monitoring of vascular changes in human skin induced by caffeine consumption. DRS spectra were recorded on volar sides of the forearms of eight healthy volunteers at time intervals of 0, 30, 60, 120, and 180 min after consumption of caffeine, while one subject served as a negative control. Analytical diffusion approximation solutions for diffuse reflectance from three-layer structures were used to assess skin composition (e.g. dermal blood volume fraction and oxygen saturation) by fitting these solutions to experimental data. The results demonstrate that cutaneous vasodynamics induced by caffeine consumption can be monitored by DRS, while changes in the control subject not consuming caffeine were insignificant.

Introducing the model of repeated exposure of skin to antiseptics: Randomised pilot trial.

Intensified hand hygiene measures were recommended for preventing the spread of SARS-CoV-2. However, these measures can lead to skin damage and the development of hand eczema, particularly among health professionals. This pilot study aimed to evaluate the effects of repeated antiseptic use on healthy skin under controlled conditions and to assess the emollient use. Twelve healthy volunteers (nine females, age = 22.3 ± 2.8 years (mean ± SD), Fitzpatrick phototypes II and III) with no skin diseases were recruited. Antiseptic was applied daily for 3 weeks on the volar sides of forearms. Emollient cream was also applied daily. Skin assessments were performed using non-invasive methods (transepidermal water loss-TEWL, skin hydration, erythema and melanin content). Prolonged antiseptic use increased TEWL, decreased hydration and elevated erythema and melanin levels. Emollient cream significantly reduced TEWL and improved hydration on antiseptic-treated sites, and also enhanced hydration on intact skin. Prolonged use of antiseptics can have adverse effects on the skin, including barrier disruption and inflammation. Emollient showed promise in improving skin hydration and reducing the damage caused by antiseptics. Further research with a larger sample is needed to confirm these findings and assess emollient efficacy during frequent antiseptic use.

Entrapment Neuropathies of the Median Nerve: An Updated Review

In this revision, we will try to address the entrapment neuropathies of the median nerve, from a clinical and practical approach, so as the family physicians or non-specialist practitioners can know more about these pathologies. Despite Carpal Tunnel Syndrome (CTS) is by far the most common entrapment neuropathy, we should know that not all the pains or paresthesias in the volar side of the hand or forearm are due to CTS. We will deliberately avoid too many anatomic data or specific treatment details, of limited utility in general practice. Nevertheless, in the references the reader can get much more information. If this paper can clarify several questions regarding the median nerve compression, signs and symptoms, the authors will feel more than happy, as this is our main objective.

Functional Outcome of Peripheral Nerve Injury after Pediatric Supracondylar Humerus Fracture: Comparison of Surgical and Conservative Treatment

Supracondylar humerus fractures are the most common elbow fractures in children up to 10 years of age. The incidence of associated nerve injuries varies up to 15% depending on the data. Traumatic and iatrogenic lesions mainly affect the ulnar nerve. The regeneration of peripheral nerves is comparatively better in childhood. In the present study, the functional results after surgical and conservative treatment of nerve injuries in children after supracondylar fractures were compared and analyzed for influencing factors. In this retrospective comparative study, clinical data of pediatric nerve injuries following supracondylar humerus fractures treated over a period of 13 years (2008-2021) were analyzed. Children who were treated surgically (neurolysis, autologous reconstruction) due to insufficient clinical/neurophysiological improvement within 6 months after trauma or who were followed up conservatively in case of regression of symptoms within 6 months after trauma were included. All patients underwent multidisciplinary follow-up. 48 patients (26 female/22 male) with nerve injuries were included in this study. All patients had a history of surgical treatment with K- wire fixation due to severe dislocated fractures. The mean age was 7±2 years. The initial symptoms were severe motor deficits in all patients and sensory deficits in 87.5% (n=42). Isolated lesions of the ulnar nerve were most common (n=24, 50%). The nerve was neurolysed in 21 patients and additionally transferred to the volar side in 15. Nerve grafting was performed in 7 children and split repair in 2. Postoperatively, there was a significant improvement in motor function in all patients. Despite comparably severe motor deficits at initial presentation, further 20 children were treated conservatively due to the regression of neurological deficits. They showed comparably good functional results. No serious complications were recorded in either group. The average follow-up time was 377.25±524.87 days. The presented study shows excellent functional results after surgical treatment of pediatric nerve injuries without severe complications. Children with comparatively high-grade lesions at initial presentation have a good chance of complete spontaneous remission even without surgery. For this reason, the indication for surgery in children should be very carefully considered.

Cutaneous nerve distribution around first extensor compartment of the wrist: Clinical implications for ultrasound-guided injections

To evaluate the course of the cutaneous nerve regarding the first extensor compartment to determine whether the dorsal or volar approach is safer for local injection into the first extensor compartment guided by ultrasound. We dissected the radial side of the wrists from 28 cadavers (52 wrists). Four-points along the imaginary line were set: the styloid process and 1 cm, 2 cm, and 3 cm proximal to the styloid process. The numbers of superficial radial nerve (SRN) and lateral antebrachial cutaneous nerve (LACN) branches were counted, and distances from the imaginary line at these points and nerve diameters were recorded. Digital images were superimposed to observe overall distribution of cutaneous nerve. There were means of 3.3 SRN and 0.9 LACN branches observed in each wrist. The mean number of both SRN and LACN branches was 2.3 on the dorsal side and 1.9 on the volar side. The superimposed images indicated that both the dorsal and volar sides comprised abundant cutaneous nerves and that their paths varied markedly between patients. However, we observed that larger nerves with meaningful diameters were more abundant on the dorsal than the volar side. There were similar numbers of cutaneous nerves on both the dorsal and volar sides; however, we observed greater abundance of thicker cutaneous nerves on the dorsal side, and these were closer to the reference line than on the volar side. This anatomical study suggests that the risk imposed to cutaneous nerves would therefore be reduced when injection on the volar side.

Three Sliding Probes Placed on Forelimb Skin for Proprioceptive Feedback Differentially yet Complementarily Contribute to Hand Gesture Detection and Object-Size Discrimination

The purpose was to assess the effectiveness of three sliding tactile probes placed on the forelimb skin to provide proprioceptive feedback for the detection of hand gestures and discrimination of object size. Tactile contactors representing the first three fingers were driven along the proximodistal axis by linear servo motors. Twenty healthy subjects were involved in the gesture detection test, with 10 of them also participating in the object-size discrimination task. Motors were controlled by computer in the first four sessions of the gesture detection experiment, while the fifth session utilized a sensorized glove. Both the volar and dorsal sides of the forearm were examined. In the object-size discrimination experiment, the method was exclusively assessed on the volar surface under four distinct feedback conditions, including all fingers and each finger separately. The psychophysical data were further analyzed using a structural equation model (SEM) to evaluate the specific contributions of each individual contactor. Subjects consistently outperformed the chance level in detecting gestures. Performance improved up to the third session, with better results obtained on the volar side. The performances were similar in the fourth and fifth sessions. The just noticeable difference for achieving a 75% discrimination accuracy was found to be 2.90 mm of movement on the skin. SEM analysis indicated that the contactor for the index finger had the lowest importance in gesture detection, while it played a more significant role in object-size discrimination. However, all fingers were found to be significant predictors of subjects' responses in both experiments, except for the thumb, which was deemed insignificant in object-size discrimination. The study highlights the importance of considering the partial contribution of each degree of freedom in a sensory feedback system, especially concerning the task, when designing such systems.

Flexor Pronator Slide Under Local Anesthesia without a Tourniquet for Non-Ischemic Contractures of the Forearm.

Flexor Pronator Slide Under Local Anesthesia without a Tourniquet for Non-Ischemic Contractures of the Forearm.

