1/7. Freon injection injury to the hand. A report of four cases.During a 6-month period, the poison center was consulted on three occasions for advice regarding accidental injection of hexafluorethane (Freon) used in the manufacturing process of athletic shoes. A fourth case was later identified after consulting physicians near the manufacturing facility. Little information exists in the medical literature concerning injection of freon or other volatile substances. In each of these cases, workers inadvertently injected concentrated hexafluorethane into a finger while holding the shoe component and attempting to inject hexafluorethane. Each case presented with edema, limitation of motion, and crepitation. hand roentgenogram revealed subcutaneous gas. Treatment was nonsurgical, consisting of splinting, tetanus immunization, and antibiotics. Rapid resolution of symptoms occurred in all four cases. Hexafluorethane is relatively inert when injected and has low toxicity. However, potential rapid expansion warrants observation for pressure injury.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. hair-thread tourniquet syndrome .We have witnessed six cases of the hair-thread tourniquet syndrome, an entity characterized by strangulation of an appendage (toes, fingers, or external genitalia) by hair or hair-like fibers in the pediatric population. All six of our cases were in infants, 12 days to 5 months of age. The offending fibers were hair in three of the four patients with toe injuries and synthetic fibers from mittens in the finger cases. All six patients were treated by immediate removal of the constricting fibers, and, in spite of the worrisome appearance of the tissue distal to the constriction, all six eventually healed without significant tissue loss. A review of the literature indicated 60 similar cases of this type reported, 24 involving toes, 14 involving fingers, and 22 involving genitals. The majority of the toe and external genitalia cases were caused by hair, whereas the majority of finger strangulations were caused by thread from mittens. At greatest risk for strangulation are the middle finger and third toe, followed by the index finger and second toe. patients with finger or penile involvement were more likely to suffer significant complications from the injuries than those patients with toe involvement. Based on our own experience and that described in the literature, we recommend prompt removal of the offending fiber, followed by prolonged conservative management of the damaged distal tissue, in the hope of maximal tissue salvage. Increased physician awareness of this syndrome is mandatory for prevention, diagnosis, and early treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Troublesome shaft fractures of the proximal phalanx. Early treatment to avoid late problems at the metacarpophalangeal and proximal phalangeal joints.Although any fracture of the proximal phalanx can potentially disrupt finger MCP and/or PIP motion, appropriate consideration based on sound principles of biomechanics and biology of healing will delineate the options available. Applying the risk/benefit associated with any particular mode of treatment is more challenging. Perhaps the most difficult thing is to anticipate and recognize failure of a treatment mode sufficiently early and then to act concisely to rectify the situation. The physician and patient must recognize what goal is realistic for each patient's injury. This encompasses the patient factors as outlined, as well as a clear awareness in the surgeon's mind of his or her technical limitations and expertise. Final function and range of motion of the MCP and PIP joints will depend not only on bony union in good position, but on restoration of the gliding function of the flexor and extensor tendons that are contiguous to the fracture site.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. mycobacterium terrae tenosynovitis: chronic infection in a previously healthy individual.We have described a case of mycobacterium terrae tenosynovitis in an otherwise healthy individual. The chronic nature of this infection suggests that aggressive surgical and medical therapy is the most prudent course for physicians faced with this infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Displaced intra-articular osteochondral fracture--cause for irreducible dislocation of the distal interphalangeal joint.One cause of irreducible dislocation of the distal interphalangeal joint is the interposition of the palmar plate or the flexor tendon between the joint surfaces. This case report describes another cause for an irreducible dislocation. Radiographic findings on the initial films are discussed to alert the attending physician to the possibility of an osteochondral fracture. Open reduction resulted in an essentially normal joint 17 months later.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. High-pressure injection injuries to the hand.Despite their appearance for over 20 years, high-pressure injection injuries to the hand are often grossly undertreated or mistreated, resulting in usually avoidable permanent impairment--often with amputation. Primary care physicians, and especially emergency room physicians, must be aware of the serious nature of this usually innocuous-appearing injury and immediately refer such patients for definitive emergency surgery.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/7. Successful management of female office workers with "repetitive stress injury" or "carpal tunnel syndrome" by a new treatment modality--application of low level laser.female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as "repetitive stress injury" (RSI) or "carpal tunnel syndrome" (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation, they have pain and tenderness at the spinous processes C5-T1 and the medial angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser (100 mW) was used and directed at the tips of the spinous processes C5-T1. The laser rapidly alleviated the pain and tingling in the arms, hands and fingers, and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labelled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities which can be managed by low level laser. Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck and shoulder posture by taping, cervical collars, and clavicle harnesses as well as improved work ergonomics.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |