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Soft tissue metastases to the hand are rare with studies suggesting an incidence of 0.2% among patients treated for cancers [9]. This paper describes the case of a 67-year-old male presenting with hand pain several years after treatment for a primary basal cell adenocarcinoma of parotid gland origin. Investigations confirmed what is believed to be the first documented case of parotid basal cell adenocarcinoma metastasizing to the hand. A description of the challenges faced in the treatment of this aggressive malignancy presents the opportunity to discuss key factors that must be considered when formulating management plans for similar presentations.

To evaluate the long-term clinical and radiographic outcomes of trapeziectomy with abductor pollicis longus tendon interposition arthroplasty for moderate to severe osteoarthritis of the thumb carpometacarpal joint (Eaton stages III-IV).We evaluated 13 patients (15 thumbs) who underwent trapeziectomy and abductor pollicis longus tendon interposition arthroplasty for end-stage osteoarthritis of the thumb carpometacarpal joint, at an average follow-up of 15 years. Subjective clinical outcomes evaluated included visual analogue scale scores and disability of arm shoulder and hand score questionnaires. Objective clinical evaluation included lateral pinch and grip tests, and a range of active and passive thumb movements. All patients underwent a radiological assessment by two independent senior radiologists. Wherever possible, results obtained from the operated thumbs were compared to the non-operated side.At a mean of 15 years post operation (range 15-17 years), there was no statistical difference between the operated and non-operated hands with regards to grip and pinch strength. In all cases CMC and MCPJ range of motion in the operative hand was either equal to or greater than non-operative counterparts. Mean visual analogue scale score was 2.13 and mean DASH score was 16.85. Mean carpal height was 0.52 and mean trapezial space ratio was 0.163. There were no early or late complications recorded and no revision surgery was required.It is the opinion of these authors that abductor pollicis longus tendon interposition arthroplasty is able to provide high-quality long-term results for patients who suffer from moderate to severe osteoarthritis of the thumb carpometacarpal joint.Therapeutic Level IV.

Subcutaneous transfer of the ulnar slip of the extensor digiti minimi (EDM) to the adductor tubercle across the dorsum of the hand restores pinch, and index finger abduction is reproduced by re-routing extensor indicis proprius around the thumb extensor tendons.Six patients with post-traumatic ulnar palsy have been treated by this method with a minimum follow-up period of 40 months. Pinch was improved from an average of 5% to 40–50% of the normal side, and index abduction to 30–40%. There was no donor morbidity.

Prospective analysis of 27 medial epicondylectomies in 22 patients with McGowan grade I ulnar neuropathy demonstrated an improvement in clinical symptoms. In all patients a N.C.V. study, in which compression of the ulnar nerve at the cubital tunnel was evident, has been a prerequisite for operation. Conduction velocity across the cubital tunnel averaged 48% of normal (26.4 +/– 8.7 metres per second) preoperatively and increased to 85% of normal (46.7 +/– 9.7 metres per second) postoperatively. A preoperative N.C.V. study allows the achievement of a high success rate, especially in the less well clinically defined group of patients with grade I neuropathy (subjective complaints without any objective signs of muscle atrophy). Medial epicondylectomy is safe and predictable in the treatment of cubital tunnel syndrome.

Tendon interposition resection arthroplasty of the trapezium is a valuable tool in treating osteoarthrosis of the first carpometacarpal joint. A previously unreported modification of such an operation is described in which a part of the abductor pollicis longus tendon is used as an interposition material. This technique was employed in a series of thirty-nine thumbs. After a minimal follow-up period of 2 years, the results of the operation are graded excellent in 48% of the patients, good in 35%, and average in the rest. Grip strength, as well as pinch strength, is about three quarters of the normal average. No patient needed a further operation.

An unusual case of localized pigmented villonodular synovitis of the ankle joint in a 3-year-old boy is described. The child was brought to the hospital because of abrupt onset of pain and joint effusion. A soft tissue mass eroding the talar dome was seen in roentgenograms. Exact diagnosis was established by excisional biopsy. Curettage of the lesion resulted in healing without recurrence at 10-year follow-up examination.

Fig. 1. Radiograph of wrist following trauma at age 13 years shows enlargement of joint space between scaphoid and lunate bone. The patient gave a history of trauma to his right wrist at the age of 13 years. At that time, the radiograph of the wrist showed some widening of the scapholunate joint space, which could be interpreted as a disruption of the scapholunate ligament, but was not diagnosed as such at that time (Fig. I). No bony injury could be seen. A plaster dressing was applied for 2 weeks. Following this episode, the patient's wrist had been functioning normally. On admission, swelling and limitation of wrist movements were noted. Radiographs of both wrists, taken in similar positions, showed features characteristic of osteochondritis dissecans of the right scaphoid (Fig. 2). Radiographs of the left wrist were normal. A plaster dressing was applied for 6 weeks to the forearm and wrist, followed by physiotherapy. Three months later, a full range of the wrist joint movements was obtained.