(1) Background: Enchondroma is one of the most common primary tumors of the hand. Usually asymptomatic, it can present with pain, deformity, and sometimes pathologic fractures. Surgical treatment is advised in these cases. Curettage is the basic treatment, but there is no consensus in the literature regarding post-void filling. The aim of our study is to present simple curettage and early mobilization as a safe and effective treatment. (2) Methods: We retrospectively analyzed patients treated at our center between 2020 and 2024. Each patient was treated with simple curettage and early mobilization. We collected demographic data and follow-up data. (3) Conclusions: We recorded no complications in our cohort, pointing out that our method is safe and reliable without any kind of immobilization. Bone grafts and other methods such as cement are good options but should be considered in specific cases.
Introduction: The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique has revolutionized outpatient hand surgery, enabling procedures such as carpal tunnel release and trigger finger release without a tourniquet. Its benefits include patient cooperation during surgery, especially for tendon repairs. However, WALANT has limitations, including a steep learning curve, longer operative preparation time, and risks such as digital ischemia and adrenaline-induced cardiac ischemia. This study evaluates the safety and effectiveness of local anesthesia with a tourniquet for short-duration outpatient hand surgeries. Materials and Methods: This case series included 300 patients undergoing carpal tunnel or trigger finger release between February 2023 and March 2024. Local anesthesia with lidocaine was administered, and a tourniquet was applied to the proximal arm. Demographic data, operative time, and pain levels during tourniquet use (measured by VAS) were recorded. Results: The average surgical time was 12 min. Most procedures involved carpal tunnel release. The average VAS pain score was 3.73, with older patients and longer surgeries reporting higher discomfort. Tourniquet release was required in only 1% of cases due to discomfort. Conclusions: For short outpatient hand surgeries, local anesthesia with a tourniquet is a safe, effective alternative to WALANT, challenging its routine use and highlighting the need for tailored anesthetic approaches.
Background: Trapeziometacarpal (TM) joint arthritis is a common condition causing pain and functional limitations, particularly in activities requiring pinch and grip strength. Surgical options such as interposition trapeziectomy and prosthetic joint replacement have demonstrated varying degrees of success. However, the role of post-operative rehabilitation in optimizing outcomes for these procedures remains underexplored. Effective rehabilitation may be critical for restoring strength, range of motion (ROM), and overall hand function; yet, no consensus exists on the best approach for either surgical modality. This study aims to evaluate the impact of post-operative rehabilitation on functional and clinical outcomes in patients undergoing interposition trapeziectomy versus prosthetic replacement for TM joint arthritis. Methods: A retrospective cohort study was conducted on patients treated for TM joint arthritis between November 2023 and October 2024. Patients were divided into two groups based on the surgical procedure: interposition trapeziectomy and prosthetic replacement. Patients randomly followed post-operative rehabilitation protocols, auto-assisted exercises, or no type of rehabilitation. The outcomes assessed included pain (VAS), return to work or heavy activities, post-operative complications, hand function (DASH score), and patient satisfaction at 1 and 6 months after surgery. Results: The prosthesis group consisted of 30 patients, while 31 patients underwent interposition trapeziectomy. Patients in both groups showed good improvements in pain, ROM, and hand function post rehabilitation. The prosthetic group demonstrated a faster recovery of strength and higher early satisfaction scores, but in the long term, the results were overlapping. No significant differences were observed in long-term functional outcomes or patient satisfaction at 6 months. In the trapeziectomy group, for patients who followed a rehabilitation program, no significant differences were found. Conclusions: Post-operative rehabilitation finds its place in recovery after both interposition trapeziectomy and prosthetic replacement for TM joint arthritis. While prosthetic replacement allows for quicker functional recovery, interposition trapeziectomy offers comparable long-term results with a lower complication profile. Tailored rehabilitation protocols may enhance outcomes and should be considered an integral part of TM joint arthritis management in selected patients.