Case Report: Intravascular Papillary Endothelial Hyperplasia In An Older Man

Masson's tumor is a benign tumor consisting of reactive proliferation of endothelial cells. It was first described by the French doctor, Pierre Masson, in 1923. A higher incidence was observed among women (1.3:1), and the average age at which it occurs is 31 years. It appears as a firm mass, with the appearance of a nodule or papule, located subcutaneously. The adjacent integument is bluish or reddish. On palpation it can be sensitive or painless. We will present the case of an 81-year-old man with Masson's tumor located at the level of the volar side of the left forearm, at the level of the flexor ulnar muscle of the carpi, which affects the ulnar artery.

Evaluation of skin prick location on the forearm using a novel skin prick automated test device.

The skin prick test (SPT) is the gold standard for identifying allergic sensitization in individuals suspected of having an inhalant allergy. Recently, it was demonstrated that SPT using a novel skin prick automated test (SPAT) device showed increased reproducibility and tolerability compared to the conventional SPT, among other benefits. This study aimed to evaluate prick location bias using the novel SPAT device. A total of 118 volunteers were enrolled in this study and underwent SPATs with histamine (nine pricks) and glycerol control (one prick) solutions on the volar side of their forearms. Imaging of the skin reactions was performed using the SPAT device, and the physician determined the longest wheal diameter by visually inspecting the images using a web interface. Prick location bias was assessed along the medial vs. lateral and proximal vs. distal axes of the forearm. In total, 944 histamine pricks were analyzed. Four medial and four lateral histamine pricks were grouped, and wheal sizes were compared. The longest wheal diameters were not significantly different between the medial and lateral prick locations (p = 0.41). Furthermore, the pricks were grouped by two based on their position on the proximal-distal axis of the forearm. No significant difference was observed among the four groups of analyzed prick locations (p = 0.73). The prick location on the volar side of the forearm did not influence wheal size in SPAT-pricked individuals.

Biomechanical study of the fixation ability of the dorsal and volar locking plate for transverse metacarpal neck fractures.

Metacarpal neck fracture is one of the most common types of hand fractures; the literature suggests that applying a bone plate on the dorsal side provides higher fixation strength than that provided by other fixation methods. However, bone plate fixation on the dorsal side may result in postoperative tendon adhesion. So far, no studies have investigated the fixation of metacarpal neck fractures on the volar side by using a bone plate. The objective of this study was to investigate the differences in the fixation results between bone plate fixation on the dorsal side and bone plate fixation on the volar side of the metacarpal in the case of a metacarpal neck fracture. A saw blade was used to create a transverse metacarpal neck fracture on 14 artificial metacarpal bone specimens. The specimens were divided into 2 groups depending on the fixation method: a volar locking plate (VLP) group and a dorsal locking plate (DLP) group. All specimens were subjected to a cantilever bending test on a material testing system, and a force-displacement curve was used to measure the yield force and stiffness, which served as an indicator of the fixation ability of the 2 fracture fixation methods. For the experimental results, the Mann-Whitney U test was used to compare the fixation abilities of the 2 fixation methods. In terms of yield force, the DLP group (266.9 ± 68.3 N) scored significantly higher than the VLP group (32.6 ± 2.7 N) (P < .05); expressed in terms of median, the DLP group scored 8.2 times higher than the VLP group. Similarly, in terms of stiffness, the DLP group (69.0 ± 13.4 N/mm, median ± interquartile range) scored significantly higher than the VLP group (12.9 ± 1.4 N/mm) (P < .05); expressed in terms of median, the DLP group scored 5.3 times higher than the VLP group. The fixation strength of volar bone plates is only about one-third of that of dorsal bone plates.

Anomaly originated flexor digitorum superficialis muscle of the small finger: A case report.

