Diagnosis of subungual glomus tumour is mostly based on detailed history and clinical examination. Recently, Magnetic Resonance Imaging (MRI) and Ultrasound have been proposed as the imaging modality to confirm the clinical diagnosis and in planning the surgical management of these tumours. However, these imaging modalities are not routinely available in rural setting and also are expensive. Due to these limitations, we set out to establish that diagnosis and management of these rare tumours can be based solely on a battery of clinical tests and history taking. Retrospectively, we reviewed nine cases of glomus tumour. A clinical evaluation proforma was developed on the basis of clinical history and specific clinical test for diagnosis of these tumours. All the cases were evaluated and treated surgically by a single surgeon with a specific technique. Post-operatively, diagnosis was confirmed by histopathological examination. Females (77.78%) were predominantly affected in this series and the tumours commonly occurred in the right hand (66.66%). Spontaneous pain, cold sensitivity test and Love's Pin test was positive in all cases (100%). Hildreth's test was positive in 88.89%. In none of the cases the tumours recurred during minimum follow-up of one year. In all cases, histopathological examination confirmed the preoperative diagnosis of glomus tumours. Diagnosis of glomus tumours can be made clinically based on history taking and clinical examination. Magnetic Resonance Imaging and Ultrasound are not necessary for diagnosis and management of typical subungual tumours.

Patients with anterior cruciate ligament (ACL)–deficient knees risk recurrent instability of the affected knee, which may predispose to meniscal injuries. Various studies have correlated the incidence of meniscal tear with elapsed time from ACL tear and number of instability events. However, it is not clear how significant an instability event needs to be to contribute to a meniscal tear. The purpose of this study was to (1) define a significant instability episode and (2) develop a checklist and scoring system for predicting meniscal tears based on significant instability episode. We hypothesized that patients with ACL-deficient knees who met the scoring threshold for a significant instability episode would have a higher incidence of meniscal tears compared with those who did not meet the threshold. Cohort study (prognosis); Level of evidence, 2. This retrospective study included patients with magnetic resonance imaging (MRI)–confirmed isolated ACL tear for longer than 3 months. We determined parameters for assessing instability episodes and defined any instability events between the MRI and ACL reconstruction as significant or insignificant. Patients were then grouped into a significant instability group (≥1 significant episode) and an insignificant instability group, and the incidence and types of meniscal tears found during surgery were compared between groups. There were 108 study patients: 62 in the significant instability group and 46 in the insignificant instability group. During surgery, 58 meniscal tears (46 medial, 12 lateral) were recorded, for an overall meniscal injury rate of 53.70%. In the significant instability group, 47 patients (75.81%) had a meniscal tear and 15 (24.19%) had intact menisci (P < .001). In the insignificant instability group, 11 patients (23.91%) had a meniscal tear and 35 (76.08%) had intact menisci (P < .001). Regarding the 58 patients with a meniscal tear, 47 (81.03%) had ≥1 significant episode of instability before surgery, as compared with 11 (18.97%) who had insignificant or no instability. The odds of having a medial meniscal tear at ACL reconstruction was 10 times higher in the significant instability group versus the insignificant instability group. The incidence of a medial meniscal tear was 10 times greater in patients with a significant episode of instability versus those with insignificant instability, as defined using a predictive scoring system. The incidence of lateral meniscal tear did not change with instability episodes.

Background/Objectives: Dislocation of the acromioclavicular joint (ACJ) is a common injury for which numerous operative fixation and reconstructive techniques have been described. This technique combines a coracoclavicular ligament (CC) repair with an acromioclavicular ligament (AC) and CC reconstruction with an additional ACJ internal brace to address both horizontal and vertical instability. Methods: The surgery is performed through a superior approach in the following sequence: (1) CC ligaments are repaired using a TightRope construct, (2) CC reconstruction is performed using a peroneus longus tendon allograft, (3) AC ligaments are repaired using an internal brace, and (4) AC reconstruction is performed with a second peroneus longus tendon allograft. The results of consecutive patients with grade IIIB, IV, and V AC joint dislocations were included. Results: Six patients with acute and six patients with chronic injuries were eligible for inclusion. The Constant–Murley Score improved significantly from 27.6 (8.0–56.5) to 61.5 (42.0–92.0) (p = 0.006 paired t-test) at 12 months of follow-up. There was one complication (frozen shoulder) from which the patient recovered spontaneously; no other complications were observed with this technique. The coracoclavicular distance (CCD) was reduced from 18.7 mm (13.0–24.0) to 10.0 mm (6.0–16.0, p < 0.001) and 10.5 mm (8.0–14.0, p = 0.002) at 12 weeks and 12 months, respectively. Conclusions: This study describes a new technique to treat acute and chronic Rockwood stage IIIB–V ACJ dislocations with promising short-term clinical and radiological results. The results suggest that the combined repair and reconstruction of the AC and CC ligaments is a safe procedure with low complication risk in experienced hands. Addressing the vertical and horizontal stability in ACJ dislocation is key to achieving optimal long-term results. Further, follow-up is required to investigate the long-term outcomes.