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Case: We report a case in the United States of a 12-year-old girl with multidrug-resistant tuberculous (MDR-TB) osteomyelitis of the hand managed with surgical debridement and second-line anti-TB therapy. The disease course was complicated by dissemination and multifocal progression. Conclusion: Despite early intervention, multidrug resistance makes TB treatment challenging and facilitated progression to disseminated disease in this case. We review the difficulties in diagnosis and treatment of pediatric MDR-TB. [ABSTRACT FROM AUTHOR]

Primary synovial chondromatosis is a rare, benign proliferative disease of the joint synovium, tenosynovium, or bursal lining, in which cartilage metaplasia leads to the development of multiple intra-articular and periarticular loose osteocartilaginous bodies. This disease usually involves larger joints (knee, hip, elbow, and shoulder), but it has also rarely been reported in the hand. Patients with this disease complain of pain, swelling, nodules, and decreased range of motion of the affected joint. Due to its nonspecific symptoms and low prevalence, this disease often goes misdiagnosed, leading to delays in patient treatment. In the literature to date, there are only a few reports of primary synovial chondromatosis. In this case report, we present a patient with a rare case of primary synovial chondromatosis localized to right small finger distal interphalangeal joint. [ABSTRACT FROM AUTHOR]

Background. Dupuytren's contracture (DC) is a fibrosing disorder that produces pathological subcutaneous nodules and cords in the normal fascia. The isolated occurrence of Dupuytren's disease of the fifth digit is uncommon. This study is aimed to describe the imaging features of an isolated digital cord of the small finger and its relationship with the neurovascular bundle. Methods. A total of 13 hands in 13 patients who were clinically diagnosed with an isolated occurrence of Dupuytren's disease of the small finger were included between October 2008 and October 2013. Two independent radiologists used ultrasound and magnetic resonance imaging (MRI) to record size, signal or echogenicity, contrast enhancement or hyperemia, calcification, and anatomical features of the cord and its relationship with the neurovascular bundle. Results. We found that ultrasound and MRI were accurate for the detection of the cords and neurovascular bundles in the small finger. The intermodality agreement between MRI and ultrasound was 100% for the detection of 6 spiraling bundles containing 13 isolated cords (46.2%). Among the subjects examined, 100% of the hands had abductor digiti minimi (ADM) area involvement, and the distal insertion of the cord was on the ulnar side of the base of the middle phalanx. On MRI, all of the cords showed predominantly low signal intensity on both T1- and T2-weighted images. On ultrasound, the ulnar cord showed a hyperechoic or isoechoic appearance in 69.3% of hands and a hypoechoic appearance in 30.7% of hands. Conclusions. The spiraling of the bundle in the isolated occurrence of Dupuytren's disease at the small finger is a frequent occurrence. MRI and ultrasound are good imaging modalities for the evaluation of the relationship between the neurovascular bundle and the isolated cord. [ABSTRACT FROM AUTHOR]

Malignant sarcomas of the upper extremity are rare tumors that can have an overwhelming impact on a patient's function, quality of life, and life expectancy. Rarer still is the malignant tumor of the hand or digits, which represent an incredibly small percentage of upper extremity tumors. This paucity of cases can lead to difficult decision making and treatment options that may not always have clearly established results and outcomes. Case. In this case, we present a young, otherwise healthy patient that was diagnosed with a primary leiomyosarcoma of the small finger. After her diagnosis, she underwent extensive oncologic workup, and subsequently underwent successful ray amputation with an excellent outcome. She remains disease free. Leiomyosarcoma is a malignant cancer that can be troublesome to diagnose in the extremities, as it is usually found in the smooth muscle of organs and the pelvis. Local control of the tumor is critical to successful, disease free treatment. Good functional and clinical outcomes can be attained with ray amputation, as seen in this patient. This case demonstrates a successful treatment approach to the patient with a primary malignant soft tissue sarcoma who was treated with a ray amputation. The clinician and surgeon must maintain a high index of suspicion of soft tissue malignancies, as a prompt diagnosis and treatment is critical to a good outcome and survival. • Leiomyosarcoma of the hand and digits is a very rare malignant tumor. • A prompt and accurate diagnosis is key to a good outcome and longer survival. • Amputation can serve as a viable treatment option with excellent outcomes. [ABSTRACT FROM AUTHOR]

This study estimated the prevalence of independent flexor digitorum superficialis function in the small fingers of 90 violin and viola players. The hypothesis tested was that the independent digital movements required in this population would select out those with absent flexor digitorum superficialis function. Professional string players were tested clinically, using standard and modified tests, for flexor digitorum superficialis function. Two additional physical tests were applied: the gap and stretch tests. These tests assess ring finger movement once the small finger is placed and the instrument is held in the chin-hold position. A statistically significant reduction in the prevalence of absent flexor digitorum superficialis function was confirmed in the musicians compared with a control group and published meta-analysis. This suggests that independent flexor digitorum superficialis function is important for professional musicians playing at an elite level. [ABSTRACT FROM PUBLISHER]

Purpose: To propose a classification system for type A ulnar polydactyly based on radiographic findings and characterize the demographic features of patients with these deformities. Methods: We identified 49 patients with type A ulnar polydactyly of the hand who were seen in our institution over 20 years. Patients'' medical records and radiographs were retrospectively reviewed and used to distinguish morphological subtypes. Results: Ninety-six percent of the deformities (64/67) were allocated to 1 of the 5 subgroups of our suggested classification, and the type that originated from the metacarpophalangeal joint was the most common. Sixty-nine percent of patients in our series (34/49) had either bilateral type A or a contralateral type B ulnar polydactyly, and 63% (31/49) had ulnar polydactyly of one or both feet. Twenty-four percent of patients (12/49) had associated syndromes or congenital anomalies involving areas other than the hand or foot. The most common syndrome associated with type A ulnar polydactyly was chondroectodermal dysplasia (n = 3). Sixty-five percent of the patients (32/49) were Caucasian, 20% were Hispanic (10/49), 12% were African American (6/49), and one was Asian. The percentage of African Americans in our series was similar to that in the general patient population seen in our institution. Conclusions: The majority of type A ulnar polydactyly can be classified into 1 of 5 morphological subtypes that have potential clinical relevance regarding surgical treatment. In patients with type A ulnar polydactyly, contralateral hand and foot polydactyly is frequent. Associated congenital anomalies and syndromes can also be present. Type of study/level of evidence: Prognostic IV. [Copyright &y& Elsevier]