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Post-traumatic dystonia is an underrecognized condition that can present with bizarre symptoms after trauma, usually out of proportion to the trigger event. We describe the case of a 31-year-old man with a severe lower extremity deformity, gradually developed after minor trauma. An interdisciplinary treatment was tried without any improvement and surgery was performed as a rescue approach. Tibialis anterior tendon transfer and hindfoot triple arthrodesis were carried out, successfully achieving a plantigrade foot and a functional gait. Despite the scarce literature available about functional results of surgery in dystonic feet, we present a step-by-step comprehensive approach to this disorder. LEVEL OF CLINICAL EVIDENCE: 4.

Cystic adventitial disease is a condition where mucinous cyst(s) develop within the adventitia of blood vessels, especially arteries. The most affected vessel is the popliteal artery while the upper limb vasculature is seldom involved. To our knowledge, there are only 2 articles reporting this disease in the ulnar artery. We present a case of a 52-year-old female patient, a manual worker in a clothing factory, with a month history of increasing pain in her right wrist and gradual weakness that incapacitated her for work activities. She was finally treated surgically and an adventitial cyst of the ulnar artery compressing the ulnar nerve was diagnosed.

ResumoO diagnóstico diferencial de dorsalgia revela-se um desafio pela proximidade da coluna dorsal a órgãos vitais assim como por sua anatomia única, inervação e articulação com as costelas. Os padrões de dor referida visceral obrigam, na maioria das vezes, a extensivos exames complementares de diagnóstico de forma a excluir condições graves. A osteoartrose da articulação costovertebral é um diagnóstico pouco reconhecido, e habitualmente é somente considerado quando a fonte de dor continua sem explicação após extensa investigação. Os autores apresentam o caso de um homem de 40 anos de idade com dor dorsal incapacitante devido a osteoartrose costovertebral isolada. A sintomatologia foi controlada após a injeção de metilprednisolona guiada por tomografia computadorizada. Este caso clínico tem como objetivo descrever a apresentação clínica de uma entidade rara que deverá ser considerada no diagnóstico diferencial de dorsalgia.

The differential diagnosis of dorsal thoracic pain can be a challange due to the proximity of the dorsal column to vital organs as well as to its unique anatomy, innervation, and rib joint. The patterns of referred visceral pain require, in most cases, extensive complementary diagnostic tests in order to exclude severe conditions. Referred pain patterns often result in numerous and expensive visceral workups in order to exclude serious conditions, and costovertebral joint osteoarthritis is usually only considered when the origin of the pain remains unexplained. The authors present the case of a 40-year-old man with disabling dorsal pain due to isolated costovertebral osteoarthrosis. The symptomatology was controlled after injection of methylprednisolone guided by computed tomography. This clinical case aims to describe the clinical presentation of a rare entity that should be considered in the differential diagnosis of back pain.