Background: Secretan’s syndrome is a rare and under-recognized condition characterized by chronic, indurated, non-pitting edema of the dorsal hand with thumb sparing. Twelve studies reporting 17 patients have been published worldwide, mostly as isolated case reports, and its pathogenesis remains debated between traumatic, inflammatory, and factitious mechanisms. This article presents a surgically managed hyperplastic case and a literature review, highlighting how precision medicine principles can guide diagnosis and treatment. Materials and Methods: A 36-year-old healthcare worker developed progressive dorsal swelling of the left hand following minor trauma, with marked restriction of metacarpophalangeal flexion. Laboratory tests and radiographs were normal. MRI demonstrated peritendinous fibrosis encasing the extensor tendons. Psychiatric evaluation excluded factitious behavior. Due to functional limitation and MRI evidence of fibrosis, selective fasciotomies and tenolysis were performed. A systematic literature review was conducted, in accordance with the PRISMA 2020 guidelines, to summarize epidemiology, clinical and imaging features, histopathology, and management options. Results: Histology revealed fibro-adipose tissue with chronic inflammatory changes and CD68+ histiocytic aggregates; microbiological cultures were negative. Postoperative rehabilitation enabled significant functional recovery. The literature review confirmed the scarcity of published cases and the absence of standardized guidelines. MRI proved the most informative imaging tool, while surgery was described only in refractory forms. Conclusions: This case and review illustrate how a precision medicine approach can optimize management of rare disorders. Early MRI-based diagnosis, multidisciplinary assessment, and phenotype-driven surgical intervention allowed tailored treatment and favorable outcome. Personalized care that integrates clinical features, imaging findings, and patient-specific factors may improve results despite the limited evidence base.
Background: Cubital Tunnel Syndrome (CuTS) is the second-most common compressive neuropathy of the upper limb, traditionally associated with prolonged elbow flexion, trauma, or anatomical constraints. With the widespread adoption of smartphones, sustained upper-limb postures have emerged as potential novel risk factors for ulnar nerve compression. This retrospective study aimed to investigate the potential correlation between smartphone use patterns and the development of CuTS. Methods: A retrospective observational study was conducted on 100 subjects recruited between 2021 and 2024, including 50 patients with EMG-confirmed CuTS who underwent surgical decompression and 50 matched controls without clinical or electrophysiological evidence of ulnar neuropathy. Demographic variables, daily smartphone use (h/day), predominant activity type, and habitual posture during device handling were collected through clinical records and questionnaires. Group comparisons were performed using t-tests and Chi-square analyses, with significance set at p < 0.05. Results: Daily smartphone use was higher in the CuTS group compared with controls (4.94 ± 1.8 vs. 4.04 ± 1.5 h/day), although the difference did not reach statistical significance (p = 0.0716). Posture during device use showed a significant association with CuTS: 82% of affected patients reported using smartphones with the elbow flexed, compared with 56% of controls, whereas supportive postures were less frequent among CuTS patients (16% vs. 38%) (p = 0.019). No significant differences were found between groups regarding smartphone activity type (p = 0.858). Conclusions: Smartphone use may contribute to ulnar nerve compression primarily through ergonomically disadvantageous postures, particularly sustained elbow flexion, rather than total usage time. These findings highlight a modifiable behavioral risk factor relevant to the rising prevalence of CuTS in the digital era. Increased clinical attention to device-handling habits and public-health strategies promoting ergonomic posture may support CuTS prevention. Prospective and biomechanically informed studies are warranted to further elucidate causal mechanisms. Unmeasured confounders (e.g., occupational and sleep-related elbow flexion) may influence these associations.
Background: Cubital Tunnel Syndrome (CuTS) is the second most common compressive neuropathy of the upper limb, traditionally associated with prolonged elbow flexion, trauma, or anatomical constraints. With the widespread adoption of smartphones, sustained upper-limb postures have emerged as potential novel risk factors for ulnar nerve compression. This retrospective study aimed to investigate the potential correlation between smartphone use patterns and the development of CuTS. Methods: A retrospective observational study was conducted on 100 subjects recruited between 2021 and 2024, including 50 patients with EMG-confirmed CuTS who underwent surgical decompression and 50 matched controls without clinical or electrophysiological evidence of ulnar neuropathy. Demographic variables, daily smartphone use (hours/day), predominant activity type, and habitual posture during device handling were collected through clinical records and questionnaires. Group comparisons were performed using t-tests and Chi-square analyses, with significance set at p < 0.05. Results: Daily smartphone use was higher in the CuTS group compared with controls (4.94 ± 1.8 vs. 4.04 ± 1.5 hours/day), although the difference did not reach statistical significance (p = 0.0716). Posture during device use showed a significant association with CuTS: 82% of affected patients reported using smartphones with the elbow flexed, compared with 56% of controls, whereas supportive postures were less frequent among CuTS patients (16% vs. 38%) (p = 0.019). No significant differences were found between groups regarding smartphone activity type (p = 0.858). Conclusions: Smartphone use may contribute to ulnar nerve compression primarily through ergonomically disadvantageous postures, particularly sustained elbow flexion, rather than total usage time. These findings highlight a modifiable behavioral risk factor relevant to the rising prevalence of CuTS in the digital era. Increased clinical attention to device-handling habits and public-health strategies promoting ergonomic posture may support CuTS prevention. Prospective and biomechanically informed studies are warranted to further elucidate causal mechanisms.