We present a clinical case of flexor digitorum superficialis (FDS) muscle belly of the small finger originating from the palm of a patient undergoing carpal tunnel surgery with a literature review. A 28-year-old right-handed woman visited our hospital with a chief complaint of a continuous tingling sensation and weakness in the right hand, which began after the volar side of her wrist was crushed by a machine during work 2 weeks prior. The patient complained of a continuous tingling sensation in the thumb, index, and middle fingers. The patient had a positive result on Tinel test of the median nerve of the wrist. As electromyography and nerve conduction velocities showed signs of severe injury in the right median nerve, exploration and carpal tunnel release were planned. Carpal tunnel release was performed under regional anesthesia using the classical open approach. The median nerve in the distal forearm and distal portion of the flexor retinaculum appeared to be narrowed and compressed. An anomalous muscle originating from the flexor retinaculum is also observed. The FDS muscle of the small finger was excised at the flexor retinaculum and musculotendinous junction and sutured to the flexor digitorum profundus tendon. At the 37-month follow-up, the patient did not experience any tingling sensation or weakness. She showed excellent range of motion of the right small finger. The grip strength was 20 kg on both the right and left sides. Quick disabilities of the arm, shoulder, and hand score was 2.3. Asymptomatic small finger FDS muscle anomalies can occur, as demonstrated in this case study. Thus, physicians should familiarize themselves with small finger FDS muscle anomalies during interactions with patients to facilitate future treatments of patient complaints related to the hand, as well as wrist laceration or trauma requiring hand exploration.

Radioulnar Instability and Ulnar Stump Stabilization in Distal Radio Ulnar Joint Arthritis: A Cadaver Study.

Salvage procedures for distal radioulnar joint (DRUJ) arthritis, like the Darrach or Sauvé-Kapandji (S-K) procedures, often result in extensor tendon ruptures at the ulnar stump. Radioulnar instability is considered the underlying cause and stump stabilization techniques are employed. This study investigated radioulnar instability, extensor tendon irritation, and the effectiveness of stump stabilization techniques following salvage procedures. Six upper limbs from three cadavers were used. Forearm rotation was measured using magnetic position sensors to assess radial movement. The Darrach procedure was performed on two limbs, comparing radial motion ranges for different ulnar osteotomy positions. The risk of tendon rupture was assessed with applied weight. The S-K procedure was performed on four limbs, evaluating stump stabilization techniques and radial movement distance underweight. Proximal osteotomy positions increased radial motion range. Extensor tendon irritation occurred when the load was applied to the volar and ulnar sides, particularly with a pronated forearm. Stump stabilization techniques did not significantly contribute to ulnar stump stabilization. Proximal ulnar osteotomy positions in DRUJ salvage procedures led to increased radioulnar instability and potential complications. Load application on the volar and ulnar sides, especially in a pronated forearm, increased the risk of tendon rupture. Stump stabilization techniques showed limited utility in stabilizing the ulnar stump or reducing complications. These findings can inform strategies for minimizing complications in DRUJ salvage procedures.

MANAGEMENT OF UNCOMMON INJURY OF 2ND METACARPOPHALANGEAL JOINT (KAPLAN'S DISLOCATION) BY OPEN DORSAL APPROACH: A CASE REPORT

Introduction: The rst Metacarpophalangeal (MCP) joint is among the most commonly injured joints in the hand, it is because of the signicant contribution of the thumb to overall hand function and its amenability to injury in work and sporting activities. In contrast to MCP dislocation of the thumb, dislocation of the other MCP joint is an uncommon. Kaplan dislocations following trauma are of rare occurrence. An uncomplicated MCP joint dislocation can be managed by closed reduction but complicated dislocation always needs open reduction for better outcome. Case Report: Here, we present a case of 26 year old male with 3 months old fracture dislocation of 2nd MCP joint Right hand, which was managed by open dorsal approach with proper reduction, k wire xation and good functional outcome. We expe Conclusion: rienced when dislocation is complete, with the head of the metacarpal displaced towards the volar side and the base of the phalanx towards the dorsal side, the dorsal approach of is found to be safe and simple with good visualization, negligible injury to Neurovascular structure and better xation

Tendon Sheath Incision for Surgical Treatment of Trigger Finger.

