The goal of this study was to quantify the frequency of advanced spinal epidural lipomatosis (SEL) detected on lumbar magnetic resonance imaging (MRI) scans performed at the authors’ hospital and to compare the frequency, cause, and progression of SEL in these cases with that reported in the literature. The total number of MRI examinations of the lumbar spine performed at this hospital over 45 months was 1498 (705 men and 793 women; mean age, 60.3 years). After the MRI data were reduced (T1- and T2-weighted sagittal and axial images) on the basis of the exclusion criteria, the anterior and posterior diameters of the dural sac and spinal canal were measured, as well as the thickness of the epidural fat. On the basis of these parameters, the severity of SEL was classified as grade 0 to grade III. Five cases of grade III SEL were diagnosed. The frequency of grade III SEL noted in this study was 0.33% (5/1498). Obesity (body mass index greater than 27.5) was noted in 3 cases, and the use of exogenous corticosteroids was noted in 3 cases. Exogenous steroid usage associated with advanced SEL in this study was greater than that reported in the literature. Most symptoms of SEL progress slowly, and early diagnosis allows for a dose reduction of the prescribed steroids. Thus, lumbar MRI examinations should be conducted aggressively in patients with exogenous steroid use and presenting with low back pain or buttock pain.

The carpal scaphoid is the most commonly fractured carpal bone in young adults after a fall on an outstretched arm that results in acute dorsal flexion of the wrist. However, stress fractures of the scaphoid are relatively rare. To the best of our knowledge, we describe the first case in the literature of carpal scaphoid stress fracture in a tennis player. An 18-year-old Japanese man who was an elite junior tennis player was referred to our hospital after radiography and computed tomography revealed a carpal scaphoid fracture. The patient presented with pain in the wrist joint and tenderness over the anatomical snuff-box with diffuse swelling and reduced active dorsal flexion and flexion of the right wrist. The patient was treated conservatively and resumed participation in competitive events 5 months after his initial presentation. In this case, the scaphoid stress fracture had resulted from repetitive practicing of the attacking backhand high volley, which involved excessive dorsal flexion of the wrist. Although rare, scaphoid stress fractures must be considered in tennis players with chronic wrist pain.

Sion by immunohistochemistry in glomus tumor samples. Methods: Eight solitary glomus tumors were surgically excised and confirmed histologically by an experienced pathologist. Paraffin-embedded tissues were prepared for immunohistochemistry. The sections were stained with separate polyclonal antibodies for S100, substance P, and cyclooxygenase-2. In three of the tumors, we measured the prostaglandin E2 concentrations. Results: All samples were positive for S100 protein and cyclooxygenase-2.Substance P was found in five of the eight samples. High prostaglandin-E2 concentrations were seen in all three samples tested. Conclusions: Cyclooxygenase-2-immunoreactive cells are present in solitary glomus tumors. Since cyclooxygenase-2 produces prostaglandin E2, which is thought to be a strong vasodilator, the pain could be caused by vasodilation in the glomus tumor, with increased intracapsular pressure. Clinical Relevance: Clinically, non-steroidal anti-inflammatory drugs that block prostaglandin production may control glomus tumor pain. However, considering the possible medication side effects, operative management remains the treatment of choice....

Isolated trapezium fracture in combination with thumb carpometacarpal (CMC) joint dislocation is extremely rare, and no treatment consensus exists. Herein, we report 3 successfully treated cases of isolated trapezium fracture with thumb CMC joint dislocation. While good short‐term results have been reported in the literature, the possibility of substantial ligament injuries that can lead to future instability of the thumb CMC joint must be noted. In order to obtain an excellent long‐term clinical result, we propose the consideration of the anatomical repair of the CMC joint in terms of both bony and ligamentous structures in cases where instability remains after fracture fixation.

BACKGROUND Hook of hamate fractures occur either due to repetitive stress from gripping sports (e.g. , golf, tennis, and baseball), leading to fatigue fracture, or as a result of trauma from falls or other injuries. The recommended treatment involves the excision of bone fragments to facilitate athletes’ early return to sports; excision surgery is also performed in trauma cases. However, some patients prefer nonsurgical treatment options, and conservative treatment should be considered. AIM To present a case series of 16 patients conservatively treated for hook of hamate fractures. METHODS This study included 16 (11 males and 5 females; right side, 6 cases; left side, 10) patients who desired conservative treatment and could be followed-up until bone union was achieved. The average age of the patients was 49.6 (range: 24-72) years. The average time from injury to consultation was 4.3 (range: 0.2-21.4) weeks. The treatment involved 4 weeks of casting from the forearm to the metacarpophalangeal joint, followed by 8 weeks of splint fixation of the wrist. Follow-up computed tomography scans were performed every 4 weeks. RESULTS Bone union was achieved in all patients. The average duration of casting was 3.7 (range: 0-5) weeks and that of splint fixation thereafter was 8.6 (range: 0-28) weeks. The patients did not exhibit joint contractures or range of motion restrictions due to prolonged immobilization. CONCLUSION Conservative treatment with external fixation may be an option for hook of hamate fractures.