Open trigger finger release is an elective surgical procedure that serves as the gold standard treatment for trigger digits. The aim of this procedure is to release the A1 pulley in a setting in which the pulley is completely visible, ultimately allowing the flexor tendons that were previously impinged on to glide more easily through the tendon sheath. Although A1-or the first annular pulley-is the site of triggering in nearly all cases, alternative sites include A2, A3, and the palmar aponeurosis1. Typically, the surgical procedure can be conducted in an outpatient setting and can vary in duration from a few minutes to half an hour. The surgical procedure involves the patient lying in the supine position with the operative hand positioned to the side. A small incision, ranging from 1 to 1.5 cm, is made on the volar side of the hand, just proximal to the A1 pulley in the skin crease in order to minimize scarring. Once the underlying neurovascular structures are exposed, the A1 pulley is released longitudinally at least to the level of the A2 pulley, followed by decompression of the flexor tendons that were previously impinged on. In order to confirm the release, the patient is asked to flex and extend the affected finger. The wound is irrigated and closed once the release is confirmed by both the patient and surgeon. Aside from an open release, trigger finger can be treated nonoperatively with use of splinting and corticosteroid injection. Alternative operative treatments include a percutaneous release, which involves the use of a needle to release the A1 pulley2. Trigger finger can initially be treated nonoperatively. If unsuccessful, surgical intervention is considered the ultimate remedy2. Because of their efficacious nature, corticosteroid injections are indicated preoperatively, particularly in non-diabetic patients3. Splinting is often an appropriate treatment option in patients who wish to avoid a corticosteroid injection1. However, if nonoperative treatment modalities fail to resolve pain and symptoms, surgical intervention is indicated2. In comparison with a percutaneous trigger finger release, an open release provides enhanced exposure and may be safer with respect to avoiding iatrogenic neurovascular injury2. However, in a randomized controlled trial, Gilberts et al. found no difference in the rates of recurrence when comparing open versus percutaneous trigger finger release4. With reported success rates ranging from 90% to 100%, the open release of the A1 pulley is considered a common procedure associated with minimal complications2. Complications of the procedure were assessed in a retrospective analysis of 43 patients who underwent 78 open trigger releases performed by 1 surgeon. In that study, the authors reported a minor complication rate of 28% and a major complication rate of 3%5. Specifically, the 2 major complications noted by the authors were a synovial fistula and a proximal interphalangeal joint arthrofibrosis. In a larger study that included 543 patients who underwent 795 open trigger releases, the authors reported a minor complication rate of 9.6% and major complication rate of 2.4%6. Furthermore, the most common complications involved persistent stiffness, swelling, or pain. In that analysis, the authors suggested that sedation, male gender, and general anesthesia may be associated with greater risk6. At the discretion of the surgeon, a longitudinal, transverse, or oblique incision is made directly on top of the tendon at the level of the metacarpophalangeal joint, which is the preferred incision site because it provides maximal accessibility to the A1 pulley.Local anesthesia is preferred because it allows the patient and surgeon to confirm the release immediately.If conducting an open trigger release on the thumb, the surgeon should identify and protect the radial digital nerve, which courses directly over the A1 pulley. MCP = metacarpophalangeal.

Case Series of Three Cases of Madura’s Foot with a Characteristic ‘Dot in Circle’ Sign: A Radiologist Perspective

Madura’s foot is a rare infectious granulomatous disease affecting the foot. The incidence of this disease has decreased in recent years due to improved living conditions. However, it can still be misdiagnosed by inexperienced surgeons as other similar conditions. Early and accurate diagnosis is crucial for optimal treatment and limb preservation. In this study, the authors present three unusual cases of Madura’s foot. A 23-year-old woman presented with swelling and draining sinuses in her left foot for six years. Imaging tests including Ultrasonography (USG), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) revealed the characteristic ‘dot in circle’ sign of Madura’s foot. However, her USG-guided biopsy did not confirm the diagnosis, and it was only through an excisional biopsy that actinomycetoma was confirmed. Another case involved a 60-year-old male with multiple soft tissue swellings on his right foot for 10 years, resulting in foot deformity. Radiographs showed multiple punched-out lytic lesions in the bones, while USG and MRI exhibited the typical ‘dot in a circle’ sign. Histopathological examination confirmed actinomycetoma. The third case involved a 36-year-old male with a chronic sinus discharging yellow pus and black granules on the volar side of his right foot. USG and MRI revealed the classic signs of Madura’s foot, and these findings were correlated with histopathological examination. The present cases confirm the specificity of the ‘dot-in-circle’ sign on MRI and USG, supported by histopathological correlation.

Percutaneous Removal of a Foreign Body From the Distal Phalanx Using a 14 Gauge Needle and Fluoroscopy

Percutaneous Removal of a Foreign Body From the Distal Phalanx Using a 14 Gauge Needle and Fluoroscopy

The Oblique Extended Reverse First Dorsal Metacarpal Artery Perforator Flap for Coverage of the Radial-Volar Defect of the Proximal Interphalangeal Joint in the Index Finger: A Case Report.

The dorsal metacarpal artery perforator flap is a flap that rises from the hand dorsum. Owing to its reliability and versatility, this flap is used as a workhorse for finger defect. However, to cover the radial-volar defect of the proximal interphalangeal joint (PIPJ) of the index finger, a longer flap is required than before. Here, we introduce the oblique extended reverse first dorsal metacarpal artery (FDMA) perforator flap to cover the radial-volar aspect defect of the index finger. A 45-year-old man got injured to the radial-volar defect of PIPJ of the left index finger caused by thermal press machine. The wound was 2 × 1 cm in size, and the joint and bone were exposed. We used FDMA perforator from anastomosis with palmar metacarpal artery at metacarpal neck. Since the defect was extended to the volar side, the flap was elevated by oblique extension to the fourth metacarpal base level. The fascia was included to the flap, and the flap was rotated counterclockwise. Finally, PIPJ was fully covered by the flap. Donor site was primarily closed. After 12 months of operation, the flap was stable without complication and limitation of range of motion. The oblique extended reverse FDMA perforator flap is a reliable method for covering the radial-volar defect of the PIPJ of the index finger. This flap, which also has an aesthetic advantage, will be a good choice for hand surgeons who want to cover the PIPJ defect of the index finger using a nonmicrosurgical option.

Ulnar Wrist Mass, Large But Not Giant

HISTORY: An active 60 year old complained of a mass on the volar ulnar side of the right wrist. First appeared seven months prior and continued to grow in size. Initially symptoms were aching pain, decreased grip strength and reduced wrist flexion interfering with physical activity and work. One month later they developed ulnar side numbness. PHYSICAL EXAM: Soft non discrete, non pulsatile mass off the volar ulnar side of the wrist deep to the FCU tendon. No atrophy. Able to fully flex and extend fingers. Weakness with wrist extension and little finger extension. TFCC load test negative. Froment’s sign negative. Light touch sensation grossly intact. DIFFERENTIAL DIAGNOSIS: Triangular fibrocartilage complex cyst, Ganglion Cyst, Tenosynovial giant cell, tumorfibroblastic/myofibroblastic lesion. TEST AND RESULTS: Wrist frontal, lateral and oblique radiographs: No underlying osseous abnormalities. Focal soft tissue bulge along ulnar aspect of the wrist. No underlying erosion. No gas or radiopaque foreign body. Wrist MRI: Mass within the volar and medial soft tissues of the wrist from the level of the distal ulnar epiphysis to the proximal aspect of the pisotriquetral articulation causing a mass effect and displacement of the adjacent ulnar neurovascular bundle. The mass demonstrates low signal intensity on T2 FS and T1. Excisional Biopsy: benign paucicellular fibrocollagenous proliferation. FINAL DIAGNOSIS: Benign fibroma of tendon sheath. TREATMENT AND OUTCOMES: Surgical excision of the volar ulnar wrist mass. The ulnar neurovascular bundle was displaced radially due to the mass. The homogeneous mass measuring 3 x 2.8 x 1.5 cm was removed in one piece and sent to pathology. At the 2 week follow up, the patient was fitted with a customized thermoplastic volar hand, wrist and forearm based orthosis since OTC DME splint would not fit with the proximal end being over the surgical site. At 4 weeks post op, the patient was doing very well and beginning to wean out of the wrist brace.